Middx HES 32 c439(1)HEBTON+ISLE WORTH Borough of Heston and sleworth ANNUAL REPORT OF THE MEDICAL OFFICER Of HEATH 1945 68598 Public Health Department, 92 Bath Road, HOUNSLOW. To the Mayor, Aldermen and Councillors of the Borough of Heston and Isleworth. Ladies and Gentlemen, I beg to submit my Annual Report for the year 1945. A report has been submitted on the School Medical Service and continuing the practice of recent years this Report consists largely of a tabulated summary. The upward trend of the birth rate has not been maintained: 15.5 per 1,000 population as compared with 16.5 in 1944, 16.3 in 1943 and 14.6 in 1942. The number of illegitimate births was 111 as compared with 85 in 1944, 90 in 1943 end 59 in 1942. Special attention continues to be given to the care of unmarried mothers and illegitimate children and efforts are made to contact the mother as early in pregnancy as possible. Hospital almoners and moral welfare workers co-operate in this matter. Contact was made in 67 cases and the final arrangements were as follows :- Mother and child living with father of the child 11 Child living with grandparents 24 Child living with other relatives 2 Mother and child left the Borough 8 Child placed with foster-mother 1 Child placed for adoption 16 Child placed in residential nursery 1 Child in care of daily guardian while mother at work 1 Child died in hospital 3 In conjunction with the Middlesex County Council arrangements have been made to provide pre-natal and post-natal residential accommodation. During the year no mothers were admitted before confinement. Three mothers and children were admitted after the confinement. During 1945 Health Visitors made visits of enquiry or supervision as under in connection with children placed for adoption :- Visits in connection with notification of children placed for adoption and to provide reports for use of the Court 155 Visits at request of adoption societies or others 43 Post-adoption visits at request of adoption societies or others The death rate per 1,000 population (civilian) was 9.7 as compared with 10.3 in 1944, 10.6 in 1943 and 10.2 in 1942. The percentage age distribution of deaths is shown below:- 1910-14 1940-44 1945 Under lyear 21.8 7.8 8.2 1-4 years 8.4 1.4 0.8 5-14 years 3.8 1.8 0.6 15 - 24 years 3.7 2.8 2.7 25 - 64 years 30.8 35.2 34.1 65 years and over 31.5 51.0 53.6 The chief causes of death were heart disease (240), cancer (162). cerebral haemorrhage (72), bronchitis (50) and pneumonia (47). 1. In 1945 the infant mortality rate was 50.7 per 1,000 live births as compared with 45.9 in 1944/46.8 in 1943 and 72.1 in 1942. The percentage of the total infant deaths occurring in babies under the age of 4 weeks was 64 as compared with 65 in 1944, 49 in 1943 and 58 in 1942. The chief causes of infant deaths during the year were prematurity (18), congenital defects (17), gastro-enteritis (11), pneumonia and bronchitis (7), otitis media (6) and other infections (9 Prematurity and congenital defects form the hard core of infant mortality and the variation from year to year in the infant mortality rate is largely due to the extent to which babies have escaped or survived infection. During 1933-1939 the infant mortality rate in the Borough varied between 40 and 50 but during 1940-1945 the variations have ranged from 45.9 to 72.1 and the increase has been due almost wholly to deaths from infections. The chief environmental condition contributing to the spread of infections is overcrowding. The need for constant care and vigilance to protect young babies against infection is illustrated by the following account of a small outbreak: Early in September the conies of death certificates received from, the Registrar revealed that two babies, aged 1 week and 3 weeks, had died in hospital from umbilical sepsis. Birth notifications showed that these children were born in a local nursing home. A vision to the home disclosed that there had been admitted to hospital with th same condition another baby who died later. There was no evidence of puerperal infection so the care of the babies and the dressing of the cord stump were investigated. No gross error of technique was revealed but the opportunity was taken to impress upon the staff the importance of guarding young babies against infection and suggestions were made as to how a more rigid asepsis might be maintained. Throat and nose swabs were taken from all the nursing home staff. Next day a fourth case of umbilical sepsis occurred and was admitted to hospita The swabs revealed that two members of the staff were carrying streptc coccus haemolyticus and one carrying streptococcus haemolyticus and staphylococcus aureus and as all three had been working in the nursery they were suspended from duty. -No further case of umbilical sepsis occurred and the home remained free of puerperal infection. Contact was then made with the two hospitals concerned in regard to their bacteriological findings. The first two babies were moribund on admission and died within a few hours so no bacteriological investigation was carried out. In the other two babies a haemolytic strepto coccus and a staphylococcus aureus were recovered from both. The streptococcus was not typed. Further swabs were taken from the carriers with a view to typing the streptococcus but no growth was obtained. Three consecutive negative swabs having been obtained from the two carriers of streptococcus they were returned to duty after a suspension lasting 15 days. In the third carrier staphylococcus aureus continued to be found and 7 weeks elapsed before three consecutive negative swabs permitted her return to duty. Slight prematurity may be missed and the baby's chance of survival lessened by failure to apply appropriate treatment Immediately It has been agreed that, for practical purposes, all babies weighing 5½ lbs. or less should be treated as premature and special cots equipped for the nursing of premature babies are available free on load Any doctor or midwife can get delivery of such a cot at any time on application to the ambulance station. The birth weights of 1,305 (88 of the 1,478 children, born to the Borough in 1945, were ascertained and of these 77 (5.9%) were 5½ lbs. or less. The average birth weigh of the 18 babies who died from prematurity was 3.2 lbs. The maternal mortality rate was 2.0 per 1,000 (live and still) births as compered with 1.9 in 1944, 0.6 in 1943 and 2.8 in 194 The still birth rate per 1,000 total births was 26 as compared with 22 in 1944, 26 in 1943 and 32 in 1942. The incidence of infectious disease has been low during the year. Scarlet fever continued to be mild and caused no deaths. A small outbreak of dysentery (sonne) occurred at a day nursery: 22 children and 1 staff were attacked, all recovered and the nursery was free of Infection at the end of six weeks. The number of notificatic 2. of tuberculosis was 155 as against 186 in 1944. The tuberculosis death rate per 100,000 population was 54.7 as compared with 63.2 in 1940-44, 60.4 in 1935-39 and 78.9 in 1930-34. There were more cases of cerebrospinal fever and poliomyelitis (infantile paralysis) than in 1944 but no increase in deaths from such causes. Diphtheria also was more prevalent: 24 cases and 2 deaths as compared with 11 cases and 1 death in 1944. One of the children who died had been immunised in 1941. This is the first death from diphtheria of a child immunised in this area: the infection was severe but there was some delay before the diagnosis was made and the child admitted to hospital. At the end of the year the proportions immunised of the population under 5 years and between 5 and 15 years of age were 44 per cent. and 74 per cent. respectively as compared with 37.3 per cent. and 65.1 per cent. in 1944. Since 1930 about 20.000 persons have been immunised ami manv of tbsm ire now over 15 years of age. The experience of diphtheria of the ;wo groups during these 16 years is shown below :- Diphtheria 1930-45 1 Non-immunised Immunised Cases Deaths Cases Deaths 779 56 22 1 Diphtheria can be kept under control only by protecting a high proportion of the child population and ALL children should be immunised at or about the age of 1 year. The fall in the number of cases of scabies in 1944 was not continued into 1945 and continuing effort to eradicate this disease is necessary. When a case occurs in a household all the members should be treated as the infection may be present in the contacts. In the absence of symptoms it is difficult to convince such contacts, especially adolescents and adult males, that they should submit to treatment. The same difficulty occurs in dealing with lousiness where school children are re-infested by adult members of the family. During the year 630 persons were given treatment for scabies and 6 adults were de-loused. The four day nurseries, with accommodation for 189 children, remained open throughout the year. There was always a list of children awaiting admission but owing to shortage of staff the nurseries could not be used to full capacity. There was less illness among the children and, but for staff shortage, the average daily attendance would have been higher than 129. The demand for this service was maintained during the year, The attendances of mothers and children under school age at the various clinics were maintained. Throughout the war years there has been a steady decrease in the applications for the supply, free or at reduced cost, of proprietary dried milk and vitamin preparations though the bulk issue has been maintained generally. This reduction is no doubt due to two factors: the rise in wages and the provision through the Ministry of Pood of milk, dried milk and vitamin supplements, free or at reduced cost, in necessitous cases. Of the orange juice issued 10,693 bottles were supplied to children between the ages of 5 and 10 years. The extent to which the various facilities for confinement lave been used during the last 8 years is shown in the following table :- Year Total Births Domiciliary confinements in Borough Nursing home & hospital confinements in Borough Confinements outs ide _ Borough No. % W.M.H. N.H. Total % No. % 1938 1484 611 41.2 516 84 6.00 40.4 273 18.4 1939 1566 650 41.5 479 114 593 37.9 323 20.6 1940 1368 633 46.3 425 70 495 36.2 240 17.5 1941 1261 573 45.4 323 94 417 33.1 271 21.5 1942 1447 597 41.2 542 135 677 46.8 173 12.0 1943 1600 580 36.3 476 189 665 41.6 355 22.1 1944 1556 478 30.7 480 185 665 42.8 413 26.5 1945 1478 366 24.8 517 160 677 45.8 435 29.4 3. Since 1940 there has been a steady fall in the proportion of confinements taking place in the mothers' homes. The housing shortage and the difficulty in obtaining domestic assistance are important contributory causes. During the year assistance was given under the Council' home-help scheme to 46 maternity cases as compared with 77 in 1944 and 51 in 1943. The home-help service was extended to cover non-maternity cases and during 1945 assistance was given to 43 households. The demand for assistance varies greatly throughout the year and this, coupled with the shortage of suitable women prepared to undertake the work on a whole-time or part-time basis, makes the administrative work very heavy in relation to the number of households assisted. When children are placed in the care of foster-mothers reguls supervisory visits are paid to see that the children receive adequate care and attention and to avoid overcrowding of foster homes. Two ambulances and one car are used by the municipal ambulanc service and are manned by a whole-time staff. The calls on this service, especially for non-accident cases, are increasing as is shown below :- 1957 & 1958 1944 & 1945 Accident calls 1788 1254 Other calls 1189 4759 The majority of the "other calls" arise in connection with attendance at hospitals for treatment or examination. The vehicle mileage covere during the year was 24,770. The water supply of the Borough is adequate and constant and apart from a few isolated cottages, every house has a direct supply from the mains. The Sanitary inspectors maintained their attention to nuisances, housing defects, food inspection and other environmental conditions. Shortage of labour and materials continued to retard the repair and maintenance of dwelling houses. Much deterioration has occurred in houses during the war and this is being tackled as rapidly as conditions permit. The number of cases of overcrowding brought to the notice of my Department is small but there is evidence from many other sources that overcrowding is prevalent. At the end of the year 29 houses, subject to Demolition Orders, were occupied. Nuisance due to emission of smoke and grit from factory chimneys was found more often than is desirable. In many cases the fuel in use was unsuitable and of poor quality but the resultant need for greater care in firing to avoid waste and nuisance was not appreciated by all concerned. Fewer complaints were received of milk being supplied in dirty bottles. This was probably due to cessation of black-out and more' staff being available in the milk trade rather than any reduction in the misuse of milk bottles by the public. The quantity of unsound food mentioned in the report as seized or surrendered refers only to food from retail premises in the Borough. An additional 8,065 lbs. and 85 tins from bulk stores were passed for disposal to the salvage section of the Ministry of Food. The work carried out under the Rats and Mice (Destruction) Act, 1919 showed a steady increase and the services of an additional operator will probably be required. The responsibility for keeping premises free of rats rests with the occupier. This involves not only getting rid of the rats when they are infesting the premises but taking such measures as are necessary to prevent re-infestation. Too frequently after the premises have been cleared the occupier continues to provide shelter and food and., when rats return to take advantage of this, complains that the clearance of the premises has not been efficient. The encouragement of occupiers to keep their premises unattractive for rats is an important part of the Rodent Officer's work. 4. During the year numerous complaints of the presence of biting mosquitoes were received from residents of Whitton and the Twickenham Road area of Isleworth. This complaint was investigated first in 1939 when the mosquito was identified as culex molestus. Some particulars of this mosquito are given below:- The most common mosquito in Britain is culex pipiens which does not bite man. In 1930 Roubaud in Paris described what he considered to be an abnormal variety of culex pipiens in that it attacked human beings. In 1934 this variety was detected at Hayling Island by Marshall and Staley who showed that it was a distinct species and suggested the name, culex molestus. In 1935 it was found in Westminster; in 1938 in Battersea, Bermondsey, Chelsea, Deptford and Greenwich; in 1939 in Isleworth and in 1940 in stagnating water in the London Underground Railways. This last observation confirmed previous indications that the primary breeding place is in dark and warm underground situations. In 1943 culex molestus was found in West Ham, Richmond and Twickenham. A careful detailed examination by an expert is necessary to distinguish the adult forms of culex molestus and culex pipiens. The larvae are identical in appearance and the usual method of identifying these species is to watch the behaviour of the adult mosquitoes reared from the larvae. Adults hatched from molestus larvae will mate and lay eggs without having had a blood meal whereas in the absence of a blood meal adults hatched from pipiens larvae remain sterile. Thus it may take some weeks to ascertain what type of mosquito is breeding in any larva-infested water. Since 1939 larvae from the following sources in the Borough have been identified as culex molestus warm dark places under boilers, underground passages in a sewage works and tanks, water butts, ponds etc. in gardens and allotments. Constant attention has been given to Mogden Sewage Works but on one occasion only (1943) has culex molestus been found breeding there. Larvae from many sources have been collected and the behaviour of the adult mosquitoes hatched therefrom observed with a view to confirming or otherwise the presence of culex molestus. To date this mosquito has been found most frequently in allotment tanks. These are probably secondary infestations and the main, and probably underground, breeding place has yet to be found. In all this work we have had the advice and assistance of Mr. J.P. Marshall, Director of the British Mosquito Control Institute. While the search for the primary breeding place continues all allotment tanks, water butts, garden ponds, gravel pits, etc. should be treated with paraffin or D.D.T. This will help to control the breeding of this fierce, pers istent and vicious human biting mosquito. On the whole the health of the Borough was maintained during 1945. The fluctuation In the Infant mortality rate has been the most disturbing feature of the war years. This report deals with certain health matters only and though there Is no reliable information available it must be admitted that many of the population, though not unfit for work, are far from enjoying perfect health. "Health is won by a way of life rather than a bottle of medicine" and a national healthservice, to be effective, must be directed towards prevention as well as cure. Social, industrial and environmental conditions which predispose to ill-health must be removed and the active co-operation of individual citi zens developed. Without this co-operation all other measures will fail and education Is the chief method by which this interest can be fostered. The staff of the Department have given loyal and generous service. I am grateful to the Chairman and Members of Committees for their consideration and support and to my colleagues in other Departments for their co-operation. I remain, Your obedient servant, A. ANDERSON. 5. GENERAL STATISTICS. 1945 1944 Population (Registrar-General's estimate). 95,100 92,370 Number of inhabited houses (rate books). 27,526 27,540 Number of houses erected during year. - - Rateable value of Borough. £956,668 £944,922 Sum represented by a penny rate. £3,928 £3 ,908 Live Births - legitimate - male. 712 737 - female. 655 700 illegitimate - male. 53 37 - female. 58 48 Birth rate per 1,000 population. 15.5 16.5 Birth rate per 1,000 population (England and Wales ). 16.1 17.6 Still Births - legitimate - male. 17 21 - female. 19 11 illegitimate - male. 2 - - female. 1 2 Still Birth Rate per 1,000 (live and still) births. 26 22 Deaths - male. 522 543 - female . 403 417 Death Rate per 1,000 population. 9.7 10.3 Death Rate per 1,000 population (England and Wales ). 11.4 11.6 Infant Mortality Rate. 50.7 45.9 Infant Mortality Rate (England and Wales). 46 46 Maternal Mortality Rate. 2.0 1.9 Maternal Mortality Rate (England and Wales). 1.8 1.9 Out-relief disbursed to Heston and Isleworth res idents. £16,992 £16,166 GENERAL PROVISION OF HEALTH SERVICE 1945 1944 Laboratory facilities - specimens examined. 1,079 734 District Nursing - visits paid. 30,993 32,610 Ambulance Service - journeys re accident. 669 585 „ „ sickness. 2,260 2 ,499 Insulin - No. of vials dispensed. 745 884 6. GENERAL PROVISION OF HEALTH SERVICES. (Continued) 1945 1944 Infant Welfare Centres - no. of sessions. 594 558 - attendances, (a) under 1 year. 19,671 18,423 (b) 1 - 5 years. 10,636 8,861 (c) all ages. 30,307 27,284 Ante-natal and Post-natal Clinics. Routine clinics - sessions. 248 250 - attendances 4,453 5,225 Consultant clinics - sessions. 44 47 - attendances. 341 428 Total attendances. 4,794 5,653 Artificial Sunlight Clinic - children treated. 80 73 Orthopaedic Treatment - children treated. 45 41 Refraction Clinic - children examined. 73 48 Minor Ailments Clinic - children treated. 44 49 Speech Clinic - children treated. 14 6 Child Guidance Clinic - children treated. 7 5 Midwives - number notifying intention to practice 57 43 - cases attended as midwife. 313 403 - cases attended as maternity nurse. 343 268 - percentage of cases where medical aid summoned. 29 29.5 - fees paid to medical practitioners. £96 £123 Municipal Domiciliary Midwife Service. No. of municipal midwives. 10 10 No. of cases booked - as midwife. 331 445 - as maternity nurse. 70 96 No. of cases completed - as midwife. 302 392 - as maternity nurse. 60 73 No. of visits - ante-natal. 3,023 3,495 - post-natal. 6,642 8,400 Home Helps - no. of cases where home help provided 89 77 Convalescent Homes - no. of mothers sent. 1 - - no. of children sent. 3 1 7. GENERAL PROVISION OF HEALTH SERVICES. (Continued) 1945 1944 Health Visitors - no. employed. 12 12 - attendances at M. & C. W. clinics, etc. 1,740 1,670 - visits to mothers and children. 13,318 12,557 Child Life Protection. No. of foster children on register. 50 52 No. of visits by Health Visitors. 585 452 Dental Treatment of Mothers and Children. Total attendances of mothers and children. 2,272 2,644 No. of extractions - mothers. 1,161 1,502 - children. 227 232 No. of fillings - mothers. 603 703 - children. 33 54 No. of dentures supplied to mothers. 174 23 Milk and Other Preparations Supplied Free or at Reduced Cost. Dried Milk (lbs .) . 129 434 National Dried Milk (lbs.). 2,672 1,481 Virol (lbs.). ½ Groats (tins). 1 • Cod liver oil (4 oz.) - - Cod liver oil emulsion (8 oz.). 1 1 Cod liver oil and malt (lbs.). 1 6 Lactagol (tins). 3 29 Bemax (tins). 15 76 Adexolin (½oz .). 1 3 Adexolin Capsules. Cartons of 14. 3 5 Cod liver oil & malt with iron (lbs.). - 9 Kalzana tablets (pkts. of 10). 23 6 Vitamin C tablets (pkts. of 30). 2 - Receipts from sales at cost price. £3,371 £3,139 Vitamin preparations distributed under Ministry of Food Scheme. Orange juice (bottles). 147,166 130,11 Cod liver oil (bottles). 14,284 14,16 Vitamin A and D tablets (packets). 3,032 3,23 8. GENERAL PROVISION OF HEALTH SERVICES. (Continued) 1945 1944 Municipal Restaurants. 3 3 Meals supplied at municipal restaurants. 174,388 237,791 „ „ „ school canteens. 771,065 756,645 Nursing Homes. No. registered at end of year, - nursing homes. 1 1 - maternity homes. - - - nursing and maternity homes. 2 2 Superannuation Acts. No. of employees examined. 5 3 Day Nurseries. No. of nurseries provided. 4 4 Accommodation for children (0-5 years). 189 189 Average daily attendance. 129 128 Scabies Clinics. No. of persons called for examination. 82 201 No. of above who attended. 28 96 Total no. of persons who attended. 956 1,042 No. of persons found to be suffering from scabies 675 666 No. of persons who completed treatment, (a) under school age. 73 69 (b) school children. 360 325 (c) over school age. 197 249 No. of persons who did not complete treatment. 28 23 No. of persons in whom scabies recurred. 31 12 SANITARY CIRCUMSTANCES OF THE AREA. There was no significant change in the sanitary circumstances of the area as compared with 1944. A summary of the work of the inspectors in regard to general sanitation is given below 1945 1944 Visits and re-visits re complaint or remedy of nuisances. 11,403 12,902 Inspections of piggeries. 37 32 Inspections of stables. 64 53 Inspections of urinals. 20 12 9. SANITARY CIRCUMSTANCES OF THE AREA. (Continued) 1945 1944 Visits re infectious disease. 659 658 Smoke observations. 11 7 Inspections re offensive trades. 24 8 Inspections of tents, vans and sheds. 186 75 Inspections and re-inspections of shops re sanitary arrangements. 34 12 Inspections of factories, workplaces, etc. 781 474 Houses disinfested. 25 21 Inspections of canal boats. 13 7 Rats and Mice (Destruction) Act, 1919. Visits to premises re infestation. 1,322 886 No. of premises treated. 446 277 Estimated no. of rats killed. 3,017 4,305 HOUSING. 1945 1944 No. of new houses erected - by private enterprise. - - - by local authority. - - No. of houses inspected for housing defects. 352 249 No. of houses found unfit for human habitation. - - No. of houses rendered fit by informal action. 156 162 No. of houses rendered fit by formal action. 42 37 No. of houses demolished in pursuance of Demolition Orders. - - No. of houses rendered fit in pursuance of undertaking. - - No. of houses where undertaking not to re-let accepted. - - No. of underground rooms closed. - - No. of houses known to be overcrowded at end of year. 78 73 No. of new cases of overcrowding found during year. 8 2 No. of oases of overcrowding relieved during year. 3 3 No. of houses demolished voluntarily. - - INSPECTION AND SUPERVISION OF FOOD. 1945 1944 Inspections of dairies, etc. 112 88 Inspections of ice cream premises. 153 1 10. INSPECTION AND SUPERVISION OP FOOD. (Continued) 1945 ] Inspections of bakehouses. 112 104 Inspections of slaughterhouses. - - Inspections of premises where food is sold or manufactured, - meat. 162 246 - fish. 48 83 - provisions. 508 909 - greengrocery and fruit. 101 285 - hawkers . 49 120 - food preparation. 587 535 - other foods. 35 47 Unsound food seized or surrendered (lbs.). 2,313 2,604 Unsound tinned food seized or surrendered (tins) 7,131 4,387 PREVALENCE OF INFECTIOUS AND OTHER DISEASES. 1945 1944 Cases Notified. Deaths. Cases Notified Deaths. Smallpox. - - - - Scarlet fever. 124 - 130 - Diphtheria. 24 2 11 1 Erysipelas . 16 1 16 - Pneumonia. 25 37 50 56 Cerebro-spina1 fever. 11 2 3 2 Epidemic encephalitis. 1 - - 1 Poliomyelitis and polioencephalitis . 7 - 3 - Typhoid fever. 1 - - - paratyphoid fever. - - - - Dysentery. 28 - 22 - Malaria. 2 - 1 - Tuberculosis . 155 52 186 44 Ophthalmia Neonatorum. 3 - 5 - Puerperal pyrexia. 45 - 87 - Measles. 1,109 1 219 - Whooping cough. 110 - 171 3 11. PREVALENCE OF INFECTIOUS AND OTHER DISEASES. (Continued) 1945 1944 Non-notifiable Infectious Diseases. German Measles . 15 603 Chicken Pox. 155 578 Mumps. 78 325 Disinfection - no. of rooms disinfected. 211 206 Hospital Treatment of notifiable Infectious Diseases. Total cases treated in hospitals. 261 223 Diphtheria Immunisation. No. of attendances at clinics. 12,033 9,299 No. given certificates after immunising. 1,389 1,064 No. submitted to primary Schick test. 1,766 1,090 - Schick positive. 1,561 1,047 - Schick negative. 63 43 No. of cases of diphtheria in immunised persons. 5 2 No. of deaths from diphtheria in immunised persons. 1 - TABLE OF CAUSES OF DEATHS DURING 1945. (According to figures furnished by the Registrar General). Causes of Death Civil Residents allages. All causes Male. Female. 522 403 1 Typhoid and paratyphoid fever - - 2 Cerebro-spina1 fever - 2 3 Scarlet fever - - 4 Whooping cough - - 5 Diphtheria 2 — 6 Tuberculosis of respiratory system 26 17 7 Other forms of tuberculosis 6 3 8 Syphilitic diseases 7 1 9 Influenza 1 2 10 Measles - 1 11 Acute polio-myelitis and polio-encephalitis - - 12 Acute infectious encephalitis - — 13m Cancer of buccal cavity and oesophagus 6 — 13f Cancer of uterus - 9 14 Cancer of stomach and duodenum 20 6 15 Cancer of breast 1 20 16 Cancer of all other sites 65 35 17 Diabetes 1 3 18 Intro-cranial vascular lesions 33 39 19 Heart disease 132 108 20 Other diseases of circulatory system 27 12 21 Bronchitis 35 15 22 Pneumonia 23 14 23 Other respiratory diseases 9 6 24 Ulceration of stomach or duodenum 11 3 25 Diarrhoea under 2 years 6 6 12. TABLE OP CAUSES OF DEATHS DURING 1945. (Continued) Causes of Death Civil Residents all ages Male. Female. 26 Appendicitis 1 1 27 Other digestive diseases 8 7 28 Nephritis 6 9 29 Puerperal and post-abortive sepsis — 1 30 Other maternal causes - 2 31 Premature birth 12 7 32 Cong. malformations, birth injury, etc. 9 19 33 Suicide 5 3 34 Road Traffic Accidents 6 5 35 Other violent causes 21 14 36 All other causes 43 33 13.