??? HES 33 ANNUAL REPORT ON THE HEALTH OF THE BOROUGH OF HESTON AND ISLEWORTH for the year 1946 A. ANDERSON, M.D., D.P.H. Medical Officer of Health INDEX Pages Staff 2, 3 The Health Committee 4 Maternity and Child Welfare Committee 4 Medical Officer's Letter 5 General Statistics, 1945-46 6 Vital Statistics 6—8 General Provision of Health Services 9—14 Infectious Diseases 14—17 Sanitary Circumstances 18—21 Housing 21 Inspection and Supervision of Food 22 Civil Defence 23—25 Summary of Vital Statistics, 1895-1946 26 Infant Deaths According to Age and Cause 27, 28 Table of Causes of Death, 1939-46 29 Age and Sex Distribution of Deaths, 1940-46 30—40 STAFF Medical Officer of Health: A. Anderson, M.D., D.P.H. Deputy Medical Officer of Health: Mrs. E. L. Roberts, M.B., Ch.B., D.P.H., Barrister-at-Law (to 30.4.46). Senior Assistant Medical Officer of Health (Acting D.M.O.H. from 1.5.46) : H. C. Broadhurst, M.B., B.S. Assistant Medical Officers of Health: W. E. MacDougall, L.D.S., L.R.C.P. & S., M.B., B.S., M.D., D.P.H. G. David, M.D., L.R.C.P. & S. Mrs. B. Vizard, M.B., Ch.B., D.P.H. (to 25.6.46). Mrs. R. Prothero, M.D., L.R.C.P. & S. (from 1.10.46). Consultant to Ante-Natal Clinic: K. Bowes, M.D., M.S., F.R.C.S. Medical Officer Diphtheria Immunisation Clinic: G. W. J. Bousfield, M.D., B.S. (part time). Divisional Dental Surgeon: E. E. Lewis, L.D.S., F.R.I.P.H. Dental Surgeons: Miss C. C. Jefferson, L.D.S. A. H. Millett, L.D.S. P. D. O'Connor, L.D.S. Mrs. S. MacDonald, L.D.S. Mrs. D. Clegg, L.D.S. Mrs. C. McK. Lindsay, L.D.S. (to 31.7.46). J. V. Perryman, L.D.S. (to 31.7.46). Orthodontic Consultant: V. A. F. Greenish, L.D.S. (to 31.5.46). Miss E. M. Still, L.D.S. (from 26.8.46). Dental Mechanic: T. Cheney (part time) Child Guidance Clinic Staff: Psychiatrist: Grace Calver, M.B., Ch.B. Psychologist: Miss M. Holt, B.A. (to 30.1.46). Miss E. Horne. (from 2.4.46 to 25.12.46). Psychiatric Social Worker : Miss D. Raynor. Speech Therapist: Miss R. M. Bennett. Chief Sanitary Inspector: R. H. Butler, A.M.I.S.E., Cert, as S.I. & M.I. (to 15.5.46). A. B. Hauldren, Cert, as S.I. & M.L (from 16.5.46). Deputy Chief Sanitary Inspector: A. B. Hauldren, Cert, as S.I. & M.L (to 15.5.46). J. S. Hodgins, Cert, as S.I., M.I., & S.E. (from 16.9.46). Sanitary Inspectors: G. Latimer, Cert, as S.I. & M.L K. J. Smith, Cert, as S.I. & M.L K. N. Kirby, Cert, as S.I. & M.L (to 31.7.46). E. Canham, Cert, as S.I. & M.I. D. E. Sheppard, Cert, as S.I. & M.L J. T. S. Templeman, Cert, as S.I. & M.L (from 1.11.46). 2 STAFF—continued. Rodent Officer: A. Farrer. Mortuary Attendant: H. E. Ellis. Disinfectors and Laboratory Attendants: F. J. Cobb. F. S. J. Allaway. Superintendent Health Visitor, Inspector of Midwives and Supervisor of Nursing Homes: Miss J. M. Evans, S.R.N., S.C.M., H.V. Cert., Cert, as S.I. Health Visitors and School Nurses: Miss M. G. Gribble, A.R.R.C., S.R.N., S.C.M., H.V. & S.N. Miss B. N. Tetley, S.R.N., S.C.M., H.V. Cert, (to 31.12.46). Mrs. A. E. Tyrrell, S.C.M., H.V. & S.N. Miss G. M. Clare, S.R.N., S.C.M., H.V. Cert. Miss R. I. Barnett, S.R.N., S.C.M., H.V. Cert. Miss W. E. Bennett, S.R.N., S.C.M., H.V. Cert, (to 4.7.46). Miss D. I. Klein, S.R.N., S.C.M., H.V. Cert. Mrs. A. W. Kiely, S.R.N., S.C.M. Miss E. E. Willis, S.R.N., S.C.M., H.V. Cert. Miss W. M. Mills, S.R.N., S.C.M., H.V. Cert. Miss E. Foggin, S.R.N., S.C.M., H.V. Cert. Miss E. Counihan, S.R.N., S.C.M., H.V. Cert, (from 1.1.46). Mrs. L. A. Settle. Municipal Midwives: Miss M. J. Alsford. Mrs. M. E. Brash (to 7.4.46). Miss B. T. Brennan (to 28.9.46). Miss E. M. Clarke (to 31.10.46). Mrs. G. N. Jukes. Miss A. A. McGovern (to 15.11.46). Chief Clerk: B. W. Kilby, Cert, as S.I. &. M.I. Clerks: H. L. Law. Miss L. R. Marshall (Cert, as S.I.). J. W. Dean. M. W. Langford. B. C. Mallaband. R. Powell (to 31.7.46). E. E. Forrest. R. G. Atkins. E. E. deLaspee. Miss M. F. Garry. Miss M. A. Dixon. Miss L. M. Perryman (to 27.10.46). G. Pitt. R. P. Sanger. L. H. Hayward (on Government Training Course). G. Taylor (to 7.12.46). P. J. Samwells (on War Service). Miss E. N. Mayles (from 14.10.46). Miss G. D. E. Ostler. Miss E. D. Paull. Miss D. M. Weston. Mrs. D. T. Woodley. Miss R. E. Warren (from 1.11.46). J. E. Woodley (Messenger). Miss E. M. Stroud. Miss D. M. B. West. Miss S. M. Underwood. Miss M. Draper (from 11.2.46). Mrs. M. A. Hodgson (from 19.2.46). Miss B. M. Corby (from 29.8.46) Miss N. R. Maskell (to 18.1.46). Miss V. MacGuinness (to 5.3.46). Miss M. Welch (to 27.3.46). Mrs. I. Baseby (to 13.4.46). Miss E. F. Cawte (to 13.4.46). Miss E. Parrington (18.3.46 to 4.6.46). Miss P. Wood-Smith (25.2.46 to 16.8.46). Mrs. E. F. E. Knibb (to 30.8.46). Miss J. O. Jordan (to 19.10.46). 3 THE HEALTH COMMITTEE HESTON AND ISLEWORTH BOROUGH COUNCIL as on the 31 st December, 1946. Alderman J. E. Dillingham (Chairman). Councillor E. C. Turner (Vice-Chairman). Alderman H. Collar. Alderman R. H. Manning (Mayor). Alderman D. Rhys. Alderman Miss M. K. Watson. Councillor E. W. Dean. Councillor Mrs. O. C. M. Denton. Councillor W. R. Foster. Councillor H. G. Hockliffe. Councillor Mrs. E. F. Manning. Councillor G. W. Morris. Councillor J. F. Thomas. MATERNITY AND CHILD WELFARE COMMITTEE. Alderman Miss M. K. Watson (Chairman). Councillor Mrs. E. F. Manning (Vice-Chairman). Alderman H. Collar. Councillor W. Chamberlain. Councillor Mrs. O. C. M. Denton. Councillor W. R. Foster. Councillor F. H. Freeman. Councillor G. J. Stephens. Councillor J. F. Thomas. Co-opted Members : Mrs. G. M. Halls. Mrs. L. D. Hudd. 4 PUBLIC HEALTH DEPARTMENT, 92 BATH ROAD, HOUNSLOW. To the Mayor, Aldermen and Councillors of the Borough of Heston and Isleworth. Ladies and Gentlemen, I have the honour to present the Annual Report on the health, vital statistics and sanitary circumstances of the Borough and on the work of the various sections of the Health Department for the year 1946. The Annual Reports since 1939 have been type-written summaries so, in anticipation that this report would be printed, I have incorporated information regarding these years with a view to providing a more permanent record. This report, therefore, may be taken as covering the years 1939-46, and it is hoped that it will enable you to review the war years and to see to what extent the health and health services of the Borough were maintained. Many tables have been included and the report is largely a factual record with little comment. It will be noted that during these years the health services have been enlarged and extended in various ways and that the services in operation before the war have now returned almost to their full pre-war activity. While at various times during these years certain aspects of the health of the Borough gave rise to anxiety, I think it may be said that conditions were seldom as bad as had been anticipated and that the service has stood up well to the strains imposed on it. During 1946 the Department lost by retirement the services of two valued members of the staff. Dr. Roberts, Deputy Medical Officer, served the Borough with loyalty, zeal and enthusiasm for twenty-six years and played a prominent but unobtrusive part in the development of the health services. Mr. Butler, Chief Sanitary Inspector, by attention to detail and with courage in the face of physical handicap, built up the reputation of his section and over a period of forty years contributed much to the welfare of the citizens. For their loyal support and assistance I am deeply grateful. I should like to take this opportunity to express my thanks to the staff of the Department for their loyal and generous assistance, to the Officers of other Departments for their help and co-operation and to the Council for support and encouragement. I remain, Your obedient servant, A. ANDERSON, Medical Officer of Health. 5 GENERAL STATISTICS 1946. 1945. Population (Registrar-General's estimate) 104,240 95,100 Number of inhabited houses (rate books) 27,613 27,526 Number of houses erected during year 229 — Rateable value of Borough £957,317 £956,668 Sum represented by a penny rate £3,962 £3,928 Live Births—legitimate—male 876 712 Live Births—legitimate—female 815 655 Live Births—illegitimate—male 62 53 Live Births—illegitimate—female 52 58 Birth Rate per 1,000 population 17.3 15.5 Birth Rate per 1,000 population (England and Wales) 19.1 16.1 Stillbirths—legitimate—male 25 17 Stillbirths—-legitimate—female 19 19 Stillbirths—illegitimate—male 2 2 Stillbirths—illegitimate—female 2 1 Stillbirth Rate per 1,000 (live and still) births 26 26 Deaths—male 588 522 Deaths—female 500 403 Death Rate per 1,000 population 10.4 9.7 Death Rate per 1,000 population (England and Wales) 11.5 11.4 Infant Mortality Rate 29.4 50.7 Infant Mortality Rate (England and Wales) 43 46 Maternal Mortality Rate 2.2 2.0 Maternal Mortality Rate (England and Wales) 1.4 1.8 Out-relief disbursed to Heston and Isleworth residents £19,008 £16,992 VITAL STATISTICS POPULATION.—The population of the Borough at the 1931 census was 75,460, and the Registrar-General's mid-year estimates for 1939-46 are shown below:— 1939 102,000 1943 95,080 1940 97,530 1944 92,370 1941 93,990 1945 95,100 1942 95,600 1946 104,240 It should be noted that these numbers refer only to the civilian population. RATEABLE VALUE.—The rateable value (a) and the sum represented by a penny rate (b) are shown below:— a b a b 1939 £912,965 £3,652 1943 £941,785 £3,825 1940 £911,969 £3,716 1944 £944,922 £3,908 1941 £941,043 £3,792 1945 £956,668 £3,928 1942 £929,684 £3,676 1946 £957,317 £3,962 INHABITED HOUSES.—The table below shows the number of inhabited houses according to the rate books:— 1939 27,389 1943 27,630 1940 27,219 1944 27,540 1941 26,850 1945 27,526 1942 27,521 1946 27,613 It would appear from the above that the number of persons per inhabited house is 3.8. The figure was 3.7 in 1939 and 4.4 at the 1931 census. The evidence from housing applications and reports 6 by Health Visitors and Sanitary Inspectors does not support the suggestion contained in these figures that overcrowding to-day is less prevalent than in 1931 and no more than in 1939. In the absence of a census or other detailed survey the figures of population and houses must be accepted with reserve. LIVE BIRTHS.—The number of live births and the birth rates per 1,000 population of the Borough and England and Wales for 1939-46 are shown in the following table:— Year Legitimate Illegitimate Total Births Birth Rate M F Total M F Total H. and I. E.andW. 1939 778 702 1,480 21 21 42 1,522 14.9 15.0 1940 641 653 1,294 17 23 40 1,334 13.7 14.6 1941 586 579 1,165 28 24 52 1,217 13.0 14.2 1942 679 662 1,341 27 32 59 1,400 14.6 15.8 1943 748 721 1,469 47 43 90 1,559 16.3 16.5 1944 737 700 1,437 37 48 85 1,522 16.5 17.6 1945 712 655 1,367 53 58 111 1,478 15.5 16.1 1946 876 815 1,691 62 52 114 1,805 17.3 19.1 The birth rate of 13.0 in 1941 is the lowest in the records of the Borough. The continuing increase in the number of illegitimate births is disquieting. STILLBIRTHS.—The number of stillbirths and the proportion per 1,000 total (live and still) births are shown below:— No. Rate per 1,000 total births. No. Rate per 1,000 total births. 1939 44 26 1943 41 26 1940 34 25 1944 34 22 1941 44 35 1945 39 26 1942 47 32 1946 48 26 Stillbirths comprised 30 per 1,000 of all births during 1934-38 as compared with 26 during 1942-46, and it is hoped that this saving of potential lives will continue. DEATHS.—The deaths of residents of the Borough shown in the following table refer only to civilians:— Year Heston and Isleworth Death Rate England and Wales No. of deaths Rate per 1,000 population M F Total 1939 447 448 895 8.9 12.1 1940 608 592 1,200 12.3 14.3 1941 476 492 968 10.3 12.9 1942 516 454 970 10.2 11.6 1943 514 490 1,004 10.6 12.1 1944 543 417 963 10.3 11.6 1945 522 403 925 9.7 11.4 1946 588 500 1,088 10.4 11.5 Some indication of the change taking place in the percentage age distribution of deaths is shown below:— 1910-14 1940-44 1945 1946 Under 1 year 21.8 7.8 8.2 4.9 1 — 4 years 8.4 1.4 0.8 0.9 5 — 14 years 3.8 1.8 0.6 1.1 15 — 24 years 3.7 2.8 2.7 2.6 25 — 64 years 30.8 35.2 34.1 34.0 65 years and over 31.5 51.0 53.6 56.5 As a result of enemy war operations, 153 (79 male, 74 female) civilian residents of the Borough were killed or died from injuries. The chief causes of death during 1939-46 were heart disease (1,981), cancer (1,237), bronchitis and pneumonia (817), cerebral haemorrhage (645), and tuberculosis (497). 7 INFANTILE MORTALITY.—The position in regard to deaths of children under the age of one year is shown below:— Year Heston and Isleworth England and Wales Rate per 1,000 live births No. of deaths Rate per 1,000 live births 1939 74 50 51 1940 77 58 57 1941 73 61 60 1942 103 72 51 1943 73 47 49 1944 71 46 45 1945 76 51 46 1946 53 29 43 The rate for 1946 is the lowest in the records of the Borough. The following table shows the trend of the change in the age distribution of infant deaths:— Age at death % of total infant deaths Rate per 1,000 live births 1911-15 1940-44 1945 1946 1911-15 1940-44 1945 1946 Under 1 week 19.8 38.3 38.2 66.0 22.2 21.5 19.6 19.4 Under 1 month 31.4 58.8 63.2 73.6 37.3 32.9 32.5 21.6 Under 3 months 54.7 76.6 77.6 86.8 61.1 42.9 40.0 25.5 3-5 months 18.8 10.2 9.2 5.7 21.0 5.7 4.7 1.7 6-8 months 14.0 7.1 4.0 5.7 15.7 4.0 2.0 1.7 9-11 months 12.5 6.1 9.2 1.9 14.0 3.4 4.7 0.6 A much higher percentage of the infant deaths now occurs at the earlier ages, but the rates show that the conditions giving rise to death at these early ages are still prevalent. This hard core of deaths under the age of four weeks, which is largely due to prematurity, congenital defects and infantile conditions associated with birth, has persisted for many years. The following table shows that the low infant mortality rate for 1946 is due to (a) a reduction in the deaths from infections and (b) a reduction in the deaths from prematurity, congenital defects, etc. The former shows what a large part infections have played and can play in infant deaths, and emphasizes again the importance of good mothercraft. The reduction in the rate due to prematurity, etc., is very welcome, and though firm deductions cannot be made from the rates for any one vear, the figures suggest that our efforts are being directed along the right lines. An unusual feature of the infant deaths in 1946 is the high proportion of deaths of boys (45 male, 8 female). Cause of death. Rate per 1,000 live births. 1911-15 1940-44 1945 1946 Prematurity 22.4 15.2 12.1 11.6 Congenital defects, etc. 8.0 7.5 11.5 5.5 Bronchitis and pneumonia 22.0 8.8 4.7 1.1 Gastro-enteritis 26.9 11.2 7.3 2.2 Other infections 13.7 2.8 1.1 1.1 MATERNAL MORTALITY.—The number of deaths due to causes associated with pregnancy and childbirth and the maternal mortality rates per 1,000 total (live and still) births for the Borough and England and Wales are shown in the following table:— Year No. of deaths Maternal Mortality Rate H. & I. H. & I. E. & W. 1939 5 3.4 2.8 1940 3 2.3 2.2 1941 3 2.4 2.2 1942 4 2.8 2.0 1943 1 0.6 2.3 1944 3 1.9 1.9 1945 3 2.0 1.8 1946 4 2.2 1.4 The average rate for the Borough for the five years 1934-38 was 3.1, so despite the variation from year to year in the above table the general tendency is towards a lowering of the rate in the Borough. 8 GENERAL PROVISION OF HEALTH SERVICES LABORATORY FACILITIES —Certain routine bacteriological work is carried out in the laboratory at the Health Department. Where more detailed investigation is required, specimens are sent to the Clinical Research Association, the Camberwell Research Laboratory, or the Emergency Public Health Laboratory Service. The numbers of specimens examined were as follows:— 1939 1,318 1943 551 1940 1,054 1944 734 1941 702 1945 1,079 1942 583 1946 563 It is anticipated that this work will be undertaken in the near future by the Public Health Laboratory Service to be established under the National Health Service Act, 1946. AMBULANCE FACILITIES.—For non-infectious and accident cases the Council used to provide a service manned by the Fire Brigade. During the war this service was transferred to the Civil: Defence Ambulance Service. At the end of the war a separate service was established under the control of the Medical Officer of Health and was housed in the old fire station in Montague Road. The present fleet consists of two ambulances and a car for sitting" cases. Delivery is awaited of two new ambulances. . The number of journeys made by this service is shown below:— Accident Other Accident Other 1939 1,190 706 1943 649 1,710 1940 998 876 1944 585 2,499 1941 898 968 1945 669 2,260 1942 804 1,390 1946 590 3,796 West Middlesex County Hospital maintains a fleet of ambulances, and an ambulance for infectious cases is provided by the South Middlesex and Richmond Joint Hospital Board. NURSING IN THE HOME.—Until 1945, when they amalgamated to form the Heston and Isleworth District Nursing Association, the Borough was served by two voluntary District Nursing Associations. The Council contributes to the funds of the Association. Visits were paid by the nurses as follows:— 1939 27,259 1943 36,125 1940 29,727 1944 32,610 1941 30,832 1945 30,993 1942 32,519 1946 27,569 The work of the Association has been handicapped in recent years by the shortage of nurses. INFANT WELFARE CENTRES.—The infant welfare centres were closed at the outbreak of war. They were re-opened at Hounslow, Isleworth and Cranford on 20th October and at Heston on 21st November, 1939, and have remained in full operation since them. At present, 14 sessions are held each week and a medical officer is in attendance at each session. The work of the centres is almost wholly of an advisory nature in regard to the diet, nurture, hygiene and minor disturbances of health of infants and young children. When further measures of treatment are required the children are referred to private practitioners, hospitals, or the appropriate clinic. The attendances at these centres are shown below:— 1939 31,988 1943 30,716 1940 24,582 1944 27,284 1941 26,298 1945 30,307 1942 27,774 1946 32,307 Prior to the war a cup of tea was provided for the mothers, but this practice has not been resumed. ANTE-NATAL AND POST-NATAL CLINICS.—The clinics, closed at the outbreak of war, were re-opened on 18th September,. 1939. They are held at Hounslow and Isleworth Health Centres, and at present there are five routine and one consultant sessions each week. The cases are referred by midwives, doctors, or West Middlesex Hospital. The attendances for post-natal examination have never been satisfactory, but some improvement has taken place during 1946 when a scheme was introduced whereby the municipal midwives give their patients a definite appointment for the nearest clinic. Where special treatment is required for ante- or post-natal conditions, women are referred to their own doctor or to hospital. The attendances at these clinics are shown below:— 1939 3,369 1943 5,708 1940 3,815 1944 5,653 1941 4,839 1945 4,794 1942 5,495 1946 6,992 An increasing number of women are seeking advice in regard to sterility and family spacing. In regard to the latter they are usually referred to the Hounslow branch of the North Kensington Women's Welfare Centre. ARTIFICIAL SUNLIGHT TREATMENT.—This treatment is provided during the winter months at Hounslow and Isleworth Health Centres. The following numbers of children under school age have been treated:— 1939 28 1943 67 1940 30 1944 73 1941 46 1945 80 1942 45 1946 102 9 ORTHOPÆDIC TREATMENT.—Children suffering from orthopaedic defects were referred to the Royal National Orthopædic or West Middlesex Hospitals. The following numbers of children under school age were sent for treatment:— 1939 9 1943 38 1940 5 1944 41 1941 8 1945 45 1942 24 1946 25 DEFECTIVE VISION TREATMENT.—Children under school age in whom a defect of vision is diagnosed or suspected are referred to the eye clinics established under the School Medical Service. The following numbers of children have been examined and spectacles prescribed where necessary:— 1939 50 1943 48 1940 54 1944 48 1941 56 1945 73 1942 45 1946 59 MINOR AILMENTS TREATMENT.—The minor ailments treatment clinics provided under the Education Acts are available for children under school age. The following numbers of children have been treated:— 1939 51 1943 39 1940 76 1944 49 1941 58 1945 44 1942 30 1946 62 SPEECH CLINIC.—The following numbers of children under school age were treated by the Speech Therapist: 6 in 1944, 14 in 1945, and 15 in 1946. MEDICAL OUT-RELIEF.—.This work is carried out by the District Medical Officers appointed by Middlesex County Council. VENEREAL DISEASE.—Facilities for diagnosis and free treatment are provided by Middlesex County Council and the nearest centres are West Middlesex and West London Hospitals. In necessitous cases fares are paid by the County Council. VACCINATION.—The work under the Vaccination Acts is carried out by the Public Vaccinators appointed by Middlesex County Council. The number of vaccinated persons in the Borough is not known. TUBERCULOSIS.—The diagnosis and treatment of persons suffering from tuberculosis is undertaken by Middlesex County Council and the clinic serving this area is at 28 Bell Road, Hounslow, MIDWIFERY SERVICE.—There are no midwives in private practice in the Borough. Midwives are employed in West Middlesex Hospital and Nursing Homes and for domiciliary confinements the Council supplies midwives. The establishment of municipal midwives was 8 till 1943 when it was raised to 10. Owing to the shortage of midwives and of suitable accommodation great difficulty has been met in trying to maintain this service and at the end of 1946 only 8 midwives were available. Had the demand for the services of municipal midwives continued at the pre-war level our available staff would have been inadequate. I he following table, showing the proportions of births at home, in West Middlesex Hospital, in Nursing Homes and outside the Borough, indicates that municipal midwives attended 41.2 per cent. of the births in 1938 and 46.3 per cent. in 1940 as compared with 25.9 per cent. in 1946. Year Total Live Births Domiciliary confinements in Borough Nursing home and, hospital confinements in Borough Confinements outside Borough No. % W.M.H. N.H. Total % No. % 1938 1,484 611 41.2 516 84 600 40.4 273 18.4 1939 1,566 650 41.5 479 114 593 37.9 323 20.6 1940 1,368 633 46.3 425 70 495 36.2 240 17.5 1941 1,261 573 45.4 323 94 417 33.1 271 21.5 1942 1,447 597 41.2 542 135 677 46.8 173 12.0 1943 1,600 580 36.3 476 189 665 41.6 355 22.1 1944 1,556 478 30.7 480 185 665 42.8 413 26.5 1945 1,478 366 24.8 517 160 677 45.8 435 29.4 1946 1,805 470 26.0 647 206 853 47.3 482 26.7 The work of the municipal midwives is supervised in detail by the Supervisor of Midwives who is also Superintendent Health Visitor and in general by one of the Assistant Medical Officers. During 1939-46 it has not been found necessary to report any midwife to the Central Midwives Board for any breach of their rules. Under these rules a midwife is required, in certain circumstances, to summon medical aid. The Council pays the doctors' fees in such cases and recovers all or part of the cost, according to circumstances, from the patient unless she has taken advantage of the Council's insurance scheme to cover such contingencies. The percentage of cases attended by midwives in which the midwife sought medical aid is shown below:— 1939 36.0 1943 38.0 1940 36.0 1944 29.5 1941 37.0 1945 29.0 1942 37.0 1946 37.7 10 All the municipal midwives have been trained in gas and air analgesia. Now that the supply of the necessary apparatus has improved and the rule requiring the presence of a second midwife or nurse has been relaxed, greater use is being made of this facility. In 1946 the midwives administered gas and air analgesia at 35 confinements. Arrangements continue for our midwives to attend post-certificate lectures and demonstrations organised jointly by the London, Middlesex and Surrey County Councils. CONVALESCENT TREATMENT FOR MOTHERS AND CHILDREN.—No facilities for such treatment are available in the Borough but mothers and children were sent for convalescent treatment as under. The cost was borne by the Council and where circumstances warranted it a charge was made. Mothers Children Mothers Children 1939 — 6 1943 — — 1940 — 5 1944 — 1 1941 1 3 1945 1 3 1942 — 2 1946 2 4 HOME HELPS.—For many years the Council has provided domesic assistance in maternity cases. In 1945 the scheme was extended to cover non-maternity domestic emergencies. During the war years the demand for this service steadily increased and is showing no signs of falling off. It has always been difficult to recruit for this work women who are suitable and are prepared to work in any house in the Borough. The arrangement whereby the recruitment and allocation of home helps was dealt with by a clerk while the supervision of their work was shared among the health visitors and midwives proved increasingly unsatisfactory and towards the end of 1946 a decision was reached to appoint a whole-time organiser. According to the circumstances of the household a charge is made for the services of a home help and the number of families assisted is shown below:— Maternity Other Maternity Other 1939 54 — 1943 51 — 1940 63 — 1944 77 — 1941 54 — 1945 46 43 1942 46 — 1946 72 76 CARE OF ILLEGITIMATE CHILDREN.—Health Visitors have always given special attention to illegitimate children but since 1943 a more determined effort has been made to contact the mothers before the birth of the child and to endeavour to secure satisfactory arrangements for ante-natal care, confinement, and for the mother and child after the lying-in period. In this work close contact is maintained with moral welfare workers, hospital almoners and other interested parties. The majority of the confinements take place in hospital. In some cases accommodation has to be found for the mother before confinement and for the mother and baby after confinement and to this end the Council arranged, through Middlesex County Council, to participate in the use of ante-natal and post-natal hostels provided by the British Red Cross Society. No case from the Borough was admitted in 1944 but the facilities were used for 3 cases in 1945 and for 2 cases in 1946. Some indication of the results of this effort on behalf of illegitimate children is shown in the following report of final arrangements where contact has been maintained:— 1944 1945 1946 Mother and child living with father of child 25 11 20 Mother and child living with grandparents 15 24 25 Mother and child living together 1 — 1 Child placed with foster mother 1 1 1 Child placed for adoption 4 16 6 Child placed in residential nursery 1 1 — Child in day nursery while mother at work 1 — 1 Mother and child left Borough 8 8 5 Child died in hospital 4 3 1 Child living with other relatives — 2 3 Child with daily guardian while mother at work maintained :— 1 — ADOPTION OF CHILDREN.—The Adoption of Children (Regulation) Act, 1939, which came into operation on 1st June, 1943, is designed to ensure that, as far as is practicable, the adoption of any inlant shall be carried out in the manner most beneficial to the child and to prevent the trading in young children by a third party whose sole object is to make money by this traffic in young lives. Adoption Societies have to be registered, must not practice for gain, and all their activities are subject to scrutiny. Under Section 7 of the Act it is the duty of any person (other than the child's parent or guardian), who participates in the arrangements for the placing of a child for adoption, to notify in writing the welfare authority of the area in which the child is to be placed. Close contact in regard to adoption is maintained with the Court officers and every assistance is given to Adoption Societies who request information in connection with their work. The Health Visitors made 162 visits in 1944, 198 in 1945 and 165 visits in 1946 in connection with the adoption of children. CHILD LIFE PROTECTION.—The Health Visitors undertake the duties of Child Life Protection Visitors. During the war the demand for foster mothers increased and constant watch had to be maintained that foster mothers notified the reception of children and did not undertake the care of more children than was reasonable in relation to premises and staff. In several cases severe warnings were issued where the reception of a child had not been notified and in one case proceedings were taken against the foster mother. In two cases restrictions were placed on the number of children to be accommodated on the premises. The numbers of foster children on the register at the end of the year and the number of visits of inspection paid during the year are shown below:— No. of children No. of visits No. of children No. of visits 1939 59 421 1943 67 591 1940 53 489 1944 52 452 1941 71 499 1945 50 585 1942 62 475 1946 49 373 11 DAY NURSERIES.—In 1941 the Council decided to provide day nurseries in preference to a supervised " daily minder " scheme as a method of enabling married women to enter industry. The first nursery, Nantly House, Hounslow (54 children) was opened on 2nd February, 1942, and was followed by Acton Lodge, Brentford End (35 children) on 1st July, 1942; Blenheim House, Hounslow West (50 children) on 9th August, 1943, and Heston Day Nursery (50 children) on 15th November, 1943. The charge for day nurseries was 1/- per day per child and the remainder of the cost was borne by the Government. On 1st April, 1946, the nurseries were taken over by the Council who receive a Government grant of approximately 50 per cent. of the net cost. The Council has continued the charge of 1/- per day per child. The main difficulties associated with the establishing of day nurseries were (a) to find suitable premises near main traffic routes, (b) to get suitable equipment, and (c) to recruit staff. The second difficulty was met for some time by the issue of standard equipment by the Government but this scheme is no longer in operation and all three difficulties remain. Throughout, the recruitment of adequate nursing and domestic staff has been a problem and this shortage has been associated with a high incidence of sickness among the staff. For example, in 1944, the proportion of the necessary nursing staff on duty in any week varied from 66 to 94 per cent. (average 79 per cent.) and of the necessary domestic staff from 64 to 100 per cent. (average 86 per cent.). This placed a severe strain on the staff on duty and but for their enthusiasm and energy the nurseries would have been closed on several occasions. Owing to the shortage of trained nursery teachers the standard of educational care in the nurseries has fallen far short of what is desirable. The average attendance of children throughout the years is shown below:— Accommodation Attendance 1942 89 71 1943 189 120 1944 189 128 1945 189 129 1946 189 135 The attendance of children on Saturdays has always been poor and if Saturdays be excluded the average daily attendance in 1946 was 151 (80 per cent. of the accommodation). Experience has shown that owing to illness, holidays, etc., the attendance of children seldom exceeds 85 per cent. of the number on the register and, to counterbalance this to some extent, children are admitted in excess of the approved accommodation when staff conditions permit. Apart from a small outbreak of dysentery in two of the nurseries no excessive Incidence of infectious disease has been noted. The demand for accommodation has shown no reduction and there has always been a list of children awaiting admission. Admission has been and is restricted to the children of mothers in employment but temporary admissions are arranged where possible in connection with domestic emergencies or where supervision in a day nursery has been recommended for a child. DENTAL TREATMENT FOR MOTHERS AND YOUNG CHILDREN.—The scheme for providing dental treatment for mothers and young children has continued in operation. Patients are referred to the dental department from the ante-natal and infant welfare clinics. A summary of the work done is given below:— 1939 1940 1941 1942 1943 1944 1945 1946 Total attendances of mothers and children 3,721 3,359 2,895 2,554 2,612 2,644 2,272 3,182 Teeth extracted— Mothers 1,780 1,714 1,633 1,732 2,069 1,509 1,161 1,291 Children 748 424 882 384 310 232 227 382 Teeth filled— Mothers 565 424 335 470 402 703 603 944 Children 181 230 215 262 135 54 33 95 Dentures supplied to mothers 249 247 208 211 241 231 174 150 SUPPLY OF MILK AND OTHER FOODS.—In connection with the ante-natal and infant welfare clinics, schemes for the provision of milk and vitamin preparations have been continued. Because of the priority given to mothers and children in connection with the national supply of liquid milk the provision of such milk through our scheme gradually ceased. When " national " dried milk was introduced distribution was arranged through the infant welfare centres. The following table indicates the extent to which milk, etc., has been supplied free or at a reduced price:— 1939 1940 1941 1942 1943 1944 1945 1946 Pasteurized milk (gals.) 11,477 7,988 — — — — — — Dried milk (lbs.) 2,059 2,448 799 1,314 532 434 129 70 National dried milk (lbs.) — 944 5,554 4,135 1,622 1,486 2,672 3,563 Cod liver oil (4 ozs.) 175 269 204 17 3 — — — Cod liver oil emulsion (8 ozs.) 370 202 348 61 23 1 1 8 Cod liver oil and malt (lbs) 561 400 131 36 1 6 1 2 Cod liver oil with malt and iron (lbs.) — — 328 122 36 9 — 3 Lactagol (tins) 149 122 265 272 59 29 3 8 Bemax (tins) 55 73 163 283 109 76 15 49 Adexolin (½ oz.) 190 184 414 186 22 3 1 — Kalzana (tablets) 3,970 5,320 1,630 3,330 910 60 23 170 Vitamin C (tablets) — — 2,720 — 180 — 60 1,500 Virol (lbs.) 99 59 39 10 11 3 1 1 Groats (tins) — — 90 82 4 — 1 — Though the table shows a general reduction in the quantities supplied free—due to less unemployment, higher level of wages and issues through the Ministry of Food—the receipts from sales at cost price have risen steadily, e.g., £1,576 in 1940, £2,279 in 1942, £3,139 in 1944 and £4,139 in 1946. 12 SUPPLY OF MINISTRY OF FOOD VITAMIN SUPPLEMENTS.—The ante-natal and infant welfare centres are distribution centres for the issue of Ministry of F"ood vitamin supplements. There are other distributing centres in the Borough and the total amounts issued are shown below:— 1941 1942 1943 1944 1945 1946 Black currant puree (Vit. C) (tins) 2,670 11,496 — — — — Black currant juice (Vit. C) (bottles) 475 1,920 — — — — Orange juice (Vit. C) (bottles) — 25,985 116,991 130,114 147,166 140,377 Cod liver oil (Vit. A & D) (bottles) 1,231 12,767 15,251 14,161 14,284 18,889 Vit. A & D tablets (packets) — — 2,526 3,230 3,032 3,033 The extent to which mothers in the Borough have taken advantage of these vitamin supplements for themselves and their children has been disappointing. The actual take-up in 1946 expressed as a percentage of the potential take-up calculated from the numbers of expectant and nursing mothers and young children is shown below (figures supplied by the Ministry of Food) :— Orange juice Cod liver oil A & D Tablets 4 weeks ending 26.1.46 60.50 30.45 41.86 5 weeks ending 24.8.46 63.60 27.46 57.39 4 weeks ending 28.12.46 60.92 49.03 61.40 Fuller use should be made of these vitamin supplements if the risk of vitamin deficiency from the restricted supply of rationed and other foods is to be avoided. SCABIES CLINIC.—At the beginning of 1942 scabies clinics were opened at Isleworth and Hounslow Health Centres. Afternoon and evening sessions were arranged but attendances were so poor that the Isleworth sessions were abandoned in March and the evening sessions in Hounslow in May. Since then all treatment has been concentrated in afternoon sessions at Hounslow. The numbers of cases treated were as follows :—992 in 1942, 974 in 1943, 643 in 1944, 630 in 1945 and 395 in 1946. No proceedings have been instituted under the Scabies Order, 1941. Propaganda and experience seem to have gradually brought about an increasing acceptance by the public of the view that early treatment avoids much discomfort and that treatment of all members of the family limits the spread of the disease. In the absence of symptoms it is difficult to convince contacts, especially adolescents and adult males, that they should submit to treatment. The same difficulty arises in dealing with lousiness where school children are re-infested by other members of the family. During recent years a varying number of adolescents and adults have been de-loused. Some came to the Department seeking treatment, others were referred from factories and others attended on pressure by Health Visitors and Sanitary Inspectors. At each de-lousing and as opportunity permits advice is given by the staff on the methods and measures to be adopted to maintain freedom from infestation. This advice appears to be particularly necessary in the case of adolescent girls. NURSING HOMES.—All nursing homes in the Borough have to be registered with the Council and are subject to supervision in regard to premises, staff and equipment. The demand for nursing home accommodation, especially for maternity cases, has been heavy and careful watch has had to be maintained to avoid overcrowding in relation to space or staff with consequent increased risk of infection. The nursing home accommodation in the Borough is shown below:— Medical and Surgical Beds Maternity Beds Medical and Surgical Beds Maternity Beds 1939 21 11 1943 16 12 1940 18 11 1944 19 13 1941 17 11 1945 18 13 1942 17 11 1946 18 13 INSULIN.—Since February, 1943, insulin has been available at the Health Department at cost, reduced price or free, according to circumstances, to persons suffering from diabetes who are not eligible to get such under the provisions of the National Health Insurance Act. The following quantities have been supplied :—670 vials in 1943, 884 in 1944, 745 in 1945 and 514 in 1946. HEALTH EDUCATION.—Posters and leaflets supplied by the Central Council for Health Education are displayed and distributed, and on several occasions special efforts were made in regard to diphtheria immunisation. Food Advisory Officers of the Ministry of Food have attended on several occasions at the ante-natal and infant welfare clinics. Through the Local Youth Committee eight youth courses on sex education were given towards the end of 1946. Two courses of lectures on mothercraft were given at Hounslow Health Centre in 1943 and 1944, but the attendance on both occasions was disappointing. Medical Officers have given talks on various aspects of public health to several organisations in the Borough. In the course of their contact with the people in their homes and at clinics the staff have continuous opportunity for health education and the importance of this aspect of their work is regularly brought to their notice. MEDICAL EXAMINATION OF STAFF.—-For superannuation and other purposes members of the Council's staff are referred to the Health Department for examination. The numbers of such medical examinations are shown below:— 1939 55 1943 6 1940 15 1944 3 1941 18 1945 5 1942 15 1946 75 13 HEALTH VISITORS.—Twelve Health Visitors, who are also School Nurses and Child Protection Visitors, are employed. Their duties, apart from School Health Service, are home visiting of mothers and children, attendance at infant welfare, ante-natal and diphtheria immunisation clinics, supervision of foster children, etc. A summary of their work is given below:— 1939 1940 1941 1942 1943 1944 1945 1946 Attendances at infant welfare centres 592 696 704 726 725 766 830 877 Attendances at ante-natal clinics 339 447 519 550 547 555 554 605 Attendances at diphtheria immunisation clinics 129 170 324 305 289 187 199 199 Attendances at scabies clinics — — — 391 103 124 126 135 Visits to expectant mothers— First 148 179 315 226 308 321 208 683 Subsequent 65 53 125 71 76 38 55 97 Visits to mothers (post-natal) 9 28 21 10 11 14 11 Visits to children under 1 year old— First 1,315 1,264 1,107 1,202 1,511 1,336 1,309 1,449 Subsequent 2,089 2,887 3,434 2,960 3,878 3,106 3,293 2,755 Visits to children 1 to 5 years old 3,256 4,790 4,775 3,949 4,827 3,722 4,424 4,255 Visits re stillbirths 29 29 36 38 36 24 29 31 Visits re infant deaths 54 67 50 85 56 64 70 37 Visits re inflamation of babies' eyes 49 65 148 67 55 61 20 36 Visits re infectious disease in children under school age 177 487 553 382 294 260 573 277 Visits re child life protection 421 489 499 475 591 452 585 373 Visits, miscellaneous 374 584 651 415 301 343 295 577 Visits—no access or person not at home 1,044 2,178 2,512 2,416 2,880 3,013 2,605 2,064 In 1946 many visits were made to investigate home conditions on behalf of West Middlesex County Hospital where admission for confinement or early discharge after confinement was under consideration. No matter what clinic or treatment facilities are provided there will always be need for home visiting by Health Visitors. It is not enough to know that a mother and child are attending a clinic as without an appreciation of the environmental conditions the best advice cannot be given. A proportion of mothers, by reason of indifference, distance or domestic conditions, do not attend infant welfare centres and can only be reached through home visiting. A mother will discuss her problems with the Health Visitor more freely in her own home than in a busy welfare centre, and effective home visiting by efficient Health Visitors is of primary importance, especially in maternity and child welfare. Despite a considerable increase in clinic sessions our establishment of Health Visitors has not changed since 1937 and therefore if home visiting is to be carried out in a thorough and unhurried manner, additional staff will be needed. INFECTIOUS DISEASES INCIDENCE OF NOTIFIABLE DISEASE.—The numbers of cases notified during the last eight years are shown below:— 1939 1940 1941 1942 1943 1944 1945 1946 Smallpox — — — — — — — — Scarlet fever 175 96 117 190 280 130 124 67 Diphtheria 51 73 37 11 5 11 24 16 Erysipelas 23 35 20 16 21 16 16 19 Pneumonia 142 200 124 72 116 50 25 47 Cerebro-spinal fever 6 43 34 12 — 3 11 13 Epidemic encephalitis — 1 1 — — — 1 — Poliomyelitis and polioencephalitis — 1 1 — — 3 7 1 Typhoid fever 3 3 2 4 1 — — 1 Paratyphoid fever — 1 30 1 — — — — Dysentery 1 — — 2 — 22 28 6 Tuberculosis: Pulmonary 118 121 157 177 165 167 128 200 Non-pulmonary 14 9 17 25 25 17 29 17 Ophthalmia neonatorum 4 2 5 3 — 5 3 2 Puerperal pyrexia 61 42 22 58 105 87 45 54 Measles (from 1940) — 1,109 580 1,085 636 219 1,109 170 Whooping-cough (from 1940) — 123 286 243 134 171 110 170 Malaria — — — — — 1 2 1 14 SCARLET FEVER.—This disease continues to be of a mild type. The incidence in 1946 (0.6 cases per 1,000 population) is the lowest in the Borough records, and the last death from scarlet fever in the Borough occurred in 1937. Since 1940 the admission of cases of scarlet fever to hospital has been restricted, and has been determined by (a) the severity of the attack, (6) the home nursing and isolation facilities, and (c) the employment of another member of the household in the preparing or distribution of Food for public consumption. Scarlet fever is due to a throat infection by haemolytic streptococci, but these same streptococci may give rise to a sore throat with no accompanying rash. To isolate in hospital only streptococcal sore throats associated with a rash while ignoring those with no rash will not protect the community against the spread of such infection. Further, the complications of scarlet fever are almost wholly due to cross infection, which seldom occurs if the patient is nursed at home. Objection is sometimes raised to the inconvenience arising from nursing cases of scarlet fever at home, but the welfare of the patient must always be the first consideration The following table shows that the restriction of admission to hospital has not resulted in a greater spread of the disease:— 1936-39 1940-43 Cases in private households 886 651 Number of above removed to hospital 765 213 Percentage of above removed to hospital 86 33 Adult home contacts 2,179 1,535 Adult home contacts per case 2.5 2.4 Child home contacts 1,012 686 Child home contacts per case 1.2 1.1 Cases of scarlet fever among adult contacts 1 3 Cases of scarlet fever among child contacts 83 44 Percentage of cases of scarlet fever among child contacts 8.2 6.4 Number of households with 2 cases 61 26 Number of households with 3 cases 7 9 Number of households with 4 cases 1 2 Number of households with 5 cases 1 — Where more than one case occurred in a household, consideration of the dates of onset of the second or subsequent cases showed that, in the majority, infection had occurred prior to the diagnosis of the first case. In other words, if the case can be isolated at home there is no advantage to the community in removing it to hospital. All persons suffering from tonsilitis should be considered infectious and should remain in isolation at home until the attack has subsided. An interesting sidelight on the age distribution of our population is revealed by the above investigation, which shows that of home contacts children are only half as numerous as adults. DIPHTHERIA.—The lowest incidence of this disease recorded in the Borough occurred in 1943, which is also the only year in which no death from diphtheria has been recorded. During the eight years under review there were 18 deaths from diphtheria: five in 1939 and 1940, three in 1941, two in 1945 and one in 1942, 1944 and 1946. Of the 228 cases and 18 deaths during 1939-46, twelve and one respectively had been immunised. The scheme for free immunisation against diphtheria has continued in operation. The extent of the work done and the proportions of the child population rendered immune are shown below:— 1939 1940 1941 1942 1943 1944 1945 1946 Number immunised: 0 — 4 years 377 433 978 1,158 1,263 719 1,063 1,369 5 — 14 years 617 599 1,666 1,583 1,393 332 320 385 Percentage of population immune at 31st December : 0 — 4 years 9.0 10.2 18.0 25.2 38.0 37.3 44.0 48.9 5 — 14 years 24.0 25.7 34.0 40.8 57.2 65.1 74.0 73.9 0 — 14 years 25.2 27.4 36.5 44.0 54.5 57.3 60.1 65.6 The proportion of the child population immunised is too small if the disease is to be kept under control. Since the start of the scheme in 1930 careful records have been kept, and thus the progress of our immunisation scheme can be studied in relation to diphtheria notifications and deaths. In recent years special efforts have been made to secure the immunisation of young children, but to date the proportion immunised before reaching school age falls far short of what is desirable. " There is still room, therefore, for further effort to reduce the incidence of diphtheria, to mitigate its severity, and perhaps even to remove it from the lists of causes of death." ERYSIPELAS.—This disease, a streptococcal infection, has been less prevalent in recent years; average number of cases per annum was 51 in 1930-34 as compared with 18 in 1942-46. The three fatal cases during 1939-46 were over 65 years of age. PNEUMONIA.—The notifications of pneumonia in recent years have been small; annual average of 181 in 1930-34 as compared with 62 in 1942-46. There is reason to believe that this is due more to failure on the part of medical practitioners to notify all cases rather than an actual reduction in incidence. The average death rate per 1,000 population from pneumonia was 0.6 in 1930-34 and CEREBRO-SPINAL FEVER.—An outbreak of cerebro-spinal fever occurred in 1940-41 and the disease (13 cases in 1946) has not yet returned to its pre-war level. By the use of sulphonamide drugs the mortality from this disease has been greatly reduced. 15 EPIDEMIC ENCEPHALITIS.—Odd cases of this disease continue to be notified, but at no time during 1939-46 has there been any signs of increasing prevalence. POLIOMYELITIS.—The occurrence of three cases in 1944, followed by seven in 1945, was viewed; with some concern, but only one case occurred jn 1946. Most patients are admitted to West Middlesex County or South Middlesex Fever Hospitals, and there are adequate arrangements at both hospitals for orthopaedic after-care. TYPHOID AND PARATYPHOID FEVERS.—Sporadic cases of these fevers continue to be notified, and efforts to trace the source of infection in individual cases seldom produce satisfactory results. In 1941 there was a small outbreak of paratyphoid fever (30 cases, no deaths). Much time and toil were expended on trying to trace the source of infection, and though there were strong reasons for suspecting artificial cream as the vehicle of infection the source was not found. It is certain that a carrier of paratyphoid bacilli, engaged in the handling of food, was not exercising due care in the cleansing of hands after using the water closet. The importance of the provision of adequate washing facilities for staff and the insistence on the use of such facilities by the staff are not realised in all premises where food is handled. DYSENTERY.—If the improved bacteriological technique now available for the detection of dysentery bacilli was used to a greater extent it is certain that more cases of dysentery would be notified. Dysentery is usually a mild disease, but as it may be fatal in infants a constant watch has to be maintained for its appearance in nurseries. In 1944 and 1945 outbreaks occurred in day nurseries, but were eradicated in due course without serious cases or fatalities. TUBERCULOSIS.—Deaths from tuberculosis reached a peak in 1941, but the following table shows that the downward trend has been resumed as far as respiratory tuberculosis is concerned:— Tuberculosis death rate per 100,000 population. Pulmonary N on-pulmonary Total 1930-34 (average) 67.5 11.5 78.9 1935-39 (average) 52.3 8.2 60.4 1940-44 (average) 55.8 7.4 63.2 1945 45.2 9.5 54.7 1946 44.1 9.6 53.7 The position in regard to notfications is not so satisfactory and the peak (200) in 1942 has been succeeded after a three years fall by a rise to 217 in 1946. While this rise may be associated with the visit to the Borough of the mass radiography unit, a reduction in notifications and in deaths from non-pulmonary tuberculosis would be a welcome improvement. OPHTHALMIA NEONATORUM.—This infection of the eyes of young babies is becoming less prevalent, and with modern forms of treatment permanent damage to vision is now unusual. Cases occurring in domiciliary midwifery practice receive special attention with a view to securing early and adequate treatment. PUERPERAL PYREXIA.—This condition is defined as " any febrile condition occurring in a woman within twenty-one days after childbirth or miscarriage in which a temperature of 100.4°F. or more has been sustained during a period of twenty-four hours or has recurred during that period." Such a febrile condition, no matter what is the cause, is notifiable, and thus if investigation suggests that the condition is likely to be puerperal fever, appropriate action can be taken. Apart from an occasional case in domiciliary or nursing home practice most of our notifications come from West Middlesex County Hospital. During the last eight years seven women have died from puerperal or post-abortion sepsis. MEASLES.—This disease was made notifiable in 1940 and has shown, apart from a break in 1944, the usual bi-annual peaks. Though there is no evidence of a reduced incidence the mortality has fallen considerably as shown below :— Death Rate from Measles per 100,000 population 1901-05 (average) 18.9 1906-10 (average) 31.4 1911-15 (average) 31.0 1916-20 (average) 16.6 1921-25 (average) 10.4 1926-30 (average) 6.8 1931-35 (average) 5.9 1936-40 (average) 1.0 1941-45 (average) 0.8 1946 Nil Adequate medical care and nursing are still essential if the large amount of ill-health in children following measles is to be prevented or reduced. 16 WHOOPING COUGH.—This condition was made notifiable in 1940. As shown below the mortality has shown a marked and steady fall: — Death Rale from Whooping Cough per 100,000 population 1901-05 (average) 31.3 1906-10 (average) 25.7 1911-15 (average) 17.7 1916-20 (average) 11.9 1921-25 (average) 8.4 1926-30 (average) 5.1 1931-35 (average) 3.6 1936-40 (average) 2.0 1941-45 (average) 2.1 1946 Nil This fall in mortality is no excuse for apathy as this distressing disease causes much ill-health in children, and every care should be taken in nursing and to avoid spread of infection. Despite much work on the subject no reliable vaccine is available for whooping cough prophylaxis. MALARIA.—As mosquitoes capable of transmitting malaria are normally present in this country, the possibility of spread on the return of members of the Forces from overseas has to be kept in mind. The cases notified in recent years were recurrences in men who had been infected abroad, and no cases, contracted in this country, were notified. INFLUENZA.—Though some progress has been made in the laboratory diagnosis of some of the upper respiratory diseases which cause so much illness each winter it is difficult to differentiate at the bedside, and the more severe and fatal cases are generally diagnosed as influenza. Locally, during the last eight years there has been no severs outbreak, though towards the end of 1945 the general rise in the deaths from influenza caused some anxiety. The deaths locally from influenza have varied from three (1942, 1945) to sixteen (1940, 1943, 1946). MUMPS, CHICKEN POX, GERMAN MEASLES.—These diseases are not notifiable, but cases are brought to the attention of the Department through schools, health visitors, etc. No unusual prevalence has been recorded during the last eight years and no deaths occurred from these diseases. The incidence of these diseases varies considerably from year to year, e.g. : mumps, 96 in 1940 and 1,038 in 1942; chicken pox, 180 in 1945 and 674 in 1942; german measles, 11 in 1946 and 1,037 in 1940. FOOD POISONING.—No large outbreak of food poisoning has occurred during 1939-46. Several small outbreaks in households, factories, etc., have been investigated, and though various foods have been implicated, the offending organism in each case has been a toxin producing staphylococcus. This germ is a frequent cause of septic sores, colds, etc., and may be found in the throat, nose or skin of apparently healthy persons. The importance of strict personal hygiene on the part of all persons responsible for the handling and cooking of food cannot be too strongly emphasised, as therein lies the chief method of prevention of these outbreaks with their associated anxiety, distress, and sometimes death. FEVER HOSPITAL.—The Borough is served by the South Middlesex Infectious Diseases Hospital which is provided by the Borough in conjunction with the Boroughs of Richmond and Twickenham. During the war years part of the hospital was used by the Emergency Medical Service as a general hospital for the admission of medical and surgical cases. The number of patients from the Borough admitted as cases of infectious disease was as follows:— 1939 410 1940 453 1941 370 1942 248 1943 348 1944 223 1945 261 1946 208 DISINFECTION.—The disinfection of bedding, etc., is done at South Middlesex Infectious Diseases Hospital by arrangement with the Hospital Joint Board. The disinfection of rooms is carried out by the disinfectors on the Health Department staff. In October, 1946, the Council, after considering a report on the subject, decided to stop terminal disinfection of rooms and bedding " except in cases of smallpox or where the Medical Officer of Health considers such disinfection to be advisable." The number of rooms disinfected during 1939-46 was as follows:— 1939 296 1940 286 1941 192 1942 255 1943 305 1944 206 1945 211 1946 143 HESTON AIRPORT.—Until 1940, when the airport passed to the control of the Royal Air Force, the Council were responsible for the operation of the Public Health (Aircraft) Regulations, 1938, and medical officers were appointed Medical Inspectors of Aliens. The following work was done during 1939:— Visits to airport by medical officers 160 Aircraft inspected 144 Passengers inspected 1,757 Passengers examined 655 Passengers placed under surveillance 405 17 SANITARY CIRCUMSTANCES WATER SUPPLY.—The water supply of the Borough is derived almost wholly from the Metropolitan Water Board. A small portion of the Cranford area is supplied by the South-West Suburban Water Company. There are 51 shallow wells in use in the Borough, and at 18 of the premises an alternative supply from the mains is available. In 1946, water samples from six wells were found to be unsatisfactory and action was started with a view to providing a supply from the mains. The following work in connection with water supplies has been carried out:— 1939 1940 1941 1942 1943 1944 1945 1946 Supplies provided or reinstated 7 14 15 76 30 29 18 22 Cisterns, cleansed, repaired, etc. 12 7 9 50 26 29 27 34 Draw-off taps connected direct to main 25 15 18 10 7 12 — 9 Service pipes or taps repaired 17 36 36 257 45 48 46 46 Cases where mains supply substituted for well supply 7 — — — 1 1 — 3 Samples taken from wells for analysis 3 — — — 1 — — 6 Wells abolished 30 — — — 1 — — — DRAINAGE AND SEWERAGE.—The drainage and sewerage of almost the whole of the Borough is arranged on the separate system and forms part of the West Middlesex Sewage Scheme. A few houses on the outskirts of the Borough drain to cesspools The following work has been carried out:— 1939 1940 1941 1942 1943 1944 1945 1946 Drains exposed for examination 89 10 64 95 100 32 66 29 Drains unstopped, repaired, etc. 167 136 307 204 256 221 323 358 Waste pipes repaired, trapped, etc. 44 24 33 43 29 48 30 84 Soil pipes repaired, etc. 13 1 6 3 1 2 4 11 Ventilating shafts repaired, etc. 15 4 6 7 5 4 5 5 Fresh air inlets repaired, etc. 47 11 10 15 — 6 3 6 Rain water pipes disconnected from drains 2 — — 1 1 5 — 2 Gully traps inserted or repaired 116 19 28 37 33 16 28 78 Disconnecting traps inserted or repaired 10 6 6 4 2 3 4 12 Disconnecting and inspection chambers provided 25 1 4 1 11 — 4 39 Disconnecting and inspection chambers repaired, etc. 47 16 26 23 38 13 15 46 Drains constructed or repaired 54 16 6 7 13 1 4 15 Total length (ft.) of drain pipes laid (a) 4in. 1,722 279 133 427 491 56 195 1,146 (b) 6in. 115 21 18 4 — — — 128 Drain tests applied 251 56 52 36 113 26 56 255 Other works executed 8 2 9 4 3 1 3 4 Cesspools emptied or repaired 2 1 — 2 — — — 1 Cesspools abolished — — — 1 — — — — RIVERS AND STREAMS.—The supervision of the rivers and streams in the Borough is carried out by Middlesex County Council. No complaint of pollution has been made to the Health Department during 1939-46. CLOSET ACCOMMODATION.—The closet accommodation of the Borough consists almost wholly of water closets connected to the sewers. A few water closets drain to cesspools. and several houses on the outskirts of the Borough have pail or chemical closets. The following works have been carried out:— 1939 1940 1941 1942 1943 1944 1945 1946 "Water closets constructed or rebuilt 14 6 7 40 5 1 5 2 Water closets where walls cleansed 22 12 6 13 18 30 28 21 Water closets fitted with new flushing apparatus 15 7 9 12 7 14 11 31 New pans or pedestals provided 61 29 26 30 31 29 45 60 Water closets repaired or improved 220 165 145 189 144 99 132 172 Water closet blockages unstopped 63 25 10 25 37 14 17 27 Other closets provided or repaired 1 6 2 — 3 1 — 3 PUBLIC CLEANSING.—The cleansing of streets and the collection and disposal of refuse are carried out under the control of the Borough Engineer. Refuse is disposed of by controlled tipping and the collection of house refuse is carried out weekly. Through action by the Health Department the following: numbers of new dustbins have been provided— 1939 83 1940 25 1941 44 1942 121 1943 100 1944 52 1945 86 1946 233 18 The following details of the salvage of waste materials have been provided by the Borough Engineer:— 1940 1941 1942 1943 1944 1945 1946 Paper {tons) 665 832 1,212 986 770 619 709 Scrap metal (tons) 549 245 416 575 55 24 28 Textiles (tons) 57 65 65 67 69 67 65 Bones (tons) 16 22 34 24 20 12 8 Bottles, jars (tons) *9 86 256 338 233 167 251 Cullet (tons) 1 — 19 61 42 6 17 Rubber (tons) †1 — 33 36 29 — 1 Kitchen waste (tons) — 225 855 940 1,037 1,083 1,173 Miscellaneous (old boots, gramophone records, etc.) (tons) — 1 13 4 14 — 60 Value £6,130 £5,417 £11,178 £11,516 £9,721 £8,231 £11,405 * Plus 5,813 doz. bottles and jars † Plus 5 doz. old tyres. ‡ Plus 105 gross razor blades. SANITARY INSPECTION OF THE AREA.—Apart from the work recorded in other paragraphs of this Report, the Sanitary Inspectors continued their general duty of abating nuisances and dealing with contraventions of the Public Health Act, etc. This work has been and continues to be seriously handicapped by shortage of labour and materials. Some particulars of the work done are given below— 1939 1940 1941 1942 1943 1944 1945 1946 Complaints received 764 722 880 1,155 1,755 1,050 1,228 1,780 Number of premises at which nuisances, etc., were located 597 477 385 572 799 487 774 1,464 Number of premises where defects were remedied:— (a) by owners or occupiers 543 367 364 499 569 328 723 1,308 (b) by Council in default — — — 2 — 9 4 6 (c) public sewers repaired by Council 17 40 39 7 26 4 14 26 Informal notices issued 622 487 367 471 710 463 671 1,101 Written reminders issued 1,027 600 298 557 669 314 330 705 Statutory notices served 96 46 27 45 108 51 146 218 Total number of inspections and re-inspections 24,206 15,711 10,903 15,016 24,599 17,364 16,167 23,804 Inspections of piggeries 53 24 1 9 42 32 37 79 Inspections of stables 215 71 — 29 197 53 64 127 Inspections of urinals 24 2 10 10 11 12 20 38 Inspections (Rag Flock Act) 17 3 — — — — — 1 Sinks repaired or renewed 64 31 36 43 32 47 29 52 Roofs repaired 274 123 145 238 174 210 187 357 Gutters repaired or renewed 216 99 92 108 95 155 134 268 Number of premises provided with damp-proof course 78 33 27 9 5 8 — 2 Yards paved or drained 86 31 36 22 12 35 13 21 Floors, walls, etc., repaired or renewed 1,003 464 424 518 627 545 617 998 Windows repaired or renewed 954 359 385 463 289 296 234 454 Doors repaired or renewed 193 69 68 201 82 97 50 103 Grates provided or repaired 202 107 113 196 95 207 116 181 Wash coppers provided or repaired 49 25 24 23 10 14 2 12 Larders provided or repaired 86 46 42 12 11 27 5 18 Offensive accumulations removed 44 26 32 18 42 15 30 51 Other nuisances abated 187 133 35 144 80 46 81 187 Visits re infectious disease, etc. 561 472 415 1,072 1,289 658 659 851 SMOKE ABATEMENT.—Nuisance due to the emission of smoke and grit from factory chimneys. The encouragement of smoke emission as a defence measure and the difficulties arising from shortage of labour, materials and fuel all tended to stultify the efforts of the Sanitary Inspectors. Where the type of fuel supplied was considered to be the main cause of the nuisance the assistance of the technical officers of the Ministry of Fuel and Power was sought. In many factories the boiler attendant is given too many other duties, with the result that the boiler firing does not get the regular attention necessary to reduce the emission of smoke to the minimum. Such regular attention is specially necessary where the plant is working' at high pressure and the fuel is not of the most suitable type. The following smoke observations have been made:— 1939 255 1943 23 1940 158 1944 7 1941 25 1945 11 1942 7 1946 29 In addition to these observations, many visits have been made to premises which have been the subject •of smoke nuisance complaint. TENTS, VANS AND SHEDS.—Many visits have been made in regard to the occupation of 'and by and the sanitary condition of tents, caravans, etc. In one area of the Borough frequent 19 difficulty has arisen by the trespass of caravans on unfenced land. The inspections made during 1939-46 were as follows:— 1939 103 1943 86 1940 54 1944 75 1941 4 1945 186 1942 66 1946 504 COMMON LODGING HOUSES.—The two common lodging houses in the Borough ceased to operate in 1942, and 37 visits of inspection were made during 1939-42. SHOPS AND OFFICES.—Visits of inspection to shops and offices with special reference to sanitary accommodation and washing facilities were made as under:— 1939 38 1943 1 1940 1 1944 12 1941 — 1945 34 1942 2 1946 81 CANAL BOATS.—The Sanitary Inspectors continue their duties as canal boat inspectors and have carried out the following inspections— 1939 63 1943 31 1940 32 1944 7 1941 4 1945 13 1942 21 1946 27 FACTORIES, WORKPLACES, ETC.—The duties placed upon the Council in respect of factories, workplaces, etc., by the Public Health and Factories Acts are carried out by the Sanitary Inspectors. A summary of the work done is given below:— 1939 1940 1941 1942 1943 1944 1945 1946 Inspections of— (a) factories 582 280 151 289 840 290 450 741 (b) other premises 2 4 3 17 51 34 20 130 (c) workplaces 146 83 12 36 296 100 146 113 (d) outworkers' premises 106 43 30 — 155 50 140 65 Defects remedied 56 69 15 20 42 12 10 44 MOSQUITOES.—In 1939, complaints were received from residents of whitton and the Twickenham Road area of Isleworth of the presence of biting mosquitoes. Specimens caught were identified as culex pipiens. As this mosquito does not bite man further specimens were sent to the British Mosquito Control Institute, where the mosquito, culex molestus, was identified. This mosquito, which closely resembles culex pipiens, was first described in Paris in 1930. It was identified in this country at Hayling Island in 1934, at Westminster in 1935, at Battersea, Bermondsey, Chelsea, Deptford and Greenwich in 1938, at Isleworth in 1939, and in stagnant water in the London Underground Railways in 1940. In 1943 it was found in West Ham, Richmond and Twickenham. A carefully 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 is to watch the behaviour of the adult mosquitoes reared from the larvae. Adults developed from molestus larvae will mate and lay eggs without having had a meal of blood, whereas in the absence of a blood meal adults from pipiens larvae remain sterile. Thus it may take a week or so to ascertain if culex molestus is breeding in any larva-infested water. Experience in the underground railways confirmed the previous indications that the favourite breeding place of culex molestus is in dark and warm underground situations. Since 1939, larvae from the following sources in the Borough have been identified as culex molestus: warm dark recesses under boilers, underground passages in a sewage works, and ponds, tanks, water butts, 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. Sanitary Inspectors have spent much time searching for possible breeding places, and 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, but as these are probably second breeding places the search for the main breeding place continues. This fierce persistent and vicious human biting mosquito is a serious nuisance, and as it has been less prevalent in 1945 and 1946 than in previous years, it is hoped that some progress is being made towards its eradication. The co-operation of all industrial concerns, gravel pit owners, gardeners, allotment holders, etc., by treating all stagnant water with paraffin, D.D.T. or other larvicide would do much to discourage mosquito breeding. DISINFESTATION.—By arrangement, the Housing Department deals with infestation by bugs, fleas, etc., in Council houses. Similar infestations in other houses are dealt with by the Health Department, and D.D.T. and other new insecticides are being used. The following work has been carried out:— Disinfested Disinfested Houses Rooms Houses Rooms 1939 23 63 1943 42 87 1940 10 22 1944 25 89 1941 16 59 1945 22 63 1942 50 98 1946 25 55 20 RATS AND MICE DESTRUCTION.— Up to February, 1944, when the powers and duties under the Rats and Mice (Destruction) Act, 1919, were transferred to the Borough Council, Middlesex County Council was the responsible Authority. To deal with this work a Rodent Officer and two operatives were appointed, and a summary of the work is given below:— 1944 1945 1946 Complaints received 227 208 240 Block inspections 6 38 59 Individual inspections 695 1,321 1,492 Individual re-inspections 146 243 322 Other visits 191 110 248 Premises treated (a) by occupiers 88 82 136 (b) by Local Authority 317 446 660 The responsibility for keeping premises free from rats and mice rests with the occupiers. If they are unable or do not care to undertake the necessary work themselves the services of the Council's operatives are available on payment on a time and material basis. Not only must the rats on the premises be dealt with, but also the conditions encouraging their presence if recurrence of infestation is to be avoided. By whatever means rats and mice gain access to premises their continued presence there is generally due to conditions on the premises which provide food and/or harbourage, and it is proper that the occupiers should be required to do something about it. Test baiting and, where necessary, treatment is carried out to sewers, watercourses, tips, etc., but unless occupiers take active measures to discourage rats little progress will be made towards eradication. HOUSING During the war years action in regard to houses incapable of being rendered in all respects fit for human habitation at a reasonable cost was largely suspended except for keeping them wind and weatherproof and to-day the shortage of houses is such that houses suitable for demolition have to be retained. The housing shortage is causing physical, mental and moral strain and until this can be relieved by the provision of new houses action in regard to slum clearance must be postponed. Attention is being given to making good the deterioration in houses arising from the restrictions and difficulties of maintenance during the war years, but progress is slow because labour and materials are still scarce. A summary of the work done in connection with housing is given below:— New houses erected— 1939 1940 194l 1942 1943 1944 1945 1946 (a) by Local Authority — — — — — — — 196 (b) by private enterprise 278 — — — — — — 33 Houses inspected 478 260 256 308 380 249 352 718 Defective houses rendered fit in consequence of informal action 247 184 246 273 266 162 156 152 Defective houses rendered fit in consequence of statutory action 27 35 29 33 65 68 45 150 Houses in respect of which Demolition Orders were made 35 14 — 1 — — — — Houses demolished in pursuance of Demolition Orders 43 12 4 — 9 5 2 8 Houses rendered fit in consequence of undertaking given by owner 12 1 1 — — — — — Separate tenements or underground rooms in respect of which Closing Orders were made 2 — — — — — — — Houses demolished voluntarily 14 4 1 — — — — — Houses in respect of which undertakings not to re-let accepted from owner 21 19 — 1 9 — — — Houses known to be overcrowded (Housing Act standard) at end of year 69 69 72 77 79 78 80 84 New cases of overcrowding reported 5 — 3 10 6 1 4 9 Cases of overcrowding relieved during year 41 — — 5 4 2 2 5 At the end of 1946 there were occupied 55 houses in respect of which Demolition Orders have been made or undertakings not to re-let accepted from the owners. The above record cannot be accepted as a true picture of overcrowding as such could be obtained only by a census or survey of all houses. The Housing Act standard is a house and not a bedroom standard and therefore presents a picture very different from the usual concept of overcrowding. The average number of new houses erected annually in the Borough during the years 1931-38 was 1,330 and though that rate of development would probably have not been maintained the loss due to the war must be considerable and will take some time to make good. 21 INSPECTION AND SUPERVISION OF FOOD MILK.—The following inspections have been made of cowsheds, dairies and retail purveyors' premises:— 1939 576 1943 241 1940 187 1944 95 1941 48 1945 136 1942 172 1946 146 Under the Milk (Special Designations) Orders, licences were issued as follows:— 1939 1940 1941 1942 1943 1944 1945 1946 Sale of "accredited" milk 2 2 1 1 1 1 — — Sale of "tuberculin-tested" milk 18 25 24 25 23 18 20 18 Sale of "pasteurised" milk 36 40 33 33 29 23 26 24 Pasteurising plant 1 1 1 1 1 1 1 1 Samples of milk have been taken at intervals for bacteriological examination and to test the efficiency of the pasteurising. Complaints of milk being supplied in dirty bottles was less frequent in 1946 as compared with the three previous years. While the importance of clean methods of milk production, handling and retailing is continuously brought to the notice of those engaged in the trade, too many members of the public fail to apply the most elementary rules of hygiene in regard to milk bottles. Such bottles should be rinsed as soon as they are emptied and should not be used for other purposes. In 1943 two convictions were obtained against retailers for selling milk in bottles containing extraneous matter. ICE CREAM.—A register is kept of all premises used for the manufacture or sale of ice cream and the following inspections of premises, vehicles, barrows, etc., have been carried out:— 1939 534 1943 5 1940 93 1944 1 1941 12 1945 153 1942 30 1946 301 BAKEHOUSES.—Regular inspections of bakehouses have been made as under:— 1939 198 1943 196 1940 62 1944 104 1941 2 1945 112 1942 52 1946 163 SLAUGHTER-HOUSES.—There is no public abattoir in the Borough and the eight private slaughter-houses were closed soon after the outbreak of war when the Government introduced centralised slaughtering as a war emergency measure. In 1939 the Sanitary Inspectors paid 382 visits to slaughterhouses to inspect meat during and after slaughter. There is one licensed knacker's yard in the Borough and the humane killer is used on all animals slaughtered there. INSPECTION OF MEAT AND OTHER FOODS.—Premises where food is prepared or sold are submitted to frequent inspection in regard to the premises and the food. The numbers of such inspections are shown below:— 1939 1940 1941 1942 1943 1944 1945 1946 Meat 1,009 427 175 293 824 246 162 192 Fish 194 105 52 101 225 83 48 93 Provisions 80 199 126 414 1,161 909 508 340 Greengrocery and fruit 158 148 73 149 665 285 101 51 Hawkers' foodstuffs 115 27 2 4 160 120 49 136 Other foods 43 304 161 253 114 47 35 32 Food preparation premises 498 194 30 110 912 535 587 852 The following quantities of unsound food were seized by or surrendered to the Sanitary Inspectors who arranged for the food to be destroyed or used for animal feeding. Close contact was maintained with the Salvage Officers of the Ministry of Food on this matter:— 1939 1940 1941 1942 1943 1944 1945 1946 Unsound food (lbs) 3,764 4,613 7,127 7,462 3,603 2,604 2,313 9,957 Unsound tinned food (tins) — — 1,164 5,855 5,757 4,387 7,131 5,123 The above unsound food was obtained from retail premises in the Borough. On request, inspections were made of bulk food stores held by the Ministry of Food, War Office, N.A.A.F.I., etc., and as a result of these inspections quantities of food were condemned as unfit for human consumption. During these years seven firms were prosecuted for selling or exposing for sale food which was unfit for human consumption. 22 CIVIL DEFENCE The responsible Authority for Civil Defence in the Borough was Middlesex County Council. The Borough Council and its officers undertook the preparation, administration and operation of civil defence measures subject to the general approval of the County Council. The following notes deal briefly with the aspects of civil defence work for which the Medical Officer of Health had responsibility, wholly or in part, for the organisation and control. FIRST AID POSTS.—First aid posts were of two types, fixed and mobile. Both were in the charge of a doctor (part time) and a trained nurse (whole time). The staff consisted of persons, whole time and part time, who had been trained in first aid and gas cleansing. The equipment of a first aid post was standard, but that of the mobile post was stored in a motor van ready for conveyance to the site of an incident. Fixed posts were established at Hounslow Health Centre, Isleworth Health Centre, Heston Village Hall and South Middlesex Infectious Diseases Hospital, and a mobile post was stationed at both Hounslow and Isleworth Health Centres. Owing to shortage of staff the post at South Middlesex Infectious Diseases Hospital was closed in November, 1939, and the premises restored to the hospital in January, 1940. AMBULANCE SERVICE.—'The original allocation for the Borough was 48 ambulances and 32 cars for sitting cases. Ambulance stations were sited as follows:— Ambulances Cars Heston Senior School 8 4 Marlborough Senior School 10 7 Heath Infants' School 10 7 Redlees Bowling Pavilion 10 7 Church Hall, Treaty Road 10 7 The Treaty Road depot was moved later to Bell Road and finally to Bulstrode Road. The Heston depot was transferred later from the Senior to the Junior School. Finally owing to a reduction in the strength of the ambulance service the depot at Redlees was vacated. When the National Fire Service was created the civil ambulance service, which had been manned by the local Fire Service, was transferred to the civil ambulance service. S TRETCHER PARTIES.—A stretcher party consisted of 5 men, one of whom was the driver of the car which conveyed the party and its equipment to incidents. All were trained in first aid. The number of parties allocated to the Borough was 32 and stretcher party depots were established as under:— Heston Senior School 7 parties Marlborough Senior School 6 parties Heath Infants' School 6 parties Redlees Bowling Pavilion 7 parties Hut, Treaty Road 6 parties Later the Heston depot was transferred to the Junior School and the Treaty Road depot to Bulstrode Road. In 1942 the stretcher parties were incorporated into the Rescue Service and came under the control of the Borough Engineer, though the Medical Officer of Health retained responsibility for training in first aid. VEHICLES.—The original scheme was to convert requisitioned commercial vehicles to ambulances by fitting stretcher carriers and to use cars provided by volunteers for sitting cases. This scheme was found to be unworkable and in November, 1939, instructions were given to purchase 20 cars for conversion to ambulances, 14 cars for sitting cases, 16 cars for stretcher parties and 2 vans for mobile first aid posts and the price limit was £70 for a van and £30 for a car. Though every care was taken in the purchase of these vehicles few were in really good mechanical condition. This, with the absence of any protection against weather and frequent changes of driver, resulted in frequent breakdown. A maintenance -department with one mechanic, later increased to two, was established in Bell Road and thus a sufficient number of vehicles was always available for immediate use despite the steadily increasing difficulty in obtaining spare parts. Later a central repair depot was established by the County Council to which vehicles requiring major repairs or overhaul were sent. CONTROL AND REPOR T CENTRE.—A responsible member of the Health Department staff was always available for duty at the Control Centre where, in conjunction with the staff of the Controller, Air Raid Precautions Officer and the Borough Engineer, the necessary action was taken when enemy activity occurred. During normal working hours staff was always available at the Health Department to undertake this work but at other times a rota of staff was on duty or immediate call during daylight -and on duty at the Control Centre during darkness. DECONTAMINATION OF CIVILIANS.—Provision for the decontamination of personnel in the event of blister gas being used was provided at each depot. For the general population decontamination facilities were provided at the first aid posts and at Hounslow and Isleworth Public Baths. The facilities at the baths were restricted to uninjured persons. With the co-operation of the Women's Voluntary Service, householders, willing to place their bathrooms at the disposal of gas contaminated persons, were listed in as many streets as possible. Emergency stocks of clothing were held at decontamination centres for issue to persons after treatment. DECONTAMINATION OF CIVILIAN CLOTHING.—Plant was installed at Hounslow Public Baths and Hounslow Model Laundries for the decontamination of civilian clothing. A scheme was prepared for the collection, labelling, treatment and return of gas contaminated clothing from decontamination centres and private houses. 23 DECONTAMINATION OF FOOD.—In conjunction with the Boroughs of Twickenham, and Brentford and Chiswick and the Urban District of Feltham, a joint scheme for the decontamination of food was prepared. All gas contaminated food was to be taken to the Rugby Ground, Twickenham, where the necessary equipment was installed to enable the food to be decontaminated, salvaged or destroyed according to the degree of contamination. Brentford Docks presented a special problem and after consultation with the Ministry of Food responsibility for dealing with gas contaminated food there was accepted by the Boroughs of Heston and Isleworth and Brentford and Chiswick. In consultation with the companies concerned arrangements were made to deal with food contaminated by gas during transit on the canals and railways in the Borough. EMERGENCY MORTUARIES.—The small bath at Hounslow Public Baths and the disused Public Baths in South Street, Isleworth, were adapted and equipped for use as emergency mortuaries capable of dealing with gas contaminated bodies. The Isleworth emergency mortuary was not used but 138 bodies were dealt with at the Hounslow mortuary. In addition the necessary enquiries were made and records completed in regard to 99 deaths from war injuries in local hospitals. REST CENTRES.—Arrangements were made to provide medical attention as required and for a nurse to visit the rest centres daily while they were in use. PUBLIC SHELTERS.—A scheme was put in operation whereby the services of a doctor were available in emergency and arrangements were made to deal with cases of infectious disease and verminous infestation. WATER SUPPLIES.—In conjunction with the Metropolitan Water Board a survey of local wells was carried out and a scheme prepared for emergency water supplies, including chlorination where necessary. EVACUATION.—When in 1944 the evacuation scheme was extended to include the Borough the evacuation of expectant mothers for confinement was dealt with by the Health Department. The general evacuation was handled by the Education Department but school children were inspected prior to evacuation and particulars of any defects or other conditions in the children transmitted to the reception Authority. BILLETING AND RE-HOUSING.—This work was undertaken by the Sanitary Inspectors and to 31st December, 1945, the following work had been carried out:— Houses requisitioned and adapted for occupation 243 Families re-housed 1,913 Persons billeted 3,859 Persons supplied with bedding only on loan 243 Persons supplied with furniture, bedding, etc., on loan 150 FOOD DAMAGED BY ENEMY ACTION—When food premises were damaged by high explosive or incendiary bombs the Sanitary Inspectors undertook the examination of the food stocks. As far as possible food was saved for processing or feeding animals rather than being destroyed. Some indication of the amount of work involved in this inspection can be deduced from the following summary of food destroyed by reasons of gross contamination by dirt or glass Miscellaneous articles such as eggs, tinned food, cakes, etc. 10,006 Lbs. of meat, sugar, tea, sweets, butter, fat, fish, etc. 29,024 Gallons of milk and ice cream 8 Bushels of fruit and vegetables 12 DEPOTS AND EQUIPMENT.—Certain works of adaptation were necessary at all depots and posts either for operational needs or the safety and comfort of members of the service. Some time elapsed before this work was completed and during the first winter there was little in the nature of comfort and amenities at some of the depots. Gradually conditions improved till the provision of reasonable sleeping, washing, cooking and recreational facilities was general. A great volume of equipment had to be provided to meet the needs of the various services. Apart from the difficulty of finding suitable storage accommodation there had to be devised methods of recording supplies, distribution and consumption. Detailed personnel records had to be kept also in regard to wages, sickness, leave, equipment, training, etc. Records had to be kept of vehicle maintenance, petrol consumption, etc. TRAINING.—The training of the men and women for the many and varied tasks which they might encounter required much time, thought and effort. In due course, theory, as far as high explosive and incendiary bombs were concerned, was supplemented by practical experience and gained much thereby Training in the treatment of blister gas casualties and in the decontamination of persons, clothing, food, etc., was far from easy and the prospect of having to deal with such was a constant source of anxiety Imagination may have over-painted the picture but fortunately training was not put to the test. PERSONNEL.—The manning of the services throughout the 24 hours by part-time volunteers, who continued at their usual employment, was impossible and recruitment on a whole-time basis had to be adopted. Such recruitment was restricted to persons not in reserved occupations and later the restriction was extended to those liable for national service. The "war establishment" of the various sections was varied from time to time but seldom were the numbers approved bv the Regional Commissioners availableUntil members of the civil defence service were "frozen" changes in personnel were frequent. 24 In the absence of any contractual obligation, grading of rank and code of discipline, it was difficult to weld into a team the whole-time or part-time, trained and untrained members of this service, and it is not surprising that during the early period of freedom from air raids, and general inaction, discontent and friction arose. Too many wanted the iron efficiency of a dictatorship as far as others were concerned while retaining the right to decide everything for themselves and showed little consideration for those who, at the sacrifice of leisure and amenities, were struggling to assemble and operate a new machine, of which the plans were incomplete, the parts delivered at irregular intervals and the design subject to frequent change. Fortunately, the majority showed a real desire to make themselves efficient, realised the need for patience and discipline, and conducted themselves with credit in conditions of monotony, discomfort and uncertainty. Throughout the war these "willing horses" carried the burden, made sure that the services would function, set a glorious example in actual raiding, gradually welded the services into an efficient and effective machine, and engendered a spirit of comradeship and tolerance. This change was helped by the establishment of graded rank, the improvement in general organisation and operational control, social activities, and by the courage, good humour and appreciation shown by the victims of enemy action. In the absence of enemy activity many gave willing assistance in the running of the general health services, helped voluntary schemes of all kinds, and by their own efforts raised funds for worthy objects. ORGANISATION.—In the beginning the whole burden of organisation, control and operation of the above services fell on the staff of the Health Department, who cheerfully shouldered this extra responsibility. With the appointment of depot superintendents and the introduction into the service of graded rank some delegation of responsibility in regard to the daily routine and operational duties was possible. Gradually the burden of administration was eased by the appointment of a staff officer, a billeting officer and clerk, and two clerks to deal with wages, stores, equipment, sickness, leave, etc., and thus, despite the call-up to the Forces of experienced staff, the Health Department was able to continue its normal duties and carry its share of civil defence. GENERAL.—The response of the British Red Cross Society, the St. John Ambulance Brigade and the Women's Voluntary Service to any requests or suggestions was immediate and gratifying. The Police and National Fire Service co-operated at all times, and public utility companies willingly gave assistance and information. The support and guidance of the Town Clerk and the spontaneous co-operation and help of my colleagues in other Departments did much to make the rough places smooth. Mr. Glisson and his staff at Hounslow Baths were particularly helpful when the emergency mortuary was in use. Of the civil defence casualty service two members warrant special mention: Mr. Phillips, a part-time volunteer, whose special knowledge acquired in the R.A.M.C. was willingly placed at my disposal in the organisation of the mortuary service and in the development of a system for handling and recording stores and equipment; and Mr. Thorp, Staff Officer, who completed his service by supervising the closing of all depots and posts, and checking, sorting and storing the great volume of records, stores and equipment. Of the Health Department staff who gave time, toil and talents to this work I am particularly indebted to Dr. Roberts and Messrs. Butler, Kilby, Crandon, Davies, Cobb and Allaway, who undertook special responsibilities. BOROUGH BOMBING RECORD Number of bombs dropped: — High explosive (including flying bombs and rockets) 351 Incendiary (approximate) 9,018 Oil 17 Phosphorus incendiary 6 Parachute mines 2 Unexploded 67 Number of casualties:— Killed 178 Seriously injured 380 Slightly injured 843 Damage to property:— Buildings destroyed and rendered uninhabitable 754 Buildings damaged 22,570 25 SUMMARY OF VITAL STATISTICS, 1895-1946 Estimated population (mid-year) Birth Rate per 1,000 population. Death Rate per 1,000 population. Infant Mortality Rate. Deaths under 1 yr. per 1,000 live births. Neo-natal Mortality Rate. Deaths under 1 mth. per 1,000 live births. Maternal Mortality Rate per 1,000 live and stillbirths. Stillbirth Rate per 1,000 live and stillbirths. Tuberculosis Death Rate per 1,000 population. 1895 27,895 30.9 17.2 125 1.4 1896 28,352 27.9 14.5 151 1.2 1897 28,765 25.3 13.6 132 1.6 1898 29,185 28.0 16.0 173 1.4 1899 29,607 31.4 17.8 155 2.2 1900 30,040 27.1 23.0 156 1.6 1901 30,959 28.5 15.7 160 1.6 1902 31,470 29.9 16.7 157 1.3 1903 31,531 32.8 14.2 99 1.8 1904 32,630 32.3 16.8 169 1.9 1905 33,194 31.0 13.9 137 1.2 1906 33,767 33.5 15.1 139 48 1.3 1907 34,351 33.0 14.2 88 30 1.2 1908 34,895 29.1 15.9 111 29 1.3 1909 35,672 27.3 15.9 91 28 1.6 1910 36,311 25.1 14.1 100 26 1.3 1911 43,684 23.9 13.6 162 43 1.5 1912 45,191 23.1 10.8 86 37 0.4 1913 46,749 24.0 11.7 103 34 0.9 1914 48,361 21.0 11.4 98 34 1.2 1915 41,836 19.6 12.5 102 40 1.6 1916 42,000 20.1 12.6 77 30 1.2 1917 40,000 16.6 14.9 117 47 1.8 1918 43,129 16.8 17.9 86 36 1.8 1919 42,020 16.8 11.6 99 52 1.0 1920 43,445 24.7 10.9 58 22 1.0 1921 47,290 20.0 11.3 69 40 1.0 1922 47,850 18.7 11.8 74 37 1.0 1923 48,030 17.5 9.8 55 26 0.9 1924 47,700 17.7 10.8 61 27 1.0 1925 48,620 17.4 10.3 73 41 0.7 1926 52,110 17.4 9.1 56 25 0.8 1927 55,870 16.1 10.7 68 36 1.0 1928 59,730 17.1 9.9 56 27 0.6 1929 63,070 17.1 11.5 46 18 0.8 1930 63,070 19.1 9.6 50 25 6.4 36 0.8 1931 76,230 17.6 10.0 49 24 5.0 30 0.7 1932 81,100 17.4 9.7 60 29 2.8 24 0.7 1933 84,460 16.3 9.4 43 19 4.9 34 0.9 1934 87,797 15.1 10.3 4S 21 2.9 32 0.8 1935 90,970 15.8 9.0 41 22 4.7 36 0.6 1936 95,000 15.7 9.6 4S 20 2.0 30 0.6 1937 99,420 14.9 9.5 40 20 3.3 23 0.5 1938 101,500 14.2 8.6 46 24 2.7 30 0.6 1939 101,100 15.0 8.8 50 23 3.4 26 0.7 1940 97,530 13.7 12.3 58 39 2.3 25 0.6 1941 93,990 12.9 10.3 61 32 2.4 35 0.8 1942 95,600 14.6 10.2 72 43 2.8 32 0.7 1943 95,080 16.3 10.6 47 23 0.6 26 0.5 1944 92,370 16.5 10.4 46 30 1.9 22 0.5 1945 95,100 15.5 9.7 51 33 2.0 26 0.5 1946 104,240 17.3 10.4 29 22 2.2 26 0.5 26 INFANT DEATHS ACCORDING TO AGE AND CAUSE Cause of death. Under 1 wk. 1-2 wks. 2-3 wks. 3-4 wks. Total under 4 wks. 1-3 mths. 3-6 mths. 6-9 mths. 9-12 mths. Total 1939.—Prematurity 16 3 - - 19 - - - - 19 Congenital defects 9 1 2 2 14 - 2 - - 16 Birth injury 2 - - - 2 - - 1 - 3 Gastro-enteritis - 1 2 - 3 1 2 - 1 7 Bronchitis and pneumonia - 1 - 1 2 4 1 4 1 12 Otitis media - - - - - 1 1 1 1 4 Whooping cough - - - - - 1 - - 1 2 Measles - - - - - - - - - - Tuberculosis - - - - - - - - - - Syphilis - - - - - - - 1 - 1 Other infections - - 2 - 2 - - - 1 3 Accident 1 - - - 1 - 2 - - 3 Other causes 3 - - - 3 - - 1 - 4 Total 31 6 6 3 46 7 8 8 5 74 1940.—Prematurity 25 2 - - 27 - - - - 27 Congenital defects 10 1 1 1 13 1 1 - - 15 Birth injury 5 1 - - 6 - - - - 6 Gastro-enteritis - 1 1 1 3 4 2 2 - 11 Bronchitis and pneumonia - 1 - - 1 2 - 4 2 9 Otitis media - - 1 - 1 1 - 1 - 3 Whooping cough - - - - - 1 - - - 1 Measles - - - - - - - - - - Tuberculosis - - - - - - - - - - Syphilis - - - - - - - - - - Other infections 1 - - 1 2 1 - 1 1 5 Accident - - - - - - - - - - Other causes - - - - - - - - - - Total 41 6 3 3 53 10 3 8 3 77 1941.—Prematurity 15 2 - 3 20 2 - - - 22 Congenital defects 11 - - 1 12 5 - - - 17 Birth injury 2 - - - 2 - - - - 2 Gastro-enteritis - - - 1 1 2 5 2 1 11 Bronchitis and pneumonia 1 - 1 1 3 4 3 2 3 15 Otitis media - - - - - 2 - - - 2 Whooping cough - - - - - - - - - - Measles - - - - - - - - - - Tuberculosis - - - - - - - - 1 1 Syphilis - - - - - - - - - - Other infections - - - - - - - - - - Accident - - - - - - - - - - Other causes 1 - - - 1 - 1 - 1 3 Total 30 2 1 6 39 15 9 4 6 73 1942.—Prematurity 12 2 2 3 19 1 - - - 20 Congenital defects 6 1 1 1 9 2 - - - 11 Birth injury 4 1 - - 5 - - - - 5 Gastro-enteritis - 1 3 10 14 4 5 3 2 28 Bronchitis and pneumonia - - 2 3 5 3 4 2 3 17 Otitis media - - 1 1 2 2 1 - - 5 Whooping cough - - - - - 1 1 - 1 3 Measles - - - - - - 1 - - 1 Tuberculosis - - - - - - - 2 - 2 Syphilis - - - - - - - - - - Other infections - - - 1 1 2 - - - 3 Accident - - - - - - 1 - - 1 Other causes 2 - - 3 5 1 - - 1 7 Total 24 5 9 22 60 16 13 7 7 103 27 Infant Deaths according to Age and Cause—continued Cause of death. Under 1 wk. 1-2 wks. 2-3 wks. 3-4 wks. Total under 4 wks. 1-3 mths. 3-6 mths. 6-9 mths. 9-12 mths. Total 1943.—Prematurity 14 1 — 1 16 2 — — — 18 Congenital defects 8 2 1 1 12 3 — — 1 16 Birth injury — — — — — — — — — — Gastro-enteritis — 1 — 3 4 7 5 3 3 22 Bronchitis and pneumonia 2 — — — 2 2 3 3 1 11 Otitis media — — — 1 1 — — — — 1 Whooping cough — — — — — — — — — — Measles — — — — — — — — 1 1 Tuberculosis — — — — — — — — — — Syphilis — — — — — — — — — — Other infections — — — — — 1 — — — 1 Accident 1 — — — 1 — — — 1 2 Other causes — — — — — 1 — — — 1 Total 25 4 1 6 36 16 8 6 7 73 1944.—Prematurity 18 1 — 1 20 — — — — 20 Congenital defects 12 1 — — 13 2 1 — 1 17 Birth injury 6 — — — 6 — — — — 6 Gastro-enteritis — — — — — 3 1 — — 4 Bronchitis and pneumonia 1 1 1 — 3 3 — 2 — 8 Otitis media — 1 1 — 2 3 — — 1 6 Whooping cough — — — — — 2 1 — — 3 Measles — — — — — — — — — — Tuberculosis — — — — — — — — 1 1 Syphilis — — — — — — — — — — Other infections — — 1 — 1 1 1 — — 3 Accident — — — — — 1 — 1 — 2 Other causes — — 1 — 1 — — — — 1 Total 37 4 4 1 46 15 4 3 3 71 1945.—Prematurity 11 3 2 1 17 1 — — — 18 Congenital defects 13 1 1 1 16 1 1 1 1 20 Birth injury 4 — — — 4 — — — . — 4 Gastro-enteritis — — 2 2 4 4 2 — 1 11 Bronchitis and pneumonia — 1 — — 1 2 2 1 1 7 Otitis media — — 1 1 2 — 1 1 2 6 Whooping cough — — — — — — — — — — Measles — — — — — — — — — — Tuberculosis — — — — — — — — — — Syphilis — — — — — — — — — — Other infections 1 1 1 1 4 2 1 — 2 9 Accident — — — — — 1 — — — 1 Other causes — — — — — — — — — — Total 29 6 7 6 48 11 7 3 7 76 1946.—Prematurity 18 1 — 1 20 1 — — — 21 Congenital defects 13 1 — — 14 1 1 — — 16 Birth injury 3 — — — 3 — — — — 3 Gastro-enteritis — — — — 3 — 1 — 4 Bronchitis and pneumonia — — — — — — 2 — — 2 Otitis media 1 — — — 1 — — — — 1 Whooping cough — — — — — — — — — — Measles — — — — — — — — — — Tuberculosis — — — — — — — 1 — 1 Syphilis — — — — — — — — — — Other infections — — 1 — 1 1 — — — 2 Accident 1 — — — 1 1 — 1 — 3 Other causes — — — — — — — — — — Total 36 2 1 1 40 7 3 3 — 53 28 29 TABLE OF CAUSES OF DEATH, 1939-46 (Supplied by Registrar-General). 1939 Causes of death. 1940-46 Causes of death. Male Female 1940 1941 1942 1943 1944 1945 1946 M F M F M F M F M F M F M F 1 Typhoid and paratyphoid fevers — — 1 Typhoid and paratyphoid fevers — — — — — — — — — — — — — — 2 Measles — — 2 Cerebro-spinal fever 1 5 2 — 1 — 1 — 1 1 — 2 — — 3 Scarlet fever — — 3 Scarlet fever — — — — — — — — — — — — — — 4 Whooping cough — 2 4 Whooping cough 2 1 1 — 3 1 — 1 2 1 — — — — 5 Diphtheria 2 3 5 Diphtheria 4 1 2 1 1 — — — 1 — 2 — — 1 6 Influenza 3 7 6 Tuberculosis of respiratory system 31 23 47 23 34 23 23 19 30 11 26 17 25 21 7 Encephalitis lethargica 1 1 7 Other forms of tuberculosis 3 2 4 4 7 6 5 2 2 1 6 3 5 5 8 Cerebro-spinal fever — — 8 Syphilitic diseases 10 — 2 3 6 2 9 7 2 2 7 1 5 4 9 Tuberculosis of respiratory system 35 27 9 Influenza 10 6 5 4 1 2 7 9 5 — 1 2 8 7 10 Other tuberculosis 3 4 10 Measles 1 1 — — 2 — 1 — — — — 1 — — 11 Syphilis 3 2 11 Acute poliomyelitis and polioencephalitis — — — — — — — — — — — — 1 — 12 General paralysis, tabes dorsalis 1 2 12 Acute infectious encephalitis — 2 — I — — — 1 1 — — — — 1 13 Cancer 70 62 13m Cancer of buccal cavity and oesophagus 4 — 3 — 7 — 9 — 8 — 6 — 6 — 14 Diabetes 2 11 13f Cancer of uterus — 12 — 8 — 11 — 13 — 9 — 9 — 7 15 Cerebral haemorrhage 16 28 14 Cancer of stomach and duodenum 16 19 14 13 12 11 12 16 18 11 20 6 18 11 16 Heart disease 124 117 15 Cancer of breast — 23 1 15 — 16 — 15 — 14 1 20 — 24 17 Aneurism 2 2 16 Cancer of all other sites 50 38 41 47 54 37 56 45 54 38 65 35 69 48 18 Other circulatory diseases 33 24 17 Diabetes 3 8 4 4 4 2 2 9 4 3 1 3 3 7 19 Bronchitis 11 10 18 Intra-cranial vascular lesions 32 42 29 40 50 50 43 54 36 46 33 39 42 65 20 Pneumonia 19 16 19 Heart disease 154 152 101 130 117 97 125 108 125 105 132 108 150 136 21 Other respiratory diseases 3 5 20 Other diseases of circulatory system 18 16 16 14 18 18 17 19 17 16 27 12 26 28 22 Peptic ulcer 5 1 21 Bronchitis 36 34 27 22 24 22 38 30 35 14 35 15 42 21 23 Diarrhoea (under 2 years of age) 3 4 22 Pneumonia 31 26 21 20 32 29 37 26 33 23 23 14 29 22 24 Appendicitis 4 3 23 Other respiratory diseases 9 10 12 3 6 3 7 6 8 4 9 6 8 2 25 Cirrhosis of liver 1 7 24 Ulceration of stomach and duodenum 9 2 12 — 10 1 15 3 12 3 11 3 12 — 26 Other liver diseases 1 2 25 Diarrhoea (under 2 years of age) 7 6 6 6 13 15 15 7 3 1 6 6 3 2 27 Other digestive diseases 6 10 26 Appendicitis 2 3 4 1 3 3 2 3 1 1 1 1 1 1 28 Acute and chronic nephritis 6 8 27 Other digestive diseases 13 6 14 19 10 7 8 11 9 14 8 7 11 16 29 Puerperal sepsis — — 28 Nephritis 10 8 17 17 7 18 7 15 10 6 6 9 14 7 30 Other puerperal diseases — 5 29 Puerperal and post-abortion sepsis — 2 — 1 — 1 — 1 — — — 1 — 1 31 Congenital deformity, prematurity, etc. 26 14 30 Other maternal causes — 1 — 2 — 3 — — — 3 — 2 — 3 32 Senility 7 26 31 Premature birth 12 16 10 10 10 9 11 7 10 10 12 7 17 4 33 Suicide 7 5 32 Congenital malformations, birth injury, etc. 9 11 11 12 14 5 12 5 14 11 9 19 19 6 34 Other violence 27 13 33 Suicide 4 5 4 8 5 2 4 3 3 2 5 3 4 5 35 Other defined causes 25 27 34 Road traffic accidents 12 4 13 5 5 2 2 2 14 4 6 5 7 5 36 Ill-defined causes 1 — 35 Other violent causes 60 59 13 12 12 11 7 13 34 32 21 14 26 6 36 All other causes 55 48 40 47 48 47 39 40 51 31 43 33 37 34 Total 447 448 Total 608 592 476 492 516 454 514 490 543 417 522 403 588 500 30 AGE AND SEX DISTRIBUTION OF DEATHS, 1940. A bridged List No. Causes of deaths. AGE IN YEARS. All ages 0 - 1 1 - 2 2-5 5-15 15 - 25 25 - 35 35-45 45-55 55 - 65 65 - 75 75 and over M F M F M F M F M F M F M F M F M F M F M F M F 1 Typhoid and paratyphoid fevers — — — — — — — — — — — — — — — — — — — — — — — — 2 Cerebro-spinal fever — — — — — 1 — — — 1 1 — — — — 2 — 1 — — — — 1 5 3 Scarlet fever — — — — — — — — — — — — — — — — — — — — — — — — 4 Whooping cough 1 — — 1 — — 1 — — — — — — — — — — — — — — — 2 1 5 Diphtheria — — — — 3 — 1 1 — — — — — — — — — — — — — — 4 1 6 Tuberculosis of respiratory system — — — — — — — — 7 9 5 6 3 4 7 1 8 1 1 1 — 1 31 23 7 Other tuberculosis — — — — — 1 1 — — — — — — — — — — — — — — — 3 2 8 Syphilitic disease — — — — — — — — — — — — — — 2 — 3 — 4 — — 1 9 1 9 Influenza 1 — — 1 — — — — — 1 — 1 1 1 2 1 1 1 5 — — — 10 6 10 Measles — — — — 1 1 — — — — — — — — — — — — — — — — 1 1 11 Acute poliomyelitis, polioencephalitis — — — — — — — — — — — — — — — — — — — — — — — — 12 Acute infectious encephalitis — — — — — — — — — — — — — 1 — — — 1 — — — — — 2 13m, 16 (2)f Cancer:— Buccal cavity and oesophagus — — — — — — — — — — — — — — — — 2 1 2 — — — 4 1 13f Uterus — — — — — — — — — — — — — 2 — 4 — 3 — 3 — — — 12 14 Stomach and duodenum — — — — — — — — — — — — 1 — 1 3 6 6 6 7 2 4 16 20 15 Breast — — — — — — — — — — — — — 6 — 7 — 2 — 3 — 5 — 23 16 (1) Respiratory system — — — — — — — — 1 — 1 — — 1 1 1 7 — 3 1 1 1 13 4 16 (3) Other sites — — — — — 1 — — 1 — — 1 3 2 3 2 7 9 15 12 7 6 35 33 17 Diabetes — — — — — — — — 2 — — — — — — 1 — 2 — 3 2 1 4 7 18 Cerebral vascular lesions — — — — — — — — — — — — 2 1 3 4 9 5 8 16 12 16 34 42 19 (1) Chronic endocarditis — — — — — — — — — 2 — 2 2 2 4 2 5 5 7 8 2 3 20 24 19 (2) Myocardial degeneration — — — — — — — — — — 2 — — — 1 4 4 7 19 15 19 38 45 64 19 (3) Coronary disease, angina pectoris — — — — — — — — — — — — 2 1 3 1 9 4 9 3 6 4 29 13 19 (4) Other diseases of the heart — — — — — — — 1 — — — 1 — 1 3 1 9 3 13 7 33 37 58 51 20 Other diseases of the circulatory system — — — — — — — — — — — — — — 3 — 4 2 4 4 7 10 18 16 21 Bronchitis 1 1 — — — — — — — — — — 4 1 2 1 9 3 8 12 11 12 35 30 22 Pneumonia (all forms) 3 4 1 — — 1 — 1 1 1 1 — 2 1 2 — 9 2 10 6 8 11 37 27 23 Other diseases of the respiratory system — — — 1 — — — — — — 1 1 2 1 — 2 4 1 1 4 — — 8 10 24 Peptic ulcer — — — — — — — — — — 1 — 3 — 2 — 1 2 — — 2 — 9 2 25 Diarrhoea (under 2 years) 6 6 1 — — — — — — — — — — — — — — — — — — — 7 6 26 Appendicitis — — — — — — — 1 — — — — 1 1 1 — — 1 — — — — 2 3 27 (1) Diseases of pharynx and tonsils — — — — — — — — 1 — — — — — 1 — 1 — — — — — 3 — 27 (2) Cirrhosis of the liver — — — — — — — — — — — — — — — — 1 — — 1 — — 1 1 27 (3) Other diseases of the liver — — — — — — — — — — — — — — — 1 2 — — 1 — — 2 2 27 (4) Other diseases of the digestive system — — — — — 1 1 — — — 2 — 1 — — 1 2 — 3 2 2 — 11 4 28 Nephritis — — — — — — — — — — — 1 1 — 2 — 2 1 3 4 2 4 10 10 2.9 (1) Septic abortion — — — — — — — — — — — — — — — — — — — — — — — — 29 (2) Puerperal sepsis — — — — — — — — — — — 1 — 1 — — — — — — — — — 2 30 (1) Other abortion — — — — — — — — — — — — — — .— — — — — — — — — — 30 (2) Other maternal causes — — — — — — — — — — — 1 — — — — — — — — — — — 1 31 Premature birth. 12 17 — — — — — — — — — — — — — — — — — — — — 12 17 ??? ??? ??? ??? ??? ??? ??? ??? ??? ??? ??? ??? ?????? ??? ??? ??? ??? ??? ??? ??? ??? ??? ??? ??? ??? ??? ??? ??? ??? ??? ??? ??? ??? ??? ??? ??? ??? ??? ??? ??? ??? ??? ??? ??? ??? ??? ??? ??? ??? ??? ??? ??? 31 32(2) Congenital malformations and infant diseases 3 8 — — — — — — — — — — — — — — — — — — — — 3 8 33 Suicide — — — — — — — — — — — 1 1 — 1 2 2 l — 1 — — 4 5 34 Road traffic accidents — — — — — — 3 1 — 1 4 — — — 1 — 1 1 2 1 1 — 12 4 35 Other violent causes — — — 1 3 2 7 9 4 7 8 4 14 12 7 2 6 8 6 4 4 8 59 57 36 (1) Erysipelas — — — — — — — — — — — — — — — — — — — 1 — — — 1 36 (2) Purulent infection and septicaemia 1 1 — — — — — 2 — — — 1 — 1 — — — 1 — — — 1 1 7 36 (3) Hodgkin's disease — — — — — — — — — 1 — — — — — — — — — — — — — 1 36 (5) Other infective diseases — — — — — — — — — — — — — — — — — — — — — — — — 36 (6) Rheumatic fever — — — — — — — 2 — 1 — — — — — — — — — — — — — 3 36 (7) Exophthalmic goitre — — — — — — — — — — — — — 1 — — — — — — — — — 1 36 (8) Diseases of the blood — — — — — 1 — — — — — — — 1 1 — 2 1 2 — — — 5 3 36 (9) Diseases of the ear and mastoid antrum 2 1 1 1 — — — — — — — — — — — — — — — — — — 3 2 36 (10) Pyelitis and diseases of the bladder — — — — — — — — 1 — — — — — — 2 — 1 5 — 1 — 7 3 36 (11) Diseases of the prostate — — — — — — — — — — — — — — — — — — 1 — 4 — 5 — 36 (12) Old Age — — — — — — — — — — — — — — — — — — 1 2 1 4 2 6 36 (4,13,14) Other causes 1 1 — — — — 1 1 1 1 1 2 4 7 5 1 7 1 4 3 1 5 25 22 ALL CAUSES 37 40 3 5 7 9 15 19 19 26 27 23 48 49 59 46 123 77 142 125 128 172 608 591 77 8 16 34 45 50 97 105 200 267 300 1,199 Percentage of total deaths from all causes 6.4 0.7 1.3 2.8 3.8 4.2 8.1 8.8 16.7 22.2 25.0 Deaths due to war operations M—44; F—47. AGE AND SEX DISTRIBUTION OF DEATHS, 1941. 1 Typhoid and paratyphoid fevers — — — — — — — — — — — — — — — — — — — — — — — — 2 Cerebro-spinal fever — — 1 — — — — — — — — — — — — — — — — — — — 1 — 3 Scarlet fever — — — — — — — — — — — — — — — — — — — — — — — — 4 Whooping cough — — — — 1 — — — — — — — — — — — — — — — — — 1 — 5 Diphtheria — — — — — 1 1 — 1 — — — — — — — — — — — — — 2 1 6 Tuberculosis of respiratory system — 1 — — — — — — 9 4 9 5 9 6 12 5 6 1 — 1 — — 45 23 7 Other tuberculosis — — — 1 — 1 2 — — 2 2 — — — — — — — — — 1 — 5 4 8 Syphilitic disease — — — — — — — — — — — — — — — — 1 1 1 2 1 — 3 3 9 Influenza — — 1 — — — — — 1 — — — — — 1 — — 1 1 1 1 3 5 5 10 Measles — — — — — — — — — — — — — — — — — — — — — — — — 11 Acute poliomyelitis, polioencephalitis — — — — — — — — — — — — — — — — — — — — — — — — 12 Acute infectious encephalitis — — — — — — — — — — — — — 1 — — — — — — — — — 1 13m, 16(2)f Cancer:— Buccal cavity and oesophagus — — — — — — — — — — — — — — 2 1 1 1 — — — 1 3 3 13f Uterus — — — — — — — — — — — — — — — 2 — 5 — 1 — 1 — 9 14 Stomach and duodenum — — — — — — — — — — — — 2 — — 1 3 3 7 7 1 2 13 13 15 Breast — — — — — — — — — — — — — 1 — 4 — 3 1 4 — 3 1 15 16 (1) Respiratory system — — — — — — — — — — 1 — — — 4 2 3 3 7 — 2 1 17 6 16 (3) Other sites — — — — — — — — 1 1 — — 1 4 2 6 8 9 10 8 3 10 25 38 17 Diabetes — — — — — — — — — — — — — — — — — — 4 3 — 1 4 4 18 Cerebral vascular lesions — — — — — — — — — — — — — 4 4 4 4 5 11 11 13 18 32 42 19 (1) Chronic endocarditis — — — — — — — — 1 1 — 2 — 1 2 3 3 2 4 4 3 6 13 19 19 (2) Myocardial degeneration — — — — — — — — — — — — — — 2 — 2 1 18 8 19 47 41 56 32 AGE AND SEX DISTRIBUTION OF DEATHS, 1941—continued. A bridged List No. Causes of deaths. AGE 1 IN YEARS. All ages 0- 1 1 - 2 2-5 5-15 15 - 25 25 - 35 35 - 45 45 - 55 55-65 65 - 75 '75 and over M F M F M F M F M F M F M F M F M F M F M F M F 19 (3) Coronary disease, angina pectoris — — — — — — — — — — — — 2 — 2 — 5 2 5 6 4 6 18 14 19 (4) Other diseases of the heart — — — — — — — — — — — — — — 5 1 2 4 10 9 13 19 30 33 20 Other diseases of the circulatory system — — — — — — — — — — — — — — 4 1 3 2 3 5 6 14 16 22 21 Bronchitis — 2 — — — — — — — — — — 2 — — — 6 1 8 8 11 11 27 22 22 Pneumonia (all forms) 7 6 1 — — — — — — — — — 3 — 2 4 3 — 4 6 2 5 22 21 23 Other diseases of the respiratory system — — — — — — — — — — — — 2 1 2 1 6 — 2 — — 1 12 3 24 Peptic ulcer — — — — — — — — — — — — 1 — 3 — 2 — 3 — 3 — 12 — 25 Diarrhoea (under 2 years) 5 6 — — — — — — —— — — — — — — — — — —— — — — 5 6 26 Appendicitis — — — — — — 2 — 1 — — — — — — — 1 — — 1 — — 4 1 27 (1) Diseases of pharynx and tonsils — — — — — — — — — — — — — — — — — — — — — — — — 27 (2) Cirrhosis of the liver — — — — — — — — — — — — 1 — — — — — — — — — 1 — 27 (3) Other diseases of the liver — — — — — — — 1 — — — — — 1 1 — 1 — 1 — — — 3 2 27 (4) Other diseases of the digestive system — 1 — 2 — — — — — — — — — — 3 — 3 2 1 5 2 5 9 15 28 Nephritis — 1 — — — — — — — — 1 2 2 1 2 3 3 2 7 6 2 2 17 17 29 (1) Septic abortion — — — — — — — — — — — — — 1 — — — — — — — — — 1 29 (2) Puerperal sepsis — — — — — — — — — — — — — — — — — — — — — — — — 30 (1) Other abortion — — — — — — — — — — — — — — — — — — — — — — — — 30 (2) Other maternal causes — — — — — — — — — 1 — — — 1 — — — — — — — — — 2 31 Premature birth 11 9 — — — — — — — — — — — — — — — — — — — — 11 9 32 (1) Injury at birth 2 — — — — — — — — — — — — — — — — — — — — — 2 — 32 (2) Congenital malformations and infantile diseases 8 10 — — — — — 2 — — — — — — — — — — — — — — 8 12 33 Suicide — — — — — — — — 1 — — 1 — 1 1 2 1 4 1 — — — 4 8 34 Road traffic accidents — — — — 1 — 2 2 — — 1 1 1 — 3 — 3 — — — 2 2 13 5 35 Other violent causes — — 1 1 — — 2 — 1 1 2 — 1 — — — 4 — 1 1 1 9 13 12 36 (1) Erysipelas — — — — — — — — — — — — — — — — — — — — — — — — 36 (2) Purulent infection and septicaemia — — — — — 1 — — — 2 — — — — 1 — — — — — 1 2 2 5 36 (3) Hodgkin's disease — — — — — — — — — — — — — — — — — — — 1 — — — 1 36 (5) Other infective diseases — — — — — — — — — — — — — — 2 — — — — — 1 — 3 — 36 (6) Rheumatic fever — — — — — — — — — — — — — — — — — — — — — — — — 36 (7) Exophthalmic goitre — — — — — — — — — — — — — — — 1 — 2 — — — 1 — 4 36 (8) Diseases of the blood — — — — — — — — — — 1 — — — 2 1 2 3 1 — — — 6 4 36 (9) Diseases of the ear and mastoid antrum 1 — — 1 — — — — — — — — — — — — — — — — — — 1 1 36 (10) Pyelitis and diseases of the bladder — — — — — — — — — — — — 1 — — — — 1 — — 1 1 2 2 36 (11) Diseases of the prostate — — — — — — — — — — — — — — — — — — 3 — 2 — 5 — 36 (12) Old Age — — — — — — — — — — — — — — — — — — — 2 1 4 1 6 36 (4,13,14) Other causes 1 2 1 — 1 1 2 — — 1 — — 3 2 3 6 1 4 4 4 2 3 18 23 ALL CAUSES 35 38 5 5 3 4 11 5 16 13 17 11 31 25 65 48 77 62 118 104 98 178 476 493 73 10 7 16 29 28 56 113 139 222 276 969 Percentage of total deaths from all causes 7.5 1.0 0.7 1.6 .3.0 2.9 5.7 11.6 14.3 22.9 28.8 33 AGE AND SEX DISTRIBUTION OF DEATHS, 1942. 1 Typhoid and paratyphoid fevers — — — — — — — — — — — — — — — — — — — — — — — — 2 Cerebro-spinal fever — — 1 — — — — — — — — — — — — — — — — — — — 1 — 3 Scarlet fever — — — — — — — — — — — — — — — — — — — — — — — — 4 Whooping cough 2 1 1 — — — — — — — — — — — — — — — — — — — 3 1 5 Diphtheria — — — — — — 1 — — — — — — — — — — — — — — — 1 — 6 Tuberculosis of respiratory system — 1 — — — — 1 — 4 9 4 6 7 2 11 2 6 2 — 1 1 — 34 23 7 Other tuberculosis 1 — 1 — — 2 3 — 1 1 2 — — — — 1 — 1 — — — 7 6 8 Syphilitic disease — — — — — — — — — — — — — — 2 2 2 — 1 — — — 5 2 9 Influenza — — — — — — — — — — — — — — — — 1 — — 1 — 1 1 2 10 Measles 1 — 1 — — — — — — — — — — — — — — — — — — — 2 — 11 Acute poliomyelitis, polioencephalitis — — — — — — — — — — — — — — — — — — — — — — — — 12 Acute infectious encephalitis — — — — — — — — — — — — — — — — — — — — — — — — 13M, 16(2)f Cancer:— Buccal cavity and oesophagus — — — — — — — — — — — — — 1 1 — 2 2 2 — 3 2 8 5 13f Uterus — — — — — — — — — — — — — — — 6 — 2 — 1 — 1 — 10 14 Stomach and duodenum — — — — — — — — — — — — 1 — 4 — — 6 6 3 1 3 12 12 15 Breast — — — — — — — — — — — 2 — 2 — 3 — 6 — 2 — 1 — 16 16 (1) Respiratory system — — — — — — — — — — — — 1 — 4 — 4 1 4 1 1 1 14 3 16 (3) Other sites — — — — — — 1 — — — — — 2 — 7 8 7 5 16 10 8 6 41 29 17 Diabetes — — — — — — — — — 1 1 — — — — — — — 2 — 1 1 4 2 18 Cerebral vascular lesions — — — — — — — — — — — — 3 1 1 6 7 12 21 17 18 22 50 58 19 (1) Chronic endocarditis — — — — — — — 1 2 — 1 3 4 1 3 2 2 3 5 5 3 3 20 18 19 (2) Myocardial degeneration — — — — — — — — — — — — — — — — — 3 14 14 28 33 42 50 19 (3) Coronary disease, angina pectoris — — — — — — — — — — — — 1 — 3 — 14 — 9 7 7 3 34 10 19 (4) Other diseases of the heart — — — — — — — — — — — 1 — 1 — — 4 1 7 6 10 11 21 20 20 Other diseases of the circulatory system 1 — — — — — — — — — — — 1 1 2 1 4 2 4 4 3 6 15 14 21 Bronchitis 1 1 — — — — — — 2 — — — — — 3 — 6 — 4 5 9 20 25 26 22 Pneumonia (all forms) 9 6 — 1 — — — — — — — 1 — 1 1 4 5 6 8 6 10 9 33 34 23 Other diseases of the respiratory system 1 — — — — — — — 1 — — — — — 2 — — 2 2 — 1 — 7 2 24 Peptic ulcer — — — — — — — — — — — — 3 — 3 — 2 — 2 — — 1 10 1 25 Diarrhoea (under 2 years) 13 15 — — — — — — — — — — — — — — — — — — — — 13 15 26 Appendicitis — — — — 1 — 1 — — 1 — — — — — 1 2 — — 1 — — 4 3 27 (1) Diseases of pharynx and tonsils — — — — — — — — — — — — — — — — — — — — — — — — 27 (2) Cirrhosis of the liver — — — — — — — — — — — — — — — — 1 — — 1 — — 1 1 27 (3) Other diseases of the liver — — — — — — — — — — — — — — — — 1 — — — 2 1 3 1 27 (4) Other diseases of the digestive system — — — — — — — — 1 — — — — 2 1 — — — 1 1 1 2 4 5 28 Nephritis — 1 — — — — — — — — — — — 1 3 — 2 2 — 4 2 8 7 16 29 (1) Septic abortion — — — — — — — — — — — — — — — — — — — — — — — — 29 (2) Puerperal sepsis — — — — — — — — — — — — — — — — — — — — — — — — 30 (1) Other abortion — — — — — — — — — — — — — — — — — — — — — — — — 30 (2) Other maternal causes — — — — — — — — — — — 1 — 2 — — — — — — — — — 3 31 Premature birth 11 9 — — — — — — — — — — — — — — — — — — — — 11 9 32 (1) Injury at birth 5 — — — — — — — — — — — — — — — — — — — — — 5 — 32 (2) Congenital malformations and infantile diseases 10 4 1 — — — — — — — — — — — — — — — — — — — 11 4 33 Suicide — — — — — — — — — — 1 — — 1 2 1 1 — — — 1 — 5 2 34 Road traffic accidents — — — 1 — — 1 — 1 — 2 — — — — — — — — — 1 1 5 2 35 Other violent causes 1 — 1 — — 2 — — — 1 3 1 — — 1 — — — — 2 6 5 12 11 34 AGE AND SEX DISTRIBUTION OF DEATHS, 1942—continued. A bridged List No. Causes of deaths. AGE IN YEARS. All ages 0 - 1 1 - 2 2-5 5-15 15 - 25 25 - 35 35 - 45 45 - 55 55 - 65 65 - 75 75 and over M F M F M F M F M F M F M F M F M F M F M F M F 36 (1) Erysipelas — — — — — — — — — — — — — — — — — — — — — — — — 36 (2) Purulent infection and septicaemia — 1 — — — — — — — — — — — — 1 — — — — — I 1 2 2 36 (3) Hodgkin's disease — — — — — — — — — — — — — — 2 — 1 — — — — — 3 — 36 (5) Other infective diseases — — — — — — — — — — 1 — — 1 — — — — 1 — 1 — 3 1 36 (6) Rheumatic fever — — — — — — — — — — — — — — — — — — — — — — — — 36 (7) Exophthalmic goitre — — — — — — — — — — — — — — — — — — — — — — — — 36 (8) Diseases of the blood — — — — — — — — — — — — — — — — — — 2 — 1 — 3 — 36 (9) Diseases of the ear and mastoid antrum 2 3 — — — — — — — — — — 1 — 1 — — — — — — — 4 3 36 (10) Pyelitis and diseases of the bladder — — — — — — — — — — — — — 2 — — 2 — 2 1 — 1 4 4 36 (11) Diseases of the prostate — — — — — — — — — — — — — — — — — — 5 — 3 — 8 — 36 (12) Old Age — — — — — — — — — — — — — — — — — — — — 4 11 4 11 36 (4,13,14) Other causes 2 1 — — — — — — 3 — 2 1 — 2 — 4 3 2 3 5 2 5 15 20 ALL CAUSES 60 43 6 2 1 2 7 4 14 13 16 18 24 21 58 40 80 57 122 98 129 159 517 457 103 8 3 11 27 34 45 98 137 220 288 974 Percentage of total deaths from all causes 10.6 0.8 0.3 1.1 2.8 3.5 4.5 10.1 14.1 22.5 29.7 Deaths due to war operations M—0; F—1. AGE AND SEX DISTRIBUTION OF DEATHS, 1943. 1 Typhoid and paratyphoid fevers — — — — — — — — — — — — — — — — — — — — — — — — 2 Cerebro-spinal fever — — 1 — — — — — — — — — — — — — — — — — — — 1 — 3 Scarlet fever — — — — — — — — — — — — — — — — — — — — — — — — 4 Whooping cough — — — — — — — 1 — — — — — — — — — — — — — — — 1 5 Diphtheria — — — — — — — — — — — — — — — — — — — — — — — — 6 Tuberculosis of respiratory system — — — — — — — — 5 7 3 6 6 2 4 2 5 2 1 — — — 24 19 7 Other tuberculosis — — — — — — 2 — 2 1 — 1 — — 1 — — — — — — — 5 2 8 Syphilitic disease — — — — — — — — — — — — — 1 3 — 4 2 1 1 1 2 9 6 9 Influenza — — — — 1 — — 1 — — — — — 1 — 1 2 — 3 4 1 2 7 9 10 Measles 1 — — — — — — — — — — — — — — — — — — — — — 1 — 11 Acute poliomyelitis, polioencephalitis — — — — — — — — — — — — — — — — — — — — — — — — 12 Acute infectious encephalitis — — — — — — — — — — — — — — — — — — — — — 1 — 1 13m, 16(2)f Cancer:— Buccal cavity and oesophagus — — — — — — — — — — — — 1 1 1 2 — 1 — 3 — 8 1 13f Uterus — — — — — — — — — — — 1 — 2 — 5 — 3 — 1 — — — 12 14 Stomach and duodenum — — — — — — — — — — — 1 — 1 4 2 2 5 5 3 1 4 12 16 is Breast — — — — — — — — — — — — — 4 1 — 5 — 4 — 1 — 15 CM Respiratory system — — — — — — — — — — — — 3 2 3 — 8 — 7 1 — — 21 3 35 16 (3) Other sites — — — — — — — — — — — 1 — 3 6 6 5 10 15 | 10 8 11 34 41 17 ) Diabetes — — — — — — — — 1 1 — 1 — 1 — 2 — 1 1 2 — 1 2 9 18 ! Cerebral vascular lesions — — — — — — — — — — — — 1 — 2 7 13 10 14 19 15 20 45 56 19 (1) j Chronic endocarditis — — — — — — — — — — 2 2 2 1 3 2 2 3 3 4 8 3 20 15 19 (2) Myocardial degeneration — — — — — — — — — — — — 1 — 2 2 — 3 16 16 31 48 50 69 19 (3) Coronary disease, angina pectoris — — — — — — — — — — — — 1 — 4 — 12 4 12 7 6 12 35 23 19 (4) Other diseases of the heart — — — — — — — — — 1 — 1 — — 1 — 3 — 3 2 14 4 21 8 20 Other diseases of the circulatory system — — — — — — — — — — — — 1 2 1 — 2 1 5 3 2 8 11 14 21 Bronchitis — 1 — — — — 1 — — — — — 2 1 7 2 13 3 9 5 6 17 38 29 22 Pneumonia (all forms) 7 3 — 2 — 2 — — 1 — 1 — 3 1 6 1 8 1 9 4 6 13 41 27 23 Other diseases of the respiratory system — — — — — — — — — 1 — — — 1 1 2 2 — 2 — 2 — 7 4 24 Peptic ulcer — — — — — — — — — — — — 1 2 3 1 9 — — — 3 — 16 3 25 Diarrhoea (under 2 years) 15 7 1 — — — — — — — — — — — — — — — — — — — 16 7 26 Appendicitis — — — — — — — — — 2 — — — — — — 2 1 1 — — — 3 3 27 (1) Diseases of pharynx and tonsils — — — — 1 — — — — — — — — — — — — — — — — — 1 — 27 (2) Cirrhosis of the liver — — — — — — — — — — — — — — — 1 — — 1 — 2 — 3 1 27 (3) Other diseases of the liver 1 — 3 1 — 1 4 27 (4) Other diseases of the digestive system — — — — — — — — — — — 1 — — 1 2 1 1 2 — — 2 4 6 28 Nephritis — — — — — — — — — 1 — 1 1 2 1 3 3 2 2 4 — 3 7 16 29 (1) Septic abortion — — — — — — — — — — — — — — — — — — — — — — — — 29 (2) Puerperal sepsis — — — — — — — — — — — 1 — — — — — — — — — — — 1 30 (1) Other abortion — — — — — — — — — — — — — — — — — — — — — — — — 30 (2) Other maternal causes — — — — — — — — — — — — — — — — — — — — — — — — 31 Premature birth 11 7 — — — — — — — — — — — — — — — — — — — — 11 7 32(1) Injury at birth — 2 — — — — — — — — — — — — — — — — — — — — — 2 32 (2) Congenital malformations and infantile diseases 11 3 — — 1 — — — — — — — — — — — — — — — — — 12 3 33 Suicide — — — — — — — — 1 — — 1 1 2 — — 1 — — — 1 — 4 3 34 Road traffic accidents — — — — — — 1 — — — — 2 — — — — 1 — — — — — 2 2 35 Other violent causes 1 1 — — — — 2 — 1 1 — — — — 1 1 — 1 — 1 2 8 7 13 36(1) Erysipelas — — — — — — — — — — — — — — — — — — — — — — — — 36 (2) Purulent infection and septicaemia — — — — — — — — — — — — — — — — — — — — — — — — 36 (3) Hodgkin's disease — — — — — — — — — — — — — — 1 — — — — — — — 1 — 36 (5) Other infective diseases — — — — — — — — — — — — — — — — — — — — — — — — 36 (6) Rheumatic fever — — — — — — — — — — — — — — — — — — — — — — — — 36 (7) Exophthalmic goitre — — — — — — — — — — — — — — 1 — — 1 — 1 — — 1 2 36 (8) Diseases of the blood — — — — 1 — — 1 — — — 1 — — — — 1 — 4 — — 2 6 4 36 (9) Diseases of the ear and mastoid antrum — 1 — — — — — — — — — — — — 1 — — — — — — — 1 1 36 (10) Pyelitis and diseases of the bladder — — — — — — — — — 1 — — — — — 1 1 2 — — — — 1 4 36 (11) Diseases of the prostate — — — — — — — — — — — — — — — — 1 — 2 — 1 — 4 — 36 (12) Old Age — — — — — — — — — — — — — — — — — — — — — 7 — 7 36 (4,13,14) Other causes — 2 — — 1 1 4 1 — 3 1 2 1 4 3 4 6 1 5 1 — 3 21 22 ALL CAUSES 46 27 2 2 5 3 10 4 11 19 7 23 25 33 61 49 109 63 124 96 114 172 514 491 73 4 8 14 30 30 58 110 172 220 286 1,005 Percentage of total deaths from all causes 7.3 0.4 0.8 1.4 3.0 3.0 5.8 10.9 17.1 21.9 28.4 36 AGE AND SEX DISTRIBUTION OF DEATHS, 1944. A bridged List No. Causes of deaths. AGE IN YEARS. All ages 0 - 1 1 - 2 2-5 5-15 15 - 25 25 - 35 35-45 45 - 55 55-65 65-75 75 and over M F M F M F M F M F M F M F M F M F M F M F M F 1 Typhoid and paratyphoid fevers — — — — — — — — — — — — — — — — — — — — — — — — 2 Cerebro-spinal fever 1 — — — — 1 — — — — — — — — — — — — — — — — 1 1 3 Scarlet fever — — — — — — — — — — — — — — — — — — — — — — — — —4 Whooping cough 2 1 — — — — — — — — — — — — — — — — — — — — 2 1 5 Diphtheria — — — — 1 — — — — — — — — — — — — — — — — — I — 6 Tuberculosis of respiratory system 1 — — — — — — — 4 3 4 1 5 3 7 3 7 — 2 1 — — 30 11 7 Other tuberculosis — — — — — — — — — — 1 — 1 — — 1 — — — — — — 2 1 8 Syphilitic disease — — — — — — — — — — — — 1 — — 1 1 1 — — — — 2 2 9 Influenza — — — — — — 1 — — — — — — — 1 — 2 — — — I — 5 — 10 Measles — — — — — — — — — — — — — — — — — — — — — — — — 11 Acute poliomyelitis, polioencephalitis — — — — — — — — — — — — — — — — — — — — — — — — 12 Acute infectious encephalitis — — — — — — — — — — — — — — — — — — — — — — 1 — 13m, 16(2)F Cancer:— Buccal cavity and oesophagus — — — — — — — — — — — — — — 1 — 1 — 3 — 3 1 8 1 13f Uterus — — — — — — — — — — — — — — — 5 — 1 — 1 — 2 — 9 14 Stomach and duodenum — — — — — — — — — — — — 1 — 3 2 3 2 9 5 2 3 18 12 15 Breast — — — — — — — — — — — — — 2 — 5 — 3 — 3 — 1 — 14 16 (1) Respiratory system — — — — — — — — — — — — — 1 4 — 6 — 7 — 4 — 21 1 16 (3) Other sites — — — — — — — — — — — — 2 1 3 6 2 8 16 9 10 12 33 36 17 Diabetes — — — — — — — — — — — — — — — — 1 1 2 1 — 1 3 3 18 Cerebral vascular lesions — — — — — — — — — — — — — 1 4 4 5 7 16 14 13 24 38 50 19 (1) Chronic endocarditis — — — — — — — — 1 — 1 — — 3 3 2 2 5 5 1 I 3 13 14 19 (2) Myocardial degeneration — — — — — — — — — — — — — 1 1 2 7 3 8 9 25 35 41 50 19 (3) Coronary disease, angina pectoris — — — — — — — — — — — — 2 — 13 — 10 3 17 10 2 9 44 22 19 (4) Other diseases of the heart — — — — — — — — — 1 — — — — 4 1 6 2 7 4 9 11 26 19 20 Other diseases of the circulatory system — — — — — — — — — — — 1 — — — 1 7 1 9 4 I 7 17 14 21 Bronchitis 1 — — — — — — — — — — — — — 4 — 5 1 10 2 15 10 35 13 22 Pneumonia (all forms) 4 3 — — — — — — — 1 — — 2 — 4 — 7 3 7 5 9 14 33 26 23 Other diseases of the respiratory system — — — — — — — — — — — 1 — — 3 — 2 — 2 I 1 2 8 4 24 Peptic ulcer — — — — — — — — — — — — 2 — 1 — 2 1 5 1 2 1 12 3 25 Diarrhoea (under 2 years) 3 1 — — — — — — — — — — — — — — — — — — — — 3 1 26 Appendicitis — — — — — — — — — — — — — 1 — — 1 — — — — — 1 1 27 (1) Diseases of pharynx and tonsils — — — — — — — — — — — — — — — — — 1 — — 1 — 1 1 27 (2) Cirrhosis of the liver — — — — — — — — — — — — — — 1 — — — — — — — 1 — 27 (3) Other diseases of the liver — — — — — — — — — — — — 1 — 1 1 — 1 3 1 1 3 6 27 (4) Other diseases of the digestive system — — — — — — — — — — — — — 1 — — 2 — — 4 1 2 3 7 28 Nephritis — — — — — — 1 1 — — — — 1 — 1 — 1 2 1 2 5 1 10 6 29 (1) Septic abortion — — — — — — — — — — — — — — — — — — — — — — — — 29 (2) Puerperal sepsis — — — — — — — — — — — — — — — — — — — — — — — — 30 (1) Other abortion — — — — — — — — — — — — — — — — — — — — — — — 30 (2) 1 Other maternal causes — — — — — — — — — — — 1 — 2 — — — — — — — — — 3 31 \ Premature birth 10 10 — — — — — — — — — — — — — — — — — — — — 10 10 32(1) Injury at birth 2 4 — — — — — — — — — — —— — — — — — — — — — 2 4 37 32(2) Congental malformations and infantile diseases 12 6 — — — — — — — — — — — — — — — — — — — — 12 6 33 Suicide — — — — — — — — — — 1 — — 1 — — l 2 — — — 3 2 34 Road traffic accidents — — — — — — 3 1 1 — 3 l — l 1 — 3 — 1 — 3 l 15 4 35 Other violent causes — 2 1 1 — 1 7 3 1 1 3 1 5 2 7 6 7 3 — 6 4 6 35 32 36 (1) Erysipelas — — — — — — — — — — — — — — — — — — — — — — — — 36 (2) Purulent infection and septicaemia 1 1 1 — — — — — — — — — — — — — — 1 — — 1 — 3 2 36 (3) Hodgkin's disease — — — — — — — — — — — — — — — — — — — — — — — — 36 (5) Other infective diseases — — — — — — — — — — — — — — — — — — — — — — — — 36 (6) Rheumatic fever — — — — — — — — — — — — 1 — — — — — — — — — 1 — 36 (7) Exophthalmic goitre — — — — — — — — — — — — — — — — — — — — — — — — 36 (8) Diseases of the blood — — — — — — — — — — — — — — 1 — 2 1 2 1 1 — 6 2 36 (9) Diseases of the ear and mastoid antrum 3 3 — — — — — 1 — — — — — — — — — — — — — — 3 4 36 (10) Pyelitis and diseases of the bladder — — — — — — — — — — — — — — — — — — 2 2 2 — 4 2 36 (11) Diseases of the prostate — — — — — — — — — — — — — — — — — — 1 — 5 — 6 — 36 (12) Old Age — — — — — — — — — — — — — — — — — — 2 — 15 8 17 8 36 (4,13,14) Other causes — — — — — — 1 1 1 — — — 1 1 2 1 4 2 1 3 — 1 10 9 ALL CAUSES 40 31 2 1 1 2 13 7 8 6 12 7 25 21 70 41 97 53 138 92 137 156 543 417 71 3 3 20 14 19 46 111 150 230 293 960 Percentage of total deaths from all causes 7.4 0.3 0.3 2.1 1.5 2.0 4.8 11.6 15.6 24.0 30.5 Deaths due to war operations M—26; F—24. age and sex distribution of deaths, 1945. 1 Typhoid and paratyphoid fevers — — — — — — — — — — — — — — — — — — — — — — — — 2 Cerebro-spinal fever — 1 — — — — — — — 1 — — — — — — — — — — — — — 2 3 Scarlet fever — — — — — — — — — — — — — — — — — — — — — — — — 4 Whooping cough — — — — — — — — — — — — — — — — — — — — — — — — 5 Diphtheria — — — — — — 2 — — — — — — — — — — — — — — — 2 — 6 Tuberculosis of respiratory system — — — — — 1 — — 2 4 5 4 4 4 4 2 8 2 3 — — — 26 17 7 Other tuberculosis — — — — — — — — 1 3 1 1 2 — 1 — — — — — — — 5 4 8 Syphilitic disease — — — — — — — — — — — — — — 1 — 4 1 1 — 1 — 7 1 9 Influenza — — — — — — — — — — — — — — — — 1 — — — — 2 1 2 10 Measles — — — — — 1 — — — — — — — — — — — — — — — — — 1 11 Acute poliomyelitis, polioencephalitis — — — — — — — — — — — — — — — — — — — — — — — — 12 Acute infectious encephalitis — — — — 1 — — — — — — — — — — — — — — — — — 1 — 13m, 16(2) f Cancer:— Buccal cavity and oesophagus — — — — — — — — — — — — 1 — — — 3 — 2 1 — 1 6 2 13f Uterus — — — — — — — — — — — — — — — 2 — 3 — 2 — 2 — 9 14 Stomach and duodenum — — — — — — — — — — — — 1 — 5 1 2 2 7 3 3 — 18 6 15 Breast — — — — — — — — — — — — — 2 — 4 — 8 1 4 — 2 1 20 16(1) Respiratory system — — — — — — — — — 1 — 1 2 — 5 — 5 1 4 2 3 1 19 6 16 (3) Other sites — — — — — — — — 1 — — 1 2 1 7 2 13 3 12 12 12 7 47 26 17 Diabetes — — — — — — — — — — — — — — — — 1 1 — 1 — 2 1 4 18 Cerebral vascular lesions — — — — — — — — — — — — — — 1 7 6 6 12 15 15 12 34 40 19 (1) Chronic endocarditis — — — — — — — 1 1 — — — 1 1 1 2 4 5 3 2 5 10 15 21 19(2) Myocardial degeneration — — — — — — — — — — — — — — 2 — 9 4 18 20 43 55 72 79 38 AGE AND SEX DISTRIBUTION OF DEATHS, 1945—continued. AbridgedList No. Causes of deaths. AGE IN YEARS. All ages 0 - 1 1 - 2 2-5 5-15 15 - 25 25 - 35 35 - 45 45 - 55 55 - 65 65 - 75 75 and over M F M F M F M F M F M F M F M F M F M F M F M F 19 (3) Coronary disease, angina pectoris — — — — — — — — — — — — 3 — 6 1 11 2 13 1 10 7 43 11 19 (4) Other diseases of the heart — — — — — — — — 1 — — — — — 1 — — — — — — — 2 — 20 Other diseases of the circulatory system — — — — — — — — — — — 1 2 — 2 1 7 1 10 3 8 4 29 10 21 Bronchitis 1 1 — — — — — — — — — — 3 — 8 1 8 2 8 4 7 7 35 15 22 Pneumonia (all forms) 3 2 1 — — — — — — — — — 1 — 1 1 3 2 3 7 11 8 23 20 23 Other diseases of the respiratory system 1 1 — — — — — — 1 — — — 1 1 — — 1 — 3 1 1 3 8 6 24 Peptic ulcer — — — — — — — — — — — — 3 — 2 — 3 — 4 — — 3 12 3 25 Diarrhoea (under 2 years) 5 6 — — — — — — — — — — — — — — — — — — — — 5 6 26 Appendicitis — — — — — — — — — — — — — — — — — — 1 1 — — 1 1 27 (1) Diseases of pharynx and tonsils — 1 — — — — — — — — — — — — — — — — — — — — — 1 27 (2) Cirrhosis of the liver — — — — — — — — — — — — — — — — 1 — — — — — 1 — 27 (3) Other diseases of the liver — — — — — — — — — — — — — — — — — 1 — — — — — 1 27 (4) Other diseases of the digestive system 1 — — — — — — — — — — — 1 — 2 — 2 1 1 — — 4 7 5 28 Nephritis — — — — — — — — — — — 1 — 1 2 — — 2 3 4 1 1 6 9 29 (1) Septic abortion — — — — — — — — — — — — — — — — — — — — — — — — 29 (2) Puerperal sepsis — — — — — — — — — — — — — 1 — — — — — — — — — 1 30 (1) Other abortion — — — — — — — — — — — — — — — — — — — — — — — — 30 (2) Other maternal causes — — — — — — — — — — — — — 2 — — — — — — — — — 2 31 Premature birth 12 6 — — — — — — — — — — — — — — — — — — — — 12 6 32 (1) Injury at birth 2 2 — — — — — — — — — — — — — — — — — — — — 2 2 32 (2) Congenital malformations and infantile diseases 6 14 — — — — — 1 — — — — — 1 — — — — — — — — 6 16 33 Suicide — — — — — — — — — — — — 2 2 1 1 — — 1 — 1 — 5 3 34 Road traffic accidents — — — — — — — 1 2 2 1 — — 1 — — 1 — 2 — — 1 6 5 35 Other violent causes 1 — — 1 — — — 2 2 1 — 3 2 6 — — — 3 4 5 5 21 14 36 (1) Erysipelas — — — — — — — — — — — — — — — — — — — 1 — — — 1 36 (2) Purulent infection and septicaemia 1 2 — — — — — 1 — — — — — — — — — — — — 1 1 2 4 36 (3) Hodgkin's disease — — — — — — — — — — — — 1 — — — — — — — — — 1 — 36 (5) Other infective diseases — — — — — — — — — — — — — 1 1 — — — — — — — 1 1 36 (6) Rheumatic fever — — — — — — — — — — — — — — — — — — — — — — — 36 (7) Exophthalmic goitre — — — — — — — — — — — — — — — — 1 2 — — — — 1 2 36 (8) Diseases of the blood — — — — — — — — — — — — — — — 1 — 1 — — 3 1 3 3 36 (9) Diseases of the ear and mastoid antrum 4 2 — — — — — — — — — — — — 1 — — — — — — — 5 2 36 (10) Pyelitis and diseases of the bladder — 1 — — — — — — — — — — — — — — — — 1 — 1 — 2 1 36 (11) Diseases of the prostate — — — — — — — — — — 1 — — — — — — — 3 — 5 — 9 — 36 (12) Old Age — — — — — — — — — — — — — — — — — — 1 — 7 4 8 4 36 (4,13,14) Other causes — — 1 — — 1 — — — 1 2 1 1 3 2 I 4 3 1 3 — 1 11 14 ALL CAUSES 37 39 2 1 I 3 2 4 11 14 11 10 34 23 62 27 98 53 121 91 143 144 522 409 76 3 4 6 25 21 57 89 151 212 287 931 Percentage of total deaths from all causes 8.2 0.3 0.4 0.7 2.7 2.2 6.1 9.6 16.2 22.8 30.8 39 AGE AND SEX DISTRIBUTION OF DEATHS, 1946. 1 Typhoid and paratyphoid fevers — — — — — — — — — — — — — — — — — — — — — — — — 2 Cerebro-spinal fever — — — — — — — — — — — — — — — — — — — — — — — — 3 Scarlet fever — — — — — — — — — — — — — — — — — — — — — — — — 4 Whooping cough — — — — — — — — — — — — — — — — — — — — — — — — 5 Diphtheria — — — — — — — — — — — — — 1 — — — — — — — — — 1 6 Tuberculosis of respiratory system — — — — — — — — 5 6 2 6 2 4 6 2 6 1 4 2 — — 25 21 7 Other tuberculosis 1 — 1 — — — 1 — 2 1 — 2 — 1 — — — — — 1 — — 5 5 8 Syphilitic disease — — — — — — — — — — — — — — 1 — 3 3 — — 1 1 5 4 9 Influenza 1 — — — — — — — — — — — — — 2 I 1 — 3 2 1 5 8 8 10 Measles — — — — — — — — — — — — — — — — — — '— — — — — — 11 Acute poliomyelitis, polioencephalitis — — — — — — — — 1 — — — — — — — — — — — — — 1 — 12 Acute infectious encephalitis — — — — — — — — — — — — — — — — — — — — — 1 — 1 13m, 16(2)f Cancer:— Buccal cavity and oesophagus — — — — — — — — — — — — — — 1 — 3 2 1 — 2 — 7 2 13f Uterus — — — — — — — — — — — — — — — 2 — 2 — 1 — 2 — 7 14 Stomach and duodenum — — — — — — — — — — — — 1 — 1 2 6 2 6 3 4 4 18 11 15 Breast — — — — — — — — — — — 1 — 2 — 4 — 5 — 5 — 6 — 23 16 (1) Respiratory system — — — — — 1 — — — — 1 1 4 2 7 2 9 2 9 — 1 1 31 9 16 (3) Other sites — — — — — — — — — — — — — 2 5 7 7 6 13 9 13 13 38 37 17 Diabetes — — — — — — — — 1 — — 1 — — — 1 — 3 1 1 1 1 3 7 18 Cerebral vascular lesions — — — — — — — — — — — 1 — 1 — 8 16 9 13 19 14 28 43 66 19 (1) Chronic endocarditis — — — — — — — — 2 1 — — 1 — — 3 2 4 3 3 — 13 6 19 (2) Myocardial degeneration — — — — — — — — — — — — — — 4 1 8 2 12 12 34 60 58 75 19 (3) Coronary disease, angina pectoris — — — — — — — — — — 1 — 2 — 9 2 20 6 18 16 16 16 66 40 19 (4) Other diseases of the heart — — — — — — — — — 1 — — — — — 1 2 2 5 2 7 8 14 14 20 Other diseases of the circulatory system — — — — — — — — — — — — — 2 4 2 8 2 4 10 10 12 26 28 21 Bronchitis 1 — — — — — — — — — — — 1 — 4 2 8 3 15 5 12 11 41 21 22 Pneumonia (all forms) 1 — 1 — — 2 — — — — — 1 1 — 4 5 1 6 7 11 13 29 24 23 Other diseases of the respiratory system — — — — — — — — — — 1 — — — 3 1 3 — 1 — 1 1 9 2 24 Peptic ulcer — — — — — — — — — — — — — — 1 — 4 — 6 — 1 — 12 — 25 Diarrhoea (under 2 years) 3 1 — 1 — — — — — — — — — — — — — — — — — — 3 2 26 Appendicitis — — — — — — 1 — — — — — — — — — — 1 — — — — 1 1 27 (1) Diseases of pharynx and tonsils — — — — — — — 1 — — — — — — — — — — — — — — — 1 27 (2) Cirrhosis of the liver — — — — — — — — — — — — — 1 — — — — — — 1 — 1 1 27 (3) Other diseases of the liver — — — — — — — — — — — — — — — — — 1 — 2 1 — 1 3 27 (4) Other diseases of the digestive system — — — — — — — — — — — 1 1 1 — 3 2 1 3 3 3 3 9 12 28 Nephritis — — — — — — 1 — — — — — 1 — — 1 2 3 6 2 4 1 14 7 29 (1) Septic abortion — — — — — — — — — — — — — — — — — — — — — — — — 29 (2) Puerperal sepsis — — — — — — — — — — — 1 — — — — — — — — — — — 1 30 (1) Other abortion — — — — — — — — — — — — — — — — — — — — — — — — 30 (2) Other maternal causes — — — — — — — — — 1 — 1 — 1 — — — — — — — — — 3 31 Premature birth 17 4 — — — — — — — — — — — — — — — — — — — — 17 4 32 (1) Injury at birth 3 — — — — — — — — — — — — — — — — — — — — — 3 — 32 (2) Congenital malformations and infantile diseases 13 3 1 — — — — 1 — — — — 1 — 1 — 1 1 — — — — 17 5 33 Suicide — — — — — — — — — — — — 1 — 1 1 1 4 1 — — — 4 5 34 Road traffic accidents — — — — — — — 2 2 — 2 1 1 1 1 — 1 — — — — 1 7 5 35 Other violent causes 3 — — — 1 1 2 — 3 — 2 — 1 — — — 2 — 2 2 10 3 26 6 40 AGE AND SEX DISTRIBUTION OF DEATHS, 1946—continued. A bridged List No. Causes of deaths. AGE IN YEARS. All ages 0 - 1 1 - 2 2-5 5-15 15-25 25 - 35 35 - 45 45 - 55 55-65 65 - 75 75 and over M F M F M F M F M F M F M F M F M F M F M F M F 36 (1) Erysipelas — — — — — — — — — — — — — — — — — 1 — — — — — 1 36 (2) Purulent infection and septicaemia 1 1 — 36 (3) Hodgkin's disease — — — — — — — — — — — — — — — — — — — — — — — — 36 (5) Other infective diseases — — — — — — — — — — — — — — 1 — — — — — — — 1 — 36 (6) Rheumatic fever — — — — — — — — — — — — — — — — — — — — — — — — 36 (7) Exophthalmic goitre — — — — — — — — — — — — — 1 — — — — — 2 — — — 3 36 (8) Diseases of the blood — — — — — — — — — — 1 — — — 2 1 2 — — 1 — 2 5 4 36 (9) Diseases of the ear and mastoid antrum 1 — — — — — 2 — — — — — — 1 — — 1 — — — — — 4 1 36 (10) Pyelitis and diseases of the bladder — — — — — — — — — — — — 1 1 — — — — — — — 1 1 2 36 (11) Diseases of the prostate — — — — — — — — — — — — — — — — 1 — 3 — 4 — 8 — 36 (12) Old Age — — — — — — — — — — — — — — — — — — — — 5 10 5 10 36 (4,13,14) Other causes — — 1 — — — — 1 2 — 1 — 1 2 — 4 1 1 1 1 1 2 8 11 ALL CAUSES 45 8 4 1 i 4 7 5 18 10 11 17 20 24 58 48 126 66 137 111 161 206 588 500 53 5 5 12 28 28 44 106 192 248 367 1088 Percentage of total deaths from all causes 4.9 0.5 0.5 1.1 2.6 2.6 4.0 9.7 17.6 22.8 33.7 ■ s ! • - -t" 1