AC 439(1) HESTON ISLEWORTH ANNUAL REPORT ON THE HEALTH OF THE BOROUGH OF HESTON AND ISLEWORTH for the year 1947 A. ANDERSON, M.D., D.P.H. Medical Officer of Health INDEX Page Adoption 10 Aged and Infirm, removal of 12 Ambulance Service 7 Ante-Natal Clinics 8 Artificial Sunlight Treatment 8 Bakehouses 19 Births, Live and Still 6 Canal Boats 17 Cerebro-Spinal Fever 13 Child Guidance Clinic8 Child Life Protection 10 Convalescent Treatment 9 Day Nurseries 10 Deaths 6 Deaths, Age and Sex Distribution 22 Deaths, Causes of 21 Defective Vision 8 Dental Treatment 11 Diphtheria 12 Diphtheria Immunisation 14 Disinfection 16 Disinfestation 17 Drainage and Sewerage 16 Epidemic Encephalitis 13 Erysipelas 13 Factories, etc. 17 Fever Hospital 15 Food and Drugs, sampling 19 Food, Inspection and Supervision of 18 Foods, Infant, supply of 11 Health Committee 4 Health Visiting 12 Home Helps 9 Home Nursing 7 Housing 18 Ice Cream 18 Illegitimate Children, Care of 10 Infant Mortality 7 Infant Welfare Centres 7 Infectious Disease 12 Page Insulin 11 Laboratory Service7 Maternal Mortality 7 M. & C.W. Committee 4 Measles 15 Meat & Other Foods, Inspection of 19 Medical Officer's Letter 5 Midwifery Service 9 Milk 18 Minor Ailments 8 Mumps 15 Nursing Homes 11 Ophthalmia Neonatorum 15 Orthopaedic Clini C8 Pneumonia 13 Polioencephalitis 15 Poliomyelitis 15 Population 6 Post Natal Clinics 8 Premature Babies, Care of 9 Puerperal Pyrexia 15 Rateable Value 6 Rats and Mice 18 Residential Nurseries 10 Sanitary Circumstances 16 Scabies 11 Scarlet Fever 12 School Health Service 9 Smoke Abatement 17 Speech Clinic 8 Staff 2 Statistics, General 6 Vital 6 Vital, Summary of 20 „ Ward Distribution 25 Tents, Vans and Sheds 17 Tuberculosis 9 & 15 Water Supply 16 Whooping Cough 15 1 STAFF Medical Officer of Health. A. Anderson, M.D., D.P.H. Deputy Medical Officer of Health. H. C. Broadhurst, M.B., B.S. (acting to 28.12.47). M. B. McCann, L.R.C.P. & S., D.P.H. (from 29.12.47;. Assistant Medical Officers. H. C. Broadhurst, M.B., B.S. W. E. McDougall, L.D.S., L.R.C.P.&S., M.B., B.S., M.D., D.P.H. (to 2.2.47). G. David, L.R.C.P.& S., M.D. (to 31.5.47). Mrs. R. Prothero, M.D., L.R.C.P. & S. R. G. Isaac, M.R.C.S., L.R.C.P. (from 1.12.47). Mrs. F. Vanes, M.R.C.S., L.R.C.P. (from 1.12.47). 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 Officer. E. E. Lewis, L.D.S. Assistant Dental Officers. Miss C. C. Jefferson, L.D.S. (to 30.4.47). Mrs. D. Clegg, L.D.S. A. H. Millett, L.D.S. (to 16.2.47). MissE. M. A. McGivern, L.D.S. (from 1.4.4' P. D. O'Connor, L.D.S. D. B. Owen, L.D.S. (from 1.5.47). Mrs. S. MacDonald, L.D.S. (to 11.5.47). Mrs. A. B. Perkins, L.D.S. (from 12.5.47). M. B. Conlin, L.D.S. (from 1.7.47). Orthodontic Consultant. Miss E. M. Still, L.D.S. Dental Mechanic. T. Cheney (part time). Child Guidance Clinic Staff. Psychiatrist : Grace Calver, M.B., Ch.B. (to 22.7.47). E. Huband, M.A., M.R.C.S., L.R.C.P. (from 1.9.47). Psychologist: Miss E. W. Rodwell (from 28.1.47 to 25.7.47). Miss H. E. Swan (from 1.9.47). Psychiatric Social Worker : Miss D. Raynor (to 31.7.47). Miss F. Chapman (from 1.9.47). Speech Therapist. Miss R. M. Bennett (to 7.11.47). Chief Sanitary Inspector. A. B. Hauldren, Cert, as S.I. and M.I. Deputy Chief Sanitary Inspector. J. S. Hodgins, Cert, as S.I., M.I. and S.E. Sanitary Inspectors. G. Latimer, Cert, as S.I. & M.I. K. J. Smith, Cert, as S.I. & M.I. E. Canham, Cert, as S.I. & M.I. D. E. Sheppard, Cert, as S.I. & M.I. (to 27.4.47). J. T. S. Templeman, Cert, as S.I. & M.I. (to 30.3.47). R. W. R. Rixson, Cert, as S.I. & M.I. (from 1.8.47). A. W. Kent, Cert, as S.I. & M.I. (from 7.8.47). Rodent Officer. Mortuary Attendant. A. Farrer. H. E. Ellis. Disinfectors and Laboratory Assistants. F. J. Cobb. F. S. J. Allaway. Superintendent Health Visitor and Non-Medical Supervisor of Midwives. Miss J. M. Evans, S.R.N., S.C.M., H.V. Cert., Cert, as S.I. 2 Health Visitors and Nurses. Miss M. G. Gribble, A.R.R.C., S.R.N., S.C.M., H.V. & S.N. (to 9.9.47). Mrs. A. E. Tyrrell, S.C.M., H.V. & S.N. (to 13.9.47). 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 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, (to 15.11.47). Miss W. M. Mills, S.R.N., S.C.M., H.V. Cert, (to 18.3.47). Miss E. Foggin, S.R.N., S.C.M., H.V. Cert. Miss E. Counihan, S.R.N., S.C.M., H.V. Cert. Miss M. A. Sutton, S.R.N., S.C.M., H.V. Cert, (from 14.7.47 to 15.9.47). Miss I. M. Pearl, S.R.N., S.C.M., H.V. Cert, (from 15.1.47). Miss D. M. Towers, S.R.N., S.C.M., H.V. Cert, (from 2.6.47). Miss A. Atkinson, S.R.N., S.C.M., H.V. Cert, (from 1.10.47). Miss E. M. Smart, S.R.N., S.R.C.N., S.C.M., H.V. Cert, (from 1.10.47). Miss I. R. Craig, R.G.N., S.C.M. (part I), H.V. Cert, (from 29.12.47). Mrs. G. Soady, S.R.N, (from 21.4.47). Mrs. L. A. Settle. Municipal Midwives. Miss M. J. Alsford. Mrs. G. N. Jukes. Miss E. N. Mayles. Miss G. D. E. Ostler. Miss E. I). Paull. Miss D. M. Weston. Mrs. D. T. Woodley. Miss R. E. Warren (to 27.1.47). Miss M. M. Cook (from 13.10.47). Miss R. J. Eigner (from 27.10.47). Miss M. Loughton (from 6.1.47). Mrs. G. Eburne (part time from 4.6.47). Home Help Organiser. Mrs. R. Chapman, S.R.N. 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. H. Dean. M. W. Langford. B. C. Mallaband. E. E. Forrest. G. Pitt. R. G. Atkins (died 3.2.47). E. E. de Laspee (to 22.10.47). Miss M. F. Garry. Miss M. A. Dixon (to 16.11.47). P. J. Sam wells. J. E. Woodley. E. J. Hutchins (from 10.2.47). P. A. Woods (from 22.9.47). B. S. Bedborough (from 29.9.47). R. P. Sanger (to 7.12.47.) L. H. Hayward (to 30.6.47). Miss S. M. Underwood. Mrs. M. A. Hodgson. Miss B. Norris (from 31.3.47). Miss E. M. Stroud (to 12.4.47). Miss D. M. B. West (to 4.9.47). Miss M. Draper (to 27.9.47). Miss B. M. Corby (to 1.3.47). Mrs. J. Keogh (from 17.2.47 to 19.8.47). Miss B. M. Block (from 24.3.47 to 31.5.47). P. R. Shortland (Messenger) (from 13.10.47). Mrs. D. M. Page (part time) (from 10.11.47). Mrs. E. M. Clare (part time) (from 17.11.47). 3 THE HEALTH COMMITTEE of HESTON AND ISLEWORTH BOROUGH COUNCIL as on the 31st December, 1947. Alderman J. E. Dillingham (Chairman). Alderman Miss M. K. Watson (Vice-Chairman). F. H. Freeman, Esq. (Mayor). Alderman D. Rhys. Councillor Mrs. M. F. Davison. Councillor E. W. Dean. Councillor Mrs. O. C. M. Denton. Councillor W. A. Elliott. Councillor F. T. Hart. Councillor H. G. Hockliffe. Councillor Mrs. E. F. Manning. Councillor A. G. Trickey. Councillor A. C. Turner. MATERNITY AND CHILD WELFARE COMMITTEE. Alderman Miss M. K. Watson (Chairman). Councillor Mrs. E. F. Manning (Vice-Chairman). Alderman J. E. Dillingham. Alderman D. Rhys. Councillor W. Chamberlain. Councillor Mrs. M. F. Davison. Councillor Mrs. O. C. M. Denton. Councillor A. G. Trickey. Councillor A. C. Turner. Co-opted Members : Mrs. G. M. Halls. Mrs. M. Mason. 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 1947. For convenience the larger statistical tables are grouped together at the end of the Report. The table of Ward Statistics (Table VI) has not been given in previous Reports. Considerable variation is normally to be expected in statistics dealing with small areas and populations and Ward Statistics would have to be studied over a period of years before any attempt could be made to draw firm conclusions from them. Apart from poliomyelitis and measles, infectious disease was less prevalent than in 1946. Diphtheria incidence was the lowest on record, but if this position is to be maintained, parents must take full advantage of the facilities for immunisation of children. Compared with 1946 reductions are recorded in illegitimate births, still births and maternal deaths. The low infant mortality rate of 1946 was not maintained, but the rate for 1947 was lower than that of the pre-war years. No new services were provided during the year, but the existing services were extended and developed in various ways. The work of the Sanitary Inspectors in regard to environmental conditions is handicapped and delayed by circumstances beyond their control, but the volume of work done is a tribute to their efforts. There is no evidence in the Report which suggests that the general health and nutrition of the citizens is not being maintained. The record could be used to support the view that improvement is taking place. While this is true of those aspects of health capable of measurement, I have a growing impression that the position is not so satisfactory in regard to the less easily defined aspects. In various ways evidence which cannot be classified accurately or submitted to numerical analysis suggests that stamina is less, fatigue more easily produced, recovery from illness slower, spirits less buoyant and that general inertia is more prevalent. Even if such be accepted it is impossible to say whether the condition arises from physical or psychological causes or both. Health in its true sense is something more than the avoidance of illness or death and this must be considered in any attempt to assess the general well-being of the population. I should like to take this opportunity to express my thanks to the staff of the Department for their loyal co-operation, to the officers of other departments for their help and to the Council for support and encouragement. I remain. Your obedient Servant, A. ANDERSON, Medical Officer of Health. 5 GENERAL STATISTICS 1946 1947 Population (Registrar-General's estimate) 104,240 106,670 Number of inhabited houses (rate books) 27,613 27,659 Number of houses erected during year 229 321 Rateable value of Borough £957,317 £976,882 Sum represented by a penny rate £3,962 £4,003 Live Births—legitimate—male 876 932 Live Births—legitimate—female 815 837 Live Births—illegitimate—male 62 30 Live Births—illegitimate—female 52 47 Birth rate per 1,000 population 17.3 17.3 Birth rate per 1,000 population (England and Wales) 19.1 20.5 Stillbirths—legitimate—male 25 27 Stillbirths—legitimate—female 19 14 Stillbirths—illegitimate—male 2 2 Stillbirths—illegitimate—female 2 2 Stillbirth Rate per 1,000 (live and still) births 26 23 Deaths—male 588 556 Deaths—female 500 562 Death rate per 1,000 population 10.4 10.5 Death rate per 1,000 population (England and Wales) 11.5 12.0 Infant Mortality rate 29.4 39.0 Infant Mortality rate (England and Wales) 43 41 Maternal Mortality rate 2.2 0.5 Maternal Mortality rate (England and Wales) 1.4 1.2 Out-relief disbursed to Heston and Isleworth residents £19,008 £21,752 VITAL STATISTICS Population.—The population of the Borough at the 1931 census was 76,460 and the RegistrarGeneral's mid-year estimate of population for 1947 was 106,670. Rateable Value.—The rateable value of the Borough for 1947 was £976,882 and the sum represented by a penny rate was £4,003. Inhabited Houses.—According to the rate books the number of inhabited houses at the end of 1947 was 27,659. Live Births.—The number of live births in 1947 was 1,846 as compared with 1,805 in 1946. The birth rate was 17.3 per 1,000 population, while that of England and Wales was 20.5. The number of illegitimate births was 77 as compared with 114 in 1946. The proportion of births which were illegitimate expressed as a percentage of the total live births, is shown below for recent years :— 1920-24 3.4 1925-29 3.9 1930-34 3.2 1935-39 2.9 1940-44 4.6 1945 7.5 1946 6.3 1947 4.2 The number of births may not appear to be of special interest as far as the year in which they occur is concerned, but it is of considerable significance for the future. From the number of live births in 1947 can be estimated the number of children entering school in the year 1952, the number entering employment in the year 1962, the number available for the Forces in the year 1965 and the number qualifying for retirement pensions in the year 2012, etc. Stillbirths.—The number of stillbirths in 1947 was 45 (41 legitimate, 4 illegitimate). The proportion of stillbirths per 1,000 total (live and still) births in recent years is shown below : No. of stillbirths Rate per 1,000 total births 1930-34 214 31.2 1935-39 224 29.4 1940-44 200 27.7 1945 39 25.7 1946 48 25.9 1947 45 23.8 It is difficult to assess accurately all the factors contributing to this saving of potential lives, but no doubt increasing attention to the nutrition and ante-natal care of expectant mothers has played a large part. Deaths.—The deaths of residents of the Borough during 1947 were 1,118 (556 male, 562 female). This represents a death rate for the Borough of 10.5 per 1,000 population, as compared with 12.0 for England and Wales. Some differences are shown in Tables II and IV, as the analysis of causes carried out locally does not agree in detail with that supplied by the Registrar-General. A progressive change is taking place in the percentage age distribution of deaths, and this is indicated in the following table:— 1910-14 1940-44 1945 1946 1947 Under 1 year 21.8 7.8 8.2 4.9 6.4 1-4 years 8.4 1.4 0.8 0.9 1.2 5-14 years 3.8 1.8 0.6 1.1 0.4 15-24 years 3.7 2.8 2.7 2.6 1.7 25-64 years 30.8 35.2 34.1 34.0 32.9 65 years and over 31.5 51.0 53.6 56.5 57.4 6 The chief causes of death during the year were heart disease (127), cancer (81), cerebral haemorrhage, etc. (58), and bronchitis (52) in males, and heart disease (130), cancer (100), cerebral haemorrhage, etc. (62), and pneumonia (37) in females. Infant Mortality.—During 1947 there were 72 deaths of children under the age of 1 year. This represents an infant mortality rate per 1,000 live births of 39 as compared with 41 for England and Wales. The causes of infant deaths are shown in Table III. in tne following tables tne cnange in tne local lniant mortality rate over 5 year periods from 1898 is shown :— No. of live births No. of deaths under 1 year Infant Mortality Rate Infant Mortality Rate expressed as percentage of rate for 1898-1902 1898-1902 4,369 698 160 100 1903-1907 5,264 665 126 79 1908-1912 5,383 590 110 69 1913-1917 .. 4,661 461 99 62 1918-1922 .. 4,326 327 76 48 1923-1927 4,333 271 63 39 1928-1932 .. 6,055 318 53 33 1933-1937 7,121 313 44 28 1938-1942 .. 6,912 393 57 36 1943-1947 .. 8,210 345 42 26 It will be seen that apart from a break in 1938-42 the fall in the infant mortality rate has been steady and continuous. The rate of fall is slowing down as preventable deaths are being eliminated. The chief causes of infant deaths are (a) prematurity and congenital defects and (b) infections. The following table shows the trend of the infant mortality rate for these two conditions:— Rate per 1,000 live births. 1911-15 1940-44 1945 1946 1947 Cause of death. Prematurity, congenital defects, etc. 30.4 22.7 23.6 17.1 18.9 Gastro-enteritis, pneumonia and other infections 62.6 22.8 12.1 4.4 15.2 The figures indicate that the hard core of deaths from prematurity, etc., is beginning to yield. They also show that too many infant deaths continue to be due to infection. While advances in medical science have done much to reduce the toll of infections, efforts must be continued to remove factors such as overcrowding and ignorance which contribute to the occurrence, spread and neglect of infections. Maternal Mortality.—The number of deaths due to causes associated with piegnancy and childbirth was one. This gives a maternal mortality rate per 1,000 total (live and still) births of 0.5 as compared with 1.2 for England and Wales. This rate of 0.5 is the lowest to be found in the Borough records. Maternal deaths are usually divided into those due to septic infection and those due to diseases and other conditions associated with pregnancy and labour, and the local trend of deaths from these two causes is shown below :— Maternal deaths per 1,000 total (live and still) births. Sepsis Other causes Total 1930-34 2.6 1.7 4.4 1935-39 1.0 2.1 3.1 1940-44 0.7 1.2 1.9 1945 0.6 1.3 2.0 1946 0.5 1.6 2.2 1947 0.5 0.5 Here, as with the national figures, the reduction in maternal deaths is shown to be due largely to the prevention of deaths from septic infection, and much of the credit for this must go to sulphonamides and penicillin. Improved ante-natal and obstetric care have played their part in the overall reduction and must continue the fight against deaths from causes other than sepsis. GENERAL PROVISION OF HEALTH SERVICES Laboratory Service.—Certain routine bacteriological work is done in the laboratory at the Health Department. When more detailed investigation is required specimens are sent to the Clinical Research Association, the Camberwell Research Laboratory or the Public Health Laboratory Seivice. The number of specimens examined during 1947 was 419. Ambulance Service.- The service provided by the Council was available throughout the 24 hours and the vehicles (2 ambulances, 1 car) were housed at the Ambulance Station in Montague Road. A new ambulance was put into service during the year. The number of journeys made during the year was 5,369 (512 accident, 4,857 other) as compared with 4,386 (590 accident, 3,796 other) in 1946. Middlesex County Council maintained a fleet of ambulances at West Middlesex County Hospital and an ambulance for infectious cases was provided by the South Middlesex and Richmond Joint Hospital Board. Home Nursing.—The Borough was served by the Heston and Isleworth District Nursing Association, whose nurses attended 2,777 patients and made 26,800 visits during 1947. The Council made a contribution to the funds of this voluntary organisation. . Infant Welfare Centres.—Sessions are held at Hounslow and Isleworth Health Centres, Heston lllage Hall and Cranford Memorial Hall. Twelve sessions are held each week and a doctor is present at each session. The work is almost wholly of an advisory nature in regard to the rearing and nurture 0 mtants and young children. When further treatment is required the children are referred to private Practitioners, hospitals, etc. At the centres mothers can purchase certain dried milks and vitamin preparations and can obtain orange iuice and vitamin suDDlements suDDlied bv the Ministry of Food. he attendance of children during 1947 is shown below:— 7 Hounslow Isleworth Heston Cranford Total No. of sessions 206 152 151 99 608 First attendances (under 1 year) 729 400 266 114 1,509 First attendances (1-5 years) 90 45 34 21 190 Total attendances (under 1 year) 9,593 5,818 4,663 2,028 22,102 Average per session 47 38 31 20 36 Total attendances (1-5 years) 3,818 2,381 2,552 1,776 10,527 Average per session 19 16 17 18 17 Medical consultations (under 1 year) 2,519 1,613 1,361 779 6,272 Average per session 12 11 9 8 10 Medical consultations (1-5 years) 1,150 686 816 580 3,232 Average per session 6 5 5 6 5 1 he total of attendances was 32,629 as compared with 32,307 in 1946. Each session is of 2\ hours and apart from any consideration of mothercraft or other talks, demonstrations, etc. to mothers, the numbers attending should permit of reasonable attention to the individual child by nurses and doctors. On this basis the Hounslow sessions are overloaded, the Isleworth sessions working to capacity, the Heston sessions nearly to capacity and only at Cranford can the load be increased without detriment. Restrictions of space limit the number of nurses who can be usefully employed at any session. The striking feature of the above table is the poor attendance of children between the ages of 1 and 5 years. Various methods such as special sessions for toddlers, appointments at 6 or 12 month intervals, toddlers waiting rooms equipped with toys and play material and under the supervision of an assistant or voluntary worker, etc., have been suggested to facilitate the attendance of pre-school children. To put any of these into operation here would require additional space and/or staff and neither is available. Nothing less than a complete examination each year by a doctor should be the aim for pre-school children, and if this could be arranged on an appointment system most mothers would be able to attend with the child. In due course the provision of nursery schools and classes will bring many children under medical supervision, but at the earliest opportunity welfare centres should be organised and staffed to allow of more attention to the toddlers. Ante-natal and Post-natal Clinics.—These clinics were held at Hounslow and Isleworth Health Centres, and each week there were 5 routine and 1 consultant sessions. Patients are referred to the clinic by midwives, doctors and West Middlesex Hospital and where special treatment is required arrangements are made with the appropriate doctor, clinic or hospital. The attendances for post-natal examination have never been satisfactory, but some improvement is taking place. All post-natal patients are seen by the consultant obstetrician. More women are seeking advice on sterility and family spacing and arrangements are made for the necessary investigation or they are referred to the Hounslow branch of the North Kensington Women's Welfare Centre. The attendances at the ante-natal and post-natal clinics during 1947 are shown below :— Routine Clinics Consultant Clinics Ante-natal. No. of mothers. (a) primipara 375 20 (b) multipara 839 14 Total attendances 6,583 449 Post-natal. No. of patients — 181 Total attendances — 280 Gynaecological. No. of patients — 24 Total attendances — 41 No. of sessions—Hounslow 153 52 Isleworth 105 — Average attendance per session— Hounslow 43 15 Average attendance per session— Isleworth 18 — The average attendance per session at the Hounslow routine clinic was much too high and placed a heavy strain on all concerned. In the hope of easing this, arrangements were made for an ante-natal clinic to be opened in Heston in 1948. During the year 273 dockets and 1,095 coupon equivalent certificates for sheets were issued at the ante-natal clinic to expectant mothers. Artificial Sunlight Treatment.—This treatment was provided during the winter months at Hounslow and Isleworth Health Centres and 95 children under school age were treated during 1947. Orthopaedic Treatment.—An orthopaedic clinic was opened at Hounslow Health Centre in January. The surgeon was on the staff of and in-patient treatment and appliances were provided by the Royal National Orthopaedic Hospital. The surgeon attended once each month, and the physiotherapist on two days each week and thus a closer supervision of orthopaedic defects was possible. During the year 52 pre-school children were examined by the surgeon, 30 were provided with appliances and 39 attendances for treatment were made. Defective Vision Treatment.—Children under school age in whom a defect of vision was diagnosed or suspected were referred to the eye clinics provided by the School Health Service. During the year 70 pre-school children were examined by the eye specialist and spectacles were provided as prescribed. Minor Ailment Treatment.—The minor ailment clinics provided under the Education Act weie open to children under school age and 63 such children were treated during 1947. Speech Clinic.—During the year 7 pre-school children were treated by the speech therapist. Child Guidance Clinic.—The child guidance clinic established under the Education Act provided treatment for children under school age and 6 such children weie treated during 1947. 8 School Health Service.—A separate report has been submitted on this service which was provided by Middlesex County Council. Apart from routine medical, dental and cleanliness inspections all the facilities of the school health service were available to pre-school children. Medical Out-relief.—This work was done by the District Medical Officers appointed by Middlesex County Council. Venereal Disease.—Facilities for free diagnosis and treatment were provided by Middlesex County Council. The nearest treatment centres were West Middlesex and West London Hospitals and fares were paid in necessitous cases. Vaccination.—The work under the Vaccination Acts was 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 was undertaken by Middlesex County Council and the clinic serving this area is at 28, Bell Road, Hounslow. In December, 1947, the County Mass X-Ray Unit visited the Borough and was installed at Messrs. A. & F. Pears, Ltd., Isleworth. Arrangements were made for factory groups, Council staff and civil servants to attend, but the general public and school leavers were not included. All doctors were informed of the visit and offered appointments for their patients. The total attendance of persons was 887 men and 900 women. Many employees who had attended eighteen months before on the first visit of the unit to the Borough did not attend on this occasion. The absence of disease on one occasion is no guarantee for the future, and full advantage should be taken of any facilities for regular X-Ray examination of the chest. Midwifery Service.—No midwife engaged in private practice in the Borough during 1947. Midwives were employed by West Middlesex Hospital, nursing homes and by the Council. The establishment of municipal midwives is 10, and during the year the number employed was increased from 8 whole-time to 9 whole-time and 1 part-time. The recruitment of midwives is handicapped by difficulty in finding suitable accommodation for them. The following table shows tne proportion oi live birtns which occurred at home, hospital or nursing home in the Borough and the proportion occurring outside the Borough during the years 1938-47. Year Total Live Births Domiciliary confinements in Borough Nursing home and hospital confinements in Borough Confinements outside Borough No. °/ /o 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 1947 1,846 488 26.4 716 145 861 46.7 497 26.9 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 a medical officer. During the year it was not necessary to report any midwife to the Central Midwives Board for a 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 from the patient unless she has taken advantage of the Council's insurance scheme to cover such contingencies. The percentage of cases in which the midwives sought medical aid was 34.6 as compared with 37.7 in 1946. All the municipal midwives have been trained in gas and air analgesia. Now that the supply of apparatus has improved and the rule requiring the presence of a second midwife or nurse has been relaxed it is easier to provide this service. The apparatus is heavy, bulky and not suitable for carrying on a cycle and the only satisfactory way of overcoming this difficulty would appear to be the provision of cars for midwives. During the year gas and air analgesia was administered by midwives to 60 patients as compared with 35 in 1946. Arrangements were continued for municipal midwives to attend post-certificate lectures and demonstrations organised jointly by the London Middlesex and Surrey County Councils. Care of Premature Babies.—The term " premature " is usually applied to every infant born before full term. If a baby is small but not premature in the foregoing sense, it may need special attention, and therefore doctors and midwives have been asked to record on birth notification cards all baby weights of 5J lbs. or less. The number of Heston and Isleworth babies notified as weighing 5 J- lbs. or less at birth when expressed as a percentage of the total Heston and Isleworth live births gave 5.2 in 1945, 5.7 in 1946 and 5.6 in 1947. Of the 104 premature babies in 1947, 25 were born at home, 73 in hospital and 6 in nursing homes. Special equipment including draught-proof cots, hot water bottles, special feeding bottles, thermometers, etc. is readily available at the request of doctor or midwife for use in cases of premature birth. Convalescent Treatment for Mothers and Children.—No facilities for such treatment are available in the Borough, but mothers and children requiring convalescent treatment were sent where accommodation could be found. During the year 1 mother was sent to a Convalescent Home. The cost was borne by the Council and a charge made according to the circumstances of the patient. Home Helps.—The chief development in this service during the year was the appointment of a whole-time organiser. The concentration in one person of the recruitment, allocation of duties and supervision of the home helps and of the investigation and priority selection of applications brought about an immediate improvement in the administration and efficiency of the service. The close personal contact oi the organiser with the home helps and applicants for assistance, resulted in the staff beipg used to the est advantage and in the removal of friction and difficulties arising from misunderstandings and the 9 divided control of the earlier system. To visit the homes of applicants to assess the type and amount of assistance required, to supervise the work of home helps by visits to households where they are employed, to recruit home helps, and to deal with emergency applications for assistance, it is essential that in an area such as the Borough the organiser should have a car and adequate clerical assistance. Indoor uniform (overalls) is now supplied to the home helps. This with the example and leadership of the organiser has done much to develop a spirit of service and to imbue the staff with the feeling that they are meeting a genuine need. This service is described as " domestic help " in the National Health Service Act, but the women employed on the work prefer the term " home help " because they consider that it describes more accurately the type of service rendered. It is true that in many cases the human touch and a wider concept than mere cleaning or cooking is needed. As confinements do not always take place at the expected time and illness or other domestic crises may occur without warning the staffing arrangements of the home help service must be flexible. While a number of women can be employed regularly for whole or part-time duty it is advisable to have a reserve of women available to meet fluctuations in demand. To find suitable women who will undertake this work in any house in the Borough on a regular or " on call " basis is not easy, and though the number employed during the year varied from 28 to 44, the supply generally fell short of the need. The steadily increasing demand for this assistance is a tribute to the growing confidence in the quality and reliability of the service. During 1947 assistance was given to 344 households (86 maternity, 258 other) as compared with 148 (72 maternity, 76 other) in 1946. According to the circumstances of the household a charge was made for the services of the home help. Care of Illegitimate Children.—Efforts were continued to contact the mothers before the birth of the child with a view to securing satisfactory arrangements for ante-natal care, confinement and for the mother and child after the lying-in period. In this work 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/or for the mother and baby after the confinement and to this end the Council arranged through Middlesex County Council, to use ante-natal and post-natal hostels provided by the British Red Cross Society. These facilities were used for 3 mothers, and 7 mothers and babies during 1947. used for 3 motheis, and 7 mothers and babies during 194/. Some indication of the final airangements for the care of these children is shown in the following table extracted from the records:— 1946 1947 Mother and child living with father of child 20 14 Mother and child living with grandparents 25 3 Child living with grandpaients — 2 Child placed for adoption 6 6 Child in day nursery while mother at work 1 2 Child placed with foster-mother 1 — Child and mother living together 1 1 Child died 1 3 Child living with other relatives 3 — Mother and child left Borough 5 3 Adoption of Children. The Adoption of Children (Regulation) Act, 1939, is designed to ensure that, as far as is practicable, the adoption of any infant 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 the 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 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. This requirement should be borne in mind by doctors, midwives, hospital almoners, clergymen, matrons of nursing homes, etc., whose advice or assistance may be sought in placing a child for adoption. Close contact was maintained with Court Officers dealing with applications for Adoption Orders and every request for information or assistance from Adoption Societies received attention. During the year the Health Visitors made 85 visits in connection with the adoption of children. Child Life Protection.—The Health Visitors undertook the duties of Child Life Protection Visitors. The number of foster children on the register at 31st December, 1947, was 60, and during the year 246 visits of inspection were made. No proceedings were taken against a foster-mother, but in several cases attention was drawn to the need for improvement in the condition or furnishing of the premises or in the care of the child. Day Nurseries.—The four day nurseries with accommodation for 189 children continued in operation during the year, and the charge was maintained at 1/'- per child per day. The attendance of children on Saturdays was poor, and only Nantly House Nursery opened regularly on Saturdays. The average attendance of children was 158 (Monday to Friday) and 17 (Saturday). The demand for accommodation continued and there was always a waiting list at each nursery. Admission generally was restricted to children of mothers in employment, but towards the end of the year the Council decided that social circumstances should also be considered and passed the following resolution " that priority be accorded in the cases of children of separated or deserted wives, widows, unmarried mothers, married women whose husbands are frequently ill and unable to work full time and other cases of children in need of special care by reason of domestic or social conditions." No excessive incidence of infectious disease was noted among the children attending the day nurseries. Shortage of staff was less than in previous years, but the educational care in the nurseries is still unsatisfactory owing to the shortage of trained nursery teachers and wardens. The chief causes of absence of staff are sickness, accidents or domestic reasons such as illness of child or relative. The percentage of time lost for these reasons during the four years 1944-47 was 8.5 among the nursery staff as compared with 4.8 and 2.4 respectively among the other women and men employed in the Health Department. So far no explanation has been found for the relatively high rate of absence in the day nursery staff. Residential Nurseries.—No residential nursery is maintained by the Council. When residential accommodation had to be found for young children because of the admission to hospital of the mother the Council undertook financial responsibility for the maintenance of the children in a short-stay residential 10 nursery, provided by Middlesex County Council. The number of children admitted under this scheme during 1947 was 9 and, according to their circumstances, a proportion of the cost was charged to the parents. Dental Treatment for Mothers and Young Children.—The services of the School Dental Department continued to be available to expectant and nursing mothers and to children under school age. Patients were referred from the ante-natal and infant welfare clinics and the work done during 1946 and 1947 is shown below:— 1946 1947 Total attendances of mothers and children 3,182 3,756 Teeth extracted—Mothers 1,291 822 Children 382 219 Teeth filled—Mothers 944 925 Children 95 252 Other operations—Mothers 670 793 Children 335 438 Dentures supplied to mothers 150 118 General anaesthetics administered 447 477 X-Ray photographs taken 82 91 Supply of Milk and Other Foods.—Schemes for the provision of milk and vitamin preparations have been continued at the ante-natal and infant welfare centres. The following table indicates the extent to which milk, etc., has been supplied free or at a reduced price during the years 1946 and 1947:— 1946 1947 Dried milk (lbs.) 70 24 National dried milk (lbs.) 3,563 4,497 Cod liver oil emulsion (8 ozs.) 8 — Cod liver oil and malt (lbs.) 2 4 Cod liver oil with malt and iron (lbs.) 3 — Lactagol (tins) 8 5 Bemax (tins) 49 56 Adexolin (| oz.) — 4 Kalzana (tablets) 170 50 Vitamin C (tablets) 1,500 500 Virol (lbs.) 1 A Ferrous Sulphate Tablets (packets) - 52 Adexolin Capsules (packets) - 4 ine receipts irom sales at cost price were compared with £4,139 in iy4b. Supply of Ministry of Food Vitamin Supplements.—The ante-natal and infant welfare clinics were distribution centres for the issue of Ministry of Food vitamin supplements. There were other distribution centres in the Borough and the amounts issued in 1946 and 1947 are shown below :— 1946 1947 Orange juice (Vitamin C) (bottles) 140,377 136,151 Cod liver oil (Vitamin A and D) (bottles) 18,889 24,619 Vitamin A and D tablets (packets) 3,033 6,268 The actual take-up in 1947 of these vitamin preparations, 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 25.1.47 56.60 30.25 67.86 4 „ „ 26.4.47 55.54 32.43 56.28 4 „ „ 28.6.47 73.08 34.25 54.70 13 „ „ 29.11.47 58.15 41.82 43.73 Fuller use should be made of these vitamin supplements to avoid any risk of vitamin deficiency in mothers and young children. Nursing Homes.—All nursing homes in the Borough have to be registered and are subject to supervision in regard to premises, staff and equipment. The demand for accommodation, especially for maternity cases, has been heavy, and careful watch has had to be maintained to avoid overcrowding. One nursing home closed in May, and at the end of the year the nursing home accommodation in the Borough was 16 medical and surgical and 8 maternity beds. Scabies Clinic.- The number of persons treated at this clinic during the year was 140 as compared with 395 in 1946, 630 in 1945 and 992 in 1942. The reduction in the incidence of this infectious and irritating skin disease is welcome. The recent epidemic has shown that if sufferers will seek treatment early and all family contacts submit to prophylatic treatment the spread of the disease can be controlled. The de-lousing of persons other than school children was undertaken by the staff of the scabies clinic. During 1947, 7 adults were de-loused and given advice on how to keep themselves free from infestation. Insulin.—The Health Department continued to supply insulin, at cost price, reduced price or free, according to circumstances, to persons suffering from diabetes who were not eligible to get such under the provision of the National Health Insurance Act. During the year 576 vials were supplied as compared with 514 in 1946. Health Education.—Posters and leaflets issued by the Central Council for Health Education were displayed and distributed at welfare centres, clinics, etc. and a special effort was made in regard to immunisation against diphtheria. The booklet " To Mothers and Fathers " published by the National Association of Maternity and Child Welfare Centres was issued free to mothers on the occasion of the irst attendance of the baby at the welfare centre. The Health Department participated in the Civic eek Exhibition in June, 1947. Medical Officers gave talks on the National Health Service and other 11 aspects of public health to various organisations in the Borough. The staff of the Department in their contact with people in their homes and at clinics have continuous opportunity for health education and the importance of this aspect of their work should not be forgotten. Medical Examination of Staff.—For superannuation and other purposes members of the staff of the Council and Middlesex County Council were referred to the Health Department for medical examination. During the year 186 such medical examinations were carried out as compared with 75 in 1946. Removal of Aged or Infirm.—The necessary applications were made to Court for the extension of the Order under Section 272 of the Middlesex County Council Act, 1944, by which an aged and infirm person was removed to an institution in 1946. Health Visitors.—Twelve Health Visitors were employed and they acted also as School Nurses and Child Life Protection Visitors. A summary of their work other than as School Nurses, is given below:— 1946 1947 Attendances at infant welfare centres 877 942 Attendances at ante-natal clinics 605 618 Attendances at diphtheria immunisation clinics 199 219 Attendances at scabies clinics 135 160 Visits to expectant mothers— First 683 755 Subsequent 97 63 Visits to mothers (post-natal) 11 12 Visits to children under 1 year old First 1,449 1,767 Subsequent 2,755 3,054 Visits to children, 1 to 5 years old 4,255 4,354 Visits re stillbirths 31 37 Visits re infant deaths 37 61 Visits re inflammation of babies' eyes 36 15 Visits re infectious disease in children under school age 277 465 Visits re child life protection 373 246 Visits, miscellaneous 577 350 Visits—no access or person not at home 2,064 2,186 It should be remembered that health visitors, except when acting as child life protection visitors, have no legal powers behind them, and the success of their efforts is dependent on sound knowledge, persuasion, and perseverence and the greatest of these probably the last. The National Health Service Act envisages the health visitor, extending her health educational activities to cover all members of the family. No matter what clinic facilities be provided, home visiting will continue to be the most important part of a health visitor's work. With our present staff of health visitors home visiting is falling short of need, and no extension of duties can be undertaken till our establishment of health visitors is increased. INFECTIOUS DISEASE Incidence of Notifiable Diseases.—The numbers of cases notified during the last eight years are shown below:— 1940 1941 1942 1943 1944 1945 1946 1947 Smallpox — — — — — — — — Scarlet fever 96 117 190 280 130 124 67 62 Diphtheria 73 37 11 5 11 24 16 3 Erysipelas 35 20 16 21 16 16 19 19 Pneumonia 200 124 72 116 50 25 47 56 Cerebro-spinal fever 43 34 12 — 3 11 13 8 Epidemic encephalitis 1 1 — — — 1 — — Poliomyelitis and 43 polioencephalitis 1 1 — — 3 7 1 Typhoid fever 3 2 4 1 — — 1 1 Paratyphoid fever 1 30 1 — — — — — Dysentery — — 2 — 22 28 6 — Tuberculosis— Pulmonary 121 157 177 165 167 128 200 160 Non-pulmonary 9 17 25 25 17 29 17 20 Ophthalmia neonatorum 2 5 3 — 5 3 2 — Puerperal pyrexia 42 22 58 105 87 45 54 60 Measles 1,109 580 1,085 636 219 1,109 170 840 Whooping cough 123 286 243 134 171 110 170 142 Malaria — — — — 1 2 1 — 12 The age distribution of notifiable disease during 1947 is shown in Table V. Scarlet Fever.—This disease continued to be of a mild type. No death from this disease has occurred in the Borough since 1937, and the incidence of the disease (62 cases) was the lowest in the Borough records. Of these 62 cases 24 were admitted to hospital. Diphtheria.—The number of cases (3) was the lowest recorded in the Borough and for the second time in recent years no death from diphtheria occurred. The incidence and death rate of this disease from 1900 are shown in the following table:— Case rate per 100,000 population Death rate per 100,000 population 1900-04 153 25 1905-09 196 15 1910-14 108 11 1915-19 166 12 1920-24 200 19 1925-29 231 13 1930-34 111 8 1935-39 41 3 1940-44 29 2 1945 24 2 1946 15 1 1947 3 Nil The steady and persistent fall since 1930 can be attributed only to immunisation. Since immunisation was started in 1930 there have been 816 cases, and 58 deaths from diphtheria, and of these 23 and 1 respectively had been immunised. The progress of the immunisation scheme is shown on the table overleaf. This disease can be kept under control only if parents will co-operate by having their children protected. In 1946 there were 1,805 births and approximately that number of children reached their first birthday in 1947, but only 728 were immunised. A much higher proportion of young children must be protected and the future record of diphtheria will be a measure, not of the efficiency of the Health Department, but of the intelligence and foresight of parents in the Borough. Erysipelas.—Though 19 cases were notified no death was due to this disease. Pneumonia.—There was a slight increase in the notification of pneumonia as compared with 1946. The death rate per 1,000 population from pneumonia was 0.6 in 1930-34, in 1942-46 and in 1947. Of the total pneumonia deaths 20 per cent, occurred at age 0-4 years and 55 per cent, at age 65 and over. Cerebro-spinal Fever.—This disease was less prevalent than in 1946, but its incidence is still higher than in the pre-war years. The sulphonamide drugs have greatly reduced the mortality from this disease. Epidemic Encephalitis.—No case or death from epidemic encephalitis occurred during 1947. 13 14 CHILDREN IMMUNISED AGAINST DIPHTHERIA, 1930-47 Age 1930-32 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 0 7 1 1 - 1 - - 1 3 4 7 3 2 8 18 13 1 87 17 31 49 45 71 58 66 113 227 378 593 482 745 986 728 2 138 40 72 93 69 87 95 114 131 281 290 256 125 207 202 181 3 158 27 89 97 52 65 66 91 92 247 234 206 54 71 103 100 4 206 31 77 93 69 61 75 105 94 219 249 205 72 47 60 107 5 309 67 89 118 81 102 109 130 119 262 291 229 64 57 69 88 6 420 59 128 122 71 91 128 117 85 283 240 224 41 60 66 46 7 403 43 77 79 38 51 82 91 78 184 186 166 42 36 56 46 8 405 42 70 59 36 34 74 72 64 209 153 169 33 38 42 38 9 402 31 38 49 40 23 104 66 66 166 156 121 32 33 41 45 10 416 28 36 44 22 32 85 51 48 157 154 132 37 32 27 47 11 262 14 33 20 26 22 54 40 55 165 130 106 41 28 37 32 12 154 12 18 12 17 12 40 28 31 105 128 109 35 25 16 16 13 132 4 24 15 14 3 26 18 38 100 109 96 42 17 24 17 14 49 1 6 7 8 5 11 4 15 35 36 41 21 10 7 6 Total 3,548 417 789 857 589 659 1,007 994 1,032 2,644 2,741 2,656 1,123 1,414 1,754 1,510 3,885 or 50.0% of estimated population aged 0-4 years 10,656 or 77.3% of estimated population aged 5-14 years Poliomyelitis and Polioencephalitis.—These names describe two types of infection by the same virus : In the former the spinal cord is chiefly affected, and in the latter the brain bears the brunt of the infection. Though poliomyelitis was apparently known to the ancients, the first account of paralysis associated with fever in young children was published towards the end of the 18th century. While scattered cases were reported in Europe and North America it was not till 1870 that the disease was recognised as occurring in epidemic form. These epidemics made their appearance first in Scandinavia, then in United States, and then in Australia. In these countries epidemics involving thousands of persons began to be more frequent, while small outbreaks occurred in England and elsewhere in Europe. Since 1936 there has been an increase in epidemics in Europe, though their distribution has been patchy. The disease has been notifiable in England since 1912, but there has been no epidemic comparable to that of 1947. Though final figures are not available the incidence was about 20 per 100,000 population. This incidence is about the same as in the United States epidemic of 1916, but much less than in the 1941 epidemic in Norway and Sweden or in the 1944 epidemic in Switzerland. With the development of the disease to epidemic proportions the age incidence has altered. Originally the disease occurred chiefly in young children— hence the name, infantile paralysis—but in recent years an increasing proportion of adolescents and young adults have been affected. Accompanying this age incidence change there has been a change in the type of disease resulting in an increase of non-paralytic cases. Poliomyelitis has been reported from all parts of the world, but a peculiar feature is that epidemics appear and recur in countries where sanitation and hygiene are at a high level. Though the virus can be demonstrated in the excreta of patients and contacts there is no sound evidence to warrant considering the disease to be transmitted by water, food or flies. The disease is thought to spread by person-to-person contact, but in what way is still unknown. The current view is that for every person showing clinical signs of the disease many are infected, but show few or no symptoms. Doctor Horstmann of Yale University summarised the position as follows in the Lancet early in 1948:—"In spite of all the information collected by many investigators in many lands we still cannot say why poliomyelitis suddenly became epidemic almost sixty years ago, why it is increasing rather than decreasing like other infectious diseases, why it is a summer disease with a preference for certain lands, how it is spread or how it may be prevented." The early symptoms of the disease are almost indistinguishable from those of any febrile disease and doctors were encouraged to arrange admission to hospital on any suspicion that an illness might be poliomyelitis. The diagnosis was confirmed in 44 cases out of 61 notified. One case, a patient in West Middlesex Hospital, was not a resident of the Borough. Of the 43 Borough cases 3 died, 21 made a complete recovery and the remaining 19 were transferred to orthopaedic hospitals or clinics for treatment of the residual paralysis. The age distribution of the cases is shown in Table V. In one household 3 cases occurred, in another household 2 cases, but the other cases occurred singly. The ward distribution of the cases was as follows:—Heston, 8; Hounslow Central, 2; Hounslow West, 2; Hounslow South, 3; Hounslow Heath, 12; Isleworth North, 6; Isleworth South, 7; Spring Grove, 3. Apart from multiple cases in the same household direct contact between cases was traced in one instance only. No closure of schools, swimming baths, children's cinema, etc. was undertaken with a view to controlling the spread of infection. Typhoid and Paratyphoid Fevers.—No case of paratyphoid fever and only one case of typhoid fever was notified during 1947. The source of infection of this one case was not traced. Dysentery.—No case of dysentery was notified during the year. Tuberculosis.—The notifications of pulmonary tuberculosis weie 40 less than in 1946, but there was an increase of 3 in the notification of non-pulmonary tuberculosis. The downward trend of deaths from tuberculosis was maintained as is shown below:— Tuberculosis Death Rate per 100,000 population. Pulmonary Non-pulmonary Total 1930-34 67.5 11.5 78.9 1935-39 52.3 8.2 60.4 1940-44 55.8 7.4 63.2 1945 45.2 9.5 54.7 1946 44.1 9.6 53.7 1947 44.1 4.7 48.7 The number of cases of tuberculosis on the Borough register at 31st December, 1947, was 887. Ophthalmia Neonatorum.—No case of this infection of the eyes of young babies was reported during the year. Puerperal Pyrexia.—This condition is defined as "any febrile condition occurring in a woman within 21 days after childbirth or miscarriage in which a temperature of 100.4 degrees F. or more has been sustained during a period of 24 hours or has recurred during that period." Such a febrile condition, no matter what is the cause, is notifiable so that appropriate action can be taken if investigation suggests that the condition is likely to be puerperal fever. During the year 60 cases were notified but no woman died from puerperal or post-abortion sepsis. Measles.—This disease was more prevalent than in 1946 and caused 2 deaths. Admission to hospital was arranged for 64 cases. Whooping Cough.—The incidence of this disease (142 cases) showed little change from previous years. Two deaths were due to whooping cough. Admission to hospital was arranged for 23 cases. Owing to the conflicting reports on the efficacy of whooping cough vaccine no effort has been made to introduce 'mmunisation against this disease. Malaria.—No case was notified during 1947. Influenza.—No epidemic of influenza occurred during 1947 and the deaths due to this disease were 8 as compared with 15 in 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. The following numbers of cases were recorded during 1947 :—mumps, 26 ; chicken pox, 396; and german measles, 66. ''ever Hospital.—The Borough is served by the South Middlesex Infectious Diseases Hospital and ring the year 218 patients from the Borough were admitted in cases of infectious disease. Close contact is maintained between the hospital and the Health Department so that any necessary action can be taken. 15 Disinfection.—The disinfection of bedding, etc. is done at South Middlesex Infectious Diseases Hospital while the disinfection of homes is carried out by the disinfectors on the Health Department staff. In 1946, after considering a report on the subject, the Council 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." Twenty-three rooms were disinfected during 1947. Food Poisoning.—No outbreak of food poisoning occurred in the Borough during 1947. Strict personal hygiene by all persons handling and cooking food is the most important matter in the prevention of such outbreaks. 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 was carried out during the year:— Supplies provided or reinstated 40 Cisterns, cleansed, repaired, etc. 43 Draw-off taps connected direct to main 6 Service pipes or taps repaired 102 Cases where mains supply substituted for well supply Nil Samples taken from wells for analysis Nil Wells abolished 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 was carried out during 1947:— Drains exposed for examination 82 Drains unstopped, repaired, etc. 392 Waste pipes repaired, trapped, etc. 75 Soil pipes repaired, etc. 13 Ventilating shafts repaired, etc. 9 Fresh air inlets repaired, etc. 6 Rainwater pipes disconnected from drains Nil Gully traps inserted or repaired 114 Disconnecting traps inserted or repaired 5 Disconnecting and inspection chambers provided 19 Disconnecting and inspection chambers repaired, etc. 91 Drains constructed or repaired 67 Total length (ft.) of drain pipes laid— (a) 4 in. 1,971 (b) 6 in. 56 Drain tests applied 123 Other works executed 7 Cesspools emptied or repaired 1 Cesspools abolished Nil Rivers and Streams.—The supervision of the rivers and streams in the Borough is carried out by Middlesex County Council. No complaint of pollution was made to the Health Department during 1947. 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 were carried out during the year:— Water closets constructed or rebuilt 16 Water closets provided in substitution for dry receptacles 2 Water closets where walls cleansed 55 Water closets fitted with new flushing apparatus 55 New pans or pedestals provided 128 Water closets repaired or improved 172 Water closet blockages unstopped 19 Other closets provided or repaired 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 149 new dustbins were provided during 1947. The following details of the salvage of waste materials have been provided by the Borougn Engineer:- 1942 1943 1944 1945 1946 1947 Paper (tons) 1,212 986 770 619 709 686 Scrap metal (tons) 416 575 55 24 28 40 Textiles (tons) 65 67 69 67 65 56 Bones (tons) 34 24 20 12 8 4 Bottles, jars (tons) 256 338 233 167 251 166 Cullet (tons) 19 61 42 6 17 10 Rubber (tons) 33 36 29 - 1 9 Kitchen waste (tons) 855 940 1,037 1,083 1,173 1,077 Miscellaneous (tons) 3 4 14 - 60 - Value £11,178 £11,516 £9,721 £8,231 £11,405 £11,207 16 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 :— Complaints received 2,017 Number of premises at which nuisances, etc., were located 1,447 Number of premises where defects were remedied:— (a) by owners or occupiers 1,414 (b) by Council in default 51 (c) public sewers repaired by Council 26 Informal notices issued 1,035 Written reminders issued 897 Statutory Notices served 206 Total number of inspections and re-inspections 21,643 Inspections of piggeries 64 Inspections of stables 99 Inspections of urinals 13 Inspections (Rag Flock Act) 2 Sinks repaired or renewed 62 Roofs repaired 485 Gutters repaired or renewed 358 Number of premises provided with damp-proof courses 2 Yards paved or drained 29 Floors, walls, etc., repaired or renewed 1,590 Windows repaired or renewed 514 Doors repaired or renewed 146 Grates provided or repaired 154 Wash coppers provided or repaired 12 Larders provided or repaired 5 Offensive accumulations removed 46 Other nuisances abated 110 Visits re infectious disease, etc. 214 Smoke Abatement.—The emission of smoke, grit and ash from a factory chimney may constitute a nuisance within the meaning of the Public Health Acts. Smoke from domestic chimneys can be a nuisance and do a lot of damage, but is free from all supervision or control. The Sanitary Inspectors carried out 46 smoke observations on factory chimneys during the year and paid many visits to premises which had been the subject of smoke nuisance complaint. Tents, Vans, Caravans.—The inspectors made 362 visits of inspection because of the occupation of land by tents, caravans, etc. In one area of the Borough trespass by caravans on unfenced land is particularly frequent. Removal of the caravans usually followed verbal notice from the Sanitary Inspector, but at other times the assistance of the Police had to be obtained and the caravans towed off the site. In this way caravans were removed on 165 occasions. The occupants were of the type who travel round the fringe of urban areas ; and go from door to door buying or selling firewood, scrap metal, etc., and it was not unusual for the caravan to be back on the same site within a few days. There are 5 sites in the Borough which have been used as caravan sites for many years. Some of these are occupied wholly or in part by persons who use caravans for business in connection with a travelling circus, roundabout, fair or stall. Under the provisions of the Middlesex County Council Act permission to establish caravans on four other sites was refused by the Council. Common Lodging Houses.—There is no common lodging house in the Borough. Canal Boats.—The Sanitary Inspectors continue their duties as canal boat inspectors and made 57 inspections during the year. Factories, Workplaces, etc.—The Factories Act placed on the Council certain duties in regard to (a) outworkers; (b) employment of persons in unwholesome premises; (c) basement bakehouses; (d) provision of sanitary conveniences in all factories, and (e) cleanliness, overcrowding, ventilation and drainage of floors in the case of factories in which mechanical power is not used. A summary of the work done is given below :— Inspection of (a) Factories—mechanical power 653 (b) Factories—non-mechanical power 31 (c) Other premises 35 (d) Workplaces 75 (e) Outworkers' premises 167 Defects remedied 34 Mosquitoes.—Complaints from the Whitton and Twickenham Road areas of the presence of biting mosquitoes have been less during 1947 than in recent years. No evidence was found of the presence of culex molestus, the biting mosquito, that caused so much annoyance during the years 1939-46. Disinfestation.—The Housing Department deals with verminous infestation in Council houses, while such infestations in other houses is dealt with by the Health Department. For this purpose D.D.I. and other new insecticides were used and 61 rooms in 22 houses were treated. Noise Nuisance.—In the Middlesex County Council Act a noise nuisance is deemed to exist "where any person makes or continues or causes to be made or continued any excessive or unreasonable or unnecessary noise which is injurious or dangerous to health." Further, it is a good defence for the person charged to show " that he has used the best practicable means of preventing or mitigating the nuisance, having regard to the cost and to other relevant circumstances." Most complaints of noise nuisance arise in connection with industrial processes carried on in factories situated close to houses. From the above nition it will be seen that many factors have to be taken into consideration in judging whether or not a noise is a nuisance within the meaning of the Act, though there may be no doubt about the annoyance 17 to residents in the neighbourhood of the factory concerned. During the year complaints of nuisance due to noise were received in regard to 8 factories. Many day and night observations were made concerning these complaints and every effort made in conjunction with the firms concerned to reduce the noise as far as was practicable. Rats and Mice Destruction.—Under the general direction of the Chief Sanitary Inspector a Rodent Officer and two operatives carry out the work required under the Rats and Mice (Destruction) Act, 1919. A summary of the work done since the powers and duties under the Act were transferred to the Council is shown below:— 1944 1945 1946 1947 Complaints received 227 208 240 275 Block inspections 6 38 59 28 Individual inspections 695 1,321 1,492 2,089 Individual re-inspections 146 243 322 225 Other visits 191 110 248 338 Premises treated — (a) By occupiers 88 82 136 100 (b) By Local Authority 317 446 660 836 The responsibility for keeping premises free from rats and mice rests with the occupiers. If they ire unable or do not care to undertake the necessary work themselves the services of the Council's operatives ire 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 >ut to sewers, watercourses, tips, etc., but unless occupiers take active measures to discourage rats, slow progress will be made towards eradication. HOUSING To-day the shortage of houses is such that houses suitable for demolition have to be retained. The lousing 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 luring 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:— (a) By Local Authority 146 (b) By private enterprise 66 Houses inspected 822 Defective houses rendered fit in consequence of informal action 262 Defective houses rendered fit in consequence of statutory action 252 Houses in respect of which Demolition Orders were made Nil Houses demolished in pursuance of Demolition Orders 10 Houses rendered fit in consequence of undertaking given by owner Nil Houses known to be overcrowded (Housing Act standard) at end of year 123 New cases of overcrowding reported 47 Cases of overcrowding relieved during the year 5 Southall Corporation erected 10 and Brentford and Chiswick Corporation 20 of the new Local Authority houses recorded in the above table. Of the 66 private enterprise houses 32 were conveyed after erection to Heston & Isleworth Corporation. In addition, 109 houses were built privately to replace houses totally destroyed by enemy action. Thus the total number of new dwellings erected in the Borough during the year was 321. At the end of 1947 tenants were occupying 52 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 is a true picture of overcrowding as such could be obtained only by a census or survey of all houses, rhe 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 the building loss due to the war will take some time to make good. INSPECTION AND SUPERVISION OF FOOD Milk.—During the year 148 inspections were made at cowsheds, dairies and retail purveyor’ premises. Under the Milk (Special Designations) Orders 18 licences for the sale of " tuberculin tested milk, 23 for the sale of " pasteurised " milk and 1 for a pasteurising plant were issued. 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 were less frequent in 1947 as compared with 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. Ice-Cream.—Under the Food and Drugs Act premises used for "the sale, or the manufacture for the purpose of sale, of ice-cream or the storage of ice-cream intended for sale" must be registered. This does not apply to premises used primarily as a club, hotel, inn or restaurant and only to a theatre, cinematograph theatre, music hall or concert hall if the ice-cream is manufactured on the premises. During the year 204 inspections of registered premises were carried out. 18 Originally, ice-cream was made from cream, milk, sugar, eggs and flavouring agents. Before the war the manufacture of ice-cream had become an important industry but, to keep the price within the range of all, substitutes such as starch and gelatine had taken the place of cream and eggs. Before the war large-scale manufacturers produced an ice-cream with a reasonable sugar and fat content, while many small dealers used custard powder or bought prepared ice-cream mixes and their product usually had a low fat content. In 1945 when the sale of ice-cream was again permitted, manufacturers were granted supplies of fat, sugar and powdered skimmed milk. The latter was soon withdrawn, and the restrictions on the use of milk and butter have resulted in many formulae being tried to give the necessary consistency and some food value. There is no statutory standard for ice-cream in this country, though just before the war the Manufacturers' Association proposed a standard of not less than 8 per cent, milk fat and not less than 10 per cent, of other milk solids. The establishment of a chemical standard would be difficult in the present food supply position. In recent years the cleanliness of ice-cream has given rise to anxiety, and though no bacteriological standard has been laid down the Ice-Cream (Heat Treatment) Regulations were brought into operation in May, 1947, with a view to improving the hygienic quality. The Regulations require all ice-cream, except complete cold-mix powders, to be heat treated with a view to killing any pathogenic organisms which may be present and lay down the temperatures at which mixtures are to be kept before and after heat treatment—these temperatures are such as to discourage bacterial growth. The enforcement of these regulations will call for regular and persistent supervision of premises, plant, etc., by Sanitary Inspectors especially as the necessary new plant is difficult to obtain. The attention of all manufacturers and vendors of ice-cream has been drawn to the Regulations, and the opportunity taken to remind them of the general hygienic requirements laid down in the Food and Drugs Act for any premises used for the manufacture or sale of any food. Bakehouses.—Visits of inspection to bakehouses numbered 140 in 1947. On six occasions complaints were received of the presence of foreign bodies, e.g., cigarette end, nail, etc., in bread or cakes. The offenders were warned in five cases, and a fine of £5 with 5 guineas costs was inflicted in the other case. Slaughterhouses, etc.—There is no public abattoir in the Borough, and the eight private slaughterhouses remain closed. There is one licensed knacker's yard and the humane killer is used on all animals slaughtered there. Inspection of Meat and Other Foods.—Premises where food is prepared or sold were submitted to regular inspections. Inspections of food were carried out during the year as follows:—Meat, 294; fish, 99; provisions, 314; vegetables and fruit, 116; hawkers foodstuffs, 46; and other foods, 15. Premises where food was prepared were submitted to 755 inspections. During the year 29,191 lbs. of unsound food and 5,774 tins of unsound tinned food were seized by or surrendered to the Sanitary Inspectors on retail premises in the Borough. The weight of unsound food is much greater than in 1946, by reason of the condemnation of 19,600 lbs. of vegetables which had been delayed in transport. No prosecution for selling or exposing for sale food which was unfit for human consumption was undei taken during 1947. Municipal Restaurants.—One municipal restaurant was closed in March, but the other was open during the whole year. The number of meals served during 1947 was 58,135 to the public and 62,032 to school children. No complaint in regard to the food served in these restaurants reached the Health Department. Food and Drugs Sampling.—During 1947 the following samples for analysis were taken in the Borough by the Public Control Department of Middlesex County Council:— No. of Samples No. found adulterated Milk 262 10 Channel Island Milk 3 - Almond substitute 1 - Boracic ointment 1 - Brandy 3 - Cooked Meat 1 - Cream Cheese 1 - Fish Cakes 1 - Gin 8 3 Meat Pies 3 - Meat Savouries 2 - Mineral oil 1 1 Rum 2 - Sausages 3 - Sausages, cooked 11 - Sausage Meat 9 - Sulphur Lozenges 1 - Sweets 2 2 Whisky 6 2 White Precipitate Ointment 1 - 322 18 As a result of these analyses four prosecutions were instituted and resulted in fines and costs amounting to £30 5s. Od. 19 20 TABLE I Summary of Vital Statistics 1895-1947 Estimated population (mid-year) Birth Rate per 1,000 populalation Death Rate per 1,000 populalation 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 still births Still Birth Rate per 1,000 live and still births Tuberculosis Death Rate pier 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 48 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 48 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 1947 106,670 17.3 10.5 39 24 0.5 24 0.5 TABLE II CAUSES OF DEATH REGISTRAR GENERAL'S RETURN Abridged List No. Cause of Death Male Female Total 1 Typhoid and paratyphoid fever - - 2 Cerebro-spinal fever 1 - 1 3 Scarlet fever - - - 4 Whooping cough - 2 2 5 Diphtheria - - - 6 Tuberculosis of respiratory system 26 21 47 7 Other forms of tuberculosis 1 4 5 8 Syphilitic disease 5 1 6 9 Influenza 3 5 8 10 Measles - 2 2 11 Acute poliomyelitis and polioencephalitis 3 2 5 12 Acute infectious encephalitis - - - 13M Cancer of the buccal cavity and oesophagus 9 - 9 13F Cancer of the uterus - 17 17 14 Cancer of the stomach and duodenum 19 15 34 15 Cancer of the breast - 19 19 16 Cancer of all other sites 53 49 102 17 Diabetes 1 7 8 18 Intra-cranial vascular lesions 58 62 120 19 Heart disease 127 130 257 20 Other diseases of circulatory system 25 23 48 21 Bronchitis 52 27 79 22 Pneumonia 27 37 64 23 Other respiratory diseases 9 8 17 24 Ulceration of stomach and duodenum 10 1 11 25 Diarrhoea (under 2 years of age) 5 7 12 26 Appendicitis 2 3 5 27 Other digestive diseases 10 13 23 28 Nephritis 11 8 19 29 Puerperal and post-abortive sepsis - - - 30 Other maternal causes - 1 1 31 Prematurity 7 6 13 32 Congenital malformations, birth injury, etc. 17 12 29 33 Suicide 8 3 11 34 Road traffic accidents 5 7 12 35 Other violent causes 11 22 33 36 All other causes 51 48 99 TOTAL 556 562 1,118 TABLE III 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 Prematurity 9 4 - - 13 - - - - 13 Congenital defects 4 1 2 - 7 2 1 1 - 11 Birth injury 5 1 - - 6 - - - - 6 Infantile diseases. 10 1 - - 11 - - - - 11 Gastro-enteritis - 2 - - 2 4 1 3 1 11 Otitis media - - - - - -1 - - - 1 Bronchitis and pneumonia - 2 1 1 4 2 3 4 - 13 Whooping cough - - - - - - - 1 - 1 Measles - - - - - - - - 1 1 Influenza - 1 - - 1 - - - - 1 Murder 1 - - - 1 - - - - 1 Accident - - - - - 1 - - - 1 Other causes - - - - - - 1 - - 1 TOTAL 29 12 3 1 45 10 6 9 2 72 21 22 TABLE V INFECTIOUS DISEASES—1947—AGE DISTRIBUTION Disease Total Under 1 yr. lyr. 2 yrs. 3 yrs. 4 yrs. 5-9 yrs. 10-14 yrs. 15-19 yrs. 20-34 yrs. 35-44 yrs. 45-64 yrs. 65 yrs. + Cases admitted to hospital Smallpox - - - - - - - - - - - - - - Enteric Fever 1 - - - - - - - - 1 - - - 1 Scarlet Fever 62 - 2 3 3 4 23 12 7 5 3 - - 24 Diphtheria 3 -- - - - - 1 - - 1 1 - - 3 Erysipelas 19 — — — 1 - — — 1 3 6 5 3 12 Puerperal Pyrexia 60 - - - - - - - 4 50 6 - - 59 Ophthalmia Neonatorum - - - - - - - - - - - - - - Acute poliomyelitis and polioencephalitis 43 2 4 - 1 1 15 4 7 6 3 - - 42 Cerebro-spinal Fever 8 2 1 1 1 1 - 1 1 - - - - 7 Pneumonia 56 3 4 2 1 3 9 2 2 5 6 9 10 21 Encephalitis lethargica - - - - - - - - - - - - - - Dysentery - - - - - - - - - - - - - - Measles 840 23 77 94 97 140 355 24 16 9 2 3 - 64 Whooping Cough 142 14 23 18 20 17 44 6 - - - - - 23 Tuberculosis:— Pulmonary 159 1 1 2 1 1 3 3 14 85 18 19 11 Non-pulmonary 20 - - - 1 - 3 1 - 11 1 3 - HESTON AND ISLEWORTH, 1947 Age and sex distribution of deaths TABLE IV Abridged List No. Causes of deaths Age in years All ages Under 1 1 2-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75 & 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 Cerebio-spinal fever - - - - 1 - - - - - - - - - - - - - - - - - 1 - 3 Scarlet fever - - - - - - - - - - - - - - - - - - - - - - - - 4 Whooping cough - 1 - 1 - - - -- - - - - - - - - - - - - - - - 2 5 Diphtheria - - - - - - - - - - - - - - - - - - - - - - - - 6 Tuberculosis of respiratory system - - - - - - - 2 2 5 2 6 3 2 9 2 8 2 2 2 - - 26 21 7 Other tuberculosis - - - - - - - 1 - 1 - - 1 1 - 1 - - - - - - 1 4 8 Syphilitic disease - - - - - - - - - - - 1 - - 2 - 2 - 1 - - 1 5 2 9 Influenza - 1 - - - - - - - - - - 1 - - 1 - - 1 1 3 3 5 10 Measles - 1 - 1 - - - - - - - - - - - - - - - - - - - 2 11 Acute poliomyelitis, polioencephalitis - - 1 - - - - 1 2 1 - - - - - - - - - - - - 3 2 12 Acute infectious encephalitis - - - - - - - - - - - - - - - - - - - - - - - - 13M, 16 (2)F Cancer :-Buccal cavity and oesophagus - - - - - - - - - - - - - - 2 - 3 1 2 - 2 4 9 5 13F Uterus - - - - - - - - - - - - - 2 - 3 - 2 - 5 - 5 - 17 14 Stomach and duodenum - - - - - - - - - - 1 - - 2 3 - 6 1 7 5 1 7 18 15 15 Breast - - - - - - - - - - - - - 4 - 6 - 3 - 3 - 3 - 19 16 (1) Respiratory system - - - - - - - - - - - - 1 - 3 1 4 1 5 5 - 2 13 9 16 (3) Other sites - - - - 1 - - - - 1 - 1 1 - 2 8 15 8 11 11 14 9 44 38 17 Diabetes - - - - - - - - - - - - - - - 1 - 1 1 2 - 3 1 7 18 Cerebral vascular lesions - - - - - - - - - - - 1 1 - 3 2 10 5 24 24 21 35 59 67 19 (1) Chronic endocarditis - - - - - - - - - - - - 1 - 2 6 4 5 1 1 1 11 9 23 19 (2) Myocardial degeneration - - - - - - - - - - - - - - - - 2 4 16 11 25 31 43 46 19(3) Coronary disease, angina pectoris - - - - - - - - - - - - 4 - 14 1 12 2 17 15 9 17 56 35 19 (4) Other diseases of the heart - - - - - - - - - - 1 - - - - - 5 1 2 6 9 18 17 25 20 Other diseases of the circulatory system - - - - - - - - - - 1 - - - 6 2 5 - 4 8 8 11 24 21 21 Bronchitis 2 1 - - - 1 - - - - 1 - - - 7 3 13 2 10 5 19 17 52 29 22 Pneumonia (all forms) 4 6 3 - - - - - - - - - 6 - - 2 4 6 5 4 8 18 30 36 23 Other diseases of the respiratory system. - - - - - - - - - 1 - 1 1 . 1 3 2 1 . 3 3 . 7 9 24 Peptic ulcer - - - - - - - - - - 1 - . . 1 . 5 . 2 . 1 1 10 1 25 Diarrhoea (under 2 years) 4 7 . . . . . . . . . . . . - . . . . . . . 5 7 26 Appendicitis . . . . . . . . . . . . . . . . . 1 1 2 . . 1 3 27 (1) Diseases of pharynx and tonsils . . . . . . . . . . . . . . . . . . . . . . . . 27(2) Cirrhosis of the liver . . . . . . . . . . . . . . . . . . . . . . . . 27 (3) Other diseases of jthe liver . . . . . . . . . . . . 1 1 . . . . 2 1 1 2 4 4 27(4) Other diseases of the digestive system . . . . . . . . . . . . 1 . 2 . 1 4 4 2 2 3 10 9 28 Nephritis - - - - - . - - 1 - 1 1 - 1 1 1 1 2 2 1 6 2 12 8 29 (1) Septic abortion - - - - - - - - - - - - - - - - - - - - - - - - 29(2) Puerperal sepsis - - - - - - - - - - - - - - - - - - - - - - - - 30(1) Other abortion - - - - - - - - - - - - - - - - - - - - - - - - 30(2) Other maternal causes - - - - - - - - - - - - - - - - - - - - - - - 1 31 Premature birth 7 6 - - - - - - - - - - - - - - - - - - - - 7 6 32 (1) Injury at birth 4 2 - - - - - - - - - - - - - - - - - - - - 4 2 32 (2) Congenital malformations&infantile diseases 12 10 1 - - - - - - - - - - - - - - - - - - - 13 10 33 Suicide - - - - - - - - - 2 - - 1 - 3 - 3 1 - - 1 - 8 3 34 Road Traffic Accidents - - - - - - - - - 1 - 1 - 3 1 1 3 - - - 1 1 5 7 35 Other violent causes - 1 - - - - - - - 1 1 - - 1 3 2 2 2 1 3 4 12 11 22 36 (1) Erysipelas - - - - - - - - - - - - - - - - - - - - - - - - 36 (2) Purulent infection and septicaemia - - - - 1 - - - - - - - - - - - - - - - - - 4 - 36 (3) Hodgkin’s disease - - - - - - - - - - - - - - - - - - - - - - - 1 36 (5) Other infective diseases - - - - - - - - - - - - - - - - - - - - - - - - 36 (6) Rheumatic fever - - - - - - - - - - - - - - - - - - - - - - - - 36 (7) Exophthalmic goitre - - - - - - - - - - - - - - - - - - - - - - - 1 36 (8) Diseases of the blood - - - - - - - - 1 - - - 1 1 1 - - 1 1 1 - 2 4 5 36 (9) Diseases of the ear and mastoid antrum - 1 - - - - - - - - - - 1 - - - - - - - - - 1 1 36 (10) Pyelitis and diseases of the bladder - - - - - - - - - - - - - - - - - - 2 - - 2 2 2 36 (11) Diseases of the prostate - - - - - - - - - - - - - - - - 2 - 2 - 7 - 11 - 36 (12) Old age - - - - - - - - - - - - - - - - - 2 - 2 5 13 5 17 36 (4,13,14) Other causes 2 - - - 1 - - - - - 1 1 2 3 4 4 1 3 4 4 1 1 16 16 ALL CAUSES 35 37 6 2 4 1 - 4 6 13 10 13 27 22 70 49 115 63 131 127 151 234 555 565 72 8 5 4 19 23 49 119 178 258 385 1,120 Percentage of total deaths from all causes 6.4 0.7 0.4 0.4 1.7 2.0 4.4 10.6 15.9 23.0 34.4 TABLE VI WARD STATISTICS, 1947 Heston Hounslow Central Hounslow West Hounslow South Hounslow Heath Isleworth North Isleworth South Spring Grove Area in acres 2,353 288 400 539 1,419 613 620 1,028 Estimated population 13,860 12,820 14,010 15,515 15,015 11,680 13,440 10,330 No. of live births 364 110 176 290 340 184 205 177 Birth rate per 1,000 population 26.3 8.6 12.6 18.7 22.6 15.7 15.2 17.1 No. of still births notified 6 3 2 8 10 5 7 4 Still birth rate per 1,000 total births 16.2 26.5 11.2 26.8 28.6 26.4 33.0 22.1 No. of deaths 223 96 138 163 161 94 138 107 Death rate per 1,000 population 16.1 7.5 9.1 10.5 10.7 8.0 10.2 10.3 No. of infant deaths.. 17 1 7 7 14 12 9 5 Infant death rate per 1,000 live births 46.7 9.1 39.8 24.1 41.2 65.2 43.9 28.2 No. of maternal deaths - - - - 1 - - - Maternal death rate per 1,000 total births - - - - 2.86 - - - No. of deaths from tuberculosis 14 4 5 9 6 2 6 6 Tuberculosis death rate per 1,000 population 1.0 0.3 0.4 0.6 0.4 0.2 0.4 0.6 No. of notifications of tuberculosis 25 13 15 24 31 24 31 17 No. of notifications-other notifiable diseases 165 62 85 154 234 221 219 91 23 THOMASONS LTD CEDAR PRESS HOUNSLOW, MIDDLESEX