u' ' IW/®^ ' «* ANNUAL REPORT ON THE HEALTH OF THE BOROUGH OF HESTON AND ISLEWORTH for the year 1948 A. ANDERSON, M.D., D.P.H. Medical Officer of Health INDEX Page Adoption 10 Ambulance Service 8 Ante-Natal Clinics 8 Births, Live and Still 6 Canal Boats 15 Child Guidance Clinic 9 Child Life Protection 10 Deaths 6 Deaths, Age and Sex Distribution 23 Deaths, Causes of 20 Dental Treatment 10 Diphtheria Immunisation 12 Diphtheria, Children Immunised 1930-48 22 Disinfection 14 Disinfestation 16 Drainage and Sewerage 14 Factories, Workplaces, etc. 15 Fever Hospital 14 Food Poisoning 14 Health Committee 4 Health Education 11 Health Visiting 11 Home Help Service 10 Home Nursing 8 Housing 16 Infant Deaths according to age 20 Illegitimate Children, Care of 10 Infant Mortality 7 Infant Welfare Centres 8 Infectious Diseases 12 Infectious Diseases, Age Distribution 21 Insulin 11 Page Laboratory Service 8 Maternal Mortality 7 Maternity and Child Welfare Committee 4 Medical Examinations of Staff 11 Midwifery Service 9 Milk, Dried, Supply of 11 Nurseries, Day 10 Nurseries, Residential 10 Nursing Homes 11 Ophthalmic Clinic 9 Orthopaedic Clinic 9 Poliomyelitis 12 Post Natal Clinics 8 Premature Babies, Care of 9 Public Cleansing 15 Rats and Mice Destruction 16 Rivers and Streams 14 Sanitary Inspection 15 Scabies 11 School Health Service 9 Smoke Abatement 15 Speech Clinic 9 Staff 2 Statistics, General 6 Statistics, Vital 6 Statistics, Vital, Summary of 19 Tents, Vans and Caravans 15 Tuberculosis 9 Vaccination 9 Venereal Diseases 9 Vitamin Supplements, Supply of 11 Water Supply 14 STAFF Medical Officer of Health. A. Anderson, M.D., D.P.H. Deputy Medical Officer of Health. M. B. McCann, L.R.C.P. & S., D.P.H. (to 18.9.48). Assistant Medical Officers. H. C. Broadhurst, M.B., B.S. Mrs. R. Prothero, M.D., L.R.C.P. & S., D.C.H. R. G. Isaac, M.R.C.S., L.R.C.P. Mrs. F. Vanes, M.R.C.S., L.R.C.P. 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. Dental Officers. P. D. O'Connor, L.D.S. (to 5.6.48). Miss E. M. A. McGivem, L.D.S. (to 30.6.48). Mrs. A. B. Perkins, L.D.S. Mrs. D. Clegg, L.D.S. D. B. Owen, L.D.S. (to 31.8.48). M. B. Conlin, L.D.S. (to 4.7.48). Dental Chairside Attendants. Miss D. Potter. Miss I. O. Williams. Miss H. L. Cogger (to 28.12.48). Miss J. Stephens. Miss P. J. Barker. Miss D. M. Graham. Miss P. A. Mantell. Orthodontic Consultant. Miss E. M. Still, L.D.S. (to 30.6.48). Dental Mechanic. T. Cheney (part-time). Eye Clinic Staff (part-time). Miss C. E. Orr-Ewing, M.B., B.S., D.O.M.S. Mrs. W. Kindness-Steel, M.B., Ch.B., D.P.H. Orthopaedic Clinic Staff (part-time). Surgeon: P. H. Newman, F.R.C.S., M.R.C.S., L.R.C.P. Physiotherapist: Mrs. B. Robinson, C.S.P. (to 31.7.48). Miss I. Black, C.S.P. (from 21.10.48). Child Guidance Clinic Staff. Psychiatrist: Miss E. Huband, M.A., M.R.C.S., L.R.C.P. Psychologist: Miss H. E. Swan, B.A. Psychiatric Social Worker: Mrs. F. H. M. Heyworth-Davis (nee Chapman). Speech Therapist. Miss M. R. Yates (from 12.1.48). 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. District Sanitary Inspectors. G. Latimer, Cert, as S.I. and M.I. K. J. Smith, Cert, as S.I. and M.I. E. Canham, Cert, as S.I. and M.I. R. W. R. Rixson, Cert, as S.I. and M.I. A. W. Kent, Cert, as S.I. and M.I. S. H. G. Stevens, Cert, as S.I., M.I. and S.E. (from 21.6.48). 2 Rodent Officer. A. Farrer. Mortuary Attendant. H. E. Ellis. Disinfectors and Laboratory Assistants. F. J. Cobb (to 20.4.48). F. S. J. Allaway. C. J. Scott (from 19.4.48). Superintendent Health Visitor and Non-Medical Supervisor of Midwives Miss J. M. Evans, S.R.N., S.C.M., H.V. cert., S.I. cert. Health Visitors and School Nurses. 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. Foggin, S.R.N., S.C.M., H.V. cert. Miss E. Counihan, S.R.N., S.C.M., H.V. cert. Miss I. M. Pearl, S.R.N., S.C.M., H.V. cert. Miss D. M. Towers, S.R.N., S.C.M., H.V. cert. Miss. A. Atkinson, S.R.N., S.C.M., H.V. cert, (on special leave from 23.9.48;. Miss E. M. Smart, S.R.N., S.R.C.N., S.C.M., H.V. cert, (on special leave from 23.9.48). Miss I. R. Craig, R.G.N., S.C.M., (part 1), H.V. cert, (to 27.11.48). Mrs. A. D. Cory, S.R.N., S.C.M., H.V. cert, (from 2.2.48). Miss I. P. Burt, S.R.N., S.C.M., H.V. cert, (from 1.11.48). Mrs. G. Soady, S.R.N., (to 31.3.48). Mrs. L. A. Settle. Domiciliary Midwives. Miss M. J. Alsford, S.C.M. Mrs. G. N. Jukes, S.C.M. Miss E. N. Mayles, S.R.N., S.C.M. Miss G. D. E. Ostler, S.C.M. Miss E. D. Paull, S.R.N., S.C.M. Miss D. M. Weston, S.C.M. Mrs. D. T. Woodley, S.C.M. Miss M. M. Cook, S.C.M. (to 14.1.48). Miss R. J. Eigner, S.R.N., S.C.M. Miss M. Loughton, S.C.M. Miss M. Regan, S.C.M. (from 1.6.48). Mrs. G. Eburne, S.C.M. (part-time) (to 31.5.48). Home Help Organiser. Mrs. R. Chapman, S.R.N. Chief Clerk. B. W. Kilby, Cert, as S.I. and 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. D. S. Bates (from 16.2.48). Miss. M. F. Garry (to 30.6.48). P. J. Samwells. Mrs. E. Rickard. J. E. Woodley. E. J. Hutchins. P. A. Woods. B. S. Bedborough. Miss S. M. Underwood. Mrs. M. A. Hodgson. Miss B. R. Norris. Mrs. K. S. Temple (from 30.3.48). W. J. Pike (from 4.10.48). Miss I. J. Peck (from 20.9.48). Miss M. T. Moore. Miss J. Appleford (from 19.1.48 to 31.3.48). Miss M. Tombs. Miss E. Cowzer (from 5.1.48 to 11.12.48). Miss P. Gilbert (from 12.4.48). P. R. Shortland (to 3.5.48). C. A. Smith (from 16.8.48). 3 THE HEALTH COMMITTEE of HESTON AND ISLEWORTH BOROUGH COUNCIL as on the 4th July, 1948. 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. Hockcliffe. 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. Councillor Mrs. O. C. M. Denton. Alderman D. Rhys. Councillor A. G. Trickey. Councillor W. Chamberlain. Councillor A. C. Turner. Councillor Mrs. M. F. Davison. 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 submit my Annual Report on the health, vital statistics and sanitary circumstances of the Borough for the year 1948. The report has been prepared on the lines suggested in Ministry of Health Circular 3/49 and for the convenience the larger statistical tables have been grouped together at the end of the Report. The year 1948 was an important one in the history of the health services of the Borough. The transfer of the personal health services from the control of the Borough Council which started with the Education Act, 1944 was completed on the 5th July by the National Health Service Act, 1946 and the Children's Act, 1948. The school medical, maternity and child welfare and ambulance services and child life protection have passed to the County Council while the fever hospital is now under the control of the Regional Hospital Board. The Borough Council's powers now in regard to "health" are nil and the Borough has reverted to its 1875 status of "sanitary" authority. For administrative purposes under the National Health Service Act, Middlesex County has been divided into ten areas and the Borough along with the Boroughs of Southall and Brentford and Chiswick constitute Area No. 9. An Area Committee consisting of representatives of the County Council, the three Borough Councils, the College of Midwives, Hospital Management Committees, Local Dental Committee, Local Medical Committee, Local Pharmaceutical Committee and a representative with knowledge of home nursing is responsible for the day-to-day administration of the services except the mental health, ambulance and "prevention of illness, care and aftercare" services which have not been delegated to the Area Committees. Matters of policy, finance, etc., are controlled by the County Council and the powers of the Area Committees are restricted to their terms of delegation and controlled by the County Council standing orders, regulations and administrative methods. Working under the general direction of the County Medical Officer of Health the Area Medical Officer is responsible to the Area Committee for the adminisstration and supervision of the services in his area. I have been appointed Area Medical Officer for Area No. 9 and the work of welding the services of the three Boroughs into a unit and changing over to the new administrative methods has occupied much of my time and delayed the preparation of this Report. The report, as far as the "transferred services" are concerned, covers the year up to 4th July only and this should be borne in mind in any comparison with previous years. The rise in the birth rate which followed the end of the war has not been maintained and the rate for 1948 is approximately the same as in the immediate pre-war years. Only in 1938 (8.6) has a lower death rate appeared in the Borough records. The low infant mortality rate of 30 is close to the 1946 record of 29. Scarlet fever, measles, whooping cough, paratyphoid fever and dysentery were slightly more prevalent than in 1947 but in no case reached epidemic proportions. Though there were fewer cases of poliomyelitis the incidence was much higher than has been usual in the Borough and the continued prevalence is disquieting. No outbreak of food poisoning was reported but evidence came to the Department in various ways (and generally too late to take any action) to suggest that a number of minor outbreaks did occur. During the year the Sanitary Inspectors gave special attention to premises used for the preparation and sale of foods and ice-cream. Their steady efforts to preach the gospel of "clean food, cooked, stored and packed in clean containers and touched only by clean hands" are meeting with some success and the public could help considerably by insisting on these conditions. 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 1947 1948 Population (Registrar-General's estimate) 106,670 106,200 Number of inhabited houses (rate books) 27,659 28,041 Number of houses erected during year 321 303 Rateable value of Borough £976,882 £983,465 Sum represented by a penny rate £4,003 £3,8% Live Births—male 962 779 Live Births—female 884 766 Birth rate per 1,000 population 17.3 14.5 Birth rate per 1,000 population (England and Wales) 20.5 17.9 Stillbirths—male 29 15 Stillbirths—female 16 24 Stillbirth Rate per 1,000 (live and still) births 23.8 24.6 Deaths—male 556 491 Deaths—female 562 447 Death rate per 1,000 population 10.5 8.8 Death rate per 1,000 population (England and Wales) 12.0 10.8 Infant Mortality rate 39.0 29.8 Infant Mortality rate (England and Wales) 41 34 Maternal Mortality rate 0.5 0.6 Maternal Mortality rate (England and Wales) 1.2 1.0 Out-relief disbursed to Heston and Isleworth residents £21,752 £11.569* * To 3rd July, 1948 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 1948 was 106,200. Rateable Value.—The rateable value of the Borough for 1948 was £983,465 and the sum represented by a penny rate was £3,896. Inhabited Houses.—According to the rate books the number of inhabited houses at the end of 1948 was 28,041. Live Births.—The number of live births in 1948 was 1,545 as compared with 1,846 in 1947. The birth rate was 14.5 per 1,000 population, while that of England and Wales was 17.9. The number of il- 1925-29 3.9 1945 7.5 1930-34 3.2 1946 6.3 1935-39 2.9 1947 4.2 1940-44 4.6 1948 3.3 Stillbirths.—The number of stillbirths in 1948 was 39 (38 legitimate, 1 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 1948 39 24.6 Deaths.—The deaths of residents of the Borough during 1948 were 938 (491 male, 447 female). This represents a death rate for the Borough of 8.8 per 1,000 population as compared with 10.8 for England and Wales. These local deaths refer only to the civilian population and deaths among men or women serving in the Forces are not included. In Tables II and IV the deaths are classified according to the Manual of the International List of Causes of Deaths, 1938. Where the cause of death recorded in the death certificate is indefinite or does not permit of ready classification the Registrar-General obtains further information from the certifying medical practitioner. The information thus obtained is not passed to the Medical Officer of Health so small discrepancies tend to occur in Table II supplied by the Registrar-General and Table IV which is compiled from local information. A progressive change is taking place in the percentage age distribution of deaths and this is shown in tne following table:— 1910-14 1940-4 1945 1946 1947 1948 Under 1 year 21.8 7.8 8.2 4.9 6.4 4.9 1-4 years 8.4 1.4 0.8 0.9 1.2 0.3 5-14 years 3.8 1.8 0.6 1.1 0.4 1.4 15-24 years 3.7 2.8 2.7 2.6 1.7 2.0 25-64 years 30.8 35.2 34.1 34.0 32.9 32.3 65 years and over 31.5 51.0 53.6 56.5 57.4 59.1 6 The overall death rate is so low that despite tlie increasing proportion of deaths at age 65 years and over, the number of old persons in the population is steadily increasing. Age has its own special difficulties and the growing problem of the aged is a challenge to our health and social welfare services. The chief causes of death during the year were heart disease (110), cancer (84), Bronchitis and pneumonia (57), and cerebral haemorrhage (46) in males, and heart disease (123), cancer (82), cerebral haemorrhage. etc., (73), and bronchitis and pneumonia (33) in females. The burden of producing and supporting the young and of maintaining the aged falls almost wholly on the population aged 15-54 years. From Table IV the percentage of the total deaths from various causes occurring at ages 15-54 and 55 and over years have been extracted, and are shown below:— Cause of death Percentage of total deaths from cause occurring at age 15-54 55 and over Tuberculosis 70.0 29.7 Cancer 23.1 76.9 Cerebral haemorrhage, etc. 6.6 93.4 Heart and circulatory diseases 10.8 88.4 Bronchitis and pneumonia 6.5 86.0 Road traffic and other accidents 37.0 52.6 It wall be seen that of the major causes of death tuberculosis, followed by road traffic and other accidents represent the greatest menace to the producing and reproducing section of the population. Both causes are preventable and a reduction in such deaths and incapacity would make a considerable contribution to our national wellbeing and towards the maintenance of our expanding social services. represents an infant mortality rate per 1,000 live births of 29.8 as compared with 34 for England and Wales. The causes of infant deaths are shown in Table III. In the following tables the change in the local infant mortality rate over 5 year periods from 1898 is shown:— No. of live births No. of deaths under 1 year Infant Mortality Rate 1898-1902 4,369 698 160 1903-1907 5,264 665 126 1908-1912 5,383 590 110 1913-1917 4,661 461 99 1918-1922 4,326 327 76 1923-1927 4,333 271 63 1928-1932 6,055 318 53 1933-1937 7,121 313 44 1938-1942 6,912 393 57 1943-1947 8,210 345 42 1948 1,545 46 30 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 beiner 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 1948 Cause of death. Prematurity, congenital defects, etc. Gastro-enteritis pneumonia and other 30.4 22.7 23.6 17.1 18.9 19.3 infections 62.6 22.8 12.1 4.4 15.2 6.4 Some signs of a downward trend in deaths from prematurity and congenital defects are appearing. The reduction in infant deaths from infection is striking but the considerable fluctuation from year to year stresses the need for continuous effort to remove overcrowding, ignorance and poverty which contribute so greatly to the occurrence, spread and neglect of infections. Maternal Mortality.—The number of deaths due to causes associated with pregnancy and childbirth was one. This gives a maternal mortality rate per 1,000 total (live and still) births of 0.6 as compared with 1.0 for England and Wales. 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 194044 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 1948 — 0.6 0.6 7 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 recent advances in prevention and treatment. 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 Service. The number of specimens examined during 1948 was 310. 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. Up to 4th July when the service was transferred to Middlesex County Council the number of journeys made was 3,233 (269 accident, 2,964 other). Home Nursing.—Up to 4th July the Borough was served by the Heston and Isleworth District Nursing Association whose nurses made 12,948 visits during that portion of the year. Infant Welfare Centres.—Sessions were held at Hounslow and Isleworth Health Centres, Heston Village Hall and Cranford Memorial Hall. Twelve sessions were held each week and a doctor was present at each session. The work was almost wholly of an advisory nature in regard to the rearing and nurture of infants and young children. When further treatment was required the children were referred to private Dractitioners. hospitals, etc. At the centres mothers can purchase certain dried milks and vitamin nrenar- ations and can obtain orange juice and vitamin supplements supplied by the Ministry of Food. The attendance of children up to 4th July, 1948 is shown in the following table:— Hounslow Isleworth Heston Cranford Total No. of sessions 104 76 76 50 306 First attendances (under 1 year) 363 187 125 60 735 First attendances (1-5 years) 56 33 11 15 115 Total attendances (under 1 year) 5,101 2,649 2,285 1,225 11,260 Average per session 49 35 30 25 36 Total attendances (1-5 years) 1,648 1,273 1,268 974 5,163 Average per session 16 17 17 20 17 Medical consultations (under 1 year) 1,081 641 671 406 2,799 Average per session 10 8 9 8 9 Medical consultations (1-5 years) 550 386 498 290 1,724 Average per session 5 5 6 6 6 The total of attendances for the half year was 16,423 as compared with 32,629 in 1947. Each session is of 2½ 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 continue to be the heaviest. Restrictions of space limit the number of nurses who can be usefully employed at any session. Ante-natal and Post-natal Clinics.—An additional session at Heston was started on 1.4.48. 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-i and post-natal clinics during 1948 up to 4th July are shown below:— Routine Clinics Consultant Clinics Ante-natal. No. of mothers. (a) primipara 197 3 (b) multipara 485 15 Total attendances 2,861 241 Post-Natal. No. of patients - 112 Total attendances - 124 Gynaecological. No. of patients - 21 Total attendances - 55 No. of sessions—Hounslow 85 26 Isleworth 52 - Heston 13 - Average attendance per session— Hounslow 23 16 Average attendance per session— Isleworth 15 - Average attendance per session— Heston 9 - The falling birth rate and the additional Heston sessions have eased the strain on the Hounslow sessions so as to permit reasonable attention to be given to patients. During the half year 917 coupon equivalent certificates for sheets were issued at the ante-natal clinic to expectant mothers. 8 Artificial Sunlight Treatment.—This treatment was provided during the winter months at Hounslow and Isleworth Health Centres and 49 children under school age were treated during 1948 up to 4th July. Orthopaedic Treatment.—The surgeon attended once each month, and the physiotherapist on two days each week. During the period 21 pre-school children were examined by the surgeon, 10 were provided with appliances and 17 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 period 61 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 were open to children under school age and 37 such children were treated during 1948 up to 4th July. Speech Clinic.—During the period 2 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 10 such children were treated during the first half of 1948. School Health Service.—This service continued to be provided by Middlesex County Council but after 5th July medical treatment of school children passed from the control of the Education Committee to the Health Committee. Medical Out-relief.—This work was done by the District Medical Officers appointed by Middlesex County Council up to the start of the national health service. Venereal Disease.—Facilities for free diagnosis and treatment were provided by Middlesex County Council up to 5th July when this service was taken over by the Regional Hospital Board. The nearest treatment centres were West Middlesex and West London Hospitals. Vaccination.—The number of vaccinated persons in the Borough is not known. Up to 5th July the work under the Vaccination Acts was carried out by the public vaccinators appointed by Middlesex County Council. Now vaccinations are carried out by general practitioners under arrangements made by the Local Health Authority and the Vaccination Act. have been repealed. Tuberculosis.—The clinic serving this area is at 28, Bell Road, Hounslow. On 5th July the arrangements for the diagnosis and treatment of persons suffering from tuberculosis passed from Middlesex County Council to the Regional Hospital Board but the County Council continue to be responsible for after-care and preventive measures. In December the Mass X-Ray Unit visited the Borough and was installed at the Board of Trade Offices, Osterley. A total of 1,107 males and 1,062 females attended including 47 boys and 46 girls from local schools. Midwifery Service.—No midwife engaged in private practice in the Borough during 1948. Midwives were employed by West Middlesex Hospital, nursing homes and by the Council. The recruitment of midwives continues to be handicapped by difficulty in finding suitable accommodation for them. The 'ollowing table shows the proportion of live births which occurred at home, hospital or nursing home in the Borough and the proportion occurring outside the Borough during the years 1938-48. 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 °/ /o 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 1948 853 240 28.2 371 49 420 49.2 193 22.6 to 4.7.48 The work of the midwives was supervised in detail by the Supervisor of Midwives and in general by a medical officer. Though the average number of confinements attended by the midwives is not large a reduction in the staff is not possible. The number of midwives must be such as to permit of the prescribed holidays and off-duty time and yet ensure that a midwife will be within reasonable reach of all patients at all times. 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 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 up to 4th July gas and air analgesia was administered by midwives to 38 patients as compared with 60 in 1947 and 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, 9 and therefore doctors and midwives have been asked to record on birth notification cards all baby weights of 5½ lbs. or less. 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. Home Help Service.—The demand for this service continued to grow. It is difficult to assess if any change in general social conditions is contributing to this increasing demand but it is certain that as the service in the hands of a capable organiser improves in quality and reliability its assistance is being sought more and more by the public and by midwives, doctors, welfare officers, children's officers, chest clinics and hospitals. Up to 4th July, 1948, assistance was given to 312 households (67 maternity, 245 other) as compared with 344 households in 1947 and 148 households 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 1 mother, and 3 mothers and babies during the first half of 1948. Some indication of the final arrangements for the care of these children is shown in the following table extracted from the records:— 1947 1948 to 4th July Mother and child living with father of child 14 13 Mother and child living with grandparents 3 4 Child living with grandparents 2 - Child placed for adoption 6 3 Child in day nursery while mother at work 2 - Child placed with foster-mother - - Child and mother living together 1 - Child died 3 1 Child living with other relatives - - Mother and child left Borough 3 2 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 practise 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. Up to 4th July the Health Visitors made 48 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 4th July, 1948, was 35, and during the year 152 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 174 (Monday to Friday) and 13 (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 social circumstances were also considered and priority was given 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. So far no explanation has been found for the relatively high rate of sickness absence in the day nursery staff. Residential Nurseries.—No residential nursery is maintained by the Council. When residential accommodation has 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 nursery, provided by Middlesex County Council. The number of children admitted under this scheme up to 4th July was 5 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 1947 and up to 4th July, 1948, is shown below:— 1947 1948 to 4th July Total attendances of mothers and children 3,756 1,899 Teeth extracted—Mothers 822 449 Children 219 130 Teeth filled—Mothers 925 457 Children 252 159 Other operations—Mothers 793 429 Children 438 229 Dentures supplied to mothers 118 79 General anaesthetics administered 477 201 X-Ray photographs taken 91 54 10 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 centre. The fllowing table indicares the ex tent to which milk, etc., has been supplied free or at a reduced price during 1947 and to 4th July, 1948:— 1947 1948 to 4th July Dried milk (lbs.) 24 18 National dried milk (lbs.) 4,497 2,795 Cod liver oil and malt (lbs.) 4 - Lactagol (tins) 5 6 Bemax (tins) 56 17 Adexolin (½ oz.) 4 - Kalzana (tablets) 50 - Vitamin C (tablets) 500 - Virol (lbs.) ½ 2 Ferrous Sulphate Tablets (packets) 52 26 Adexolin Capsules (packets) 4 - The receipts to 4th July, 1948, from sales at cost price were £1,653 compared with £4,292 in 1947. Supply of Ministry of Food Vitamin Supplements.—The ante-natal and infant welfare clinics were distribution centres tor the issue ot Ministry or food vitamin supplements, There were other distribution centres in the Borough and the amounts issued in 1947 and 1948 are shown below:— 1947 1948 Orange juice (Vitamin C) (bottles) 136,151 119,184 Cod liver oil (Vitamin A and D) (bottles) 24,619 27,652 Vitamin A and D tablets (packets) 6,268 7,262 The actual take-up in 1948 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 13 weeks ending 13.5.48 52.50 36.72 46.28 13 „ „ 28.8.48 57.86 37.41 43.52 13 „ „ 27.11.48 51.49 41.12 48.63 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. At the end of the year the nursing home accommodation in the Borough was 16 medical and surgical and 8 maternity beds. Scabies Clinic.—This clinic was closed at the end of March and the number of persons treated was 23. In 1942 treatment was given to 992 persons and the steady fall in cases of this irritating skin disease is welcome. The epidemic has shown that, if sufferers will seek treatment early and all family contacts submit to prophylactic treatment, the spread of the disease can be controlled. 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 to 4th July, 319 vials were supplied as compared with 576 in 1947. 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 first attendance of the baby at the welfare centre. Medical Officers gave talks on the National Health Service and other 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 were referred to the Health Department for medical examination. During the year 96 such medical examinations were carried out. 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, up to 4th July is given below:— Attendances at infant welfare centres 490 Attendances at ante-natal clinics 340 Attendances at diphtheria immunisation clinics 105 Attendances at other clinics 31 Visits to expectant mothers— First 129 Subsequent 16 Visits to mothers (post-natal) 3 Visits to children under 1 year old First 864 Subsequent 1,624 Visits to children, 1 to 5 years old 2,431 Visits re stillbirths 19 Visits re infant deaths 20 Visits re inflammation of babies' eyes 11 Visits re infectious disease in children under school age 353 Visits re child life protection 152 Visits, miscellaneous 526 Visits—no access or person not at home 1,061 11 It should be remembered that health visitors, except when acting as cnild 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 is probably the last. 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. INFECTIOUS DISEASE Incidence of Notifiable Diseases.-The number of cases notified during the last nine years are shown below:- 1940 1941 1942 1943 1944 1945 1946 1947 1948 Smallpox - - - - - - - - - Scarlet fever 96 117 190 280 130 124 67 62 159 Diphtheria 73 37 11 5 11 24 16 3 2 Erysipelas 35 20 16 21 16 16 19 19 21 Pneumonia 200 124 72 116 50 25 47 56 41 Cerebro-spinal fever 43 34 12 - 3 11 13 8 2 Epidemic encephalitis 1 1 - - - 1 - - - Poliomyelitis and polioencephalitis 1 1 - - 3 7 1 43 29 Typhoid fever 3 2 4 1 - - 1 1 - Paratyphoid fever 1 30 1 - - - - - 3 Dysentery - - 2 - 22 28 6 - 5 Tuberculosis Pulmonary 121 157 177 165 167 128 200 160 147 N on-pulmonary 9 17 25 25 17 29 17 20 21 Ophthalmia neonatorum 2 5 3 - 5 3 2 - - Puerperal pyrexia 42 22 58 105 87 45 54 60 23 Measles 1,109 580 1,085 636 219 1,109 170 840 571 Whooping cough 123 286 243 134 171 110 170 142 227 Malaria - - - - 1 2 1 - - The age distribution of notifiable disease during 1948 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. Of these 159 cases, 65 were admitted to hospital. Diphtheria.-The number of cases (2) 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 1948 2 Nil The steady and persistent fall since 1930 can be attributed only to immunisation. Since immunisation was started in 1930 there have been 818 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 Table VI. This disease can be kept under control only if the parents will co-operate by having their children protected. In 1947 there were 1,846 births and approximately that number of children reached their first birthday in 1948, but only 1,032 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 21 cases were notified no death was due to this disease. Pneumonia.-There was a slight decrease in the notification of pneumonia as compared with 1947. The death rate per 1,000 population from pneumonia was 0.4 as compared with 0.6 in 1947. Of the total pneumonia deaths 12 per cent occurred at age 0-4 years and 62 per cent, at age 65 and over. Cerebro-Spinal Fever.-This disease was less prevalent than in 1947. The sulphonamide drugs have greatly reduced the mortality from this disease. Epidemic Encephalitis.-No case or death from epidemic encephalitis occurred during 1948. 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 12 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. The incidence was 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 symptons. 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." During an epidemic crowding should be avoided as far as possible because as far as is known personto-person contact is the chief mode of spread. The virus has been found in excreta therefore food should be protected from flies, bathing avoided in rivers or streams subject to pollution and hands washed as necessary to prevent contamination of food. Any danger in a swimming bath where the water is filtered and adequately chlorinated would most likely arise from spitting, etc., by the users especially if the bath is allowed to be overcrowded. The early symptoms of the disease are similar to those of any febrile disease and doctors are encouraged to arrange admission to hospital as soon as there is any sign of involvement of the nervous system or other signs raising a suspicion that the illness might be poliomyelitis. Something of the difficulty in tracing the origin and spread of this disease is shown by the following:— In a house occupied by 6 adults and 7 children under the age of 16 years illness occurred as under:— A. aged 17 years—headache on 15/8/48; vomiting on 16/8/48, seen by doctor; vomiting and weakness of legs 17/8/48; sent to hospital on 18/8/48 and diagnosis of polioencephalitis confirmed; made a complete recovery. B. aged 5 years—headache and feeling sick 17/8/48; not seen by doctor; full recovery after 3 days. C. aged 11 years—headache and vomiting 18/8/48; not seen by doctor; full recovery after 3 days in bed. D. aged 4 years—headache and backache 20/8/48; not seen by doctor; full recovery next day. E. aged 9 years—headache and sickness 21/8/48; not seen by doctor; full recovery after 2 days in bed. F. aged 16 years—headache and sickness 21/8/48; doctor suspected food poisoning; full recovery in 2 days. G. aged 26 years—headache, sickness and " tightness of spine " 21/8/48; doctor suspected food poisoning; full recovery and back at work in 3 days. H. aged 25 years—headache and vomiting 22/8/48; returned to work 24/8/48; recurrence of symptoms 25/8/48; doctor attended; full recovery and resumed work on 30/8/48. The remaining 2 adults and 3 children had no symptoms. Enquiries in the neighbourhood revealed that immediately prior to and during the period covered by the illnesses of A. to H. a number of adults and children had been unwell. The symptoms were vague and had passed off in 24 to 48 hours. In most cases the dates of the illness could not be recalled with accuracy. The most careful enquiries failed to reveal any article of food which was consumed only by the sufferers. The 5 persons who escaped in the first house had consumed the same food as the 8 persons who were ill. It is impossible to state whether A. was an isolated case of polioencephalitis or the only one of a group of persons infected by the virus who developed evidence of involvement of the nervous system. The diagnosis was confirmed in 29 out of the 37 cases notified during the year. One case, a patient in West Middlesex Hospital, was not a resident of the Borough. Of the 28 Borough cases 2 died. 16 made a complete recovery and the remaining 10 were transferred to orthopaedic hospitals and clinics for treatment of the residual paralysis. In one household 2 cases occurred but the other cases occurred singly. No closure of schools, swimming baths, children's cinema, etc., with a view to controlling the spread of infection was carried out. Typhoid and Paratyphoid Fevers.—No case of typhoid fever but 3 cases of paratyphoid fever were notified during 1948. The source of infection of these cases was not traced. Dysentery.—Five cases of dysentery were notified during the year. Investigation failed to reveal the source of infection or any connection between the cases. Tuberculosis.—The notifications of pulmonary tuberculosis were 13 less than in 1947, but there was an increase of 1 in the notifications 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 N ono-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 1948 33.0 7.5 40.5 The number of cases of tuberculosis on the Borough register at 31st December, 1948, was 774. Ophthalmia Neonatorum.—No case of this infection of the eyes of young babies was reported during the year. 13 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 23 cases were notified but no woman died from puerperal or post-abortion sepsis. Measles.—This disease was less prevalent in 1947 and caused no deaths. Admission to hospital was arranged for 23 cases. Whooping Cough.—The incidence of this disease was greater than in recent years but no death was due to whooping cough. Admission to hospital was arranged for 12 cases. Malaria.—No case was notified during 1948. Influenza.—No epidemic of influenza occurred during 1948 and the deaths due to this disease were 5 as compared with 8 in 1947. 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 1948:—mumps, 434; chicken pox, 500; and german measles, 7. Fever Hospital.—The Borough is served by the South Middlesex Infectious Diseases Hospital and during the year 237 patients from the Borough were admitted as cases of infectious disease. Close contact is maintained between the hospital and the Health Department so that any necessary action can be taken. Disinfection.—The disinfection of bedding, etc., is done at the 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-eight rooms were disinfected during 1948. Food Poisoning.—No outbreak of food poisoning was reported in the Borough during 1948. 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 Surburban Water Company. There are 50 shallow wells in use in the Borough, and at 28 of the premises an alternative supply from the mains is available. The following work in connection with water supplies was carried out during the year:— Supplies provided or reinstated 26 Cisterns, cleansed, repaired, etc. 37 Draw-off taps connected direct to main 9 Service pipes or taps repaired 53 Cases where mains supply substituted for well supply 1 Samples taken from wells for analysis Nil Wells abolished Nil 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 1948. Drains exposed for examination 30 Drains unstopped, repaired, etc. 326 Waste pipes repaired, trapped, etc. 91 Soil pipes repaired, etc. 21 Ventilating shafts repaired, etc. 10 Fresh air inlets repaired, etc. 6 Rainwater pipes disconnected from drains 1 Gully traps inserted or repaired 89 Disconnecting traps inserted or repaired 6 Disconnecting and inspection chambers provided 24 Disconnecting and inspection chambers repaired, etc. 55 Drains constructed or repaired 38 Total length (ft.) of drain pipes laid— (a) 4 in. 1,017 (b) 6 in. 14 Drain tests applied 172 Other works executed 17 Cesspools emptied or repaired 3 Cesspools abolished 3 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 1948. 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 14 Water closets provided in substitution for dry receptacles 6 Water closets where walls cleansed 62 Water closets fitted with new flushing apparatus 44 New pans or pedestals provided 113 Water closets repaired or improved 160 Water closet blockages unstopped 16 Other closets provided or repaired 4 14 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 128 new dustbins were provided during 1948. The following details of the salvage of waste materials have been provided by the Borough Engineer:— 1944 1945 1946 1947 1948 Paper (tons) 770 619 709 686 943 Scrap metal (tons) 55 24 28 40 83 Textiles (tons) 69 67 65 56 64 Bones (tons) 20 12 8 4 3 Bottles, jars (tons) 233 167 251 166 109 Cullet (tons) 42 6 17 10 14 Rubber (tons) 29 — 1 9 1 Kitchen waste (tons) 1,037 1,083 1,173 1,077 1,110 Miscellaneous (tons) 14 — 60 — 1 £9,721 £8,231 £11,405 £11,207 £12,322 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 1,689 Number of premises at which nuisances etc., were located 512 Number of premises where defects were remedied:— (a) by owners or occupiers 1,420 (b) by Council in default 18 (c) public sewers repaired by Council 9 Informal notices issued 1,173 Written reminders issued 1,011 Statutory Notices served 156 Total number of inspections and re-inspections 25,164 Inspections of piggeries 50 Inspections of stables 101 Inspections of urinals 11 Inspections (Rag Flock Act) Nil Sinks repaired or renewed 80 Roofs repaired 486 Gutters repaired or renewed 355 Number of premises provided with damp-proof courses 29 Yards paved or drained 45 Floors, walls, etc., repaired or renewed 2,441 Windows repaired or renewed 730 Doors repaired or renewed 191 Grates provided or repaired 205 Wash coppers provided or repaired 24 Larders provided or repaired 5 Offensive accumulations removed 46 Other nuisances abated 152 Visits re infectious disease, etc. 237 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 it is free from all supervision or control. The Sanitary Inspectors carried out 76 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 760 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 207 caravans were removed. The occupants were of the type who travel round the fringe of urban areas, 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 13 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 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 overleaf:— 15 Inspection of (a) Factories—mechanical power 274 (b) Factories—non-mechanical power 73 (c) Other premises 4 (d) Workplaces 132 (e) Outworkers' premises 131 Defects remedied 42 Mosquitoes.— Complaints from Whitton and Twickenham Road areas of the presence of biting mosquitoes have been less during 1948 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.T. and other new insecticides were used and 40 rooms in 17 houses were treated. During the year 33 wasp nests were destroyed and 4 premises cleared of cockroaches. 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 revelant circumstances." Most complaints of noise nuisance arise in connection with industrial processes carried on in factories situated close to houses. From the above definition it will be seen that many factors have to be taken into consideration in judging whether or not a noise is a nuisance with the meaning of the Act, though there may be no doubt about the annoyance to residents in the neighbourhood of the factory concerned. During the year complaints of nuisance due to noise were received in regard to four 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 1948 Complaints received 227 208 240 275 391 Block inspections 6 38 59 28 9 Individual inspections 695 1,321 1,492 2,089 2,026 Individual re-inspections 146 243 322 225 234 Other visits 191 110 248 338 408 Premises treated— (a) By occupiers 88 82 136 100 111 (b) By Local Authority . 317 446 660 836 806 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, 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 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:— (a) By Local Authority 258 (b) By private enterprise 45 Houses inspected 673 Defective houses rendered fit in consequence of informal action 89 Defective houses rendered fit in consequence of statutory action 141 Houses in respect of which Demolition Orders were made 11 Houses demolished in pursuance of Demolition Orders Nil Houses rendered fit in consequence of undertaking given by owner Nil Houses known to be overcrowded (Housing Act Standard) at end of year 88 New cases of overcrowding reported 27 Cases of overcrowding relieved during the year 65 Southall Corporation erected 54, Brentford and Chiswick Corporation 14 and Ministry of Civil Aviation 39 of the new Local Authority houses recorded in the above table. Of the 45 private enterprise houses 41 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 303. At the end of 1948 tenants were occupying 56 houses in respect of which Demolition Orders have been made or undertakings not to re-let accepted from 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. 16 INSPECTION AND SUPERVISION OF FOOD Milk.— During the year 179 inspections were made at cowsheds, dairies and retail purveyors' premises. Under the Milk (Special Designations) Orders 18 licences for the sale of "tuberculin tested" milk, 24 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 1948 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 bdttles. 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 469 inspections of registered premises were carried out. 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 restriction on the uses of milk and butter have resulted in many formulae being tried to give the necessary consistency and some food value. 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 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. During the year 90 samples of ice-cream were taken for submission to the methylene blue reductase, plate count and coliform tests and these samples were graded by the bacteriologists as follows:—excellent, 7; good, 6; satisfactory, 47; doubtful, 8; and unsatisfactory, 22. This high proportion of unsatisfactory samples shows that only too frequently ice-cream is not prepared or served under hygienic conditions. All unsatisfactory samples are followed up with a view to tracing lapses from strict cleanliness in manufacture, storage, or retailing. Bakehouses.—Visits of inspection to bakehouses numbered 162 in 1948. On three 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 two cases, and a fine of £2 with 10 shillings 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, 405; fish, 145; provisions, 326; vegetables and fruit, 96; hawkers foodstuffs, 83; and other foods, 9. Premises where food was prepared were submitted to 1,136 inspections. During the year 13,635 lbs. of unsound food and 3,729 tins of unsound tinned food were seized by or surrendered to the Sanitary Inspectors on retail premises in the Borough. On five occasions food, unfit for human consumption was found being sold or exposed for sale. In three cases the offenders were warned and fines amounting to £20 were inflicted in the other two cases. Municipal Restaurants.—One municipal restaurant was open during the whole year. The number of meals served during 1948 was 38,471 to the public and 41,152 to school children. No complaint in regard to the food served in this restaurant reached the Health Department. Food and Drug Sampling.—During 1948 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 200 — Milk new 48 3 Channel Island Milk 2 - Milk South Devon 1 — Milk Condensed 1 — Brandy 3 - Cooked Meat 2 — Gelatine 1 — Gin 31 — Malt Vinegar 1 — Meat Savoury 1 — Pepper white 1 — Rum 8 — Salad Cream 1 1 Salad Oil 1 — Sausages 8 — Sausages (Beef) 5 — 17 Sausages cooked 11 - Sausage Meat 7 - Smoked Haddock 1 1 Soles 2 2 Toffee Crunch 1 1 Whisky 30 - 367 8 As a result of these analyses three prosecutions were instituted, in one case Toffee Crunch, the proceedings were taken under the Merchandise Marks Act, 1887. The fines and costs amounted to £30 5s. 0d. 18 TABLE I Summary of Vital Statistics 1895-1948 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 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 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 1948 106,200 14.5 8.8 30 20 0.6 25 0.4 19 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 - - - 3 Scarlet fever — — - 4 Whooping cough — — - 5 Diphtheria — — - 6 Tuberculosis of respiratory system 23 13 36 7 Other forms of tuberculosis 5 3 8 8 Syphilitic disease 2 2 4 9 Influenza 4 1 5 10 Measles — — - 11 Acute poliomyelitis and polioencephalitis 2 — 2 12 Acute infectious encephalitis — 1 1 13M Cancer of the buccal cavity and oesophagus 7 — 7 13F Cancer of the uterus — 13 13 14 Cancer of the stomach and duodenum 12 10 22 15 Cancer of the breast — 19 19 16 Cancer of all other sites 65 40 105 17 Diabetes 1 6 7 18 Intra-cranial vascular lesions 46 73 119 19 Heart disease 110 123 233 20 Other disease of circulatory system 22 23 45 21 Bronchitis 37 13 50 22 Pneumonia 20 20 40 23 Other respiratory diseases 13 12 25 24 Ulceration of stomach and duodenum 10 1 11 25 Diarrhoea (under 2 years of age) — 2 2 26 Appendicitis 3 — 3 27 Other digestive diseases 12 5 17 28 Nephritis 9 8 17 29 Puerperal and Post-abortive sepsis - - - 30 Other maternal causes - 1 1 31 Prematurity 6 3 9 32 Congenital malformations, birth injury, etc. 16 8 24 33 Suicide 5 4 9 34 Road traffic accidents 8 1 9 35 Other violent causes 16 14 30 36 All other causes 37 28 65 TOTAL 491 447 938 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 7 - 2 - 9 - - - - 9 Congenital defects 8 1 3 - 12 2 - 1 - 15 Birth Injury 1 - - - 1 - - - - 1 Infantile diseases 6 - - - 6 - - - - 6 Gastro-enteritis - - - - - 2 - - - 2 Otitis media - - - - - 2 - 1 - 3 Bronchitis and pneumonia 1 1 - - 2 1 2 - - 5 Syphilis — — - — — — 1 - — 1 Volvulus — — - - - 1 - - - 1 Marasmus — — - - - 1 - - - 1 Accident — — - 1 1 - - 1 - 2 TOTAL 23 2 5 1 31 9 3 3 — 46 20 HESTON AND ISLEWORTH, 1948 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 Cerebro-spinal fever - - - - - - - - - - - - - - - - - - - - - - - - 3 Scarlet fever - - - - - - - - - - - - - - - - - - - - - - - - 4 Whooping cough - - - - - - - - - - - - - - - - - - - - - - - - 5 Diphtheria - - - - - - - - - - - - - - - - - - - - - - - - 6 Tuberculosis of respiratory system - - - - - - - - 1 4 6 4 4 1 3 1 2 2 6 - - 1 22 13 7 Other tuberculosis - - - - - - 1 - 1 2 1 - 1 1 - - 1 - - - - - 5 3 8 Syphilitic disease - 1 - - - - - - - - - - - - - - 2 - - - - - 2 1 9 Influenza - - - - - - - - - - 1 - - - - - - - 1 - 2 1 4 1 10 Measles - - - - - - - - - - - - - - - - - - - - - - - - 11 Acute poliomyelitis, polioencephalitis - - - - - - 1 - - - - - 1 - - - - - - - - - 2 - 12 Acute infectious encephalitis - - - - - - - - - 1 - - - - - - - - - - - - - 1 13M, 16 (2)F Cancer:—Buccal cavity and oesophagus - - - - - - - - - - - 1 - - 1 - 2 - 1 1 3 - 7 2 13F Uterus - - - - - - - - - - - 1 - 1 - 2 - 4 - 3 - 2 - 13 14 Stomach and duodenum - - - - - - - - - - - - 1 - 2 2 5 - 3 5 2 4 13 11 15 Breast - - - - - - - - - - - 1 - 1 - 2 - 7 - 6 - 3 - 20 16 (1) Respiratory system - - - - - - - - - - - - 3 - 5 2 4 2 8 1 3 1 23 6 16 (3) Other sites - - - - - - - - - - 1 - - 1 5 7 8 7 12 7 15 11 41 33 17 Diabetes - - - - - - - - - - - - - 1 1 - - - - 2 - 2 1 5 18 Cerebral vascular lesions - - - - - - - - - - - - 2 - 3 3 7 8 13 22 23 41 48 74 19 (1) Chronic endocarditis - - - - - - - - - - - 1 - - 2 4 2 2 3 7 2 6 10 20 19 (2) Myocardial degeneration - - - - - - - - - - - - 1 - 1 1 1 1 9 7 13 33 25 42 19 (3) Coronary disease, angina pectoris - - - - - - - - - - - - 2 - 9 2 13 5 14 11 15 15 53 33 19(4) Other diseases of the heart - - - - - - - 2 - - - - 1 - - - 5 - 4 9 10 17 20 28 20 Other diseases of the circulatory system - - - - - - - - - 1 - - 1 - - 2 6 2 3 4 9 10 19 19 21 Bronchitis - - - 1 - - - - - - - - - - 3 - 13 - 12 5 10 7 38 13 22 Pneumonia (all forms) 4 - - - - - - - 1 - - - - 1 2 - 2 5 7 3 5 11 21 21 23 Other diseases of the respiratory system - - - - - - 1 - - 1 1 - 1 1 - - 3 1 2 2 2 4 10 9 24 Peptic ulcer - - - - - - - - - - 1 - 1 - 1 - 4 - 4 1 - - 11 1 25 Diarrhoea (under 2 years) - 2 - - - - - - - - - - - - - - - - - - - - - 2 26 Appendicitis - - - - - - 1 - - - - - - - - - - - 2 - - - 3 - 27(1) Diseases of pharynx and tonsils - - - - - - - - - - - - - - - - - - 1 - - - 1 - 27 (2) Cirrhosis of the liver - - - - - - - - - - - - - - - - - - - - - - - - 27 (3) Other diseases of the liver - - - - - - - - - - 1 1 - - - - - 1 - - - 3 1 5 27(4) Other diseases of the digestive system 1 - - - - - - - - - - - - - - - 4 - 2 2 3 - 10 2 28 Nephritis - - - - - - 1 - - - 1 - 2 1 1 1 3 1 - 1 1 3 9 7 29(1) Septic abortion - - - - - - - - - - - - - - - - - - - - - - - - 29(2) Puerperal sepsis - - - - - - - - - - - - - - - - - - - - - - - - 30(1) Other abortion - - - - - - - - - - - - - - - - - - - - - - - - 30(2) Other maternal causes - - - - - - - - - - - 1 - - - - - - - - - - - 1 31 Premature birth 6 3 - - - - - - - - - - - - - - - - - - - - 6 3 32(1) Injury at birth 1 - - - - - - - - - - - - - - - - - - - - - 1 — 32 (2) Congenital malformations & infantile diseases 15 7 - - - - - 1 - - 1 - - - 1 - - - - - - - 17 8 33 Suicide - - - - - - - - - 1 - - 2 - - 1 4 1 - 1 - - 6 4 34 Road Traffic Accidents - - - - - - - - 1 1 2 2 1 - - - 1 - 1 - 1 - 7 1 35 Other violent causes 2 - - - - - 1 1 1 - 3 - - 2 1 - 2 1 1 3 5 5 16 14 36(1) Erysipelas - - - - - - - - - - - - - - - - - - - - - - - - 36 (2) Purulent infection and septicaemia - - - - - - - - 1 - - - - - - - - - - - - - 1 - 36 (3) Hodgkin's disease - - - - - - - - - - - - - - - - - - - - - - ??? - 36(5) Other infective diseases - - - - - - - - - - - - - - - - 1 - - - - - 1 - 36(6) Rheumatic fever - - - - - - 1 - - - - - - 1 1 - - - - - 1 - 3 1 36 (7) Exophthalmic goitre - - - - - - - - - - - - - - - - - - - - - - - - 36 (8) Diseases of the blood - - 1 - - - 1 1 - - 1 1 1 - - - 1 - - 2 1 - 7 4 36 (9) Diseases of the ear and mastoid antrum 2 1 - 1 - - - - - - - - - - - - - - - - - - 2 2 36 (10) Pyelitis and diseases of the bladder - - - - - - - - - - - - - - - 1 1 - 1 - 1 1 3 2 36 (11) Diseases of the prostate - - - - - - - - - - - - - - - - 2 - 3 - 5 - 10 - 36 (12) Old age - - - - - - - - - - - - - - - - - - - 1 2 12 2 13 (4, 13, 14) Other causes - - - - - - - - 1 - - - 1 - 1 2 3 1 1 4 3 1 10 8 ALL CAUSES 31 15 1 2 - - 8 5 8 11 20 13 26 12 44 33 102 51 114 110 137 194 491 446 46 3 - 13 19 33 38 77 153 224 331 937 Percentage of total deaths from all causes 4.9 0.3 - 1.4 2.0 3.6 4.1 8.2 16.3 23.9 35.3 21 TABLE V INFECTIOUS DISEASES—1948—AGE DISTRIBUTION Disease Total Under lyr. 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 - - - - - - - - - - - - - - Para-Typhoid 3 1 - - - 1 - - 1 — — — - 3 Scarlet Fever 159 — 2 4 10 24 96 14 3 3 3 - - 65 Diphtheria 2 - - - - - - - 1 1 - - - 2 Erysipelas 21 - 1 - - - 1 1 - 1 3 10 4 7 Puerperal Pyrexia 23 - - - - - - - 1 15 7 - - 23 Ophthalmia Neonatorum - - - - - - - - - - - - - - Acute poliomyelitis and polioencephalitis 29 - 1 - 1 1 11 4 3 4 4 - - 28 Cerebro-spinal Fever 2 - - - - - - - - 1 1 - - 2 Pneumonia 41 3 3 2 1 1 3 1 2 2 3 10 10 7 Encephalitis lethargica - - - - - - - - - - - - - - Dysentery 5 - - - 2 - 2 - - - 1 - - 5 Measles 571 15 62 63 67 84 257 10 7 6 - - - 23 Whooping Cough 227 16 28 30 20 46 82 1 1 3 - - - 12 Tuberculosis:— Pulmonary 147 - - 1 1 - 7 1 16 73 18 22 8 Non-pulmonary 21 — 1 1 1 — 3 1 2 6 1 4 1 22 TABLE VI CHILDREN IMMUNISED AGAINST DIPHTHERIA, 1930-48 Age 1930-33 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 0 8 1 - 1 - - 1 3 4 7 3 2 8 18 13 83 4,311 or 54.0% of estimated population aged 0-4 years 1 104 31 49 45 71 58 66 113 227 378 593 482 745 986 728 949 2 178 72 93 69 87 95 114 131 281 290 256 125 207 202 181 195 3 185 89 97 52 65 66 91 92 247 234 206 54 71 103 100 50 4 237 77 93 69 61 75 105 94 219 249 205 72 47 60 107 51 5 376 89 118 81 102 109 130 119 262 291 229 64 57 69 88 112 10,562 or 79.6% of estimated population aged 5-14 years 6 479 128 122 71 91 128 117 85 283 240 224 41 60 66 46 38 7 446 77 79 38 51 82 91 78 184 186 166 42 36 56 46 21 8 447 70 59 36 34 74 72 64 209 153 169 33 38 42 38 20 9 433 38 49 40 23 104 66 66 166 156 121 32 33 41 45 13 10 444 36 44 22 32 85 51 48 157 154 132 37 32 27 47 11 11 276 33 20 26 22 54 40 55 165 130 106 41 28 37 32 11 12 166 18 12 17 12 40 28 31 105 128 109 35 25 16 16 10 13 136 24 15 14 3 26 18 38 100 109 96 42 17 24 17 1 14 50 6 7 8 5 11 4 15 35 36 41 21 10 7 6 2 Total 3,965 789 857 589 659 1,007 994 1,032 2,644 2,741 2,656 1,123 1,414 1,754 1,510 1,567 (In calculating the totals at the end of 1948 no account is taken of deaths or movement of population which may have occurred since 1934).