AC 439 (I) HESTONE ISLEWORTH library HES 36 ANNUAL REPORT OF THE MEDICAL OFFICER of HEALTH OF THE BOROUGH OF HESTON AND ISLEWORTH for the year 1949 A. ANDERSON, M.D., D.P.H. Medical Officer of Health INDEX 1 Page Bakehouses 15 Births, Live and Still 5 Burials 16 Canal Boats 12 Clean Food Campaign 16 Closet Accommodation 11 Common Lodging Houses 12 Conferences and Refresher Courses 16 Deaths 6 Deaths, Age and Sex Distribution 19 Deaths, Causes of 18 Disinfection 9 Disinfestation 12 Drainage and Sewerage 11 Factories, No. on Register, Inspections and Defects, etc. 22 Factories, Workplaces etc. 12 Fever Hospital 9 Food and Drugs Sampling 15 Food Poisoning 9 Health Committee 3 Health Education 16 Housing 13 Ice Cream 14 Infant Deaths according to Age and Cause 18 Infant Mortality 6 Infectious Diseases 7 Infectious Diseases, Age Distribution 10 Infectious Diseases, Notifications and Deaths 21 Page Laboratory Service 9 Maternal Mortality 7 Meat and Other Food Inspection 15 Medical Examinations of Staff 16 Noise Nuisances 12 Milk 13 Mosquitoes 12 Municipal Restaurant 15 Persons in need of care and attention 16 Poliomyelitis 8 Public Cleansing 11 Public Mortuary 16 Rats and Mice Destruction 13 Rivers and Streams 11 Sanitary Inspection 11 Shops Act, 1934, Section 10 13 Slaughter Houses etc. 15 Smoke Abatement 12 Staff 2 Statistics Comparative 22 Statistics General 5 Statistics Vital 5 Statistics, Vital, Summary of 17 Swimming Baths 13 Tents, Vans and Caravans 12 Tuberculosis 8 Water Supply 9 STAFF Medical Officer of Health (part-time). A. Anderson, M.D., D.P.H. 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. R. W. R. Rixson, Cert. as S.I. and M.I. (to 16.5.49). A. W. Kent, Cert. as S.I. and M.I. (to 31.1.49). S. H. G. Stevens, Cert. as S.I., M.I. and S.E. J. A. Dawson, Cert. as S.I. and M.I. (from 1.6.49). R. C. Rogers, Cert. as S.I. and M.I. (from 20.6.49). S. Sadler, Cert. as S.I. and M.I. (from 27.6.49). \ Rodent Officer. A. Farrer. Rodent Operatives. R. Ashurst. R. Clark. Mortuary Attendant. H. E. Ellis. Disinfectors, Drain Testers, etc. F. S. J. Allaway. C. J. Scott. Clerks. B. W. Kilby, Cert. as S.I. and M.I. (part-time). Mrs. L. R. Butler, Cert. as S.I. D. S. Bates. B. S. Bedborough. E. J. Hutchins. Mrs. M. A. Hodgson (to 26.8.49). Mrs. H. Cummins (Temp. from 12.9.49 to 26.11.49). Miss J. M. Bettles (from 28.11.49). 2 THE HEALTH COMMITTEE of HESTON AND ISLEWORTH BOROUGH COUNCIL to May, 1949 Alderman J. E. Dillingham (Chairman). Alderman Miss M. K. Watson (Vice-Chairman). F. H. Freeman, J.P., Esq. (Mayor). Alderman W. E. Bray. 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. from May, 1949. Alderman Mrs. O. C. M. Denton (Chairman). Councillor A. G. Trickey (Vice-Chairman). Alderman F. T. Hart, J.P. (Mayor). Alderman W. E. Bray. Alderman J. E. Dillingham Alderman Miss M. K. Watson. Councillor R. J. H. Brinsley. Councillor Mrs. M. F. Davison. Councillor Mrs. D. M. Elliott. Councillor A. J. Fielder, J.P., C.C. Councillor Mrs. M. Hennig. Councillor P. A. J. James. Councillor W. Pope. Councillor Mrs. M. J. Tozer. 3 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 1949. The report has been prepared on the lines suggested in Ministry of Health Circular 2/50 and for convenience the larger statistical tables have been grouped together at the end of the report. The report covers fewer matters than formerly because there is no reference to the services which were transferred to the County Council and Regional Hospital Board under the National Health Service Act, 1946. Of the services transferred from the Council, the priority dental service for expectant and nursing mothers, young children and school children has suffered severely and any prospect of recovery is remote. The other services have not lost the momentum they had acquired prior to 5th July, 1948, but it is too early to say whether they are to gain fresh impetus under the new administration. During the year certain duties in regard to the production and heat treatment of milk were transferred from the Borough Council to the Ministry of Agriculture and the County Council. Excepting the year 1941 the birth rate is the lowest in the Borough records, but it is gratifying to note a marked reduction in the proportion of stillbirths. The general death rate still compares favourably with that for England and Wales and heart disease and cancer continue to occupy leading places among the causes of death. The infant mortality rate shows a striking fall and is considerably lower than any rate previously recorded in the Borough. Poliomyelitis was less prevalent than in 1947 and 1948, but still sufficiently frequent to be disquieting. Though the death rate from tuberculosis was the lowest in the Borough records the number of notifications was the highest in the last ten years. Improved methods of diagnosis and the continued search for the early symptomless case are showing up our lack of adequate facilities for treatment. No Borough resident has died from diphtheria since 1946, and for the first time in any year no case of this disease occurred. This is a fitting record for the 20th year of our immunisation campaign and it is to be hoped that parents will co-operate by continuing to have their children protected. Other infectious diseases showed little change from previous years. A considerable volume of work has been carried out by the Sanitary Inspectors. Their day-to-day efforts to maintain and improve environmental conditions and to safeguard our food supply present no high lights but a study of the Report will show that their labour has not been fruitless. The work of the Department is closely linked with other departments of the Council and throughout the year the officers of other Departments have given generously of their help and advice. I would like to take this opportunity to express to my staff my thanks for their loyal co-operation and to acknowledge with gratitude the support and encouragement received from the Council. I remain, Your obedient Servant, A. ANDERSON, Medical Officer of Health- \ 4 GENERAL STATISTICS 1948 1949 Population (Registrar-General's estimate) 106,200 106,900 Number of inhabited houses (rate books) 28,041 28,217 Number of houses erected during year 303 161 Rateable Value of Borough £983,465 £970,555 Sum represented by a penny rate £3,896 £3,964 Live Births—male 779 707 Live Births—female 766 742 Birth rate per 1,000 population 14.5 13.6 Birth rate per 1,000 population (England and Wales) 17.9 16.7 Stillbirths—male 15 15 Stillbirths—female 24 12 Stillbirth Rate per 1,000 (live and still) births 24.6 18.3 Deaths—male 491 573 Deaths—female 447 478 Death rate per 1,000 population 8.8 9.8 Death rate per 1,000 population (England and Wales) 10.8 11.7 Infant Mortality rate 29.8 17.3 Infant Mortality rate (England and Wales) 34 32 Maternal Mortality rate 0.6 2.0 Maternal Mortality rate (England and Wales) 1.0 1.0 VITAL STATISTICS Population.—The population of the Borough at the 1931 census was 76,460 and the RegistrarGeneral's mid-year estimate of the population for the year 1949 is total population 108,200 and civilian population 106,900. Throughout this Report comment, tables of figures and rates refer to the civilian population only. Rateable Value.—The rateable value of the Borough for 1949 was £970,555 and the sum represented by a penny rate was £3,964. Inhabited Houses.—According to the rate books the number of inhabited houses at the end of the year was 28,217. In relation to the estimated population this yields an average of approximately 4 persons per house. While this average appears to be low accurate information will not be available till after the 1951 census. Live Births.—The number of live births in 1949 was 1,449 as compared with 1,545 in 1948. The birth rate was 13.6 per 1,000 population while that for England and Wales was 16.7 A lower birth rate than this has only been recorded once (1941) for the Borough. The number of illegitimate births was 60 as compared with 51 for 1948. The proportion of live births which were illegitimate, expressed as a percentage of the total live births, is shown below for recent years:— 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 1949 4.1 For England and Wales males always exceed females in live and still births, but this is not constant for smaller areas. The position in regard to the Borough since 1930 is shown below:— Sex ratio: males per 100 females Year Live Births Still Births Total Births 1930 117 120 117 1931 109 100 109 1932 103 106 104 1933 108 113 110 1934 103 144 104 1935 106 116 106 1936 107 100 107 1937 111 52 109 1938 103 105 103 1939 110 132 111 1940 97 100 97 1941 102 120 102 1942 102 96 102 1943 107 95 107 1944 103 161 104 1945 107 95 107 1946 108 129 109 1947 109 181 110 1948 102 63 100 1949 95 125 96 It has been suggested that the sex ratio at birth might be an indication of social conditions, but a study of the Borough records gives no support to this view. Others have suggested that the sex ratio at birth is influenced by the ages of the mothers and the position in the family of the births but the necessary local information to test this is not available. The national sex ratio at birth rose during both World Wars, but no such change occurred locally. Since 1916 the local sex ratio at birth was less than 100 in 1919, 1922, 1926, 1940 and 1949. 5 Stillbirths.—The number of stillbirths in 1949 was 27 (24 legitimate, 3 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 1949 27 18.3 Deaths.—The deaths of residents of the Borough during 1949 were 1,051 (573 male, 478 female). This represents a death rate for the Borough of 9.8 per 1,000 population. The deaths in any area are influenced by the sex and age distribution of the population and to permit of true comparison the RegistrarGeneral calculates what is called the area comparability factor and when this is applied to the local death rate the result is 10.7 as compared with a death rate of 11.7 per 1,000 population for England and Wales. In Tables II and IV the deaths are classified according to the Manual of the International List of Causes of Death, 1938. To help in classifying deaths the Registrar-General has additional information not available to the Medical Officer of Health so small discrepancies may occur between Table II supplied by the Registrar-General and Table IV compiled from local information. All statistical rates recorded in this Report are calculated from Table II. A progressive change is taking place in the percentage age distribution of deaths and this is shown in the following table:— 1910-14 1940-44 1945 1946 1947 1948 1949 Under 1 year 21.8 7.8 8.2 4.9 6.4 4.9 2.4 1-4 years 8.4 1.4 0.8 0.9 1.2 0.3 1.0 5-14 years 3.8 1.8 0.6 1.1 0.4 1.4 0.8 15-24 years 3.7 2.8 2.7 2.6 1.7 2.0 1.6 25-64 years 30.8 35.2 34.1 34.0 32.9 32.3 31.8 65 years and over 31.5 51.0 53.6 56.5 57.4 59.1 62.4 The chief causes of death were heart disease (161), cancer (115), and cerebral haemorrhage (48) in males and heart disease (134), cancer (86) and cerebral haemorrhage (51) in females. Infant Mortality.—During 1949 there were 25 deaths of children under the age of 1 year. This represents an infant mortality rate per 1,000 live births of 17.3 as compared with 32 for England and Wales. The causes of infant deaths are shown in Table III. In the following table 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 1949 1,449 25 17 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 for 1949 is the lowest in the Borough records. The considerable fall in the rate in 1949 is due to a marked and unexplained reduction in the number of infant deaths due to prematurity and congenital defects. On theoretical grounds an infant mortality rate in the neighbourhood of 20 should be possible and the low rate this year encourages the hope that practice may yet catch up with theory. The age distribution of infant deaths is changing and today, as is shown in the following table, the majority of such deaths occur in babies under the age of one month. Age Distribution of Infant Deaths. Age at death No. of deaths Percentage of total Infant deaths Rate per 1,000 live births 1911-15 1940-44 1945-49 1911-15 1940-44 1945-49 1911-15 1940-44 1945-49 Under 1 week 113 151 129 19.8 38.3 47.4 22.2 21.5 15.9 Under 1 month 190 232 180 31.4 58.8 66.2 37.3 32.9 22.2 Under 3 months 311 302 219 54.7 76.6 80.5 61.1 42.9 27.0 Under 6 months 418 342 240 73.5 86.8 88.2 82.1 48.6 29.5 Under 9 months 498 370 262 87.5 94.0 96.7 97.8 52.6 32.3 Under 12 months 569 394 272 100.0 100.0 100.0 111.8 56.1 33.5 6 There has been an overall reduction in infant deaths from all causes but the reduction has been greatest in preventable infections as is shown in the table below:— Causes of Infant Deaths Cause of death Percentage of total infant deaths Rate per 1,000 live births 1911-15 1940-44 1945-49 1911-15 1940-44 1945-49 Prematurity 20.0 27.1 23.9 22.4 15.2 8.0 Congenital defects, birth injury and infantile diseases 17.2 23.6 39.0 19.3 13.2 13.0 Gastro-enteritis 24.1 20.0 11.0 27.0 11.2 3.7 Pneumonia and bronchitis 20.0 15.7 12.1 22.0 8.8 4.1 Tuberculosis 2.3 1.0 0.4 2.6 0.6 0.1 Other infections 10.0 8.1 6.6 11.8 4.6 2.2 Other causes 6.4 4.5 7.0 6.9 2.5 2.4 Deaths from preventable infections are still too frequent but there are indications that the hard core of deaths from prematurity and congenital defects is being reduced. Maternal Mortality.—The number of deaths due to causes associated with pregnancy and childbirth was three. This gives a maternal mortality rate per 1,000 total (live and still) births of 2.0 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 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 1948 — 0.6 0.6 1949 — 2.0 2.0 Here, as throughout the country, advances in the prevention and treatment of septic infections can be measured by the considerable reduction in deaths from septic abortion, puerperal fever, etc. Fluctuations in the number of maternal deaths due to causes other than sepsis serve to remind us of the need for improving ante-natal and obstetric care. INFECTIOUS DISEASE Incidence of Notifiable Diseases.—The number of cases notified during the last ten years are shown below:— 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 Smallpox — — — — — — — — — — Scarlet fever 96 117 190 280 130 124 67 62 159 138 Diphtheria 73 37 11 5 11 24 16 3 2 — Erysipelas 35 20 16 21 16 16 19 19 21 26 Pneumonia 200 124 72 116 50 25 47 56 41 52 Cerebro-spinal fever 43 34 12 — 3 11 13 8 2 2 Epidemic encephalitis 1 1 — — — 1 — — — — Poliomyelitis and polioencephalitis 1 1 — — 3 7 1 43 29 14 Typhoid fever 3 2 4 1 — — 1 1 — — Paratyphoid fever 1 30 1 — — — — — 3 — Dysentery — — 2 — 22 28 6 — 5 2 Tuberculosis— Pulmonary 121 157 177 165 167 128 200 160 147 208 Non-Pulmonary 9 17 25 25 17 29 17 20 21 11 Ophthalmia neonatorum 2 5 3 — 5 3 2 — — — Puerperal pyrexia 42 22 58 105 87 45 54 60 23 16 Measles 1,109 580 1,085 636 219 1,109 170 840 571 523 Whooping cough 123 286 243 134 171 110 170 142 227 173 Malaria — — — — 1 2 1 — — 1 The age distribution of notifiable disease during 1949 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 the 138 cases, 54 were admitted to hospital. Diphtheria.—For the first time in the Borough no case of diphtheria occurred during the year and this is a tribute to the persistent campaign of immunisation during the last 20 years. Recently some evidence has been forthcoming to suggest that inoculations against diphtheria, whooping cough, etc., may influence the occurrence of paralysis when poliomyelitis is prevalent. This is particularly disquieting 7 when the continuance of immunisation is needed to prevent diphtheria reasserting itself as the scourge of former years. The position concerning diphtheria and poliomyelitis in the Borough during the last 20 years is shown below:— Diphtheria Poliomyelitis Cases Deaths Cases Deaths 1930 165 19 — — 1931 62 4 — — 1932 58 3 1 1 1933 50 2 5 3 1934 99 4 2 — 1935 72 3 — — 1936 21 2 1 1 1937 18 1 1 1 1938 40 2 3 1 1939 51 5 — — 1940 73 5 1 — 1941 37 3 1 — 1942 11 1 — — 1943 5 — — — 1944 11 1 3 — 1945 24 2 7 — 1946 16 1 1 1 1947 3 — 43 5 1948 2 — 29 2 1949 — — 14 1 Total 818 58 112 16 The memory of the public of the ravages of diphtheria is fading, but is alive to the distressing features of poliomyelitis. The sure safeguard against diphtheria should not be lightly abandoned because of a possible connection with a disease of whose origin, spread and control so little is known. Erysipelas.—Though 26 cases were notified no death was due to this disease. Pneumonia.—There was a slight increase in the notifications of pneumonia when compared with 1948. The death rate from pneumonia per 1,000 population was 0.5 as compared with 0.4 in 1948 and 0.6 in 1947. Of the total pneumonia deaths 11 per cent. occurred at age 0-4 years and 75 per cent. at age 65 years and over. Cerebro-Spinal Fever.—Only 2 cases of meningococcal infection were notified during the year. The sulphonamide drugs have reduced greatly the mortality from this infection. Epidemic Encephalitis.—No cases were notified during the year but two deaths were certified as due to this disease. Poliomyelitis and Polioencephalitis.—These names describe two types of infection by the same virus; in the former the spinal cord is affected and in the latter the brain bears the brunt of the infection. This disease was less prevalent in 1949 than in 1947 and 1948. One case, a patient in West Middlesex Hospital, was not a Borough resident. Of the 13 Borough cases 1 died, 5 made a complete recovery and the remaining 7 were transferred to orthopaedic hospitals or clinics according to the degree of residual paralysis. In none of these 14 cases was there a history of any inoculation within one month of the onset of poliomyelitis. No closure was adopted of schools, swimming baths, children's cinema, etc., with a view to controlling the spread of infection. Typhoid and Paratyphoid Fevers.—No case of these diseases was recorded during 1949. Dysentery.—Though dysentery is becoming more prevalent in the country generally only 2 cases were notified in the Borough during 1949. The possibility of this infection should be borne in mind in all cases of diarrhoea and on the least suspicion a specimen of faeces should be sent off for bacteriological examination. Tuberculosis.—The notifications of pulmonary tuberculosis were 61 more than in 1948, but there was a decrease of 10 in the notifications of non-pulmonarv tuberculosis. The downward trend of deaths from tuberculosis was maintained as is shown below:— Tuberculosis Death Rate per 100,000 population. Pulmonary N on-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 1949 29.0 2.8 31.8 The number of cases of tuberculosis on the Borough register at 31st December, 1949, was The high incidence of tuberculosis in the age group 15-34 years (see Table V) is of great national concern and there is urgent need for the provision of adequate facilities for treatment. 8 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 16 cases were notified but no woman died from puerperal or post-abortion sepsis. Measles.—This disease was less prevalent than in 1948 and caused no deaths. Admission to hospital was arranged for 46 cases. Whooping Cough.—The incidence of this disease was not so great as in 1948, and no death was due to whooping cough. Admission to hospital was arranged for 12 cases. Malaria.—One case was notified during 1949 and on enquiry it was shown to be a relapse; the original infection having been acquired overseas. Influenza.—No epidemic of influenza occurred during 1949 and the deaths due to this disease were 6 as compared with 5 in 1948 and 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 1949:—mumps 85; chicken pox 61; and german measles 5. Fever Hospitals.—The Borough is served by the South Middlesex Infectious Diseases Hospital and during the year 209 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-six rooms and four hospital wards were disinfected during 1949. Laboratory.—Certain routine bacteriological work is done in the laboratory at the Health Department. When more detailed investigation is required specimens are sent to the National Public Health Laboratory Service. The number of specimens examined during 1949 was 254. Food Poisoning.—Section 17 (1) of the Food and Drugs Act, 1938, states: "If a registered medical practitioner becomes aware, or suspects, that a patient whom he is attending within the district of any local authority is suffering from food poisoning, he shall forthwith send to the medical officer of health of that district a certificate stating— (a) the name, age and sex of the patient, and the address of the premises where the patient is; and (b) particulars of the food poisoning from which he is, or is suspected to be, suffering." Experience suggests that all medical practitioners do not recall this statutory obligation to notify actual or suspected cases of food poisoning and certainly the importance of notification "forthwith" is not realised. If the Health Department is to have a real chance of tracing the origin and source of food poisoning they should be on the job as soon as food poisoning is suspected. During 1949 notifications of the occurrence of food poisoning in 11 persons was received and information from sources other than notifications by medical practitioners was received concerning 150 cases, while a further two cases were found during investigations into these outbreaks. Some details of these outbreaks are set out in tabular form overleaf. Much time and effort was devoted to tracing the source of infection in these outbreaks but in most cases with little success. The Public Health Laboratory Service has recently published (Mon. Bull, Min. of Hlth., 1950, 9,148) particulars of 3,495 food poisoning incidents investigated during 1941-48. In 91 per cent. of these incidents salmonella organisms were isolated. The source of infection in most of these incidents was not traced, but as these organisms are found in the intestines of man and certain animals and may be present without giving rise to symptoms the importance of personal hygiene among food handlers must again be emphasized. Washing of the hands after using the toilet is essential and would do much to reduce the risks of food poisoning. 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 41 shallow wells in use in the Borough. They serve 22 houses and 21 business premises, and at 29 of the premises (11 houses and 18 business) an alternative supply from the mains is available. The water from 6 wells is known to be unsatisfactory, but as new housing and industrial development is taking place in the vicinity it is hoped to replace these wells by a main supply at an early date. The following work in connection with water supplies was carried out during the year:— Supplies provided or reinstated 29 Cisterns cleansed, repaired, etc. 9 Draw-off taps connected direct to main 6 Service pipes or taps repaired 31 Cases where mains supply substituted for well supply Nil Samples taken from wells for analysis 1 Samples taken from mains for analysis 2 Wells abolished Nil 9 10 FOOD POISONING OUTBREAKS 1949 Outbreak No. Date of onset Date of notification or other information No. of persons at risk No. of persons affected No. of deaths of affected persons Organism causing outbreak Food transmitting infection Food suspected of transmitting Place of infection Remarks 1 6-4-49 7-4-49 225 123 — Staphylococcus — Chicken Works canteen Chicken cooked previous day and reheated before serving. Recommendations made re kitchen hygiene. 2 16-4-49 17-6-49 ? 3 — Not ascertained — Blancmange School canteen outside Borough 3 14-7-49 18-7-49 ? 3 — Not ascertained — Ice Cream Street Hawker outside Borough Sample of ice cream taken at our request proved unsatisfactory. 4 20-7-49 25-7-49 2 1 — Not ascertained — Tinned sild. Home 5 30-7-49 4-8-49 ? 1 — Not ascertained — — Home Consumer suspected milk, but no confirmatory evidence. 6 1-8-49 2-8-49 6 6 — Not ascertained — Pickles Home 3 other persons in house did not consume pickles and had no symptons. Bacteriological and chemical tests negative. 7 1-8-49 8-8-49 14 1 — Not ascertained — Ice Cream Local premises Premises, plant and samples, satisfactory. 8 13-8-49 23-8-49 3 1 — Salmonella aertrycka — Algerian dates Home Late notification; source of infection not traced. 9 4-9-49 6-9-49 2 2 — Not ascertained — Potato crisps Local Purchase Crisps consumed on day's outing. 10 17-9-49 18-9-49 ? 2 — Not ascertained — Chocolates Purchased locally Bacteriological and chemical tests negative. 11 12-10-49 13-10-49 181 20 — Not ascertained — Steak and Kidney Pie Local school canteen Source of infection not traced; recommendations made as to kitchen hygiene. 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 1949:— Drains exposed for examination 22 Drains unstopped, repaired, etc. 230 Waste pipes repaired, trapped, etc. 20 Soil pipes repaired, etc. 6 Ventilating shafts repaired, etc. 10 Fresh air inlets repaired, etc. 23 Rainwater pipes disconnected from drains 1 Gully traps inserted or repaired 63 Disconnecting traps inserted or repaired 6 Disconnecting and inspection chambers provided 21 Disconnecting and inspection chambers repaired, etc. 62 Drains constructed or repaired 38 Total length (ft.) of drain pipes laid— (а) 4" 1,334 (b) 6' 150 Drain tests applied 166 Other works executed 14 Cesspools emptied or repaired 8 Cesspools abolished 19 During the long hot dry summer a nuisance from smell arose from the sewage purification works at Mogden. 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 1949. 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 27 Water closets provided in substitution for dry receptacles, etc. Nil Water closets where walls cleansed 37 Water closets fitted with new flushing apparatus 25 New pans or pedestals provided 3 Water closets repaired or improved 116 Water closets blockages unstopped 17 Other closets provided or repaired 1 Water closets connected to sewer and cesspools abolished 19 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 115 new dustbins were provided during 1949. The following details of the salvage of waste materials have been provided by the Borough Engineer:— 1945 1946 1947 1948 1949 Paper (tons) 619 709 686 943 1,228 Scrap metal (tons) 24 28 40 83 102 Textiles (tons) 67 65 56 64 84 Bones (tons) 12 8 4 3 2 Bottles, jars (tons) 167 251 166 109 23 Cullet (tons) 6 17 10 14 12 Rubber (tons) — 1 9 1 1 Kitchen Waste (tons) 1,083 1,173 1,077 1,110 1,074 Miscellaneous (tons) — 60 — 1 — £8,231 £11,405 £11,207 £12,322 £12,702 Sanitary Inspection of the Borough.—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. 1,416 Number of premises at which nuisances, etc., were located 1,428 Number of premises where defects were remedied:— (a) by owners or occupiers 1,262 (b) by Council in default 14 (c) public sewers repaired by Council 26 Informal notices issued 968 Written reminders issued 1,161 Statutory notices served 153 Total number of inspections and re-inspections 24,463 Inspections of piggeries 53 Inspections of stables 99 Inspections of urinals 26 Inspections (Rag Flock Act) 2 Sinks repaired or renewed 41 11 Roofs repaired 248 Gutters repaired or renewed 146 Number of premises provided with damp-proof courses 10 Yards paved or drained 21 Floors, walls, etc., repaired or renewed 1,130 Windows repaired or renewed 486 Doors repaired or renewed 138 Grates provided or repaired 137 Wash coppers provided or repaired 1 Larders provided or repaired 5 Offensive accumulations removed 47 Other nuisances abated 147 Visits re infectious disease, etc. 210 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 202 smoke observations on factory chimneys during the year and paid many visits to premises which had been the subject of smoke nuisance complaint. The quality of fuel supplied is the usual excuse given for the occurrence of a smoke nuisance. While this may be a contributory factor much could be done to prevent waste by more careful attention to firing and to the condition of the plant. Tents, Vans, Caravans.—The inspectors made 860 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 153 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 11 other sites was refused by the Council. During the year proceedings were taken on 5 occasions against owners of land and on 3 occasions against occupiers of caravans for contraventions of Section 345 of the Middlesex County Council Act, 1944. Fines and/or costs were imposed on each occasion. 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 90 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 and in Table VIII. Inspection of (a) Factories—mechanical power 788 (b) Factories—non-mechanical power 55 (c) Other premises 24 (d) Workplaces 118 (e) Outworkers' premises 229 Defects remedied 46 Mosquitoes.—Complaints from Whitton and Twickenham Road areas of the presence of biting mosquitoes have been less during 1949 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 Health Department deals with bug and other infestations in houses and other premises and for this purpose D.D.T. and other new insecticides are used. During the year 84 rooms in 30 houses were treated while 23 wasp nests were destroyed, 8 premises cleared of cockroaches, 3 of earwigs, 1 of steam beetles and 1 of ants. 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 definition it will be seen that many factors have to be taken into consideration in judging whether or no a noise is a nuisance within 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 six factories. Day and night observations were made concerning tnes complaints and every effort made in conjunction with the firms concerned to reduce the noise as far as was practicable. 12 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. Shops Act, 1934, Section 10.—Certificates of Exemption in regard to the provision of sanitary accommodation were issued for 2 shops. Swimming Baths.—One private and three municipal swimming baths are situate in the Borough and are open to the public. During the year 10 samples of water were taken from these baths and the results of the analysis were satisfactory in each case. The purpose of the filtration and chlorination of swimming bath water is to provide a constant supply of clear and sparkling water reasonably protected against contamination by disease producing germs. The great variation in "bathing loads" and consequently in degree of pollution makes the protection of swimming bath water no simple task. While baths' staff do everything to maintain a "safe" standard of bath water the bathers themselves could assist very materially by the observance of strict personal hygiene. HOUSING Shortage of houses continues to be a prominent feature of our social circumstances. The compulsory and prolonged sharing of houses by families causes increasing frustration and despair which reveal themselves in neurotic types of illness and unhappy and broken homes. The attainment of a standard of one family to one house or flat would bring great happiness and good health to the community. A poor house is better than none, and so action in regard to slum clearance and sub-standard houses must be postponed or reduced to a minimum. Action under the Housing Act is governed by "reasonable cost" and this, while rents remain static and building costs soar, is very difficult to assess. Great discretion has to be exercised in deciding whether action should be taken under the nuisance sections of the Public Health Act or the repair or demolition sections of the Housing Act. The department tries to hold the balance evenly and to ask only for essential work to be done. In general house owners have co-operated with the department and, though the Council has carried out a considerable amount of work in default of the owners, there has been little recourse to legal proceedings. A summary of the work done in connection with housing is given below:— New houses erected:— (a) By Local Authority 120 (b) By private enterprise 41 Houses inspected 546 Defective houses rendered fit in consequence of informal action 93 Defective houses rendered fit in consequence of statutory action 85 Houses in respect of which Demolition Orders were made 5 Houses demolished in pursuance of Demolition Orders 8 Houses demolished where Undertakings had been given 5 Houses rendered fit in consequence of undertaking given by owner Nil Houses known to be overcrowded (Housing Act Standard) at end of year 98 New cases of overcrowding reported 32 Cases of overcrowding relieved during the year 22 Certificates issued under Section 12 of the Rent and Mortgage Interest Restriction (Amendment) Act, 1923 1 Of the 41 houses erected by private enterprise 22 replaced houses which had been totally destroyed by enemy action. At the end of the year 54 houses in respect of which Demolition Orders had been made or Undertakings not to re-let accepted from the owners were still occupied. The Housing Department is kept informed of the conditions of these premises and of families whose application for housing accommodation can be supported by the department on medical or sanitary grounds. The official Housing Act Standards for overcrowding are assessed in terms of floor area per person and total rooms in the house relative to the number of occupants and give a very different picture from overcrowding measured on a bedroom standard. INSPECTION AND SUPERVISION OF FOOD Milk.—During the year 182 inspections were made at cowsheds, dairies and retail purveyors, premises. Under the Milk (Special Designations) Orders 22 licences for the sale of "tuberculin tested " milk, 24 for the sale of " pasteurised " milk and 2 for pasteurising plants were issued. 13 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 during recent years is shown below:— 1945 1946 1947 1948 1949 Complaints received 208 240 275 391 419 Block inspections 38 59 28 9 9 Individual inspections 1,321 1,492 2,089 2,026 2,862 Individual re-inspections 243 322 225 234 271 Other visits 110 248 338 408 408 Premises treated— (a) By occupiers 82 136 100 111 71 (b) By Local Authority 446 660 836 806 848 Under the new Regulations which came into force on 1st October, 1949, the following additional licences for the sale of milk were issued:—11 for "tuberculin tested" milk, 7 for "pasteurised" milk and 32 for "sterilised" milk. The Food and Drugs (Milk and Dairies) Act, 1944, came into operation on 1st October, 1949, and transferred the control of dairy farms to the Ministry of Agriculture. The Milk (Special Designations) Act, 1949, gives the Minister of Food power to specify areas in which only designated milks can be sold by retail. Under these two Acts the following Regulations have been made: The Milk and Dairies Regulations, 1949; The Milk (Special Designation) (Raw Milk) Regulations, 1949; The Milk (Special Designation) (Pasteurised and Sterilised Milk) Regulations, 1949. The immediate effects of these Acts and Regulations may be summarised as under:— (i) registration, inspection and supervision of dairy farms transferred from local authorities to Ministry of Agriculture, (ii) licensing of designated raw milks, i.e., " tuberculin tested" transferred from local authorities to Ministry of Agriculture. (iii) increased powers to Medical Officer of Health to investigate outbreaks of infectious disease associated with milk and if satisfied to stop sale of milk, (iv) licensing of pasteurising and sterilising plants transferred from local sanitary authorities to local authorities under the Food and Drugs Act, 1938. The registration of milk distributors, who are not producers, and of premises used as dairies (not being dairy farms) remains with local sanitary authorities such as the Council. The result of all this legislation is that in the production and distribution of milk the Ministries of Health, Food and Agriculture share the responsibility each with their area officers, inspectors, etc. Other bodies concerned are the Milk Marketing Board, Central Milk and Dairies Advisory Committee, county agricultural executive committees, county advisory committees, county and county borough councils, Food and Drugs Act authorities and local sanitary authorities. Milk is of considerable importance to the health and nutrition of the people and it is to be hoped that this multiplicity of authorities will contribute to a better and safer milk supply. Samples of milk have been taken at intervals for bacteriological examination and to test the efficiency of pasteurising. Complaints of milk being supplied in dirty bottles or in bottles containing extraneous matter continue to be received. While the importance of clean methods of production, handling and retailing of milk is brought continuously to the notice of the trade, the public could help by more hygienic treatment of milk bottles. Such bottles should be rinsed in cold water 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. The number of premises registered at the end of the year was 150. During the year 867 inspections of registered premises were carried out. Originally, ice-cream was made from cream, milk, sugar, eggs and flavour-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 largescale 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, etc.) 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, 1938, for any premises used for the manufacture or sale of food. During the year 147 samples of ice-cream were submitted to the methylene blue, plate count and coliform tests. The grading of the samples by the bacteriologists is shown below in comparison with the grading in 1948:— Grading 1948 1949 No. % No. % Excellent 13 14.4 66.6 59 40.1 68.7 Satisfactory 47 52.2 42 28.6 Doubtful 8 8.9 1 0.7 Unsatisfactory 22 24.4 45 30.6 The high proportion of unsatisfactory samples shows how frequently hygienic methods are not adopted in the manufacture and retailing of ice-cream. This is supported by the examination of 22 samples of the water used for rinsing "servers" which were graded as excellent 2; satisfactory 10; unsatisfactory 10. All unsatisfactory samples are followed up in an effort to trace lapses from strict cleanliness in manufactue, storage or retailing. 14 Bakehouses.—Visits of inspection to bakehouses numbered 153 in 1949. On three occasions complaints were received of the presence of foreign matter in bread and cakes and in each case the offenders were warned. 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 516; fish 259; provisions 459; vegetables and fruit 155; foodstuffs on hawkers' stalls or vehicles 577; and other foods 44. Premises where food was prepared were submitted to 1,423 inspections and defects were remedied or improvements secured at a number of premises. Special attention was given to kitchens at restaurants and cafe premises. During the year 11,773 lbs. of unsound food and 7,729 tins, jars, etc., of unsound food were seized by or surrendered to the Sanitary Inspectors at retail premises in the Borough. On six occasions food, unfit for human consumption, was found being sold or exposed for sale. In three cases the offenders were warned and proceedings in two cases resulted in fines amounting to £20 and costs of £4 4s. Od. In the remaining case the Ministry of Food instituted proceedings for waste of food and a penalty of £20 and 5 guineas costs was inflicted. Occasionally animals are slaughtered locally and the carcases inspected. Such action is recorded in the following table which is in the form suggested by the Ministry of Health:— Carcases Inspected and Condemned Cattle excluding cows Cows Calves Sheep and Lambs Pigs Number killed (if known) — 1 — 10 Number inspected — 1 — 10 All diseases except Tuberculosis: Whole carcases condemned — — — — Carcases of which some part or organ was condemned — — — — Percentage of the number inspected affected with disease other than tuberculosis — — — — Tuberculosis only: Whole carcases condemned — — — — Carcases of which some part or organ was condemned — 1 — 2 Percentage of the number inspected affected with tuberculosis — 100 — 20 An additional 7 cows were inspected at a knacker's yard at the time of slaughter and all were unfit for human consumption. Premises used for "the preparation or manufacture of sausages or potted, pressed, pickled or preserved food intended for sale" are required by the Food and Drugs Act, 1938, to be registered. At the end of the year 89 such premises were registered in the Borough. Section 16 of the Food and Drugs Act, 1938, states:—"every dealer in ice-cream who in a street or other place of public resort sells, or offers or exposes for sale, ice-cream from a stall, or from a cart, barrow or other vehicle or from a basket, pail, tray or other container used without a stall or vehicle, shall have his name and address legibly and conspicuously displayed on the stall, vehicle or container, as the case may be." During the year the Council, by resolution, extended the above section to all kinds of food. Under Section 279 of the Middlesex County Council Act, 1944, hawkers of meat, fish, fruit and vegetables and their storage premises require to be registered. During 1949 three applications for registration were refused and at the end of the year 68 hawkers were on the register. Municipal Restaurants.—One municipal restaurant was open throughout the year. During part of the year the restaurant provided meals for some schools and for the "meals on wheels" scheme and the total of mid-day dinners supplied was 33,300. The restaurant also provided light refreshments and on occasions catered for functions held in the Isleworth Public Hall. No complaint of the food served in this restaurant reached the Health Department. Food and Drugs Sampling.—During 1949 the following samples for analysis were taken in the Borough by the Public Control Department of the Middlesex County Council:— No. of Samples No. found unsatisfactory Milk 83 1 Milk (new) 212 19 Milk (Channel Island) 2 — Milk (South Devon) 1 — Brandy 3 — Cooked Meat 2 — Glycerine 1 — Gin 8 2 Malt Vinegar 3 — Meat Savoury 1 — Apricot Jam 1 — Rum 4 — 15 Salad Cream 4 1 Coffee and Chicory Essence 1 — Sausages 9 — Liver Sausage 1 — Sausage Meat 3 — Aniseed Balls 1 — Chocolate Toffees 1 — Sherbet 1 — Sherbet Sucker 1 1 Smoked Haddock 1 — Fresh Haddock 1 — Whiskey 28 1 Cream Cakes 4 — Cream Cheese 1 — Ice-Cream 2 — Potato Crisps 2 — Pressed Pork 1 — Rock Sweetmeat 1 — 384 25 Of the 19 incorrect new milk samples 12 containing added water were procured from one farmer on whom fines and costs amounting to £31 were imposed. Clean Food Campaign.—No special campaign in regard to clean food was carried out during the year but the Sanitary Inspectors made 1,340 visits more than in 1948 in connection with the inspection and supervision of food. Their continuous efforts to press home the lesson of "clean food, cooked, stored and packed in clean containers and touched only by clean hands" are meeting with some success. Towards the end of the year the Council decided to adopt the Ministry of Food "Model Byelaws for Securing Clean Food." GENERAL MATTERS Persons in Need of Care and Attention.—Section 47 of the National Assistance Act, 1948, places the responsibility on the Council of taking action to secure "the necessary care and attention for persons who— (a) are suffering from grave chronic disease or, being aged, infirm or physically incapacitated, are living in insanitary conditions and (b) are unable to devote to themselves, and are not receiving from other persons, proper care and attention." The action to be taken involves application to the Court for an Order for the compulsory removal of the person concerned to institution or hospital. Before bringing such cases to the notice of the Council every effort is made to arrange voluntary admission or for the necessary care to be given by relatives, friends, etc. During the year one application concerning a bedridden man, living in insanitary conditions and not receiving adequate care from relatives, was made to the Court for an Order but after hearing the evidence the Magistrates decided to make no Order. The person concerned was kept under observation till his death later in the year. Burials.—Under Section 50 of the National Assistant Act, 1948, it is the duty of the Council to arrange the burial of any person who has died in the district where it appears that there are no suitable arrangements for the disposal of the body. During 1949, 73 burials were arranged in accordance with this section. Public Mortuary.—The public mortuary is situated in the grounds of Holy Trinity Church. The premises are out of date and unsuitable for post-mortem examinations or the retention of a body for other than a very short time so by arrangement with Acton Borough Council and the Coroner bodies are taken direct to or transferred to Acton Mortuary. The Council pays a proportion of the cost of the maintenance of the Acton Mortuary. During 1949, 12 bodies were deposited in the local mortuary. Medical Examination of Staff.—For superannuation or other purposes 28 members of the Councils staff were referred to the Health Department for medical examination. Conferences and Refresher Courses.—The Medical Officer of Health attended the Royal Sanitary Institute Congress and the refresher course for County District Medical Officers organised by the Society of Medical Officers of Health. The Chief Sanitary Inspector attended the Conference of the Sanitary Inspectors Association. The Deputy Chief Sanitary Inspector and two District Sanitary Inspectors attended a refresher course for sanitary inspectors arranged by the Central Council for Health Education. Health Education.—No special campaign of health education was in operation during the year. Posters issued by the Central Council for Health Education continued to be displayed on the boards formerly used by the Empire Marketing Board. During the year the Medical Officer of Health gave talks to several organisations in the Borough on various aspects of the health services. Though the work of the department is not primarily educational the staff are fully aware of the opportunities given by their contac with the people for drawing attention to matters bearing on health and hygiene. 16 TABLE I Summary of Vital Statistics 1895-1949 Estimated Civilian population (mid-year) Birth Rate per 1,000 populalation Death Rate per 1,000 populalation Infant Mortality Rate Neo-natal Mortality Rate 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 Deaths under 1 yr. per 1,000 live births Deaths under 1 mth. per 1,000 live births 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 1949 106,900 13.6 9.8 17 12 2.0 18 0.3 17 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 — — — 5 Diphtheria — — — 6 Tuberculosis of respiratory system 21 10 31 7 Other forms of tuberculosis 2 1 3 8 Syphilitic disease 5 — 5 9 Influenza 2 4 6 10 Measles — — — 11 Acute poliomyelitis and polioencephalitis — 1 1 12 Acute infectious encephalitis — 2 2 13M Cancer of the buccal cavity and oesophagus 8 — 8 13F Cancer of the uterus — 11 11 14 Cancer of the stomach and duodenum 12 6 18 15 Cancer of the breast — 21 21 16 Cancer of all other sites 95 48 143 17 Diabetes — 3 3 18 Intra-cranial vascular lesions 48 51 99 19 Heart disease 161 134 295 20 Other disease of circulatory system 31 26 57 21 Bronchitis 51 26 77 22 Pneumonia 24 29 53 23 Other respiratory diseases 6 9 15 24 Ulceration of stomach and duodenum 12 3 15 25 Diarrhoea (under 2 years of age) — 1 1 26 Appendicitis — 2 2 27 Other digestive diseases 12 14 26 28 Nephritis 10 11 21 29 Puerperal and Post-abortive sepsis — — — 30 Other maternal causes — 3 3 31 Prematurity 2 2 4 32 Congenital malformations, birth injury, etc. 12 3 15 33 Suicide 5 2 7 34 Road traffic accidents 6 8 14 35 Other violent causes 9 11 20 36 All other causes 39 35 74 Total 573 478 1,051 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 3 — 1 4 — — — 4 Congenital defects 1 — 1 — 2 1 — 1 — 4 Birth Injury 1 — — — 1 — — — J. Infantile diseases 2 — — — 2 — — — L Gastro-enteritis 1 — 1 Atelectasis 6 — — — 6 — — — 0 Bronchitis and pneumonia 1 1 2 1 4 Intussusception 1 1 1 Marasmus 1 — — — Accident — — — 1 1 — — — 1 TOTAL 13 — 2 2 17 2 2 4 — 25 18 HESTON AND ISLEWORTH, 1949 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 — — — — — — — — — — — — — — — — — — — — — 1 — 1 3 Scarlet fever — — — — — — — — — — — — — — — — — — — — — — — — 4 Whooping cough — — — — — — — — — — — — — — — — — — — — — — — — 5 Diphtheria — — — — — — — — — — — — — — — — — — — — — — — — 6 Tuberculosis of respiratory system — — — — — — — — 2 1 1 4 5 1 5 — 8 3 1 1 — — 22 10 7 Other tuberculosis — — — — — — — — 2 — — — — 1 — — — — — — — — 2 1 8 Syphilitic disease — — — — — — — — — — — — — — 1 — — — 3 — 1 — 5 — 9 Influenza — — — — — — — — — — — — — — 1 1 — — — 1 — 3 1 5 10 Measles — — — — — — — — — — — — — — — — — — — — — — — — 11 Acute poliomyelitis, polioencephalitis — — — — — — — — — — — 1 — — — — — — — — — — — 1 12 Acute infectious encephalitis — — — — — — — 1 — — — — — 1 — — — — — — — — — 2 13M, 16 (2)F Cancer:—Buccal cavity and oesophagus — — — — — — — — — — — — — — 1 — 2 — 2 1 3 1 8 2 13F Uterus — — — — — — — — — — — — — — — 3 — 2 — 3 — 3 — 11 14 Stomach and duodenum — — — — — — — — — — — — — 1 1 — 4 1 4 — 3 4 12 6 15 Breast — — — — — — — — — — — — — 1 — 4 — 6 — 6 — 4 — 21 16 (1) Respiratory system — — — — — — — — — — — — — — 7 2 13 2 13 2 2 — 35 6 16 (3) Other sites — — 1 — 1 — — 1 — — 1 1 1 4 8 9 14 8 20 9 14 10 60 42 17 Diabetes — — — — — — — — — — — 1 — — — — — — — — — 2 — 3 18 Cerebral vascular lesions — — — — — — — — 1 1 — — — — 3 4 10 5 10 16 25 25 49 51 19 (1) Chronic endocarditis — — — — — — — — — 1 — 1 1 — — 2 4 3 4 3 3 4 12 14 19 (2) Myocardial degeneration — — — — — — — — — — — — — — 2 1 6 1 11 8 34 48 53 58 19 (3) Coronary disease, angina pectoris — — — — — — — — — — — — 1 — 16 1 21 6 23 16 21 24 82 47 19(4) Other diseases of the heart — — — — — — — 1 — — — — — — 1 1 5 1 3 1 8 11 17 15 20 Other diseases of the circulatory system — — — — — — — — — — — — 1 1 2 — 4 3 8 9 14 12 29 25 21 Bronchitis — — — — — — — — — — — — 1 — 1 1 13 1 19 7 18 19 52 28 22 Pneumonia (all forms) 2 2 — 1 1 — — — — — — — — 1 1 — 5 1 5 7 10 18 24 30 23 Other diseases of the respiratory system — — — — — — — 1 — — 1 — 1 — 2 1 — 1 1 3 — 1 5 7 24 Peptic ulcer — — — — — — — — — — — — — — 4 — 4 2 2 1 2 — 12 3 25 Diarrhoea (under 2 years) — 1 — — — — — — — — — — — — — — — — — — — — — 1 26 Appendicitis — — — — — — — — — — — — — — — — — — — 1 — 1 — 2 27 (1) Diseases of pharynx and tonsils — — — — — — — — — — — — — — — — — — — — — — — 1 27 (2) Cirrhosis of the liver — — — — — — — — — — — — — 1 — — 1 1 1 — — — 2 2 27 (3) Other diseases of the liver — — — — — — — — — — — — — — — 1 — — — 1 — 2 — 5 27 (4) Other diseases of the digestive system 1 — — — — — — — — 1 — — 2 — 1 — 2 2 3 2 1 9 6 28 Nephritis — — — — — 1 — — 1 1 — — 1 — — 1 1 1 4 1 3 6 10 11 29(1) Septic abortion — — — — — — — — — — — — — — — — — — — — — — — — 29 (2) Puerperal sepsis — — — — — — — — — — — — — — — — — — — — — — — — 30 (1) Other abortion — — — — — — — — — — — — — — — — — — — — — — — — 30 (2) Other maternal causes — — — — — — — — — — — — — 3 — — — — — — — — — 4 31 Premature birth 2 2 — — — — — — — — — — — — — — — — — — — — 2 2 32 (1) Injury at birth 1 — — — — — — — — — — — — — — — — — — — — — 1 — 32(2) Congenital malformations & infantile diseases 10 3 — — — — — — 1 — — — — — — — — — — — — — 11 3 33 Suicide — — — — — — — — — — —1 — — — — 1 3 — — — 1 1 5 2 34 Road Traffic Accidents — — — — — 1 — 2 1 — 1 — 1 — — 1 1 1 — 1 2 2 6 8 35 Other violent causes — 1 — 1 — — — — 1 — — — 1 1 5 — — 1 — 2 2 4 9 10 36 (1) Erysipelas — — — — — — — — — — — — — — — — — — — — — — — — 36 (2) Purulent infection and septicaemia — — — — — — — — — — — — — — — — 1 — — — — — 1 — 36(3) Hodgkin's disease — — — — — — — — — — — — — — — — — — — — — — — — 36 (5) Other infective diseases — — — — — — — — — — — — 1 — — 2 — — — — — — 1 2 36(6) Rheumatic fever — — — — — — — — — — — 2 — 1 2 — — — — — — 1 4 36 (7) Exophthalmic goitre — — — — — — — — — — — — — — — — — — — — — — — — 36 (8) Diseases of the blood — — — — 1 — — — — — — 1 1 — 1 1 — 1 — 2 2 — 5 5 36 (9) Diseases of the ear and mastoid antrum — — — — — — — — — — — — — — — — — — — — — 1 — 2 36 (10) Pyelitis and diseases of the bladder — — — — — — — — — — — — 1 — — 1 — — 1 1 — — 2 2 36 (11) Diseases of the prostate — — — — — — — — — — — — — — — — — — — — 10 — 17 — 36 (12) Old age — — — — — — — — — — — — — — — — — — — — 5 5 5 5 36 (4,13, 14) Other causes — — — — 1 — 2 — — 1 — — — — 1 2 1 — 1 4 — 5 6 12 ALL CAUSES 16 9 1 2 4 3 2 6 10 7 5 11 19 17 65 42 122 53 144 110 185 218 573 478 25 3 7 8 17 16 36 107 175 254 403 1051 Percentage of total deaths from all causes 2.4 0.3 0.7 0.8 1.6 1.5 3.4 10.1 1 16.7 24.2 38.3 19 20 TABLE V INFECTIOUS DISEASES—1949—AGE DISTRIBUTION Disease Total Under 1 yr. 1 yr. 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 - - - - - - - - - - - - - - Typhoid Fever - - - - - - - - - - - - - - Para-Typhoid Fever - - - - - - - - - - - - - - Scarlet Fever 138 1 2 1 11 23 75 19 5 — 1 — — 54 Diphtheria — — - — — — — — — — — — — — Erysipelas 26 — — — - — — - — 3 4 8 11 7 Puerperal Pyrexia 16 - - - - - - - 2 12 2 — — 10 Ophthalmia Neonatorum - - - - - - - - - - - - - - Acute poliomyelitis and polioencephalitis 14 — 1 3 1 1 3 3 — 2 — — — 14 Cerebro-spinal Fever 2 — 1 — — — 1 — — — — — — 2 Pneumonia 52 2 3 4 1 2 6 3 1 5 3 14 8 9 Encephalitis lethargica - - - - - - - - - - - - - - Dysentery 2 — — — — — 1 — — — — 1 — 2 Measles 523 17 72 92 64 77 194 5 1 1 — — — 46 Whooping Cough 173 16 14 20 23 29 60 4 — 7 — — — 12 Food Poisoning 11 — 1 — — — 1 — 3 3 1 2 — 4 Tuberculosis:— P ulmoxii ary 208 — — 3 l 3 6 6 21 92 25 44 7 11 - 1 1 - - - - 4 5 - - - 21 NOTIFICATIONS AND DEATHS FROM CERTAIN INFECTIOUS DISEASES TABLE VI HESTON AND ISLEWORTH, 1930-1949 Year Smallpox Scarlet Fever Diphtheria Erysipelas Pneumonia Cerebro-Spinal Fever Epidemic Encephalitis Poliomyelitis and Polioencephalitis * Typhoid Fever Paratyphoid Fever Dysentery Measles Whooping Cough Influenza Tuberculosis Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths 1930 16 — 209 4 165 19 43 — 119 38 3 — 3 2 — — 7 — — — — — — 8 — — — 4 85 48 1931 — — 204 2 62 4 39 — 148 54 5 3 — 1 — — 3 — — — — — — — — — — 18 114 54 1932 — — 207 — 58 3 37 — 199 58 8 2 — — 1 1 4 — — — — — — 14 — 5 — 18 105 58 1933 — — 391 4 50 2 54 1 234 45 6 3 2 2 5 3 5 — — — — — — 1 — 6 — 24 140 76 1934 — — 386 2 99 4 82 2 205 56 3 — 1 — 2 — 2 — — — — — — 12 — 2 — 8 113 72 1935 — — 213 1 72 3 25 — 116 39 1 1 2 5 — — 4 — — — — — — — — — — 1 129 53 1936 — — 224 — 21 2 51 — 70 43 1 — — — 1 1 2 — — — — — — 2 — 2 — 8 112 61 1937 — — 242 1 18 1 45 — 124 41 5 1 — 1 — 1 6 — — — — — — 1 — 1 — 38 102 53 1938 — — 314 — 40 2 43 — 159 36 8 5 1 — 3 1 4 — — — 2 — — 2 — 1 — 6 113 58 1939 — — 175 — 51 5 23 — 142 35 6 — — 2 — — 3 — — — 1 — — — — 2 — 10 132 69 1940 — — 96 — 73 5 35 1 200 57 43 6 1 2 1 — 4 — — — — — 1109 2 123 3 — 16 130 59 1941 — — 117 — 37 3 20 — 124 41 34 2 1 1 1 — 2 — 30 — — 2 580 — 286 1 — 9 174 78 1942 — — 190 — 11 1 16 — 72 67 12 1 — — — — 4 — 1 — 2 2 1085 2 243 4 — 3 202 70 1943 — — 280 — 5 — 21 — 116 63 — 1 — 1 — — 1 — — — — — 636 1 134 1 — 16 190 49 1944 — — 130 — 11 1 16 — 50 59 3 2 — 1 3 — — — — — 22 — 219 — 171 3 — 5 184 44 1945 — — 124 — 24 2 16 1 25 37 11 2 1 — 7 — — — — — 28 — 1107 1 110 — — 3 157 52 1946 — — 67 — 16 1 19 1 47 53 13 — — 1 1 1 1 — — — 6 — 170 — 170 — — 16 217 56 1947 — — 62 — 3 — 19 — 56 40 8 1 — — 43 5 1 — — — — — 840 2 142 2 — 8 180 52 1948 — — 159 — 2 — 21 — 41 42 2 — — 1 29 2 — — 3 — 5 — 571 — 227 — — 5 168 43 1949 — — 138 — — — 26 — 52 53 2 1 — 2 14 1 — — — — 2 — 523 — 173 — — 6 219 36 * Includes paratyphoid fever to 1939. TABLE VII COMPARATIVE STATISTICS, 1949 England and Wales Rates per 1,000 Heston and Isleworth Civilian Population Births— Live Births 16.7 (a) 13.6 Still Births 0.39 (a) 0.25 Deaths— All causes 11.7 (a) 9.8 Typhoid and Paratyphoid 0.00 0.00 Whooping Cough 0.01 0.00 Diphtheria 0.00 0.00 Tuberculosis 0.45 0.32 Influenza 0.15 0.06 Smallpox 0.00 0.00 Poliomyelitis 0.01 0.01 Pneumonia 0.51 0.50 Notifications— Typhoid fever 0.01 0.00 Paratyphoid fever 0.01 0.00 Cerebro-spinal fever 0.02 0.02 Scarlet fever 1.63 1.30 Whooping cough 2.39 1.62 Diphtheria 0.04 0.00 Erysipelas 0.19 0.24 Smallpox 0.00 0.00 Measles 8.95 4.90 Pneumonia 0.80 0.49 Poliomyelitis 0.14 0.13 Food Poisoning 0.14 0.10 (a) Rates per 1,000 total population. TABLE VIII FACTORIES ACTS, 1937 and 1948 PART I OF THE ACT 1. Inspections for purposes of provisions as to health (including inspections made by Sanitary Inspectors). Premises Number on Register Number of Inspections Written Notices Occupiers prosecuted (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 43 55 4 — (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 351 788 32 — (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding outworkers' premises) 4 24 — — TOTAL 398 867 36 — 2.—Cases in which Defects were found— Particulars Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied Referred To H.M. By H.M. Inspector Inspector Want of Cleanliness (S.1) — — — — — Overcrowding (S.2) 1 — — — — Unreasonable temperature (S.3) 1 — — — — Inadequate ventilation (S.4) — — — — — Ineffective drainage of floors (S.6) — — — — — Sanitary Conveniences (S.7)— (a) insufficient 1 5 — — — (b) unsuitable or defective 33 31 — 1 — (c) not separate for sexes 2 3 — 1 — Other offences against the Act (not including offences relating to Outwork) 10 7 10 — — TOTAL 48 46 10 2 — 22 csoah JL r*i$s thomasons ltd hounslow. middlesex