HES 37 LIBRARY AC 439(1) HESTOW ISLE WORTH ANNUAL REPORT OF THE MEDICAL OFFICER of HEALTH OF THE BOROUGH OF HESTON AND ISLEWORTH for the year 1950 A. ANDERSON, M.D., D.P.H. Medical Officer of Health. INDEX Page Bakehouses 14 Births, Live and Still 5 Burials 17 Canal Boats 12 Closet Accommodation 9 Common Lodging Houses 12 Conferences and Refresher Courses 18 Deaths 5 Deaths, Age and Sex Distribution 23 Deaths, Causes of 21 Disinfection 9 Disinfestation 12 Drainage and Sewerage 9 Factories, No. on Register, Inspections and Defects, etc. 26 Factories, Workplaces etc. 12 Fever Hospital 8 Food and Drugs Sampling 15 Food Hygiene Campaign 15 Food Poisoning 9 Health Committee 3 Health Education 18 Housing 17 Ice Cream 14 Infant Deaths according to Age and Cause 22 Infant Mortality 6 Infectious Diseases 6 Infectious Diseases, Age Distribution 24 Infectious Diseases, Notifications and Deaths 25 Page Laboratory Service 9 Maternal Mortality 6 Meat and Other Food Inspection 14 Medical Examinations of Staff 18 Noise Nuisances 12 Milk 13 Mosquitoes 12 Municipal Restaurant 15 Persons in need of care and attention 18 Poliomyelitis 7 Public Cleansing 11 Public Mortuary 17 Rags, etc., Exchange of Articles for 13 Rats and Mice Destruction 13 Rivers and Streams 9 Sanitary Inspection 11 Shops Act, 1934, Section 10 13 Slaughter Houses etc. 14 Smoke Abatement 12 Staff 2 Statistics Comparative 26 Statistics General 5 Statistics Vital 5 Statistics, Vital, Summary of 20 Swimming Baths 13 Tents, Vans and Caravans 12 Tuberculosis 8 Water Supply 9 1 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. (to 31.3.50). K. J. Smith, Cert. as S.I. and M.I. (from 1.7.50). District Sanitary Inspectors. G. Latimer, Cert. as S.I. and M.I. K. J. Smith, Cert. as S.I. and M.I. (to 30.6.50). S. H. G. Stevens, Cert. as S.I., M.I. and S.E. J. A. Dawson, Cert. as S.I. and M.I. R. C. Rogers, Cert. as S.I. and M.I. (to 12.3.50). S. Sadler, Cert. as S.l. and M.I. (to 2.7.50). 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 (to 17.9.50). E. J. Hutchins. Miss J. M. Bettles (to 9.6.50). Miss P. M. Whittington (from 17.7.50). F. B. Capes (from 9.10.50). 2 THE HEALTH COMMITTEE of HESTON AND ISLEWORTH BOROUGH COUNCIL to May, 1950 Alderman Mrs. O. C. M. Denton (Chairman). Councillor A. G. Trickey (Vice-Chairman). Alderman F. T. Hart, J.P. (Mayor) Councillor Mrs. D. M. Elliott. Alderman W. E. Bray. Councillor A. J. Fielder, J.P., C.C. Alderman J. E. Dillingham. Councillor Mrs. M. Hennig. Alderman Miss M. K. Watson. Councillor P. A. J. James. Councillor R. J. H. Brinsley. Councillor W. Pope. Councillor Mrs. M. F. Davison. Councillor Mrs. M. J. Tozer. from May, 1950. Alderman Mrs. O. C. M. Denton (Chairman). Councillor Mrs. M. Hennig (Vice-Chairman). Alderman V. C. Denton, J.P. (Mayor) Councillor A. J. Fielder, J.P., C.C. Alderman W. E. Bray. Councillor H. F. Nicholls. Alderman J. E. Dillingham. Councillor S. J. H. Sims. Councillor A. G. Cross. Councillor Mrs. A. B. Tolman. Councillor Mrs. M. F. Davison. Councillor Mrs. M. J. Tozer. Councillor Mrs. D. M. Elliott. Councillor A. G. Trickey. 3 PUBLIC HEALTH DEPARTMENT, 92, BATH ROAD, HOUNSLOW. To the Mayor, Alderman 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 1950. The report has been prepared on lines suggested by the Ministry of Health and for convenience the larger statistical tables have been grouped together at the end of the report. Since the inauguration of the National Health Service there has been continuous floodlighting of the curative services and though the prevention of disease appears to have been relegated to a minor role its importance should not be forgotten. The birth rate is the lowest on record and if the low rate continues serious social changes will appear in the future. The death rate and the incidence of infectious diseases compare favourably with previous years. The very low infant mortality rate of 1949 has not been maintained but the rate for 1950 is still below the average of recent years. From time to time adverse comment is made on the nutritional state of the people. In 1950 the British Medical Association published their Report of the Committee on Nutrition. This report revealed that there are gaps in the knowledge of the science of nutrition and in our supervision of the nutrition of sections of the population but the main conclusion was that by no standard known to medical science is there any evidence that the physical health of the people has suffered from any known dietary deficiency. In this connection the following table on food consumption published in Ministry Food Bulletin No. 611 is of interest :— Food Supplies (1b. per head per annum) moving into Civilian Consumption in the United Kingdom. 1934-38 average 1950 Dairy products (excluding butter) total as milk solids 38.3 53.9 Meat (including canned meat, bacon and ham) (as edible weight) 109.6 95.4 Fish, poultry and game (edible weight) 32.8 27.7 Eggs and egg products (shell egg equivalent) 28.6 31.7 Oils and fats (fat content) 45.3 44.9 Sugar and syrups (sugar content) 109.9 80.8 Potatoes 176.0 242.5 Pulses and nuts 9.6 11.1 Fruit (including tomatoes) (fresh equivalent) 141.4 129.6 Vegetables 107.5 102.7 Grain products 210.1 221.3 Tea, coffee and cocoa 14.7 13.0 Health is not only a matter of absence of disease and adequate nutrition. It is influenced by social and environmental conditions, and there is considerable evidence of "social sickness" in our family and communal life. The shortage of houses is an important factor, but there are many others needing attention in the creation of a healthy, stable and well adjusted community. Attention to environmental conditions during the year was severely restricted by shortage of Sanitary Inspectors, and this is reflected in comparison with the previous year as shown below:- 1949 1950 General inspections re nuisance, etc. 24,463 18,921 Smoke observations 202 37 Inspections of factories, etc. 1,214 881 Housing inspections 546 419 Inspections re ice cream 867 331 Ice Cream samples tested 147 — Inspections of meat and other foods 2,010 1,936 Inspections of food premises 1,423 1,155 The Chief Sanitary Inspector and his assistants have worked hard to maintain the service and I am pleased to record that the staff shortage has now been made good. Throughout the year full co-operation and help was received from other Departments of the Council. I would like to express thanks to my staff for their loyal co-operation and to the Council for support and encouragement. I remain, Your obedient Servant, A. ANDERSON, Medical Officer of Health. 4 GENERAL STATISTICS 1949 1950 Area in acres 7,261 7,261 Population (Registrar-General's estimate) 106,900 107,300 Number of inhabited houses (rate books) 28,217 28,428 Number of houses erected during year 161 232 Rateable Value of Borough £970,555 £983,775 Sum represented by a penny rate £3,964 £3,993 Live Births—male 707 643 Live Births—female 742 604 Birth rate per 1,000 population 13.6 11.6 Birth rate per 1,000 population (England and Wales) 16.7 15.8 Stillbirths—male 15 13 Stillbirths—female 12 10 Stillbirth Rate per 1,000 (live and still) births 18.3 18.0 Deaths—male 573 529 Deaths—female 478 536 Death rate per 1,000 population 9.8 9.9 Death rate per 1,000 population (England and Wales) 11.7 11.6 Infant Mortality rate 17.3 24.4 Infant Mortality rate (England and Wales) 32 29.8 Maternal Mortality rate 2.0 0.8 Maternal Mortality rate (England and Wales) 1.0 0.9 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 1950 is 107,300. This figure includes members of the armed forces stationed in the Borough. Rateable Value.—The rateable value of the Borough for 1950 was £983,775 and the sum represented by a penny rate was £3,993. Inhabited Houses.—According to the rate books the number of inhabited houses at the end of the year was 28,428. 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 1950 was 1,247 as compared with 1,449 in 1949. The birth rate was 11.6 per 1,000 population. This is the lowest birth rate in the Borough records. The birth rate will vary, apart from other causes, according to the age and sex distribution of the population and to permit of a true comparison with other areas the Registrar-General supplies for each local sanitary authority what is called the area comparability factor. When this is applied to the above Borough birth rate the result is 11.1 as compared with the birth rate of 15.8 per 1,000 population for England and Wales. The number of illegitimate births was 51 as compared with 60 in 1949. 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 1930-34 3.2 1935-39 2.9 1940-44 4.6 1945-49 5.1 1950 4.1 Stillbirths.—The number of stillbirths in 1950 was 23 (22 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 1945-49 198 23.8 1950 23 18.0 Deaths.—A difficulty in the quantitative study of deaths has always been the classification of the causes of deaths into groups. With the setting up of the General Register Office of England and Wales in 1837 the matter of the names and statistical classification of disease became a subject of constant study. The need for a uniform classification of disease, not only for local and national use, but also for international use, was soon recognised, and since 1885, various international classifications have been used. With the development of medical knowledge the need for revision of the classification arises and in 1900 it was agreed that decennial revisions were desirable. Since the last revision in 1938 the need for the quantitative study of disease as well as of death has been realised and the World Health Organisation issued in 1948 Regulations regarding Nomenclature (including the Compilation and Publication of Statistics) with Respect to Diseases and Causes of Death to come into force on 1st January, 1950. These Regulations were adopted by Great Britain and throughout this report the new classification is used. The deaths of residents of the Borough during 1950 were 1,065 (529 male, 536 female). This represents a death rate for the Borough of 9.9 per 1,000 population. The deaths in any area are influenced by the sex and age distribution of the population and to permit of a true comparison the Registrar-General calculates for each local sanitary authority area what is called an area comparability factor. When this is applied to the above Borough rate the result is 10.9 as compared with a death rate of 11.6 per 1,000 population for England and Wales. 5 In Table II is given the classification of deaths compiled by the Registrar-General. In Table IV the classification has been compiled from local information. To help in classifying causes of death the Registrar-General may obtain additional information which is not available to the Medical Officer of Health and thus small discrepancies may be noticed on comparing the two Tables. 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 1945-49 1950 Under 1 year 21.8 7.8 5.3 2.8 1-4 years 8.4 1.4 0.8 0.4 5-14 years 3.8 1.8 2.1 0.5 15-24 years 3.7 2.8 2.1 1.2 25-64 years 30.8 35.2 33.0 33.1 65 years and over 31.5 51.0 56.7 62.0 The chief causes of death in males were heart and circulatory diseases (168), cancer (89), bronchitis and pneumonia (60), and cerebral haemorrhage (47). In females the chief causes of death were heart and circulatory diseases (187), cancer (97), cerebral haemorrhage (83) and bronchitis and pneumonia (38). It should be noted that 65 per cent. of the deaths due to accidents other than motor vehicle accidents occurred in persons aged 65 years and over. Practically all these deaths were the result of falls and this special liability of old persons should be borne in mind by all having any responsibility for the care of such persons. Infant Mortality.—During 1950 there were 30 deaths of children under the age of 1 year. This represents an infant mortality rate per 1,000 live births of 24.4 as compared with 29.8 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 1950 1,247 30 24 It will be seen that the fall in the infant mortality rate has generally been steady and continuous. On theoretical grounds an infant mortality rate in the neighbourhood of 20 should be possible and the falling rate encourages the hope that practice may yet catch up with theory. 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 0.8 as compared with 0.9 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 1945-49 0.2 1.2 1.4 1950 — 0.8 0.8 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:- 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 Smallpox — — — — — — — — — - Scarlet Fever 117 190 280 130 124 67 62 159 138 92 Diphtheria 37 11 5 11 24 16 3 2 — 1 Erysipelas 20 16 21 16 16 19 19 21 26 12 Pneumonia 124 72 116 50 25 47 56 41 52 64 Cerebro-spinal fever 34 12 — 3 11 13 8 2 2 — Epidemic encephalitis 1 — — - 1 — — — — - Poliomyelitis and polioencephalitis 1 - - 3 7 1 43 29 14 9 Typhoid fever 2 4 1 — — 1 1 — — 3 Paratyphoid fever 30 1 - - - - - 3 — 6 Dysentery — 2 — 22 28 6 — 5 2 6 6 INFECTIOUS DISEASE—contd. Tuberculosis—Pulmonary 157 177 165 167 128 200 160 147 208 163 do. Non-Pulmonary 17 25 25 17 29 17 20 21 11 19 Opthalmia neonatorum 5 3 — 5 3 2 — — — 1 Puerperal pyrexia 22 58 105 87 45 54 60 23 16 8 Measles 580 1,085 636 219 1,109 170 840 571 523 881 Whooping cough 286 243 134 171 110 170 142 227 173 206 Malaria — — — 1 2 1 — — 1 1 Undulant fever - - - - - - - - - 1 The age distribution of notifiable disease during 1950 is shown in Table V. An interesting feature of the present half century is the reduction in deaths due to infectious disease. In the Borough infectious diseases including tuberculosis caused 16.4 per cent. of the total deaths in 1900-04 as compared with 4.8 per cent. in 1946-50—a tribute to the progress of preventive medicine. 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 92 cases, 25 were admitted to hospital. Diphtheria.—One case of diphtheria occurred in the Borough during 1950. The person concerned had been immunised in 1941, repeated tests failed to produce evidence of the presence in the throat of the diphtheria bacillus, the illness was uneventful, but the medical officer of the fever hospital considered the patient to be suffering from a " very mild attack of diphtheria." The occurrence of an occasional case of diphtheria serves to remind us that only by continuing to immunise a considerable proportion of our children can this disease be kept under control. There has been a reduction in the number of children attending for immunisation against diphtheria. This is not wholly due to the fall in the birth rate, but undoubtedly has been influenced by the publicity given to the suggestion that prophylactic inoculations may have some association with the development of paralysis when poliomyelitis is prevalent. Last year I wrote " 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 " and so far, I see no reason to modify that statement. Erysipelas.—Though 12 cases were notified no death was due to this disease. Pneumonia.—There was a slight increase in the notifications of pneumonia when compared with 1949. The death rate from pneumonia per 1,000 population was 0.3 as compared with 0.5 in 1949 and 0.4 in 1948. Of the total pneumonia deaths 10 per cent. occurred at age 0-4 years and 80 per cent. at age 65 years and over. Cerebro-Spinal Fever.—No case of meningococcal infection was notified during the year. Epidemic Encephalitis.—No case was notified during the year. 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. The incidence of this disease in the Borough in recent years is shown below:- Cases Deaths 1930 — — 1931 — — 1932 1 1 1933 5 3 1934 2 — 1935 — — 1936 1 1 1937 1 1 1938 3 1 1939 — — 1940 1 — 1941 1 — 1942 — — 1943 — — 1944 3 — 1945 7 — 1946 1 1 1947 43 5 1948 29 2 1949 14 1 1950 9 — During the same period there were 58 deaths due to diphtheria, 48 due to measles and 33 due to whooping cough. Of the 9 cases in 1950 one was a soldier notified from Hounslow Barracks and one was a resident of Brentford and Chiswick notified from West Middlesex Hospital. Of the 7 local residents 4 were males and 3 females and their ages ranged from 1 to 57 years. One child aged 1 year who developed paralysis of the legs had been inoculated in the arm against diphtheria and whooping cough three months previously. Of these 7 patients two developed no paralysis, one had mild paralysis and after discharge from the fever hospital attended hospital as an out-patient for physiotherapy, and the remaining five were transferred from the fever hospital to orthopaedic hospitals. No closure of schools, swimming baths, children's cinemas, etc., was adopted with a view to controlling the spread of infection. 7 Typhoid Fever.—During the year three cases of typhoid fever were notified. One had just returned from a holiday in Spain, and the history of the illness pointed to the infection having been acquired there. The other two cases, notified in January and March respectively, were nurses in West Middlesex Hospital. Extensive enquiries and the bacteriological examination of specimens of blood and excreta from many contacts failed to reveal the source of infection. Paratyphoid Fever.—During the year six cases of paratyphoid fever were notified. Five of these occurred in June, they resided in various parts of the Borough and no connection between them was traced. The mother of one of the children was found to be a carrier. The type of paratyphoid bacillus concerned in all these persons is uncommon in this country, and the Ministry of Health and the Public Health Laboratory Service co-operated in extensive and varied enquiries designed to ascertain the source of the infection, but after three months of effort the mystery remained unsolved. The remaining case occurred in September and again efforts to trace the source of infection were unsuccessful. Dysentery.—This disease shows great variations in prevalence from year to year and from place to place. Six cases were notified in the Borough during 1950. One was a nurse in West Middlesex Hospital and the others resided in various parts of the Borough. The possibility of this infection should be kept in mind in all cases of diarrhoea and on the least suspicion a specimen of faeces should be submitted to bacteriological examination. Tuberculosis.—The notifications of pulmonary tuberculosis were 45 less then in 1949, but there was an increase of 8 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 Non-Pulmonary Total 1930-34 67.5 11.5 78.9 1935-39 52.3 8.2 60.4 1940-44 55.8 7.4 63.2 1945-49 39.1 6.7 45.8 1950 33.6 0.9 34.5 The number of cases of tuberculosis on the Borough register at 31st December, 1950 was 935. "Tuberculosis as a constitutional disease is a serious menace to public health in that it is infectious, insidious in onset, usually runs a chronic course and exerts its maximum effect on those age groups that are of the greatest value to the productive capacity of a nation." The recent efforts to increase the number of beds available for cases of tuberculosis are welcome. Towards the end of the year the Mass X-Ray Unit visited the Borough, it was located at West Middlesex Hospital for 19 days, and at Bulstrode School for 4 days. The sessions at West Middlesex Hospital were reserved for selected groups from factories, etc., and 5,884 persons attended. The sessions at Bulstrode School were open to the general public and despite the very bad weather, 2,397 persons (965 men, 1,432 women) attended. This is a record number for public sessions, and no doubt the press publicity paid for by the Council and the personal attendance of the Mayor and members of the Council did much to encourage citizens to take advantage of the presence of the Unit in the Borough. Of the 2,397 persons who attended the public sessions 74 were recalled for large films, but only 9 were considered to require further investigation (this does not necessarily indicate tuberculosis). Ophthalmia Neonatorum.—One case of this infection of the eyes of young babies was notified 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 8 cases were notified, but no woman died from puerperal or post-abortion sepsis. Measles.—This disease was more prevalent than in 1949, but caused no deaths. Admission to hospital was arranged for 26 cases. Whooping Cough.—The incidence of this disease was greater than in 1949, but no death was due to whooping cough. Admission to hospital was arranged for 14 cases. Malaria.—One case was notified during the year and enquiry revealed it to be a recurrence of an infection acquired overseas. Influenza.—No epidemic of influenza occurred during 1950, and the deaths due to this disease were 6 as compared with 6 in 1949 and 5 in 1948. 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 1950 mumps 196 ; chicken pox 219 ; and German measles 5. Undulant Fever.—One case was notified during the year. This disease is caused by the germ responsible for contagious abortion in cattle and is usually transmitted by infected milk. The probable source of infection was unpasteurised milk derived from a farm outside the Borough and the circumstances were reported to the Ministry of Agriculture. Fever Hospitals.—The Borough is served by the South Middlesex Infectious Diseases Hospital but on occasion accommodation in other fever hospitals of the North West Metropolitan Regional Hospital Board is used. During the year 97 patients from the Borough were admitted to these hospitals, Close contact is maintained between the hospitals and the Health Department so that any necessary action can be taken. 8 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-four rooms were disinfected during 1950. 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 1950 was 215. 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. The possibility of food poisoning should be kept in mind in all cases of "gastric flu" and unexplained vomiting and diarrhoea. During 1950 notification of the occurrence of food poisoning in 5 persons was received and information from other sources revealed a further case. Some details of these cases are set out in tabular form overleaf. Tracing the source of food poisoning takes up much time and effort and though the source can usually be suspected proof is not always forthcoming. 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 17 Cisterns cleansed, repaired, etc. 8 Draw-off taps connected direct to main 6 Service pipes or taps repaired 29 Cases where mains supply substituted for well supply Nil Samples taken from wells for analysis Nil Samples taken from mains for analysis 1 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 1950 :— Drains exposed for examination 27 Drains unstopped, repaired, etc. 334 Waste pipes repaired, trapped, etc. 33 Soil pipes repaired, etc. 7 Ventilating shafts repaired, etc. 10 Fresh air inlets repaired, etc. 7 Rainwater pipes disconnected from drains 1 Gully traps inserted or repaired 46 Disconnecting traps inserted or repaired 6 Disconnecting and inspection chambers provided 10 Disconnecting and inspection chambers repaired, etc. 65 Drains constructed or repaired 21 Total length (ft.) of drain pipes laid— (a) 4" 884 (b) 6" 9 Drain tests applied 108 Other works executed 4 Cesspools emptied or repaired 1 Cesspools abolished 3 Rivers and Streams.—No complaint of pollution was made to the Health Department during 1950. A watch is kept on streams for evidence of breeding of mosquitoes. 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 13 Water closets provided in substitution for dry receptacles, etc. Nil Water closets where walls cleansed 19 Water closets fitted with new flushing apparatus 16 New pans or pedestals provided 45 Water closets repaired or improved 102 Water closets blockages unstopped 11 Other closets provided or repaired 7 Water closets connected to sewer and cesspools abolished 3 9 10 FOOD POISONING OUTBREAKS 1950 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 19-5-50 23-5-50 ? 1 — Not ascertained — Meat pie Restaurant outside — 2 22-7-50 26-7-50 13 1 — Salmonella typhimurium — — Borough Home — 3 14-8-50 24-8-50 ? 1 — Not ascertained — — — Notification from hospital but patient resided outside Borough. 4 26-9-50 11-10-50 ? 1 — Not ascertained — Corned Beef Cafe outside Borough — 5 3-10-50 14-10-50 ? 1 — Not ascertained — — Home Notification from hospital, but patient resided outside Borough. 6 25-5-50 6-6-50 3 1 — Salmonella typhimurium — — — 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 58 new dustbins were provided during 1950. The following details of the salvage of waste materials have been provided by the Borough Engineer:— 1946 1947 1948 1949 1950 Paper (tons) 709 686 943 1,228 1,331 Scrap metal (tons) 28 40 83 102 80 Textiles (tons) 65 56 64 84 75 Bones (tons) 8 4 3 2 1 Bottles, jars (tons) 251 166 109 23 36 Cullet (tons) 17 10 14 12 6 Rubber (tons) 1 9 1 1 — Kitchen Waste (tons) 1,173 1,077 1,110 1,074 1,013 Miscellaneous (tons) 60 — 1 - - £11,405 £11,207 £12,322 £12,702 £14,426 During the year the Council gave consent, subject to conditions designed to prevent nuisance, for refuse to be tipped at Millstream Field, Hounslow Heath and at gravel pits on the Heston Airport site. 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 continues to be handicapped by shortage of labour and materials and by rising costs. Some particulars of the work done are given below :— Complaints received 1,252 Number of premises at which nuisances, etc., were located 978 Number of premises where defects were remedied:— (a) by owners or occupiers 969 (b) by Council in default 11 (c) public sewers repaired by Council 20 Informal notices issued 667 Written reminders issued 869 Statutory notices served 104 Total number of inspections and re-inspections 18,921 Inspections of piggeries 66 Inspections of stables 85 Inspections of urinals 24 Sinks repaired or renewed 42 Roofs repaired 262 Gutters repaired or renewed 151 Number of premises provided with damp-proof courses 4 Yards paved or drained 21 Floors, walls, etc., repaired or renewed 1,114 Windows repaired or renewed 470 Doors repaired or renewed 171 Grates provided or repaired 163 Wash coppers provided or repaired 11 Larders provided or repaired 10 Offensive accumulations removed 40 Other nuisances abated 161 Visits re infectious disease, etc. 462 "Any accumulation or deposit which is prejudicial to health or a nuisance" is a statutory nuisance, to be dealt with under the Public Health Act, 1936. Complaints are received of deposits and accumulations in rear passages, on unfenced land and, at the outskirts of the Borough, in roadside ditches and ponds. These accumulations consist of such material as garden refuse, rubble, tins, defective water tanks, broken furniture and household utensils, etc., and though unsightly, are seldom "prejudicial to health or a nuisance" within the meaning of the Public Health Act. Children are sometimes blamed for these deposits. Undoubtedly children use them as play material, but the most casual inspection reveals that citizens or other adults with no pride in the general appearance of the Borough have deliberately dumped their rubbish on the site. The Department does what it can to deal with these accumulations, but legal action is seldom possible and rarely can the offenders be traced. Carbon black is transhipped from barges and coasting vessels to lorries at a wharf in Isleworth. This fine powder is liable to be carried on to the roadway by the vehicles and to be blown into adjacent houses by the wind. Complaints have been received from the occupants of houses in the vicinity of the wharf and considerable attention has been given to this matter in consultation with the owner of the wharf and representatives of the trade concerned in an effort to solve the problem. During the year complaints were received of a nuisance from the roosting and breeding of feral pigeons in premises in the Hounslow area. There are restrictions on the methods to be employed in capturing pigeons and trapping and capture by hand, where access to roosting places was possible, were the methods adopted. In this way 130 pigeons were caught. Ringed birds were handed over to a person interested in homing pigeons who undertook to try to return the birds to their owners and the other birds were killed. Nothing could be done about the pigeons roosting in inaccessible places, but property owners were advised to take such measures as were possible to prevent access to vacant property and to discourage roosting. Unfortunately many people do not appreciate how much damage can be done by pigeons and encourage their presence by making food available to them. 11 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 37 smoke observations on factory chimneys during the year and paid many visits to premises which had been the subject of smoke nuisance complaint. A grit nuisance from the chimney of Government premises was abated on representations' being made to the Department concerned. The usual excuse given for the occurrence of a smoke nuisance is that the right type of fuel for the boilers cannot be obtained. While this is a contributory factor, there is no doubt that smoke nuisance in most cases is due to bad stoking, inattention to damper control and/or defects in the plant. The Chief Sanitary Inspector arranged for two films, "Boiler House Practice" and "C02 and Draught," to be shown at the Health Department on 30th January to an audience of 39 composed chiefly of representatives, including stokers, from firms operating steam-heating plants in the Borough. The Divisional Engineer, Ministry of Fuel and Power, was present, and dealt with questions raised at the conclusion of the films. With the co-operation of the Education Department a course on boiler-house practice was started at Spring Grove Polytechnic in the autumn but, though notice of the course was widely circulated to persons and firms who should have been interested, the number who enrolled for the course was very disappointing. "The Stoker's Manual" and "The Maintenance of Industrial Boiler Plant," published by His Majesty's Stationery Office for a few pence should be in the hands of all stokers. The Department of Scientific and Industrial Research has evolved apparatus for measuring atmospheric pollution and has expressed a desire that Local Sanitary Authorities should, throughout the country, install such apparatus so that regular records should be available for investigation. The Council decided to participate in the scheme, but owing to delay in delivery of the apparatus, no recordings were made during the year. Tents, Vans, Caravans.—There are five sites in the Borough which have been used as caravan sites for many years. Some are occupied wholly or in part by persons who use caravans for business in connection with a travelling circus, fair or stall. During the year the inspectors made 969 visits of inspection because of the occupation of land by caravans. The area of the Borough where trespass by caravans on unfenced land was so frequent has been reduced by recent building operations and trespass was not so frequent during 1950. Removal of the caravans usually followed verbal notice from the Sanitary Inspector, but at times the assistance of the Police had to be obtained. In this way 38 caravans were removed during the year. Four applications, under the provisions of the Middlesex County Council Act, for permission to place caravans on sites within the Borough were considered ; one was approved and three refused. 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 87 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 488 (b) Factories—non-mechanical power 29 (c) Other premises 5 (d) Workplaces 112 (e) Outworkers' premises 247 Defects remedied 19 At the end of the year the number of outworkers registered with the Department was 167. Mosquitoes.—No complaint of the presence of biting mosquitoes was received during the year. Culex molestus, the biting mosquito that caused so much annoyance during 1939-46, appears to have ceased to breed in the district. Householders, gardeners and allotment holders can do much to discourage breeding of mosquitoes by attending to ponds, water buts, liquid manure pits, etc. 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 120 rooms in 48 houses were treated, while 10 wasp nests were destroyed, 13 premises cleared of cockroaches, 1 of crickets, 1 of moths and 3 of ants. One pond was treated to prevent breeding of mosquitoes. 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 residents in the neighbourhood of the factory concerned. During the year complaints of nuisance due to noise were received in regard to five factories. Day and night observations were made concerning the complaints and in conjunction with the firms concerned measures were taken to reduce the noise as far as was practicable. 12 Rats and Mice Destruction.—The Prevention of Damage by Pests Act, 1949, came into operation on 30th March, 1950, on which date the Rats and Mice (Destruction) Act, 1919, was repealed. The new Act transferred the duties and responsibilities from County Councils to Borough and District Councils. Under the 1919 Act the primary duty of keeping premises free from rats and mice was placed on the occupier, but now the obligation "to keep their area, so far as practicable, free from rats and mice" is placed upon the local authority. Occupiers are required to give notice when they have knowledge that rats or mice are present in substantial numbers, but there is no guidance as to what constitutes a " substantial " number. Owners and occupiers of food premises are required to notify the Ministry of Agriculture and Fisheries, and not the local authority, of any infestation of their premises which involves a risk of substantial loss of or damage to food. Local authorities are empowered, by formal notice, to require owners or occupiers of property to comply with requirements necessary to keep the district, so far as practicable free from rats and mice. There is a right of appeal to the Court only if the notice requires the execution of structural work. The Act retains the principle that the owner or occupier has a right to arrange for the destruction of rats and mice on his property, whether or not in pursuance of a notice served upon him. Except where the local authority are satisfied that it is necessary to treat a group of separately occupied premises as a " block " occupiers may employ persons to keep property free from rats and mice, but if such persons are not rodent operatives employed by the local authority, the results of the service rendered by such persons must be to the satisfaction of the local authority. It is obligatory on the Council to recover the expenses reasonably incurred in taking steps for the destruction of rats and mice on business premises, but permissive as far as the cost of treating private dwellings is concerned. The council has decided to make no charge for the treatment of private dwelling-houses unless there is failure on the part of the owner or occupier to co-operate in preventing infestation. The Ministry of Agriculture and Fisheries may make to local authorities a grant equal to one half of the expenditure incurred in the performance of their duties under the Act so far as such expenditure has not been recovered. No notification of the presence of rats or mice in substantial numbers has been received, but by the visits of the Sanitary Inspectors and the Rodent Officer and complaints of " rats coming from next door," no gross infestation should escape attention. The Council employs a Rodent Officer who is responsible for svstematic inspection, planning; of treatment, supervising the work of the rodent operatives and checking results. A summary of the work done in recent years is shown below:- 1946 1947 1948 1949 1950 Complaints received 240 275 391 419 421 Block inspections 59 28 9 9 37 Individual inspections 1,492 2,089 2,026 2,862 2,574 Individual re-inspections 322 225 234 271 316 Other visits 248 338 408 408 402 Premises treated— (a) By occupiers 136 100 111 71 25 (b) By Local Authority 660 836 806 848 882 Test baiting, and where necessary, treatment is carried out to sewers, watercourses, tips, etc. By whatever means rats and mice gain access to premises their continued presence is due to conditions on the premises which provide food and/or shelter. Unless occupiers take the necessary precautions to discourage rats progress towards eradication will be slow. During the year a young child was poisoned by consuming a bait intended for rats. The child recovered, but the source of the bait was not traced. The incident should be a warning of the need for constant care in the use of rat poison. The services of the Council's skilled staff are available to all. Exchange of Articles for Rags, etc.—Under the Public Health Act, 1936, it is an offence for any person who collects or deals in rags, etc., to sell or deliver, whether gratuitously or not, any article whatsoever to a child under the age of 14 years, in exchange for rags, etc. The Police notify the Council of any such contraventions coming to their notice. During the year one dealer in rags was prosecuted and a fine of 40/- was imposed. Shops Act, 1934, Section 10.—During the year a Certificate of Exemption in regard to the provision of washing facilities was issued for one shop. Adequate arrangements having been made the Certificate of Exemption in relation to the provision of sanitary accommodation was withdrawn in the case of one shop. Swimming Baths.—One private and three municipal swimming baths are situate in the Borough and were open to the public. During the year 4 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. INSPECTION AND SUPERVISION OF FOOD Milk.—During the year 132 inspections were made at dairies and retail purveyors premises. Under the Milk (Special Designation) Regulations 37 licences for the sale of " tuberculin tested" milk, 42 for the sale of " pasteurised " milk and 34 for the sale of " sterilised " milk were issued. Complaints of milk being supplied in dirty bottles or in bottles containing extraneous matter continue to be received. Though the number is small in relation to vast issue to the public the Department continues to bring to the notice of the trade the importance of clean methods of handling and retailing milk. The public could also give more attention to this matter. Bottles should not be returned to the milkman before being well rinsed in cold water. Milk remaining in bottles draws flies, provides a good growing medium for germs and may give the bottles a bad odour. Bottles in which milk has dried are hard to wash afterwards. Milk bottles should not be used for purposes other than to hold milk. Everyone is 13 aware of the misuse of milk bottles, but few consider how difficult it may be to clean these bottles properly. Milk retailers do take care, but there is always a danger that residues following misuse may escape detection and the bottle be refilled with milk. Ice-Cream.—Under the Food and Drugs Act premises used for " the sale, or the manufacture for the purpose of sale, of ice-cream, of 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 175. Two applications for the registration of premises for the sale of ice-cream were refused. During the year 331 inspections of registered premises were carried out. No samples were taken for bacteriological tests. 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 Regulations also require that ice-cream shall be protected from dirt, dust or other contamination. The enforcement of these Regulations calls for regular and persistent supervision of premises, plant and methods of manufacture and handling. Bakehouses.—There are 25 bakehouses in the Borough and 142 visits of inspection were made during the year. 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. Slaughter of Animals Act, 1933.—During the year 6 applications for a licence as a slaughterman were granted. 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 532; fish 203; provisions 642; vegetables and fruit 251; foodstuffs on hawker's stalls or vehicles 162; and other foods 146. Premises where food was prepared were submitted to 1,155 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 9,008 lbs. of unsound food, 352 eggs and 7,568 tins, jars, etc., of unsound food were seized by or surrendered to the Sanitary Inspectors at retail premises in the Borough. A particular feature of the year was the finding of extraneous matter in foods. The following were encountered flat head machine screw in bread; metal nail in caramel toffee; metal nail in cake; piece of wood in tart; metal button in chocolate coated toffee; gravel chipping in bread; part of razor blade in bottle of milk ; and a cigarette end in a packet of potato crisps. The articles of food, in all but two cases, were produced outside the Borough. The presence of such extraneous matter in food may arise by accident, but the frequency and variety suggest carelessness as the more probable cause. A severe warning was issued to all the firms concerned. Proceedings were taken where unsound mussels were found exposed for sale and these resulted in a fine of £20 and £5 5s. costs. 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) — — — — 6 Number inspected — — — — 6 All diseases except Tuberculosis: Whole carcases condemned — — — — - Carcases of which some part or organ was condemned - - - - 1 Percentage of the number inspected affected with disease other than Tuberculosis - - - - 16.6 Tuberculosis only : Whole carcases condemned — — — — — Carcases of which some part or organ was condemned - - - - - Percentage of the number inspected affected with tuberculosis - - - - - 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 end of the year 88 such premises were registered in the Borough. 14 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." The Council has 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. At the end of the year 71 hawkers were on the register. Municipal Restaurants.—One municipal restaurant was open till 30th September, 1950. The restaurant provided meals for some schools and for the "meals on wheels" scheme and the total mid-day dinners supplied was 15,232. 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 1950 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 99 4 Milk (new) 146 10 Cherry Brandy 1 — Cooked Meats 1 — Pork, English Dairy Fed 1 1 Spirits, various 39 — Aspirin 1 — Baking Powder 1 1 Butter 1 — Curry Powder 1 — Zinc and castor oil ointment 1 — Mercury ointment 1 — Smoked haddock 4 3 Fresh haddock 1 — Salad Cream 1 — Marmalade 3 — Sausages 14 — Sausage, cooked 1 — Suet, shredded beef 1 — Jelly crystals 2 — Jelly tablets 1 — Lemon cheese 1 — Lemon curd 1 1 Lemon powder 1 — Lemon spread 2 — Dressed crab 1 — Cake 7 — Milk chocolate 1 — Ice Cream 1 — Peanuts, salted 1 _ I Pepper, white 1 - Roll, butter and cheese 1 1 339 21 The sample of "English Dairy Fed Pork" was found to be jellied pig intestines. The firm concerned was fined £5 with £5 5s. costs and the manager fined £5 for aiding and abetting the sale. Food Hygiene Campaign.—In the years immediately prior to the war considerable progress was being made towards hygienic methods of handling, storing and transporting food. In competition among themselves and against overseas products the trade was taking considerable interest and generally co-operating well with local sanitary authorities. Further the public were showing some discrimination, and this stimulated the trade to aim at higher standards. The developments in the canning and processing of foods had brought home to the trade the paramount importance of cleanliness. Within the limits of the existing legislation local sanitary authorities had been active in trying to improve the general standard of hygiene in regard to food. The Food and Drugs Act, 1938, increased their powers, but unfortunately did not become operative till October, 1939, and before then war had come. The war brought many difficulties. Customers and the trade became interested largely in quantity rather than quality ; shortages of material and labour resulted in premises not being kept up to standard, and in the employment of unskilled staff ; black-out, air raids, etc., all contributed to the gradual lowering of standards and there was little that Health Departments could do to prevent this. When hunger or fear of hunger stalked abroad, when the trade had to take what food they could get and when the nation was lighting for survival the necessities of peace time were often regarded as needless refinements in war. Another important war-time development was the great increase in the establishment of works and school canteens, municipal restaurants and other catering establishments. Many of these were started in unsuitable and cramped premises with make-shift equipment and untrained staff. This development ol communal feeding soon revealed an inherent danger—carelessness in the kitchen endangered the health oi many people. Infection of food in a domestic kitchen exposes a few to risk, but in a school or works canteen large numbers may be affected. It is difficult to get reliable information on which to base an 15 opinion about whether or not food poisoning is on the increase, but with the great extension of communal feeding it is certain that the chances are much greater of errors of omission or commission in kitchens affecting a large number of people. With the end of the war it was natural that an attempt should be made to return to peace-time standards. To Health Departments their work on housing and food hygiene seemed to be the chief war casualties and attention was given to them. It soon became evident to sanitary inspectors visiting food premises and catering establishments and to medical officers investigating food poisoning outbreaks that much ground had been lost. In their efforts to bring about an improvement various methods may be adopted and some comment on these is given below:— 1. The continuous work of Sanitary Inspectors to get premises improved and brought up to the standards of Section 13 of the Food and Drugs Act, 1938. 2. The regular visiting and inspection by Sanitary Inspectors of all premises where food is stored, prepared, cooked or handled. 3. The systematic inspection by the Rodent Officer of food premises for evidence of infestation by rats, mice or other pests. The work done under 1, 2 and 3 is unspectacular and gets little publicity. It is educational as well as supervisory. Most progress is made by informal discussion and agreement with the persons concerned and only where difficulty or obstruction is met or gross offences are revealed is any report made to the Council with a view to statutory action or prosecution. In this way much is done to disseminate information about the construction of premises, suitable equipment, correct storage of food and personal hygiene of persons handling food. The Council decided to adopt the Model Byelaws issued by the Ministry of Food with regard to the handling, wrapping and delivery of food and the sale of food in the open air and these byelaws came into operation in the Borough on 19th June, 1950. Local publicity was given to the adoption of these byelaws and caterers and food traders are reminded of them by the Sanitary Inspectors. They form a useful guide, but by the end of the year only about 90 copies had been purchased—and there are in the Borough, nearly 400 catering establishments, 175 premises registered for the manufacture or sale of ice cream, 88 premises registered for the "preparation or manufacture of sausages or potted, pressed, pickled or preserved food intended for sale " in addition to butchers, grocers, bakers, etc., shops ! 4. Lectures to persons employed in food shops and catering establishments. Short courses of lectures on the importance of personal hygiene and clean handling and storage of food in the prevention of food poisoning are designed usually to draw attention to the personal responsibility of each food handler. A course of three lectures was given at the Health Department during the afternoons of 13th, 20th and 27th March and the attendances were 119, 122 and 149 on these three days. Though approximately 700 notices of these lectures had been issued, this response was considered to be satisfactory in view of the lectures being held during working hours. The audience, on enquiry, expressed themselves in favour of a course of evening lectures so a course of four lectures was given at the Health Department at 8 p.m. on the evenings of 15th, 22nd, 28th June and 6th July. Notices were issued as before and the attendances on these four nights was 12, 12, 10 and 8. While it must be admitted that many factors influence the attendance at such lectures no firm reliance can be placed on them as a method of education in food hygiene. 5. Film shows. It was thought that the poor attendance at the evening lectures might have been due to the season of the year so a film show was arranged at the Health Department for 8 p.m. on 21st November. The show was timed to last about 60 minutes, and the films dealt with food poisoning, flies and clean handling of milk. Notices were issued as before and an audience of 31 attended. With films, as with lectures, the response cannot be predicted. 6. Clean food or food hygience exhibitions. Some sanitary authorities have organised such exhibitions usually in a local hall and lasting for one week. Those that I have seen consisted largely of exhibits by food trade equipment manufacturers, firms making detergents or other cleansing solutions, trade associations engaged on research in connection with particular types of food, sections of the Ministry of Food, etc., supplemented by lectures and films. In my opinion these exhibitions tend to be too technical for the general public. While some of the stalls may be of interest to individual traders the exhibitions in general seem to fail to stimulate interest among persons employed in food and allied trades. 7. Clean Food Guilds. Some sanitary authorities in conjunction with local food traders have set up voluntary clean food guilds. The organisation varies, but generally the idea is to lay down standards for premises, equipment and methods and to encourage traders to comply with these standards. These guilds have met with varying success and having no statutory authority depend wholly on the response of individual traders. The new byelaws have indicated standards which must be applied to all and not be restricted to gnil'j members. The report of the Catering Trade Working Party "Hygiene in Catering Establishments' and the Report of the Manufactured Meat Products Working Party published by H.M. Stationery Office should be read by all concerned, employers and employees. A study of these three documents should leave no one in any doubt about the standards required. 8. Education of the General Public. Improved food hygiene within the trade is a powerful factor in the education of the public who compare the standards adopted in shops and catering establishments. Through the press and other publicity the attention of the public is being drawn to the need of improved hygiene in regard to food ana despite rationing and other restrictions there are signs that the public are slowly beginning to exercise discrimination and to insist on reasonable standards. Judgment has to be exercised in efforts to stunujat public interest. It is easy to say "always wash your hands after using a water closet,"but it should be remembered that in public lavatories washing facilities may be absent and if present involve an expenditu of 2d. or 3d. for their use; houses continue to be erected with the washing facilities separate from the wa closet; canteens and catering kitchens exist where the only washing facility is the sink used for wasni g 16 utensils and preparing vegetables; school wash basins are some distance from the water closets, etc., and even where washing facilities are available the supply of hot water, towels and soap may be inadequate. Again, in food poisoning, the real dangers are often unseen to the public who tend to concentrate on obvious infringements of general hygiene such as dirty bank notes, unwrapped bread and cracked crockery which so far have not been shown to be the sources of food poisoning. Now that school meals are general in all schools a great opportunity exists for food hygiene, by precept and example, to become a standard part of day to day education. A consideration of the foregoing shows that local sanitary authorities, in their efforts to improve food hygiene, must rely chiefly on the day to day work of the sanitary inspectors. The human element is prone to failure and there is no substitute for the regular, systematic and persistent inspection of food premises of all kinds by such staff. Organised educational work among staff employed in the trade and among the public can supplement the work of the sanitary inspectors and should be continued though the results may be disappointing and uncertain. HOUSING Shortage of houses continues to be a prominent feature of our social circumstances. The compulsory and prolonged sharing of houses by families causes not only physical discomfort but leads to frustration and discontent which reveal themselves in neurotic type of illness and unhappy and broken homes. Scarcity of homes makes the start of family life difficult for the unmarried, and the bearing and rearing of children difficult for the married. The numbers of new houses erected in the Borough in recent irpars arp shown below :— The numbers of new houses erected in the Borough in recent irpars arp shown below:— 1946 1947 1948 1949 1950 By Local Authority 196 146 258 120 196 By private enterprise 33 66 45 41 36 Total 229 212 303 161 232 The value of money has gone down and costs of repair and maintenance have increased considerably while rents have remained fixed by the Rent Restrictions Acts. As a result of this income from house property is becoming inadequate to meet the cost of maintenance. There is a grave risk that such circumstances, if continued, will create a future liability in the replacement of houses which, if attended to now, could provide reasonable homes for years. A poor house is better than none, and in some cases perhaps preferable to sharing a good house, but because of general housing shortage people should not be left to continue indefinitely in occupation of insanitary property. Action in regard to slum clearance and sub-standard houses continues to be postponed as far as is possible, but this delaying tactic brings its own problems. Action under the Housing Acts is governed by "reasonable" cost and this, with rents static and costs soaring, is very difficult to assess. Care has to be exercised in deciding whether action under the repair and demolition sections of the Housing Act or under the nuisance sections of the Public Health Act is appropriate. The department tries to hold the balance evenly and to ask only for essential work to be done. A summary of the action taken during the year is given below:— Houses inspected 419 Defective houses rendered fit in consequence of informal action 197 Defective houses rendered fit in consequence of statutory action 88 Houses in respect of which Demolition Orders were made 5 Houses demolished in pursuance of Demolition Orders 10 Houses in respect of which undertakings not to re-let accepted 6 Houses demolished where undertakings had been given 4 Houses rendered fit in consequence of undertaking given by owner — Houses in respect of part of which Closing Orders were made 1 Houses known to be overcrowded (Housing Act Standard) at end of year 135 New cases of overcrowding reported 55 Cases of overcrowding relieved during the year 18 Certificates issued under Section 12 of the Rent and Mortgage Interest Restriction (Amendment) Act, 1923 — At the end of the year 58 houses were still occupied though subject to Demolition Orders, Closing Orders, or undertakings not to re-let. The continuing occupation of these houses is a matter of some concern. The Housing Department is kept informed of adverse housing conditions coming to the notice of the Health Department. Assistance is given to the Housing Department in the assessment of applications for re-housing where priority is claimed on medical or public health grounds. It must be pointed out that the above record of overcrowding refers only to houses known to be overcrowded according to the Housing Act Standard. For example: one house consisting of 2 living rooms, 3 bedrooms (2+box room) and scullery is occupied as follows:—bedroom—3 adult men; bedroom 2 adult women and child aged 6 years; bedroom—3 children aged 12, 9 and 2 years; living room— 1 adult man. These occupants are the equivalent of 8\ Housing Act "units," but the house is not overcrowded according to the Housing Act Standard unless the number of "units" is in excess of 10. The Housing Act assesses overcrowding in terms of floor area per person and total rooms in the house and not on a bedroom standard. GENERAL MATTERS Burials.—Under Section 50 of the National Assistance 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 1950, 96 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 17 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. Medical Examination of Staff.—For superannuation or other purposes 43 members of the Council's 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. The Chief Sanitary Inspector attended the Conference of the Sanitary Inspectors' Association. Health Education.—Reference has already been made to the special efforts in regard to smoke abatement and food hygiene. 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 contact with the people for drawing attention to matters bearing on health and hygiene. 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 no application was made for such an Order. People are living longer, the housing shortage is accentuating the difficulty which may ensure when "crabbed age and youth" have to share limited accommodation and family responsibilities seem to be less readily accepted than in the past. The fact cannot be hidden that the aged can be most trying, and productive of much tension in those living with and caring for them, but it is difficult to believe that prior to 5th July, 1948, so many aged and infirm persons were left by their relatives to their own resources in their own homes. No charge is made for hospital care and the relatives cannot be charged for accommodation in a National Assistance institution or for the services of a home help and one is forced to the conclusion that the corporate spirit of family life is deteriorating because of the constant demand for " someone to do something " in regard to aged and infirm relatives. Though no application was made during the year for an Order for the compulsory removal of an aged or infirm person many cases needing some care and attention were brought to the notice of the Department. A few particulars of some of the cases are given below:— 1. Miss A.—aged 81 years; partially paralysed and incontinent of urine; in lodgings and only facility for washing clothes is wash basin in bathroom; aged male relative living near at hand does his best to provide meals and wash bedding; requested home help assistance as no one could be found to undertake the washing; gas ring in room, wash basin in bathroom and inadequate soap ration are insufficient for home help to do washing or cooking; admission to hospital arranged after some delay. 2. Mrs. B.—widow: aged 76 years; senile mental changes; private home in which she is resident refuse to keep her any longer; children have accommodation but refuse to take mother; admission to another private home arranged. 3. Mr. C.—widower: aged 78 years; living alone in dilapidated and filthy caravan in company with emaciated dog; dependent on neighbours for food as unable to care for himself; admission to hospital arranged and dog destroyed by R.S.P.C.A. 4. Mrs. D.—widow: aged 70 years; lives in one room; not seen by neighbours for some days; room and person found in filthy condition; Mental Welfare Officer arranged admission to hospital. 5. Mrs. E.—widow: aged 87 years; almost blind; incontinent; cannot dress or feed herself; only known relative aged 70 years, lives at a distance and visits occasionally; Welfare Officer and National Association for the Blind unable to help; home help assistance given for 2 years; continued deterioration necessitated removal to hospital. 6. Mrs. F.—widow: aged 90 years; occupies flat; signs of deterioration in personal care; never undresses and appears to live on cups of tea and biscuits; occasional incontinence; refuses to go to institution; relatives collect pension, do shopping and send washing to laundry; danger of fire when alone in house; family well advanced in years and though some have accommodation none will take the old lady; efforts being made to get her to agree to go to institution. 7. Mr. G.—(76 years) and Mrs. G. (74 years): occupy one room on first floor; Mr. G. confined to bed and Mrs. G. can walk only with aid of crutches; all cooking has to be done on open coa fire; all water for personal and other washing has to be carried upstairs; water closet in bac yard; no relatives able to assist or provide accommodation; because of absence of cooking and washing facilities home help assistance of no real value; unwilling to go to institution to fear of separation; dependent on kindness of neighbours; recommended for ''meals on wheels and owner of house approached re provision of some cooking facilities. 18 The various authorities with responsibilities for the care of the aged, infirm and chronic sick are Regional Hospital Boards, Local Health Authorities, Local Sanitary Authorities, General Medical Practitioners and the National Assistance Board. The line of demarcation between the chronic sick and the infirm is very indefinite and a decision has to be made before welfare authority or hospital will act. Most are reluctant to go to hospital or institution and pending persuasion or the finding of a vacancy the home help service has to shoulder the responsibility. At present 70 per cent, of the time of the home helps is given to the care of the aged, infirm, chronic sick and incurable in their own homes. The length of time that a home help may be required for these cases seems to be till death or occasionally till admission to hospital or institution—often a matter of months and even years. Many of the aged are unable to handle their financial affairs and in the absence of relatives no one appears to have any responsibility in this matter. The washing of bed linen is often a heavy task for those caring for the aged and incurable, and there is urgent need for some type of laundry facility to deal with this problem. The care of the aged, infirm and chronic sick is a growing task. The first principle should be the care of old people by their own relatives in their own homes. While this is "morally right and economically essential "there is an urgent need for some method of co-ordinating the functions of the various authorities so that appropriate action can be taken speedily and effectively. 19 TABLE I Summary of Vital Statistics 1895-1950 Estimated Civilian 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 1949 106,900 13.6 9.8 17 12 2.0 18 0.3 1950 107,300 11.6 9.9 24 14 0.8 18 0.3 20 TABLE II REGISTRAR-GENERAL'S RETURN OF CAUSES OF DEATH, 1950 Abridged List No. Cause of Death Male Female Total B 1 Tuberculosis, respiratory 21 15 36 B 2 Tuberculosis, other — 1 1 B 3 Syphilitic disease 3 — 3 B 8 Diphtheria — — — B 9 Whooping Cough — — — BIO Meningococcal infections — — — B 12 Acute poliomyelitis — — — B 14 Measles — — — B 4—7, 11, 15-17 Other infective and parasitic diseases 2 2 4 B 18 Malignant neoplasm, stomach 10 12 22 Malignant neoplasm, lungs 24 4 28 Malignant neoplasm, breast — 18 18 Malignant neoplasm, uterus — 12 12 Other malignant and lymphatic neoplasms 53 48 101 Leukaemia, aleukaemia 2 3 5 B 20 Diabetes 1 5 6 B 22 Vascular lesions of nervous system 47 83 130 B 26 pt. Coronary disease, angina 81 49 130 B 28 Hypertension with heart disease 16 11 27 B 25, 26 pt. 27 Other heart disease 63 115 178 B 29 46 pt. Other circulatory disease 24 23 47 B 30 Influenza 4 2 6 B 31 Pneumonia 15 15 30 B 32 Bronchitis 45 23 68 B 46 pt. Other respiratory diseases 2 5 7 B 33 Ulcer of stomach and duodenum 7 4 11 43 pt. Gastritis, enteritis, diarrhoea 5 - 5 B 38 Nephritis and nephrosis 7 3 10 B 39 Hyperplasia of prostate 6 - 6 B 40 Pregnancy, childbirth, abortion — 1 1 B 41 Congenital malformations 7 6 13 Residual Other defined and ill-defined diseases 56 53 109 BE 47 Motor vehicle accidents 14 6 20 BE 48 All other accidents 12 17 29 BE 49 Suicide 2 — 2 BE 50 Homicide and operations of war — — — Total 529 536 1,065 21 22 TABLE III INFANT DEATHS ACCORDING TO AGE AND CAUSE, 1950 Cause of Death Age Total Days Months under 1 1 2 3 4 5 6 7-13 14-20 21-28 1 2 3 4 5 6 7 8 9 10 11 Pneumonia — — — — — — — 1 — — — 1 — 1 — 1 — — — — — 4 Bronchitis - - - - - - - - - - - - - - 1 - - - - - - 1 Gastro-enteritis — — — — — — — — — — — — — 1 1 — — — — 1 — 3 Birth injuries 2 — 1 1 - - - - - - - - - - - - - - - - - 4 Atelectasis 4 3 - - - - - - - - - - - - - - - - - - - 7 Congenital malformations — 1 - - — — 1 — — — — 2 — 1 1 — — — — — — 6 Prematurity — 1 1 1 - - - - - - - - - - - - - - - - - 3 Haemolytic disease 1 - - - - - - - - - - - - - - - - - - - - 1 Meningitis (B. coli) — — — — — — — — — — 1 — — — — — — — — — — 1 TOTAL 7 5 2 2 — — 1 1 — — 1 3 — 3 3 1 — — — 1 — 30 TABLE IV. CAUSES OF DEATH ACCORDING TO AGE AND SEX, 1950 Abbrev. List No. Cause Groups All Ages Age in Years Under 1 1-2 2-3 3-4 4-5 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 ! 70-74 75-79 80-84 85 & 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 M F M F M F M F M F M F M F M F M F M F M F B 1 Tuberculosis of respiratory system 21 15 — — — — — — — - - - - - - 1 - - 1 - 4 1 2 1 1 - - 4 1 2 2 5 3 - - - 1 l 3 - 1 1 - - - - B 2 Tuberculosis, other forms - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 3 - - - - - - - - - B 3 Syphilis and its sequelae 3 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - B 4 Typhoid fever - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - B 5 Chopera - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - B 6 Dysentery, all forms - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - B7 Scarlet fever and streptococcal sore throat - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - B 8 Diphtheria - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - B 9 Whooping Cough - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - B 10 Meningococcal infections - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - B 11 Plague - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - B 12 Acute poliomyelitis - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Smallpox - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - B 14 Measles - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - B 15 Typhus and other rickettsial diseases - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - B 16 Malaria - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - B 17 Other infective and parasitic diseases 2 1 - - - - - - - - - - - - - - - - - - - - - - - - - - 1 1 1 - - - - - - - - - - - - - - - B 18 Malignant neoplasms—stomach - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 2 1 l 2 — 1 1 1 1 — 1 — 6 lungs 24 4 1 — 2 — 4 1 7 i 3 1 5 - - - - - - -1 breast — 18 — — — — — — — — — — — — — — 1 — — — — — — 1 2 3 3 — 2 - 2 — 2 — 2 — 1 — — uterus — 12 — — — — — — — — — — — — — — — — — — — — — — 1 — — — 4 - 4 — — - 2 — — — — — 1 — — other sites 53 48 - - - - - - - - - - - - - - - - - - 1 - - - - - - - 2 2 2 3 4 6 3 6 7 8 9 5 12 11 5 3 1 3 leukaemia, etc. 2 3 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - B 19 Benign and unspecified neoplasms 3 4 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 1 — 1 — — — — — 1 — — 1 — — B 20 Diabetes 1 3 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 1 1 — — — — B 21 Anaemias - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - B 22 Vascular lesions affecting central nervous system 48 89 - - - - - - - - - - - - - - - - - - - - - - - - 1 1 3 5 7 5 2 6 6 5 8 7 6 12 4 24 7 13 3 11 B 23 Non-meningococcal meningitis 1 1 — — — — — — — -— — — — — — B 24 Rheumatic fever 1 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - B 25 Chronic rheumatic heart disease 5 20 2 2 — 3 1 1 — — 1 2 1 2 1 2 — 1 1 2 1 B 26 Arteriosclerotic and degenerative heart disease— coronary disease, angina 79 49 - - - - - - - - - - - - - - - - - - - - - - - - 7 — 3 1 10 2 7 1 14 5 9 9 13 12 8 6 5 8 3 5 other 54 67 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 3 2 9 2 9 6 8 15 14 19 9 23 B 27 Other diseases of the heart 12 21 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - — 2 2 4 3 — 2 5 — 5 B 28 Hypertension with heart disease 17 10 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 2 1 2 1 4 1 1 2 4 4 2 — 1 1 B 29 Hypertension without mention of heart 9 2 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 3 2 - 1 - - 1 2 1 — — B 30 Influenza 4 4 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - B 31 Pneumonia 15 15 2 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 1 — 1 1 — 1 2 3 3 6 2 1 5 B 32 Bronchitis 44 23 — 1 - - - - - - - - - - - - - - 1 - - - - - 1 — 1 — - — 4 1 5 — 6 1 9 2 7 6 5 2 4 6 1 4 B 33 Ulcer of stomach and duodenum 7 3 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 2 1 2 1 1 - - - - - - 1 B 34 Appendicitis 2 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - B 35 Intestinal obstruction and hernia. 6 2 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 - - - 1 1 — — B 36 Gastritis, enteritis, colitis, etc. 5 3 3 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 - 1 1 1 - — 1 — ' B 37 Cirrhosis of liver - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - B 38 Nephritis and nephrosis 8 4 - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 - 1 2 - - - - - 1 — 1 3 — — — B 39 Hyperplasia of prostate - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - B 40 Complications of pregnancy, childbirth and puerperium — 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - B 41 Congenital malformations 8 6 4 2 1 - - - - - - - - - - - - - - - - - - - - 2 - - - - - 1 2 1 - - - - - - - - - - - - B 42 Birth injuries, post-natal asphyxia, atelectasis 5 6 5 6 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - B 43 Infections of the new born - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - B 44 Immaturity and other diseases peculiar to early infancy 3 1 3 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - B 45 Senility, ill-defined and unknown causes—senility 8 12 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 3 4 2 3 7 ill-defined causes 4 4 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 2 2 - - - 2 B 46 Other circulatory diseases 7 13 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 3 2 — 2 2 2 2 1 — 3 Other respiratory diseases 2 5 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 1 — — — 1 — — 1 — BE 47 All other diseases 19 25 — - - - - - - - - — — — — 2 1 1 1 1 1 1 3 1 2 2 1 3 2 3 1 2 6 1 4 1 2 1 1 BE 47 Motor vehicle accidents 14 6 — — — 1 1 — 1 2 — — — — 1 2 — — 2 2 1 — — — 2 2 1 1 — — BE 48 All other accidents 7 19 — — — 1 1 — 1 — — — — — — — _ — — — 1 3 1 1 1 1 3 1 5 1 5 BE 49 Suicide - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Self-inflicted injury 4 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 BE 50 Homicide - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Operartions of war -j - 1 - ALL CAUSES 528 536 18 12 1 1 - 1 - 1 1 - 2 - 3 2 - 4 i 2 6 3i 6 5 4 7 6 22 10 24 19 47 29 40 32 I 61 38 73 44 65 70 65 93 62 76 25 84 1064 30 1 1 2 2 3 2 5 8 9 9 13 32 43 76 72 99 117 135 158 138 109 Percentage of total deaths from all causes 2.81 0.09 0.09 0.19 0.19 0.28 0.19 1 0.47 0.75 0.85 0.85 1.21 3.00 4.04 7.05 6.77 9.30 10.99 12.69 14.85 12.97 10.25 24 TABLE V INFECTIOUS DISEASES—1950—AGE DISTRIBUTION Disease Total Under lyr. 1yr. 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 3 - - - - - - - 1 2 — — — 3 Para-Typhoid Fever 6 — — 1 — — — 3 1 1 — — — 6 Scarlet Fever 92 1 4 7 11 6 50 9 2 1 1 — — 25 Diphtheria 1 — — — — — — — — 1 — — — 1 Erysipelas 12 - - - - - - - - 2 2 4 4 3 Puerperal Pyrexia 8 — — — — — — — — 8 — — — 7 Ophthalmia Neonatorum 1 1 - - - - - - - - - - - 1 Acute Poliomyelitis and polioencephalitis 9 2 — - 1 1 — — 2 2 — 1 — 9 Cerebro-spinal Fever - - - - — - - - - - - - - - Pneumonia 64 6 3 1 i 3 6 1 — 7 8 10 18 13 Undulant Fever 1 — — — — 1 — — — — — — i Malaria 1 — — — — — — — — 1 — — — Dysentery 6 1 1 1 — — 1 1 1 — — — — 5 Measles 881 26 73 95 105 118 442 11 5 6 — — — 9 Whooping Cough 206 14 15 18 29 38 89 2 1 — — — — 10 Food Poisoning 5 - - — — — 1 1 — — 1 1 1 4 Tuberculosis:— Pulmonary 1 163 - - - l - 3 3 29 66 14 38 9 - Non-pulmonary 19 - - 1 - - 1 l 3 5 2 1 2 4 - 25 NOTIFICATIONS AND DEATHS FROM CERTAIN INFECTIOUS DISEASES TABLE V] HESTON AND ISLEWORTH, 1931-1950 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 1931 - - 204 2 62 4 39 — 148 54 5 3 1 - - 3 - - - - - - - - - Not Notifiable 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 1950 - - 92 — 1 - 12 — 64 30 — — 9 — 3 6 6 881 — 206 — 6 182 37 * Includes paratyphoid fever to 1939. TABLE VII COMPARATIVE STATISTICS 1950 England and Wales Rates per 1,000 Heston and Isle worth Civilian Population. Births— Live Births 15.8 11.6 Still Births 0.37 0.21 Deaths— All causes 11.6 9.9 Typhoid and Paratyphoid 0.00 0.00 Whooping Cough 0.01 0.00 Diphtheria 0.00 0.00 Tuberculosis 0.36 0.34 Influenza 0.10 0.06 Smallpox 0.00 0.00 Poliomyelitis 0.02 0.00 Pneumonia 0.46 0.28 Notifications— Typhoid fever 0.00 0.03 Paratyphoid fever 0.01 0.06 Meningococcal infection 0.03 0.00 Scarlet Fever 1.50 0.86 Whooping cough 3.60 1.90 Diphtheria 0.02 0.00 Erysipelas 0.17 0.11 Smallpox 0.00 0.00 Measles 8.39 8.21 Pneumonia 0.70 0.60 Poliomyelitis 0.18 0.09 Food Poisoning 0.17 0.05 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 Inspections Number of Written Notices Occupiers prosecuted (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 45 29 5 - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 339 488 9 - (iii) Other premises in which Section 7 is enforced by the Local Authority (excluding outworkers' premises) 4 5 — TOTAL .. 388 522 14 — - - — '—' 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.l) - - - - - Overcrowding (S.2) 1 1 — — Unreasonable temperature (S.3) — — — — Inadequate ventilation (S.4) 1 1 — — Ineffective drainage of floors (S.6) — — — — Sanitary Conveniences (S.7)— (a) insufficient 6 8 — — (b) unsuitable or defective 5 6 4 — (c) not separate for sexes — 1 — — Other offences against the Act (not including offences relating to Outwork) 2 2 3 — — TOTAL 15 19 3 4 — — — — — 21 26 7'