AZ 439 (1) Hesnw ISLE WORTH HES 38 ANNUAL REPORT OF THE MEDICAL OFFICER of HEALTH OF THE BOROUGH OF HESTON AND ISLEWORTH for the year 1951 A. ANDERSON, M.D., D.P.H. Medical Officer of Health. INDEX Page Bakehouses 20 Births, Live and Still 5 Burials 23 Canal Boats 17 Closet Accommodation 15 Common Lodging Houses 17 Deaths 5 Deaths, Age and Sex Distribution 27 Deaths, Causes of 25 Disinfection 10 Disinfestation 17 Drainage and Sewerage 15 Factories, No. on Register, Inspections and Defects, etc. 30 Factories, Workplaces etc. 17 Fever Hospital 10 Food and Drugs Sampling 20 Food Hygiene Campaign 21 Food Poisoning 10 Foods, Welfare 22 Health Committee 3 Health Education 23 Housing 22 Ice Cream 19 Infant Deaths according to Age and Cause 26 Infant Mortality 7 Infectious Diseases 7 Infectious Diseases, Age Distribution 28 Infectious Diseases, Notifications and Deaths 29 Page Laboratory Service 10 Maternal Mortality 7 Meat and Other Food Inspection 20 Medical Examinations of Staff 23 Noise Nuisances 17 Milk 19 Mosquitoes 17 Municipal Restaurant 20 Persons in need of care and attention 23 Poliomyelitis 8 Public Cleansing 15 Public Mortuary 23 Rags, etc., Exchange of Articles for 18 Rag Flock & other Filling Materials Act 1951. 18 Rats and Mice Destruction 18 Rivers and Streams 15 Sanitary Inspection 16 Shops Act, 1950, Section 38 18 Slaughter Houses, etc. 20 Smoke Abatement 16 Staff 2 Statistics Comparative 30 Statistics General 5 Statistics Vital 5 Statistics, Vital, Summary of 24 Swimming Baths 18 Tents, Vans and Caravans 17 Tuberculosis 9 Water Supply 13 STAFF Medical Officer of Health (part-time). A. Anderson, M.D., D.P.H. Deputy Medical Officer of Health (part-time). W. Paterson, M.B., Ch.B., D.P.H. (from 1.3.51). Chief Sanitary Inspector. A. B. Hauldren, Cert, as S.I. and M.I. Deputy Chief Sanitary Inspector K. J. Smith, Cert, as S.I. and M.I. District Sanitary Inspectors. G. Latimer, Cert, as S. I. and M.I. S. H. G. Stevens, Cert, as S.I., M.I. and S.E. J. A. Dawson, Cert, as S.I. and M.I. W. Bowles, Cert, as S.I. and M.I. (from 15.1.51). P. G. T. Woods, Cert, as S.I. and M.I. (from 1.3.51). H. L. Hughes, Cert, as S.I. and M.I. (from 20.8.51). J. K. Edson, Cert, as S.I. and M.I. (from 1.9.51). 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. E. J. Hutchins. Miss P. M. Whittington. F. B. Capes. 2 THE HEALTH COMMITTEE of HESTON A*ND ISLEWORTH BOROUGH COUNCIL to May, 1951 Alderman Mrs. 0. 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. from May, 1951. Alderman Mrs. O. C. M. Denton (Chairman). Councillor Mrs. M. Hennig (Vice-Chairman). Councillor G. J. Stephens, O.B.E., J.P., C.C. (Mayor). Councillor C. W. Elliott. Alderman R. H. Manning, J.P. Councillor Mrs. D. M. Elliott. Alderman F. E. Kinsey. Councillor H. F. Nicholls. Alderman A. G. Trickey (Resigned 4.12.51). Councillor H. J. Proud. Councillor A. G. Cross. Councillor Mrs. A. B. Tolman. Councillor H. J. Davis. Councillor Mrs. M. J. Tozer. 3 PUBLIC HEALTH DEPARTMENT, 92, BATH ROAD, HOUNSLOW. To the Mayor, Aldermen and Councillors of the Borough of Heston and Isleworth, Ladies and Gentlemen, I have the honour to submit my Annual Report on the health, vital statistics and sanitary circumstances of the Borough for the year 1951. 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. 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 show little departure from previous years and call for no special comment. The low infant mortality rate continued and for the first time in the Borough records no woman died from any condition associated with pregnancy and childbirth, The recruitment of a full staff of Sanitary Inspectors has enabled full attention to be given to environmental matters and this is reflected in the records of work done. Only health services under the direct control of the Council are considered in this Report. Many factors contribute to the health and well being of the citizens and many agencies are concerned. This multiplicity of agencies, statutory and voluntary, should not be allowed to obscure the primary responsibility of each individual citizen. Health and social services provide measures designed to prevent and cure disease but they fall short of their real goal if they fail to encourage individuals to take a greater interest in their own health and that of their children. The health of individuals is the measure of the health of a nation. Only the failures of preventive medicine such as outbreaks of smallpox have any news value and the slow but steady progress through the years attracts no headlines. This Report deals with the continued plodding of your Health Department but here and there casts a backward glance to gauge the distance travelled and to seek encouragement to keep right on. Throughout the year I have had full co-operation and assistance from the other Departments of the Council. The loyal co-operation of my staff has continued and I would like to express my thanks to the Council for their support and encouragement. I remain, Your obedient Servant, A. ANDERSON, Medical Officer of Health. 4 GENERAL STATISTICS 1950 1951 Area in acres 7,261 7,261 Population (Registrar-General's estimate) 107,300 106,400 Number of inhabited houses (rate books) 28,428 28,608 Number of houses erected during year 232 255 Rateable Value of Borough £983,775 £997,847 Sum represented by a penny rate £3,993 £4,060 Live Births—male 643 634 Live Births—female 604 567 Birth rate per 1,000 population 11.6 11.3 Birth rate per 1,000 population (England and Wales) 15.8 15.5 Stillbirths—male 13 12 Stillbirths—female 10 13 Stillbirths Rate per 1,000 (live and still) births 18.0 20.4 Deaths—male 529 558 Deaths—female 536 547 Death rate per 1,000 population 9.9 10.4 Death rate per 1,000 population (England and Wales) 11.6 12.5 Infant Mortality rate 24.4 18.3 Infant Mortality rate (England and Wales) 29.8 29.6 Maternal Mortality rate 0.8 Nil Maternal Mortality rate (England and Wales) 0.9 0.8 VITAL STATISTICS Population.—The population of the Borough was 76,460 at the 1931 census and 106,636 at the 1951 census. The Registrar-General's mid-year estimate of the population for the year 1951 is 106,400. The Registrar-General's detailed analysis of the census returns for the Borough has not yet been issued. Rateable Value.—The rateable value of the Borough for 1951 was £997,847 and the sum represented by a penny rate was £4,060. Inhabited Houses.—According to the rate books the number of inhabited houses at the end of the year was 28,608. 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 the 1951 census returns have been analysed. Live Births.—The number of live births in 1951 was 1,201 as compared with 1,247 in 1950. The birth rate was 11.3 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 10.8 as compared with the birth rate of 15.5 per 1,000 population for England and Wales. The number of illegitimate births was 43 as compared with 51 in 1950. The proportion of live births which were illegitimate, expressed as a percentage of the total live births, is shown below for recent years:— 1925-29 3.9 1945-49 5.1 1930-34 3.2 1950 4.1 1935-39 2.9 1951 3.6 1940-44 4.6 Of the total births (live and still) 76 per cent. occurred in hospital as compared with about 45 per cent. in the years prior to the introduction of the National Health Service. Stillbirths.—The number of stillbirths in 1951 was 25 (23 legitimate, 2 illegitimate). Tlje proportion of stillbirths per 1,000 total (live and still) births in recent years is shown below:— No. of Rate per 1,000 Stillbirths 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 1951 25 20.4 Deaths.—The deaths of residents of the Borough during 1951 were 1,105 (558 male, 547 female). This represents a death rate for the Borough of 10.4 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 11.3 as compared with a death rate 12.5 per 1,000 population for England and Wales. In Table II is given the classification of death 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 Wealth and thus small discrepancies may be noticed on comparing the two Tables. 5 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 1951 Under 1 year 21.8 7.8 5.3 2.8 2.0 1-4 years 8.4 1.4 0.8 0.4 0.4 5-14 years 3.8 1.8 2.1 0.5 0.6 15-24 3.7 2.8 2.1 1.2 0.7 25-64 years 30.8 35.2 33.0 33.1 32.9 65 years and over 31.5 51.0 56.7 62.0 63.4 The chief causes of death in males were heart and circulatory diseases (166), cancer (112), bronchitis and pneumonia (72), and cerebral haemorrhage (45). In females the chief causes of death were heart and circulatory diseases (162), cerebral haemorrhage (105), cancer (76) and bronchitis and pneumonia (50). Throughout the country an increase in the number of deaths certified as due to cancer of the lung has been noted in recent years. Another feature of interest in this connection is that this disease is much more prevalent in males than in females. No explanation for this increase in cancer of the lung or its prevalence in males is available. The suggestion has been made that it may be associated in some way with tobacco smoking, but further investigation is necessary. In the following table deaths in the Borough from cancer of the lung and from pulmonary tuberculosis are shown:— Deaths Due to Cancer of the Lung Pulmonary Tuberculosis Year M F Total Rate per 1,000 pop. M F Total Rate per 1,000 pop. 1940 13 4 17 0.17 31 23 54 0.55 1941 17 6 23 0.24 45 23 68 0.72 1942 14 3 17 0.18 34 23 57 0.60 1943 21 3 24 0.25 24 19 43 0.45 1944 21 1 22 0.24 30 11 41 0.44 1945 19 6 25 0.26 26 17 43 0.45 1946 31 9 40 0.38 25 21 46 0.44 1947 13 9 22 0.21 26 21 47 0.44 1948 23 6 29 0.27 22 13 35 0.33 1949 35 6 41 0.38 22 10 32 0.30 1950 24 4 28 0.26 21 15 36 0.34 1951 34 4 38 0.36 18 8 26 0.24 It is customary to look upon the infectious diseases as taking the greatest toll of child life but the following table shows that the position is changing in the Borough:— Accidental Deaths Deaths due to Infectious Disease Road Traffic Other Accidents Total Tuberculosis Other infections Total 0-4 yrs. 5-14 yrs. 0-4 yrs. 5-14 yrs. 0-4 yrs. 5-14 yrs. 0-4 yrs. 5-14 yrs. 1940 - 4 1 1 6 1 1 8 3 13 1941 1 4 2 2 9 3 2 3 1 9 1942 1 1 4 — 6 3 6 7 1 17 1943 — 1 2 2 5 — 2 2 1 5 1944 — 4 1 1 6 1 — 6 — 7 1945 — 1 2 — 3 1 — 3 2 6 1946 — 2 5 2 9 2 1 — — 3 1947 — — 1 — 1 — 3 6 1 10 1948 — — 2 2 4 — 1 — 1 2 1949 1 2 2 — 5 — — — 1 1 1950 2 3 2 1 8 — — — — — 1951 — — — 1 1 1 — 1 1 3 27 36 28 48 Total 63 76 It is obvious that while deaths from infectious disease are falling in number accidental deaths are showing no similar change. It should be realised that (a) more children under 15 years are killed in their own homes than die from accidental causes elsewhere, including road accidents and (b) more children under 15 years die from accidents in the home than die from any single infectious disease. While considering fatal accidents the prolonged illness and crippling that may follow serious non-fatal accidents should not be forgotten. All investigations into the causes of home accidents show that the human factor is responsible for a large proportion and that most accidents are preventable. Here is a rich field o preventive medicine in which parents, general practitioners, Health Department staffs, architects, heating and lighting engineers, etc., can all play their part. 6 The Secretary of the Road Safety Committee informs me that in the Borough during 1951 there were 519 road accidents. These accidents caused 12 deaths, serious injury to 98 persons, and slight injury to 508 persons. In the Borough there are 5 miles only of road with no speed limit and on these 5 miles occurred 83 per cent. of the deaths, 47 per cent. of the serious injury and 43 per cent. of the slight injury. This " toll of the roads " can be prevented but only if motorists, cyclists and pedestrians exercise due care and consideration for others. How this can best be developed and encouraged has been the subject of many suggestions and many methods are being tried. While improved roads, lighting, etc. may reduce the risk of road accidents the real remedy is in the hands of the individual road users. Care and courtesy can control crashes and casualties. Infant Mortality.—During 1951 there were 22 deaths of children under the age of 1 year. This represents an infant mortality rate per 1,000 live births of 18.3 as compared with 29.6 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 1951 1,201 22 18 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 nil. This gives a maternal mortality rate per 1,000 total (live and still) births of nil as compared with 0.8 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 1951 — — — 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:— 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 Smallpox - - - - - - - - - - Scarlet Fever 190 280 130 124 67 62 159 138 92 67 Diphtheria 11 5 11 24 16 3 2 - 1 - Erysipelas 16 21 16 16 19 19 21 26 12 12 Pneumonia 72 116 50 25 47 56 41 52 64 59 Meningococcal Infection 12 - 3 11 13 8 2 2 — 5 Epidemic encephalitis - - - 1 - - — — — — Post-infective encephalitis - - - - - - - - - 1 Poliomyelitis and polioencephalitis - - 3 7 1 43 29 14 9 4 Typhoid fever 4 1 - - 1 1 - - 3 1 Paratyphoid fever 1 - - - - - 3 - 6 1 Dysentery 2 - 22 28 6 - 5 2 6 77 Food Poisoning - - - - - - - - 5 6 Tuberculosis—Pulmonary 177 165 167 128 200 160 147 208 163 163 Tuberculosis— Non-Pulmonary 25 25 17 29 17 20 21 11 19 22 Opthalmia neonatorum 3 — 5 3 2 — — — 1 1 Puerperal pyrexia 58 105 87 45 54 60 23 16 8 13 Measles 1,085 636 219 1,109 170 840 571 523 881 790 Whooping cough 243 134 171 110 170 142 227 173 206 222 Malaria - - 1 2 1 - - 1 1 - Undulant fever - - - - - - - - 1 — 7 The age distribution of notifiable disease during 1951 is shown in Table V. Scarlet Fever.—This disease continued to be of a mild type. No death from this disease has occurred in the Borough since 1937. Of the 67 cases 26 were admitted to hospital. Diphtheria.—No case of diphtheria occurred in the Borough during 1951. Dr. Logan, Chief Medical Statistician of the Registrar-General's Department, writing on " recent trends of diphtheria" stated:— , " Almost 10,000 persons died from diphtheria in England and Wales in 1901; 32 in 1951. From being one of the most serious causes of death of children in this country, diphtheria has now fallen to a position of numerical insignificance. The situation is now being reached—a situation scarcely dreamed of in 1940 when the national immunisation campaign started—where the eradication of diphtheria as an indigenous disease in this country can be foreseen as a very real possibility within the next few years, provided there is no slackening in the immunisation efforts that have been so dramatically successful in the past 10 years. Complacency resulting from what has already been achieved, or loss of interest or confidence in immunisation, may mean that diphtheria will go on occurring endemically and epidemically in this country indefinitely with the ever-present risk of a return to high mortality; but a vigorously continued immunisation campaign, combined with existing methods of epidemic control, may free us entirely from the disease except for the occasional imported case." The number of children attending for immunisation has fallen again this year. If this disease is to be kept under control a much higher proportion of young children must be protected. The future record of diphtheria in this Borough will be a measure, not of the efficiency of the Health Department, but of the intelligence and foresight of parents. Erysipelas.—Though 12 cases were notified no death was due to this disease. Pneumonia.—There was a slight reduction in the notifications of pneumonia when compared with 1950. The death rate from pneumonia per 1,000 population was 0.4 as compared with 0.3 in 1950 and 0.5 in 1949. Of the total pneumonia deaths 13 per cent. occurred at age 0-4 years and 70 per cent. at age 65 years and over. Meningococcal Infection.—Five cases of cerebrospinal fever were notified during the year and one death was due to this disease. The mortality from this disease has fallen considerably since the introduction of sulphonamide drugs. Epidemic Encephalitis.—No case was notified during the year. Post-Infective Encephalitis.—Encephalitis is known to occur as a complication of other infectious disease. One case following Mumps was notified. 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. During the year 4 cases were notified and there was no death from this disease. Two cases only developed any paralysis; on discharge from the fever hospital one was transferred to a orthopaedic hospital and the other referred to orthopaedic out-patient department for further treatment. This disease, which used to occur as sporadic cases or small outbreaks, has been generally prevalent throughout the country for some years. Though the widespread epidemic of 1947 has not been repeated and the incidence is tending to fall, there is no inidcation that the disease is returning to the comparative rarity of "20 years ago. Typhoid Fever.—One case of typhoid fever was notified during the year. The patient had returned from India via Egypt a short time before the onset of the illness and the infection appeared to have been picked up abroad. No secondary cases occurred. Paratyphoid Fever.—During the year one case of paratyphoid fever was notified. This isolated case was a young child, no secondary cases occurred but the source of the infection was not traced. Dysentery.—This disease shows great variations in prevalence from year to year and from place to place. During the year 77 cases were notified as compared with 6 cases in 1950. Two were residents' of Brentford and Chiswick notified from West Middlesex Hospital, 6 were members of the nursing stall of West Middlesex Hospital, 3 were members of the nursing staff of South Middlesex Infectious Diseases Hospital and the remainder resided in various parts of the Borough. The age range varied from 3 months to 72 years and 53 per cent. were under the age of 5 years. There were 39 primary cases and the remaining 38 cases were brought to light during the investigation of the primary cases, In many of these 38 cases the illness had been so slight that no treatment or medical attention had been sought and but for the search for sources of infection by the Department these cases would have been missed. Among the 66 cases occurring in families in the Borough 34 were single cases, while 2 cases each arose in 7 houses, 3 cases each in 4 houses and 6 cases in one house. This infection spread to the day nurseries. In Heston Day Nursery 18 children were affected, in Acton Lodge Day Nursery 2 staff and one child and in Blenheim House Day Nursery 1 staff and 5 children. The infection in all cases was of the Sonne type and the illness was mild in practically every case. The mildness of the illness is deceptive and unless it is constantly kept in mind cases are likely to be missed. In all cases of diarrhoea in children and on the least suspicion in adults a specimen of faeces should be sen for bacteriological investigation. Only by constant vigilance will this disease be kept under some degre of control. 8 Tuberculosis.—The notifications of pulmonary tuberculosis were the same as in 1950, but there was an increase of 3 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 1951 24.4 0.9 25.4 The number of cases of tuberculosis on the Borough register at 31st December, 1951, was 1,012. "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." Persistent and co-ordinated effort by Regional Hospital Boards, Executive Councils, Local Health Authorities and Local Sanitary Authorities is needed to strengthen and accelerate the attack on this disease. The Mass X-Ray Unit visited the Firestone Tyre and Rubber Company factory in August and 1,801 (68 per cent.) of the staff attended for X-ray. Of these 67 were recalled for large films but only 15 were considered to require further medical investigation for conditions which were not necessarily tubercular. Ophthalmia Neonatorum.—One case of this infection of the eyes of young babies was notified during the year. Puerperal Pyrexia.—The Puerperal Pyrexia Regulations, 1951, came into operation on 1st August. They amended the definition of puerperal pyrexia to read as follows:—" any febrile condition occurring in a woman in whom a temperature of 100.4 °F. (38° Centigrade) or more has occurred within fourteen days after childbirth or miscarriage." Because of the capacity of the sulphomanide and antibiotic drugs to control fever it became necessary to amend the definition so that all puerperal or post-abortion fever should continue to be notified. During the year 8 cases were notified but no woman died from puerperal or post-abortion sepsis. Measles.—This infectious disease, due to a virus, occurs all over the world and in urban areas is almost constantly present. At about two yearly intervals epidemics occur (see chart). These epidemics may be slow in developing (1940-1941), explosive (1944-1945) or occur in two waves (1942-1943). During the years 1940-1951 the local cases were distributed in age groups as follows:—0-4 years, 54.1%; 5-9 years, 42.2% and 10 years and over, 3.7%. During the same period there were 9 deaths due to measles and the ages of the children were:—under 1 year, 3; 1 year, 2; 2-4 years, 3 and 5-9 years, 1 and generally it can be said that the younger the child the greater the risk. Measles itself is not a killing disease and death is usually due to some complication of which pneumonia is the most frequent. As far as is known the incidence of measles has not varied over the centuries but there has been a considerable reduction in the deaths from this disease. This is shown in the following table dealing with measles deaths in the Borough:— Year Total No. of deaths Annual Mortality Rate per 100,000 population 1901-05 29 18.9 (average) 1906-10 53 31.4 „ 1911-15 68 31.0 „ 1916-20 36 16.6 „ 1921-25 23 10.4 „ 1926-30 21 6.8 „ 1931-35 27 5.9 „ 1936-40 7 1.0 „ 1941-45 4 0.8 „ 1946-50 2 0.0 „ 1951 1 1.0 „ This change has been brought about by improved social conditions, more widespread general and health education, improved medical and nursing care and latterly by the discovery of new drugs and antibistics. Measles remains a highly infectious disease and should always be treated as a serious illness especially in young children. Whooping Cough.—This disease is prevalent throughout the temperate zone, it is almost always to be found in urban populations and exhibits periodic epidemics. These epidemics (see chart) are seldom so widespread as in measles but it should be noted that not infrequently they occur at the same time as measles outbreaks. Though attacks may occur at any age the disease is one which chiefly affects infants and young children. In the Borough during the years 1940-51 more than 60 per cent. of the cases and JO per cent. of the deaths occurred in children under school age. As with measles there has been a considerable fall in the deaths from whooping cough and the relevant figures for the Borough are shown below:— 9 Year Total No. of deaths Annual Mortality Rate per 100,000 population 1901-05 50 31.3 (average) 1906-10 43 25.7 „ 1911-15 39 17.7 „ 1916-20 24 11.9 „ 1921-25 19 8.4 „ 1926-30 15 5.1 „ 1931-35 13 3.6 „ 1936-40 9 2.0 „ 1941-45 9 2.1 „ 1946-50 2 0.0 „ 1951 — 0.0 „ As with measles the same causes have contributed to this fall and with the production of improved vaccines there is now some genuine hope that preventive inoculation can reduce the incidence and severity of this distressing illness. Influenza.—There was a short epidemic of influenza at the beginning of the year. Deaths due to this disease were 33 as compared with 6 in 1950, 6 in 1949 and 5 in 1948. Of these 33 deaths 80 per cent. occurred in persons over 60 years of age. 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 cases were recorded during 1951:—mumps 505; chicken pox 348; and German measles 33. 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 84 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. 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." Ten rooms were disinfected during 1951. 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 1951 was 426. 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 1951 notification of the occurrence of food poisoning in 6 persons was received and information from other sources revealed further, 126 cases. 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. During 1950 over 17,000 persons in England and Wales were known to have been affected either in outbreaks (two or more related cases in persons in different families), family outbreaks (two or more related cases in members of the same family) or as sporadic cases (not, as far as could be ascertained, related to other cases). Considering each outbreak, family outbreak and sporadic case as one unit or incident there were 3,979 such food poisoning incidents in 1950—an increase of 64 per cent. over the incidents reported in 1949. The following extract from an article on " Food Poisoning in England and Wales, 1950, published in the Monthly Bulletin of the Ministry of Health for October, 1951, should be of interest:— " Processed and made-up meat dishes are by far the most important foods in the spread of infection. Forty-eight per cent. of all outbreaks where the vehicle of infection was ascertained were associated with meat pies, sausage meat, brawn, cold meats, stews, re-heated and made-up dishes, pressed beef, rissoles, gravy, stock and similar dishes. Prevention of food poisoning due to contamination of this kind of food is not primarily a bacteriological problem. If meat dishes were eaten as soon as they were cooked, the incidence of food poisoning would be greatly reduced. Those who are responsible for the preparation of food, especially meat, for consumption by the public should know that, when food is eaten as soon as it is prepared, not only is the risk of food poisoning reduced but the food is of superior flavour and palatability. 10 It is for the catering trade to realise their responsibilities in this matter and to devise new methods for the preparation of food in large quantity. Food prepared one or two days before it is to be eaten, allowed to cool slowly—often in a warm kitchen—and then reheated slowly to a moderate temperature before it is served is potentially dangerous to the customer. If it is impossible for meals in canteens and restaurants to be prepared and eaten within a few hours, then apparatus for the rapid cooling of food and refrigeration at 4°C. until it is to be reheated must be brought into general use. When such food is reheated, it must be brought to boiling point before it is served. Food poisoning is not only the result of unsatisfactory methods of preparation. Much of it is due to a disregard of elementary personal hygiene. Staphylococcal outbreaks almost always result from contamination of food by the food handlers. As in previous years in a number of outbreaks the epidemic phage type of staphylococcus has been found on the hands, in the nose or in boils or abrasions on the face, hands or forearms of the food handlers. It is clear that, until food handlers are educated in personal hygiene, outbreaks will continue to occur. Hot water, soap and towels in kitchens and food preparation rooms, and the frequent use of them by food handlers during the course of their work would make a great and immediate contribution to the solution of the problem. When the salmonella infections are considered, the need for personal hygiene and washing of hands after visits to the water closet is of paramount importance. Whatever may be shown to be the most common source of contamination of food, all foodstuffs and especially food which is not cooked and eaten hot, must be protected from the excreta of vermin, animals and birds, from flies and cockroaches, and from the excreta-soiled hands of these engaged in preparing food." Some people, basing their opinions solely on personal experience and information, tend to play down the drive for food hygiene and the prevention of food poisoning. A consideration of local and national outbreaks shows the ever present danger and the need for care and vigilance by all responsible in any way for the preparation, handling and storage of food. During the year the Sanitary Inspectors have continued their efforts to educate food handlers and to secure genuine compliance with the byelaws " with regard to the handling, wrapping and delivery of food and the sale of food in the open air " introduced by the Council in June, 1950. SANITARY CIRCUMSTANCES Physical Characteristics.—The Borough has an area of 7,261 acres and lies in the Thames Valley on the north bank of the river. From the river the land rises slowly until at North Hyde it is about 100 feet above sea level. The subsoil consists of " drift gravels " and lying on them in places are patches of clay. The following open spaces are laid out and controlled by the Borough Council:— Park Farm and Avenue House, Cranford 40.29 acres Heston Fair Ground 9.38 „ Church Meadow, Bath Road 9.20 „ Children's Playground, Sutton Lane 0.60 „ Kingsley Road Playing Field 0.95 „ Greenhams Land, London Road 14.75 ,, St. John's Gardens, Isleworth 5.73 „ Riverside Walk, Isleworth 0.75 „ Children's Playground, Northcote Avenue 0.85 ,, Playground, London Road 1.84 ,, Bowling Green, Jersey Gardens 0.59 „ Isleworth Promenade 1.0 „ Heston Park 14.29 „ Lampton Park 24.20 „ Beaversfield Park 9.77 „ Inwood Park 10.25 „ Redlees Park 16.47 „ Jersey Gardens 7.87 ,, Football Ground, Denbigh Road 3.70 ,, Midsummer Children's Playground 1.52 ,, 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 13 Cisterns cleansed, repaired, etc. 15 Draw-off taps connected direct to main 3 Service pipes or taps repaired 16 Cases where mains supplied substituted for well supply Nil Samples taken from wells for analysis 4 Samples taken from mains for analysis 1 Wells abolished Nil 13 FOOD POISONING OUTBREAKS 1951 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 26-5-51 28-5-51 6 5 - Not ascertained - Baked Beans Home - 2 26-9-51 29-9-51 ? 1 — Proteus Vulgaris — — — Notified from hospital outside Borough but patient resident within Borough. 3 6-11-51 7-11-51 172 94 — Not ascertained — Roast Beef Works Canteen — 4 9-11-51 13-11-51 450 7 — Not ascertained — - School Canteen - 5 12-11-51 14-11-51 450 25 — Not ascertained - Beef Works Canteen - 14 The provision of a safe and adequate water supply is of great public health importance and to supply a large population is a task of some magnitude. The Metropolitan Water Board draws its supply of water from the Rivers Thames and Lee ( part of the latter forming the New River) and 89 wells and boreholes. They have 49 storage, balancing and subsidence reservoirs for unfiltered water extending over an area of 3,356 acres and having a total capacity of nearly twenty-six thousand million gallons of water. The water taken from the rivers is purified at 13 filtration works, comprising 165 slow sand filters which occupy an area of 163 acres. As a further precaution chlorination of the water is carried out. The distribution system consists of a vast network of 85 filtered water service reservoirs and nearly 8,500 miles of mains. The quantity of water supplied is between three and four hundred million gallons per day. The ease with which pure and wholesome water is obtained by turning on a tap tends to make one forget the huge organisation and the care and attention needed to provide and protect our water supply. Considerable expense is involved and every effort should be made to avoid waste of water. In recent years evidence has accumulated in U.S.A. and in this country that the presence of fluorine in drinking water increases the resistance of teeth to caries. It is also know that excess of fluorine in drinking water will cause mottling and discolouration of teeth. Large scale experiments on the addition of a controlled amount of fluorine to drinking water have been carried out in U.S.A. and this has been followed by a reduction in the incidence of dental caries in children. Though fluorine is a cumulative poison there is no evidence that, in the concentration which will reduce caries, it produces any ill effect. The problem of dental caries in children in this country is a serious one and it is hoped that earnest consideration will be given to the possibility of its reduction by the addition of controlled amounts of fluorine to water supplies. 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 1951:— Drains exposed for examination 75 Drains unstopped, repaired, etc. 280 Waste pipes repaired, trapped, etc. 14 Soil pipes repaired, etc. 1 Ventilating shafts repaired, etc. 4 Fresh air inlets repaired, etc. 9 Rainwater pipes disconnected from drains Nil Gully traps inserted or repaired 35 Disconnecting traps inserted or repaired 3 Disconnecting and inspection chambers provided 4 Disconnecting and inspection chambers repaired, etc. 44 Drains constructed or repaired 5 Total length (ft.) of drain pipes laid— (a) 4" 162' (b) 6" 23' Drain tests applied 44 Other works executed 11 Cesspools emptied or repaired 1 Cesspools abolished Nil Rivers and Streams.—No complaint of pollution was made to the Health Department during 1951. 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 6 Water closets provided in substitution for dry receptacles, etc. Nil Water closets where walls cleansed 23 Water closets fitted with new flushing apparatus 21 New pans or pedestals provided 30 Water closets repaired or improved 81 Water closets blockages unstopped 23 Other closets provided or repaired Nil Water closets connected to sewer and cesspools abolished Nil 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 94 new dustbins were provided durine 1951. The following details of the salvage of waste materials have been provided by the Borough Engineer:— 1947 1948 1949 1950 1951 Paper (tons 686 943 1,228 1,331 1,111 Scrap metal (tons) 40 83 102 80 78 Textiles (tons) 56 64 84 75 57 Bones (tons) 4 3 2 1 — Bottles, jars (tons) 166 109 23 36 63 Cullet (tons) 10 14 12 6 4 Rubber (tons) 9 1 1 — — Kitchen Waste (tons) 1,077 1,110 1,074 1,013 1,032 Miscellaneous (tons) — — — — — £11,207 £12,322 £12,702 £14,426 £20,902 15 Sanitary Inspection of the Borough.—In addition to the work recorded in other paragraphs of this Report the Sanitary Inspectors continued their general duties of abating nuisances and dealing with contraventions of the Public Health Act, etc. To carry out effectively the sanitary inspection of a district the Local Government Board in 1910 recommended a minimum of one inspector per 10,000 population. Since then the duties have increased and the present establishment of inspectors for the Borough is nine. Not only must the inspectors deal promptly with complaints but they must have time to pay regular routine visits to premises if a steady and progressive improvement in the sanitary circumstances of the Borough is to be maintained. The abatement of nuisances and the remedying of defects is still handicapped and delayed by shortage of materials and labour and by rising costs. Some particulars of the work done are shown below:— Complaints received 1,301 Number of premises at which nuisances, etc., were located 1,005 Number of premises where defects were remedied:— (a) by owners or occupier 981 (b) by Council in default 5 (c) public sewers repaired by Council 15 Informal notices issued 727 Written reminders issued 722 Statutory notices served 101 Total number of inspections and re-inspections 21,429 Inspections of piggeries 71 Inspections of stables 82 Inspections of urinals 57 Sinks provided or repaired 24 Roofs repaired 249 Gutters repaired or renewed 177 Brickwork, sills, etc., repaired or renewed 270 Premises provided with damp-proof courses 3 Sites covered with impervious material 3 Yards and forecourts paved or drained 28 Rooms stripped, cleansed and redecorated 423 Floors, walls and ceilings repaired or renewed 1,038 Rooms in which ventilation provided or improved 30 Rooms in which lighting provided or improved 2 Windows repaired or renewed 416 Doors and other woodwork repaired or renewed 157 Staircases replaced or repaired 10 Handrails or balusters repaired or renewed 9 Grates provided or repaired 133 Wash coppers provided or repaired 5 Instances where ventilation under floors provided or improved 18 Larders provided or repaired 11 Domestic cleansing enforced 11 Improper keeping of animals abated 5 Offensive accumulations removed 34 Pigsties provided, repaired, cleansed, etc. 3 Urinals provided, repaired, cleansed, etc. 4 Other repairs carried out or nuisances abated 127 Visits re infectious disease, etc. 311 Action in Court was taken for the abatement of a nuisance due to carbon black. The Magistrates made an Abatement Order and laid down certain conditions to be complied with by the defendants. 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. During the year the Sanitary Inspectors made 98 smoke observations on factory chimneys and made many visits to premises concerning which complaints of smoke nuisance had been received. Smoke nuisances were proved at three premises. At two of these the nuisance arose from defects in the boiler plant and though the nuisances were duly abated there was some delay in getting the necessary spare parts. In the third case the type of fuel was thought to be a contributory cause, the help of the technical staff of the Ministry of Fuel and Power was obtained and in due course the nuisance was abated. The usual excuse given for the occurrence of a smoke nuisance is that the right type of fuel for the boiler cannot be obtained. While this may make boiler firing more difficult there is no doubt that smoke nuisance in most cases is due to bad stoking or defects in the plant. The best designed plant will not give satisfactory results unless it is operated correctly and maintained properly. Smoke from domestic chimneys can be a nuisance and does a lot of damage, but is free from all supervision and control. In 1946 the Fuel and Power Advisory Council submitted a report on " Domestic Fuel Policy" in which they say " our coal is used for domestic heating with a degree of inefficiency, whicli is not, so far as we can ascertain, even approached in any other country in the world." They strongly recommended the replacement of old fashioned coal grates by modern multi-fuel appliances which burn efficiently and as smokelessly as possible and the increased production of smokeless solid fuels suitable for domestic purposes. Local Authorities in building new houses are now required to install solid fuel burning apparatus taken from a list of such appliances approved by the Ministry of Fuel and Power and where plans are approved for private building, a similar requirement is made. The replacement of existing ranges and fire grates in existing houses by such approved appliances would make an important contribution to a cleaner atmosphere. These appliances will not only burn smokeless fuel such as coke but will burn coal more efficiently and thus give more heat, less dust and dirt in the home and less atmospheric pollution. 16 The need for making the best use of our fuel and for avoiding waste is a matter of national concern. During the year the Federation of British Industries published " Fuel Economy Pays"; the Combustion Engineering Association held a special conference on the subject; the National Union of Manufacturers and the Trades Union Council gave the matter publicity and the Coal Utilisation Joint Council did much to instruct housewives on how the best results can be obtained from solid fuel supplies. With the cooperation of the Education Department another course on boiler house practice was arranged at Spring Grove Polytechnic but the response from employees of local firms was most disappointing. In 1950 the Council decided to co-operate with the Department of Scientific and Industrial Research by installing apparatus for measuring atmospheric pollution. Owing to delay in the delivery of the apparatus observations could not be taken before May, 1951. Two sets of apparatus are in use; one on the roof of the Health Department in Bath Road, Hounslow, and the other on the roof of " Heath House," London Road, Isleworth. The results recorded to the end of the year were as follows:— Health Department Heath House Month Rainfall (inches) Deposit (tons per sq. mile) Mg. SO3 per day per 100 sq. cms. Rainfall (inches) Deposit (tons per sq. mile) Mg. SO3 per day per 100 sq. cms. May 2.04 13.95 0.78 2.12 16.65 0.86 June 0.78 14.27 0.44 0.81 17.36 0.44 July 1.11 10.06 0.22 0.94 12.90 0.31 Aug. 3.73 12.87 0.44 3.84 12.09 0.35 Sept. 2.15 8.52 0.31 2.19 9.29 0.30 Oct. 0.76 10.26 0.92 0.80 13.51 1.20 Nov. 5.20 11.87 1.12 4.81 14.15 0.94 Dec. 1.42 9.89 1.49 1.50 10.13 1.38 The amount of pollution by sulphur gases is expressed as sulphur trioxide (SO3) in milligrammes per day per 100 square centimetres. Sulphur trioxide when in contact with water forms sulphuric acid and its presence in the atmosphere is one of the causes of corrosion of metals and building materials. The deposit from the atmosphere consists chiefly of soot, ash and soluble matter. Tents, Vans and 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 843 visits of inspection because of the occupation of land by caravans. Trepass by caravans on unfenced land was not as frequent as in recent years, but action had to be taken for the removal of 30 caravans. Six applications, under the provisions of the Middlesex County Council Act, for permission to place caravans on sites within the Borough were considered; three were approved and three refused. Because of an attempt to establish, without the consent of the Council, a caravan site on the south west border of the Borough" action was taken in Court. The defendants were fined £5 with £5 5s. costs and £5 5s. with £3 3s. costs while 16 occupiers of caravans were fined 10/- each. 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 48 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, over crowding, 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 878 (b) Factories—non-mechanical power 41 (c) Other premises 27 (d) Workplaces 144 (e) Outworkers' premises 341 Defects remedied 65 At the end of the year the number of outworkers registered with the Department was 134 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, waterbuts, 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 75 rooms in 33 houses were treated, while 19 wasp nests were destroyed, 7 premises cleared of cockroaches, 1 of woodworm and 2 of ants. Four ponds or tanks were 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 c larged to show '' that he has used the best practicable means of preventing or mitigating the nuisance, laving 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 not 17 a noise is a nuisance within the meaning of the Act, though there may be no doubt about the annoyance to residents in the neighbourhood of the factory concerned. During the year complaints of nuisance due to noise were received in regard to three factories. Day and night observations were made concerning these complaints and in conjunction with the firms concerned measures were taken to reduce the noise as far as was practicable. Individual susceptibility to noise or vibration varies greatly and what may annoy one person will not be noticed appreciably by another. The mechanics of noise and vibration transmission are difficult subjects and theroetical solutions do not always prove practicable or effective. In many cases a lessening only of the nuisance is the maximum result that can be anticipated. The siting of factories or the establishment of industrial processes in or near houses is a potential source of noise nuisance and this should be born in mind in town planning. Rats and Mice Destruction, etc.—The Prevention of Damage by Pests Act, 1949, which came into operation on 30th March, 1950, repealed the Rats and Mice (Destruction) Act, 1919. The responsibility " to keep their area, as far as practicable, free from rats and mice " is placed on the Council and occupiers of premises are required to give notice when they have knowledge that rats or mice are present in substantial numbers. 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 or 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 systematic 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:— 1947 1948 1949 1950 1951 Complaints received 275 391 419 421 607 Block inspections 28 9 9 37 89 Individual inspections 2,089 2,026 2,862 2,574 3,150 Individual re-inspections 225 234 271 316 221 Other visits 338 408 408 402 438 Premises treated— (a) By occupiers 100 111 71 25 19 (b) By Local Authority 836 806 848 882 743 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 provided food and/or shelter. Unless occupiers take the necessary precautions to discourage rats, progress towards eradication will be slow. 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 seven dealers in rags were prosecuted and fines of 40/- imposed in each case. Shops Act, 1950, Section 38.—During the year a Certificate of Exemption issued under section 10 of the Shops Act, 1934, in regard to the provision of sanitary conveniences and washing facilities was withdrawn in the case of one shop, adequate arrangements having been made on the premises. 60 inspections and re-inspections were made during the year. Rag Flock and Other Filling Materials Act, 1951.—This Act came into operation on 1st November, 1951. It is designed to ensure that filling materials used in upholstery, etc., comply with prescribed conditions of cleanliness. Premises using filling materials have to be registered and premises where rag flock is manufactured or stored have to be licensed. It is an offence to sell articles containing unclean materials. Certain records have to be kept on registered and licensed premises and authorised officers of a local authority have powers to enter, inspect and take samples. Under this Act 5 premises in the Borough have been registered and the Sanitary Inspectors made 27 visits of inspection. Swimming Baths.—Three swimming baths are provided by the Council and one private swimming bath is in operation in the Borough. The size and extent of usage of the three municipal baths are shown below:— Hounslow Heston Isleworth Area of bath major 75'x30' 100'x 48' 100'x 48' minor 50'x25' — — Capacity of bath (gallons) major 71,000 200,000 200,000 minor 36,000 — — Total number of persons using swimming bath in 1951 96,674 157,897 104,105 Maximum number of persons using swimming bath on any one day 1,026 1,709 1,060 (19/7/51) (2/7/51) (1/8/51) No. of slipper baths male 15 - 11 female 9 — 11 No. of persons using slipper baths during 1951 male 29,664 - 16,350 female 14,257 — 10,127 18 The baths waters are treated by continuous filtration and chlorination. At Hounslow Baths the breakpoint system of chlorination was installed during the year. The advantage of this system, which is more expensive than the usual process and requires close and skilled supervision is the stronger and more rapid bactericidal action and this is of special importance at times of high bathing load. While baths' staff do everything to maintain a " safe " standard of bath water the bathers could assist very materially by the observance of strict personal hygiene. Verminous Premises and Articles.—Action in regard to one house has to be taken under Sections 83 and 84 of the Public Health Act, 1936. INSPECTION AND SUPERVISION OF FOOD Milk.—During the year 67 inspections were made at dairies and retail purveyors premises. Under the Milk (Special Designation) Regulations 36 licences for the sale of " tuberculin tested " milk, 42 for the sale of " pasteurised " milk and 39 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 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. The Milk (Special Designations) (Specified Areas) Order, 1951, came into operation on 1st October. This Order defined the County of Middlesex as an area in which the use of a special designation becomes obligatory for the purpose of all sales of milk by retail for human consumption (other than a catering sale). The special designations permitted are " sterilised," " pasteurised " and " tuberculin tested." Ice-Cream.—Under the Food and Drugs Act premises used for " the sale or the manufacture for the purpose of sale, of ice-cream, or the storage of ice-cream intended for sale " must be registered. This does not apply to premises used primarily as a club, hotel, inn or restaurant and only to a theatre, cinematograph theatre, music hall or concert hall if the ice-cream is manufactured on the premises. The number of premises registered at the end of the year was 177. 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 heal 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. During the year 563 inspections of registered premises were carried out and 169 samples of ice cream and one sample of rinse water taken for bacteriological tests. The results of these 169 tests are shown below:— Date Excellent Satisfactory Doubtful Unsatisfactory 30th April 4 7 1 — 9th May 5 4 2 1 15th May 8 4 — — 19th May 10 1 1 — 31st May 6 2 4 — 7th June 5 5 — — 18th June 4 1 7 — 26th June 3 3 4 2 5th July 1 8 — 1 20th July 5 — 2 5 1st Aug. 3 2 2 5 17th Aug. 1 — 2 3 6th Sept. — 4 1 1 14th Sept. — 3 5 1 25th Sept. 6 — — — 28th Sept. 3 4 3 - 15th Oct. - 2 2 - A comparison of these results with previous years is shown below:— 1948 1949 1950 1951 No. of samples 90 147 — 169 Grading—excellent 13 59 — 64 satisfactory 47 42 — 50 doubtful 8 1 — 36 unsatisfactory 22 45 — 19 % excellent and satisfactory 66.6 68.7 - 67.5 19 The proportion of doubtful and unsatisfactory samples is still too high. It should be noted that unsatisfactory samples are more frequent during the season when production capacity is being worked to the full. All doubtful and unsatisfactory samples are followed up in an effort to trace lapses from strict cleanliness in manufacture, storage and retailing. BAKEHOUSES.—There are 25 bakehouses in the Borough and 168 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. During the year 4 visits of inspection were made. Slaughter of Animals Act, 1933.—During the year 5 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, 331; fish, 100; provisions, 510; vegetables and fruit, 93; foodstuffs on hawker's stalls or vehicles, 170; and other foods, 86. Premises where food was prepared were submitted to 1,077 inspections and defects were remedied or improvements secured at a number of premises. Special attention was given to kitchens at restaurants and cafe premises. 93 inspections were carried out under the Public Health Meat Regulations. During the year 14,715 lbs. of unsound food and 6,489 tins, jars, etc., of unsound food were seized by or surrendered to the Sanitary Inspectors at retail premises in the Borough. No proceedings were taken in respect of unsound food. As in 1950 a particular feature was the finding of extraneous matter in food. During the year the following instances were encountered:—Coke in bread; metal nail in cake (2 cases); vegetable debris in bottle of mineral water; splinter of wood in cake; wasp in doughnut. In three cases the articles of food were produced at premises in the Borough. A severe warning was issued to all the firms concerned. The presence of extraneous matter in food may arise by accident, but the' enquiries made suggest some degree of carelessness as the more probably cause. 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. All the pigs were killed on premises infected with swine fever. CARCASES INSPECTED AND CONDEMNED Cattle excluding Cows Cows Calves Sheep and Lambs Pigs Number killed (if known) — — — — 35 Number inspected — — — — 35 All diseases except Tuberculosis— Whole carcases condemned — — — — Carcases of which some part or organ was condemned — — — — 5 Percentage of the number inspected affected with disease other than Tuberculosis — — — — 14.28 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 the end of the year 89 such premises were registered in the Borough. Section 16 of the Food and Drugs Act, 1938, states:—" every dealer in ice-cream who in a street or other place of public resort sells, or offers or exposes for sale, ice-cream from a stall, or from a cart, barrow or other vehicle or from a basket, pail, tray or other container used without a stall or vehicle, shall have his name and address legibly and conspicuously displayed on the stall, vehicle or container, as the case may be." 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 65 hawkers were on the register. Municipal Restaurants.—There is no municipal restaurant in the Borough but during the year the 24 school canteens provided 1,520,160 meals. Food and Drugs Sampling.—During 1951 the following samples for analysis were taken in the Borough by the Public Control Department of the Middlesex County Council:— 20  No. of Samples No. found unsatisfactory Milk, various 157 2 Almonds, ground 1 — Aspirin 1 — Baking Powder 1 — Cakes, various 35 — Cooked meats, various 9 — Cream 2 1 Cream, synthetic 2 — Custard mixture 1 — Dried Egg 1 — Fish, various 16 3 Gelatine 2 - Gin 8 — Grape Fruit Squash 1 — Ice Cream 2 — Ice Cream mixture 1 — Jam 1 — Jelly 2 — Lemon Curd 1 — Malted Milk 1 — Meat Pie, various 2 — Mincemeat 1 — Morfat Whip, compound 1 — Salad Cream 1 — Sausages—various 33 — Sausage Meat 2 — Sausage Roll 3 — Self-raising Flour 1 — Semolina 1 — Tincture of Quinine 1 — Tomato Ketchup 1 1 Tomato Soup 2 — Vinegar 2 — Whisky 17 — White Pepper 1 — 314 7 The samples of milk were slightly deficient in solids-not-fat, but contained no added water. An official caution was issued to the vendor of imitation cream as "cream." For labelling "witch" as lemon "sole" and passing off the one for the other on sale, a firm of fishmongers was prosecuted and fined a total of £10, with £2 2s. costs, and the shop manager was fined £10, with £2 2s. costs, for aiding and abetting the offences. An official caution was issued in respect of the contamination with tin of a sample of tomato ketchup. Food Hygiene.—In the report for 1950 the various methods used to encourage the policy of "clean food, handled by clean hands and transported, prepared and stored under clean conditions" were described. During 1951, with a full staff of Sanitary Inspectors available, the work was concentrated on regular visiting and inspection. The response by the traders and employees was fairly good, but there is still considerable room for improvement. As a result of these visits of inspection the following works were carried out at food premises:— Repairs to walls, floors, windows, etc. 8 Painting and decoration (internal) 16 Adequate ventilation provided 7 Floors cleansed 1 Apparatus and equipment cleansed 1 Hot water supplies provided 9 Washing facilities, soap and towels provided 3 Measures taken to prevent contamination of food 21 Impervious (easily cleansed) surfaces provided 4 Sinks, washing facilities, etc., repaired or improved 4 Hygiene notices provided in water closets 9 While structural improvement, suitable equipment and adequate washing facilities all contribute towards clean food the really important matter is the exercise of strict personal hygiene by all employed in the trade. The Council accepted the suggestion made in Ministry of Food Circular 20/51 that food traders should be invited to display on their premises a notice asking customers, in the interest of hygiene, not to bring dogs into the premises. 21 Welfare Foods.—Under the Welfare (Foods) Scheme of the Ministry of Food the following vitamin supplements are available:— Orange juice (6 oz. bottles at 5d. per bottle)— . Expectant Mothers 1 bottle per 9 days Babies under 6 months 1 bottle per 4 weeks Children aged between 6 months and 5 years 1 bottle per 2 weeks Cod Liver Oil compound (6 oz. bottles, free)— Expectant Mothers (not taking Vit. A. & D. tablets) 1 bottle per 6 weeks Children under 5 years 1 bottle per 6 weeks Vitamin A and D tablets (45 in packet, free)— Expectant mothers (as alternative to cod liver oil) 1 packet per 6 weeks Nursing mothers 1 packet per 6 weeks for 30 weeks after confinement It is possible to calculate what the average weekly consumption of these welfare foods should be if full advantage was taken of the scheme. The actual issues in the Borough expressed as a percentage of the possible issue during certain periods of 1951 are shown below:— Orange juice Cod Liver oil A and D Tablets 13 weeks to 24/2/51 42% 35% 40% 13 weeks to 26/5/51 42% 33% 40% 13 weeks to 25/8/51 51% 28% 39% As these vitamin preparations can be obtained at the Food Office and on fifteen occasions weekly at seven other premises, to describe the above figures merely as disappointing would be an under-statement. On all and every occasion so many are ready to complain of the inadequacy of our diet yet so few seem to be willing to make the small effort required to collect for themselves or their children these vitamin supplements which are provided to counteract one possible deficiency in our diet. 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 years are shown below:— 1946 1947 1948 1949 1950 1951 Heston and Isleworth B.C. 196 148 151 90 196 220 Brentford and Chiswick B.C. — 20 14 — — — Southall B.C. — 10 54 — — — Middlesex County Council — — — — — 4 Ministry of Civil Aviation — — 39 30 — 8 Private enterprise— (a) new houses 23 34 4 18 36 23 (b) reconstructed after war destruction 11 109 41 23 — — 230 321 303 161 232 255 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 Acts or under the nuisance sections of the Public Health Act is appropriate. The department tries to hold the balance evenly. Three appeals against notices under Section 9 of the Housing Act, 1936, were made but before a date was fixed for the hearing schedules of work were agreed and the appeals withdrawn. A summary of the action taken during the year is given below:— Houses inspected 414 Defective houses rendered fit in consequence of informal action 364 Defective houses rendered fit in consequence of statutory action 47 Houses in respect of which Demolition Orders were made 1 Houses demolished in pursuance of Demolition Orders 3 Houses in respect of which undertakings not to re-let accepted Houses demolished where undertakings had been given 6 Houses rendered fit in consequence of undertaking given by owner 3 Houses in respect of part of which Closing Orders were made Houses known to be overcrowded (Housing Act Standard) at end of year 129 New cases of overcrowding reported 25 Cases of overcrowding relieved during the year 31 Certificates issued under Section 12 of the Rent and Mortgage Interest Restriction (Amendment) Act, 1923 - 22 At the end of the year 54 houses, subject to Demolition Orders, Closing Orders or Undertakings not to re-let till rendered fit, were still occupied. The continued occupation of these houses is a matter of some concern and a special report on the matter was submitted to the Health Committee in July. After consultation with the Housing Committee an approach was made to the Ministry of Housing and Local Government. The Ministry undertook, when sites became available, to give an additional allocation of houses to be used specifically for the re-housing of occupants of such unfit houses. 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. 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 1951,85 burials were arranged in accordance with this section. Public Mortuary.—The public mortuary is situated in the grounds of Holy Trinity Church. The premises are out-of-date and unsuitable for post-mortem examinations or the retention of a body for other than a very short time, so by arrangement with Acton Borough Council and the Coroner bodies are taken direct to or transferred to Acton Mortuary. The Council pays a proportion of the cost of the maintenance of the Acton Mortuary. Medical Examination of Staff.—For superannuation or other purposes 36 members of the Council's staff were referred to the Health Department for medical examination. Health Education.—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. The National Assistance (Amendment) Act, 1951, shortens the legal precedure for obtaining an Order "if its is certified by the medical officer of health and another registered medical practitioner that in their opinion it is necessary, in the interests of the person, to remove him without delay." During the year no application was made for an Order. People are living longer, the housing shortage is accentuating the difficulty which may ensue 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. 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 the demand for "someone to do something" in regard to aged and infirm relative grows. 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. The care of the aged, infirm and chronic sick is a growing task. In this work there is great scope for voluntary effort and 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 work of statutory authorities and voluntary agencies so that the best use is made of premises, staff and the " milk of human kindness." 23 TABLE I Summary of Vital Statistics 1895-1951 Estimated Civilian population (mid-year) Birth Rate per 1,000 populalation Rate 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 1951 106,400 11.3 10.4 18 14 0.0 20 0.3 24 TABLE II REGISTRAR-GENERAL'S RETURN OF CAUSES OF DEATH, 1951 Abridged List No. Cause of Death Male Female Total B 1 Tuberculosis, respiratory 18 8 26 B 2 Tuberculosis, other — 1 1 B 3 Syphilitic disease 7 3 10 B 8 Diphtheria — — — B 9 Whooping Cough — — — B 10 Meningococcal infections 1 — 1 B 12 Acute poliomyelitis — — — B 14 Measles — 1 1 B 4-7,11, 15-17 Other infective and parasitic diseases 1 - 1 B 18 Malignant neoplasm, stomach 15 9 24 Malignant neoplasm, lungs 34 4 38 Malignant neoplasm, breast — 13 13 Malignant neoplasm, uterus — 3 3 Other malignant and lymphatic neoplasms 57 43 100 Leukaemia, aleukaemia 6 4 10 B 20 Diabetes 2 5 5 B 22 Vascular lesions of nervous system 45 105 150 B 26 pt. Coronary disease, angina 88 44 132 B 28 Hypertension with heart disease 13 21 34 B 25 26 pt. 27 Other heart disease 58 95 153 B 29 46 pt. Other circulatory disease 30 23 53 B 30 Influenza 14 19 33 B 31 Pneumonia 20 16 36 B 32 Bronchitis 52 34 86 B 46 pt. Other respiratory diseases 7 4 11 B 33 Ulcer of stomach and duodenum 13 5 18 B 36, 43 pt. Gastritis, enteritis, diarrhoea — 3 3 B 38 Nephritis and nephrosis 8 9 17 B 39 Hyperplasia of prostate 8 — 8 B 40 Pregnancy, childbirth, abortion — — — B 41 Congenital malformations 2 2 4 Residial Other defined and ill-defined diseases 41 56 97 B E 47 Motor vehicle accidents 7 5 12 B E 48 All other accidents 7 10 17 B E 49 Suicide 4 4 8 B E 50 Homicide and operations of war — — — Total 558 547 1,105 25 TABLE III INFANTS DEATHS ACCORDING TO AGE AND CAUSE, 1951 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 - - - - - - - - - - - 2 Bronchitis - - - - - - - - - - - - - - - - - - - - 1 1 Hypothyroidism - - - - — - - - - - - 1 - - - - - - - - - 1 Birth injuries - 1 - - 1 - - - - - - - - - - - - - - - - 2 Atelectasis 2 3 - 1 - - - - - - - - - - - - - - - - - 6 Congenital malformations 1 1 - - - - - - - 1 - 1 - - - - - - - - - 4 Prematurity 1 1 - 1 1 1 - - - - - - - - - - - - - - - 4 Middle ear infection - - - - - - - - - - - - - - 1 - - - - - - 1 Meningococcal infection - - - - - - - - - - - - - 1 - - - - - - - 1 TOTAL 4 5 - 2 3 1 - - - 2 - 2 - 1 1 - - - - - 1 22 26 TABLE IV. CAUSES OF DEATH ACCORDING TO AGE AND SEX, 1951. 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 18 8 - - - - - - - - - - - - - - - 2 - 1 1 1 4 1 - - 1 2 - 1 2 - 6 - 1 - 1 - 1 - 1 - - - - - B 2 Tuberculosis, other forms - 1 - - - 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - B 3 Syphilis and its sequelae 7 3 - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 - - 2 - - - 2 - - - 2 1 1 - - 1 B 4 Typhoid fever - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - B 5 Cholera - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - B 6 Dysentery, all forms - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - B 7 Scarlet fever and streptococcal sore throat - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - B 8 Diphtheria - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - B 9 Whooping Cough - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - B 10 Meningococcal infections 1 - 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - B 11 Plague - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - B 12 Acute poliomyelitis - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - B 13 Smallpox - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - B 14 Measles - 1 - - - - - - - - - - - 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - B 15 Typhus and other rickettsial diseases - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - B 16 Malaria - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - B 17 Other infective and parasitic diseases 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 - - - - - - - - - - - - - - - B 18 Malignant neosplasms—stomach 16 10 - - - - - - - - - - - - - - - - 1 - - - - - - - 1 - 3 1 2 - 1 - 1 2 3 1 1 4 1 - - 1 2 1 lungs 34 4 - - - - - - - - - - - - - - - - - - - - - - - - 2 1 2 - 5 - 9 - 8 - 6 3 1 - 1 - - - - - breast 1 13 - - - - - - - - - - - - - - - - - - - - - - - - - 1 - - - 3 1 - - 2 - 3 - - - 2 - 1 - 1 uterus - 4 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 - - - 1 - 1 - 1 - - other sites 56 41 - - - - - - - - - - - 1 1 - - - - - - 1 - 1 - - 1 4 5 3 2 1 8 9 7 3 7 5 8 4 9 4 7 2 1 3 leukaemia, etc. 6 4 - - - - - - 1 - - 1 1 - - - - - - - - - - - - 1 1 - - - - - - - - 2 2 - 1 - - - - - - - B 19 Benign and unspecified neoplasms 4 - - - - - - - - - - - - - - - - - - - - - - - 1 - - - - - 1 - 1 - 1 - - - - - - - - - - - B 20 Diabetes 2 2 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 - - - - - - - - 1 1 1 - - B 21 Anaemias 1 2 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 - - - - 2 B 22 Vascular lesions affecting central nervous system 45 105 - - - - - - - - - - - - - - - - - - - - - 1 - 1 1 2 - 4 3 6 7 8 5 8 4 10 8 18 12 19 2 12 3 15 B 23 Non-meningococcal meningitis - 1 - - - - - - - - - 1 - - - - - - - - - - - - - - - - - - - - - - - 1 - - - - - - - - - - B 24 Rheumatic fever - 1 - - - - - - - - - - - - - 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - B 25 Chronic rheumatic heart disease 11 22 - - - - - - - - - - - - - - - - - - - - - 1 1 - 1 1 1 2 2 2 - 4 - 2 3 2 3 4 - 1 - 1 - 2 B 26 Arteriosclerotic and degenerative heart disease— coronary disease, angina 88 44 - - - - - - - - - - - - - - - - - - - - - - - - 1 - 4 - 8 - 13 3 13 7 20 3 13 11 10 8 5 6 - 6 other 54 65 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 2 4 2 1 5 13 4 10 9 14 13 12 30 B 27 Other diseases of the heart 8 14 - - - - - - - - - - - - - - - - - - - 1 - - - - - - - - - - - 2 1 2 1 4 2 2 1 1 1 1 2 1 B 28 Hypertension with heart disease 13 20 - - - - - - - - - - - - - - - - - - - - - - 1 - - 1 - 1 - - - - 1 2 3 - 3 3 1 2 3 7 1 4 B 29 Hypertension without mention of heart 3 7 - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 - - - - - - - - 2 1 4 1 - - 1 B 30 Influenza 14 19 - - - - - - - - - - - - - - - - - - - - 1 1 - - - - 1 - 1 1 2 - 3 1 2 - 2 1 1 7 - 5 1 3 B 31 Pneumonia 20 16 - - - 1 - - - - - - - - - - - - - - - - - - 1 - 1 - - - - - 2 1 4 - 3 - 4 1 1 2 2 5 2 6 B 32 Bronchitis 52 34 1 - - - - - - - - - - -- - - - - - - - - - - - - 2 1 1 - 1 - 6 - 11 1 5 1 10 4 6 13 8 6 1 8 B 33 Ulcer of stomach and duodenum 13 5 - - - - - - - - - - - - - - - - - - - - 1 - - - - 1 - - 2 1 1 - - 1 3 - 4 - - 1 2 1 - - B 34 Appendicitis 2 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 - - 1 1 - - - - - - - B 35 Intestinal obstruction and hernia 1 4 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 1 1 - - - - - - - 2 - - B 36 Gastritis, enteritis, colitis, etc. - 2 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 - - - - - - - - - 1 - - B 37 Cirrhosis of liver 1 1 - - - - - - - - - - - - - - - - - - - - - 1 - - - - - - - - - - 1 - - - - - - - - - - - B 38 Nephritis and nephrosis 8 9 - - - - - - - - - - - - - - 1 - - - - - - - - 1 1 - - 1 1 - 2 - - 1 1 1 - 2 2 1 - 1 - 1 B 39 Hyperplasia of prostate 8 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 - 3 - - - - - - - B 40 Complications of pregnancy, childbirth and puerperium - 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - B 41 Congenital malformations 2 2 2 2 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - B 42 Birth injuries, post-natal asphyxia, atelectasis 6 2 6 2 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - B 43 Infections of the new born 2 - 2 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - B 44 Immaturity and other diseases peculiar to early infancy 1 3 1 3 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - B 45 Senility, ill-defined and unknown causes—senility 7 13 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 - 1 4 3 1 2 8 ill-defined causes - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - B 46 Other circulatory diseases 11 10 - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 - - 2 - - - 1 1 1 2 - 1 6 1 1 4 Other respiratory diseases 4 5 - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 - 1 1 2 - - - - 1 - 2 - 1 - - All other diseases 15 26 1 1 - - - - 1 - - - - - 1 - - 1 - - - - 2 1 1 - - - - 1 - 1 3 2 3 1 4 - 5 4 3 2 3 - - BE 47 Motor vehicle accidents 7 5 - - - - - - - - - - - - - - - 1 - 1 1 - - 1 1 - - - - - 1 1 - - 2 - 1 - - 1 - - - - 1 - BE 48 All other accidents 7 11 - - - - - - - - - - 1 - - - - - - - - - - - - - 2 - 2 - - - - - - - 1 - - 2 - 2 1 2 1 5 BE 49 Suicide 3 4 - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 1 - 1 1 1 1 - - 1 - - - - - - Self-inflicted injury 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 - - - - - - - - - - - - - - - - - BE 50 Homicide - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Operations of war - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ALL CAUSES 554 544 14 8 - 2 - - 2 - - 2 2 2 2 1 1 4 1 2 2 3 6 9 6 4 15 14 20 15 36 16 66 36 70 43 73 44 80 73 65 89 63 75 30 102 1,098 22 2 - 2 2 4 3 5 3 5 15 10 29 35 52 102 113 117 153 154 138 132 Percentage of total deaths from all causes 2.00 0.18 - 0.18 0.18 0.36 0.27 0.46 0.27 0.46 1.37 0.91 2.64 3.19 4.73 9.29 10.29 10.66 13.93 14.02 12.57 12.02 TABLE V INFECTIOUS DISEASES—1951—AGE DISTRIBUTION Disease Total Under l yr. l yr. 2 yrs. 3 yrs. 4 yrs. 5-9 yrs. 10-14 yrs. 15-19 yrs. 20-34 yrs. 35-44 yrs. 45-64 yrs. 65 yrs. + Cases admitted to hospital Smallpox - - - - - - - - - - - - - - Typhoid Fever 1 - - - - - - - - 1 - - - 1 Para-Typhoid Fever 1 - - - 1 - - - - - - - - 1 Scarlet Fever 67 - - - 5 17 30 7 3 2 3 - - 26 Diphtheria - - - - - - - - - - - - - - Erysipelas 12 - - - - - - - - - 3 7 2 2 Puerperal Pyrexia 13 - - - - - - - - 13 - - - 13 Ophthalmia Neonatorum 1 1 - - - - - - - - - - - 1 Acute Poliomyelitis and polioencephalitis 4 - - - - - 1 1 - 1 1 - - 4 Cerbro-spinal Fever 5 3 1 -- 1 - - - - - - - 4 Pneumonia 59 7 1 9 3 1 3 1 - 2 3 14 15 27 Undulant Fever - - - - - - - - - - - - - - Malaria - - - - - - - - - - - - - - Dysentery 77 4 17 13 9 11 5 1 6 12 5 3 1 25 Measles 790 21 70 106 147 148 272 7 9 10 - - - 28 Whooping Cough 220 27 17 28 29 35 72 12 - 2 - - - 10 Food Poisoning 6 - - - - - - 2 1 - 1 1 1 1 Tuberculosis :— Pulmonary 163 3 2 2 - - 3 2 17 73 21 36 7 - Non-pulmonary 22 - 1 - - 1 1 2 4 10 - 2 1 - 28 TABLE VI NOTIFICATIONS AND DEATHS FROM CERTAIN INFECTIOUS DISEASES HESTON AND ISLEWORTH, 1932-1951 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 Death Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths 1932 - - 207 - 58 3 37 - 199 58 8 2 - - 1 1 4 - - - - - - 14 - 5 Not Notifiable 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 1951 - - 67 - - - 12 - 59 38 5 1 - - 4 - 1 - 1 - 77 - 790 1 220 - 33 185 27 *Includes para typhoid fever to 1939. 29 TABLE VII COMPARATIVE STATISTICS 1951 England and Wales Heston and Isleworth Rate per 1,000 Civilian Population. Births- Live Births 15.5 11.3 Still Births 0.36 0.23 Deaths— All causes 12.5 10.4 Typhoid and Paratyphoid 0.00 0.00 Whooping Cough 0.01 0.00 Diphtheria 0.00 0.00 Tuberculosis 0.31 0.25 Influenza 0.38 0.31 Smallpox 0.00 0.00 Poliomyelitis 0.00 0.00 Pneumonia 0.61 0.36 Notifications— Typhoid fever 0.00 0.01 Paratyphoid fever 0.02 0.01 Meningococcal infection 0.03 0.05 Scarlet Fever 1.11 0.63 Whooping cough 3.87 2.06 Diphtheria 0.02 0.00 Erysipelas 0.14 0.11 Smallpox 0.00 0.00 Measles 14.07 7.42 Pneumonia 0.99 0.55 Poliomyelitis 0.05 0.04 Food Poisoning 0.13 0.06 TABLE VIII FACTORIES ACTS, 1937 and 1948 PART I OF THE ACT 1. Inspections for purposes of provisions as to health made by Sanitary Inspectors Premises Number on Register Number of Inspections Written Notices Occupiers prosecuted (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 45 41 - - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 347 878 56 - (iii) Other premises in which Section 7 is enforced by the Local Authority (excluding outworkers' premises) 5 27 2 — TOTAL 397 946 58 - 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. Inspector By H.M. Inspector Want of Cleanliness (S.1) - - - - - Overcrowding (S.2) - 1 - - - Unreasonable temperature (S.3) - - - - - Inadequate ventilation (S.4) - - - - - Ineffective drainage of floors (S.6) 1 1 - 1 - Sanitary Conveniences (S.7)— (a) insufficient 2 4 - 1 - (b) unsuitable or defective 54 57 - 3 - (c) not separate for sexes - 2 - - - Other offences against the Act (not including offences relating to Outwork) 3 - - - - TOTAL 60 65 - 5 - 30