AC439(1) H2355n 152Ehora HES 39 ANNUAL REPORT OF THE MEDICAL OFFICER of HEALTH OF THE BOROUGH OF HESTON AND ISLEWORTH for the year 1952 A. ANDERSON, M. D., D.P.H. Medical Officer of Health. INDEX Page Bakehouses 23 Births, Live and Still 5 Burials 27 Canal Boats 20 Closet Accommodation 18 Common Lodging Houses 20 Deaths 5 Deaths, Age and Sex Distribution 31 Deaths, Causes of 29 Disinfection 11 Disinfestation 21 Drainage and Sewerage 18 Factories, No. on Register, Inspections and Defects, etc. 34 Factories, Workplaces etc. 20 Fever Hospitals 11 Food and Drugs Sampling 24 Food Hygiene 24 Food Poisoning 11 Health Committee 3 Health Education 27 Health Services provided by Other Authorities 16 Housing 25 Ice Cream 23 Infant Deaths according to Age and Cause 30 Infant Mortality 7 Infectious Diseases 8 Infectious Diseases, Age Distribution 32 Infectious Diseases, Notifications and Deaths 33 Laboratory Service 11 Maternal Mortality 8 Page Meat and Other Food Inspection 23 Medical Examinations of Staff 27 Milk 22 Mosquitoes 21 Municipal Restaurants and School Canteens 23 Noise Nuisances 21 Nutrition 24 Persons in need of care and attention 27 Pet Animals' Act, 1951 22 Poliomyelitis 9 Public Cleansing 18 Public Mortuary 27 Rags, etc., Exchange of Articles for 21 Rag Flock & other Filling Materials Act 1951 22 Rats and Mice Destruction 21 Rivers and Streams 18 Sanitary Circumstances 17 Sanitary Inspection 19 Shops Act, 1950, Section 38 21 Slaughter Houses, etc. 23 Smoke Abatement 20 Staff 2 Statistics Comparative 34 Statistics General 5 Statistics Vital 5 Statistics, Vital, Summary of 28 Swimming Baths 22 Tents, Vans and Caravans 20 Tuberculosis 10 Water Supply 18 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. 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. P. G. T. Woods, Cert. as S.I. and M.I. H. L. Hughes, Cert. as S.I. and M.I. J. K. Edson, Cert. as S.I. and M.I. Rodent Officer. A. Farrer. Rodent Operatives. R. Ashurst. R. Clark. Mortuary Attendants, 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. Miss D. Ives (from 7.1.52 to 6.9.52). Mrs. K. M. Richards (from 13.10.52). F. B. Capes. 2 THE HEALTH COMMITTEE of HESTON AND ISLEWORTH BOROUGH COUNCIL to May, 1952 Alderman Mrs. 0. 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. from May, 1952 Alderman Mrs. O. C. M. Denton (Chairman) Councillor Mrs. M. Hennig (Vice-Chairman). Alderman D. Gilfillan, J.P. (Mayor) (died Sept., 1952) Councillor H. F. Nicholls. Alderman H. Edwards, J.P. (Mayor) Councillor H. J. Proud. —from October, 1952. Councillor H. I. W. Simmons. Alderman J. E. Dillingham. Councillor J. Theobald. Councillor A. G. Cross from 29.7.52 Councillor J. F. Thomas. —replacing Councillor Fielder. Councillor E. F. Tolman (died Nov. 1952) Councillor H. J. Davis. Councillor Miss M. K. Watson, J.P. Councillor C. W. Elliott. Councillor F. H. Fielder—resigned. 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 1952. The report has been prepared on the 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 continues well below the rate for the country; the death rate shows little departure from recent years; the infant mortality rate remains under 20 and the tuberculosis death rate is the lowest in the Borough records. For the second year in succession no woman died from any condition associated with pregnancy and childbirth but the low still birth rate of recent years was not maintained. No case of diphtheria occurred and apart from some increase in scarlet fever and measles there was no undue prevalence of infectious disease. While, on the whole, the Report indicates progress there is no room for complacency. The World Health Organisation of the United Nations defines health as " a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity " and we still fall far short of that standard. In his Report for the year 1951 the Chief Medical Officer of the Ministry of Health states:—"One result of all the work which has been carried out over the past century has been that such an improvement has taken place in the physical environment in this country, that the average Briton can now enjoy a much healthier and more agreeable life than his ancestors. It is important to realize that most of this improvement has been effected without his having had to exert himself or put himself to any great inconvenience. A silent army of sanitary technicians has unobtrusively worked this miracle on his behalf. We have now reached the point where further improvement in the physical environment is likely to show diminishing returns and the tendency during the present century has been for the public health worker to transfer the emphasis of his attention from the environment to the person. We have, in fact, arrived at a time when the citizen himself must actively participate in the campaign for better health if further substantial progress is to be made. We are leaving the era of sanitary engineering and are entering into that of personal hygiene in which each person must definitely contribute to the common weal." Since the introduction of the National Health Service the public have certainly shown signs of being disease-conscious and hospital-minded and it is difficult to find any evidence of interest in preventive medicine and health. The concentration of thought on disease and hospitals must be diverted to the individual's responsibility for his own health. No matter what new drugs may be discovered or operations devised it will still remain true that " health is won by a way of life and not by a bottle of medicine." I am pleased to acknowledge the generous co-operation and assistance I have received from other Departments. The loyal and willing assistance of my staff has continued and given me much pleasure. I would like to express to the Council my thanks for their encouragement and support. I remain, Your obedient servant, A. ANDERSON, Medical Officer of Health. 4 GENERAL STATISTICS 1951 1952 Area in acres 7,261 7,261 Population (Registrar-General's estimate) 106,400 105,600 Number of inhabited houses (rate books) 28,608 28,879 Number of houses erected during year 255 249 Rateable Value of Borough £997,847 £1,013,810 Sum represented by a penny rate £4,060 £4,146 Live Births—male 634 632 Live Births—female 567 606 Birth rate per 1,000 population 11.3 11.7 Birth rate per 1,000 population (England and Wales) 15.5 15.3 Stillbirths—male 12 17 Stillbirths—female 13 16 Stillbirths Rate per 1,000 (live and still) births 20.4 25.9 Deaths—male 558 547 Deaths—female 547 520 Death rate per 1,000 population 10.4 10.1 Death rate per 1,000 population (England and Wales) 12.5 11.3 Infant Mortality rate 18.3 18.6 Infant Mortality rate (England and Wales) 29.6 27.6 Maternal Mortality rate Nil Nil Maternal Mortality rate (England and Wales) 0.8 0.7 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 1952 is 105,600. 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 1952 was £1,013,810 and the sum represented by a penny rate was £4,146. Inhabited Houses.—According to the rate books the number of inhabited houses at the end of the year was 28,879. 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 1952 was 1,238 as compared with 1,201 in 1951. The birth rate was 11.7 per 1,000 population. The birth rate will vary, apart from other causes, according to the age and sex distribution of the population and to permit of a true comparison with other areas the Registrar-General supplies for each local sanitary authority what is called the area comparability factor. When this is applied to the above Borough birth rate the result is 11.2 as compared with the birth rate o) 15.3 per 1,000 population for England and Wales. The number of illegitimate births was 61 as compared with 43 in 1951. 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 1952 4.9 Of the total notified births (live and still) 78 percent. 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 1952 was 33 (31 legitimate, 2 illegitimate). The proportion of stillbirths per 1,000 total (live and still) births in recent years is shown below:— No. of Stillbirths Rate per 1,000 total births 1930-34 214 31.2 1935-39 224 29.4 1940-44 200 27.7 1945-49 198 23.8 1950 23 18.0 1951 25 20.4 1952 33 25.9 Deaths.—The deaths of residents of the Borough during 1952 were 1,067 (547 male, 520 female). This represents a death rate for the Borough of 10.1 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 RegistrarGeneral 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 11.0 as compared with a death rate 11.3 per 1,000 population for England and Wales. The Registrar-General has classified the deaths registered during the year and the details are given in Table II. In Table IV the deaths occurring during the year have been classified on local information. To help in classifying causes of death the Registrar-General may obtain additional information which is not available to the Medical Officer of Health. For these two reasons discrepancies may be noticed on comparing Tables II and IV. The cause of death was certified by the Coroner in 214 cases. 5 A progressive change is taking place in the percentage age distribution of deaths and this is shown in the following table:— 1910-14 1945-19 1950 1951 1952 Under 1 year 21.8 5.3 2.8 2.0 2.15 1—4 years 8.4 0.8 0.4 0.4 0.74 5-14 years 3.8 2.1 0.5 0.6 0.18 15-24 years 3.7 2.1 1.2 0.7 0.84 25-64 years 30.8 33.0 33.1 32.9 31.11 65 years and over 31.5 56.7 62.0 63.4 64.48 The chief causes of death in males were heart and circulatory diseases (198), cancer (96), bronchitis and pneumonia (88) and cerebral haemorrhage (43). In females the chief causes of death were heart and circulatory diseases (174), cancer (95), cerebral haemorrhage (78), and bronchitis and pneumonia (56). The following table shows the age distribution of deaths from pulmonary tuberculosis and cancer of the lung during the ten years 1943-52:— Age at Death Pulmonary Tuberculosis Cancer of the lung Male Female Male Female 15-24 years 23 34 - 1 25-34 years 31 41 2 2 35—44 years 31 22 20 6 45-54 years 47 18 45 7 55-64 years 59 12 91 12 65 years and over 30 10 90 23 221 137 248 51 It will be seen that, in men, cancer of the lung causes as many deaths as pulmonary tuberculosis. The former is more frequent in the higher age groups, but it should be noted that it does take an appreciable toll during normal working life. The relative freedom of women from cancer of the lung is still unexplained. A careful analysis of the tobacco smoking habits of about 1,500 lung cancer patients and of the same number of patients suffering from other conditions and matched as to age, sex, social status, etc. has been carried out and the investigators came to the conclusion that tobacco smoking is a factor in the production of cancer of the lung. What part tobacco smoking does play has yet to be discovered and further research is being undertaken. The Borough was enveloped in dense fog from the morning of 5th December till the morning of 9th December. The effect of this on deaths from bronchitis and pneumonia is shown in the following graph:— Weekly deaths of HESTON & ISLE WORTH residents from BRONCHITIS AND PNEUMONIA 6 It can be seen at once that fog is a real health hazard. Many factors contribute to the development of fog but on this occasion no one had any doubt about the importance of atmospheric pollution. "You can taste the soot and sulphur "was the general comment, but there was little evidence of any acceptance of a personal responsibility for the presence of the soot and sulphur. These polluters of the atmosphere come from domestic fires and industrial furnaces and only by attention to both methods of consuming raw coal can there be any real prospect of improvement. Despite any difficulties in obtaining modern appliances and suitable fuel much could be done by care and attention by all responsible for the burning of raw coal. The Secretary of the Road Safety Committee informs me that in the Borough during 1952 there were 522 road accidents which resulted in 11 deaths, serious injury to 114 persons and slight injury to 506 persons. These figures show no improvement when compared with 1951. The number of deaths from road traffic accidents and other accidents in Borough residents during the last ten years is shown below:— Year Road Traffic All ages Other Accidents Age in years Age in years All ages 0-4 5-14 15-64 65 + 0-4 5-14 15-64 65 + 1943 1 3 4 2 2 5 11 20 1944 — 4 10 5 19 1 1 5 10 17 1945 — 1 7 3 11 2 — 10 15 27 1946 — 2 9 1 12 5 2 8 17 32 1947 — — 10 2 12 1 — 12 20 33 1948 — — 8 2 10 2 2 10 14 28 1949 1 2 6 5 14 2 — 9 8 19 1950 2 3 8 7 20 2 1 6 17 26 1951 — — 9 3 12 — 1 4 13 18 1952 — 1 3 7 11 — — 3 12 15 Total 3 14 73 35 125 17 9 72 137 235 During the same ten years there occurred in the Borough 113 cases and 9 deaths due to poliomyelitis. In other words as a cause of death and disability poliomyelitis is of little import when compared with road traffic and other accidents yet it can give rise to a clamour for action while accidents tend to be accepted as a necessary evil. Poliomyelitis cannot be prevented as yet but accidents can. Prevention of accidents is the responsibility of every individual citizen. Care and attention in the home, in the factory and on the roads by everyone is necessary if the tragic results of accidents are to be reduced. Another feature of the above table is the large number of deaths due to accidental causes among persons aged 65 years and over. Falls in their homes, in institutions and in the road are all too frequent and all who have the care of old people should see that staircases are well lighted and fitted with handrails, that stair and other carpets are firmly fixed and that floors are not too highly polished. Old people are reluctant and even obstinate about admitting to the frailties of age, but if more of them could be induced to use rubber-tipped walking sticks, even indoors, many of these fatal falls might be avoided. Infant Mortality.—During 1952 there were 23 deaths of children under the age of 1 year. This represents an infant mortality rate per 1,000 live births of 18.6 as compared with 27.6 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 1952 1,238 23 19 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. The following table shows the age distribution of infant deaths during the last five years:— 7  Under 1 week 1-4 weeks 1-3 months 3-12 months 1948 23 8 9 6 1949 13 4 2 6 1950 17 1 4 8 1951 15 2 2 3 1952 16 2 5 — Total 84 17 22 23 % of Total 57.5 11.6 15.1 15.8 Thus nearly 60 percent. of these deaths occurred before the babies were one week old. The majority of these deaths were due to prematurity, conditions associated with prematurity and congenital defects. The search for the causes of prematurity and the best methods of treatment continues and therein lies the main hope of further appreciable reduction in the infant mortality rate. 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 0.7 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 — — — 1952 — — — 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 Notification to the Medical Officer of Health is the essential preliminary to the control of infectious disease. It has been so useful that it has been suggested that it might be adopted in investigations into other diseases such as gastric ulcer, rhematism, etc. and into the causes and prevention of accidents. The diseases notifiable under the Public Health Act, 1936, are smallpox, cholera, diphtheria, membranous croup, erysipelas, scarlet fever, typhus fever, typhoid fever, enteric fever, and relapsing fever. Under Regulations issued by the Minister of Health the following diseases are also notifiable:—plague, poliomyelitis, tuberculosis, malaria, dysentery, puerperal pyrexia, ophthalmia neonatorum, acute primary pneumonia, acute influenzal pneumonia, whooping cough, measles, acute encephalitis and meningococcal infection. Food poisoning is notifiable under the provisions of the Food and Drugs Act, 1938. A medical practitioner, " as soon as he becomes aware that the patient is suffering from a notifiable disease " should send a notification to the Medical Officer of Health and all practitioners are supplied with forms for this purpose. If consideration of any action to discover the source of or prevent the spread of infectious disease is to be effective notification should reach the Medical Officer of Health as soon as possible but this does not happen always. In some cases this may be due to delay by the patient in seeking medical advice but more often it is an omission by the practitioner. The exclusion from work of adult contacts is now only recommended in exceptional cases where the type of disease and the nature of the contact's employment present a special risk of the spread of infection. The exclusion from school of contacts has been curtailed considerably and generally is restricted now to contacts of smallpox, poliomyelitis, diphtheria and scarlet fever. In actual practice the contribution of school exclusion of contacts to the prevention of the spread of infection has not justified the loss of schooling arising therefrom. The two common sites in the human body where disease producing bacteria and viruses may be found are the bowels and the nose and throat. The diarrhoeal diseases are spread by contamination of food by vermin, flies or failure to wash the hands thoroughly after the toilet. The remedy here is a higher standard of personal and food hygiene. The diseases affecting the nose and throat are spread by droplets sprayed out in talking, coughing, sneezing, etc. As " coughs and sneezes spread diseases " the handkerchief is a useful weapon in preventing spread, but it should be changed frequently during the acute stage of the illness. Insect and water borne diseases are now, due to the great improvement in sanitation and water supplies, of comparatively minor importance in this country. The virtual abolition of diphtheria resulting from immunisation, the continuing mild type of scarlet fever, improved sanitation and hygiene and the availability of powerful curative agents such as the sulphonamides and antibiotics for use in other bacterial diseases have produced a great change in the picture of infectious diseases and as the bacterial diseases fade into the background the virus diseases come into prominence. Nature is adaptable and bacteria and viruses continue their struggle for existence. They have already shown a capacity to develop resistance to drugs and antibiotics and their behaviour must be the subject of constant study if we are to maintain or extend the ground already won. 8 Incidence of Notifiable Diseases.—The number of cases notified during the last ten years are shown below:— 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 Smallpox — — — — — — — — — — Scarlet Fever 280 130 124 67 62 159 138 92 67 161 Diphtheria 5 11 24 16 3 2 — 1 — — Erysipelas 21 16 16 19 19 21 26 12 12 19 Pneumonia 116 50 25 47 56 41 52 64 59 58 Meningococcal infection — 3 11 13 8 2 2 - 5 5 Epidemic encephalitis - - 1 - - - - - - - Post-infective encephalitis - - - - - - - - 1 — Poliomyelitis and polioencephalitis - 3 7 1 43 29 14 9 4 3 Typhoid fever 1 — — 1 1 — — 3 1 — Paratyphoid fever — — — — — 3 — 6 1 7 Dysentery — 22 28 6 — 5 2 6 77 28 Food Poisoning - - - - - - - 5 6 53 Tuberculosis—Pulmonary 165 167 128 200 160 147 208 163 163 148 Tuberculosis—N on-Pulmonary 25 17 29 17 20 21 11 19 22 20 Opthalmia neonatorum — 5 3 2 — — — 1 1 2 Puerperal pyrexia 105 87 45 54 60 23 16 8 13 53 Measles 636 219 1,109 170 840 571 523 881 790 1,027 Whooping Cough 134 171 110 170 142 227 173 206 222 86 Malaria — 1 2 1 — — 1 1 — 1 Undulant fever - - - - - - - 1 — 1 The age distribution of notifiable disease during 1952 is shown in Table V. Smallpox.—No case of smallpox occurred in the Borough during 1952. Persons arriving in the Borough from parts of the world where smallpox is prevalent are kept under observation till any chance of their developing the disease is over. Freedom from smallpox has resulted in a neglect of infant vaccination. According to the returns made by local practitioners 348 children under the age of one year were vaccinated in 1952; less than 30 per cent, of the births. Modern travel is such that the risk of importing smallpox is ever present. Scarlet Fever.—The continuing mildness of this disease is tending to make parents and possibly doctors, careless about home isolation and other measures to prevent the spread of infection. Of the 161 cases which occurred during the year 46 were admitted to hospital. No death from this disease has occurred in the Borough since 1937. Diphtheria.—No explanation other than immunisation can be offered to account for the great change (shown in Table VI) that has come about in regard to diphtheria. This change can be maintained only if a sufficiently high proportion of the child population continue to be protected by immunisation. Unfortunately the removal of the fear of diphtheria has resulted in a fall in the proportion of new babies being immunised. Complacency is dangerous. Erysipelas.—The number of notifications, 19, is an increase of seven compared with the previous two years and one death was due to this disease. Pneumonia.—Notification of pneumonia showed no change from 1951. The death rate from pneumonia per 1,000 population was 0.5 as compared with 0.4 in 1951 and 0.3 in 1950. Of the total pneumonia deaths 86 per cent, occurred at age 65 years and over. Meningococcal Infection.—Five cases of this disease, formerly classified as cerebrospinal fever, were notified and one was fatal. The mortality from this disease has fallen considerably since the introduction of the sulphonamide drugs. Epidemic Encephalitis.—No notification was received during the year. Post-Infective Encephalitis.—Encephalitis is known to occur as a complication of other infectious diseases but no such case was notified during 1952. 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 three cases were notified and there was no death from this disease. Two cases showed no paralysis but the third child developed some weakness of the left leg and was referred to the orthopaedic department at West Middlesex Hospital. Poliomyelitis was more prevalent throughout the country in 1952 as compared with 1951 and while this continues the risk of a local epidemic will remain. Typhoid Fever.—No case of typhoid fever was notified during the year. Paratyphoid Fever.—During the year seven cases of paratyphoid fever were notified. The ages of the cases ranged from 6 to 72 years, and two were males. One case occurred in February, five in September and one in October, and all were single cases. In one case the infection was probably contracted at an Army Cadet Camp and 33 local contacts were investigated as possible carriers. The remaining six cases were carefully investigated but no source of infection was traced. None of these patients died. The infection generally was mild and in four of the cases the diagnosis followed the investigation of an indefinite 9 Dysentery.—This disease shows great variations in prevalence from year to year and from place to place. During the year 28 cases were notified as compared with 77 in 1951 and 6 in 1950. Nine of these cases were originally notified as dysentery, three were notified as food poisoning and found on investigation to be dysentery and the remaining 16 were found as a result of investigations by the Health Department. There were 7 single cases while 2 cases arose in one household, 3 cases in one household, 4 cases in one household and 6 cases in each of two households. The ages of these cases ranged from 1 to 81 years, fifteen were over school age and six were under school age. No connection was traced between any of the households affected and a point of interest was that all the cases occurred during the first half of the year. 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 such that medical advice is not always sought and unless the disease is kept constantly 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 sent for bacteriological investigation. Only by such vigilance will this disease be kept under some degree of control. Tuberculosis.—During the year 148 notifications of pulmonary tuberculosis and 20 notifications of non-pulmonarv tuberculosis were received. The trend of the Borough death rate from tuberculosis is shown below:— Tuberculosis Death Rate per 100,000 population Pulmonary N on-pulmonary Total 1930-34 67.5 11.5 78.9 1935-39 52.3 8.2 60.4 1940—44 55.8 7.4 63.2 1945-49 39.1 6.7 45.8 1950 33.6 0.9 34.5 1951 24.4 0.9 25.4 1952 15.1 2.8 17.9 The decline in the death rate from tuberculosis in this country started about the middle of last century and it is difficult to assess the many factors which may have played their part. A point of some interest is that the age of maximum tuberculosis mortality in females remains under 35 years whereas it has changed in males from 20-25 years in 1851-60 to 55-65 years today. "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."New drugs and methods of treatment have recently altered the picture for victims of the disease but there is little or no evidence that we have made appreciable progress in prevention. Here housing, after-care and health education can do much. In 1906 Calmette and Guerin began to cultivate a particular strain of the tubercle bacillus and in due course claimed that an injection of this strain would stimulate the body defence against the tubercle bacillus without producing the disease itself in those inoculated. The strain is now known as Bacillus Calmette-Guerin (B.C.G.) and since the war has been used extensively in many parts of the world. Very conflicting evidence as to its value in preventing tuberculosis has been submitted and today the differences of opinion as to its value and as to how it should be used are not reconciled. In 1950 the Ministry of Health permitted the importation of the "vaccine" for use for "contacts," students and nurses. In September, 1950, the Tuberculosis Research Unit of the Medical Research Council started an investigation into the preventive qualities of the vaccine and in an attempt to decide whether or not its general introduction into this country is justified. Those taking part in the trial are all volunteers from pupils in their last year at Secondary Modern Schools and Heston and Isleworth is one of the participating districts. During the last term at school each volunteer had a chest X-ray and after preliminary tuberculin skin tests a proportion were inoculated with the vaccine. Over 50,000 children throughout the country are now concerned in the trial, and they will be followed up for three years by annual tuberculin skin tests, X-ray of the chest and home visits by Health Visitors. The response in the Borough was good and it is hoped that the volunteers, who have now left school, will co-operate till the end of the trial. It is hoped that this research will settle the question as to whether B.C.G. should be used for selected cases or should be made available for all. In July the Mass X-ray unit visited Heston Aerodrome and 733 staff attended for X-ray. A scheme is in operation in Middlesex designed to encourage pupils, after leaving school, to submit themselves to regular chest X-ray examination. Lists of the names and addresses of pupils leaving school are sent by the Education Department to the mass X-ray unit and the scheme is explained in the following letter which is sent by the Medical Officer in charge of the mass X-ray unit to the parents:— " During their school days, your children have led fairly protected lives, as far as exposure to Tuberculosis is concerned. This is because they have only come in contact with a limited number of adults, and Tuberculosis is much more often found in adults than in children. As soon as school leavers enter the community at large, whether as students, factory workers, or clerks, they mix with many more adults, some of whom will probably be suffering from unsuspected Tuberculosis. To protect your children during the first five years after they have left school, at a time when the\ are Most Vulnerable to Tuberculosis the following scheme has been worked out for school leavers of the County of Middlesex:— 1. A register with the names and addresses of all school leavers will be kept by this Mass X-ray Unit. 2. Within a year of leaving school, all children will be notified by letter when the Mass X-ray Unit is in their neighbourhood, and asked to attend for a chest X-ray. 3. This procedure will be repeated until the school leavers reach the age of 21. It is hoped that by then they will realise the benefit of regular chest X-rays, and of their own accord make arrangements to be X-rayed each year. 4. Results of the X-ray examinations will be sent to the parents. I hope that all parents will co-operate in this vast preventive scheme, and ensure that their children respond to our annual invitations." Ophthalmia Neonatorum.—Two cases of this infection of the eyes of young babies were notified during the year but neither case suffered any permanent damage to sight. 10 Puerperal Pyrexia.—During the year 53 cases were notified as compared with 13 cases in 1951. This increase is largely due to the change in the definition of puerperal pyrexia introduced by the Puerperal Pyrexia Regulations, 1951. No woman died from puerperal or post-abortion sepsis. Measles.—This disease was more prevalent than in 1951 but caused no death. Whooping Cough.—The notifications of whooping cough, 86, were the lowest in the last ten years. Facilities for immunisation against this disease are available. The condition is most fatal in young babies and protection should be provided before the child is six months old. There is evidence that, with the improvement in the vaccine, the protection if not complete does mitigate the severity of the attack. According to the records 857 children received inoculations against whooping cough during the year. Malaria.—One case of malaria was notified during the year and investigation revealed that the infection was contracted overseas. Undulant Fever.—One case was notified during the year. This disease is caused by the germ responsible for contagious abortion in cattle and is usually transmitted by infected milk. No consumption of unpasteurized milk was admitted but as the man was employed in the manufacture of fertiliser, etc., from condemned meat and bones it is possible that he handled infected material. Psittacosis.—One case of this disease was brought to the notice of the Department during the year. The patient had purchased a young parrot from a street stall. The parrot did not thrive and died three weeks later and was almost certainly the source of the infection. At one time only birds of the parrot family were suspected of carrying the virus but now a number of other birds such as pigeons and domestic fowls have been found to be carrying the same type of virus. The possibility of psittacosis should be borne in mind in any case of pneumonia or febrile illness in a person handling poultry, pigeons, budgerigars or parrots and enquiries made as to any recent illness among the birds. Influenza.—This disease was not very prevalent in 1952. It caused 4 deaths as compared with 33 in 1951, 6 in 1950 and 6 in 1949. Mumps, Chicken Pox, German Measles.—These diseases are not notifiable but cases are brought to the notice of the Department through schools, health visitors, etc. During the year the following cases were recorded:—mumps, 59; chicken pox, 385 and German measles, 148. The latter disease has received considerable attention recently because its occurrence in a mother during the early months of pregnancy may result in the child being born with a congenital defect. 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 177 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." During the year 11 rooms were disinfected and 3 lots of bedding destroyed. 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 1952 was 504. The majority of these specimens were taken during the investigation of paratyphoid fever, dysentery and food poisoning. 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:— (а) 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. Delay in notification so hampered the investigation of cases that the attention of some medical practitioners had to be drawn to their statutory obligations. The possibility of food poisoning should be kept in mind in all cases of " gastric flu " and unexplained vomiting and diarrhoea. During 1952 notifications of the occurrence of food poisoning in 53 persons were received and during the course of our investigations a further 7 cases were discovered. There was no large outbreak and the cases were distributed as follows:—4 cases in each of 4 households, 3 cases in each of 2 households, 2 cases in each of 3 households and the remaining 32 were single cases. A considerable amount of time and effort was devoted to investigation of these incidents. The responsible organism was identified in 4 incidents but the source of infection was not traced with certainty in any case, some detail of the cases is set out in tabular form overleaf. No death from food poisoning occurred. According to the Ministry of Food the average number of meals and hot beverages served per week, based on a 16 week survey in 1952, in catering establishments in the United Kingdom was hot beverages, 315,000,000; main meals, 78,600,000; breakfasts, 12,600,000; and light meals, 141,100,000. These figures indicate the ever present danger from carelessness or accident in the personal hygiene of food handlers and in the storage, cooking and serving of food. In general the catering trade is alive to their responsibilities in this matter but there is still considerable room for improvement by individual concerns and by persons engaged in the trade. During the year the Sanitary Inspectors have continued their efforts to educate food handlers and traders not only in the letter but the spirit of the Food and Drugs Act nand the bvelaws associated therewith. 11 FOOD POISONING OUTBREAKS 1952 Outbreak No. Date of onset Date of notification or other information No. of persons at risk No. of persons affected No. of deaths oi affected persons Organisms causing outbreak Food transmitting infection Food suspected of transmitting infection Place of infection Remarks 1 27-12-51 2-1-52 6 1 — Not ascertained — ? Home Other members of household consuming same food showed no signs or symptoms. 2 28-12-51 2-1-52 4 1 — Not ascertained — — Home — 3 3-1-52 8-1-52 4 2 — Not ascertained — — Home — 4 31-12-51 8-1-52 1 1 — Not ascertained — — — Aged person living alone and unable to give coherent history of illness. 5 31-12-51 8-1-52 ? 1 — Not ascertained — — — Midday meal at Works' Canteen, other meals at home. 6 6-1-52 10-1-52 3 1 — Not ascertained — Home — 7 9-1-52 15-1-52 4 3 — Not ascertained Home — 8 12-1-52 16-1-52 ? 1 — Not ascertained — Mid-day meal Works' Canteen — 9 12-1-52 16-1-52 ? 1 — Not ascertained — — Meal in Works' Canteen and in ant on day before attack. 10 10-1-52 16-1-52 ? 1 — Not ascertained — — ? Works' Employed as cook at Works' Canteen, but no cases of food poisoning among employees. 11 13-1-52 18-1-52 2 2 — Not ascertained — Processed Cheese Canteen Home — 12 16-1-52 19-1-52 5 1 Not ascertained Home — 12 FOOD POISONING OUTBREAKS 1952—(Continued) 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 Organisms causing outbreak Food transmitting infection Food suspected of transmitting infection Place of infection Remarks 13 21-1-52 24-1-52 2 1 — Not ascertained — Pork Home — 14 13-1-52 24-1-52 ? 1 — Not ascertained — ? Home — 15 6-2-52 13-2-52 5 1 — Not ascertained — ? Home Investigation revealed 3 children in household suffering from dysentery (sonne). Probable that attack was dysentery rather than food poisoning. 16 17-3-52 17-3-52 6 1 — Not ascertained — — Home Faecal specimens from patient and rest of family showed no pathogens except for child aged 2 years whose specimen showed shigella sonnei. 17 7-4-52 10-4-52 ? 1 — Not ascertained — Venison London Restaurant — 18 24-4-52 28-4-52 ? 1 — Not ascertained — Hors Roeuvres London Restaurant Enquiries revealed that person preparing hors d'oeuvres had diarrhoea 2 days previously. 19 3-5-52 5-5-52 3 1 — Not ascertained — — Home — 20 7-5-52 9-5-52 6 1 — Not ascertained — Pressed Beef Home — 21 29-5-52 31-5-52 p 4 — Salmonella " Newport " — Meat Pie Home Sliced meat pie purchased on Epsom Downs—source of pie could not be traced. 22 7-6-52 7-6-52 1 1 — Not ascertained — — Home Admitted to hospital with diagnosis of "gastric influenza" but considered to be probably food poisoning. 13 FOOD POISONING OUTBREAKS 1952—{Continued) 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 Organisms causing outbreak Food transmitting infection Food suspected of transmitting infection Place of infection Remarks 23 13-6-52 16-6-52 3 1 — Not ascertained — — Small Cafe — 24 21-6-52 28-6-52 5 1 — Not ascertained — Pork Home — 25 5-7-52 8-7-52 2 1 — Not ascertained — — Home — 26 5-7-52 8-7-52 4 4 — Not ascertained — Pork Home — 27 8-7-52 11-7-52 2 1 — Not ascertained — Tinned lobster Work — 28 8-7-52 25-7-52 ? 1 — Salmonella typhi-murium — — — Case admitted to hospital as gastroenteritis and presence of salmonella typhi-murium reported at time of discharge—source of infection not traced. 29 27-7-52 30-7-52 4 3 — Not ascertained — ? Home 30 4-8-52 7-8-52 2 1 — Not ascertained — Tinned herring Home — 31 2-8-52 7-8-52 ? 1 — Not ascertained — — ?"Z" Reserve Training Camp Home — 32 11-8-52 15-8-52 3 1 — Not ascertained — — — 33 11-8-52 19-8-52 p 1 Not ascertained — — — Mid-day meal at Works' Canteen, other meals at home. 14 FOOD POISONING OUTBREAKS 1952— (Continued) 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 Organisms causing outbreak Food transmitting infection Food suspected of transmitting infection Place of infection Remarks 34 19-8-52 21-8-52 3 2 Not ascertained — — Home — 35 2-9-52 3-9-52 7 1 — Not ascertained — — Home Patient admitted to hospital—all investigations negative but considered to be case of mild food infection. 36 19-10-52 23-10-52 2 2 — Not ascertained — Chocolates Cinema No faecal specimens obtained, but sample of suspected chocolates showed "coliforms and faecal streptococci." 37 6-11-52 13-11-52 4 3 — Salmonella "Newport" — Herring Roe Home One member of household is carrier of Salmonella "Newport." 38 11-11-52 22-11-52 ? 1 — Salmonella typhi-murium — — Case admitted to Nursing home with a history of diarrhoea before admission. 39 26-11-52 4-12-52 7 1 — Not ascertained — — Home — 40 8-12-52 10-12-52 4 1 — Not ascertained — — Home — 41 9-12-52 12-12-52 1 1 — Not ascertained — — Home — 15 HEALTH SERVICES PROVIDED BY OTHER AUTHORITIES North-West Metropolitan Regional Hospital Board.—Two general hospitals (West Middlesex, 1,150 beds and Hounslow, 81 beds) and one fever hospital (South Middlesex, 140 beds) are situate in the Borough. Part of the accommodation in the fever hospital is used for surgical cases. The West Middlesex and South Middlesex Hospitals are controlled by the South West Middlesex Hospital Management Committee while Hounslow Hospital and the Chest Clinic are the responsibility of the Staines Group Hospital Management Committee. The Regional Hospital Board provides the specialist services for the hospitals and for domiciliary consultations. Middlesex County Council—Health Department.—The County Council is the Local Health Authority under the National Health Service Act, 1946. The following services are provided in the Borough:— (a) Ante-natal and post-natal clinics, 92 Bath Road, Hounslow Monday and Wednesday mornings. Thursday afternoon. Busch Corner, Isleworth Tuesday afternoon. Heston Village Hall Thursday afternoon. (b) Infant welfare clinics 92 Bath Road, Hounslow Tuesday, Wednesday, Thursday and Friday afternoons. Busch Corner, Isleworth Monday, Wednesday afternoons. Heston Village Hall Monday, Tuesday afternoons. Friday morning. Cranford Memorial Hall Monday, Friday afternoons. (c) Immunisation and vaccination clinics 92 Bath Road, Hounslow Wednesday afternoon, Thursday morning. Busch Corner, Isleworth Tuesday (fortnightly) afternoon. Heston Village Hall Tuesday (fortnightly) morning. (d) Artificial Sunlight clinics (wintermonths) 92 Bath Road, Hounslow Tuesday and Friday afternoons. Busch Corner, Isleworth Tuesday and Friday afternoons. (e) Dental clinics 92 Bath Road, Hounslow } Busch Corner, Isleworth} Monday to Friday daily and Saturday mornings. (f) Day nurseries Approved Accommodation Nantly House, Lampton Road 54 children. Blenheim House, Bath Road 50 children. Heston 50 children. Acton Lodge, Brentford End 35 children. These day nurseries admit children aged 0-5 years and a charge is made for the care of the children. (g) Midwifery Service. Certified midwives are employed for attendance as midwives or maternity nurses at domiciliary confinements. Gas and air analgesia is available. Maternity outfits are supplied free for home confinements. (h) Home Nursing Male and female nurses are employed as "district" nurses. Where nursing equipment is required for use in the home arrangements have been made for this to be supplied on loan through the British Red Cross Society at the Depot in School Road. (i) Health Visitors Health Visitors who also act as School Nurses are employed in clinics and home visiting. Their work is largely educational and social and is defined in the Act as " giving advice as to the care of young children, persons suffering from illness and expectant and nursing mothers and as to the measures necessary to prevent the spread of infection." (j) Domestic Helps Home helps are employed to provide domestic help for households "where such help is required owing to the presence of any person who is ill, lying-in, an expectant mother, mentalh defective, aged or a child not over compulsory school age." A charge is made for this service and in assessing this regard is had to the means of the persons concerned. (k) Prevention of Illness, Care and After-care The care and after-care of tuberculous persons is dealt with by the Welfare Officer at the Chest Clinic. Among other things the County Council scheme provides for the admission of persons, not in need of medical or nursing care, to recuperative holiday homes and for this a charge is made according to the person's circumstances. (l) Ambulance Service Provision is made for the conveyance of sick, accident and emergency cases and the service is organised in association with the Fire Service. The accident and emergency service is stationed at the Fire Station, Isleworth, and the sick removal service at West Middlesex Hospital. (m) Mental Health This service provides for the ascertainment of cases of mental ill-health and mental deficiency, the statutory supervision and guardianship of mental defectives living in the commmunity and the provision of after-care for persons who have undergone treatment for mental illness The office of the Mental Welfare (Duly Authorised) Officer for the Borough is at County Offices Great West Road, Brentford. 16 Middlesex County Council—Education Department.—The school Health Service is staffed by the County Health Department and provides the following services:— (a) routine medical inspection of pupils (b) cleanliness surveys of pupils (c) dental inspection of pupils (d) ascertainment of handicapped pupils in need of special education (e) treatment clinics as under:— (i) minor ailments 92 Bath Road, Hounslow daily mornings Busch Corner, Isleworth daily mornings Heston Village Hall daily mornings Cranford Junior School daily mornings (ii) Medical consultation 92 Bath Road, Hounslow Tuesday, Friday mornings Busch Corner, Isleworth Monday, Thursday mornings Heston Village Hall Thursday morning Cranford Junior School Tuesday (fortnightly) morning (iii) eye clinic 92 Bath Road, Hounslow Monday, Wednesday afternoons. Monday morning Busch Corner, Isleworth Thursday morning (iv) allergy clinic 92 Bath Road, Hounslow Wednesday morning (v) orthopaedic clinic 92 Bath Road, Hounslow 4th Monday morning (vi) physiotherapy 92 Bath Road, Hounslow Wednesday, Thursday afternoons. Thursday morning (vii) dental clinic} artificial sunlight clinic} (see under Health Department) immunisation clinic} (viii) child guidance clinic Alexandra School, Hounslow by appointment (ix) speech therapy by appointment Middlesex County Council—Welfare Department.—This service is concerned with the welfare of aged, physically and mentally infirm, blind and partially sighted, deaf and dumb, epileptic and crippled persons and the provision of temporary accommodation for persons in urgent need thereof. The address of the Welfare Officer for the Borough is County Offices, Great West Road, Brentford. Middlesex County Council—Children's Department.—This Department deals with children taken into or committed to the care of the County Council, supervision of foster children, adoption, child neglect, etc. The Children's Officer for the Borough works from County Offices, Great West Road, Brentford. Middlesex Executive Council.—This body is responsible for the provision under the National Health Service Act of the general practitioner, dental (other than Local Health Authority provision for expectant and nursing mothers, young children and school children), pharmaceutical and supplementary ophthalmic services. The headquarters of the Council is at North West House, 119 Marylebone Road, 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 „ hootball Ground, Denbigh Road 3.70 „ Midsummer Children's Playground 1.52 „ 17 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 in the Borough 46 shallow and 3 artesian wells serving 42 premises and of these 7 houses and 2 business premises are without an alternative supply. The water from 6 wells is known to be unsatisfactory but during the year a new water main was laid and a start made in the provision of a mains supply to these houses. The following work in connection with water supplies was carried out during the year:— Supplies provided or reinstated 11 Cisterns cleansed, repaired, etc. 10 Draw-off taps connected direct to main 5 Service pipes or taps repaired 14 Cases where mains supplies substituted for well supply 3 Samples taken from wells for analysis Nil Samples taken from mains for analysis 4 Wells abolished Nil Drainage and Sewerage.—The drainage and sewerage of almost the whole of the Borough is arranged on the separate system and forms part of the West Middlesex Sewage Scheme. A few houses on the outskirts of the Borough drain to cesspools. The following work was carried out during 1952:— Drains exposed for examination 79 Drains unstopped, repaired, etc. 324 WTaste pipes repaired, trapped, etc. 17 Soil pipes repaired, etc. 2 Ventilating shafts repaired, etc. 8 Fresh air inlets repaired, etc. 2 Rainwater pipes disconnected from drains 1 Gully traps inserted or repaired 32 Disconnecting traps inserted or repaired 8 Disconnecting and inspection chambers provided 4 Disconnecting and inspection chambers repaired, etc. 51 Drains constructed or repaired 20 Total length (ft.) of drain pipes laid— (a) 4" 802 (b) 6" 30 Drain tests applied 25 Other works executed 11 Cesspools emptied or repaired — Cesspools abolished 1 While the Borough is responsible for the local sewerage of its own district the duty of the disposal of sewage is the responsibility of Middlesex County Council. The West Middlesex Main Drainage Undertaking has been in full operation since 1936. It serves an area, including the Borough, of 162 square miles with a population (1951 census) of 1,340,000. There are 70 miles of main sewers varying in diameter from 2 feet to 13 feet. The sewage flow at the Mogden Works averages 85 million gallons per day though this may reach as high as 250 million gallons per day in wet weather. A programme of extensions to purification plant at an estimated cost of £352,000 has been approved. Rivers and Streams.—No complaint of pollution was made to the Health Department during 1952. 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 12 Water closets provided in substitution for dry receptacles, etc. — Water closets where walls cleansed 24 Water closets fitted with new flushing apparatus 17 New pans or pedestals provided 37 Water closets repaired or improved 96 Water closets blockages unstopped 15 Other closets provided or repaired 5 Water closets connected to sewer and cesspools abolished - Urinals constructed, rebuilt or repaired 12 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 45 new dustbins were provided during 1952. The following details of the salvage of waste materials have been provided by the Borough Engineer:— 18  1948 1949 1950 1951 1952 Paper (tons) 943 1,228 1,331 1,111 1,023 Scrap metal (tons) 83 102 80 78 89 Textiles (tons) 64 84 75 57 50 Bones (tons) 3 2 1 — — Bottles, jars (tons) 109 23 36 63 10 Cullet (tons) 14 12 6 4 7 Rubber (tons) 1 1 — — — Kitchen Waste (tons) 1,110 1,074 1,013 1,032 929 Miscellaneous (tons) — — — — — £12,322 £12,702 £14,426 £20,902 £15,614 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 investigating complaints, abating nuisances and dealing with contraventions of the Public Health Act. Originally the sanitary inspector was expected to exercise legal powers to improve environmental conditions. The legal powers and duties remain but today these officers are increasingly regarded more as advisors than as policemen. To give good advice and to try to see that it is followed requires more tact, tenacity and time than to demand that the law be obeyed—and often produces more lasting results. Not all complaints brought to the Health Department deal with matters on which the Department is empowered to take action and in such cases complainants are advised, as far is is known, how and where the matter may receive attention. Some particulars of the work done are shown below:— Inspections following complaint 1,140 Number of premises at which nuisances, etc. were located 877 Number of premises where defects were remedied (a) by owners or occupiers 861 (b) by Council in default 8 (c) public sewers repaired by Council 23 Informal notices issued 529 Written reminders issued 789 Statutory notices served 125 Total number of inspections and re-inspections 23,511 Inspections of piggeries 99 Inspections of stables 82 Inspections of urinals 61 Sinks provided or repaired 21 Roofs repaired 222 Gutters repaired or renewed 147 Brickwork, sills, etc., repaired or renewed 293 Premises provided with damp-proof courses 8 Sites covered with impervious material — Yards and forecourts paved or drained 38 External painting 34 Rooms stripped, cleansed and redecorated 634 Floors, walls and ceilings repaired or renewed 744 Rooms in which ventilation provided or improved 10 Rooms in which lighting provided or improved Windows repaired or renewed 329 Doors and other woodwork repaired or renewed 94 Staircases replaced or repaired 7 Lighting to staircase provided or improved 1 Handrails or balusters repaired or renewed 9 Grates provided or repaired 122 Wash coppers provided or repaired 7 Instances where ventilation under floor provided or improved 18 Larders provided or repaired 7 Domestic cleansing enforced 5 Improper keeping of animals abated 4 Offensive accumulations removed 27 Pigsties provided, repaired, cleansed, etc. 1 Other repairs carried out or nuisances abated 6 Visits re infectious diseases, etc. 722 Complaints continue to be received of nuisance caused by pigeons. Apart from those particularly affected the public tends to be on the side of the pigeons, but the damage and nuisance caused by them is considerable. Apart from the fouling of premises they love cement and mortar and thus open up brickwork lor frost and rain to attack. The public should not encourage pigeons by making food available to them. Throughout the Borough unfenced land, rear passages, roadside ditches and ponds are used as dumps for garden refuse, rubble, tins, disused water tanks, broken furniture, defective household utensils, worn motor tyres, etc., and these accumulations are most unsightly. They are seldom " prejudicial to health or a nuisance" within the meaning of the Public Health Act. The Department does what it can to deal with these eyesores but rarely can the offenders be traced. The fouling of footpaths by dogs is much too prevalent. Training of dogs would do much to prevent this and there is no excuse for permitting dogs on lead to foul footpaths. A local bye-law states " No person being in charge of a dog in any street or public place, and having the dog on a lead, shall allow or permit such dog to deposit its excrement upon the public footway," and for such offence there is a penalty 19 not exceeding £5. Here the difficulty is to secure the name and address of the offender and of witnesses willing to testify. 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 266 smoke observations on factory chimneys and made many visits to premises concerning which complaints of smoke nuisance had been received. Five smoke nuisances were proved at two premises. The nuisance in one case was alleged to be due to fuel and improvement followed when a change of supplier was arranged. The other nuisance occurred at a hospital and there the engineer admitted the faults of his stokers and arranged for them to attend a course of lecturers. With the co-operation of the Education Department another course on boiler house practice was arranged at Spring Grove Polytechnic but the attendance of employees of local firms was disappointing. In 1950 the Council agreed to co-operate with the Department of Scientific and Industrial Research by installing apparatus for measuring atmospheric pollution. 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 detailed monthly analyses are forwarded for record and study to the Central Department but the main features are recorded below:— Health Department Heath House Rainfall (inches) Deposit (tons per sq. mile) Sulphur (Mgms. S03 per day per 100 sq. cm.) Rainfall (inches) Deposit (tons per sq. mile Sulphur (Mgms. S03 per day per 100 sq. cm.) January 1.81 10.51 1.29 1.89 11.52 1.45 February 0.67 9.92 0.94 0.75 12.23 1.33 March 2.33 12.11 0.68 2.44 13.55 0.51 April 1.34 10.30 0.67 1.26 9.93 0.62 May 1.73 10.68 0.52 1.73 10.64 0.56 June 1.77 10.37 0.40 1.77 10.61 0.41 July 0.55 10.54 0.34 0.47 9.29 0.30 August 3.74 8.35 0.34 3.23 8.85 0.37 September 2.88 10.13 0.40 2.96 11.11 0.45 October 2.72 9.51 0.90 2.44 11.18 1.00 November 3.43 12.62 1.36 3.11 15.74 1.55 December 2.21 13.65 2.32 2.52 14.25 2.10 Average 2.10 10.72 0.85 2.05 11.57 0.89 A point of interest in the above table is that the heaviest rainfall occurred in August. The average sulphur deposit during May to September inclusive, when domestic fuel burning is at a minimum, was 0.41 milligrammes as compared with an average of 1.20 milligrammes during the other seven months. The meteorological conditions in December, when fog was prevalent, did not favour the dispersal of smoke and this is reflected in the high records of deposit and sulphur. There is universal agreement that soot and sulphur compounds from the burning of coal accelerate the destruction of metals, fabrics and structures. Steel and non-ferrous metals are corroded and brickwork, stonework, cement and mortar all suffer damage. Our ceilings, windows, curtains and "marks' over radiators all show evidence of atmospheric pollution. Here is a problem which, apart from constituting a health hazard, affects us all materially in some way or other and it is up to everyone in their own sphere to do what they can to reduce atmospheric pollution. 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 784 visits of inspection because of the occupation of land by caravans. Trespass by caravans on unfenced land was not as frequent as in recent years, but action had to be taken for the removal of 28 caravans. Four applications, under the provision of the Middlesex County Council Act, for permission to place caravans on sites within the Borough were considered; three were approved for a limited period and one was refused. Action was taken in Court in regard to two offenders against the provisions of the Middlesex County Council Act. A fine of 20/- was imposed on two occasions against one offender. A fine of 20/- was imposed on the other offender who entered an appeal which was allowed. 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 54 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; (« provision of sanitary conveniences in all factories, and (e) cleanliness, over-crowding, ventilation an drainage of floors in the case of factories in which mechanical power is not used. A summary of the wor done is given below and in Table VIII. 20 Inspection of (a) Factories—mechanical power 950 (b) Factories—non-mechanical power 51 (c) Other premises 5 (d) Workplaces 179 (e) Outworkers' premises 282 Defects remedied 32 At the end of the year the number of outworkers registered with the Department was 168. 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 insecticides are used. During the year 78 rooms in 35 houses were treated while 42 wasp nests were destroyed, 4 premises cleared of cockroaches, 2 cleared of ants, 7 cleared of fleas and 1 of moths. Treatment of ponds and tanks to prevent the breeding of mosquitoes was carried out on 119 occasions. Noise Nuisance.—In the Middlesex County Council Act a noise nuisance is deemed to exist "where any person makes or continues or causes to be made or continued any excessive or unreasonable or unnecessary noise which is injurious or dangerous to health." Further, it is a good defence for the person charged to show "that he has used the best practicable means of preventing or mitigating the nuisance, having regard to the cost and to other relevant circumstances." Most complaints of noise nuisance arise in connection with industrial processes carried on in factories situated close to houses. From the above definition it will be seen that many factors have to be taken into consideration in judging whether or not 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 five 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 theoretical 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 of rats or mice in substantial numbers has been received, but by the visits of the Sanitary Inspectors and the Rodent Officer and complaints of " rats coming from next door," no gross infestation should escape attention. The Council employs a Rodent Officer who is responsible for 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:— 1948 1949 1950 1951 1952 Complaints received 391 419 421 607 618 Block inspections 9 9 37 89 51 Individual inspections 2,026 2,862 2,574 3,150 4,441 Individual re-inspections 234 271 316 221 669 Other visits 408 408 402 438 614 Premises treated— (a) By occupiers 111 71 25 19 41 (b) By Local Authority 806 848 882 743 1,075 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 of 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 two dealers in rags were prosecuted and fines of 20/- imposed in each case. Shops Act, 1950, Section 38.—This section requires shops to be reasonably ventilated, heated and lighted and that there should be suitable and sufficient sanitary and washing facilities for the persons employed therein. In this connection 33 inspections were made during the year. 21 Rag Flock and Other Filling Materials Act, 1951.—This Act came into operation on 1stNovember, 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 12 visits of inspection. Swimming Baths.—Three swimming baths are provided by the Council and one private swimming bath was 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' x 25' — — Capacity of bath (gallons) major 71,000 200,000 200,000 minor 36,000 — — Total number of persons using swimming bath in 1952 101,281 161,084 116,661 Maximum number of persons using swimming bath on any one day 1,617 (1/7/52) 1,739 (28/6/52) 1,060 (28/6/52) No. of slipper baths male 15 — 11 female 9 — 11 No. of persons using slipper 1952 baths during male 29,837 — 16,491 female 14,638 — 10,325 The baths waters are treated by continuous filtration and chlorination. At Hounslow Baths the breakpoint system of chlorination has been installed. 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. During the year 9 samples of baths water were taken and all were found to be satisfactory. Verminous Premises and Articles.—Action in regard to one house had to be taken under Sections 83 and 84 of the Public Health Act, 1936. Verminous Persons.—Under the provisions of Section 85 of the Public Health Act, 1936, four verminous persons were cleansed. During the year 294 children in attendance at schools in the Borough were found to be verminous and because of the failure of parents to take the necessary action 112 of these children had to be cleansed by the School Health Department. Louse infestation is much too prevalent and is due solely to lack of personal cleanliness. Reluctance to wash and comb hair has never been an adequate excuse and is less so now when preparations can be obtained from any pharmacist which when applied to the hair do not reveal their presence by odour or otherwise but do kill lice. Pet Animals' Act, 1951.—This Act came into operation on 1st April, 1952. It is designed to regulate the sale of pet animals and the main provision is that no person shall keep a pet shop except under the authority of a licence granted in accordance with the provisions of the Act. Before issuing a licence regard has to be had to the need for securing. (a) that animals will at all times be kept in accommodation suitable as respects size, temperature, lighting, ventilation and cleanliness; (b) that animals will be adequately supplied with suitable food and drink and (so far as necessary) visited at suitable intervals; (c) that animals, being mammals, will not be sold at too early an age; (d) that all reasonable precautions will be taken to prevent the spread among animals of infectious diseases; (e) that appropriate steps will be taken in case of fire or other emergency. Under the provisions of this Act 5 premises in the Borough have been licensed. INSPECTION AND SUPERVISION OF FOOD Milk.—During the year 141 inspections were made at dairies and retail purveyors premises. Under the Milk (Special Designation) Regulations 39 licences for the sale of " tuberculin tested " milk, 42 for the sale of " pasteurised " milk and 42 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. 22 During the year 5 complaints of extraneous matter in milk bottles were received: 2 relating to "lass, 2 in regard to dirt and 1 of the presence of a metal pen holder. All were investigated and warnings issued to the vendors in 3 cases while the Food and Drugs Authority instituted in one case proceedings which resulted in a fine of £10 and 3 guineas costs. The Milk (Special Designations) (Specified Areas) Order, 1951, came into operation on 1st October, 1951. 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 196. 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 icecream, except complete cold-mix powders, to be heat treated with a view to killing any pathogenic organisms which may be present and lay down the temperatures at which mixtures are to be kept before and after heat treatment—these temperatures are such as to discourage bacterial growth. The Regulations also require that ice-cream shall be protected from dirt, dust or other contamination. The enforcement of these Regulations calls for regular and persistent supervision of premises, plant and methods of manufacture and handling. During the year 760 inspections of registered premises were carried out. The following results were obtained from the bacteriological examination of the following samples:— Excellent Satisfactory Doubtful Unsatisfactory Ice Cream 56 24 17 10 Water ices or "lollies" — 59 2 30 Rinse water — 1 2 3 Ingredients — 3 — 3 The percentage of doubtful and unsatisfactory samples was 31.9 as compared with 32.5 in 1951, 31.3 in 1949 and 33.4 in 1948. The proportion of unsatisfactory samples is still too high and involves the Department in much follow-up work in an effort to trace lapses from strict cleanliness in manufacture, storage and retailing. Bakehouses.—There are 23 bakehouses in the Borough and 162 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 one visit of inspection was made. Slaughter of Animals Act, 1933.—During the year 4 applications for a licence as a slaughterman were granted. Inspection of Meat and Other Foods.—There are in the Borough 146 catering establishments, 23 bakeries, 71 butchers' shops, 29 fish shops, 15 milk depots and 377 retail premises (grocers, confectioners, greengrocers, etc.) subject to inspection and supervision and 1,401 inspections were made. During the year inspections of food were carried out as follows: meat, 819; fish, 185; provisions, 542; vegetables and fruit, 236; foodstuffs on hawkers' stalls or vehicles, 138 and other foods, 540. During the year 17,014 lbs. and 6,886 tins, jars, etc. of unsound food were seized by or surrendered to the Sanitary Inspectors at retail premises in the Borough. The following items were brought to the Department because the purchasers were not satisfied that they were fit for human consumption: meat and meat pies, 5; fish, 1; bread, 11; sandwich spread, 1; cake, 1; bacon, 1; chocolate, 1; margarine, 1; fruit drink, 1; apples, 1; cheese, 1; and lemonade powder, 1. Two of these items were sent for analysis and found to be satisfactory, in two cases foreign bodies were found to be present and warning letters were sent to the firms concerned but in the remaining 22 cases no cause for action was found. No animal slaughtered on local premises was inspected. One offender against the Public Health (Meat) Regulations was fined £2 on each of 8 summonses with 4 guineas costs. 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 91 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 11 of the Middlesex County Council Act, 1950 (adopted 1/2/52), hawkers of food and their storage premises require to be registered. At the end of the year 73 hawkers were on the register. Municipal Restaurants and School Canteens.—There is no municipal restaurant in the Borough but during the year the 22 school canteens provided 1,430,545 meals. The school dinner is designed to provide about one-third of the child's daily protein requirement "gether with a due proportion of other foods. Parents should not depend too much on the school dinner and other meals at home should be adequate and varied. 23 Food and Drugs Sampling.—During 1952 the following samples for analysis were taken in the Borough by the Public Control Department of the Middlesex County Council:— No. of Samples No. found unsatisfactory Milk, various 322 68 Arrowroot 5 — Baking Powder 1 — Cakes, various 24 — Cooked meats, various 17 — Camphorated chalk 2 — Chicken 1 — Cornflour 1 — Curry powder 3 — Drugs 2 — Fish cake 1 — Fish, various 36 1 Fish paste 1 — Gelatine 2 — Ice Cream 1 — Jam 1 — Jelly 5 — Lemon Curd 3 — Marmalade 1 — Marzipan 1 — Meat pie, various 3 — Milk powder 1 — Non-brewed condiment 3 — Pepper 2 — Piccalilli 1 — Sausages 31 4 Soft drinks 2 1 Soup 3 1 Spirits 25 — Suet 1 — Sweets 2 — Canned plums 11 1 Vinegar 10 — Yoghurt 2 — Sauce 1 — 528 76 Of the unsatisfactory milk samples 21 were associated with one producer in whose case proceedings resulted in a fine of £1 with 28 guineas costs. Official cautions were issued to the offenders concerned with all the other unsatisfactory samples. 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 1952, 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 the following works were carried out at food premises:— Cold water supplies provided, repaired or improved 8 Hot water supplies provided, repaired or improved 11 Water closets provided, repaired or improved 31 Washing facilities provided or improved 4 Drainage provided or repaired 47 Dustbins provided 11 Yards paved or repaired 4 Walls and ceilings repaired or cleansed 55 Floors repaired 10 Premises cleansed 17 Ventilation provided or improved 6 Verminous conditions abated 3 Food stores provided or improved 2 Protection of foodstuffs enforced 35 Equipment repaired or improved 11 Nuisances abated and other action 26 As far as possible the plans of all premises which will be associated with the preparation and sale of tood are examined by this Department. In this way it is possible to influence the standard of premises and equipment and we welcome consultations. While structural improvement, suitable equipment and adequate sanitary and 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 public must support the Council by demanding in all food premises a high standard of hygiene in premises, equipment and methods. Nutrition.—The surveys carried out throughout the country by the Ministry of Health and all available local evidence fail to produce definite evidence of malnutrition. Under the Welfare (Foods) Scheme of the Ministry of Food vitamin supplements are available free or at low cost to expectant and nursing mothers and to children under the age of 5 years. It is possible to calculate what the average weekly consumption of these vitamin supplements should be if full advantage 24 was taken of the scheme. The actual issues in the Borough, expressed as a percentage of the possible issue, during certain periods of 1952 are shown below:— Orange Juice Cod Liver Oil A and D Tablets 13 weeks to 23/2/52 40.5 35.0 38.5 13 weeks to 31/5/52 43.1 31.4 39.0 13 weeks to 30/8/52 49.0 24.9 38.3 13 weeks to 30/11/52 41.7 30.6 38.6 Milk is available free to all school children. Meals at a low cost, or free if the family circumstances warrant it, are provided at all schools maintained by the Education Authority. Checks made by the Education Department at various times show, as under, the extent to which advantage is taken of this p[rovision of milk and meals:— No. of pupils present % taking milk % taking meals October, 1951 12,832 81.1 54.5 February, 1952 12,291 79.7 54.4 June, 1952 12,410 83.9 51.7 October, 1952 12,832 81.1 53.3 The following information is extracted from Ministry of Food Bulletin No. 691 and shows the meat consumption in Great Britain during the years 1946-1952:— Carcase Meat Canned Coined Meat (tons) Total (tons) Ration Quality (tons) Manufacturing Quality (tons) 1946 1,381,600 149,800 132,100 1,663,500 1947 1,334,300 145,300 150,900 1,630,500 1948 1,266,100 150,900 88,300 1,505,300 1949 1,236,400 140,200 50,900 1,427,500 1950 1,402,400 284,700 62,800 1,749,900 1951 1,032,700 180,900 38,700 1,252,300 1952 1.183,400 204,300 2,400 1,390,100 In Ministry of Food Bulletin No. 701 a table shows the sources from which supplies of the main foods and feeding stuffs in the United Kingdom were derived before the war, in 1951 and 1952. The following information has been extracted from that table:— Supplies Available ('000 tons) Pre-war 1951 1952 Wheat and flour 6,361 6,301 6,050 Oats 2,057 2,722 2,907 Barley 1,654 3,152 3,466 Sugar 2,480 2,747 2,560 Carcase meat and offal 2,160 1,457 1,581 Bacon and ham 561 436 537 Butter 526 323 274 Cheese 186 238 192 Eggs in shell 547 571 540 While restrictions on the availability of food continue it is important that the nutritive values of the various foods should be appreciated so as to use them to best advantage and that, owing to the great expansion of community feeding, the best methods of cooking on a large scale should be used. This information is presented in a simple and practical way in the Manual of Nutrition published by Her Majesty's Stationery Office (2/-) and should be studied by all concerned in large scale catering. The maintenance and even improvement, of the general level of nutrition despite years of rationing indicates that quantity is not the sole consideration and that a careful selection of essential foods in balanced proportions is important. 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:— 1948 1949 1950 1951 1952 Heston and Isleworth B.C. 151 90 196 220 162 Brentford and Chiswick B.C. 14 — - — — Southall B.C. 54 — — — — Middlesex County Council — — — 4 — Ministry of Civil Aviation 39 30 — 8 — Metropolitan Police — — — — 12 private enterprise— (a) new houses 4 18 36 23 24 (b) reconstructed after war destruction 41 23 1 (c) housing associations — — — — 50 303 161 232 255 249 25 Action under the Housing Acts is governed by "reasonable" cost. The Royal Institution of Chartered Surveyors has-published a detailed analysis of housing repair costs which shows that in November, 1952, repair costs had risen to 293 percent. of the 1939 figures. With rents static it follows that repairs which would have been "reasonable" in 1939 are no longer so and action has to taken under the demolition sections of the Housing Acts unless a policy is pursued of turning a blind eye to the real condition of the house while trying to keep it wind and weatherproof. Delay in carrying out repairs and maintenance results in accelerated deterioration and ultimately in costly repair or replacement. Action in regard to slum clearance and sub-standard houses continues to be postponed as far as possible but the Department is only too well aware that the delaying tactic is creating its own problem. It is not easy to decide, in the light of present conditions and the knowledge of future difficulty, what action to take in regard to houses not in all respects fit for human habitation In general owners have been co-operative and no appeal was made against notices served under the Public Health Act or Section 9 of the Housing Act. A summary of the action taken during the year is shown below:— Houses inspected 367 Defective houses rendered fit in consequence of informal action 342 Defective houses rendered fit in consequence of statutory action 34 Houses in respect of which Demolition Orders were made 3 Houses demolished in pursuance of Demolition Orders 2 Houses in respect of which undertakings not to re-let accepted 3 Houses demolished where undertakings had been given — Houses rendered fit in consequence of undertaking given by owner — Houses in respect of part of which Closing Orders were made 1 Houses known to be overcrowded (Housing Act Standard) at end of year 45 New cases of overcrowding reported 24 Cases of overcrowding relieved during the year 103 Certificate issued under Section 12 of the Rent and Mortgage Interest Restriction (Amendment) Act. 1923 - At the end of the year the following 51 houses subject to Demolition Orders or undertakings not to relet till rendered fit were still occupied:— Situation Date of Demolition Order or undertaking 2, Rose Cottages, Worton Road .. 27.9.38 15, Wellington Road North 25.10.38 14, Brickfield Yard 25.10.38 16, Brickfield Yard 25.10.38 18, Brickfield Yard 25.10.38 3, Park Cottages 28.12.38 4, Park Cottages 28.12.38 75, Bath Road 31.1.39 373, Staines Road 28.2.39 11, Tivoli Road 28.2.39 13, Tivoli Road 28.2.39 15, Tivoli Road 28.2.39 106, Linkfield Road 28.3.39 41, Hanworth Road 28.3.39 45, Hanworth Road 28.3.39 49, Hanworth Road 28.3.39 15, Inverness Road 28.3.39 17, Inverness Road 28.3.39 98, Linkfield Road 28.3.39 100, Linkfield Road 27.6.39 122, New Heston Road 25.7.39 124, New Heston Road 25.7.39 126, New Heston Road 25.7.39 130, New Heston Road 25.7.39 411, Staines Road 26.3.40 162, Linkfield Road 164, Linkfield Road 30.4.40 30.4.40 1, Richmond Cottages 25.6.40 3, Richmond Cottages 25.6.40 Richmond House 25.6.40 8a, Derby Road 27.7.48 20, Inwood Road 26.10.48 28, Inwood Road 26.10.48 34, Inwood Road 26.10.48 102, Linkfield Road 22.2.49 721, London Road 29.3.49 8, New Heston Road 31.1.50 10, New Heston Road 31.1.50 12, New Heston Road 31.1.50 14, New Heston Road 31.1.50 159, Martindale Road 25.7.50 161, Martindale Road 25.7.50 165, Martindale Road 25.7.50 167, Martindale Road 25.7.50 3, Lower Square 31.1.51 67, Pears Road 29.4.52 4, Derby Road 29.7.52 169, Martindale Road 30.9.52 14, Derby Road 28.10.52 10, South Street 30.12.52 134, Wellington Road South 30.12.52 26 All these houses are incapable of being made fit at a reasonable cost and their continued occupation is a matter of some concern. Deterioration progresses and little or nothing can be done to slow this down. While many considerations must govern the selection of tenants for Council houses it should be noted that more than ten years have passed since some of these houses were condemned. 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 1952, 64 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 22 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. Other Departments have cooperated by displaying health education material. 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— (а) 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. The National Assistance (Amendment) Act, 1951, shortens the legal procedure for obtaining an Order "if it 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." Before bringing such cases to the notice of the Council every effort is made to arrange voluntary admission or for the necessary care to be given by relatives, friends, etc. During the year one application was made for an Order and the person concerned was removed in due course to an institution. 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. We are now confronted with a situation where an ever increasing number of elderly persons must either have an opportunity to work and support themselves or be supported by a proportionately dwindling group of younger people. All elderly persons are not fit for work and varying types and degrees of care must be devised to meet a wide range of need. Many agencies are concerned in this work. Among official agencies we have local sanitary authorities, local health authorities, welfare authorities, regional hospital boards, executive councils and the National Assistance Board. Much voluntary work is done through churches, "Darby and Joan" and such types of clubs, philanthrophic societies, community associations, wireless for the bedridden," mayor's and other special funds, Women's Voluntary Services, British Red ross Society and many other organisations. Despite all this effort old people continue to be found who, somehow or other, have been missed by all these agencies and in whose case, only too often, differences arise as to which official or voluntary agency should accept this new responsibility. The care of the aged can be most trying and exhausting but the growing task must be faced and can bring much satisfaction if tackled in the right spirit. There is real need for some authority to organise a service for the aged just as m the past maternity and child welfare authority were created. This authority should have power to secure any necessary action and should give much attention to the prevention or slowing down of deterioration in the aged by an organised system of home visitation and supervision. 27 TABLE I Summary of Vital Statistics 1895-1952 Estimated Civilian population (mid-year) Birth Rate per 1,000 populalation Rate Death Rate per 1,000 populalation Infant Mortality Rate Neo-natal Mortality Rate Maternal Mortality Rate per 1,000 live and still births Still Birth Rate per 1,000 live and still births Tuberculosis Death Rate per 1,000 population Deaths under 1 yr. per 1,000 live births Deaths under 1 mth. per 1,000 live births 1895 27,895 30.9 17.2 125 — — — 1.4 1896 28,352 27.9 14.5 151 — — — 1.2 1897 28,765 25.3 13.6 132 — — — 1.6 1898 29,185 28.0 16.0 173 — — — 1.4 1899 29,607 31.4 17.8 155 — — — 2.2 1900 30,040 27.1 23.0 156 — — — 1.6 1901 30,959 28.5 15.7 160 — — — 1.6 1902 31,470 29.9 16.7 157 — — — 1.3 1903 31,531 32.8 14.2 99 — — — 1.8 1904 32,630 32.3 16.8 169 — — — 1.9 1905 33,194 31.0 13.9 137 — — — 1.2 1906 33,767 33.5 15.1 139 48 — — 1.3 1907 34,351 33.0 14.2 88 30 — — 1.2 1908 34,895 29.1 15.9 111 29 — — 1.3 1909 35,672 27.3 15.9 91 28 — — 1.6 1910 36,311 25.1 14.1 100 26 — — 1.3 1911 43,684 23.9 13.6 162 43 — — 1.5 1912 45,191 23.1 10.8 86 37 — — 0.4 1913 46,749 24.0 11.7 103 34 — — 0.9 1914 48,361 21.0 11.4 98 34 — — 1.2 1915 41,836 19.6 12.5 102 40 — — 1.6 1916 42,000 20.1 12.6 77 30 — — 1.2 1917 40,000 16.6 14.9 117 47 — — 1.8 1918 43,129 16.8 17.9 86 36 — — 1.8 1919 42,020 16.8 11.6 99 52 — — 1.0 1920 43,445 24.7 10.9 58 22 — — 1.0 1921 47,290 20.0 11.3 69 40 — — 1.0 1922 47,850 18.7 11.8 74 37 — — 1.0 1923 48,030 17.5 9.8 55 26 — — 0.9 1924 47,700 17.7 10.8 61 27 — — 1.0 1925 48,620 17.4 10.3 73 41 — — 0.7 1926 52,110 17.4 9.1 56 25 — — 0.8 1927 55,870 16.1 10.7 68 36 — — 1.0 1928 59,730 17.1 9.9 56 27 — — 0.6 1929 63,070 17.1 11.5 46 18 — — 0.8 1930 63,070 19.1 9.6 50 25 6.4 36 0.8 1931 76,230 17.6 10.0 49 24 5.0 30 0.7 1932 81,100 17.4 9.7 60 29 2.8 24 0.7 1933 84,460 16.3 9.4 43 19 4.9 34 0.9 1934 87,797 15.1 10.3 48 21 2.9 32 0.8 1935 90,970 15.8 9.0 41 22 4.7 36 0.6 1936 95,000 15.7 9.6 48 20 2.0 30 0.6 1937 99,420 14.9 9.5 40 20 3.3 23 0.5 1938 101,500 14.2 8.6 46 24 2.7 30 0.6 1939 101,100 15.0 8.8 50 23 3.4 26 0.7 1940 97,530 13.7 12.3 58 39 2.3 25 0.6 1941 93,990 12.9 10.3 61 32 2.4 35 0.8 1942 95,600 14.6 10.2 72 43 2.8 32 0.7 1943 95,080 16.3 10.6 47 23 0.6 26 0.5 1944 92,370 16.5 10.4 46 30 1.9 22 0.5 1945 95,100 15.5 9.7 51 33 2.0 26 0.5 1946 104,240 17.3 10.4 29 22 2.2 26 0.5 1947 106,670 17.3 10.5 39 24 0.5 24 0.5 1948 106,200 14.5 8.8 30 20 0.6 25 0.4 1949 106,900 13.6 9.8 17 12 2.0 18 0.3 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 1952 105,600 11.7 10.1 19 15 0.0 26 0.2 28 TABLE II REGISTRAR-GENERAL'S RETURN OF CAUSES OF DEATH, 1952 Abridged List No. Cause of Death Male Female Total B 1 Tuberculosis, respiratory 8 8 16 B 2 Tuberculosis, other 2 1 3 B 3 Syphilitic disease 3 1 4 B 8 Diphtheria — — — B 9 Whooping Cough — — — B 10 Meningococcal infections — 1 1 B 12 Acute poliomyelitis — — — B 14 Measles — — — B 4-7, 11, 15-17 Other infective and parasitic diseases 2 5 7 B 18 Malignant neoplasm, stomach 12 12 24 Malignant neoplasm, lungs 28 5 33 Malignant neoplasm, breast — 23 23 Malignant neoplasm, uterus — 7 7 Other malignant and lymphatic neoplasms 54. 45 99 Leukaemia, aleukaemia 2 3 5 B 20 Diabetes — 2 2 B 22 Vascular lesions of nervous systems 43 78 121 B 26 pt. Coronary disease, angina 100 61 161 B 28 Hypertension with heart disease 10 18 28 B 25 26 pt. 27 Other heart disease 58 77 135 B 29 46 pt. Other circulatory disease 40 36 76 B 30 Influenza 1 3 4 B 31 Pneumonia 29 22 51 B 32 Bronchitis 59 34 93 B 46 pt. Other respiratory diseases 6 5 11 B 33 Ulcer of stomach and duodenum 6 4 10 B 36, 43 pt. Gastritis, enteritis, diarrhoea 1 1 2 B 38 Nephritis and nephrosis 10 3 13 B 39 Hyperplasia of prostate 10 — 10 B 40 Pregnancy, childbirth, abortion — — — B 41 Congenital malformations 5 2 7 Residial Other defined and ill-defined diseases 42 46 88 BE 47 Motor vehicle accidents 10 3 13 BE 48 All other accidents 3 12 15 BE 49 Suicide 3 2 5 BE 50 Homicide and operations of war — — — Total 547 520 1,067 29 TABLE III INFANTS' DEATHS ACCORDING TO AGE AND CAUSE, 1952 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 Birth asphyxia 2 — — — — — —— — — — — — — — — — — — — — — 2 Pneumonia — 1 — 1 — — — — — — — — — — — — — — — — — 2 Haemorrhagic disease — 1 — — — — — — — — — — — — — — — — — — — 1 Birth injuries 1 1 — — —— — — — — — — — — — — — — — — — — 2 Atelectasis 3 3 — — — — — 2 — — — — — — — — — — — — — 8 Congenital malformations — — 1 — — — — — — — 2 2 — — — — — — — — — 5 Prematurity 1 — — — — —— — — — — — — — — — — — — — — — 1 Gastroenteritis — — — — — — — — — — 1 — — — — — — — — — 1 Septicaemia — — — — 1 — — — — — — — — — — — — — — — — 1 TOTAL 7 6 1 1 1 — — 2 - — 3 2 — — — — — — — — — 23 30 TABLE IV. CAUSES OF DEATH ACCORDING TO AGE AND SEX, 1952 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 8 8 - - - - - - - - - - - - - - - - 1 - 1 3 1 - - 1 - 1 1 1 1 - - - - 1 - 3 - - 1 - - - - B 2 Tuberculosis, other forms 2 1 - - - - -- - - - - - - - - - - - - - - - - - - - 1 1 - - - - - - - - - - - - - - - - - B 3 Syphilis and its sequelae 3 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - B 4 Typhoid fever - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - B 5 Cholera - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - B 6 Dysentery, all forms - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - B 7 Scarlet fever and streptococcal sore throat — 1 - - - - - - - - - - - - - - - -- - - - - - - - - - - - - -- - - - - - - - - - B 8 Dipheria - - - - - -- - - - - - - - - - - - - -- -- - - - - - - -- - - - -- - - - - - - - B 9 Whooping Cough - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - B 10 Meningococcal infections — 1 - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - B 11 Plague - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - B 12 Acute polooyelitis - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - B 13 Small pox - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - B 14 Measles - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - B 15 Typhus and other rickettsial diseases - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - -- - B 16 Malaria - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - B 17 Other infective and parasitic diseases 2 3 - - - - - - - - - - - - - - - - - - - - - - - - - 1 - 1 - - - - - - - - - - B 18 Malignant neoplasms—stomach 12 12 - - - - - - - - - - - - - - - - - - - - - - - - -- - - 2 1 2 3 3 - - 1 1 1 - 2 3 4 - - lungs 27 5 - - - - - - - - - - - - - - - - - - 1 - - - 1 - 1 - - - - - 7 1 7 1 6 2 - - 2 - - - - - breast - 22 — — - - - - - - - - - - - - - - - -- - - — - - 1 - 3 3 - 2 - 3 - - - 4 4 - - - uterus - 7 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 2 - 2 — — — — — — — — other sites 57 47 — — — — —— 1 1 — — — — — — —— — — — — — — — — 1 — 1 5 3 3 3 4 8 5 8 6 8 4 5 8 10 6 4 4 5 — leukaemia, etc. 2 3 — — — — — — — — —— — — — — — — — — — — — — — — — — — — — — — — — — — — — — 1 2 — — — — — B 19 Benign and unspecified neoplasma — — — — — — — — — — — — — — — — — — — — — — — — — — — — — —— 1 1 — — — — — — — — — — — — — B 20 Diabetes — — — —— — — — — —— — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — B 21 Anaimias 3 1 — — — — — — — — — — — — — — — — — — — —— — — — 1 — — — — — — — — — — — 1 — 1 1 — — — — B 22 Vascular lesions affecting central nervous system 44 78 — — — — — — — — — — — — — — —— — — — — — — — — — — — 2 3 4 4 4 7 5 9 11 12 9 18 5 15 2 8 B 23 Non-meningococcal meningitis — 1— — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — B 24 Rheumatic fever — — — — — — — — — — — — — — — — — — —— — — — 1 — — —— — — — — — — — — — — — — — — B 25 Chronic rheumatic heart disease 14 17 — — — — — — — — — — — — — — — — — — — — — 2 — — 1 — — j 1 1 1 1 — 2 1 2 3 1 4 2 2 — 3 B 26 Arteriosclerotic and degenerative heart disease— coronary disease, angina 101 64 — — — — — — — — — — — — — — — — — — — 1 — 3 — 1 1 4 — 13 4 8 1 10 7 20 10 15 11 15 15 5 2 7 6 8 other 38 73 — — — — — — — — —— — — — — — — — — — — — — — — — — — — — — 2 3 2 1 3 7 7 6 10 12 20 — 26 B 27 Other diseases of the heart 9 4 — — — — — — — — —— —— — — — — — — — — — — — — — — — — — — — 2 1 — — 1 — — 2 — 1 — \ — B 28 Hypertension with heart disease 20 19 — — — — — — — — —— — — — — — — — — — — — —— — — — — — 1 1 4 — 1 — 2 1 3 — 2 4 4 5 3 2 B 29 Hypertension without mention of heart 5 5 — — — —— — — — — —— — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 1 1 — l 2 B 30 Influenza 1 3 — — — — — — — —— — — — — — — —— — — — — — — — — — — — — — — — — — — — — 1 — — — — 1 — B 31 Pneumonia 30 22 —— — — — — — — — — — — — — — — — — — — — — — — — 1 — — — — 1 — 2 2 2 j 6 1 7 3 4 6 7 8 B 32 Bronchitis 61 34 — — — — — — — 1 — — — — — — — — — — — — — — — — — — — 3 1 11 2 13 2 6 4 9 12 9 4 — — 7 B 33 Ulcer of stomach and duodenum 7 4 — — — — — —— — — — — — — — — — — — — — —— — — — — — — — — — — — — — — — — — — — — — — — B 34 Appendicits 2 4 — — — — — — 1 1 — — — — — — — — — — —— — —— — — — —— — — — — — — — — — — — — — B 35 Intestinal obstruction and hernia.. 1 4 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 2 — — — — — 1 B 36 Gastritis, enteritis, colitis, etc. 1 1 — 1 — — —— — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — B 37 Cirrhosis of liver — 1 — — — — — — — — — — — —— — — — — — — — — — — —— — — — — —— — — — — — — — — B 38 Nephritis and nephrosis 10 3 — — — — — — — — — — — — — — — — — — — — — — — 1 — 1 1 2 —. 2 — — — — — — — — — — 1 2 — B 39 Hyperplasia of prostate 11 — — — — — — . — — — — — — — — — — — — — — — — — — — — — — — — — — — 3 — 1 — 1 4 2 — — — B 40 Complications of pregnancy, childbirth and puerperium — — — — — — — —— — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — B 41 Congenital malformations 4 2 4 1 — 1 — — — — — — — — — — — — — — — — — — — — — — — — —— — — — — — — — — — — — — — — B 42 Birth injuries, post-natal asphyxia, atelectasis 9 3 9 3 — — — —— — — — — —— — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — B 43 Infections of the new born — 3 — 3 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — B 44 Immaturity and other diseases peculiar to early infancy 2 — 2 — — — — — — — — — — — —— — — — — — — — — — — — — — — — — — — — — — — — — — — — —— B 45 Senility, ill-defined and unknown causes—senility —ill-defined causes 2 6 — — — — — — — — — — — — — — — —— — — — — — — — — — — — — — — — — — — — 1 1 — 3 1 2 5 3 — — — — — — — — — — — — — — — — — — — — — — —— — —— — — — — 1 —. 1 2 1 — 2 1 B 46 Other circulatory diseases 10 12 — — — — — — — — — — — — — — — — — — — — — — — — — — 1 — — — 1 — 2 — 2 — 1 6 2 3 1 3 Other respiratory diseases 10 6 — — — — — — — — — — — — — — 1 — — — — — 1 — — 1 1 — 1 1 — 1 2 — 1 — 1 — 1 2 1 — — 1 — BE 47 All other diseases 15 18 — — — — — —— — — —— —— — — — — — — — — — — — — — 1 2 — — 1 3 2 1 3 1 4 3 4 1 1 — 2 Motor vehicle accidents 9 3 — — — — — — — — — — — —— — — — — 1 — — — — — — — —— —— — — — — 3 1 — 1 2 — — — — — BE 48 All other accidents 3 12 — — — — — — — — — —— — — — — — — — 1 1 — — — — — — — 1 — — — — — — — — — — — — 1 6 1 4 BE 49 Suicide 2 2 — — — — — — — — —— — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Self-inflicted injury 2 2 — — — — — — — — — — — — — — — — — — — — — — — 1 — 1 — — — — — — — — — — — — 1 — — — — BE 50 Homicide — — — — — — — — —— — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Operations of war — — — — — — — —— — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — ALL CAUSES 547 523 15 8 — 1 — 1 2 2 1 1 1 — 1 — 3 — 4 2 4 6 5 — 8 3 15 12 18 15 33 28 59 24 64 39 63 46 69 71 86 97 52 88 44 79 1,070 23 1 1 4 2 1 1 3 6 10 5 11 27 33 61 83 103 109 140 183 140 123 Percentage of total deaths from all causes 2.15 0.09 0.09 0.37 0.19 0.09 0.09 0.28 0.56 0.93 0.47 < ,1.03 2.52 3.08 5.70 7.76 9.62 10.19 13.08 17.10 13.08 11.03 TABLE V INFECTIOUS DISEASES—1952—AGE DISTRIBUTION Disease Total Under 1 yr. lyr. 2 yrs. 3 yrs. 4 yrs. 5-9 yrs. 10-14 yrs. 15-19 yrs. 20-34 yrs. 35-44 yrs. 45-64 yrs. 65 yrs. + Cases admitted to hospital Smallpox — — — — — — — — — — — — — Typhoid Fever — — — — — — — — — — — — — — Para-Typhoid Fever 7 — — — — — 2 3 1 — — — 1 7 Scarlet Fever 161 1 1 2 13 17 117 7 2 1 — — — 46 Diphtheria — — — — — — — — — — — — — — Erysipelas 19 — — — — — — — — 2 2 11 4 3 Puerperal Pyrexia 53 — — — — — — — 3 46 4 — — 53 Ophthalmia Neonatorum 2 2 — — — — — — — — — — — — Acute Poliomyelitis and polioencephalitis 3 — 1 — — 1 1 — — — — — — 3 Meningococcal Infection 5 1 — 2 — — 1 — — — — — 1 5 Pneumonia 58 1 1 — 3 5 5 — — 5 6 22 10 17 Undulant Fever 1 — — — — — — — — — — 1 — 1 Malaria 1 — — — — — — — — 1 — — — — Dysentery 28 — 1 2 1 2 6 1 2 5 1 4 3 2 Measles 1,027 31 83 102 126 162 501 8 3 8 3 — — 27 Whooping Cough 86 9 10 13 9 13 32 — — — — — — 6 Food Poisoning 53 — — — 2 — 3 2 2 15 11 15 3 1 Tuberculosis:— Pulmonary 148 — 1 — — 3 l 12 67 28 25 11 — Non --pulm.on ary 20 1 1 — 1 — 1 1 — 5 6 5 — — 32 NOTIFICATIONS AND DEATHS FROM CERTAIN INFECTIOUS DISEASES TABLE VI HESTON AND ISLEWORTH, 1933-1952 Year Smallpox Scarlet Fever Diphtheria Erysipelas . Pneumonia Meningococcal Infection 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 1933 — — 391 4 50 2 54 1 234 45 6 3 2 2 5 3 5 — — — — — — 1 — 6 Not Notifiable 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 1952 — — 161 — — — 19 1 58 51 5 1 — — 3 — — — 7 — 28 — 1027 — 86 — 4 168 19 33 *Includes para typhoid fever to 1939. TABLE VII COMPARATIVE STATISTICS 1952 England and Wales Rate per 1,000 Civilian Heston and Isleworth Population. Births— Live Births 15.3 11.7 Still Births 0.35 0.31 Deaths— All causes 11.3 10.1 Typhoid and Paratyphoid 0.00 0.00 Whooping Cough 0.00 0.00 Diphtheria 0.00 0.00 Tuberculosis 0.24 0.18 Influenza 0.04 0.04 Smallpox 0.00 0.00 Poliomyelitis 0.01 0.00 Pneumonia 0.47 0.48 Notifications— Typhoid fever 0.00 0.00 Paratyphoid fever 0.02 0.07 Meningococcal infection 0.03 0.05 Scarlet Fever 1.53 1.52 Whooping cough 2.61 0.81 Diphtheria 0.01 0.00 Erysipelas 0.14 0.18 Smallpox 0.00 0.00 Measles 8.86 9.72 Pneumonia 0.72 0.55 Poliomyelitis 0.09 0.03 Food Poisoning 0.13 0.50 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 Authorities 46 51 — — (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 355 950 25 — (iii) Other premises in which Sectior 7 is enforced by the Local Authority (excluding outworkers' premise) 5 5 — — TOTAL 406 1,006 25 — 2.—Cases in which Defects were found— Particulars Number of cases in which defects were found Number of case in which prosecutions were instituted Found Remedied Referred To H.M. Inspector By H.M. Inspector Want of Cleanliness (S.l) — — — — — Overcrowding (S.2) — — — — — Unreasonable temperature (S.3) — — -— — — Inadequate ventilation (S.4) — — — — — Ineffective drainage of floors (S.6) — — — — — Sanitary Conveniences (S.7)— (a) insufficient 1 3 — 1 — (b) unsuitable or defective 24 26 — 2 — (c) not separate for sexes — — — — — Other offences against the Act (not including offences relating to Outwork) — 3 — — — TOTAL 25 32 — 3 — 34