1 Mr O Inrn D S B 2. Library AC 439 (1) Horston HES 42 ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH OF THE BOROUGH OF HESTON AND ISLEWORTH for the year 1955 A, ANDERSON, M.D., D.P.H., Medical Officer of Health. INDEX PAGE Accidents 7 Atmospheric Pollution 21 Bakehouses 22 Births, Live 6 Births, Still 6 Burials 28 Canal Boats 19 Closet Accommodation 17 Common Lodging Houses 19 Deaths 7 Deaths, Age and Sex Distribution 33 Deaths, Causes of 31 Disinfection 11 Disinfestation 20 Drainage and Sewerage 16 Factories No. on Register Inspections and Defects, etc. 39 Factories, Workplaces, etc. 19 Fever Hospitals 11 Food and Drugs Sampling 23 Food Hygiene. 24 Food Poisoning 11 Health Committee 3 Health Education 29 Health Services provided by Other Authorities 14 Housing 25 Ice Cream 22 Infant Deaths according to Age and Cause 32 Infant Mortality 8 Infectious Diseases 8 Infectious Diseases, Age Distribution 34 Infectious Diseases, Notifications and Deaths 35 Laboratory Service 11 Laundry Service 29 Maternal Mortality 8 Meat and Other Food Inspection 23 PAGE Medical Examinations of Staff 28 Meteorology 37 Milk 22 Mosquitoes 20 Municipal Restaurants and School Canteens 23 Noise Nuisances 20 Nutrition 25 Persons in need of care and attention 29 Pet Animals Act, 1951 21 Physical Characteristics 16 Public Cleansing 17 Public Mortuary 28 Rags, etc. Exchange of Articles for 18 Rag Flock and Other Filling Materials Act, 1951 20 Rats and Mice Destruction 20 Rivers and Streams 17 Sanitary Circumstances 16 Sanitary Inspection 17 Shops, Act 1950 Section 38 20 Slaughter of Animals (Amendment) Act, 1954 23 Slaughterhouses, etc. 23 Smoke Abatement 18 Staff 2 Statistics, Certain Vital, County of Middlesex 36 Statistics General 6 Statistics Vital 6 Statistics Vital, Summary of 30 Swimming Baths 21 Tents, Vans and Caravans 19 Tuberculosis 10 Verminous Premises, Articles and Persons 21 Water Supply 16 Wind Direction 38 STAFF Medical Officer of Health (Part-time) A. Anderson, M„ D„, D.P, H Deputy Medical Officer of Health (part-time) E.N. Christie, 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.HG 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. J K Edson. Cert , as S. I., M I. and San. Science. L Howarth, Cert, as S.I. and M.I. (to 5.3.55). D G Martin Cert, as SI. and M.I. (from 1.6.55). Rodent Officer A Parrer Rodent Operatives R Ashurst. R B Denyer (to 20.3,55). G Avery (from 11 4.55), Mortuary Attendants, Disinfectors, Drain Testers, Etc. F, S.J Allaway G Matthews (to 3.9.55) L.R Smith ( from 12.9.55). Clerks. BW, 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, Mrs. K M Richards ( to 29.2.55). Mrs. J Knight (from 14,3.55). AC Rogers. -2- THE HEALTH COMMITTEE of HESTON AND ISLEWORTH BOROUGH COUNCIL to May. 1955 Alderman Mrs. 0. C. M. Denton (Chairman) Councillor Mrs. M. Hennig (Vice-Chairman) Alderman Mrs. M. P. Davison, J.P. (Mayor) Councillor P. J. Jansen. Alderman J.E. Dillingham. Councillor Mrs. R. New. Councillor A.G. Cross. Councillor G.K. Roberts. Councillor J. Curwood. Councillor Mrs. M.J. Tozer. Councillor H. J. Davis. Councillor C.J. Van Ryne. Councillor A.P. Greenfield. Councillor Miss M. K. Watson. J. P. from May, 1955 Councillor Mrs. M. Hennig (Chairman) Councillor Mrs. M. J. Tozer (Vice Chairman) Councillor J. Theobald, J.P. (Mayor) Alderman J.E. Dillingham. Alderman Mrs. A.B. Tolman. Councillor W.H. Bolster. B. Com.Sc. Councillor A.G. Cross. Councillor Sqdn/Ldr. E.R. Cuff. Councillor J. Curwood Councillor E.T. Harding. Councillor F.J. Jansen. Councillor Mrs. R. New. Councillor A.H. Nixon. Councillor P.G. Raybaud. 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 for the year 1955. 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 was the lowest in the Borough records and the death rate showed little change from recent years. The infant mortality rate was lower than in 1954 but the problems of prematurity, birth asphyxia and congenital defects still remain unsolved. Cancer and degenerative diseases of the circulatory system continue to be the chief causes of death. Accidents take an appreciable toll of human life and cause much temporary and permanent disability. The number of mechanically propelled vehicles on our roads steadily increases. It is difficult to think of circumstances that would justify or of roads permitting with any degree of safety the "cruising speeds" claimed for modern cars. The accident record of our best roads does little to support the view that new roads are the solution of the road accident problem. Reduction in road accidents can be brought about only by the exercise of care and consideration by all road users and the faster the rate of travel the greater the care should be. Nearly 75 per cent, of all deaths from accidents in the home occur at ages 65 and over and most of these are due to falls. This matter should have special attention from all having any responsibility for the care of the aged. Burns and scalds of young children are still too frequent and like most accidents only too often could have been avoided by reasonable care and forethought. Apart from the anticipated high incidence of measles the infections giving rise to most concern during the year were poliomyelitis, dysentery and food poisoning. The virus of poliomyelitis can be recovered from the bowel of both cases and contacts and the germs causing dysentery and many outbreaks of food poisoning are found in the faeces of cases and carriers. While no food vehicle has been shown to be associated with outbreaks of poliomyelitis and it is unusual to find one associated with dysentery, it is difficult to avoid the impression that lack of personal hygiene, which is such an important factor in food poisoning, may play a part in the spread of other diseases. Training in personal hygiene and especially cleansing of the hands should begin in infancy and the practice be maintained throughout life. There are no signs of any reduction in the incidence of food poisoning. While the type of germ and the source of infection cannot be proved in all cases there is overwhelming evidence that the following measures could reduce markedly the occurrence of food poisoning;- (a) strict personal hygiene by all food handlers (b) rapid cooling, followed by proper refrigeration, of all meat dishes not intended for immediate consumption. Scrupulous cleanliness of the hands, including attention to minor cuts and sores, will reduce the chance of contamination of food and rapid cooling and refrigeration will prevent multiplication of any bacteria which may have gained access to the food. There is a tendency to look outside ourselves for sources of spread of infection and in this respect the following extract from the report of the Chief Medical Officer of the Ministry of Health is of interest:- "The telephone seems to have a recurrent attraction for armchair hygienists who periodically raise the bogey of infections which have been or can be transmitted by its means. Numerous investigations have been made since the opening of the present century to determine whether, in fact, there is much risk of the spread of disease, especially by those instruments in public call boxes, and all have demonstrated that the risk is negligible." Section 85(2) of the Housing Act, 1936 states- "the authority shall secure that in the selection of their tenants a reasonable preference is given to persons who are occupying insanitary or overcrowded houses, have large families or are living under unsatisfactory housing conditions." In other words housing is an essential part of the Council's health services and should be closely linked with the Council's efforts to deal with unfit houses. -4- On occasion the statement is made that families are no longer caring for their aged members as they did in the past. Only too often such a generalisation is made on meagre evidence. The percentage of persons aged 70 years and over in the Borough has risen from 3.4 at the 1901 census to 6.2 at the 1951 census. In other words the number of aged persons has increased considerably and there are now in the Borough some 6,500 persons aged 70 years and over. It must be obvious to all that the vast majority of these are caring for themselves or being looked after by relatives and I can find no evidence that the proportion of aged persons lacking reasonable care is increasing. As the number of aged persons in the population grows so must the amount of provision for their care by state, municipal and voluntary agencies increase. Many official and voluntary bodies are participating in this work, but there is urgent need for some method of co-ordinating these efforts so as to secure the best results from the time and money expended. Since the coming into operation of the National Health Service Act the work of the Department has been restricted largely to dealing with environmental conditions. This is the concern of the Sanitary Inspectors whose day-to-day attention to housing, nuisances, food inspection, food hygiene etc. continued throughout the year. It should be noted that repairs, improvements and abatement of nuisances are brought about largely by informal action and that only in few instances has the full force of the legislation to be brought into operation. I have had generous co-operation from all other Departments. The loyal and willing assistance of my staff has lightened my task and I would like to thank the Council for their encouragement and support. I remain, Your obedient servant, A.ANDERSON. Medical Officer of Health. -5- GENERAL STATISTICS Year Area in acres Population (Registrar-General's estimate) Number of inhabited houses (rate books) Number of houses erected during year Rateable Value of Borough Sum represented by a penny rate Live Births - male Live Births - female Birth rate per 1,000 population Birth rate per 1,000 population (England and Wales) Stillbirths - male Stillbirths - female Stillbirths rate per 1,000 (live and still) births Deaths - male Deaths - female Death rate per 1,000 population Death rate per 1,000 population (England and Wales) Infant Mortality rate Infant Mortality rate (England and Wales) Maternal Mortality rate Maternal Mortality rate (England and Wales) 1955 7,218 105,500 29,846 497 £1,059,942 £4,350 623 541 11.0 15.0 14 6 16.9 591 523 10.6 11.7 24.1 24.9 0.0 0.6 VITAL STATISTICS POPULATION The Registrar -General's mid-year estimate of the population of the Borough for tne year 1955 is 105 500. RATEABLE VALUE The rateable value of the Borough for 1955 was £1,059,942 and the sum represented by a penny rate was £4,350. INHABITED HOUSES According to the rate books, the number of inhabited houses at the end of the year was 29,846. In relation to the estimated population, this yields an average of approximately 4 persons per house. LIVE BIRTHS The number of live births in 1955 was 1,164 as compared with 1,185 in 1954. The birth rate was 11.0 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 RegistrarGeneral supplies for each local sanitary authority what is called the area comparability factor. When this is applied to the Borough birth rate, the result is 10.9 as compared with the birth rate of 15.0 per 1,000 population for England and Wales. It might be thought that the fall in the birth rate was associated with the increasing proportion of elderly in the population, but this is not confirmed when the births are related to the number of women of child-bearing age as is shown below:- Total live births Birth rate per 1,000 population Birth rate per 1,000 women 15-44 years 1911-15 5046 22.3 98.0 1931 -35 6893 16.4 63.1 1951-55 6056 11.5 51.2 The number of illegitimate births was 49, as compared with 43 in 1954. 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 1950-54 4.0 1935-39 2.9 1955 4.2 1940-44 4.6 The majority of births continue to occur in hospital. STILLBIRTHS The number of stillbirths in 1955 was 20 (20 legitimate, illegitimate). The proportion of stillbirths per 1,000 total (live and still) births in recent years is shown below:- -6- 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 1950-54 129 20.6 1955 20 16.9 This loss of potential lives remains a problem and until more is known of the causes little improvement can be expected. DEATHS The deaths of residents of the Borough during 1955 were 1,114 (591 male, 523 female). This represents a death rate for the Borough of 10.6 per 1,000 population. The deaths in any area are influenced by the sex and age distribution of the population, and to permit of a true comparison, the Registrar-General calculates for each local sanitary authority area what is called an area comparability factor. When this is applied to the above Borough rate, the result is 10.9 as compared with a death rate of 11.7 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 190 cases. A progressive change is taking place in the percentage age distribution of deaths, and this is shown in the following table:- 1910-14 1945-49 1950-54 1955 Under 1 year 21.8 5.3 2.4 2.61 1-4 years 8.4 0.8 0.5 0.18 5-14 years 3.8 2.1 0.4 0.54 15-24 years 3.7 2.1 0.8 0.99 25-64 years 30.8 33.0 31.6 27.67 65 years and over 31.5 56.7 64.3 67.98 The chief causes of death in males were heart and circulatory diseases (188), cancer (106), cerebral haemorrhage (83), and bronchitis and pneumonia (66). In females, the chief causes of death were heart and circulatory disease (158), cancer (108), cerebral haemorrhage (83), and bronchitis and pneumonia (40). The Secretary of the Road Safety Committee informs me that during 1955 there were 704 road accidents which resulted in 19 deaths, serious injury to 148 persons and slight injury to 720 persons. 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 Other Accidents Age in years All ages Age in years All ages 0-4 5-14 15-64 65+ 0-4 5-14 15-64 65+ 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 1953 - - 9 8 17 - - 5 15 20 1954 - 1 9 3 13 1 - 9 13 23 1955 - - 7 7 14 - 1 4 13 18 Total 3 9 78 45 135 13 7 70 142 232 -7- During these ten years more children under the age of 15 years met accidental deaths than died of diphtheria, scarlet fever, measles, whooping cough and poliomyelitis combined. 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. For old people accidents are a special risk. Cremations in Great Britain have increased from 4.31 per cent of all deaths in 1941 to 24.57 per cent, in 1955- At the end of the year 82 crematoria were in operation. INFANT MORTALITY- During 1955 there were 28 deaths of children under the age of 1 year. This represents an infant mortality rate per 1,000 live births of 24.1 as compared with 24.9 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 Mo rtality 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 1952 6 680 146 22 1953 1,268 23 18 1954 1.185 31 26 1955 1,164 28 24 If the loss of life from stillbirths and early death of babies is to be reduced, local health authorities., general practitioners and hospitals have a part to play in trying to improve mothercraft, ante-natal care and the management of birth. MATERNAL MORTALITY- No death occurred due to causes associated with pregnancy and childbirth. 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 1950-54 - 0.3 0.3 1955 - - - 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. INFECTIOUS DISEASE Notification to the Medical Officer of Health is the essential preliminary to the control of infectious disease. The diseases required by statute to be notified:- smallpox, cholera, diptheria, membranous croup, erysipelas, scarlet fever, typhus fever, typhoid fever paratyphoid fever, relapsing fever, plague, poliomyelitis, tuberculosis, malaria , dysentery, puerperal pyrexia, ophthalmia neonatorum, acute primary pneumonia, acute influenzal pneumonia, whooping cough. measles, acute encephalitis, meningococcal infection, and food poisoning. It is known that all cases are not notified, but there are no grounds for suspecting that the level of notification varies to any great extent from year to year. Persons travelling overseas may require to produce evidence of recent vaccination against smallpox or inoculation against yellow fever, cholera and typhoid fever, Such certificates require to be endorsed by the Medical Officer of Health, and during the year 365 were so endorsed. -8- INCIDENCE OF NOTIFIABLE DISEASE - The number of cases notified during the last ten years are shown below:- 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 Smallpox - - - - - - - - - - Scarlet Fever 67 62 159 138 92 67 161 161 71 74 Diphtheria 16 3 2 - 1 - - - - - Erysipelas 19 19 21 26 12 12 19 16 17 17 Pneumonia 47 56 41 52 64 59 58 78 34 50 Meningococcal Infection 13 8 2 2 - 5 5 1 4 - Epidemic encephalitis - - ~ - - - - • - 1 Post-infective encephalitis - - - - 1 - r 1 - Poliomvelitis and polioencephalitis 1 43 29 14 9 4 3 11 - 13 Typhoid fever 1 1 » - 3 1 - - - - Paratyphoid fever - - 3 - 6 1 7 - 1 - Dysentery 6 - 5 2 6 77 28 13 9 131 Food Poisoning - - - - 5 6 53 53 48 45 Tuberculosis Pulmonary 200 160 147 208 163 163 148 123 81 61 Tuberculosis Non-pulmonary 17 20 21 11 19 22 20 18 7 6 Ophthalmia neonatorum 2 - •• - 1 1 2 13 - - Puerperal pyrexia 54 60 23 16 8 13 53 67 33 49 Measles 170 840 571 523 881 790 1,027 602 38 1,568 Whooping Cough 170 142 227 173 206 222 86 291 35 177 Malaria 1 - - 1 1 - 1 3 2 1 Undulant fever - - - - 1 - 1 - - - The age distribution of notifiable disease during 1955 is shown in Table V„ SMALLPOX - No case of smallpox occurred in the Borough during 1955. 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, 375 children under the age of one year were vaccinated in 1955. 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 74 cases which occurred during the year, 13 were admitted to hospital No death from this disease has occurred in the Borough since 1937 DIPHTHERIA - The Borough s freedom from diphtheria was maintained during the year. The ravages of this disease are not remembered by the younger parents and they must not be lulled into a false sence of security, As far as is known immunisation is the one safeguard, but unfortunately the proportion of young children protected is falling The number of children under the age of one year who were immunised during 1955 was 525 as compared with 610 in 1954 ERYSIPELAS- The number of notifications was 17, but no death was due to this disease. PNEUMONIA- Notifications of pneumonia were 50, as compared with 34 in 1954. The death rate from pneumonia per 1000 population was 0.4, compared with 0.3 in 1954. Of the total pneumonia deaths 80 per cent, occurred at age 65 and over. MENINGOCOCCAL INFECTION- No case was notified during the year. EPIDEMIC ENCEPHALITIS- One notification was received during the year. The patient was admitted to hospital and recovered. POST-INFECTIVE ENCEPHALITIS- Encephalitis is known to occur as a complication of other infectious diseases, but no such case was notified during 1955. POLIOMYELITIS AND POLIOENCEPHALITIS- During the year 13 cases were notified. Of these 8 showed no paralysis and of the others 2 were transferred to orthopaedic hospitals and 3 to orthopaedic departments for further treatment. The method of spread of this disease has still to be discovered. The virus has been isolated from the throat and bowel of patients, from the bowel of symptomless contacts and from sewage even in places where no case of the disease has been notified for years. Again, where no case of poliomyelitis has been known to occur antibodies to the virus have been found in the blood of a large proportion of the children tested. These findings support the view that the infection is much more widespread than the occurrence of clinical cases would suggest. -9- TYPHOID FEVER- No case of typhoid fever was notified during the year. PARATYPHOID FEVER - No notification was received during 1955. DYSENTERY- This disease shows great variations in prevalence from year to year and from place to place. During the year, 131 cases were notified. The ages of the cases ranged widely but most cases occurred in children aged 5-9 years. Two outbreaks occurred in houses occupied by several families. 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. Though the bowel is the usual habitat of dysentery germs, there is little evidence to implicate contaminated food as the method of transmission. Infection seems to be spread from person to person and contamination of hands the most likely method. TUBERCULOSIS- During the year, 61 notifications of pulmonary tuberculosis, and 6 notifications of non-pulmonary tuberculosis were received. This is the lowest tuberculosis notification rate recorded in the Borough. In recent years the notification rate has remained at much the same level, though the death rate from tuberculosis has fallen and this suggested that there was still some reservoir of infection which was not being treated. Persons continue to be certified as dying from tuberculosis who have not been notified during life, but it is hoped that with the improved facilities for diagnosis and treatment now available, any reluctance to seek investigation and treatment will disappear. Early diagnosis and treatment are essential to reduce the risks of the spread of infection. The trend of the Borough death rate from tuberoulosis is shown below:- Tuberculosis Pulmonary Death Rate per 100,0 Non-pulmonary 00 population 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 1950-54 18.9 1.1 20.0 1955 13.3 1.0 14.2 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. The hunchbacks, the scarred necks and the discharging sinuses around joints which were only two common among children and adolescents in the early years of the century have gone and this reduction in non-pulihonary tuberculosis is due largely to the pasteurisation of milk and the increasing elimination of tuberculosis from dairy herds, A permanent mass x-ray unit has been established at West Middlesex Hospital and is open to the public without appointment. OPHTHALMIA NEONATORUM - For the second time since the disease was made notifiable, no case was reported in the Borough. It is a tribute to preventive medicine that this infection of the eyes of babies which was once a common cause of blindness has now been brought under control. It is unlikely that the disease will disappear completely but when it does occur, modern treatment should prevent any damage to sight. PUERPERAL PYREXIA - During the year 49 cases were notified as compared with 33 cases in 1954. A change in the definition of puerperal pyrexia was introduced by the Puerperal Pyrexia Regulations 1951. No woman died from puerperal or postabortion sepsis. MEASLES - As was anticipated measles was widely prevalent in 1955 and 1,568 cases were notified. 0J Measles is one of those infections of which the patient is liable to be highly infectious before the diagnosis of his illness has been established. Early infectiousness makes the application of preventive measures practically impossible and largely accounts for the extremely rapid spread of the infection throughout the susceptible section of the child community." WHOOPING COUGH - The notifications of whooping cough, 177, were much more than in 1954. Facilities for immunisation against this disease are available. The condition is most fatal in young babies, and protection should be provided before 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 attac -10- MALARIA One case of malaria was notified during the year and investigations showed that the infection had been contracted abroad. INFLUENZA- This disease was not prevalent during the year. It caused 4 deaths as compared with 2 in 1954, 26 in 1953, 4 in 1952 and 33 in 1951. The Medical Research Council are continuing their efforts to find an effective influenza vaccine. 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, 51; chicken pox 172; and German measles. 10. 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, 128 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 one room was disinfected and 7 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 1955 was 1 497 The majority of these specimens were taken during the investigation of 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 (a) the name age and sex of the patient and the address of the premises where the patient is and (b) particulars of the food poisoning from which he is or is suspected to be, suffering. 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 continues to hamper the investigation of cases. The possibility of food poisoning should be kept in mind in all cases of "gastric flu9' and unexplained vomiting and diarrhoea. During 1955. notifications of the occurrence of food poisoning in 45 persons were received, and during the course of our Invest!eations and from other sources, a further 246 cases were discovered. -11- A summary of the cases is given below:- Cases of Food Poisoning 1st Quarter 53(6) 2nd Quarter 18(15) 3rd Quarter 88(18) 4th Quarter 201(6) Total 360(45) Outbreaks due-to identified agents Total outbreaks 3 (2) Total cases 206 (9) Outbreaks of undiscovered cause Total outbreaks 6(3) Total cases 124 (7) Single cases Agent identified unknown cai 2 (2) 28 (27) ise Total cases 30 (29) () notified under Section 17 of the Food and Drugs Act, 1938. The investigation of cases of food poisoning or suspected food poisoning absorbs much time and effort and places a heavy burden of work on the Public Health Laboratory Service. Only two outbreaks were of any size; 47 cases in a Teachers' Training College and 196 cases in a factory. Generally all the persons affected or concerned in food poisoning incidents are only too willing to co-operate in our investigations but this was not so at one factory. This gives rise to difficulties and hampers action as is shown by the following three food poisohing incidents at this factory:- Incident 1 - On 7th October 1954 notice of an outbreak of food poisoning was received. Enquiries at the factory on that date showed that 18 members of the night shift had suffered from diarrhoea, nausea and abdominal pains about noon on 5th October. A few of the affected persons stated that they had felt out of sorts on arriving home from work on the morning of 5th October. All the affected persons had consumed stewed steak in the works' canteen at midnight on 4th October. The stewed steak had been prepared that morning and served at midday to approximately 400 persons, none of whom complained of any ill-effects. The remainder of the stewed steak had been kept till evening when, after the addition of two tins of steak, it was heated for the nightshift, None of the midnight meal was available for examination. The hygienic condition of the premises, equipment and stores was satisfactory. All the affected persons were asked to provide specimens of faeces, but were reluctant to do so as they had all recovered fully. In general the attitude of the canteen staff was antagonistic, but after a talk by the Sanitary Inspector on the purpose of the investigation specimens were supplied by 13 of the 21 members of the Canteen staff on 9th to 12th October. No food poisoning organisms were found. This outbreak appeared to be due to contamination of the stewed steak and the opportunity for growth of an organism provided by the cooling and reheating. The delay in getting faecal specimens reduced the chances of finding the germ. Incident 2 - On 18th August, 1955 another outbreak of food poisoning was reported Enquiries at the factory on that date showed that 69 were affected. All had taken lunch at the canteen on 17th August and the only food consumed by all was roast beef and gravy. The roast beef had been cooked on 16th August and reheated on 17th August. The gravy had been prepared from the fat obtained at the roasting of the beef on 16th August. The onset of symptoms ranged from 8 to 14 hours after the consumption of the suspected food. Samples of the roast beef and of two other items of the midday meal on 17th August were obtained for bacteriological examination. No food poisoning organisms were found, but all specimens showed the presence of bowel germs. Only two of the canteen staff provided faecal specimens and the report on these was negative. This outbreak appeared to be due to the contamination of the food by bowel organisms and the opportunity for their growth provided by the cooling and reheating. The probable source of the contamination was reported and the non-cooperation of the canteen staff in the investigations discussed with the personnel manager and the works medical officer. Incident 3 - On 22nd September, 1955, notice was received that a large number of employees were suffering from food poisoning. A visit to the factory showed that some 50 persons had reported at the works medical centre that morning suffering from diarrhoea, vomiting, fever and collapse to a varying degree. Some 20 persons after being seen by the works medical officer were sent home by car. The onset of symptons lay between 1 a.m. and 5 a.m. on 22nd September. Preliminary enquiries showed that all the affected persons had consumed roll and dripping served during the morning break on 21st September, but only a few had taken lunch at the canteen on that day. The dripping had been obtained from roast beef cooked on 19th September and- thereafter stored in the larder. None of the dripping or of the items of the midday meal of 21st September was available for bacteriological examination. Arrangements were put in hand to obtain specimens of faeces from the canteen staff and from the affected persons. Some of the affected persons resided outside the Borough so the assistance of the Medical Officers of Health of the districts concerned was sought for obtaining specimens. On the morning of 23rd September specimens had been provided by 4 affected persons and 8 of the 22 members of the canteen staff. A talk was given to the canteen staff on the severity of the outbreak, on the importance of full investigation and the need for their full co-operation. As a result of this a further two faecal specimens were obtained and 12 of the staff permitted throat and nose swabs to be taken. On 26th September 4 more specimens were provided by the canteen staff. On that afternoon the laboratory reported that, though no pathogenic organisms had been found in the throat and nose swabs, salmonella typhi-murlum (a food poison germ) was present in some of the faeca specimens. On the same day telephone messages about the presence of this germ in faecal specimens were received from some of the Medical Officers of Health whose assistance had been sought. -12- A review of the position on the morning of 27th September showed (a) that over 150 persons were affected and three of them so severely as to necessitate removal to hospital (b) that the rate of return to work of the affected persons was slow and that many who had returned to work were not fully recovered (c) that salmonella typhimurium had been found in 15 faecal specimens from affected factory staff and (d) that the same germ was present in faecal specimens from four of the canteen staff. After consultation with the works' medical officer the firm was advised to suspend temporarily from work all canteen staff and the appropriate notices under the Public Health (Infectious Diseases) Regulations, 1953, were issued to the canteen staff known to be harbouring salmonella typhi-murium. The firm agreed to pay wages during suspension to the canteen staff subject to them submitting specimens as required for bacteriological examination. Three negative results at not less than two day intervals was agreed as the basis on which return to work in the canteen would be permitted. By 28th September a final list of the names and addresses of all affected persons was available. The total was 195 and a letter was sent to each informing them of the nature of the outbreak, advising them to inform their own doctors and stressing the need to wash the hands thoroughly, after using the water closet, to prevent the spread of infection. On the same day arrangements were made for a firm of caterers to take over the canteen. Despite the talks to them some of the canteen staff appeared not to appreciate the seriousness of the outbreak, resented their suspension from work and wrote or called at the Health Department to express their views. At the end of the investigation salmonella typhi-murium had been found in 6 members of the canteen staff and in 18 affected factory workers. No member of the canteen staff admitted to a recent gastro-intestinal illness. A search of the staff records showed that one had suffered from gastro-enteritis in 1949 and 1951. No bacteriological investigation of these illnesses had been carried out, but as she was severly affected by the food poisoning it is most unlikely that she was a carrier. Another admitted that she had provided faecal specimens in 1953, but an enquiry to the Medical Officer of Health of the district concerned, revealed that the investigation arose from contact with dysentery and that no pathogenic organisms were found. During the follow up of canteen staff it was learned that an out-break of diarrhoea had occurred in the household of another. Faecal specimens from all in the house contained salmonella typhi-muruim, but other than a statement that the diarrhoea started "at the same time as the food poisoning" the date of onset could not be fixed. As the laboratory results, in relation to canteen staff, were received permission to return to canteen work was given and any notices issued under the Public Health (Infectious Diseases) Regulations 1953 were withdrawn as under:- 7th October 2 staff 10 days after suspension from work 11th do 4 do 14 do 12th do 2 do 15 do I 13th do 2 do 16 do 14th do 2 do 17 do lgth do 3 do 21 do 19th do 1 do 22 do 21st do 1 do 24 do 24th do 1 do 27 do 25th do. 1 do 28 do 28th do 1 do 31 do 29th do 1 do 32 do 4th November 1 do 39 do 17th December 1 do 81 do The suspension from work in some cases was longer than it might have been because of difficulties and delays in obtaining specimens, but in one only of the canteen staff was the carrier state persistent. Apart from the time lost from work by the canteen staff this outbreak of food poisoning resulted in a loss of over 600 working days by the affected members of the factory staff. On 27th October the canteen staff took over the catering again, but prior to this they were given a course of three lectures on food hygiene. A report was submitted to the firm concerned and advice offered as to the action that should be taken to reduce the chances of further outbreaks of food poisoning. The nature or source of the outbreak at the Teachers' Training College was not found. in December it was reported that at one school a number of pupils and staff had suffered from vomiting and diarrhoea. Bacteriological investigation of school meals and specimens from adults and children failed to reveal any food poisoning germs. Enquiries showed that a similar illness occurred among other members of the families of the affected persons and that in varying degree three other schools in the same district had been affected; Vomiting was the most prominent symptom and the illness appeared to be of the nature of ""epidemic winter vomiting" which was reported here in 1954. -13- 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 hospit al is used for other 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 New Heston Road Thursday afternoon. (b) Infant welfare clinics 92 Bath Road Hounslow Tuesday, Wednesday, Thursday and Friday afternoons. Busch Corner, Isleworth Monday and Wednesday afternoons New Heston Road Monday and Tuesday afternoons. Friday morning. Cranford Memorial Hall Monday and Friday afternoons, (c) Immunisation and vaccination clinics 92 Bath Road Hounslow Wednesday afternoon Thursday morning. Busch Corner, Isleworth Tuesday (fortnightly) afternoon New Heston Road Tuesday (fortnightly) morning (d) Artificial Sunlight clinics (winter months) 92 Bath Road, Hounslow ) Tuesday and Friday afternoons Busch Corner, Isleworth) Tuesday and Friday afternoons (e) Dental clinics 92 Bath Road Hounslow ) Monday to Friday daily and Busch Corner, Isleworth) Saturday mornings, (f) Day nurseries Approved accommodation, Nantly House, Lampton Road 54 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 78 Lampton Road, Hounslow. (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, mentally 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. -14- (k) Prevention of Illness, Care and After-care. The care and after-care of tuberculosis 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. (1) 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 community, 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. 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. New Heston Road daily - mornings. Cranford Junior School daily - mornings. (ii) Medical consultation 92 Bath Road, Hounslow Tuesday and Friday mornings. Busch Corner, Isleworth Monday and Wednesday mornings. New Heston Road Thursday morning. Cranford Junior School Tuesday (fortnightly) - morning. (iii) Eye clinic 92 Bath Road, Hounslow Monday and Wednesday afternoons Monday morning Busch Corner, Isleworth Thursday morning (iv) Allergy clinic 92 Bath Road, Hounslow. Monday afternoons (v) Orthopaedic clinic 92 Bath Road, Hounslow. 4th Monday morning (vi) Physiotherapy 92 Bath Road, Hounslow. Wednesday and Thursday afternoons. Thursday morning. (vii) Dental clinic ) Artificial sunlight clinic ) (see under Health Department) Immunisation clinic ) (viii) Child guidance clinic Old Town 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. -15- 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, N.W.I. SANITARY CIRCUMSTANCES PHYSICAL CHARACTERISTICS- The Borough has an area of 7,218 acres and lies in the Thames Valley on the north bank of the river. Prom 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 do Church Meadow, Bath Road 9.20 do Children's Playground, Sutton Lane 0.60 do Kingsley Road Playing Field 0.95 do Greenhams Land, London Road 14.75 do St. John's Gardens, Isleworth 5.73 do Riverside Walk, Isleworth 0.75 do Children's Playground, Northcote Avenue 0.85 do Playground, London Road 1.84 do Bowling Green, Jersey Gardens 0.59 do Isleworth Promenade 1.0 do Heston Park 14.29 do Lampton Park 24.20 do Beaversfield Park 9.77 do Inwood Park 10.25 do Redless Park 16.47 do Jersey Gardens 7.87 do Football Ground, Denbigh Road 3.70 do Midsummer Children's Playground 1.52 do 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 44 shallow and 3 artesian wells serving 41 premises and of these 4 houses and 2 business premises are without an alternative supply. The following work in connection with water supplies was carried out during the year:- Supplies provided or reinstated 12 Cistern, cleansed, repaired, etc. 6 Draw-off taps connected direct to main Service pipes or taps repaired 13 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 1955:= Drains exposed for examination 86 Drains unstopped, repaired, etc. 353 Waste pipes repaired, trapped, etc. 55 Soil pipes repaired, etc 4 Ventilating shafts repaired, etc. 6 Fresh air inlets repaired, etc. 3 Rainwater pipes disconnected from drains 4 Gully traps inserted or repaired 13 Disconnecting traps inserted or repaired 6 Disconnecting and inspection chambers provided 25 Disconnecting and inspection chambers repaired, etc. 25 Drains constructed or repaired 5 Total length (ft,) of drain pipes laid - (a) 4" 68 (b) 6" 29 Drain tests applied 24 Other works executed 7 Cesspools emptied or repaired 1 Cesspools abolished 1 -16- While the Borough is responsible for the local sewerage of its own district, the duty of the disposal of sewerage is the responsibility of the 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. In recent years the increasing use of synthetic detergents has given rise to difficulties at the disposal works. Apart from some interference with the purification process, parts of the works have at times been buried in foam. Research at the works has succeeded in overcoming the foam problem - at considerable annual cost and efforts are continuing to secure an effluent of the highest standard of purity. RIVERS AND STREAMS- No complaint of pollution was made to the Health Department during 1955. A watch is kept on streams for evidenc of breeding of mosquitoes. The County Council has started systematic sampling of the River Brent at fixed points at monthly intervals. Samples are also taken of surface waters which are suspected of causing pollution. The Department co-operates in the tracing of possible sources of pollution and in seeking a remedy where pollution is proved. 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 10 Water closets provided in substitution for dry receptacles,,etc. 3 Water closets where walls cleansed 14 Water closets fitted with new flushing apparatus 16 New pans or pedestals provided 40 Water closets repaired or improved 72 Water closets blockages unstopped 8 Other closets provided or repaired 3 Urinals constructed, rebuilt or repaired 8 PUBLIC CLEANSING - The cleansing of streets and 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 the action of the Health Department 34 new dustbins were provided during the year. Salvage continues to be collected at the same time as refuse and is segregated before sale. The collection of kitchen waste was discontinued in January, 1954. The returns for the past five years are as follows:- 1951 1952 1953 1954 1955 Paper (tons) 1,111 1,023 986 1,000 897 Scrap metal (tons) 78 89 84 90 38 Textiles (tons) 57 50 41. 27 34 Bottles, jars (tons) 63 10 11 17 4 Cullet (tons) 4 7 - 3 - Kitchen Waste (tons) 1,032 929 822 9 Total Income £20,902 £15,614 £11,440 £8,705 £8,490 Recruitment of staff for this work is not easy and the public could help by seeing that dry refuse only is placed in bins and that gates are unbarred on the usual day of collection. Throughout the Borough litter is to be found in our streets, parks and open spaces and ranges from discarded bus tickets to "any old iron" . While it has to be admitted that there may be difficulties in disposing of garden refuse and items that cannot be burned easily much of the unsightliness arising from litter is due to carelessness and lack of consideration. The Health Department can act only if the the deposits are "prejudicial to health or a nuisance" as defined in the Public Health Acts and this is seldom the case. 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 -17- 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 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 as is known how and where the matter may receive attention. Some particulars of the work done are shown below:- Inspections following complaint 1,432 Number of premises at which nuisance, etc. were located 752 Number of premises where defects were remedied (a) by owners or occupiers 586 (b) by Council in default 12 (c) public sewers repaired by Council 23 Informal notices issued 337 Written reminders issued 732 Statutory notices served 20 Total number of inspections and re-inspections 22,133 Inspections of piggeries 16 Inspections of stables 25 Inspections of urinals 161 Sinks provided or repaired 23 Roofs repaired 159 Gutters repaired or renewed 134 Brickwork, sills etc., repaired or renewed 285 Premises provided with damp proof courses 7 Sites covered with impervious material 8 Yards and forecourts paved or drained 22 External painting 44 Rooms stripped, cleansed and redecorated 575 Floor, walls and ceilings repaired or renewed 654 Rooms in which ventilation provided or improved 9 Rooms in which lighting provided or improved 1 Windows repaired or renewed 396 Doors and other woodwork repaired or renewed 129 Staircases replaced or repaired 13 Lighting to staircase provided or improved Handrails or balusters repaired or renewed 7 Grates provided or repaired 75 Instances where ventilation under floor provided or improved 13 Larders provided or repaired 6 Domestic cleansing enforced 19 Improper keeping of animals abated 6 Offensive accumulations removed 28 Other repairs carried out or nuisances abated 123 Visits re infectious diseases, etc. 942 Complaints continue to be received of nuisance cause 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. They foul premises and by damage to cement and mortar expose brickwork to attack by rain and frost. The department does what it can to assist and advise complainants, but it must be pointed out that the Council has no power to catch or destroy pigeons on private property or to spend money for such a purpose. 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 not exceeding £5 Here the difficulty is to secure the name and address of the offender and of witnesses willing to testify. EXCHANGE OF ARTICLES FOR RAGS, etc. - Under the Public Health Act, 1936, it is an offence for any person who collects or deals in rags, etc., to sell or deliver, whether gratuitously or not, any article whatsoever to a child under the age of 14 years in exchange for rags etc. The Police notify the Council of any such contraventions coming to their notice. During the year, a person was prosecuted and a fine of £2 with 2 guineas costs was imposed. 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 147 smoke observations and paid many visits to premises in regard to which complaints of smoke nuisance had been received, One smoke nuisance proved, was due to faulty stoking. With the co-operation of the -18- Education Department, a course on boiler house practice was arranged at Spring Grove Polytechnic, but the attendance was disappointing. Complaints about the quality of fuel are still too frequent, while defects in plant and inadequate training of stokers receive too little attention. The Council co-operates with the Department of Scientific and Industrial Research by measuring atmospheric pollution in the Borough. 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 analysis 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. So per day per 100 sq.cm.) Rainfall (inches) Deposit (tons per sq. mile) Sulphur (Mgms. So per day per 100 sq. cm.) January 2.21 13.21 1.39 2.09 10.88 1.22 February 1.26 11.74 1.21 1.18 13.55 1.19 March 0.87 9.13 1.16 1.00 10.13 1.22 April 0,32 7.01 0.66 0.39 10.47 0.74 May 3.31 8.66 0.99 3.23 7.08 1.02 June 2.21 10.43 0.84 2.14 7.03 0.85 July 0.20 6.20 0.42 0.24 4.46 0.33 August 0.67 4.62 0.40 0.67 4.53 0.53 September 1.81 5.75 0.49 1.85 7.13 0.50 October 3.43 9.41 1.16 3.35 9.83 1.17 November 1.10 6.88 0.72 0.95 7.33 1.06 December 1.89 10.03 1.16 1.69 9.05 1.13 Average 1.61 8.59 0.88 1.56 8.46 0.92 Average 1952 - 1954 1.97 9.22 0.96 2.00 9.46 1.02 In general, atmospheric pollution in the Borough was less in 1955 than in the previous three years. The continuing rise in coal prices may do more than the years of propaganda to encourage fuel economy and so reduce smoke. 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 716 visits of inspection because of the occupation of land by caravans, Tresspass by caravans on unfenced land continues. Two new applications under the provisions of the Middlesex County Council Acts for permission to place caravans on sites within the Borough were considered. Both were refused. COMMON LODGING HOUSES There is no common lodging house in the Borough. CANAL BOATS The Sanitary Inspectors continue their duties as canal boat inspectors, and made 53 inspections during the year. FACTORIES, WORKPLACES, etc. - The Factories Act placed on the Council certain duties in regard to (a) outworkers: (b) employment of persons in unwholesome premises; (c) basement bakehouses; (d) provision of sanitary conveniences in all factories, and (e) cleanliness, over-crowding, ventilation and drainage of floors in the case of factories in which mechanical power is not used. A summary of the work done is given below and in Table IX Inspection of (a) Factories - mechanical power 654 (b) Factories - non-mechanical power 43 (c) Other premises 10 (d) Workplaces 12 (e) Outworkers' premises 204 Defects remedied 15 At the end of the year the number of outworkers registered with the Department was 197. -19- 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, 117 rooms in 43 houses were treated, while 31 wasp nests were destroyed, 6 premises cleared of cockroaches, one cleared of ants, and four of other insects. Treatment of ponds and tanks to prevent the breeding of mosquitoes was carried out as necessary, 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 three factories. Day and night observations were made concerning these complaints and in conjunction with the firms concerned, measures were taken to reduce the noise as far as was practic able. RATS AND MICE DESTRUCTION etc The Prevention of Damage by Pests Act, 1949, places the responsibility on the Council to keep their area as far as practicable, free from rats and mice!" and occupiers of premises are required to give notice when they have knowledge that rats and 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 their 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 1 rats coming from next door,'' no gross infestation should excape attention. The Council employs a RodentOfficer who is responsible for systematic inspection, plannincr frpaImpnt simprv.isine the work of the rodent ooeratives and checking results,, A summary of the work done in recent years is shown below:- 1951 1952 1953 1954 1955 Complaints received 607 618 527 533 692 Block inspections 89 51 46 43 66 Individual inspections and re-inspections 3 371 5,110 4,970 4,381 4,541 Other visits 438 614 654 503 419 Premises treated (a) By occupier 19 41 7 18 15 (b) By Local Authority 743 1,075 930 883 1,004 Test baiting and where necessary, treatment is carried out to sewers, watercourses, tips, etc. Destruction of part of the rat population by chemical or other poisoning may increase the food supply and improve the chances of survival of the remainder. Eradication requires environmental conditions which hinder survival, i.e., no food and no shelter and occupiers of premises should bear this in mind. SHOPS ACT , 1950, SECTION 38 = Shops require to be reasonably ventilated, heated and lighted, and there should be suitable and sufficient sanitary and washing facilities for the persons employed therein. In this connection 30 inspections were made during the year. One certificate of exemption re provision of sanitary accommodation was grantee. RAG FLOCK AND OTHER FILLING MATERIALS ACT , 1951- This Act is designed to ensure that filling materials used in upholstery, etc., comply with prescribed conditions of cleanliness. Premises using filling materials have to be registere -20- 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, five premises in the Borough have been registered and the Sanitary Inspectors made three visits of insnectin. 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 useage of the three municipal baths are shown below:- Hounslow. Heston. Isleworth. Area of bath major 75' x 30' 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 1955 119,244 155,452 122,466 Maximum number of persons using swimming bath on any one day 967 1,628 1,020 No. of slipper baths Male 15 - 11 female 9 - 11 No. of persons using slipper baths during 1955 42,610 - 24,061 The baths waters are treated by continuous filtration and chlorination. At all 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 six samples of baths water were taken and all were found to be satisfactory. VERMINOUS PREMISES AND ARTICLES No action had to be taken under Sections 83 and 84 of the Public Health Act, 1936. VERMINOUS PERSONS No verminous person was cleansed under the provisions of Section 85 of the Public Health Act, 1936. During the year 133 children in attendance at schools in the Borough were found to be verminous and because of the failure of parents to take necessary action 39 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. It is not confined to school children and is found in factory and workplace. Only too often school children after being cleansed, become re-infested at home. The problem of the persistently verminous children or family is a difficult one and is usually not one of uncleanliness alone. It is merely a feature of something more fundamental and only by finding and removing the real cause of this failure of social adaptation can there be a chance of lasting improvement. PET ANIMALS ACT , 1951 - This Act 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. Under the provisions of this Act, seven premises in the Borough have been licensed and 39 visits of inspection were made during the year. ATMOSPHERIC POLLUTION • Council houses erected in recent years have been fitted with grates designed to burn coal and/or smokeless fuels. During the winter the Sanitary Inspectors, calling at such premises in the course of their duties, made enquiries about the use of smokeless fuel etc. and the results are summarised below:- 1. Do you know that your grate is designed to burn coke or other smokeless fuel ? Yes - 55 (94.8%) No - 3 ( 5.2%) 2. Have you tried Coke ? 42 (71.4%) Coalite ? 15 (25.9%) Anthracite ? 6 (10.3%) Other smokeless fuel? 1 ( 1.7%) 3. What do you burn now ? Coal ? 22 (37.7%) Coal and coke ? 24 (41.4%) Coal and coalite ? 1 ( 1.7%) Coke ? 11 (19.0%) 21 4. Why do you not use smokeless fuel ? Too expensive ? 9 (15,5%) Difficult to obtain ? 6 (10.3%) Not sufficient heat ? 10 (17.1%) No reply 33 (56.9%) 5. Do you bank your fire overnight ? Yes - 10 (17.1%) No - 48 (82.8%) The number of households concerned is too small to justify any firm comment, but broadly the enquiry indicates that (a) the majority have tried smokeless fuels (b) such trials have not resulted in the general use of smokeless fuels (c) smokeless fuels when used are frequently mixed with coal and (d) banking of fires overnight (Usually with coal slack) is fairly prevalent. Pew householders appreciate the contribution made to atmospheric pollution by domestic consumption of raw coal This, coupled with the cost and delays in delivery of smokeless fuels, is retarding the progress towards clean air. INSPECTION AND SUPERVISION OF FOOD MILK - during the year, 89 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 50 for the sale of "sterilised" milk were issued. 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". Complaints of milk being supplied in dirty bottles continue to be received The number is very small in relation to the large issue to the public. The trade provides machinery and plant which is adequate to cleanse milk bottles which have not been misused, but more care is needed to see that those which have not been adequatelycleansed are removed on leaving the washing plant. The consumer can also help by the hygienic care of the bottles. They should never be used for any other purpose than to hold milk,. After use, they should be well rinsed in cold water to remove any milk residue. 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 230. The Ice-Cream (Heat Treatment, etc.) Regulations require all ice-cream except complete cold-mix powders, to be heat treated with a view to killing any pathogenic organisms which may be present and lay down the temperatures at which mixtures are to be kept before and after heat treatment these temperatures are such as to discourage bacterial growth The Regulations also require that ice cream shall be protected from dirt, dust or other contamination. The enforcement of these Regulations calls for regular and persistent supervision of premises, plant and methods of manufacturing and handling. During the year, 406 inspections of registered premises were carried out The following results were obtained from the bacteriological examination of the following samples:- Satisfactory Doubtful Unsatisfactory Ice-Cream 43 3 1 Water ices or "lollies" 27 2 3 Milk ices - - - Rinse water 1 - - The percentage of doubtful and unsatisfactory samples was 11.4, as compared with 3.4 in 1954, 3,6 in 1953, 31.9 in 1952 and 32.5 in 1951 Most of the ice-cream sold in the Borough is now produced by large firms employing chemists and bacteriologists to check the quality and hygienic condition of their product. BAKEHOUSES There are 21 bakehouses in the Borough and 93 visits of inspection were made during the year. 22 SLAUGHTERHOUSES, etc. - There is no public abattoir, private slaughterhouse or knacker's yard operating in the Borough. SLAUGHTER OF ANIMALS (AMENDMENT) ACT, 1954 - Four applications for a licence as a slaughterman, granted under the 1933 Act remained in operation till 30th September. No applications for licences have been received under the provisions of the new Act. INSPECTION OF MEAT AND OTHER FOODS - There are in the Borough 145 catering establishments, 21 bakeries, 73 butchers' shops, 30 fish shops and 363 other retail food premises subject to inspection and supervision. During the year inspections of food were carried out as follows:= meat, 673, fish, 161; provisions, 318; vegetables and fruit, 151; foodstuffs on hawkers' vehicles or stalls, 108; and other foods, 475. At retail premises 5,829 lbs. and 4,591 tins etc. of unsound food were seized by or surrendered to the Sanitary Inspectors during the year. The following foods were brought to the Department because the purchasers were not satisfied that they were fit for human consumption;- Bread, 10 lemon curd, 1; sugar, 1; sponge cake, 1; Christmas cake, 1: fish cakes, 4; savoury food, 1 and cordial, 1. In 14 cases foreign bodies were found to be present cautions were issued in 11 cases while the Health Committee issued formal warnings in 2 cases and instituted proceedings in one case which resulted in a fine of £2. with 1½ guineas costs. The complaint in regard to sugar was not established, but proceedings re the fish cakes brought a fine of £2. with 21/- costs. The Christmas cake, on analysis, was found to be satisfactory, but the makers refunded the purchase price. Premises used for J the preparation or manufacture of sausages or potted, pressed pickled or preserved food for sale95 are required under the Food and Drugs Act, 1938, to be registered, and at the end of the year, 99 such premises were registered. Under Section 11 of the Middlesex County Council Act, 1950, hawkers of food and their storage premises require to be registered. At the end of the year, 63 hawkers were on the register. MUNICIPAL RESTAURANTS AND SCHOOL CANTEENS - There is no municipal restaurant in the Borough, but during the year the 19 school canteens provided 1,337,076 meals. By the provision of new schools and the replacement or improvement of school canteens established during the war, the facilities for meals at schools are being brought up to modern standards. FOOD AND DRUGS SAMPLING During 1955 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 146 14 Butter 14 - Cakes 8 - Cake Mix 1 - Cheese 7 1 Coffee and chicory essence 1 - Cocoanut, shredded 1 - Cooked meats 7 - Crab meat 1 - Cream 11 - Curry powder 1 - Drugs 21 - Fish 16 1 Fish paste 2 - Fruit juice 1 - Fruit sundae 1 - Ice cream 3 - Jelly 2 - Lard 2 - Liver 11 - Margarine 1 - Meat paste 2 - Peas (tinned) 3 - Minced meat 7 - Mincemeat 2 - Pears 1 1 Non-brewed condiment 4 - Oranges 3 - Pickles 2 - Preserves 5 - Sausages and sausage meat 10 - Sweets 2 - 23  No of Samples No. found unsatisfactory Soups 1 - Self raising flour 1 - Sphagetti in tomato sauce 1 - Tomato sauce 2 - Victoria plums 7 - Vinegar 13 - Suet 1 - Wines and spirits 26 - 351 17 The Chief Officer of the Public Control Department submitted the following comments with regard to the samples noted as unsatisfactory:- "Milk. These fourteen samples were all of new milk taken on delivery from farmers to premises in your Borough, four farmers in all being involved. In two cases the samples were found to be slightly deficient in fat, but associated samples were genuine and therefore no action was taken. Regarding the remaining two cases, in one case the milk was deficient in solids-not-fat, but here again associated samples were genuine and no further action was taken. In the other case the samples were found to be deficient in fat and solids-not-fat. Formal samples were procured and all proved to be genuine. Cheese. This sample was sold as "cream cheese", but was found to be processed whole milk cheese. An official caution was issued. Fish. A sample sold as "sliced smoked salmon" was found to be dyed smoked coal-fish. It was packed and imported from Germany. The importers were officially cautioned. Pears. Imported Italian pears contained an excess lead content due, through the use abroad, of poisonous insecticides. An official caution was issued to the importers in respect of this sample." The following work in connection with the inspection and supervision of food in the Borough was carried out by the Public Control Department:- Merchandise Marks Acts, 1887-1926. 226 inspections of premises were undertaken to ensure that the Marking Order relating to certain imported foodstuffs made under the Merchandise Marks Act, 1926 were complied with. 1,241 separate displays of meat apples, tomatoes, poultry and dried fruit were examined. No serious infringement was disclosed. The Labelling of Food Order, 1953. This Order requires, inter alia, that in general pre-packed foods shall bear on the label, a clear statement of the designation of the food and in the case of compound foods the ingredients. It also requires that the name and address of the packer or labeller appears. At 88 premises 323 articles or pre-packed food was examined. No substantial infringements were discovered. Special Designated Milk. During the year in question three firms were licensed by my Council to use the special designation " pasteurised" in respect of milk processed at premises within the Borough of Heston and Isleworth. Each premises was inspected regularly and compliance with the requirements of the Act or Regulations was maintained in each case. 146 samples were taken, all of which were correct. Safe Milk. In addition to the foregoing, 41 samples of raw milk were procured within the Borough and submitted to test for the presence of tubercle bacilli. None was found contaminated." FOOD HYGIENE - The work of promoting sound standards of hygiene in food premises has been steadily pursued. As far as possible, the plans of all premises which will be associated with the preparation and sale of food are examined. In this way it is possible to influence the standard of premises and equipment and consultation on these matters is velcomed. During the year, 1,968 visits of inspection were paid with a view to securing "clean food, handled by clean hands and transported, prepared and stored under clean conditions" and as a result of these visits the following works were carried out:- Cold water supplies provided, repaired or improved 1 Hot water supplies provided, repaired or improved 5 Water closets provided, repaired or improved 5 Sinks provided and waste pipes repaired 6 Ventilation provided or improved 1 Drainage provided or repaired 31 Dustbins provided 12 24 Walls and ceilings repaired or cleansed 51 Floors repaired 5 Premises cleansed 9 Protection of foodstuffs enforced 5 Equipment repaired or improved 14 Offensive accumulations removed 6 Nuisances abated and other action 11 Food Stores provided, improved or cleansed 6 Lighting improved 1 While well designed and equipped premises are important, they only fulfil their real purpose when associated with hygienic habits in their users. Man in the source of most food infections and if he desires clean food he must practice personal hygiene If every mother obeyed in her kitchen the same rules she wishes to see obeyed in shops and restaurants and brought up her family to obey these rules instinctively, it would mean much for the future These children will not only be the housewives of the future, but also the future cooks and food handlers. Schools are doing something to teach children to treat food as it should be treated, but the best place for children to be introduced to hygienic habits is at home, where they should be part of the child's natural background. There is a wide field of consumer's choice as far as food shops and catering premises are concerned. If the public make their choice with firmness and discretion the trade will respond and the number of complaints would decrease. NUTRITION - 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 five years. The distribution of these welfare foods is now the responsibility of the local health authorities. Though this now links the scheme closely with the maternity and child welfare services, the use made of these facilities by mothers is still below expectation. 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 these facilities:- No. of pupils present % taking milk % taking meals February, 1952 12,291 79.7 54.4 June, 1952 12,410 83.9 51.7 October. 1952 13,062 81.8 53.3 June, 1953 12,954 83.5 44.6 October, 1953 13,375 83.2 45.8 June, 1954 12,943 83.4 44.3 October, 1954 13,743 81.2 47.2 September, 1955 13,633 82.4 50.0 Gross malnutrition is not seen in this country now , though no doubt there is still much nutritional defect of a lesser degree. Quantity of food is not the only consideration in maintaining a good level of nutrition. A careful selection of essential foods in balanced proportions is important and now that adequate supplies are available the temptation to consume carbohydrates and fats rather than body building foods should be watched, especially in children. HOUSING Shortage of houses continues to be one of our social problems. The compulsory and prolonged sharing of houses by families causes physical discomfort, but also leads to frustration and discontent. Scarcity of separate accommodation makes the start of family life difficult for the unmarried and the bearing and rearing of children difficult for the married. A house is not fulfilling its true social purpose unless it is also a home and it can seldom be a home if occupied by more than one family. The numbers of new houses erected in the Borough in recent years is shown below:- 1946-51 1952 1953 1954 1955 Heston and Isleworth B,C. 1001 162 117 23 217 Brentford and Chiswick B.C. 34 - - - - Southall B.C. 64 - - - - Middlesex County Council 4 - - - 1 Ministry of Civil Aviation 77 - - - - Metropolitan Police 12 6 - 11 Prison Commissioners - - - 8 10 25  1946-51 1952 1953 1954 1955 Private enterprise - (a) new houses 138 24 27 76 219 (b) reconstructed after war destruction 184 1 - - - (c) housing associations - 50 140 1ll 39 (d) additional dwellings by conversion - - 3 - - 1592 249 293 218 497 What action is to be taken concerning unfit houses is governed by the cost of the necessary works. Unless the house is capable at reasonable expense of being rendered fit " action must be in the direction of closing or demolition. "Reasonable expense" has never been defined and with restrictions on rents and the high cost of repairs, its interpretation is far from easy, but the Housing Repairs and Rents Act, 1954 has now defined the matters to be taken into consideration in assessing fitness for human habitation. The action taken in insanitary and unfit dwelling houses during the year is summarised in the following return which has been submitted to the Ministry of Housing and Local Government:- 1. INSPECTION OP DWELLING-HOUSES DURING THE YEAR: (1) (a) Total number of dwelling-houses inspected for housing defects (Under Public Health and Housing Acts): 327 (b) Number of inspections made for the purpose: 406 (2) (a) Number of dwelling-houses (included under head (1) above) which were inspected and recorded under Housing Regulations, 1925 and 1932: 123 (b) Number of inspections made for the purpose: 200 (3) (a) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation: 51 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation: 177 2. REMEDY OP DEFECTS DURING THE YEAR WITHOUT SERVICE OF FORMAL NOTICES: Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their Officers 256 3. ACTION UNDER STATUTORY POWERS DURING THE YEAR: (a) Proceedings under sections 9, 10 and 16 of the Housing Act, 1936. (1) Number of dwelling-houses in respect of which notices were served requiring repairs: 12 (2) Number of dwelling houses which were rendered fit after service of formal notices: (a) by Owners. 10 (b) by Local Authority in default of owners: 11 (b) Proceedings under Public Health Acts: (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied: 4 (2) Number of dwelling houses in which defects were remedied after service of formal notices: (a) by Owners: 2 (b) by Local Authority in default of owners NIL (c) Proceedings under sections 11 and 13 of the Housing Act, 1936: (1) Number of dwelling-houses in respect of which Demolition Orders were made: 11 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders: NIL 26 (3) Number of dwelling-houses rendered fit in consequence of Undertakings given by Owner: 2 (4) Number of dwelling-houses in respect of which undertakings from owners accepted, not to relet houses for human habitation: 5 (5) Number of dwelling-houses demolished in pursuance of Undertakings: 13 (d) Proceedings under section 12 of the Housing Act, 1936: (1) Number of separate tenements, or underground rooms in respect of which Closing Orders were made: 1 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit: NIL (e) Proceedings under section 155 of the Housing Act, 1936: Number of prosecutions taken for letting, attempting to let, occupying or permitting to occupy houses ordered to be closed: NIL (f) Housing Act, 1949= and Local Government (Miscellaneous Provisions) Act, 1953: (1) Demolition Orders Quashed NIL (g) Local Government (Miscellaneous Provisions) Act, 1953: (1) Demolition Orders determined and Closing Orders substituted NIL (2) Closing Orders made under section 10(1) 2 (3) Number of dwelling-houses demolished 1 4. HOUSING ACT, 1936 - OVERCROWDING: (1) (a) Number of dwellings overcrowded at the end of the year: 41 (b) Number of families dwelling therein: 74 (c) Number of persons dwelling therein: 317 (2) Number of new cases of overcrowding reported during the year: 9 (3) (a) Number of cases of overcrowding relieved during the year: 13 (b) Number of persons concerned in such cases: 93 (4) Particulars of any case in which dwelling-houses have again become over-crowded after the Local Authority have taken steps for the abatement of overcrowding: NIL 5. OTHER MATTERS: (1) Number of dwelling-houses demolished voluntarily: 4 Section 26 of the Housing Repairs and Rents Act, 1954, permits a tenant on whom a M repairs increase1" notice has been served, to apply to the Council for a certificate that either or both of the conditions justifying an increase of rent (in good repair and reasonably suitable for occupation) are not fulfilled and the Counci if satisfied that the house fails to fulfil either or both conditions, must certify accordingly and while such a certificate is in force "no sum shall be recoverable b; way of repairs increase". During the year, 27 such certificates were issued. On the application of the landlord, the Council must revoke the certificate, if the works necessary to comply with both the conditions justifying an increase in ren have been carried out to their satisfaction. During the year, 28 such certificates were revoked. At the end of the year, the following 37 houses, subject to Demolition or Closing Orders or to undertakings not to re-let till rendered fit, were still occupied:- Situation Date of Demolition Order or Undertaking 14, Brickfield Yard 25.10.38 16, Brickfield Yard 25.10.38 18, Brickfield Yard 25.10.38 3, Park Cottages 28.12.38 27 Situation Date of Demolition Order or Undertaking 4, Park Cottages 28.12.38 11, Tivoli Road 28. 2.39 13, Tivoli Road 28. 2.39 106, Linkfield Road 28. 3.39 49, Hanworth 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. 7.39 102, Linkfield Road 22. 2.49 721, London Road 29. 3.49 8, New Heston Road 31. 1.50 159, Martindale Road 25. 7.50 165, Martindale Road 25. 7.50 67, Pears Road 29. 4.52 169, Martindale Road 30. 9.52 133, Grove Road 30. 3.54 135, Grove Road 30. 3.54 139, Grove Road 30. 3.54 43, Pears Road 26. 4.55 68, Talbot Road 28. 6.55 10, Ivy Road 28. 6.55 2, Algar Road 26. 7.55 4, Algar Road 26. 7.55 58, The Grove 29.11.55 31, Hibernia Road 29.11.55 1, Castle Place 29.12.55 2, Castle Place 29.12.55 3, Castle Place 29.12.55 4, Castle Place 29.12.55 5, Castle Place 29.12.55 6, Castle Place 29.12.55 14, Linkfield Road 29.12.55 All these houses are Incapable of being made fit at a reasonable cost and in each case the owner has had full opportunity to submit to the Council any proposals for their retention and to object to the action taken by the Council. The continued occupation of these unfit houses is a matter of some concern especially as local authorities are now asked to give special attention to unfit houses. In compliance with the Housing Repairs and Rents Act, 1954, the Council has submitted their proposals for dealing with unfit houses to the Minister of Housing and Local Government. The Housing Department is kept informed of adverse housing conditions coming to the notice of the Health Department and assistance is given in the assessment of applications for re-housing where priority on medical grounds is claimed. At the end of the year the Council was managing 3,260 Council houses, 105 requisitioned premises (including 5 rest centres) and 39 premises loaned to them by the Ministry of Transport and Civil Aviation. During the year the Council approved expenditure as under = (a) advances of £403,605 under the Small Dwellings acquisition Acts in relation to 269 houses (b) improvement grants of £5075 under section 20 of the Housing Act, 1949 in relation to 24 houses (c) repairs loans of £2018 under section 4 of the Housing Act, 1949 in relation to 8 houses (d) repair costs of £621 under section 9 of the Housing Act, 1939 in relation to 7 houses. 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 1955, three 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 maintenance of the Acton Mortuary. MEDICAL EXAMINATION OF STAFF - For superannuation or other purposes 30 members of the Council's staff were referred to the Health Department for medical examination. GENERAL MATTERS 28 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 co-operated by displaying health educational material. People will submit to hygienic procedures which do not involve them in any personal effort, but will avoid anything which demands positive action or initiative on their part. This is the real problem of health education, but there are indications that people are beginning to appreciate the importance of personal effort in the maintenance of health. PERSONS IN NEED OP CARE AND ATTENTION - Section 47 of the National Assistance Act, 1948, places the responsibility on the Council of taking action to secure " the necessary care and attention for persons who:- (a) are suffering from grave chronic disease or, being aged, infirm or physically incapacitated are living in insanitary conditions and (b) are unable to devote to themselves, and are not receiving from other persons, proper care and attention " The action to be taken involves application to the Court for an Order for the compulsory removal of the person concerned to the 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. Despite the growing interest of statutory and voluntary agencies in the welfare of the aged, cases come to the notice of the Department of neglected aged persons living in insanitary conditions. Such persons are usually most reluctant to accept assistance or to go to hospital or institution, but fortunately, in most cases, peaceful persuasion secures their co-operation in some degree and the necessary action can be taken. In no case was it necessary to seek authority to apply for an Order. LAUNDRY SERVICE - One of the problems in the care of aged and sick persons in their own homes is soiled clothing and bed linen. Where washing facilities are poor and the persons concerned neither have nor can afford assistance, the cleansing of clothing and bedding presents serious difficulty. In some cases, action under Section 84 of the Public Health Act, 1936, is the-only solution and the Council has made arrangements with a laundry firm for the cleansing of articles where the Medical Officer of Health has issued the certificate required by the Act. The number of cases in which such action has been necessary is small, but the provision of these facilities has met a genuine need. 29 TABLE 1 Summary of Vital Statistics 1986-1955. Estimate d Civilian population (mid-year) Birth Rate per 1,000 populalation Death Rate per 1,000 populalation Infant Mortality Rate Deaths under lyr. per 1,000 live births Neo-natal Mortality Rate Deaths under lmth. per 1,000 live births Maternal Mortality Rate per 1,000 live and still births Still Birth Rate per 1,000 live and still births Tuberculosis Death Rate per 1,000 populaltion 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 - - - 1.2 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 9.7 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 191,100 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 16 0.2 1953 105,100 12.1 10.1 18 11 0.8 19 0.1 1954 105,600 11.2 9.6 26 19 0.0 20 0.1 1955 105,500 11.0 10.6 24 17 0.0 17 0.1 30 TABLE II REGISTRAR GENERAL' S RETURN OF CAUSES OF DEATH, 1955. Abridged List No. Cause of Death Male Female Total B 1 Tuberculosis, respiratory 10 4 14 B 2 Tuberculosis, other 1 - 1 B 3 Syphilitic disease 3 1 4 B 8 Diphtheria - - - B 9 Whooping Cough - - - B 10 Meningococcal infections - - - B 12 Acute poliomyelitis — - - B 14 Measles - - - B 4-7; 11 15- 17 Other infective and parasitic diseases - 2 2 B 18 Malignant neoplasm, stomach 20 15 35 Malignant neoplasm, lungs 35 7 42 Malignant neoplasm, breast - 16 16 Malignant neoplasm, uterus - 10 10 Other malignant and lymphatic neoplasms 47 59 106 Leukaemia, aleukaemia 4 1 5 B 20 Diabetes 3 1 4 B 22 Vascular lesions of nervous systems 83 83 166 B 26pt Coronary disease, angina 103 60 163 B 28 Hypertension with heart disease 22 15 37 B 25 26pt. 27 Other heart disease 62 75 137 B 29 46pt. Other circulatory disease .. 23 23 46 B 30 Influenza 1 3 4 B 31 Pneumonia 27 19 46 B 32 Bronchitis , 37 21 58 B 46pt, Other respiratory diseases 10 5 15 B 33 Ulcer of stomach and duodenum 7 1 8 B 36 43pt„ Gastritis enteritis, diarrhoea 5 2 7 B 38 Nephritis and nephrosis 3 2 5 B 39 Hyperplasia of prostate 9 - 9 B 40 Pregnancy childbirth, abortion - - - B 41 Congenital malformations 6 4 10 Residial Other defined and ill-defined diseases 46 76 124 B E 47 Mator vehicle accidents 10 4 14 B E 48 All other accidentB 7 11 18 B E 49 Suicide 5 3 8 B E 50 Homicide and operations of war - - - Total 591 523 1114 31 32 TABLE III INFANTS' DEATHS ACCORDING TO AGE AND CAUSE, 1955 Cause of Death Age Total Days Months under 1 1 2 3 4 5 6 7=13 14- 20 21-28 1 2 3 4 5 6 7 8 9 10 11 Pneumonia - - - - - - - — - - 2 - - - - - - - - - - 2 Bronchitis - - - - - - - - - - 1 - - - - - - - - - 1 Birth injuries - - - 1 - - - - 1 - - - - - - - - - - - - 2 Atelectasis & birth asphyxia 4 - 1 1 - - - - - - - - - - - - - - - - - 6 Congenital malformations 2 - 1 - - - - - - - - - - 1 - 1 - 1 - - 1 7 Prematurity 4 - 1 - - - 1 1 - - - - - - - - - - - - - 7 Lung abscess - - - - - - - - - - - - - - - - - - 1 - - 1 Meningitis - 1 - - - - - - - - - - - - - - - - - - - 1 Haemorrhagic disease 1 - - - - - - 1 - - - - - - - - - - - - - 2 TOTAL 11 1 3 2 - - 1 2 1 - 2 1 - 1 - 1 - 1 1 - 1 29 TABLE IV. CAUSES OF DEATH ACCORDING TO AGE AND SEX, 1955. 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 6^69 70-74 75-79 80-84 86 k 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 10 4 — — — — — — — — — — — — — — — — — — — — — — — 1 — 1 1 — — 1 2 1 2 — 1 — 1 — 2 — — — — — B 2 Tuberculosis, other forms 1 — — — — — — — — — — — — — — — — — — — — 1 — — — — — — — — — — — — — — — — — — — — — — B 3 Syphilis and its sequelae 1 1 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 1 — — 1 — — B 4 Typhoid fever — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — B 5 Cholera — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — B 6 Dysentery, all forms — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — B 7 Scarlet fever and streptococcal sore throat — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — B 8 Diphtheria — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — B 9 Whooping Cough — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — B 10 Meningococcal infections — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — B 11 Plague — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — B 12 Acute poliomyelitis — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — B 13 Snail pox — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — B 14 Measles — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — B 15 Typhus and other rickettsial diseases — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — B 16 Malaria — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — B 17 Other infective and parasitic diseases — 1 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 1 — — — — — — — — — — B 18 Malignant neoplasms - stomach 21 14 — — — — — — — — — — — — — — — — — — — — — 2 — — — — — — 3 1 1 1 6 — 4 — 3 1 2 5 2 3 — 1 lungs 33 8 — — — — — — — — — — — — — — — — — — — — — — — 1 — — — 1 3 2 6 — 8 1 6 — 8 — 2 1 — 2 — — breast 17 — — — — — — — — — — — — — — — — — — — — — — — — — 1 — 1 — 5 — 1 — 1 — — — 2 — 1 — 2 — 2 uterus 9 — — — — — — — — — — — — — — — — — — — — — — — — — 1 — 1 — — — 1 — 1 — 2 — 2 — — — 1 — — other sites 47 57 — — — — — — — — — — — — — — — — — — — 1 2 — 1 1 1 1 6 2 3 7 4 4 7 5 9 7 6 8 5 9 3 7 — 5 leukaemia, etc. 4 1 — — — — — — — — — — — — — — — — — — — — — — — — — — — — 2 — 1 — — 1 — — 1 — — — — — — — B 19 Benign and unspecified neoplasms — 1 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 1 — — — — — — — — — — — — — B 20 Diabetes 3 1 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 1 1 — 2 — — — — — — — B 21 Anaemias 1 1 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 1 — — — — — — 1 — — — — — — — B 22 Vascular lesions affecting central nervous system 82 87 — — — — — — — — — — — — — — — — 1 — — — — — — — 1 — — — 1 2 3 2 10 7 10 13 18 17 23 15 9 18 6 13 B 23 Non-meningococcal meningitis 2 — 1 — — — — — — — — — — — — — — — — — — — — — — — — —— — — — —— — — 1 — — — — — — — — — — — B 24 Rheumatic fever — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — B 25 Chronic rheumatic heart disease 8 10 — — — — — — — — — — — — — — — — — — — — — — — — 1 — 1 — — 1 2 — 1 2 1 1 — 1 2 3 — 2 — — B 26 Arteriosclerotic and degenerative heart disease - coronary disease, angina 108 63 — — — — — — — — — — — — — — — — — — — — — — — — 3 — 5 — 11 3 10 5 18 7 14 9 22 15 13 5 9 15 3 4 other 40 56 — — — — — — — — — — — — — — 1 — — — — — — — — — 1 — — — — — 1 — 1 — 1 3 3 2 5 10 12 20 15 21 B 27 Other diseases of the heart 14 10 — — — — — — — — — — — — — — — — — — — — — — — — 1 — — 1 — — 2 — — 2 1 1 5 2 2 1 3 2 1 B 28 Hypertension with heart disease 21 12 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 1 1 3 1 3 3 7 1 4 1 3 3 — 1 B 29 Hypertension without mention of heart 5 7 — — — — — — — — — — — — — — — — — — — — — — — — — — — 1 — — 2 — — — 1 1 — 1 — — 2 3 — 1 B 30 Influenta 2 3 — — — — — — — — — — — — — — — — — 1 — — — — — — — — — — — — — — — — 1 1 — 1 1 —— — — — — B 31 Pneumonia 29 20 2 — 1 — — — — — — — — — — — — 1 1 — — 1 — — — — 1 — — 2 — — 1 1 1 4 1 3 2 7 5 6 4 1 4 B 32 Bronchitis 37 27 1 — — — — — — — — — — — — — — — — — 1 — — — 1 — — — 1 1 4 1 3 — 6 1 5 2 8 3 3 5 3 8 — 6 B 33 Ulcer of stomach and duodenum 6 1 — — — — — — — — — — 1 — — — — — — — — — — — — — — — — — — — — — — — 2 — 2 — 1 — 1 — — 1 B 34 Appendicitis 3 1 — — — — — — — — — — — — — — — — — — — — — — 1 — — — — — 1 — — — — — — — 1 — — 1 — — — — B 35 Intestinal obstruction and hernia 2 5 — — — — — — — — — — — — — — — — — — — — — — — 1 — — — — — — — — — — — 1 1 — 1 1 — — — 1 B 36 Gastritis, enteritis, colitis, etc 6 3 — — — — — — — — — — — — — — — 1 — — — — — — — — — — 1 — — — — — — 1 — — — 1 2 — — 1 1 — B 37 Cirrhosis of liver 3 2 — — — — — — — — — — — — — — — — 1 — — — — — — — — — — 1 — — 1 1 1 — 1 — — — — — — — — — B 38 Nephritis and nephrosis 3 3 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 2 — — 1 — — — 2 1 — B 39 Hyperplasia of prostrate 9 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 2 — 2 — 4 — 1 — — — B 40 Complications of pregnancy, childbirth and puerperium . — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — B 41 Congenital malformations 6 4 4 3 1 — — — — — — — — 1 — — — — — — — — — — — — — — 1 — — — — — — — — — — — — — — — — — B 42 Birth injuries, post-natal asphyxia, atelectasis 4 4 4 4 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — —— — — — Infections of the new born — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — B 44 Inmaturity and other diseases peculiar to early infancy 6 3 6 3 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — B 45 Senility, ill-defined and unknown causes - senility .. 10 26 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 1 — 1 — 4 2 2 5 2 19 - ill-defined causes — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — B 46 Other circulatory diseases 14 10 — — — — — — — — — — — — — — — — — — — — — — — — — — — 1 — 1 1 4 — 2 — 2 1 3 2 — 1 1 4 Other respiratory diseases 13 2 1 — — — — — — — — — 1 — — — — — — — — — — — — — — — — 1 2 — — — 3 — 2 — 2 — 1 — — — 1 — All other diseases 13 29 — — — — — — — — — — 1 1 — — — — — — 1 — 1 — — 1 — 3 1 — 2 2 — 4 1 — 1 3 2 4 1 5 1 3 1 3 BE 47 Motor vehicle accidents 10 4 — — — — — — — — — — — — — — 2 — 1 — — — — — — — — 1 — — — — —1 — 2 — 1 — 1 2 1 — 1 1 — — BE 48 All other accidents 7 11 — — — — — — — — — — 1 — — — — — — — — 1 — — 1 — — — — — 1 — — — — 1 — 1 — 4 1 1 — 3 3 — BE 49 Suicide 5 3 — — — — — — — — — — — — — — 1 — — — — —— — — 1 — — 1 — 1 — — 1 — — — 2 — — 1 — — — — — — Self inflicted injury — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — BE 50 Homicide — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Operations of war — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — ALL CAUSES 588 521 19 10 2 — — — — — — — 4 2 — — 4 2 4 1 2 2 4 3 5 5 8 11 17 11 36 27 42 23 76 35 79 50 101 70 91 75 66 108 37 87 1,109 29 2 – – – 6 – 6 5 4 7 10 19 28 63 65 111 129 171 166 164 124 Percentage of total deaths from all causes – 2.61 0. 18 – – – 0.54 – 0.54 0.45 0.36 0.63 0.91 1.71 2.52 5.68 5.86 10.0 11.63 16.42 14.96 14.79 11.18 33 34 TABLE V INFECTIOUS DISEASES-1955-AGE DISTRIBUTION Disease Total Under 1 yr. 1 yrs. 2 yrs. 3 yrs. 4 yrs. 5-9 yrs. 10-14 yrs. 15-19 yrs. 20-34 yrs. 35-44 yrs. 45-64 yrs. 65 yrs. Cases admitted to hospital Smallpox - - - - - - - - - - - - - Typhoid Fever - - - - - - - - - - - - - - Para-Typhoid Fever - - - - - - - - - - - - - - Scarlet Fever 74 - 2 1 2 12 45 8 2 2 - - - 13 Diphtheria - - - - - - - - - - - - - - Erysipelas 17 - - - - - - 1 3 1 7 5 1 Puerperal Pyrexia 49 - - - - - - - 4 38 7 - - 46 Ophthalmia Neonatorum - - - - - - - - - - - - - - Acute Encephalitis 1 - - - - - - - - 1 - - - 1 Acute Poliomyelitis and polioencephalitis 13 - 1 3 1 1 2 1 2 2 - - - 12 Meningoccal Infection - - - - - - - - - - - - - - Pneumonia 50 - 3 1 1 1 8 1 - 5 3 10 17 10 Malaria 1 - - - - - - - - - - 1 - 1 Dysentery 131 - 3 11 8 8 46 17 4 17 8 6 3 9 Measles 1568 35 106 138 164 199 878 28 4 9 3 3 1 25 Whooping Cough 177 10 9 12 22 27 83 4 1 6 1 1 1 7 Food Poisoning 45 1 - 3 2 1 7 3 2 15 5 6 - 3 Tuberculosis:Pulmonary 61 - 2 - 1 1 2 3 23 8 19 2 Non-pulmonary 6 1 - - - - - - 3 l - i - NOTIFICATIONS AND DEATHS FROM CERTAIN INFECTIOUS DISEASES HESTON AND ISLEWORTH, 1936-1955. TABLE V Year Smallpox Scarlet Fever Diphtheria Erysipelas Pneumonia Meningococcal Infection Epidemic Encephalitis Foliomyelitis and Polioencephalitis *Typhoid Fever Paratyphoid Fever Dysentery Measles Whooping Cough Influenza Tuberculosis Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths 1936 - _ 224 - 21 2 51 - 70 43 1 - - - 1 i 2 - - - - - - 2 - 2 Not Notifiable 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 R 1 - 3 1 4 - - - 2 - - 2 - 1 6 113 58 1939 - - 175 - 51 5 23 - 142 35 6 - - 2 - - - - - - 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 - - - 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 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 1953 - — 161 — - - 16 - 78 48 1 - - - 11 - - - - - 13 - 602 - 291 - 26 141 10 1954 _ - 71 - - - 17 - 34 31 4 - - - - - - - 1 - 9 - 38 - 35 - 2 8 12 1955 - - 74 - - - 17 - 50 46 — - 1 - 13 - - - - - 131 — 1568 - 177 - 4 67 14 * Includes para typhoid fever to 1939. 35 TABLE VII. COUNTY OF MIDDLESEX. CERTAIN VITAL STATISTICS FOR THE YEAR 1955. District Population mid-1954 Birth rate per 1000 population Death rate per 1000 population Specific death rates per 1000 population Infant mortality per 1000 live births Maternal mortality per 1000 total births Crude Adjusted Crude Adjusted Pulmonary tuberculosis Cancer Infant Neo-natal Acton 66,720 12.7 11.8 10.4 10.2 0.16 2.3 20.0 9.4 — Brentford & Chiswick 58,750 13.4 12.5 10.9 10.4 0.12 2.3 12.7 10.2 - Ealing 184,600 12.4 11.9 10.2 10.7 0.09 2.0 22.7 15.3 0.43 Edmonton 99,200 12.1 11.5 8.6 9.5 0.08 1.7 17.5 14.2 1.63 Enfield 109,000 12.5 12.4 10.7 11.6 0.13 1.0 19.1 16.9 0.72 Feltham 48,870 16.0 15.8 7.1 10.5 0.10 1.2 15.3 7.7 - Finchley 69,860 12.8 12.2 10.7 9.5 0.10 2.1 21.3 16.8 Friern Barnet 28,560 11.1 11.7 16.6 15.6 0.14 1.4 25.2 18.9 - Harrow 217,100 12.7 13.0 9.0 10.3 0.06 1.9 17.1 12.0 0.36 Hayes & Harlington 65,400 14.2 13.3 7.4 11.1 0.17 1.5 21.5 15.0 1.05 Hendon 154,000 12.6 11.8 10.1 10.5 0.07 2.1 20.7 16.0 0.51 Heston & Isleworth 105,500 11.0 10.9 10.6 10.9 0.13 2.0 24.1 17.2 - Hornsey 97,600 13.9 12.8 10.8 9.5 0.03 2.1 18.5 13.3 1.45 Potters Bar 17,790 13.6 13.1 8.0 9.0 0.06 1.5 8.3 4.1 - Rnislip & Northwood 72,700 12.7 12.8 8.1 9.5 0.11 2.0 22.8 18.5 - Southall 53,840 13.0 12.9 11.9 12.7 0.15 2.0 17.2 10.0 — Southgate 71,870 10.8 11.8 11.3 8.9 0.11 2.3 19.3 11.6 - Staines 42,330 17.3 16.6 8.4 9.3 0.09 1.6 10.1 12.3 1.32 Snnbury 25,460 17.8 16.7 8.1 9.1 0.16 1.5 19.9 17.7 — Tottenham 122,100 12.4 11.8 10.9 11.2 0.19 2.5 16.5 13.2 0.65 Twickenham 104,300 12.1 12.3 11.1 10.2 0.14 2.2 22.9 17.4 - Uxbridge 57,940 17.1 15.9 8.7 10.4 0.16 1.9 14.2 11.1 - Wemb1ey 129,000 10.8 10.8 8.1 8.9 0.04 1.8 17.2 14.3 0.70 Willesden 176,000 14.9 13.4 9.6 10.4 0.14 2.1 20.2 14.5 0.37 Wood Green 50,610 11.7 11.5 10.3 9.5 0.12 2.1 23.6 16.9 - Yiewsley & W. Drayton Z2,900 16.9 15.5 6.9 8.9 0.13 1.3 23.2 18.0 2.50 COUNTY 2, 256, 000 13.0 12.6 9.8 10.3 0.11 2.0 19.4 14.1 0.47 36 TABLE VII (a). METEOROLOGY (Extracted from records supplied by Chief Engineer, Mogden Sewerage Works.) Week Barometer Tempreture (°F) Days with Rainfal1 Total Rainfall (inches) Ending Highest Lowest Max. Min. Jan. 8th. 30.42 29.78 39.0 31.0 5 0.48 16th. 29.89 28.90 54.0 21.0 6 1.11 22nd. 30.20 28.77 50.0 23.0 5 0.51 29th. 30.33 29.55 57.0 36.0 5 0.02 Feb. 5 th. 29.84 28.93 56.0 34.0 6 0.61 12th. 30.08 29.68 55.0 28.0 6 0.30 19th. 30.10 29.09 41.0 19.0 6 0.17 26th. 30.07 29.60 40.0 30.0 5 0.13 Mar. 5th. 30.47 29.80 49.0 21.0 1 0.16 12th. 30.34 29.55 42.0 30.0 5 0.03 19th. 30.38 29.79 53.0 25.0 2 Trace 26th. 29.91 29.30 65 0 30.0 5 0.73 Apr. 2nd. 30.39 29.91 47.0 31.0 1 0.07 9th. 30.22 29.93 62.0 38.0 6 0.03 16th. 30.56 30.00 *67.0 36.0 NIL NIL 23rd. 30.60 30.00 64.0 34.0 NIL NIL 30 th. 30.27 29.73 69,0 33.0 4 0.06 May 7th. 30.08 29.38 63.0 42.0 6 0.46 14th. 30.13 29.49 64.0 35.0 6 0.37 21st. 30.40 29.11 59.0 35.0 7 1.45 28th. 30.40 29.71 66.0 39.0 4 1.32 June 4th. 30.39 29.56 72.0 44.0 2 0.54 11th. 29.96 29.48 75.0 40.0 5 1.10 18th. 30.14 29.43 74.0 48.0 1 0.02 25th. 30 24 29.68 73.0 51.0 2 0.28 July 2nd. 30.18 29.73 73.0 43.0 1 0,02 9th. 30.35 29.68 78.0 48.0 1 0.09 16th. 30.17 29.90 85.0 55.0 2 0.18 23rd. 30.21 29.96 88.0 52.0 1 0.03 30 th. 30.12 29.83 80.0 55.0 NIL NIL Aug. 6th. 30.18 29.95 81.0 49.0 1 0,10 13th. 30.21 29.87 79.0 42.0 3 0.75 20 th. 30.23 29.92 85.0 54.0 Trace Trace 27th. 30.26 29091 87.0 56.0 1 0.05 Sept 3rd. 30.10 30.06 80.0 52.0 1 0.01 10 th. 30.08 30.00 75.0 48.0 3 0.50 17th. 30.23 29.55 68.0 45.0 6 0.30 24th. 30.26 29.80 73.0 41.0 3 0.79 Oct. 1st. 30.40 30.14 70.0 40.0 Trace Trace 8th. 30.14 29.50 69.0 38.0 3 0.57 15th. 30.34 30.02 70.0 30.0 Trace Trace 22nd. 30.17 29.23 60.0 27.0 4 1.11 29 th. 30.36 29.89 62.0 28.0 3 0.20 Nov, 5th. 30.04 29.34 59.0 25.0 3 0.62 12th. 30.13 29.28 62.0 45.0 5 0.21 19th. 30.64 30.13 52.0 29.0 Trace Trace 26th. 30.55 30.10 51.0 30.0 2 0.04 Dec. 3rd,. 30.45 29.76 55.0 27.0 Trace Trace 10th. 30.53 29.36 55.0 32.0 2 0.09 17th. 29.90 28.88 55.0 31.0 5 1.08 24th. 30.14 29.30 54.0 23.0 3 0.18 31st. 30.17 29.12 49.0 35.0 6 0.43 37 TABLE VIII (b) WIND DIRECTION (Sum, of Daily Records, 52 weeks) N. .. .. 22 days N.N. E .. .. .. 20 days N. E .. .. .. 44 days E N. E .. .. 8 days E .. .. .. 13 days E & E .. .. 4 days S, E .. .. .. 9 days S. StE .. .. 8 days S. .. .. .. 11 days S. S. W. .. .. 11 days S. W. . . . . .. 26 days W. S, W. .. .. 24 days W. .. .. 32 days W. N. W„ .. .. 10 days N.W. .. .. 22 days N. N. W„ .. .. 6 days Calm .. .. .. 94 days TABLE IX FACTORIES ACTS, 1937 and 1948 PART I OF THE ACT 1. Inspections for purposes of provisions as to health made by Sanitary Inspectors Premises Number on Register Number of Inspections Written Notices Occupiers Prosecuted (i) Factories in which Sections 1,2,3, 4 and 6 are to be enforced by Local Authorities 41 43 - - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority , 383 645 14 - (iii) Other premises in which Section 7 is enforced by the Local Authority (excluding outworkers' premises) 6 10 - - TOTAL 430 698 14 - 2. Cases in which Defects were found - Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied Referred To H.M. Inspector By H.M. Inspector Want of Cleanliness (S.1) - - - - - Overcrowding (S.2) - - - - - Unreasonable temperature (S.3) - - - - - Inadequate ventilation (&,4) - - - - - Ineffective drainage of floors (S.6) - - - - - Sanitary Conveniences (S.7) - - - - - - (a) insufficient - 1 - - - (b) unsuitable or defective 14 14 - 2 - (c) not separate for sexes - - - - - Other offences against the Act (not including offences relating to Outwork) - - - - - TOTAL 14 15 - 2 - 39