AC439(1) ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH OF THE BOROUGH OF HEALTH AND ISLEWORTH for the year 1956 A. ANDERSON, M.D., D.P.H., Medical Officer of Health. INDEX PAGE PAGE Accidents 7 Medical Examinations of Staff 26 Bakehouses 19 Meteorology 35 Births, Live 6 Milk 19 Births, Still 6 Municipal Restaurants and School Canteens 20 Burials 25 Noise Nuisances 17 Canal Boats 17 Persons in need of care and Closet Accommodation 14 attention 26 Common Lodging Houses 17 Pet Animals Act, 1951 19 Deaths 7 Physical Characteristics 13 Deaths, Age and Sex Distribution 29 & 30 Public Cleansing 15 Deaths, Causes of 28 Public Mortuary 26 Disinfection 11 Rags, etc. Exchange of Articles for 16 Disinfestation 17 Rag Flock and Other Pilling Materials Act, 1951 18 Drainage and Sewerage 14 Rats and Mice Destruction 17 Factories No on Register inspections and Defects, etc. 37 Rivers and Streams 14 Factories, Workplaces, etc 17 Sanitary Circumstances 13 Fever Hospitals 11 Sanitary Inspection 15 Food and Drugs Sampling 20 Shops Act, 1950 Section 38 18 Food Hygiene 22 Slaughter of Animals (Amendment) Act, 1954 19 Food Poisoning 11 Slaughterhouses, etc 19 Health Committee 3 Smoke Abatement 16 Health Education 26 Staff 2 Health Services provided by Other Authorities 11 Statistics, Certain Vital, County of Middlesex 34 Housing 22 Statistics General 6 Ice Cream 19 Statistics Vital 6 Infant Deaths according to Age and Cause 31 Statistics Vital, Summary of 27 Infant Mortality 8 Swimming Baths 18 Infectious Diseases 9 Tents, Vans and Caravans 16 Infectious Diseases, Tuberculosis 10 Age Distribution 32 Verminous Premises, Articles and Infectious Diseases, Notifications Persons 18 and Deaths 33 Water Supply 14 Laboratory Service 11 Wind Direction 36 Laundry Service 26 Maternal Mortality 9 Meat and Other Food Inspection 20 1 STAFF. Medical Officer of Health A. Anderson, M.D,,D.P,H. Deputy Medical Officer of Health. E.N. Christie, M.B., Ch.B., D.P.H. Chief Public Health Inspector. A.B. Hauldren, Cert. as P.H.I, and M.I. Deputy Chief Public Health Inspector. K J. Smith, Cert, as P.H I. and M.I. District Public Health Inspectors. G. Latimer, Cert. as P.H.I. and M.I. S.H G. Stevens, Cert. as P.H I.. M.I. and S.E J.A. Dawson. Cer. as P.H I. and M.I. W, Bowles. Cert. as P.H I. and M.I. P-G.T. Woods. Cert. as P.H.I. and M.I. J. K. Edson. Cert. as P-H. I. M.I. and San. Science, D.G. Martin. Cert. as P.H.I. and M.I. Rodent Officer A. Farrer. Rodent Operatives. R. Ashurst, G. Avery. (to 21.1.56) M.L. Worthington (from 13.2.56). Mortuary Attendants, Disinfectors, Drain Testers, etc. F.S.J. Allaway. L,R. Smith. Clerks. B W. Kilby, Cert, as P.H.I, and M.I. (Part time) Mrs L-R. Butler, Cert, as P.H.I. D. S. Bates. E.J. Hutchins Miss p,M. Whittington (to 23.9.56) Mrs. J. Knight, (to 17.12.56) AC. Rogers (to 23.10.56) Mrs. N.N. Vaughan (from 12.11.56) Mrs, L. E. O'Gorman. (from 26.11.56) 2 THE HEALTH COMMITTEE of HESTON AND ISLEWORTH BOROUGH COUNCIL. to May, 1956 Councillor Mrs. M. Hennig (Chairman) Councillor Mrs. M.J. Tozer (Vice-Chairman) Councillor J. Theobald, J.P. (Mayor) Councillor J. Curwood. Alderman J E. Dillingham, Councillor E.T. Harding. Alderman Mrs. A.B. Tolnn. Councillor P.J. Jansen. Councillor W H. Bolster. B. Com.Sc. Councillor Mrs. R. New. Councillor A.G. Cross. Councillor A.H. Nixon. Councillor Sqdn/Ldr. E.R. Cuff. Councillor P.G. Raybaud. from May, 1956. Councillor Mrs M. Hennig (Chairman) Councillor F. A. Raybaud. (Vice-Chairman) Councillor R.G. Dunnett, J.P. (Mayor) Councillor C.E. Maryon Davis. Alderman J.E. Dillingham Councillor E. T. Harding. Alderman Mrs. A B Tolmn. Councillor P.J. Jansen. Councillor W.H. Bolster. Councillor Mrs. R. New. Councillor Mrs. EM Coleman. Councillor AH. Nixon. Councillor AG. Cross. Councillor N.V Wright. 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 1956. The report has been prepared on the lines suggested by the Ministry of Health and the larger statistical tables have been grouped together at the end of the report. The birth rate continues well below the national rate and now closely approximates to the local death rate The local death rate remains slightly lower than the national rate. The chief causes of death are cancer and degenerative diseases of the circulatory system. Cancer of the lung continues to. increase and evidence is steadily accumulating on the close association of this condition with smoking, especially of cigarettes. On, thinking of preventable deaths, accidents immediately come to mind Some accidental deaths among old persons are probably inevitable but greater care at home and at work could avoid not only deaths but much disability. Deaths from accidental poisoning and ignition of clothing in children should not occur. Care, courtesy and consideration by all road users is the real solution of road traffic accidents. The incidence of infectious disease generally was low throughout the year. It is pleasing to record that the numbers of children vaccinated against smallpox and inoculated against diphtheria and whooping cough showed an increase as compared with 1955 A start was made in the protection of children against poliomyelitis by the use of the British vaccine. The demand for protection was high, but the amount of vaccine available was small, and at the end of the year relatively few children had been treated It is hoped that steadily increasing quantities of vaccine will become available, but some time must elapse before the degree of protection can be assessed. New cases of pulmonary tuberculosis are being found in the middle and older age groups in greater proportion than in the past. Admittedly the incidence and fatality of this disease are falling, but the undiscovered infective case remains the chief source of infection. Modern methods of treatment have greatly improved the outlook in this disease and no person developing a cough, loss of appetite or loss of weight should hesitate to have an X-ray of the lungs. The mass X-ray unit at West Middlesex Hospital is available to all without appointment. The coming into operation of the Pood Hygiene Regulations marked an important step in the campaign against food infections. A guide to the Regulations was supplied to all firms handling food and the Inspectors paid visits to discuss problems, give advice and survey premises. Co-operation by the trade has been good and the public must have noticed the steady improvement in food premises and catering establishments. Advances in design of premises, in provision of washing and storage facilities, in methods of display and handling are important but must be supported by hygienic habits among the persons employed in the handling of food. The public can help by refusing patronage where they see faults in food hygiene, but personal hygiene is a matter of education and should begin in the home. Increasing attention has been given to the problem of unfit houses. There are no large aggregations of such houses in the Borough, and the demolition of unfit houses will provide no sites on which many new houses can be erected. The long continued occupation of houses after they have been declared unfit by the Council is a matter of some concern and it is hoped that as new houses become available, the vacation of unfit houses may be expedited. The volume of official and voluntary work on the care and welfare of the aged grows. These efforts vary widely in their nature, range and scope and any scheme designed to improve co-operation among the many agencies "concerned should be welcomed and supported. During the year an Act was passed to provide that Sanitary Inspectors shall, in future, be designated Public Health Inspectors, The word 'sanitary' has come to have a restricted meaning and the change in designation indicates the wide nature of the work of these inspectors and emphasises that they are an essential and integral part of the local public health team Problems associated with the diagnosis and treatment of existing disease have received much prominence since the introduction of the National Health Service, but the maintenance of good living and environmental conditions as a contribution to the prevention of disease should not be forgotten. Under proposals made by the Minister of Health, the Public Health Inspectors Education Board has been established with the following objects:- 4 (1) to examine for and issue a Diploma in Public Health Inspection as the basic qualification to be recognised by the Minister. (2) to examine for other certificates it may consider necessary for public health inspectors (3) to approve courses of instruction for all its examinations. (4) to approve local authorities for the purpose of practical training; and (5) to keep under review all questions relating to the recruitment, training and examination of public health inspectors. A recommendation has been made that paid pupillage with local authorities should become the normal avenue of entry for public health inspectors. The Council has had a paid pupillage scheme for many years. An occasional enquiry about the scheme is received but the prospects of public health inspectors are not attractive to the boys, and what is more important, less attractive still to their parents. Despite the removal of former anxieties and fears such as unemployment, poverty, workhouses for the aged, corporal punishment for children, etc,, and the increasing scope of the 'welfare' state, the public is restless and the consumption of barbiturat and tranquillisers increases. The present tendency to accept fear and anxiety as evidence of illness, to excuse all departures from normal behaviour as due to faulty upbringing, broken homes, etc. and to seek freedom from anxiety as the main aim of society may be signs of sickness in society itself. Much is being learned of the part fear and anxiety may play in illness and of the factors which contribute to behaviour problems and to failure to live in harmony with the community, but in mental as in physical health, no matter how much may be done by the medical and social services, the individual must shoulder some responsibility. 'No personality can be considered mature, balanced and integrated until he accepts responsibility for his motives and actions and does so as freely as he makes his claims to rights. Rights and obligations are, in fact, incapable of existence apart from each other like positive and negative charges of electricity. The year 1956 marked the centenary of the foundation of the Society of Medical Officers of Health Probably no century in history has witnessed such marked changes in medical and social development. The transformation in environmental conditions, the provision of wholesome water supplies, the treatment of sewage and refuse, the drive for pure and unadulterated food, the care of the school child, the measures for the maintenance of the health of mother and child, the schemes for the welfare of the physically and mentally handicapped, and the aged, and the sustained attack on epidemic disease provide a continuous record of time, toil and talent given by many. From the initial effort to establish sound sanitation the public health service has steadily progressed and widened the sphere of activities. The notable achievements of the past are a source of pride but there is still a heavy burden of ill-health, both physical and mental, to be tackled if citizens are to enjoy the fullness of life. I have had willing co-operation from all other Departments. I would like to thank the Council for their encouragement and support, and my staff for their loyal assistance. I remain, Your obedient servant, A. ANDERSON. Medical Officer of Health. 5 GENERAL STATISTICS Year 1956 Area in acres 7,218 Population (Registrar-General s estimate) 105,100 Number of habitable premises (rate books) 30,011 Number of houses erected during year 273 Rateable Value of Borough £2,032,341 Sum represented by a penny rate £8,420 Live Births - male 637 Live Births - female 598 Birth rate per 1,000 population 11.8 Birth rate per 1,000 population (England and Wales) 15.7 Stillbirths - male 13 Stillbirths - female 11 Stillbirths rate per 1,000 (live and still) births 19.1 Deaths - male 640 Deaths - female 495 Death rate per 1,000 population 10.8 Death rate per 1,000 population (England and Wales) 11.7 Infant Mortality rate 17.8 infant Mortality rate (England and Wales) 23.8 Maternal Mortality rate 0 0 Maternal Mortality rate (England and Wales) 0.6 VITAL STATISTICS POPULATION The Registrar General s mid-year estimate of the population of the Borough for the year 1956 is 105,100 RATEABLE VALUE The rateable value of the Borough for 1956 was £2.032,341 and the sum represented by a penny rate was £8.420 INHABITED HOUSES According to the rate books, the number of habitable houses, flats and shops with living accommodation at the end of the year was 30,011 In relation to the estimated population, this yields and average of approximately 4 persons per house, LIVE BIRTHS The number of live births in 1956 was 1,235 as compared with 1 164 in 1955 The birth rate was 11,1 per 1 000 population. The birth rate will vary, apart from other causes according to the age and sex distribution of the population, and to permit of a true comparison with other areas, the Registrar General supplies for each local sanitary authority what is called the area comparability factor. When this is applied to the Borough birth rate, the result is ll„0 as compared with the birth rate of 15 7 per 1 000 population for England and Wales. The number of illegitimate births was 41. as compared with 49 in 1955 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 194549 5.1 1930-34 3.2 1950-54 4.0 1935-39 2.9 1955 4.2 1940-44 4.6 1956 3.3 The majority of births continue to occur in hospital. STILLBIRTHS The number of stillbirths in 1956 was 24 (21 legitimate, 3 illegitimate) The proportion of stillbirths perl 000 total (live and still) births in recent years is shown below:- No of Rate per 1,000 Stillbirths total births 1930-34 214 31.2 1935-39 224 29.4 1940-44 200 27.7 1945-49 198 23.8 1950-54 129 20.6 1955 20 16.9 1956 24 19.1 This loss of potential lives remains a problem and until more is known of the causes little further improvement can be expected. 6 DEATHS The deaths of residents of the Borough during 1956 were 1,135 (640 male, 495 female) This represents a death rate for the Borough of 10.8 per 1,000 population- The deaths in any area are influenced by the sex and age distribution of the population. and to permit of a true comparison the Registrar-General calculates for each local sanitary authority area what is called an area comparability factor. When this is applied to the above Borough rate, the result is 11,4 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 Tables II III and IV The cause of death was certified by the Coroner in 242 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 1956 Under 1 year 21.8 5.3 2.4 1.9 1-4 years 8.4 0.8 0.5 0.4 5*14 years 3.8 2.1 0.4 0.5 15-24 years 3.7 2.1 0.8 0.5 25-64 years 30.8 33.0 31.6 29.4 65 years and over 31.5 56. 7 64.3 67.3 The chief causes of death in males were heart and circulatory diseases, cancer, bronchitis and pneumonia cerebral haemorrhage In females, the chief causes of death were heart and circulatory disease cerebral haemorrhage, cancer, bronchitis and pneumonia The Secretary of the Road Safety Committee informs me that during 1956 there were 667 road accidents which resulted in 15 deaths serious injury to 145 persons and slight injury to 670 persons. The number of deaths from motor vehicle and other accidents in Borough residents during the last ten years is shown below Motor Vehicle Accidents Other Accidents Year Age in years -All ages Age in years All ages 0-4 5 14 15 64 65- 0 4 5 14 15-64 65- 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 1956 - 2 9 6 17 - - 11 8 19 Total 3 9 78 50 140 8 5 73 133 219 Below is a table showing the causes of accidental deaths (other than motor vehicles) in males and females for the years 1952 56:- ACCIDENTAL DEATHS (OTHER THAN MOTOR VEHICLE) 1952 56 0-4 yrs. 5-14 yrs. 15-24 yrs. 25-44 yrs. 45-64 yrs. 65-74 yrs. 75 yrs. & over. MALE Fall in hospital, institution etc. - - - - - 1 8 Fall at home 1 - - - - - 6 Fall in street or outdoors - - - - 3 - - Drowning _ - - 1 1 1 1 Choking (food, vomit etc) - - - 1 2 - - Coal gas poisoning - - - 2 1 - 3 Railway Accidents - - - - 3 1 - Pedal cycle accident - - 1 - 1 - - Burns - 1 - - - - 1 Caught in machinery - - - 2 - - - 7  0-4 yrs. 5-14 yrs. 15-24 yrs. 25-44 yrs. 45-64 yrs. 65-74 yrs. 75 yrs & over MALE (Contd ) Struck by falling wall - - - - 1 - - Aeroplane Accident - - - 1 - - - Accident at sport - - 2 - - - - Fall at work - - - 1 - - - Gun shot accident - - 1 - - - - FEMALE Fall at home - - - - 1 5 19 Fall in hospital, institutionetc. - - - - - 2 8 Burns - - - - - - 3 Coal gas poisoning - - - - - 1 2 Railway accident - - - 1 - - - Pedal cycle accident - - - - - - 1 Poisoning - - - - 1 1 - Fall from horse - - 1 - - - - Anaesthesia death - — - - 1 - - It should be noted that in females 89 4 per cent. of the deaths occurred at age 65 years and over as compared with 45.8 per cent. in males. Prevention of accidents is the responsibility of everyone. Care and attention in the home, in the factory and on the roads is essential and the special proneness to accidents of the aged should be remembered INFANT MORTALITY - During 1956 there were 22 deaths of children under the age of 1 year. This represents an infant mortality rate per 1,000 live births of 17.8 as compared with 23.8 for England and Wales. The causes of infant deaths are shown in Table V. In the following table, the change in the local infant mo over 5 year periods from 1898 is shown:- NO.of live births No. of deaths under 1 year infant Mortality Rate 1898-1902 4,369 698 160 1903-1907 5,264 665 126 1908-1912 5,383 590 110 1913-1917 4,661 461 99 1918-1922 4,326 327 76 1923-1927 4,333 271 63 1928-1932 6,055 318 53 1933-1937 7,121 313 44 19381942 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 1956 1,235 22 18 The changing significance in infant mortality of certain causes of death is indicated below:- Deaths under 1 year of age per 1 000 live births. 1901-05 1911-15 1921-25 1931-35 1941-45 1951-55 Tuberculosis 4.0 2.4 0.7 1.1 0.6 _ Measles and whooping cough 7.7 8.1 1.4 1.0 1.1 - Bronchitis and pneumonia 22.4 21.5 9.8 7.1 7.5 2.8 Diarrhoea and enteritis 37.4 22.5 9.8 3.7 9.3 0.3 Prematurity, congenital malformations, etc. 25.5 26.8 19.2 20.3 24.9 15.5 All other causes 46.1 29.0 25.6 14.7 11.3 2.5 The hard core of infant deaths is due to congenital malformations, prematurity and associated conditions and most of these deaths occur before the age of one week. Continued effort is needed from all concerned to improve antenatal care, management of labour and the nurture of young babies. 8 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 - - - 1956 - - - 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 diphtheria 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 be required 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 463 were so endorsed. INCIDENCE OF NOTIFIABLE DISEASE The number of cases notified during the year is shown in Table VI and the trend of infectious diseases during the last 20 years in Table VII SMALLPOX No case of smallpox occurred in the Borough during 1956 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 570 children under the age of one year were vaccinated in 1956 as compared with 375 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 67 cases which occurred during the year, 14 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 number of children under the age of one year who were immunised during 1956 was 699 as compared with 525 in 1955 ERYSIPELAS The number of notifications was 12, but no death was due to this disease PNEUMONIA • Notifications of pneumonia were 27. as compared with 50 in 1955. Of the total pneumonia deaths 70 per cent occurred at age 65 and over MENINGOCOCCAL INFECTION - One case was notified during the year. EPIDEMIC ENCEPHALITIS - One notification was received during the year The patient was admitted to hospital but died POST-INFECTIVE ENCEPHALITIS - Encephalitis is known to occur as a complication of other infectious diseases but no such case was notified during 1956. POLIOMYELITIS During the year 5 cases were notified. Of these 1 showed no paralysis and of the others 1 was transferred to an orthopaedic hospital and 2 to orthopaedic departments for further treatment. Inoculation against poliomyelitis was started during the year. The British type of vaccine was used and at the end of the year 330 children had received two injections and 30 children one injection No reaction following any of these injections was reported 9 TYPHOID FEVER-No case of typhoid fever was notified during the year. PARATYPHOID FEVER-No notification was received during the year. DYSENTERY This disease shows great variations in prevalence from year to year and from place to place During the year, 22 cases were notified, as compared with 131 in 1955 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 sus picion 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 62 notifications of pulmonary tuberculosis, and 7 notifications of non-pulmonary tuberculosis were received. 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 The proportion of new notified cases aged 45 years and over has risen here from 25.9 per cent, in 1937-41 to 37,4 per cent in 1952-56 in males, and from 9 1 per cent to 19.5 per cent in females in the same periods, and it is probably in this older age group that undetected and untreated pulmonary tuberculosis persists. Early diagnosis and treatment are essential to prevent the spread of infection The trend of the Borough death rate from tuberculosis is shown below Tuberculosis Death Rate per 100 000 population Pulmonary Non pulmonary Total 1930-34 67.5 11.5 78.9 1935-39 52.3 8.2 60.4 1940-44 55.8 7.4 63.2 1945-49 39.1 6.7 45.8 1950-54 18.9 1.1 20.0 1955 13.3 1.0 14.2 1956 10.5 0.9 11.4 A permanent mass X-ray unit has been established at West Middlesex Hospital and is open to the public without appointment, OPTHALMIA NEONATORUM-No case was reported in the Borough PUERPERAL PYREXIA During the year 69 cases were notified as compared with 49 cases in 1955 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-The Borough was relatively free of this disease during 1956 - 244 cases as compared with 1,568 in 1955. WHOOPING COUGH The notifications of whooping cough, 96, were fewer than in 1955. Facilities for immunisation against this disease are available. The condition is most fatal in young babies, and protection should be provided before the child is six months old. There is evidence that, with the improvement in the vaccine, the protection, if not complete, does mitigate the severity of the attack MALARIA - No case of malaria was notified during the year, INFLUENZA This disease was not prevalent during the year. It caused 4 deaths as compared with 4 in 1955, 2 in 1954, and 26 in 1953. The Medical Research Council is continuing its 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, 58; Chicken pox 324, and German measles. 28. 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. 10 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 119 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 8 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 1956 was 542 The majority of these specimens were taken during the investigation of dysentery and food poisoning FOOD POISONING - During 1956 notifications of the occurrence of food poisoning in 51 persons were received, and during the course of our investigations and from other sources, a further 44 cases were discovered A summary of the cases is given below:- Cases of Food Poisoning 1st 2nd 3rd 4th Quarter Quarter Quarter Quarter Total 7(7) 43(14) 10(10) 35(20) 95(51) Outbreaks due to indentified agents Total outbreaks Total cases 4 (2) 35 (8) Outbreaks of undiscovered cause Total outbreaks Total cases 9 (7) 37 (21) Single cases Agent indentified unknown cause Total cases 2 (2) 21 (20) 23 (22) () notified under Section 17 of the Food and Drugs Act 1938 HEALTH SERVICES PROVIDED BY OTHER AUTHORITIES NORTHWEST METROPOLITAN REGIONAL HOSPITAL BOARD - Two general hospitals (West Middlesex, 1,150 beds and Hounslow, 81 beds) and one fever hospital (South Middlesex, 140 beds) are situate in the Borough Part of the accommodation in the fever hospital is used for 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 and Thursday afternoons 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, Tuesday and Wednesday afternoons Cranford Memorial Hall Monday and Friday afternoons (c) Immunisation and vaccination clinics 92, Bath Road, Hounslow Busch Corner, isleworth By appointment New Heston Road 11 (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 This day nursery admits children 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 domicilary 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 There 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 (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 perso'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 12 (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 1st, Thursday afternoon (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 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 1 The cost per head of population of the services provided by Middlesex Executive Council for the year ending 3lst March, 1956 was:- £ s d Administration 1 0.338 General Medical Services 1 3 10,244 Pharmaceutical Services 1 1 10.528 (excluding charges to patients) General Dental Services 17 11 995 (excluding charges to patients) Supplementary Ophthalmic Services 4 3 552 (excluding charges to patients) Other expenditure 0 021 Total 3 9 0 678 In 1955 a total of 12,250,210 prescriptions were issued to 2 214 310 persons The prescription frequency per person in that year was 5,53 and the average total cost per person was 25/3d FAMILY PLANNING ASSOCIATION - This voluntary organisation holds sessions at 92, Bath Road, Hounslow, on Monday, Tuesday and Thursday evenings Some 3 000 patients attended during 1956 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, From the river, the land rises slowly until at North Hyde it is about 100 feet above sea level. The subsoil consists of 'drift gravels and lying on them in places are patches of clay, 13 The following open spaces are laid out and controlled by the Borough Council:- Park Farm and Avenue House, Cranford 40.29 acres Heston Fair Ground 9.38 " Church Meadow, Bath Road 9.20 " Children's Playground, Sutton Lane 0.60 " Kingsley Road Playing Field 0.95 " Greenhams Land, London Road 14.75 " St. John's Gardens, isleworth 5.73 " Riverside Walk, Isleworth 0.75 " Children" s Playground, Northcote Avenue 0.85 " Playground, London Road 1.84 " Bowling Green, Jersey Gardens 0.59 " Isleworth Promenade 1,0 " Heston Park 14.29 " Lampton Park 24.20 " Beaversfield Park 9.77 " Inwood Park 10.25 " Redlees Park 16.47 " Jersey Gardens 7.87 " Football Ground, Denbigh Road 3.70 " Midsummer Children's Playground 1,52 " WATER SUPPLY The water supply of the Borough is derived almost wholly from the Metropolitan Water Board, A small portion of the Cranford area is supplied by the South-West Suburban Water Company, There are in the Borough 43 shallow and 3 artesian wells serving 40 premises and of these 4 houses and 1 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 14 Cistern, cleansed, repaired, etc, 3 Draw-off taps connected direct to main 3 Service pipes or taps repaired 21 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 1956: - Drains exposed for examination 130 Drains unstopped, repaired, etc. 408 Waste pipes repaired, trapped, etc. 14 Soil pipes repaired, etc. 6 Ventilating shafts repaired etc. 3 Fresh air inlets repaired, etc. 2 Gully traps inserted or repaired 33 Disconnecting traps inserted or repaired 12 Disconnecting and inspection chambers provided 6 Disconnecting and inspection chambers repaired. etc. 30 Drains constructed or repaired 14 Total length (ft.) of drain pipes laid- (a) 4" 339 (b) 6" 18 Drain tests applied 44 Other works executed 16 Cesspools emptied or repaired 3 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, whose West Middlesex Main Drainage Undertaking has been in full operation since 1936. 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 1956, 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:- 14 Water closets constructed or rebuilt 1 Water closets provided in substitution for dry receptacles, etc. 3 Water closets where walls cleansed 22 Water closets fitted with new flushing apparatus 26 New pans or pedestals provided 26 Water closets repaired or improved 40 Water closets blockages unstopped 3 Other closets provided or repaired 3 Urinals constructed, rebuilt or repaired 5 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 30 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:- 1952 1953 1954 1955 1956 Paper (tons) 1.023 986 1,000 897 1,082 Scrap metal (tons) 89 84 90 38 73 Textiles (tons) 50 41 27 34 13 Bottles, jars (tons) 10 11 17 4 2 Cullet (tons) 7 - 3 - - Kitchen Waste (tons) 929 822 9 - - total income £15,614 £11,440 £8,705 £8,490 £9,414 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 care lessness and lack of consideration. The Health Department can act only if 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 Public Health Inspectors continued their general duties of investigating complaints, abating muisances and dealing with contraventions of the Public Health Act, 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 1,711 Number of premises at which nuisance, etc. were located 1 310 Number of premises where defects were remedied (a) by owners or occupiers 853 (b) by Council in default 6 (c) public sewers repaired by Council 10 Informal notices issued 801 Written reminders issued 988 Statutory notices served 48 Total number of inspections and re-inspections 22,235 Inspections of piggeries 18 Inspections of stables 18 Inspections of urinals 225 Sinks provided or repaired 12 Roofs repaired 174 Gutters repaired or renewed 165 Brickwork, sills, etc., repaired or renewed 357 Premises provided with damp-proof courses 12 Sites covered with impervious material 8 Yards and forecourts paved or drained 21 External painting 22 Rooms stripped, cleansed and redecorated 361 Floors, walls and ceilings, repaired or renewed 576 Rooms in which ventilation provided or improved 11 Rooms in which lighting provided or improved 12 Windows repaired or renewed 371 15 Doors and other woodwork repaired or renewed 132 Staircases replaced or repaired 10 Lighting to staircase provided or improved 8 Handrails or balusters repaired or renewed 6 Grates provided or repaired 82 Instances where ventilation under floor provided or improved 15 Larders provided or repaired 18 Domestic cleansing enforced 1 Improper keeping of animals abated 3 Offensive accumulations removed 27 Other repairs carried out or nuisances abated 257 Visits re infectious diseases, etc. 420 Complaints continue to be received of nuisance caused by pigeons. Apart from those particularly affected, the public tends to be on the side of the pigeons, but the damage and nuisance caused by them is considerable. 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. EXCHANGE OP 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 contra ventions coming to their notice. 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 Public Health Inspectors made 118 smoke observations and paid many visits to premises in regard to which complaints of smoke nuisance had been received. 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 analyses are forwarded for record and study to the Central Department, but the main features are recorded below: Health Department Heath House Rainfall (inches) Deposit (tons per sq.mile) Sulphur (Mgms., SOg per day per 100 sq cm.) Rainfall (inches) Deposit (tons per sq. mile) Sulphur (Mgms, So3 per day per 100 sq. cm.) January 3.39 12.25 1.23 2.99 10.23 1.68 February 0.15 10.27 1.15 0.15 12.03 1.37 March 0.59 8.59 1.25 0. 67 11.08 1.23 April 1.18 12.52 0.88 1.10 13.92 0.79 May 0.12 5.27 0.28 0.12 4.56 0.48 June 1.93 7.29 0.24 2.09 8.89 0.26 July 4.45 8.18 0.33 4.30 8.72 0.27 August 3.90 8.62 0.32 3.94 9.26 0.28 September 2.99 7.53 0.57 2.60 9.16 0.66 October 1.50 7.42 0.86 0.99 7.66 1.11 November 0.36 5.51 0.86 0.32 5.57 0.92 December 2.44 13.21 1.66 2.33 11.62 1.81 Average 1.92 8.88 0.80 1.80 9.39 0.90 Average 1952-1955 1.88 9.03 0.92 1.89 9.21 0.99 In general, atmospheric pollution in the Borough was less in 1956 than m the previous four years. 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 per sons, who use caravans for business in connection with a travelling circus, fair or stall. During the year, the inspectors made 1,314 visits of inspection because of the occupation of land by caravans. 16 Trespass by caravans on road verges and unfenced land continues especially on the western outskirts of the Borough. The vagrant type who occupy these caravans deposit domestic refuse, litter of all kinds, waste water and faecal matter in the neighbourhood of the sites occupied Much time and effort have been given in attempts to clear them from their usual camping sites but only too often within 24 hours they are back again. Under the provisions of the Middlesex County Council Acts three applications for permission to place caravans on sites in the Borough were considered two were granted and one refused. COMMON LODGING HOUSES - There is no common lodging house in the Borough, CANAL BOATS - The Public Health Inspectors continue their duties as canal boat inspectors, and made 41 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 X. Inspection of (a) Factories - mechanical power 630 (b) Factories - non mechanical power 36 (c) Other premises 13 (d) Workplaces 30 (e) Outworkers' premises 92 Defects remedied 19 At the end of the year the number of outworkers registered with the Department was 229, and the trades on which they were engaged were as follows Wearing apparel 190 Lace, lace curtains and nets 2 Curtains and furniture hangings 5 Furniture and upholstery 2 Brass and brass articles 1 Artificial flowers 1 Carding, etc., of buttons, etc, 20 Stuffed toys 6 Cosaques, Christmas crackers, Christmas' stockings, etc 2 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, 37 rooms in 14 houses were treated, while 28 wasp nests were destroyed, 14 premises cleared of cockroaches, 9 cleared of ants, and 4 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 10 complaints of nuisance from noise were received Seven were associated with factories, one with an electrically operated sewing machine, one with gravel extraction and one with the use of loud speakers. In five cases there appeared to be some justification for the complaint and with the co-operation of the users of the machinery, considerable reduction in noise was achieved 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 there is failure on the part of the owner or occupier to cooperate 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 such1expenditure has not been recovered. 17 The Council employs a Rodent Officer who is responsible for systematic inspection planning of treatment supervising the work of the rodent operatives and checking results A summary of the work done in recent years is shown below.- 1952 1953 1954 1955 1956 Complaints received Block inspections individual inspections and re-inspections Other visits 618 527 533 692 634 51 5,110 46 4,970 43 4.381 66 4,541 53 4 162 614 654 503 419 561 Premises treated - (a) By occupier 41 7 18 15 14 (by By Local Authority 1,075 930 883 1,004 982 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 12 inspections were made during the year No certificate of exemption re provision of sanitary accommodation was granted 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 registered and premises where rag flock is manufactured or stored have to be licensed It is an offence to sell articles containing unclean materials Certain records have to be kept on registered and licensed premises and authorised officers of a local authority have powers to enter inspect and take samples Under this Act. five premises in the Borough have been registered and the Public Health Inspectors made 5 visits of inspection, SWIMMING BATHS Three swimming baths are provided by the Council and one private swimming bath was in operation in the Borough The size and extent of 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 1956 128,039 160,903 138 699 Maximum number of persons using swimming bath on any one day 901 1,475 912 No of slipper baths Male 15 - 11 Female 9 - 11 No of persons using slipper baths during 1956 41,644 - 24,997 The baths waters are treated by continuous filtration and breakpoint chlorination 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 7 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 129 children in attendance at schools in the Borough were found to be verminous and because of the failure of parents to take necessary action 35 of these children had to be cleansed by the School Health Department, 18 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 work-place. The problem of the persistently verminous children or family is a difficult one and is usually not one of uncleanliness alone. 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, 8 premises in the Borough have been licensed and 14 visits of inspection were made during the year INSPECTION AND SUPERVISION OF FOOD MILK - At the end of the year, 12 dairies were registered under the Milk and Dairies Regulations. During the year, 52 inspections were made at dairies and retail purveyors' premises Under the Milk (Special Designation) Regulations, 40 licences for the sale of 'tuberculin tested' milk 45 for the sale of 'pasteurised' milk, and 53 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 consumer can help by the hygienic care of the bottles which 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 218 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, 169 inspections of registered premises were carried out. The following results were obtained from the bacteriological examination of samples:- Satisfactory Doubtful Unsatisfactory Ice-Cream 43 14 10 Water Ices or 'lollies' 21 2 4 Milk ices 2 Rinse water 1 - - The percentage of doubtful and unsatisfactory samples was 31 2 as compared with 114 in 1955 This was largely due to efforts to trace the source of trouble at one producing plant, BAKEHOUSES There are 20 bakehouses in the Borough and 123 visits of inspection were made during the year. SLAUGHTERHOUSES, etc. - There is no public abattoir, private slaughterhouse or knacker" s yard operating in the Borough. SLAUGHTER OF ANIMALS (AMENDMENT) ACT, 1954 - No application for a licence, under the provisions of the Act, has been received. 19 INSPECTION OP MEAT AND OTHER FOODS - In addition to those mentioned elsewhere in this report, other food premises in the Borough and the number of inspections are listed below;- Number inspections Butchers Shops 74 635 Cafes, Canteens, Clubs, etc. 157 962 Fish shops 29 208 Greengrocers 56 160 Grocery and provision 192 376 Hotels, public houses, etc. 48 192 Manufacturers, packers, etc. 11 56 Confectioners, sweets 142 392 - flour 18 143 At retail premises 3,206 lbs, and 2,836 tins of unsound food were seized by or surrendered, to the Public Health Inspector. These unsound foods were deposited on the Council's refuse tip and immediately and adequately covered by refuse or other material. The following foods were brought to the Department because the purchasers were not satisfied that they were fit for human consumption- bread 10, Meat, 3 cakes, 2; milk, 2; savoury food preparation, l; toffee, 1; peas, l; orange juice, 1; saveloys, 1; block salt, 1, cyder, 1; tinned beans, 1; flaked rice, 1, and meat pie, 1. The complaints were not substantiated in 24 cases. An official warning was issued in one case and proceedings in two cases resulted in fines amounting to £25 Premises used for "the preparation or manufacture of sausages or potted, pressed, pickled or preserved food for sale' are required under the Food and Drugs Act, 1955 to be registered, and at the end of the year, 98 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, 42 hawkers were on the register (greengrocery, 30; fish, 8 ice-cream, 4) and 154 inspections of their vehicles and wares were carried out. MUNICIPAL RESTAURANTS AND SCHOOL CANTEENS There is no municipal restaurant in the Borough, but during the year the 20 school canteens provided 1,370,798 meals. By the provision of new schools and the replacement of school canteens established during the war, the facilities for meals at schools are being improved, FOOD AND DRUGS SAMPLING - The following information on the work done in the Borough during 1956 has been supplied by the Public Control Department of Middlesex County Council:- ARTICLE TOTAL SAMPLES PROCURED UNSATISFACTORY Milk, new. 59 21 Milk, various 85 - Butter 13 - Bread 2 1 Cakes 4 - Cooked Meats 4 - Cream 11 1 Drugs 15 - Fish 18 2 Fish, canned 4 1 Fish products 3 - Flour 4 - Fruit 5 - Fruit, canned 10 - Ice Cream 6 - Jelly 3 - Liver 10 - Margarine 2 - Meat and meat products 9 - Miscellaneous 14 3 Non-brewed condiment 9 - Peas 4 - Pickles 6 - Preserves 3 - Pepper 2 - Sausages, etc. 7 1 carried forward 312 30 20 ARTICLE TOTAL SAMPLES PROCURED UNSATISFACTORY brought forward 312 30 Suet 2 - Sweets 5 - Sago 1 1 Vinegar 11 1 Wines and Spirits 15 - TOTAL 346 32 Milk Fifteen samples from one farmer were found to be deficient in fat and investigations have not yet been completed. The remaining six samples, from different farmers, were all slightly deficient in fat but associated and subsequent samples were genuine and no further action was taken Bread. A loaf of bread contained oil from the mixing machine The bakers were given a verbal warning. Cream. A restaurant sold as "Pineapple and Cream', pineapple and imitation cream. An official caution was issued. Pish. Two samples of fish, described and sold as 'Plaice Fillets', proved to be dab fillets. Proceedings were instituted and a fine of £2 0s 0d plus £4 4s 0d costs were imposed. Fish, canned This sample was falsely described as White Fish Caviare' It was not genuine caviare, which is made from the roe of the sturgeon The importers have agreed to have to labels amended Miscellaneous Two samples of an article described as 'saffron were found to be artificial saffron An official caution was issued A sample of tonic water was described as 'Lemon Tonic Water' and thereby offended Article 8 (f) of the Labelling of Food Order, 1953 The Manufacturers agreed to amend their label Sausages, etc. A sample of pork sausage meat contained undeclared preservative. Subsequent samples proved to be genuine and no further action was taken Sago. A sample of sago was submitted by a private purchaser with the complaint that it developed a mauve tint in water. This apparently does sometimes happen to sago It is not harmful, and no action was taken Vinegar A sample described and sold as 'vinegar' proved to be non brewed condiment An official caution was issued, The Food and Drugs Act, 1955, in section 47 contains new provisions concerning the descriptions which can be applied to certain substances which resemble cream in appearance but are not cream This has necessitated the making of many inspection visits and the giving of advice to all traders likely to be concerned to ensure that they are fully aware of these new requirements, Merchandise Marks Act, 1887-1926. 156 inspections of shops were undertaken to ensure that the Marking orders relating to certain imported foodstuffs made under the Merchandise Marks Act, 1926 were complied with 691 separate displays of meat, apples, tomatoes, poultry, dried fruit and butter were examined Verbal cautions were given in respect of minor infringements not being found so serious as to warrant more stringent action. No serious infringement was disclosed The Labelling of Food Order, 1953. This Order requires that, in general, prepacked 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 96 premises 297 articles of prepacked food were examined. No proceedings were taken in respect of any of the infringements detected and manufacturers took immediate steps to correct unsatisfactory labels as soon as their attention was drawn to them, False or Misleading Descriptions. A considerable amount of work is carried out each year in scrutinising advertisements and the labelling of pre-packed food and taking such action as iS possible to secure satisfactory amendments in those cases where a label or advertisement contains a false or misleading description of the food to which it relates. During the year under review corrective action has been taken in respect of cherry wine, biscuits, chocolate Easter eggs, flour and sugar confectionery, imitation caviare, blackcurrant punch, fruit juice drinks and creme de menthe. 21 Special Designated Milk During the year in question three licences were issued by my Council in respect of the use of the special designation pasteurised for milk processed in the Borough, Each premises was inspected regularly and compliance with the requirements of the Act of Regulations was maintained in each case 135 samples were taken, all of which were certified as being satisfactory. Safe Milk. In addition to the foregoing, 43 samples of raw milk were procured within the Borough and submitted to test for the presence of tubercle bacilli None was found contaminated POOD 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 welcomed 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 3 Hot water supplies provided, repaired or improved 67 Water closets provided repaired or improved 57 Sinks provided and waste pipes repaired 50 Ventilation provided or improved 26 Drainage provided repaired or improved 38 Dustbins provided 15 Verminous conditions abated 1 Keeping of animals abated 1 Prescribed notices affixed 76 Walls and ceilings repaired or cleansed 120 Floors repaired or cleansed 43 Premises cleansed 25 Protection of foodstuffs enforced 107 Equipment repaired or improved 222 Offensive accumulations removed 4 Nuisances abated and other action 31 Pood stores provided, improved or cleansed 6 Lighting improved 12 Windows and other woodwork repaired or repainted 71 The volume of work far exceeds what was done in 1955 and this was due to the coming into operation of the Pood Hygiene Regulations 1955. These Regulations deal with (1) general requirements, (2) requirements relating to persons engaged in the handling of food, (3) requirements relating to food premises, (4) requirements relating to stalls, (5) requirements relating to the transport and carrying of meat and (6) administrative provisions The general purport of the Regulations is to lay down requirements in respect of (a) the cleanliness of food premises stalls etc and of apparatus and equipment (b) the hygienic handling of food (c) the cleanliness of persons engaged in the handling of food and of their clothing and the action to be taken when they suffer from, or are carriers of certain infections, (d) the construction, repair and maintenance of food premises, stalls, vehicles, etc and the facilities to be provided (e) the temperature at which certain foods which are par ticularly liable to transmit diseases, be kept in food premises A brochure of these Regulations was sent to every caterer and food trader This was followed up by systematic visiting by the Public Health inspectors to see that the Regulations were understood to discuss any matters arising and to carry out an inspection of the premises. In general food traders appeared to welcome the laying down of a standard with which all would have to comply 22 HOUSING The numbers of new houses erected in the Borough in recent years is shown below, ■ 1946-52 1953 1954 1955 1956 Heston and Isleworth B.C 1,163 117 23 217 20 Brentford and Chiswick B.C 34 - - - 22 Southall B.C 64 - - - - Middlesex County Council 4 - - 1 - Ministry of Civil Aviation 77 - - - - Metropolitan Police 12 6 - 11 - Prison Commissioners - - 8 10 - Private enterprise- (a) new houses 162 27 76 219 172 (b) reconstructed after war destruction 185 - - - - (c) housing associations 50 140 111 39 59 (d) additional dwellings by conversion - 3 - - - 1,751 293 218 497 237 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): 268 (b) Number of inspections made for the purpose 326 (2) (a) Number of dwelling-houses (included under head (1) above) which were inspected and recorded under Housing Regulations, 1925 and 1932 60 (b) Number of inspections made for the purpose: 118 (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: 55 (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 142 2 REMEDY OF 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 127 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: 26 (2) Number of dwelling-houses which were rendered fit after service of formal notices (a) by Owners: 19 (b) by Local Authority in default of owners; 6 (b) Proceedings under Public Health Acts: (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 2 (2) Number of dwelling-houses in which defects were remedied after service of formal notices: (a) by Owners: Nil (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: 20 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders: 11 (3) Number of dwelling-houses rendered fit in consequence of Undertakings given by Owner; 1 (4) Number of dwelling-houses in respect of which undertakings from owners accepted, not to relet houses for human habitation 15 (5) Number of dwelling-houses demolished in pursuance of Undertakings: Nil 23 (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: Nil (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit: 1 (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): Nil (3) Number of dwelling-houses demolished: Nil 4 HOUSING ACT, 1936 - OVERCROWDING: (1) (a) Number of dwellings overcrowded at the end of the year: 37 (b) Number of families dwelling therein: 68 (c) Number of persons dwelling therein: 295 (2) Number of new cases of overcrowding reported during the year: 6 (3) (a) Number of cases of overcrowding relieved during the year: 9 (b) Number of persons concerned in such cases: 61 (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: 2 Section 26 of the Housing Repairs and Rents Act 1954. permits a tenant, on whom a 'repairs increase' 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 Council, 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 by way of repairs increase'. During the year, 8 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 increasein rent have been carried out to their satisfaction. During the year, 14 such certificates were revoked. At the end of the year, the following 61 houses, subject to Demolition or Closin Orders or to undertakings not to re-lpt till rendered fit, were still occupied:• Situation. Date of Demolition Order or Undertaking 14, Brickfield Yard 25.10.38 18, Brickfield Yard 25.10.38 3, Park Cottages 28.12.38 4, Park Cottages 28.12.38 11, Tivoli Road 28. 2.39 13, Tivoli Road 28. 2.39 106, Linkfield 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 24 Situation Date of Demolition Order or Undertaking 102, Linkfield Road 22. 2 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 10, Ivy Road 28. 6.55 2, Algar Road 26 7.55 4:, Algar Road 26. 7.55 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 6 Castle Place 29 12.55 180 Linkfield Road 28 2.56 184, Linkfield Road 28. 2.56 173 Spring Grove Road 28. 2.56 175 Spring Grove Road 28. 2.56 4, Church Street 24. 4.56 820, Bath Road 29. 5.56 822, Bath Road 29. 5.56 824, Bath Road 29 5.56 826, Bath Road 29 5.56 828, Bath Road 29. 5 56 830, and 832 Bath Road (jointly occupied) 29. 5.56 38, Haliburton Road 29.5 56 134, Hanworth Road 26.6 56 136, Hanworth Road 26. 6.56 138, Hanworth Road 26 6.56 140, Hanworth Road 26 6.56 10, and 12 Barrack Road (jointly occupied) 31 7,56 14, Barrack Road 31. 7 56 26, Barrack Road 25. 9.56 28, Barrack Road 25. 9.56 30, Park Road 30 10.56 300, North Hyde Lane 27.11.56 302, North Hyde Lane 27.11.56 304, North Hyde Lane 27.11.56 306, North Hyde Lane 27 11 56 308, North Hyde Lane 27 11.56 310, North Hyde Lane 27.11.56 312, North Hyde Lane 27,11.56 314, North Hyde Lane 27 11 56 316, North Hyde Lane 27.11.56 318, North Hyde Lane 27.11.56 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 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 During the year the Council approved expenditure as under (a) advances of £341 002 under the Small Dwellings Acquisition Acts in relation to 237 houses (b) improvement grants of £2,468 under section 20 of the Housing Act, 1949 in relation to 12 houses (c) repairs loans of £3 245 under section 4 of the Housing Act 1949, in relation to 12 houses (d) repair costs of £1,714 under section 9 of the Housing Act 1939 for work in default in relation to 11 houses GENERAL MATTERS BURIALS - Under Section 50 of the National Assistance Act, 1948, it is the duty of the Council to arrange the burial of any person who has died in the district, where it appears that there are no suitable arrangements for the disposal of the body. During 1956, two burials were arranged in accordance with this section. 25 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 150 members of the Council's staff were referred to the Health Department for medical examination. HEALTH EDUCATION- Posters issued by the Central Council for Health Education continued to be displayed on the boards formerly used by the Empire Marketing Board. During the year, the Medical Officer of Health gave talks to several organisations in the Borough on various aspects of the health services. Though the work of the department is not primarily educational, the staff are fully aware of the opportunities given by their contact with the people for drawing attention to matters bearing on health and hygiene. Other Departments have co-operated by displaying health educational material. PERSONS IN NEED OF CARE AND ATTENTION- Section 47 of the National Assistance Act, 1948, places the responsibility on the'Council of taking action to secure 'the necessary care and attention for persons who:- (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'. 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 for compulsory removal to hospital or institution, 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 cleasing 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. BLOOD TRANSFUSION SERVICE- Sessions for the collection of blood from donors were held as under: Hounslow Isleworth. 7th, 8th and 9th January 15th April 12th, 13th and 14th May 12th August 15th, 16th and 17th September. 9th December. 26 TABLE 1 Summary of Vital Statistics 1897-1956 Estimated Civilian population (mid- year) Birth Rate per 1,000 populalation Death Rate per 1,000 populalation Infant Mortality Rate Neo- natal Mortality Rate Maternal Mortality Rate per 1,000 live and still births Still Birth Rate per 1,000 live and still births Tuberculosis Death Rate per 1,000 population Deaths under lyr. per 1,000 live births Deaths under 1mth. per 1,000 live births 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 1916 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 1926 48,620 17.4 10.3 73 41 - - 0.1 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 99,20 14.9 9.5 40 20 3.3 23 0.5 1938 101,500 14.2 8.6 46 24 2.7 30 0.6 1939 101,100 15.0 8.8 50 23 3.4 26 0.7 1940 97,530 13.7 12.3 58 39 2.3 25 0.6 1941 93,990 12.9 10.3 61 32 2.4 35 0.8 1942 95,600 14.6 10.2 72 43 2.8 32 0.7 1943 95,080 16.3 10.6 47 23 0.6 26 0.5 1944 92,370 16.5 10.4 46 30 1.9 22 0.5 1945 95,100 15.5 9.7 51 33 2.0 26 0.5 1946 104,240 17.3 10.4 29 22 2.2 26 0.5 1947 106,670 17.3 10.6 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 1956 105,100 11.1 10.8 18 15 0.0 19 0.1 27 TABLE II REGISTRAR-GENERAL'S RETURN OF CAUSES OF DEATH, 1956. Abridged List No. Cause of Death Male Female Total B 1 Tuberculosis, respiratory 7 4 11 B 2 Tuberculosis, other 1 - 1 B 3 Syphilitic disease 3 - 3 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 1 1 2 B 18 Malignant neoplasm, stomach 17 6 23 Malignant neoplasm, lungs 44 7 51 Malignant neoplasm, breast - 19 19 Malignant neoplasm, uterus - 8 8 Other malignant and lymphatic neoplasms 71 43 114 Leukaemia, aleukaemia 2 3 5 B 20 Diabetes 4 3 7 B 22 Vascular lesions of nervous systems 55 89 144 B 26pt, Coronary disease, angina 130 50 180 B 28 Hypertension with heart disease 15 16 31 B 25 26pt, 27 Other heart disease 61 77 138 B 29 46pt. Other circulatory disease 29 26 55 B 30 Influenza 1 3 4 B 31 Pneumonia 30 30 60 B 32 Bronchitis 49 16 65 B 46pt. Other respiratory diseases 8 3 11 B 33 Ulcer of stomach and duodenum 8 7 15 B 36 43pt. Gastritis, enteritis diarrhoea 1 2 3 B 38 Nephritis and nephrosis 5 6 11 B 39 Hyperplasia of prostate 7 - 7 B 40 Pregnancy, childbirth, abortion - - B 41 Cogenital malformations 6 4 10 Residual Other defined and ill defined diseases 50 55 105 B E 47 Motor vehicle accidents 12 5 17 B E 48 All other accidents 13 6 19 B E 49 Suicide 9 6 15 B E 50 Homicide and operations of war 1 - 1 Total 640 495 1135 28 TABLE III. CAUSES OF DEATH (MALES) AT CERTAIN AGES, 1956. Under 1 1-4 5- 14 15- 24 25 44 45 64 65 74 75- over Total Tuberculosis, respiratory - - - - 1 5 1 - 7 Tuberculosis, other - 1 - - - - - - 1 Syphilitic disease - - - - - 1 1 1 3 Diphtheria - - - - - - - - - Whooping cough - - - - - - - - - Meningococcal infection - - - - - - - - - Acute Poliomyelitis - - - - - - - - - Measles - - - - - - - - - Other infective and parasitic di seases - 1 - - - - - - 1 Cancer stomach - - - - 1 7 5 4 17 lung - - - - 1 26 13 4 44 breast - - - - - - - - - uterus - - - - - - - - - other - - 1 - 2 21 23 24 71 leukoemia - - - - 1 - 1 - 2 Diabetes - - - - - 2 1 1 4 Cerebral haemorrhage, etc. - - - - - 9 19 27 55 Cornary disease, angina - - - - 3 56 44 27 130 Hypertension with heart disease - - - - - 3 4 8 15 Other heart disease - - - - 1 11 13 36 61 Other circulatory disease - - - - - 10 7 12 29 Influenia - - - - - - 1 - 1 Pneumonia 4 - - - - 10 6 10 30 Bronchitis - - - - - 14 17 18 49 Other respiratory diseases - - - - - 5 1 2 8 Ulcer of stomach & duodenum - - - - - 1 2 5 8 Gastritis, enteritis, etc. - - - 1 - - - - 1 Nephritis and nephrosis - - -- - - 1 1 3 5 Prostatic enlargement - - - - - 1 2 4 7 Pregnancy, childbirth,., abortion - - - - - - - - - Congenital malformations 2 - - - 1 2 1 - 6 Other diseases 10 - 1 - - 12 6 21 50 Motor vehicle accidents - - 1 3 2 3 3 - 12 All other accidents - - - 1 1 7 1 3 13 Suicide - - - - 2 6 - 1 9 Homicide and war operations - - - - 1 - - - 1 Total 16 2 3 5 17 213 173 211 640 Percentage of Total: 2.5 0.3 0.5 0.8 2.6 33.2 27.1 33.0 29 TABLE IV CAUSES OF DEATH (FEMALES) AT CERTAIN AGES, 1956. Under 1 1-4 5- 14 15- 24 25-44 45- 64 65-74 75- over Total Tuberculosis, respiratory - - - - - 3 - 1 4 Tuberculosis other - - - - - - - - - Syphilitic disease - - - - - - - - - Diphtheria - - - - - - - - - Whooping cough - - - - - - - - - Meningococcal infection - - - - - - - - Acute poliomyelitis - - - - - - - - - Measles - - - - - - - - Other infective and parasitic diseases 1 1 Cancer stomach - - - - - 2 1 3 6 lung - - - - - 3 2 2 7 breast - - - - 1 10 6 2 19 uterus - - - - 2 1 2 3 8 other - 1 - - 3 17 11 11 43 leukoemia - - - - - 1 1 1 3 Diabetes - - - - - - - 3 3 Cerebral haemorrhage, etc. - - - - 1 10 29 49 89 Coronary disease, angina - - - - - 4 21 25 50 Hypertension with heart di sease 1 6 9 16 Other heart disease - - - - 1 9 10 57 77 Other circulatory disease - - - - - 5 9 12 26 Influenza - - - - - 1 1 1 3 Pneumonia - 1 - - - 3 5 21 30 Bronchitis - - - - - - 3 13 16 Other respiratory diseases - - 1 - - - 1 1 3 Ulcer of stomach S duodenum - - - - - 1 3 3 7 Gastritis, enteritis, etc. - - - - - 1 1 - 2 Nephritis and nephrosis - - - - - 2 4 - 6 Prostatic enlargement - - - - - - Pregnancy, childbirth abortion - - - - - - - - - Congenital malformation 3 1 - - - - - - 4 Other disease . . 3 - - - 14 12 26 55 Mator vehicle accidents - - l - - 1 1 2 5 All other accidents - - - - 1 1 - 4 6 Suicide - - - - 1 4 1 - 6 Homicide and war operations - - - - - - - - - - Total 6 3 2 - 10 95 130 249 495 Percentage of Total 1.2 0.6 0.4 - 2.0 19.2 26.4 50.2 30 31 TABLE V INFANTS' DEATHS ACCORDING TO AGE AND CAUSE, 1956. Cause of Death Age Total Days Months Under 1 1 2 3 4 5 6 7-13 14-20 21-28 1 2 3 4 5 6 7 8 9 10 11 Pneumonia 1 - - - - - - - - - - - - 1 - - 1 1 - - - 4 Birth injuries - 1 - 1 - - - - - - - - - - - - - - - - - 2 Atelectasis & birth asphyxia -- 2 1 1 - - - - - - - - - - - - - - - - - 4 Congenital malformations 4 - - - - - - - - - - - - - 1 - - - - - - 5 Prematurity 3 1 - 1 - - - - - - - - - - - - - - - - 5 Haemorrhagic disease - - - - - 1 - - - - - - - - - - - - - - - 1 Umbilical haemorrhage 1 - - - - - - - - - - - - - - - - - - 1 TOTAL 9 4 1 3 - 1 - - - - - - - 1 1 - 1 1 - - - 22 32 TABLE VI INFECTIOUS DISEASES AGE DISTRIBUTION - 1956 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 yr s. Cases admitted to hospital Snall pox - - - - - - - - - - - - - - Typhoid Fever - - - - - - - - - - - - - - Para-Typhoid Fever - - - - - - - - - - - - - - Scarlet Fever 67 - 2 4 5 6 36 11 1 1 1 - - 14 Diphtheri a - - - - - - - -- - - - - - - Erysipelas 12 - - - - - - 1 - - - 4 4 2 Puerperal Pyrexia 69 - - - - - - - 9 53 7 - - 68 Ophthalmia Neonatorum - - - - - - - - - - - - - - Acute Encephalitis 1 - 1 - - - - - - - - - - 1 Acute Poliomyelitis 5 - - - 1 - 2 - - 1 - 1 - 5 Meningoccal Infection 1 - - . - 1 - - - - - - - 1 Pneumonia 27 - - - - - 2 1 - - - 19 5 6 Dysentery 22 2 2 2 1 1 1 1 - 9 2 - 1 6 Measles 244 12 19 27 27 36 113 4 4 2 - - - 11 Whooping Cough 96 7 10 9 13 9 40 6 1 ' - - 1 - 3 Food Poisoning 51 - 1 4 3 4 7 2 5 8 7 8 2 2 Tuberculosis Pulmonary 62 1 - - - 1 3 4 8 19 8 14 4 Non-pulmonary 7 - - - - - - 1 - 3 2 1 - 33 NOTIFICATIONS AND DEATHS FROM CERTAIN INFECTIOUS DISEASES HESTON AND ISLEWORTH, 1937-1956 TABLE VII Year Snallpox Scarlet Fever Diphtheria Erysipelas Pneumonia Meningococcal Infection Epidemic Encephalitis Poliomyelitis and Polioencephalitis Typhoid Fever Paratyphoid Fever Dysentery Measles Whooping Cough Influenza Tuberculosis Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths 1937 - - 242 1 18 1 45 - 124 41 5 1 - 1 - 1 - - - - - - 1 - 1 Not Notifiable 38 102 53 1938 - - 314 - 40 2 43 159 36 8 5 1 - 3 1 4 - - - 2 - - 2 - 1 6 113 58 1939 - - 175 - 51 5 23 - 142 35 6 - - 2 - - - - - 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 - - - - 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 1956 - - 67 - - - 12 - 27 60 1 - 1 1 5 - - - - 22 - 244 - 96 - 4 69 12 * Includes para typhoid fever to 1939. 34 TABLE VIII COUNTY COUNCIL OF MIDDLESEX CERTAIN VITAL STATISTICS FOR THE YEAR 1956. District Population mid- 1956 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 66,240 13.8 12.8 11,0 11.4 0.14 2.2 23.0 13. - Brentford & Chiswick 58,330 14.1 13.1 10.9 111 0.07 2.8 18.2 15.6 - Ealing 184,200 13.6 13.1 10.4 11,4 0.11 1.8 13.9 10.7 - Edmonton 98,110 12.9 12.6 9 8 11,2 0.13 2.2 22.9 15.8 - Enfield 109,000 12 4 12.4 11.0 9,4 0.09 2.1 24 3 17.7 - Feltham 49,230 16.7 16.2 6 6 10,6 0.06 1.3 21.9 18.2 Finchley , 69,800 13.0 12.4 11,9 10.9 0.11 2.2 13 8.8 1.08 Friem Barnet 28,570 11.6 12.2 17,7 9.7 0.04 2.2 21.1 15.1 - Harrow 216,200 12.9 13.2 8,8 10.6 0.06 1.9 21.1 16.8 0.0 Hayes & Harlington 66,460 15.2 14.3 7.5 12,2 0.08 1.6 14. 11.8 0.7 Hendon 153,200 13.0 12.4 10,2 10.7 0.11 2.2 18.0 15.5 - Heston & Isleworth 105,100 11.8 11.7 10 8 11.4 0.10 2,0 17.8 14.6 - Hornsey 97,220 15.0 14 0 11,5 10.4 0.12 2.2 23.3 15.8 1.34 Potters Bar 18,910 15.7 14 8 9.2 11.7 - 1.8 27.0 20.3 - Ruislip-Northwood 73,930 13.7 13.8 7.3 9,3 0.01 1.6 15.8 11.8 098 Southal 1 , 53,220 13.4 13.4 12 3 10.5 0.17 2.4 18.2 14.0 1.39 Southgate 71,670 11.2 12.2 11.8 9.9 0.03 2.6 13.8 7.5 -- Staines 44,200 17.2 16.2 8.8 10.7 0.07 1.9 23.7 22.4 - Sunbury 26,700 19.6 17.8 7 6 9,6 0.04 1.3 19.1 11.5 - Tottenham 120,700 12.9 12.5 10 4 11.3 0.15 2.3 24 4 21.8 1.25 Twickenham 104,000 12.8 13.2 11.4 10,9 0.14 2.1 10.5 6.8 0.74 Uxbridge „, 59,640 17.8 16.4 8.2 10.6 0.07 1.6 17.9 11.3 -- Welfembley 128,300 11.6 11.7 9.0 10.6 0.06 2.1 16.8 12.7 1.32 Willesden 174,900 15.3 13.9 9.9 11.4 0.14 2.1 22.8 17.9 1.83 Wood Green 50,100 11.5 11.5 10.7 10 5 0.02 2.5 17.3 15.6 - Yiewsley & West Drayton 23,070 18.5 17.0 6 5 9,1 - 1.1 16.4 14.1 - COUNTY 2,251,000 13.6 13.2 10,0 10.8 0.10 2.0 19.1 14.6 0.58 TABLE IX.(a) METEOROLOGY (Extracted from records supplied by Chief Engineer, Mogden Sewerage Works). Week Ending Barometer Temperature (°p) Days with Rainfal1 Total Rainfall (inches) Highest Lowest Max. Min Jan 7th. 30.56 29.52 54.0 29.0 3 0.23 14th. 29.81 28.77 50.0 28.0 7 1.16 21st. 30.02 29.49 52.0 28.0 3 0.13 28th. 30.20 29.39 55.0 26.0 5 1.12 Feb. 4 th. 30.73 30.69 54.0 15.0 3 0.95 11th. 30.63 30.02 51.0 23.0 4 0.11 18th. 30.17 29.60 40.0 22.0 2 0.03 25 th. 30.39 29 87 37.0 19 0 1 0 04 Mar. 3rd. 30.38 29.63 59.0 31.0 3 0.49 10th. 30.56 29.85 55.0 29.0 1 0.01 17th. 30.33 29.79 58.0 28.0 NIL NIL 24 th. 29.83 29.24 61.0 36.0 2 0.11 31st. 30.27 29.56 63.0 39.0 2 0.13 Apr. 7th. 30.35 30.00 59.0 31.0 1 0.07 14th. 30.14 29.43 66.0 37.0 4 0.81 21st. 30.37 29.67 59.0 31.0 1 0.12 28 th. 29.99 29.65 59.0 32.0 2 0.09 May. 5th. 30.35 29.96 72.0 35.0 1 0.03 12th. 30.33 29.90 76.0 39.0 2 0.08 19th. 30.47 29.98 71.0 35.0 NIL NIL 26th. 30.40 29.80 77.0 38.0 1 0.04 June. 2nd. 30.35 29.53 79.0 47.0 1 0.06 9th. 30.25 29.45 67.0 44.0 5 0.83 16th. 30.29 29.64 70.0 42.0 5 0.63 23rd. 30.46 29.70 68.0 43.0 1 0.01 30th 30.27 29.52 76.0 45.0 3 0.23 July 7th. 30.17 29.60 78.0 53.0 5 0.44 14th. 30.26 29.65 83.0 50.0 3 2.40 21st. 30.16 29.63 75.0 50.0 3 1.60 28 th. 30.33 29.05 83.0 54.0 2 0.31 Aug. 4th 30.18 29.54 68.0 47.0 4 0.79 11th. 30.35 29.47 74.0 47.0 4 0.56 18th. 30.00 29.28 70.0 49.0 5 0.70 25 th. 29.98 29.13 69.0 45.0 5 0.95 Sept. 1st. 30.21 29.49 68.0 44.0 6 1.34 8th 30.02 29.53 69.0 50.0 6 0.95 15 th. 30.28 29.74 76.0 50.0 3 0.33 22nd. 30.27 29.71 76.0 51.0 1 0.02 29 th. 29.92 29.46 79.0 47.0 2 0.22 Oct. 6th. 30.28 29.73 68.0 39.0 4 1.70 13th. 30.47 30.23 64.0 40.0 3 0.05 20 th. 30.85 29.33 64.0 42.0 5 0.21 27th. 30.40 29.86 63.0 31.0 2 0.14 Nov. 3rd. 30.49 29.95 52.0 37.0 4 0.15 10 th. 30.56 29.58 58.0 34.0 5 0.13 17th. 30.53 29.81 57,0 30.0 6 0.2 24th. 30.52 29.77 48.0 21.0 3 0.04 Dec. 1st. 30.39 29.42 55.0 29.0 4 0.03 8th. 30.48 30.06 56.0 38.0 4 0.02 15th. 30.28 29.39 57.0 40.0 7 0.92 22nd. 30.48 29.44 56.0 29.0 4 0.15 29th. 30.17 29.08 50.0 30.0 6 0.99 35 TABLE IX.(b) WIND DIRECTION (Sum, of Daily Records, 52 weeks) N. 26 days N. N. R 18 days N. E. 26 days E. N. E, 9 days E. 18 days E. S. R 10 days & E. 5 days S. s. E. 5 days a 14 days S.s.w 3 days S. W. 44 days w. s. w. 29 days w. 32 days W. N. W. 12 days N. W. 20 days N. N. W. 19 days Calm 74 days 36 TABLE X FACTORIES ACTS 1937 and 1948 PART I OP THE ACT 1. Inspections for purposes of provisions as to health made by Public Health Inspectors Premises Number on Register Number of Inspect ions Written Notices Occupiers Prosecuted (i) Factories in which Sections 1, 2, 3 4 and 6 are to be enforced by Local Authorities 35 36 - - (ii) Factories not included in (1) in which Section 7 is enforced by the Local Authority 386 630 17 - (iii) Other premises in which Section 7 is enforced by the Local Authority (excluding outworkers" premises) 6 13 - - TOTAL 427 679 17 - 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 - - - - - Overcrowding (S. 2) - - - - - Unreasonable temperature (S. 3) - - - - - Inadequate ventilation (S. 4) - - - - - Ineffective drainage of floors (S. 6) - - - - - Sanitary Conveniences (s. 7) (a) insufficient 1 3 - - - (b) unsuitable or defective 15 15 - 5 - (c) not separate for sexes 2 1 - 1 - Other offences against the Act (not including offences relating to Outworks) 1 - 1 - - TOTAL 19 19 1 6 - 37