AC 439 (1) 10w. Sb 2 Library HES 45 ANNUAL REPORT OF THE Nidd MEDICAL OFFICER OF HEALTH OF THE BOROUGH OF HESTON AND ISLEWORTH for the year 1958 A. ANDERSON, M.D., D.P.H., Medical Officer of Health. B INDEX Page Page Accidents 7 Laundry Service 26 Bakehouses 19 Marriage Guidance Council 13 Births, Live 6 Maternal Mortality 8 Births, Still 6 Meat and Other Pood Inspection 20 Blood Transfusion Service 27 Medical Examinations of Staff 26 Burials 26 Meteorology 36 Canal Boats 16 Milk 19 Clean Air 16 Municipal Restaurants and School Canteens 20 Closet Accommodation 14 Noise Nuisances 17 Common Lodging Houses 16 Persons in need of care and attention 26 Deaths 7 Pet Animals Act, 1951 19 Deaths, Age and Sex Distribution 30 & 31 Physical Characteristics 13 Deaths, Causes of 29 Public Cleansing 14 Disinfection 10 Public Mortuary 26 Disinfestation 17 Rags, etc. Exchange of Articles for 15 Drainage and Sewerage 14 Rag Flock and Other Filling Factories, No. on Register, Materials Act. 1951 18 Inspection and Defects, etc. 38 Rats and Mice Destruction 17 factories, Workplaces, etc. 17 Rivers and Streams 14 Family Planning Association 13 Sanitary Circumstances 13 Fever Hospitals 10 Sanitary Inspection 15 Food and Drugs Sampling 20 Shops Act, 1950. Section 38 18 Food Hygiene 22 Slaughter of Animals (Amendment) Act, Food Poisoning 0 1954 19 Health Committee 3 Slaughterhouses, etc. 19 Health Education 26 staff 2 Health Services provided by Other Statistics, Certain Vital. County of Authorities 11 Middlesex 35 Housing 22 statistics, General 6 Icecream 19 statistics. Vital 6 Infant Deaths according to Age and Case 32 statistics Vital, Summary of 28 Swimming Baths 18 Infant Mortality 8 Tents, Vans and Caravans 16 infectious Diseases Tuberculosis Infectious Diseases, Age Distribution 33 Verminous Premises, Articles and persons 19 Infectious Diseases, Notifications and Deaths 34 water Supply 13 Laboratory Service 10 Wind Direction 37 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, Cert, as P.H.I, and M.I. W. Bowles, 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. F. W. Goldsmith, Cert, as P.H.I, and M.I. Rodent Officer: A. Farrer. Rodent Operatives: R. Ashurst. A. L. Worthington. Mortuary Attendants, Disinfectors, Drain Testers, etc.: F.S.J. All away (to 16.8.58). L. Woodhead. L. Wisdom (from 1.9.58). Clerks; B.W. Kilby, Cert, as P.H.I, and M.I. (Part time). Mrs. L. R. Butler, Cert, as P.H.I, (to 4.6.58). D. S. Bates. C. J.C. Mail (from 22.9.58). E. J. Hutchins. Mrs. N.N. Vaughan (to 15.1.58). Mrs. L. E. 0' Gorman. Mrs. M. E. Ponsford. F.R. Money (from 3.2. 58). 2 THE HEALTH COMMITTEE Of HESTON AND ISLEWOBTH BOROUGH COUNCIL to May, 1958 Councillor Mrs. M. Hennig (Chairman) Councillor E.T. Harding, M.S.R. (Vice-Chairman) Councillor P. E. Kinsey, J. P. (Mayor) Councillor Mrs. E. M. Coleipan Alderman P.J. Jansen Councillor A.G. Cross Alderman Mrs. A. B. Tolmon Councillor A.J. Pielder, J. P. Councillor D. B. Andrews Councillor Mrs. R. New Councillor A.J. Beach Councillor A.H. Nixon Councillor W.H. Bolster, B. Com. Sc. Councillor N. V. Wright from May, 1958 Alderman F.J. Jansen (Chairman) Councillor Mrs. R. New (Vice-chairman) Alderman A.J. Fielder, J.P. (Mayor) Councillor R.D. Flynn Alderman v.C. Denton, D. L., J. P., F. C. I. S. Councillor Mrs. M. Hennig Alderman Mrs. A. B. Tolmon Councillor Mrs. V. G. A. Seeker Councillor A. J. Beach Councillor F.J. Shercliff Councillor Mrs. E.M. Coleman Councillor I.J. Thomas Councillor A. G. Cross, C. C. Councillor J. B. Webb 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 1958- 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. It is inevitable that some items in the report show little or no variation from year to year. Yearly changes occur in statistical tables, and while such variations must be observed and studied, a better view is obtained by studying the trends over a period of years. The increase in the birth rate recorded last year has not been maintained. This year the Borough rate (12-0) is the lowest in the 26 Middlesex districts and well below the rate of 16.4 of England and Wales. Approximately 80 per cent, of local births still occur in hospital. The death rate has remained fairly constant over recent years and closely approximates to the national rate. The majority of deaths occurred at age 65 years and over, The chief causes of local deaths during working life (15 - 64 years) and at higher ages for the last five years are shown below as percentages of all deaths at the specified ages; 15 - 64 years 65 years and over Cancer 32.9 13.9 Cerebral Haemorrhage 10.5 13.6 Coronary Disease 16.5 15.5 Other Heart and Circulatory disease 11.3 24.6 Bronchitis and Pneumonia 5.9 13.0 Accident 4.8 1.8 It will be noted that the same causes account for just over 80 per cent of the deaths in both age groups but cancer accidents and coronary disease are relatively greater killers during working life. There were 63 deaths from cancer of the lung compared with an average of 46 per year during the previous five years. Evidence continues to grow to support the view that there is an association between cigarette smoking and cancer of the lung. The evidence comes from many countries but as yet the exact nature of the association has not been elucidated. According to official returns no reduction in the consumption of cigarettes is occurring in this countfy. There is a growing preference for filter tip cigarettes, but I know of no evidence to show that filter tips give any re«U protection. It appears that most confirmed smokers will continue to take the risk and, against this example and the flood of trade advertisements, it is difficult to dissuade youth from starting cigarette smoking. It is most disquietening that investigations have shown that cigarette smoking is already fairly prevalent among older school children. The infant mortality rate and the tuberculosis death rate are the lowest in the local records, while this is gratifying, deaths from accidents, coronary disease, etc. continue unabated. The death rate from coronary and other degenerative heart conditions has been rising steadily. The rise has been fairly rapid in recent years. The increase in the average age of the population has played some part in this but the rise has been as marked in the 25-64 year group as in the 65 years and over group. Much research continues to be devoted to this problem, various aspects of modern life e.g. sedentary work, diet with special reference to intake of fat, cigarette smoking, emotional stress, etc. appear to be possible contributory factors, but the real cause awaits discovery. The research has shown the importance of the basic rules of health - an adequate and balanced diet, reasonable physical exercise, sufficient sleep and rest and a tranquil mind. Moderation in all things may not be an attractive philosophy, but its practical value has been realised throughout the ages. In general, the infectious disease incidence in the Borough was low and most infections were of a mild type, while the newer drugs have greatly strengthened our treatment of infection it should not be forgotten that germs and insects can adapt themselves to changes. Most flies are now resistant to D.D.T. and the recent increase in 4 gonorrhoea and staphylococcal infections are examples of germs developing resistance to antibiotics. Prevention is still important and it is pleasing to record a general increase, compared with last year, in the number of children immunised against various infections. When the age of eligibility for poliomyelitis vaccination was raised from 15 to 25 years, the response of this vulnerable age group was very poor. It is a pity that when prevention succeeds the need for its continuance tends to be forgotten. Though there was no outbreak of any size the number of cases of food poisoning notified was higher than last year. Where only one case occurs in a household and bacteriological investigation reveals no pathogenic organisms, it raises doubt about the illness being due to food infection. In most cases the gastro-intestinal symptoms are probably due to some other cause, but it is good that practitioners should always have food poisoning in mind. It is important that notification be prompt if the Department's investigations are to have any chance of success. Contamination of food may arise in many ways, but only too often the source of infection is human. Germs capable of causing food poisoning are usually carried in the nose and bowel and are conveyed to food by hands. Thus strict personal cleanliness by all handlers of food in home, shop, food factory and restaurant is important. The number of contraventions of the Pood Hygiene Regulations found or. food premises is decreasing, but hygienic premises must be supported by hygienic practice. This applies to the customer as well as to the food retailer and it should be remembered that all dirty milk bottles are primarily due to the faulty hygiene of the consumer. The incidence of chronic respiratory infections such as bronchitis is directly associated with the degree of atmospheric pollution. Apart from direct and indirect damage to health, atmospheric pollution has a destructive effect on huildings, paintwork, fabrics, etc. The degree of atmospheric pollution in the Borough, compared with many more industrial areas, is not high but the records kept over the last eight years show no signs of a decrease. It is higher than it should be if the health of the citizens is to be safeguarded adequately. Attention has been gjyen to this and at the end of the year the first Smoke Control Order was awaiting confirmation. The Department maintained steady action to deal with unfit houses. While difficulties in providing alternative accommodation persist careful thought has to be given to action which may result in the demolition or closing of a house. By informal action every effort is made to secure the repair and improvement of houses, but if this fails the provision of the Housing Acts must be applied. Shortage of houses results in applicants seeking support for their applications on medical grounds. In general, adverse housing conditions may cause or aggravate physical and mental illness, but advocating priority in individual cases is not an easy decision. Many matters have to be taken into consideration and medical priority is put to best use when it is restricted to where true medical benefit will follow re-housing. Observations throughout the Borough give no indication that the Litter Act has, as yet, produced any significant change. Road verges, open spaces and vacant land are used only too often for the dumping of household, garden and other rubbish. While some of this dumping is deliberate, much is due to thoughtlessness. People who would not do so in their own homes and gardens, discard anywhere else cigarette packets, sweet and ice wrappings, bus tickets, empty match boxes, etc. Even where waste bins are provided there is as much, or more, litter around than in the bin. One ice-cream manufacturer has provided litter baskets wherever his products are sold, and it is pleasing to note the increasing use being made of them. Just as a house is no tidier than its occupants, so a town is no tidier than those who live in it. The work of the Department and especially of the Public Health inspectors, touches the welfare of the citizens in many ways. The Council's efforts are devoted largely to reducing health hazards, but in preventive medicine emphasis is shifting today from things which can be done for people to things which people must do for themselves. people who submit without protest to any health procedure imposed on them will avoid or evade the most trivial procedures which demand some positive co-operation or initiative on their part. The purpose of health education is to make the individual aware of matters affecting his health in the hope of gaining his active co-operation ln raaintaining it. To the Council for their encouragement and support, to my colleagues in other epartments for their co-operation and to my staff for their loyal assistance, I would like to record my thanks. I remain, Your obedient Servant, A. ANDERSON, Medical Officer of Health 5 GENERAL STATISTICS Year - 1958 Area in acres 7,261 Population (Registrar-General's estimate) 105,100 Number of habitable premises (rate books) 30,805 Number of houses erected during year 272 Rateable Value of Borough £2,007,451 Sum represented by a penny rate £8,240 Live Births - male 632 Live Births - female 632 Birth rate per 1,000 population 12.0 Birth rate per 1,000 population (England and Wales) 16,4 Stillbirths - male 9 Stillbirths - female 8 Stillbirths rate per 1,000 (live and still) births 13.3 Deaths - male 545 Deaths - female 571 Death rate per 1,000 population 10.6 Death rate per 1,000 population (England and Wales) 11.7 infant Mortality rate 16.6 Infant Mortality rate (England and Wales) 22.5 Maternal Mortality rate 0.0 Maternal Mortality rate (England and Wales) 0.4 VITAL STATISTICS POPULATION The Registrar-General's mid year estimate of the population of the Borough for the year 1958 is 105,100 RATEABLE VALUE. The rateable value of the Borough for 1958 was £2,007,451 and the sum represented by a penny rate was £8,240 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 30,805, in relation to the estimated population, this yields an average of approximately 3.5 persons per house. LIVE BIRTHS The number of live births in 1958 was 1,264 as compared with 1,305 in 1957 The birth rate was 12.0 per 1,000 population. The birth rate will vary apart from other causes, according to the age and sex distribution of the population, and to permit of a true comparison with other areas, the 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 12.0 as compared with the birth rate of 16.4 per 1,000 population for England and Wales, The number of illegitimate births was 45 as compared with 47 in 1957- 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 1950-54 4.0 1930-34 3.2 1955 4.2 1935-39 2.9 1956 3.3 1940-44 4.6 1957 3.6 1945-49 5.1 1958 3.6 Of the total live and still births, 75.7 occurred in hospital. STILLBIRTHS The number of stillbirths in 1958 was 17. The proportion of stillbirths per 1,000 total (live and still) births in recent years is shown below:- No. of Stillbirths Rate per 1,000 total births 1930-34 214 31.2 1935-39 224 29.4 1940-44 200 27.7 6  No. of Stillbirths Rate per 1,000 total births 1945-49 198 23.8 1950-54 129 20.6 1955 20 16.9 1956 24 19.1 1957 15 11.4 1958 17 13.3 This loss of potential lives remains a problem and until more is known of the causes little further improvement can be expected DEATHS The deaths of residents of the Borough during 1958 were 1,116 (545 male, 571 female). This represents a death rate for the Borough of 10 6 per 1,000 population The deaths in any area are influenced by the sex and age distribution of the population, and to permit of a true comparison, the Registrar-General calculates for each local sanitary authority area what is called an area comparability factor. When this is applied to the above Borough rate, the result is 11.3 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, ill, and IV The cause of death was certified by the Coroner in 238 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 1958 Under 1 year 21.8 5.3 2.4 1.9 1-4 years 8.4 0.8 0.5 0.09 5-14 years 3.8 2.1 0.4 0.6 15 - 24 years 3.7 2.1 0. 8 1.2 25 - 64 years 30.8 33.0 31.6 29.1 65 years and over 31.5 56.7 64.3 67.1 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 diseases; cerebral haemorrhage; cancer; bronchitis and pneumonia. In females 53.4 per cent of deaths occurred at age 75 years and over as compared with 30. 8 per cent in males The Secretary of the Road Safety Committee informs me that during 1958 there were 805 road accidents which resulted in 17 deaths, serious injury to 184 persons and slight injury to 776 persons. All these figures show an increase in the corresponding figures for 1957. The number of deaths from motor vehicle and other accidents in Borough residents during the last ten years is shown below:- Year Motor Vehicle Accidents Age in years Other Accidents Age in years 0-4 5-14 15-64 65+- All ages 0-4 5-14 15-64 65 + All ages 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 1957 1 - 5 4 10 2 - 1 15 18 1958 1 2 10 4 17 - - 7 9 16 Total 5 11 75 54 145 7 3 59 123 192 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 7 INFANT MORTALITY. During 1958 there were 21 deaths of children under the age of 1 year. This represents an infant mortality rate per 1,000 live births of 16.6 as compared with 22.5 for England and Wales. The causes of infant deaths are shown in Table V. In the following table, the change in the local infant mortality rate over 5 year periods from 1898 is shown:- No. of live births No. of deaths under 1 year Infant Mortality Rate 1898 - 1902 4,369 698 160 1903 - 1907 5,264 665 126 1908 - 1912 5,383 590 110 1913 - 1917 4,661 461 99 1918 - 1922 4,326 327 76 1923 - 1927 4,333 271 63 1928 - 1932 6,055 318 53 1933 - 1937 7,121 313 44 1938 - 1942 6,912 393 57 1943 - 1947 8,210 345 42 1948 - 1952 6,680 146 22 1953 - 1957 6,157 134 22 1958 1,264 21 17 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 ante-natal care, management of labour and the nurture of young babies. 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 - 1934 2.6 1.7 4.4 1935 - 1939 1.0 2.1 3.1 1940 - 1944 0.7 1.2 1.9 1945 - 1949 0.2 1.2 1.4 1950 - 1954 - 0.3 0.3 1955 - - - 1956 - - - 1957 - - - 1958 - - - INFECTIOUS DISEASE Notification to the Medical Officer of Health is the essential preliminary to control of infectious disease. The diseases required by statute to be notified:smallpox, cholera, diphtheria, membranous croup, erysipelas, scarlet fever, typhus fever, paratyphoid dever, 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 575 were so endorsed. INCIDENCE OP 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. 8 SMALLPOX. No case of smallpox occurred in the Borough during 1958. 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. According to the returns 832 children under the age of one year were vaccinated in 1958 as compared with 492 in 1957. Modern travel is such that the risk of importing smallpox is ever present. SCARLET FEVER. This disease continues to be mild but 62 cases were notified during the year. 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 1958 was 900 as compared with 553 in 1957. ERYSIPELAS. The number of notifications was 6 but no death was due to this disease. PNEUMONIA. Notifications of pneumonia were 45 as compared with 39 in 1957. Of the total pneumonia deaths 85 per cent, occurred at age 65 and over. MENINGOCOCCAL INFECTION. No case was notified during the year. EPIDEMIC ENCEPHALITIS. No notification was received during the year. POST-INFECTIVE ENCEPHALITIS. Encephalitis is known to occur as a complication of other infectious diseases, but no such case was notified during 1958. POLIOMYELITIS. No case occurred during the year. Inoculation against poliomyelitis was continued during the year, and 10,517 children, 426 adolescents and 397 expectant mothers were given two injections of vaccine. At the end of the year 3,413 children have also had a third injection. Experience has shown that reactions, local or general, to these inoculations are comparatively rare TYPHOID FEVER. One case of typhoid fever was notified during the year. The infection occurred during a visit to several countries in Europe. 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 15 cases were notified, as compared with 7 in 1957. 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. TUBERCULOSIS. During the year 74 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 trend of the Borough death rate from tuberculosis is shown below:- Tuberculosis Death Rate per 100,000 population Pulmonary Non-pulmonary Total 1930 - 1934 67.5 11.5 78.9 1935 - 1939 52.3 8.2 60.4 1940 - 1944 55.8 7.4 63.2 1945 - 1949 39.1 6 7 45.8 1950 - 1954 18.9 1.1 20.0 1955 13.3 1.0 14.2 1956 10.5 0.9 11.4 1957 6.9 - 6.9 1958 4.8 - 4.8 A permanent mass X-ray unit has been established at West Middlesex Hospital and is open to the public without appointment. During the year 459 children were inoculated with B.C. G. vaccine as a protection against tuberculosis. 9 OPHTHALMIA NEONATORUM. One case was reported but no damage to sight resulted. PUERPERAL PYREXIA. During the year 70 cases were notified as compared with 98 cases in 1957. No woman died from puerperal or post-abortion sepsis. MEASLES. This disease was less prevalent - 275 cases as compared with 804 in 1957. WHOOPING COUGH. The notifications of whooping cough, 44, were fewer than in 1957. Facilities for immunisation against this disease are available, and 795 were inoculated. 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. One case of malaria was notified during the year. The infection had been contracted overseas. INFLUENZA. This disease caused 7 deaths as compared with 9 in 1957. 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 91; Chicken pox, 249 and and German measles, 62. 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, 126 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. During the year six rooms were disinfected and 10 lots of bedding destroyed. Five lots of clothing were disinfected before being sent abroad. 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 1958 was 298. FOOD POISONING. During 1958 notifications of the occurrence of food poisoning in 73 persons were received, and during the course* of our investigations and from other sources, a further 7 cases were discovered. A summary of the cases is given below - Cases of Pood Poisoning 1st 2nd 3rd 4th Quarter Quarter Quarter Quarter Total 19(14) 9(7) 26(26) 26(26) 80(73) Outbreaks due to identified agents Total outbreaks Total cases 2 4(4) Outbreaks of undiscovered cause Total outbreaks Total cases 15 41(34) Single cases Agent identified Unknown cause Total cases 9 28 35(35) () notified under Section 26 of the Food and Drugs Act, 1955. The majority were single cases. The largest number affected in any one outbreak was 5 and this was associated with a Works canteen. 10 HEALTH SERVICES PROVIDED BY OTHER AUTHORITIES NORTH-WEST METROPOLITAN REGIONAL HOSPITAL BOARD. Two general hospitals (West Middlesex, 1,150 beds and Houfislow, 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 New Heston Road Tuesday and Thursday afternoons Thursday afternoon (b) Infant Welfare Clinics 92, Bath Road, Hounslow Tuesday, Wednesday, Thursday and Friday afternoons Busch Corner, Isleworth New Heston Road Monday and Wednesday afternoons Monday, Tuesday and Wednesday afternoons Cranford (Holy Angel's Church Hall, Bath Road) Friday afternoon (c) Immunisation and vaccination clinics 92, Bath Road, Hounslow Busch Corner, Isleworth New Heston Road By appointment (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 Busch Corner, Isleworth Monday to Friday daily and 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. Their work is largely educational and social, and is defined in the Act as 'giving advice as to the care of young children, persons suffering from illness and expectant and nursing mothers, and as to the measures necessary to prevent the spread of infection'. (j) Domestic Helps Home helps are employed to provide domestic help for households 'where such held is required owing to the presence of any person who is ill, lying-in, an expectwt mother, mentally, defective, aged, or a child not 11 over compulsory school age'. A charge is made for this service and in assessing this, regard is had to the means of the person concerned. (k) Prevention of Illness, Care and After-care. The care and after-care of tuberculous persons is dealt with by the Welfare Officer at the Chest Clinic. Among other things, the County Council scheme provides for the admission of persons, not in need of medical or nursing care, to recuperative holiday homes and for this a charge is made according to the person's circumstances. (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 illhealth 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 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 Tuesday and Friday mornings (ii) Medical consultation 92, Bath Road, Hounslow Tuesday and Friday mornings Busch Corner, Isleworth Monday and Wednesday mornings New Heston Road Friday 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 2nd Monday afternoon (vi) Physiotherapy 92, Bath Road, Hounslow Wednesday and Thursday afternoon! Thursday morning (vii) Dental Clinic (viii) Artificial Sunlight Clinic (ix) Immunisation Clinic see under Health Department (x) Child Guidance Clinic Old Town School, Hounslow, by appointment (xi) Speech Therapy by appointment 12 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 pursing mothers, young children and school children) pharmacei^ical and supplementary ophthalmic services. The headquarters of the Council is at North West House, 119, M^rylebone Road, N.W.I. 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 1958. » MARRIAGE GUIDANCE COUNCIL- The Borough Council makes a contribution to the Richmond Marriage Guidance Council, and enquiries should be made to Mrs. Hoyland, 100, Sandy Lane, Teddington. (KIN. 8227). SANITARY CIRCUMSTANCES PHYSICAL CHARACTERISTICS. The Borough has an area of 7,261 acres and lies in the Thames Valley on the north bank of the river. From the river, the land rises slowly until at North Hyde it is about 100 feet above sea level. The subsoil consists of 'drift gravels' and lying on them in places are patches of clay The following open spaces are laid out and controlled by the Borough Council:- Park Farm and Avenue House, Cranford 40.29 acres Heston Fair Ground 9.38 ,, Church Meadow, Bath Road 9.20 ,, Children's Playground, Sutton Lane 0.60 ,, Kingsley Road Playing Field 6.95 ,, Greenharas 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 % 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 20 Cisterns cleansed, repaired, etc. 2 Draw-off taps connected direct to main 1 Service pipes or taps repaired 11 Mains water substituted for well water 1 13 DRAINAGE AND SEWERAGE. The drainage and sewerage of almost the whole of the Borough is arranged on the separate system and forms part of the West Middlesex Sewage Scheme. A few houses on the outskirts of the Borough drain to cesspools. The following work was carried out during 1958 - Drains exposed for examination 48 Drains unstopped, repaired etc. 262 Waste pipes repaired, trapped, etc. 32 Soil pipes repaired, etc. 11 Ventilation shafts repaired, etc. 12 Rainwater pipes disconnected from drains 2 Gully traps inserted or repaired 43 Disconnecting traps inserted or repaired 5 Disconnecting and inspection chambers provided 18 Disconnecting and inspection chambers repaired, etc. 56 Drains constructed or repaired 31 Total length (ft) of drain pipes laid - (a) 4" 608 (b) 6" 104 (C) 9" 150 Drain tests applied 127 Other works executed 25 Cesspools emptied or repaired 6 While the Borough is responsible for the local sewerage of its own district the duty of the disposal of sewage is the responsibility of the Middlesex County Council, whose West Middlesex 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 1958. CLOSET ACCOMMODATION- The closet accommodation of the Borough consists almost wholly of water closets connected to the sewers, A few water closets drain to cesspools, and several houses on the outskirts of the Borough have pail or chemical closets. The following works were carried out during the year:- Water closets constructed or rebuilt 5 Water closets where walls cleansed 33 Water closets fitted with new flushing apparatus 23 New pans or pedestals provided 21 Water closets repaired or improved 32 Water closets blockages unstopped 2 Other closets provided or repaired 1 Urinals constructed, rebuilt or repaired 2 Houses connected to sewer and cesspool demolished 1 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 29 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:- 14  1954 1955 1956 1957 1958 paper (tons) 1,000 897 1,082 994 1,045 Scrap metal (tons) 90 38 73 26 31 Textiles (tons) 27 34 13 10 3 Bottles, jars (tons) 17 4 2 - - Cullet (tons) 3 - - - - Kitchen Waste (tons) 9 - - - - Total income £8,705 £8,490 £9,414 £8,102 £8,564 SANITARY INSPECTION OP THE BOROUGH. In addition to the work recorded in other paragraphs of this Report, the Public Health Inspectors continue their general duties of investigating complaints, abating nuisances 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 1,538 Number of premises at which nuisance, etc. were located 698 Number of premises where defects were remedied (a) by owners or occupiers 562 (b) by Council in default 7 (c) public sewers repaired by Council 16 Informal notices issued 336 Written reminders issued 576 Statutory notices served 36 Total number of inspections and re-inspections 22,423 Inspectionsof piggeries 13 Inspections of stables 9 Inspections of urinals 146 Sinks provided or repaired 16 Roofs repaired 181 Gutters repaired or renewed 139 Brickwork, sills, etc., repaired or renewed 291 Premises provided with damp-proof courses 4 Yards and forecourts paved or drained 32 External painting 42 Rooms stripped, cleansed and redecorated 282 Floors, walls and ceilings, repaired or renewed 520 Rooms in which ventilation provided or improved 11 Windows repaired or renewed 377 Doors and other woodwork repaired or renewed 139 Staircases replaced or repaired 14 Lighting to staircases provided or improved 2 Handrails or balusters repaired or renewed 17 Grates provided or repaired 64 Washing coppers provided or repaired 6 Instances where ventilation under floor provided or improved 19 Pood stores provided or repaired 13 Domestic cleansing enforced 4 Improper keeping of animals abated 3 Offensive accumulations removed 36 Other repairs carried out or nuisances abated 245 Visits re infectious diseases, etc. 614 Complaints continue to be received of nuisance caused by pigeons. 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 OF ARTICLES FOR RAGS, etc. Under the Public Health Act, 1936, it is an offence for any person who collects or deals in rags, etc., to sell or deliver whether gratuitously or not, any article whatsoever to a child under the age of 14 years in exchange for rags, etc. The Police notify the Council of any such contraventions coming to their notice, and in one case a fine of 40/- plus 10/- costs was imposed. 15 CLEAN AIR The Clean Air Act, 1956 became fully operative on 1st June. During the year the Public Health Inspectors made 200 smoke observations and paid many visits to premises in regard to which complaints of smoke nuisance has been received. 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. S03 per day per 100 sq. cm.) Rainfall (inches) Deposit (tons per sq. mile) Sulphur (Mgms.Sog per day per 100 sq. cm.) January 2.13 8.97 2.39 2.05 9.83 2.34 February 2.40 9.68 2.05 2.36 11.08 1.98 March 1.14 10.64 2.75 1.14 10.27 3.37 April 1.18 10.10 1.22 1.14 9.36 1.40 May 2.48 9.51 0.63 2.52 10.74 0.62 June 3.39 11.77 0.49 3.63 10.61 0.85 July 2.25 7.77 0.83 1.81 8.51 0.64 August 3.23 6.30 0.68 3.23 8.17 0.63 September 3.62 8.28 0.66 3.82 7.53 0.78 October 3.31 9.07 1.18 3.43 9.02 1.01 November 0.67 5.71 2.03 0.63 6.38 2.04 December 3.23 11.57 1.70 3.19 13.38 1.67 Average 2.42 9.11 1.38 2.41 9.57 1.44 Average 1953-57 1.84 8.77 0.95 1.83 9.05 1.03 In November the Council made a Smoke Control Order for an area of 186 acres in Isleworth, containing 1,628 dwellings, 7 industrial premises^ 19 commercial premises and 10 churches, schools, etc. Confirmation of the Order is awaited. In July the attention of the Minister of Health was drawn to a smoke nuisance from the chimneys of West Middlesex Hospital. TENTS, VANS AND CARAVANS, There are five sites in the Borough which have been used as caravan sites for many years. Some are occupied wholly or in part by persons, who use caravans for business in connection with a travelling circus, fair or stall. During the year, the inspectors made 1,065 visits of inspection because of the occupation of land by caravans. 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 two applications for permission to place a caravan on a site in the Borough for a further period of two years were granted. COMMON LODGING HOUSES. There is no common lodging house in the Borough. CANAL BOATS. The Public Health Inspectors continued their duties as canal boat inspectors, and made 38 inspections during the year. 16 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 460 (b) Factories - non-mechanical power 25 (c) Other premises 4 (d) Workplaces 7 (e) Outworkers' premises 74 Defects remedied 28 At the end of the year the number of outworkers registered with the Department was 246 and the trades on which they were engaged were as follows:- Wearing apparel 196 Lace, lace curtains and nets 2 Curtains and furniture hangings 13 Furniture and upholstery 2 Brass and brass articles 1 Artificial flowers 1 Carding, etc. of buttons, etc. 18 Stuffed toys 6 Cosaques, Christmas crackers, Christmas stockings, etc. 6 Umbrellas, etc. 1 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, 63 rooms and 3 houses were treated, while 11 wasp nests were destroyed, 10 premises cleared of cockroaches, 6 cleared of ants, and 14 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. All were associated with factories or industrial premises. In most cases there appeared to be some justification for the complaint and, with the co-operation of the users of the factories, the nuisance was remedied in 7 cases and some abatement secured in the others. 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 co-operate in preventing infestation. The Ministry of Agriculture and Fisheries may make to local authorities a grant equal to one half of the expenditure incurred in the performance of their duties under the Act so far as such expenditure has not been recovered. 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:- 1954 1955 1956 1957 1958 Complaints received 533 692 634 629 676 Block inspections 43 66 53 89 93 Individual inspections and re-inspections 4,381 4,541 4,162 4,441 4,631 Other visits 503 419 561 645 720 Premises treated - (a) By occupier 18 15 14 16 18 (b) By local authority 883 1,004 982 1,052 1.191 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 survivial 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 31 inspections were made during the year. No certificate of exemption re provision of sanitary accommodation was granted. RAG FLOCK AND OTHER PILLING MATERIALS ACT. 195L 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. 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 1958 139,178 199,877 158,798 Maximum number of persons using swimming bath on any one day 895 1,852 1,013 No. of slipper baths male 15 - 11 female 9 - 11 No. of persons using slipper baths during 1958 36.329 - 24,280 The baths waters are treated by continuous filtration and breakpoint chlorination. While baths' staff do everything to maintain a 'safe' standard of bath water and bathers could assist very materially by the observance of strict personal hygiene. During the year 4 samples of baths water and 2 from a paddling pool were taken and all were found to be satisfactory. 18 VERMINOUS PREMISES AND ARTICLES. No action had to be taken under Sections 83 and 84 of the Public Health Act, 1936. VERMINOUS PERSONS. One verminous persons was cleansed under the provisions of Section 85 of the Public Health Act, 1936. During the year 87 children in attendance at schools in the Borough were found to be verminous and because of the failure of parents to take necessary action 34 of these children had to be cleansed by the School Health Department. Louse infestation is much too prevalent, and is due solely to lack of personal cleanliness. 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 24 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 68 inspections were made at dairies and retail purveyors' premises. Under the Milk (Special Designation) Regulations, 42 licences for the sale of 'tuberculin tested' milk, 44 for the sale of "pasteurised' milk, and 52 for the sale of "sterilised' milk were issued. The Milk (Special Designations) (Special Areas) Order, 1951. came into operation on 1st October, 1951. This Order defined the County of Middlesex as an area in which the use of a special designation becomes obligatory for the purpose of all sales of milk by retail for human consumption (other than a catering sale). The special designations permitted are 'sterilised', 'pasteurised' and 'tuberculin tested'. ICE CREAM. Under the Pood 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 239 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 method of manufacturing and handling. During the year, 96 inspections of registered premises were carried out. The following results were obtained from the bacteriological examination of samples:- Satisfactory Doubtful Uisatisfactory Ice-cream 36 3 6 Water Ices or 'lollies' 13 - - Milk Ices 9 1 2 The percentage of doubtbul and unsatisfactory samples was 17.1 as compared with 13,3 in 1957 and 31.2 in 1956. BAKEHOUSES. There are 21 bakehouses in the Borough and 85 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 OP ANIMALS (AMENDMENT) ACT, 1954- No application for a licence, under the provisions of the Act, has been received. 19 INSPECTION OF 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 73 488 Cafes, Canteens, Clubs, etc. 163 520 Fish Shops 26 165 Greengrocers 86 127 Grocery and provision 185 296 Hotels, public houses, etc. 84 80 Manufacturers, packers, etc. 14 15 Confectioners, sweets 143 150 - flour 23 113 At retail premises 4,715 lbs. and 1,415 tins or packets of unsound food were seized by, or surrendered, to the Public Health inspectors. 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, 6; cakes, 4; chicken, 3; bacon, 3; cheese, 1; minced meat, 2; meat pie, 1; meat, 2; cereals, 2; nuts and raisins, 1; sausage roll, 1. The complaints were not substantiated in 11 cases; 12 official warnings were issued and proceedings in 3 cases resulted in fines and costs amounting to £22 4s 0d. Premises used for 'the preparation or manufacture of sausages or potted, pressed, pickled or preserved food for sale' are required under the Pood and Drugs Act, 1955, to be registered, and at the end of the year 107 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 29 hawkers were on the register (greengrocery 18, fish 8, ice-cream 3) and 34 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 1,336,558 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 1958 has been supplied by the public Control Department of Middlesex County Council:- Article Total Samples Procured. Unsatisfactory Milk, (new) 108 32 Milk, (various) 61 - Butter 5 - Cakes 7 - Cooked Meat 10 - Cream 21 - Drugs 9 1 Fish and Fish Products 15 - Fruit, fresh and canned 12 - Fruit Juice, Squash, etc. 6 - Ice Cream 11 - Liver 4 - Meat and Meat products 16 - Pickles and Sauces 7 - Preserves 7 - Sausages, etc. 4 1 Spirits 5 - Sweets 6 2 carried forward 314 36 20 Article Total Samples Procured. Unsatisfactory brought forward 314 36 Vegetables, fresh and canned 4 - Vinegar 12 - Miscellaneous 20 - Total 350 36 MILK- Two separate consignments of new milk were delivered from two dairy farmers to a milk processing depot in your district and, when sampled many of the churns contained milk which was slightly deficient both in milk fat and in solidsnot-fat; there was no evidence of added water. The farmers were informed of these results and this information was also passed to the Milk Mvketing Board in order that the farmers might have the benefit of that Board's Advisory Service, DRUGS. A preliminary sample of tincture of iodine was found to be slightly deficient in iodine contents A follow-up sample from the same source was found to be genuine and no further action was taken. SAUSAGES. A delivery of sausages was not labelled to disclose the presence of any preservative although preservative, in an amount permitted, was found to be present, The trader concerned was cautioned. SUGAR CONFECTIONERY. A sample of Cherry Brandy Pudge and one of Rum Pudge was each found to contain no proof spirit; an official caution was sent to the manufacturers. MERCHANDISE MARKS ACTS, 1887 - 1953. The majority of the inspection work carried out under the provisions of the above Acts relates to ensuring that the requirements of the various Marking Orders made under the provisions of the Act of 1926, and which relate to the marking with an indication of origin of certain imported foodstuffs when exposed for sale or sold, are complied with, Inspections were made at 283 separate premises of 1,120 displays of meat, apples, tomatoes, poultry, dried fruit., butter. No infringements were detected. LABELLING OP FOOD ORDER. 1953. This Order requires pre-packed food to be marked with the name and address, or with the registered trade mark, of the packer or labeller. it also requires such food to be labelled with its common or usual name (if any) and with the names of the ingredients of a compounded food. It also controls the manner in which the presence of vitamins and minerals is disclosed and prescribes specific labelling of certain foods. A total of 2011 articles of pre-packed food was examined at 197 premises to ascertain whether the above requirements were complied with. A sample of curry paste was found to be marked incorrectly with details of the ingredients; a letter of caution was sent to the importers. FALSE OR MISLEADING DESCRIPTIONS. As in previous years food advertisements and labels have been scrutinised for false or misleading statements and descriptions. Much of this scrutiny of food labels can be combined with inspection work under the Labelling of Pood Order. No serious infringements were disclosed, Corrective action was secured in relation to descriptions applied to "milk block', Double Tea', an imitation cream powder, cakes filled with a mixture of butter and sugar, canned mixed vegetables, raspberry syrup, powdered soup mixes, medium red salmon, gorgonzola cheese spread and cheese spread. SPECIAL DESIGNATED MILK. During 1958 my Council issued two Dealer's (Pasteuriser' s) licences in respect of premises within your area where milk is processed These premises were regularly inspected.- and compliance with statutory requirements was well maintained. A total of 133 samples of designated milk was taken, all of which were certified as being satisfactory. SAFE MILK, in addition to the foregoing, 41 samples of raw milk were procured within your borough and submitted to test for the presence of tubercle bacilli. None was found contaminated. 21 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 of securing 'clean food, handled by clean hands and transported, prepared and stored under clean conditions'. As a result of these visits contraventions of the Pood Hygiene Regulations were found at 33 premises and were remedied at 73 premises during the year. Some particulars of the contraventions found and remedied are given below:- Contraventions of Food Hygiene Regulations Found Remedied Articles/Equipment not kept clean 11 22 Articles/Equipment not in good order 10 66 Containers not protected from contamination 2 14 Food so placed as to involve risk of contamination 4 76 Food placed within 18" of ground and not adequately protected 1 22 Personal cleanliness not observed 1 1 Improper wrapping materials used - - Inadequate trapping of drain inlets - 1 Water Closets not kept clean and in efficient order 6 22 Insufficient lighting and ventilation to water closets 6 5 Absence of 'Wash your hands' notices in water closets 4 33 Inadequate cold water supply - 3 Absence of suitable and sufficient wash-hand basins 4 22 Absence of hot water at a suitably controlled temperature over wash-hand basins 6 31 Absence of soap, nail brushes, clean towels etc., near wash-hand basins 4 16 Absence of first aid materials 3 13 Absence of accommodation for clothing not worn during working hours 5 16 Absence of suitable and sufficient sinks for the washing of food and equipment 3 12 Absence of hot water at a suitably controlled temperature over sink 7 17 Absence of soap, clean clothes etc„, at sink - - Absence of suitable and sufficient lighting in food rooms 2 9 Absence of suitable and sufficient ventilation in food rooms 5 6 Walls, floors, etc., not kept clean 15 102 Walls, floors, etc., not kept in good order 14 94 Covered receptacle for refuse not provided 1 17 Accumulations of refuse etc. 2 17 Specified foods not stored at prescribed temperature 1 4 Miscellaneous 6 15 Totals 123 656 HOUSING The numbers of new houses erected in the Borough in recent years is shown below:- 1946-54 1955 1956 1957 1958 Heston and Isleworth B.C. 1,303 217 20 178 98 Brentford and Chiswick B.C. 34 - 22 - 6 Southall B.C. 64 - - - - Middlesex County Council 4 1 - - - Ministry of Civil Aviation 77 - - - - carried forward 1,482 218 42 178 104 22  1946-54 1955 1956 1957 1958 carried forward 1,482 218 42 178 104 Metropolitan Police 18 11 - - - prison Commissioners 8 10 - - - private Enterprise - (a) new houses 265 219 172 233 168 (b) reconstructed after war destruction 185 - - - - (c) housing associations 301 39 59 30 - (d) additional dwellings by conversion 3 - - - - 2,262 497 273 441 272 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 Act, 1957 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 OF DWELLING-HOUSES DURING THE YEAR: (1) (a) Total number of dwelling-houses inspected for housing defects (Under Public Health and Housing Acts): 269 (b) Number of inspections made for the purpose; 338 (2) (a) Number of dwelling-houses (included under head (l) above) which were inspected and recorded under Housing Regulations, 1925 and 1932: 69 (b) Number of inspections made for the purpose: 138 (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: 69 (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 164 2. REMEDY OP DEFECTS DURING THE YEAR WITHOUT SERVICE OF FORMAL NOTICES: Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their Officers 117 3. ACTION UNDER STATUTORY POWERS DURING THE YEAR (a) Proceedings under sections 9, 10 and 12 of the Housing Act, 1957: (1) Number of dwelling-houses in respect of which notices were served requiring repairs; 4 (2) Number of dwelling-houses which were rendered fit after service of formal notices: (a) by owner: 4 (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 3 (2) Number of dwelling-houses in which defects were remedied after service of formal notices: (a) by owner: 8 (b) by Local Authority in default of owners: 23 (c) Proceedings under sections 16, 17, 24, 27 and 28 of the Housing Act, 1957: (1) Number of dwelling-houses in respect of which Undertakings from Owners accepted to render houses fit or not to relet for human habitation: (a) To render fit 1 (Part) (b) Not to re-let 1 (2) Number of dwelling-houses rendered fit in consequence of Undertakings given by owners: 3 (3) Number of dwelling-houses demolished which were subject to undertakings not to re-let: 2 (4) Number of dwelling-houses in respect of which Demolition Orders were made: 11 (5) Number of dwelling-houses demolished in pursuance of Demolition Orders: 18 (6) Number of dwelling-houses in respect of which Closing Orders were made in lieu of Demolition Orders: 7 (7) Number of dwelling-houses in respect of which Closing Orders were revoked and Demolition Orders substituted: (8) Number of Demolition Orders revoked: 2 (9) Number of Closing Orders determined, the premises having been rendered fit: 1 HOUSING ACT, 1957 - OVERCROWDING. (1) (a) Number of dwellings overcrowded at the end of the year: 23 (b) Number of families dwelling therein: 38 (c) Number of persons dwelling therein: 169 (2) Number of new cases of overcrowding reported during the year: 4 (3) (a) Number of cases of overcrowding relieved during the year: 14 (b) Number of persons concerned in such cases: 96 (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: OTHER MATTERS: (1) Number of dwelling-houses demolished voluntarily: 3 (2) Certificates of Disrepair: Number of decisions not to issue certificates 1 Number of decisions to issue certificates - (a) in respect of some but not all defects 77 (b) in respect of all defects 17 Number of undertakings given by landlords to remedy defects (Form 'K') 68 Number of Certificates issued 35 Number of applications by landlords to Local Authority for cancellation of certificates 32 Number of objections by tenants to cancellation of certificates 14 Number of certificates cancelled. 23 24 (3) At the end of the year, the following 46 houses, subject to Demolition or Closing Orders or to undertakings not to re-let till rendered fit, were still occupied:- Situation Date of Demolition Order or Undertaking 14, Brickfield Yard 25.10.38 18, do. 25.10.38 3, Park Cottages 28.12.38 4, do. 28.12.38 11, Tivoli Road 28.2.39 13, do. 28.2.39 98, Linkfield Road 28.3.39 100. do. 27.6.39 122, New Heston Road 25.7.39 124, do. 25.7.39 159 Martindale Road 25.7.50 165, do. 25.7.50 169, do. 30.9.52 10, Ivy Road 28.6.55 4, Algar Road 26.7.55 180, Linkfield Road 28.2.56 184, do. 28.2.56 173, Spring Grove Road 28.2.56 175, do. 28.2.56 38, Haliburton Road 29.5.56 304, North Hyde Lane 27.11.56 308, do. 27.11.56 21, Whitton Road 24.9.57 8091 Bath Road 26.11.57 811, do. 26.11.57 813, do. 26.11.57 817, do. 26.11.57 819, do. 26.11.57 1, Derby Road 26.11.57 41, Grove Road 26.11.57 43, do. 26.11.57 45, do. 26.11.57 47, do. 26.11.57 49, do. 26.11.57 5, Frampton Road 25.3.58 1, Vine Place 25.3.58 3, do. 25.3.58 37, Cross Lances Road 29.4.58 39, do. 29.4.58 113, Heston Road 27.5.58 83, Whitton Road 27.5.58 23, Frampton Road 28.10.58 9, Hanworth Terrace 28.10.58 61, Staines Road 28.10.58 63, do. 28.10.58 319, Wellington Road 28.10.58 67, (part) Wellington Road 25.11.58 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. 25 During the year the Council approved expenditure as under:- (a) advances of £496,150 under the Housing (Financial Provisions) Act, 1958 in relation to 329 houses. (b) improvement grants of £10,671 under section 30 of the Housing (Financial Provisions) Act, 1958 in relation to 30 houses. (c) repairs loans of £2,419 under section 43 of the Housing (Financial Provisions) Act, 1958 in relation to 17 houses. (d) Repair costs of £936 under section 9 of the Housing Act, 1957, for work in default in relation to 4 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 1958 three burials were arranged in accordance with this section. PUBLIC MORTUARY The public mortuary is situated in the grounds of Holy Trinity Church, The premises are out-of-date and unsuitable for post-mortem examination or the retention of a body for other than a very short time, so by arrangement with the Coroner, bodies are taken direct to or transferred to Acton or Hampton Mortuaries The Council pays a charge made for the use of these mortuaries, MEDICAL EXAMINATION OF STAFF, For superannuation or other purposes 153 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. 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 cleansing of articles where the Medical Officer of Health has issued the certificates 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. 26 BLOOD TRANSFUSION SERVICE. Sessions for the collection of blood from donors were held as under:- Hounslow Isleworth 12th, 13th and 14th April 9th March 13th, 14th and 15th September 13th July 22nd December 16th August 30th November 23rd December 27 TABLE 1 Summary of Vital Statistics 1899=1958 Estimated Civilian population (mid- year) Birth Rate per 1, 000 population Death Rate per 1, 000 1ation 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 populationv Deaths under 1yr. per 1, 000 live births Deaths under 1mth. per 1,000 live births 1899 29,607 31.4 17.8 155 2.2 1900 30,040 27.1 23.0 156 - - - 1.6 1901 30,969 28.5 15.7 160 - - - 1.6 1902 31,470 29.9 16.7 157 - - - 1.2 1903 31,631 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 16.1 139 48 - - 1.3 1907 34,361 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 46,191 23.1 10.8 86 37 - - 0.4 1913 46,749 24.0 11.7 103 34 - - 0.9 1914 48,361 21.0 11.4 98 34 - - 1.2 1915 41,836 19.6 12.5 102 40 - - 1.6 1916 42,000 20.1 12.6 77 30 - - 1.2 1817 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 62 - - 1.0 1920 43,445 24.7 10.9 68 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 17.6 9.8 66 26 - - 0.9 1924 47,700 17.7 10.8 61 27 - - 1.0 1926 48,620 17.4 10.3 73 41 - - 0.7 1926 62,110 17.4 9.1 56 25 - - 0.8 1927 66,870 16.1 10.7 68 36 - - 1.0 1928 59,730 17.1 9.9 66 27 - - 0.6 1929 63,070 17.1 11.5 46 18 - - 0.8 1930 ' 68,070 19.1 9.6 50 26 6.4 36 0.8 1981 76,230 17.6 10.0 49 24 5,0 30 0.7 1932 81,100 17.4 9.7 60 29 2.8 24 0.7 1933 84,460 16.3 9.4 43 19 4.9 34 0.9 1934 87,797 15.1 10.3 48 21 2,9 32 0.8 1936 90,970 15.8 9.0 41 22 4.7 36 0.6 1936 95,000 15.7 9.6 48 20 2.0 30 0.6 1937 99,420 14.9 9.5 40 20 3,3 23 0.6 1938 101,600 14.2 8.6 46 24 2.7 30 0.6 1939 101,100 15.0 8.8 60 23 3.4 26 0.7 1940 97,630 13.7 12.3 68 39 2.3 26 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 0.6 1945 95,100 16.6 9.7 61 33 2.0 26 0.6 1946 104,240 17.3 10.4 29 22 2.2 26 0.6 1947 106,670 17.3 10.5 39 24 0.6 24 0.5 1948 106,200 14.6 8.8 30 20 0.6 26 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 16 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 1957 105,100 12.3 10.3 23 17 0.0 11 0.07 1958 105,100 12.0 10.6 17 13 0.0 13 0.06 28 TABLE II REGISTRAR GENERAL'S RETURN OF CAUSES OF DEATH 1958. Abridged List No. Cause of Death Male Female Total B. 1 Tuberculosis, respiratory 5 - 5 B. 2 Tuberculosis, other - - - E 3. Syphilitic disease 3 1 4 B.8 Diphtheria - - - B. 9 Whooping Cough - - - B. 10 Meningococcal Infections - - - B. 12 Acute Poliomyelitis - - - B. 14 Measles - - - B. 4-7, 11 15- 17 Other Infective and parasitic diseases 1 3 4 B. 18 Malignant neoplasm, stomach 10 8 18 Malignant neoplasm, lungs 50 13 63 Malignant neoplasm, breast - 24 24 Malignant neoplasm, uterus - 11 11 Other malignant and lymphatic neoplasms 53 45 98 Leukaemia, aleukaemia 5 - 5 B. 20 Diabetes - 7 7 B. 22 Vascular Lesions of nervous system 46 102 148 B. 26 pt. Coronary disease, angina 107 67 174 B. 23 Hypertension with heart disease 18 26 44 B. 25 26 pt. 27 Other heart disease 42 79 121 B. 29 46 pt. Other circulatory disease 28 29 57 B. 30 Influenza 6 1 7 B. 31 Pneumonia 26 34 60 B. 32 Bronchitis 41 20 61 B. 46 pt. Other respiratory diseases 4 1 5 B. 33 Ulcer of stomach and duodenum 7 3 10 B. 36 43 pt. Gastritis, enteritis, diarrhœa 1 3 4 B. 38 Nephritis and nephrosis 5 2 7 B. 39 Hyperplasia of prostate 8 - 8 B. 40 Pregnancy, childbirth, abortion - - - B. 41 Congenital mal formations 5 4 9 Residual Other defined and ill-defined diseases 46 73 119 B. E 47 Motor vehicle accidents 12 5 17 B. E. 48 All other accidents 12 4 16 B. E. 49 Suicide 4 6 10 B. E. 50 Homicide and operations of war ~ - - Total 545 571 1, 116 29 TABLE III CAUSES OF DEATH (MALES) AT CERTAIN AGES. 1958. Under 1 1-4 5-14 15- 24 25-44 45-64 65-74 75-over Total Tuberculosis, respiratory - - - - 1 2 2 - 5 Tuberculosis, other - - — - - - - - - Syphilitic disease - - - - - 1 2 - 3 Diphtheria - - - - - - - - - Whooping Cough - - - - - - - - - Meningococcal Infection - - - - - - - - - Acute Poliomyelitis - - - - - - - - - Measles - - - - - - - - - Other Infective & parasitic diseases - - - - - - 1 - 1 Cancer - stomach - - - - — 6 3 2 10 lung - - - 1 - 28 17 4 60 breast - - - - - - - - . uterus - - - - - - - - - other - - - - 3 22 17 11 53 leukaemia - - - - - 2 2 1 5 Diabetes - - - - - - - - - Cerebral Haemorrhage, etc. - - 1 - 1 12 16 17 46 Coronary disease, angina - - - - 6 44 32 26 107 Hypertension with heart disease - - - - - 7 5 6 18 Other heart disease - - - - 1 10 7 24 42 Other circulatory disease - - - - - 8 6 16 28 Influenza - - - - - 1 2 3 6 Pneumonia 2 - - - 1 3 11 9 26 Bronchitis - - - - - 14 12 16 41 Other respiratory diseases - - - - - - 3 1 4 Ulcer of stomach & duodenum - - - - 1 3 1 2 7 Gastritis, enteritis, etc. - - - - 1 - - - 1 Nephritis and nephrosis - - - 2 - 3 - - 6 Prostatic enlargement - - - - - 2 1 5 8 Pregnancy, childbirth, abortion - - - - - - - - - Congenital malformations - - - 1 1 2 - 1 6 Other diseases 9 - - - 1 8 8 20 46 Motor vehicle accidents - 1 1 5 1 2 1 1 12 All other accidents - - - 2 1 2 2 6 12 Suicide - - - - 2 2 - - 4 Homicide and war operations - " - - - - - - - Total 11 1 2 11 20 183 149 168 545 Percentage of Total 2.0 0.2 0.4 2.0 3.7 33.6 27.3 30.8 30 TABLE IV CAUSES OF DEATH (FEMALES) AT CERTAIN AGES, 1958- Under 1 1-4 5- 14 15- 24 25-44 45-64 65-74 75-over Total Tuberculosis, respiratory - - - - - - - - - Tuberculosis, other - - - - - - - - - Syphilitic disease - - - - - - 1 - 1 Diphtheria - - - - - - - - - Whooping cough - - - - - - - - - Meningococcal Infection - - - - - - - - - Acute poliomyelitis - - - - - - - - - Measles - - - - - - - - - Other infective & parasitic diseases - - 1 - - - 2 - 3 Cancer - stomach — - - - 1 2 3 2 8 lung - - - - 4 4 3 2 13 breast - - - - 3 12 5 4 24 uterus - - - - 1 6 1 3 11 other - - 2 1 3 16 6 17 45 leukaemia - - - - - - - - - Diabetes - - - - - 3 - 4 7 Cerebral haemorrhage, etc. - - - - 1 22 23 56 102 Coronary disease, angina - - - - - 10 18 39 67 Hypertension with heart disease - - - - - 3 8 15 26 Other heart disease - - - - - 7 10 62 79 Other circulatory disease - - - - 2 2 6 19 29 Influenza - - - - - 1 - - 1 Pneumonia 2 - - - - 1 11 20 34 Bronchitis - - - - - 2 6 12 20 Other respiratory diseases - - 1 - - - - - 1 Ulcer of stomach & duodenum - - - - - - 1 2 3 Gastritis, enteritis, etc. - - - - - - 1 2 3 Nephritis and nephrosis - - - 1 - 1 - 2 Prostatic enlargement - - - - - - - - - Pregnancy, childbirth, abortion - - - - - - - - - Congenital malformation 4 - - - - - - - 4 Other disease 4 - - 1 2 13 11 42 73 Motor vehicle accidents - - 1 - 2 - 1 1 5 All other accidents - - - - - 2 - 2 4 Suicide - - - - 1 3 1 1 6 Homicide and war operations - - - - - - - - - Total 10 - 5 2 21 109 119 305 571 Percentage of Total 1.7 - 0.9 0.4 3.7 19.1 20.8 53.4 31 32 TABLE V INFANTS' DEATHS ACCORDING TO AGE AND CAUSE. 1958. Cause of Death Age Total Days Months under 1 1 2 3 4 5 6 7-13 14-20 21- 28 1 2 3 4 5 6 7 8 9 10 11 Pneumonia - - - - - - - 2 - - - - 1 1 - - - - - - - 4 Birth Injuries 1 - - - - - - - - - - - - - - - - - - - - 1 Atelectasis & birth asphyxia 3 1 2 - - - - 1 - - - - - - - - - - - - - 7 Congenital malformations 1 - - - - - - - - - 1 - - 1 1 - - - - - - 4 Prematurity 4 - - 1 - - - - - - - - - - - - - - - - - 6 TOTAL 9 1 2 1 - - - 3 - - 1 - 1 2 1 - - - - - - 21 33 INFECTIOUS DISEASES. AGE DISTRIBUTION - 1958 Disease Total Under 1 yr. 1 yr. 2 yrs. 3 yrs. 4 yrs. 6- 9 yrs. 10-14 yrs. 15-19 yrs. 20-34 yrs. 35 44 yrs. 45-64 yrs. 66 yrs. Cases admitted to hospital Smallpox - - - - - - - - - - - - - - Typhoid Fever 1 - - - - - - - - - 1 - - 1 Para-Typhoid Fever - - - - - - - - - - - - - - Scarlet Fever 62 - - 3 2 14 28 12 2 - 1 - - 6 Diphtheria - - - - - - - - - - - - - - Erysipelas 6 - - - - - - - - - 2 3 1 1 Puerperal Pyrexia 70 - - - - - - - 6 48 16 - - 70 Ophthalmia Neonatorum 1 1 - - - - - - - - - - - 1 Acute Encephalitis - - - - - - - - - - - - - - Acute Poliomyelitis - - - - - - - - - - - - - - Meningococcal Infection - - - - - - - - - - - - - - Pneumonia 46 - 1 1 - - 6 1 - 3 6 15 12 11 Dysentery 15 1 2 - 1 1 3 4 - 2 1 - - 4 Measles 275 9 28 27 36 33 135 3 3 1 - - - 2 Whooping Cough 44 5 4 9 3 8 14 - - - 1 - - 3 Food Poisoning 73 4 2 4 6 5 3 4 1 21 7 12 4 7 Tuberculosis:- Pulmonary 74 2 - - - 1 2 - 4 23 8 25 9 Non-Pulmonary 7 - - - - - - - 1 - 2 1 3 Malaria 1 - - - - - - - - 1 - - - 34 NOTIFICATIONS AND DEATHS FROM CERTAIN INFECTIOUS DISEASES HESTON AND ISLEWORTH 1939-1958 TABLE VII Year Smallpox Scarlet Fever Diphtheria Erysipelas Pneumonia Meningococcal Infection Epidemic Encephalitis Poliomyelitis and Polioencephalitis Typhoid Fever Paratyphoid Fever . Dysentery Measles Whooping Cough . Influenza Tuberculosis Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths 1939 - - 175 - 61 5 23 - 142 35 6 - - 2 - - 3 - - - 1 - - - - 2 Not Notifiable 10 132 69 1940 - - 96 - 73 5 35 1 200 67 43 6 1 2 1 - 4 - - - - - 1109 2 123 3 16 130 69 1941 - - 117 - 37 3 20 - 124 41 34 2 1 1 1 - 2 - 30 - - 2 680 - 286 1 9 174 78 1942 - - 190 - 11 1 16 - 72 67 12 1 - - - - 4 - 1 - 2 2 1086 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 69 3 2 - 1 3 - - - - - 22 - 219 - 171 3 6 184 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 6 1 - - - - - 840 2 142 2 8 180 52 1948 - - 159 - 2 - 21 - 41 42 2 - - 1 29 2 - - 3 - 6 - 571 - 227 - 6 168 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 6 1 - - 4 - 1 - 1 - 77 - 790 1 220 - 33 186 27 1952 - - 161 - - - 19 1 58 51 6 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 88 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 1957 - - 36 - - - 8 - 39 64 2 - 2 - 2 - - - - - 7 - 804 - 74 - 9 82 7 1958 - - 62 - - - 6 - 45 60 - - - - - — 1 - - - 15 - 275 - 44 - 7 81 5 35 TABLE VIII COUNTY OF MIDDLESEX CERTAIN VITAL STATISTICS FOR TOE YEAR 1958 District Population mid- 1958 Live 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 (a) (a) (a) (a) (a) (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) Acton 65,360 15.1 14.2 11.0 11.4 0.06 (4) 2.2 (147) 22.2 (22) 18.2 (18) - (-) Brentford & Cbiswick 57,150 14.0 13.2 11.2 11.2 0.12 (7) 2.2 (127) 17.6 (14) 12.5 (10) 1.23 (1) Ealing 183,000 14.4 14.0 10.4 11.2 0.05 (10) 2.2 (398) 14.8 (39) 11.4 (30) - (-) Edmonton 95,180 13.0 12.9 9.9 11.2 0.07 (7) 2.1 (200) 17.0 (21) 13.0 (16) 0.80 (1) Enfield 109,300 13.8 13.8 10.6 10.6 0.06 (7) 2.1 (228) 19.2 (29) 16.2 (23) - (-) Feltham 50,780 16.6 16.1 7.4 11.7 0.02 (1) 1.4 (73) 21.3 (18) 16.6 (14) - (-) Finchley 69,080 13.1 12.6 11.9 10.8 0.03 (2) 2.2 (163) 20.0 (18) 10.0 (9) 1.09 (1) Friern Barnet 28,540 11.6 12.9 14.1 9.0 0.04 (1) 2.2 (62) 12.2 (4) 3.0 (1) - (-) Harrow 214,300 13.2 13.5 9.3 11.1 0.04 (8) 1.9 (414) 17.0 (48) 13.8 (39) 0.70 (2) Hayes & Harlington 67,780 16.6 16.6 7.4 12.0 0.06 (4) 1.5 (101) 16.1 (17) 13.3 (16) - (-) Hendon 151,500 12.9 12.4 10.4 11.1 0.07 (10) 2.2 (330) 13.9 (27) 10.3 (20) 0.51 (1) Heston & Isleworth 105,100 12.0 12.0 10.6 11.3 0.05 (6) 2.0 (214) 16.6 (21) 12.7 (16) - (-) Hornsey 96,670 18.1 16.8 11.8 10.6 0.06 (6) 2.2 (214) 18.9 (33) 16.6 (29) - (-) Potters Bar 22,000 18.1 16.3 7.7 10.6 0.18 (4) 1.4 (31) 10.1 (4) 6.0 (2) - (-) Ruis1ip-Northwood 74,930 13.4 13.4 8.0 10.1 0.04 (3) 1.8 (137) 12.9 (13) 9.9 (10) - (-) Southall 52,830 16.5 16.0 12.0 10.1 0.08 (4) 2.6 (136) 20.7 (17) 16.9 (13) - (-) Southgate 70,940 11.4 12.3 13.3 10.9 0.11 (8) 2.2 (155) 21.0 (17) 16.1 (13) - (-) Staines 46,850 18.2 16.7 8.8 11.2 0.02 (1) 2.0 (94) 23.5 (20) 16.3 (13) - (-) Sunbury 28,440 19.6 17.6 10.5 11.9 0.14 (4) 2.0 (68) 14.4 (8) 5.4 (3) - (-) Tottenham 117,700 14.9 14.6 11.2 12.0 0.08 (10) 2.5 (297) 21.7 (38) 16.0 (28) 0.56 (1) Twickenham 103,500 13.3 13.7 11.4 10.8 0.13 (13) 2.1 (222) 24.0 (33) 17.4 (24) - (-) Uxbridge 63,120 17.7 16.1 9.9 12.9 0.06 (4) 1.9 (119) 29.6 (33) 26.9 (30) 0.88 (1) Wembley 126,800 12.0 12.1 8.8 10.3 0.06 (7) 2.1 (262) 19.1 (29) 12.5 (19) - (-) Willesden 173,100 18.6 17.1 10.0 11.3 0.08 (14) 2.1 (363) 21.5 (69) 16.6 (53) 0.61 (2) Wood Green 49,100 12.9 12.9 11.7 11.3 0.08 (4) 2.6 (129) 23.6 (16) 15.7 (10) 1.54 (1) Yiewsley & West Drayton 23,950 17.2 16.5 7.3 10.5 - (-) 1.4 (34) 19.4 (8) 14.6 (6) 4.75 (2) COUNTY 2,247,000 14.5 14.2 10.3 11.1 0.07 (148) 2.1 (4698) 18.9 (616) 14.2 (464) 0.39 (13) NOTE Absolute number8 are given in parenthesis in addition to rates to afford valied comparison. TABLE IX(a) METEOROLOGY (Extract from records supplied by Chief Engineer, Mogden Sewerage Works) Week Ending Barometer Temperature (°F) Days with Rainfall Total Rainfall (inches) Highest Lowest Max. Min. Jan. 4th 30.16 29.13 51.0 32.0 4 0.64 11th 30.09 28.70 56.0 29.0 6 0.62 18th 30.57 29.50 49.0 30.0 4 0.00 25th 29.98 29.34 45.0 22.0 4 0.16 Feb. 1st 30.48 29.73 52.0 33.0 6 0.58 8th 30.61 29.10 56.0 29.0 6 0.28 16th 30.25 29.08 59.0 34.0 6 0.58 22nd 30.13 29.46 54.0 30.0 4 0.38 Mar. 1st 30.21 29.06 53.0 29.0 4 1.11 8th 30.39 29.68 56.0 25.0 3 0.22 15th 30.00 29.04 49.0 24.0 2 0.04 22nd 30.39 29.80 48.0 26.0 nil 0.00 29th 30.13 29.20 58.0 30.0 6 0.54 Apr. 5th 30.14 29.40 57.0 31.0 5 1.26 12th 30.43 30.00 49.0 32.0 5 0.00 19th 30.22 29.87 61.0 34.0 2 0.03 26th 30.24 29.59 65.0 41.0 3 0.10 May 3rd 30.45 30.34 78.0 40.0 1 0.01 10th 30.16 29.70 68.0 46.0 5 0.10 17th 30.07 29.02 54.0 39.0 4 0.40 24th 30.17 29.92 68.0 42.0 2 0.12 31st 30.05 29.77 67.0 41.0 7 1.60 June 7th 30.10 29.72 73.0 47.0 4 1.06 14th 30.30 29.88 70.0 45.0 4 0.98 21st 30.20 29.45 78.0 48.0 4 0.68 28th 29.86 29.29 68.0 48.0 6 1.79 July 5th 30.01 29.56 75.0 54.0 6 0.65 12th 30.33 29.48 82.0 56.0 1 0.12 19th 30.22 29.47 80.0 49.0 5 0.95 26th 30.06 29.36 80.0 46.0 6 0.60 Aug. 2nd 30.25 29.47 74.0 48.0 7 0.43 9th 30.23 29.70 73.0 50.0 6 0.45 16th 29.91 29.71 82.0 53.6 5 0.20 23rd 29.91 29.41 73.0 51.0 7 1.03 30th 29.98 29.53 74.0 53.0 5 1.34 Sept. 6th 29.98 29.79 78.0 58.0 4 1.62 13th 30.26 29.94 78.0 42.0 1 0.03 20th 30.21 29.61 81.0 51.0 5 1.16 27th 30.20 29.63 66.0 44.0 5 0.73 Oct. 4th 29.86 29.13 65.0 50.0 7 1.13 11th 30.08 29.61 65.0 38.0 7 0.56 18th 30.38 29.73 65.0 40.0 2 0.61 25th 30.63 30.24 61.0 45.0 4 0.07 Nov. 1st 30.48 29.73 61.0 33.0 4 1.07 8th 30.08 29.61 58.0 43.0 5 0,86 15th 30.32 29.70 52.0 32.0 5 0.29 22nd 30.60 30.21 53.0 34.0 1 0.00 29th 30.29 30.04 49.0 32.0 4 0.05 Dec. 6th 30.34 29.31 47.0 32.0 - 0.00 13th 29.96 28.66 50.0 34.0 7 1.57 20th 29.28 26.65 58.0 33.0 5 0.53 27th 30.07 29.28 57.0 36.0 5 0.16 36 TABLE IX. (b) WIND DIRECTION (Sum. of Daily Records, 52 weeks) N. 15 days N.N.E. 9 days N.E. 16 days E.N.E. 13 days E. 16 days E.S.E. 9 days S.E. 16 days S.S.E. 5 days S. 18 days S.S.w. 17 days s.w. 52 days w.s.w. 19 days w. 40 days W.N.W. 19 days N.W. 16 days N.N.W. 14 days Calm 71 days 37 TABLE X FACTORIES ACTS, 1937 and 1948 PART I OF THE ACT 1. Inspections for purposes of provisions as to health made by Public Health Inspectors Premises Number on Regi ster Number of Inspections Written Notices Occupiers Prosecuted (i) Factories in which Sections 1,2,3, 4 and 6 are to be enforced by Local Authorities 34 25 - - (ii) Factories not included in (1) in which Section 7 is enforced by the Local Authority 378 460 29 - (iii) Qther premises in which Section 7 is enforced by the Local Authority (excluding outworkers0 premises) 6 4 - - TOTAL 418 489 29 - 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 E.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 2 - - 1 - (b) Unsuitable or defective 26 27 - 4 - (c) not separate for sexes 1 - 1 - - Other offences against the Act (not including offences relating to Outwork) 2 1 1 - - TOTAL 31 28 2 5 - 38