AC 437(1) II HES 50 ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH OF THE BOROUGH OF HESTON AND ISLEWORTH for the year 1963 A. ANDERSON, M.D., D.P.H., Medical Officer of Health. INDEX Page Accidents 14 Bakehouses 26 Births, live 13 Births, still 13 Blood Transfusion Service 31 Burials 31 Canal Boats 22 Clean Air 21 Closet Accommodation 20 Common Lodging Houses 22 Deaths 14 Deaths, Age and Sex Distribution 34 & 35 Deaths, causes of 33 Disinfection 17 Disinfestation 24 Drainage and Sewerage 20 Factories, No. on Register Inspection and Defects, etc. 41 & 42 Factories, Workplaces, etc. 22 Family Planning Association 19 Fever Hospitals 17 Food and Drugs Sampling 27 Food Hygiene 27 Food Poisoning 17 Health Committee 3 Health Education 31 Health Services provided by Other Authorities 16 Housing 27 Ice Cream 25 Infant Deaths according to Age and Cause 36 Infant Mortality 14 Infectious Diseases 15 Infectious Diseases, Age Distribution 37 Infectious Diseases, Notifications and Deaths 38 Laboratory Service 17 Page Laundry Service 31 Marriage Guidance Council 18 Maternal Mortality 15 Meat and Other Food Inspection 26 Medical Examinations of Staff 31 Meteorology 39 Milk 25 Municipal Restaurants and School Canteens 27 Noise Nuisances 24 Persons in need of care and attention 31 Pet Animals Act, 1951 25 Physical Characteristics 19 Public Cleansing 21 Public Mortuary 31 Rags, etc. Exchange of Articles for 21 Rag Flock and Other Filling Materials Act, 1951 25 Rats and Mice Destruction 24 Rivers and Streams 20 Sanitary Circumstances 19 Sanitary Inspection 21 Shops Act, 1950, Section 38 24 Slaughter of Animals (Amendment) Act, 1954 26 Slaughterhouses, etc. 26 Staff 2 Statistics, General 11 Statistics, Vital 11 Statistics Vital, Summary of 32 Swimming Baths 25 Tents, Vans and Caravans 22 Tuberculosis 16 Verminous Premises, Articles and Persons 25 Water Supply 20 Wind Direction 40 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 K.J. Smith. F.A.P.H.I., M.R.S.H. Deputy Chief Public Health Inspector: S.H.G. Stevens, Cert. as P.H. I., M.I. and S.E. District Public Health Inspectors G. Latimer Cert. as P.H.I. and M.I. W. Bowles Cert. as P H I. and M.I. D.G Martin Cert. as P.H.I. and M.I. F.W. Goldsmith Cert. as P.H.I. and M.I. J.A.K. Garratt Cert. as P.H I. and M.I. D.A. McLaren, Cert. as P.H.I. and M.I. M. Hall, Cert. as P.H.I. and M.I. A.G. Babbage, Cert. as P.H.I. and M.I. (from 25.3.63) Pupil Public Health Inspector: D.P Seal (to 8.9.63) Rodent Officer: A. Farrer Rodent Operatives: A.L. Worthington J.D. Sorrell Disinfectors, Drain Testers, etc: L. Wisdom M.S. North Administrative and Clerical Staff: H.L. Law, A.R.S.H., M.R.I.P.H.H. (part-time) D S. Bates, LM.R.S.H. C.J.C. Mail E. J. Hutchins F. R. Money Mrs. L.E.O. Gorman Mrs. J. A. Morgan Miss V.A. Honess 2 THE HEALTH COMMITTEE of HESTON AND ISLEWORTH BOROUGH COUNCIL to May, 1963 Councillor Mrs. M. Hennig (Chairman) Alderman Mrs. A.B. Tolmon (Vice-Chairman) Councillor W.F. Bowhill. J.P. (Mayor) Aldermen F.J. Jansen, M, Inst. M.S.M. Councillor H. Candeland M. Eng. Councillor Mrs. E.M. Coleman, J.P. Councillor A.G. Cross, C.C. Councillor R.D. Flynn Councillor F.A. Foster Councillor G.A.M Greenland Councillor F.H.P. Hobbs Councillor E.W.J. Killick Councillor P.B. Tuley Councillor A. White from May, 1963 Councillor R. D Flynn (Chairman) Councillor Mrs. V.G.A. Secker J.P. (Vice-Chairman) Alderman F.J. Jansen, J.P., M, Inst. M.S.M. (Mayor) Alderman Mrs. A. B. Tolmon Alderman J.A. Pope (from 24.9.63) Councillor H. Candeland, M. Eng. Councillor Mrs. E.M Coleman. J.P. Councillor A.G. Cross, C.C. Councillor F.A. Foster (to 16.9.63) Councillor G.A.M. Greenland Councillor Mrs. M. Hennig Councillor F.H.P. Hobbs Councillor G. McKay Councillor D.B. Wheatley Councillor A. White 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 present my Annual Report on the health, vital statistics and sanitary circumstances of the Borough for the year 1963. Having completed 25 years as your Medical Officer of Health. I have taken the liberty on this occasion of a backward look and of hazarding a glance to the future. As Area Medical Officer. I have continued to have responsibility for the health services transferred from the Borough to the County Council by the Education Act 1944 and the National Health Service Act, 1946, and now to be returned under the London Government Act, 1963 and so I have included some notes on these services, as they have operated in the Borough. For some time now the population of the Borough has shown only minor fluctuations near the 100,000 mark. While the total shows little change there has been considerable alteration in the age distribution. At the 1921 census the proportion of the population aged 65 years and over was 6 per cent, but by the 1961 census this proportion had risen to 12 per cent and the indications are that it will continue to rise for some years. This increasing proportion of elderly persons in the population brings with it medical and social problems of some magnitude. The work of the late Dr. Marjorie Warren (West Middlesex Hospital), Drs. Anderson and Cowan (Rutherglen local authority/hospital clinic), Dr. Maddison (Teddington local authority clinic) and others has shown that health impairment in elderly persons can be postponed. Surveys have shown that only too often the aged accept deterioration as inevitable and that there is much more ill health among them than their visits to or by doctors would indicate. Men and women today can anticipate some 10-15 years of retirement. Some preparation for this and some type of health supervision are necessary if these years are to be reasonably happy and fulfilling. Health in elderly persons is closely linked with their social conditions and because of this some controversy arises as to whether the general practitioner of the local health authority should accept responsibility for their general care. Medical treatment must be a matter for the general practitioner, but local health authorities might consider providing clinics where general advice on diet exercise, hobbies social services, etc. could be given. Such clinics, like infant welfare clinics, should be so distributed as to be within reasonable reach of the majority of the population, and should work in close association with the general practitioners and local voluntary organisations. The rise in the birth rate during the later war and immediate post war years was not maintained and the rate reached its lowest level in the Borough records in 1955. In recent years the rate has shown a steady rise again and this seams to be linked with a lowering of the average age at marriage. Of live births the percentage illegitimate has risen from 4.2 in 1939-43 (war years) to 5.4 in 1959-63. This is a matter of some concern especially in relation to the youth of some of the mothers. The still birth rate has fallen from 22.1 per 1,000 total births in 1939-43 to 16.0 in 1959-63. The average annual infant mortality rate in 1939-43 was 57.6 but for 1959-63 was 18.2, Below is shown the percentage of infant deaths due to certain causes:- 1939-43 1959-63 Prematurity 26.5 27.6 Congenital defects 18.7 20.5 Bronchitis and pneumonia 16.0 11.8 Gastro enteritis 19.7 ­ Other infections 9.7 2.4 In other words the reduction in infant mortality has been brought about largely by the elimination of infections and efforts must now be concentrated on the problem of prematurity and congenital defects. There has also been a change in the age distribution of infant deaths. Of the total infant deaths. 38 per cent occurred in children under the age of one week in 1939-43 as compared with 67 per cent in 1959-63. The same factors are probably in operation in causing still births and early infant deaths, and this can be expressed collectively in the peri natal mortality rate (stillbirths and deaths under one week per 1,000 total live and stillbirths). For 1939-43 this rate was 49.8 but fell to 27.9 in 1959-63 The recent report of the British Perinatal Mortality Survey has shown that further improvement is possible and has indicated some of the lines on which action could be taken. The Borough death rate has always been below the National level. The lowest recorded was in 1955 but since then there has been a slow but steady increase. 4 This is to be expected as the proportion of aged in the population rises and deaths now tend to be concentrated at the upper age levels as shown below:- 1939-43 1959-63 0 - 4 years 9.4% 2.6% 5-14 years 1.8% 0.4% 15 - 24 years 3.2% 0.8% 25 - 64 years 35.5% 28.0% 65 - 74 years 22.4% 24.7% 75 years and over 27.7% 43.5% The causes of death have also shown a change and the cancers and degenerative diseases of later life now predominate. This is shown in the following table showing the actual numbers of deaths from various causes:- 1939-43 1959-63 Tuberculosis 325 35 Other infectious diseases 46 8 Bronchitis 254 328 Pneumonia 257 320 Cancer 750 1,180 Intra-cranial haemorrhage 384 630 Heart disease 1,125 1,824 Bronchitis and pneumonia still take their toll especially in the elderly and the role of atmospheric pollution in their causation is being increasingly recognised. The problem of arterial degeneration in the brain and in the coronary arteries still awaits elucidation. Though the exact cause of cancer is not known, the indications are that several factors may be involved and vary with the site of the cancer. Throughout the world cancer varies widely in relation to incidence and site, but wherever it has been investigated the association between cigarette smoking and cancer of the lung remains constant. The problem now is how to discourage the smoking of cigarettes, especially in the young as it is obvious to all that the habit, once acquired, is not easy to break. "The habitual use of tobacco is related primarily to psychological and social drives" and cigarette smoking must, like spitting, become socially unacceptable if it is to be abandoned by the young. Youth ape the habits of adults and the main responsibility of securing a new outlook on cigarette smoking must rest with parents and all who have dealings with children. The toll from road and home accidents is still too high and should be the personal concern of everyone at all times. Our forefathers well knew the risks then associated with pregnancy and childbirth, especially the dreaded childbirth fever. Fortunately, one can record steady improvement here and the maternal mortality rate of 2.3 per 1,000 live and stillbirths of 1939 43 has fallen to 0.3 in 1959-63. Apart from a small outbreak of poliomyelitis in 1947-49, the record of the Borough in regard to infectious disease has been relatively uneventful. The fears engendered by infectious diseases among our grandparents are no longer with us and the present tendency, except when smallpox or other infectious disease starts a scare, is to belittle the precautions and preventive measures still recommended. This is due to decreased incidence of many of these diseases, to the diseases generally being milder and to the reduction in deaths brought about by improved treatment (see Table VII). The reduction in the incidence of tuberculosis, diphtheria, typhoid and paratyphoid fevers, erysipelas and to a lesser extent in scarlet fever is noticeable, but the increase in dysentery, food poisoning and gastro-intestinal illness of unknown origin is still a matter of concern Fortunately, these conditions are seldom fatal, but as human carriers play such a large part in their spread, they indicate the need for improvement in our standards of personal hygiene. The steady elimination of tuberculosis in cattle, the pasteurisation of milk, and the new drugs have greatly reduced the incidence of tuberculosis, eased the dangers of spread and markedly improved the prospects of cure, but there is no excuse for complacency. Mass X-ray surveys still find previously unrecognised cases of pulmonary tuberculosis to the extent of nearly 3 per 1,000 of persons submitting themselves for X-ray in the Greater London area. The Borough was one of the pioneers in immunisation and started their campaign against diphtheria in 1930. For this work they were fortunate in securing the services of Dr. Guy Bousfield whose work in this field continued till 1963. The meticulous standards he set and the stimulus of his alert and enquiring mind laid a foundation of excellence which it is hoped can be maintained. Since these early days advances in immunisation have been made and protection is now available, at clinics or through general practitioners, against smallpox diphtheria, whooping cough, tetanus and Poliomyelitis. To children in their later years at school B.C.G. inoculation against tuberculosis is also available. It is sad to relate that the very success of these measures has resulted in local authorities having to intensify their efforts to induce 5 parents to give their children these benefits. It is becoming increasingly difficult to maintain in the population an adequate proportion of protected children and this is necessary if the ever-present risk of outbreaks is to be kept to a minimum. Good housing is an important factor in the attainment and maintenance of health and local authorities have been faced by the twofold task of providing houses (a) to ease the general shortage, aggravated in some areas by war damage and (b) to replace unfit houses. During the twenty-five years. 1939-63, there were erected in the Borough 2,230 houses by local authorities and 2,713 by private enterprise, housing associations and other bodies and it is of interest to note that the proportion of the population living at more than 1½ persons per room fell from 6.9 per cent at the 1951 census to 3.9 per cent at the 1961 census. The housing shortage continues and the special needs of the aged and earlier age of marriage raise problems of the size of houses to be provided and still maintain flexibility. A new feature of the housing programme is the provision of high flat blocks. No doubt they reduce the encroachment on the restricted space available for housing, but they present their own problems e.g., noise, heating, waste disposal, washing and clothes drying within the building and space for prams, cycles and cars, play space especially for toddlers and facilities for hobbies outside the dwellings. Cost has been responsible for cutting space within houses to a minimum. Improved standards are needed to meet the needs of children and young people, to provide for television, etc. and it is hoped that new building methods may make this possible. While new houses continue to be built, time does not stand still for old houses. The conditions rendering a house legally unfit for occupation are laid down in the Housing Act, 1357. This is a less rigid standard than that of the Housing Act, 1930 and falls short of the recommendation of the Central Housing Advisory Committee in 1946 and of the standards applied to discretionary improvement grants. In these days, in addition to sound structural conditions, certain amenities should be considered essential to render a house fit for occupation and the standard should not be less than that applicable to improvement grants. During 1939-63, in addition to the Cranford Lane, Pears Road, The Lawns (Bath Road), Linkfield Road and New Heston Road Clearance Orders, 164 individual houses were dealt with by Demolition or Closing Orders and essential repairs carried out at 5,777 houses under the provisions of the Housing Acts. On the present legal standard of fitness, the great majority of the "slum" property in the Borough, apart from small pockets in areas scheduled for redevelopment or street widening, has been dealt with but too many houses still lack internal water closets, baths, hot water supplies, etc. The housing shortage has encouraged the occupation of houses by members of more than one family and new legislation has recently been introduced in an effort to control houses "in multiple occupation". It has always been the responsibility of a Health Department to secure that food is "fit for human consumption" and is "of the nature, substance and quality demanded by the purchaser " With the rapid development in recent years of ever widening methods of preservation, storage, transportation, pre-cooking, pre-packing, etc. of food, the Public Health Inspector must always be on the alert. For example raw meat, treated in the Borough by an additive to enhance its appearance, caused unpleasant symptoms when it was consumed elsewhere- the use of this preparation has now been prohibited. These developments involve physical, chemical and biological processes and their main advantage is to make all types of food available at all times of the year, but a constant watch must be maintained to see that the methods are safe to use and free from the risk of causing disease or illness. As some 60 per cent. of our food has to be imported and as it is impossible to provide our largely urban population with entirely fresh food, some method of preservation of imported food and much of our home grown food is necessary. The increase in communal feeding in factories, schools, etc. during and since the war brought outbreaks of food poisoning into prominence because of the large numbers of persons sometimes involved in such outbreaks. Food hygiene in shops, restaurants canteens, food stores etc. has received much attention. The improvement in kitchen and shop equipment must be obvious to all, but this is not enough. In many outbreaks the source of infection is a food handler and all who are engaged in the handling and cooking of food must practice high standards of personal hygiene. Since the earliest days of public health, effort has been directed to maintaining the purity of water ana food, but only in recent years has attention been given to the air we breathe. Smoke belching from chimneys was thought to be a sign of prosperity and it has taken many years of effort by enthusiasts to convince us that smoke is waste and that pollutants in the air are a menace to health and cause much material damage. The death rate from bronchitis in this country is higher than elsewhere and is twice as great in our large towns as in our rural areas. The Borough has made good progress in its plan to render the town smokeless, but much remains to be done. New developments in the gas industry are having effects on the supply of smokeless fuels suitable for use in open grates and alternative fuels and methods of heating will have to come into use. The co-operation of the public in our present smokeless zones has been good but if (to a large extent) the open fire has to be adandoned in future smokeless zones some resistance is to be anticipated. The Clean Air Act has been criticised on the ground that it deals only with smoke and leaves the emission of sulphur gases untouched. The search for methods of extracting sulphur from fuels and flue gases 6 tinues but failure to date is no reason for ceasing efforts to reduce other atmospheric pollutants. In smoke control areas, problems are arising in regard to the disposal of garden refuse, afterbirths, dressings, etc. which cannot be placed in dustbins and local authorities may yet have to consider ways of dealing with these difficulties. The proximity of the Borough to London Airport has focussed attention on noise especially that of aircraft. The ability of the average person to exclude some noises while attending to others is a matter of everyday experience, but there is no doubt that aircraft noise can be very disturbing in schools, offices and in any other work where relative quiet is essential. The type of construction of houses, offices, etc. seem to have a bearing on the intensity and reverberation of noise from aircraft and as there seems as yet to be little prospect of reducing the noise of aeroplane engines, this point might be worthy of consideration by architects. In the disturbance caused by aircraft noise there may be a subconscious element of fear. Road or rail traffic noise does not conjure up the idea of being personally involved if an accident occurs but the same cannot be said of aircraft passing overhead and to some, at night aircraft noise may recall war memories. Reaction to sound is individual and personal and what disturbs one person may be relatively unnoticed by another. All will agree that efforts should be made to reduce noise of all kinds but one wonders if any noise will ever disturb the present youth who seem to be happy only when television radio, tape-recorders and gramophones are at full volume or even further amplified. Ante natal clinics provide medical supervision for mothers during pregnancy and in recent years increasing attention has been given to mothercraft teaching and relaxation classes, There are now 4 weekly sessions as compared with 6 in 1939 and the average annual attendance has fallen from 4,645 in 1939-43 to 3,287 in 1959-63. The work of infant welfare clinics is largely advisory in regard to the diet nurture and welfare of babies and young children. In recent years so much has been said and written about child psychology and the importance of the relationship between parents and children that parents are almost made to feel guilty. The association between emotional and behaviour problems in children and broken or disturbed homes is undoubted, but most parents are genuinely interested in the Welfare of their children, and it is to be hoped that infant welfare clinics will continue to provide support and encouragement. At each session welfare foods (National dried milk, orange juice, etc.) are available to all eligible persons and other proprietory brands of infant foods, vitamins etc. are on sale to mothers attending the clinics. The number of items stocked is such as to meet the needs of most children and attempts to look upon these clinics as shops which should stock everything must be resisted. Ten sessions are now held each week and the average annual attendance has fallen from 28,272 in 193943 to 18 750 in 1959-63. The general arrangement of the school health service has not changed. Periodic medical examinations of "entrants" "intermediates" and "leavers''' are carried out in the schools and minor ailment consultation orthopaedic eye clinics and speech therapy continue. In some districts periodic medical examinations of all intermediates" and "leavers" has been replaced by selective examination of pupils considered by head teachers school nurses and others to be in need of medical examination. Here when a school is to be visited for periodic medical examination, the head teacher is asked to submit the names of any other pupils in whose case a medical examination is thought to be advisable. Further, at any time a head teacher or school nurse may refer or a parent may bring, a pupil to the school consultation clinic, so it might be said that we combine the periodic and selective systems. Due to the reduction in the incidence of malnutrition skin infections, running ears, inflamed eyes etc. the numbers attending the minor ailment and consultation clinics have fallen. Emotional disturbances social maladjustment school phobia and failure to progress in school now take up much of the school medical officer's time. The solution of these problems is complicated as in many cases they seem to be associated with some unstabilizing factor in the home. The Child Guidance Clinic, under the administrative control of the School Medical Officer was started in 1943. Later control passed to the Education Officer and there it remains despite the recommendation of the Ministry of Education that such clinics should be an integral part of the school health service. School medical officers endeavour to maintain a link with this clinic and to secure exchange of information. The volume of work at this clinic is heavy and treatment is lengthy even when adequate and suitable trained staff can be recruited. A primary responsibility of the school health service is to find children suffering from handicaps and to make recommendations as to special education for such children. Early diagnosis is essential if handicapped children are to get the maximum benefit from treatment and special education and therefore school medical officers participate in the maternity and child welfare services. The Education Department has responsibilities for handicapped children from the age of 2 years and now there is a nursery section in many special schools. The handicapped children for whom special provision may have to be made are usually grouped in the following categories:- (a) blind, (b) partially sighted, (c) deaf (d) partial hearing (e) delicate (f) diabetic, (g) educationally sub normal (h) epileptic (i) maladjusted (j) physically handicapped 7 and (k) children with speech defects. Special problems arise in the cases of children suffering from two or more handicaps. Busch House School for delicate pupils was opened in 1938. Since then there has been a slow but steady change in the type of pupil admitted. Gone, to a large extent, are the chronic chest infections,, the undernourished, the suspected tuberculosis, the debility following acute illness, etc. and instead we have a large proportion of children whose illhealth is associated with, or due to, emotional or psychogenic causes and an increased linkage between the school and the Child Guidance Clinic is being developed. The organisation of the school is being amended to permit the admission of slightly maladjusted pupils as well as delicate pupils. The opening of Martindale School for the physically handicapped and Heston School for the deaf in 1956 and their associated special diagnostic and advisory clinic added much to the work, but also to the interest of the school health service. The demand on these special clinics has been heavy. A new hearing clinic, a pioneer in design and equipment was opened in 1962 and work on a new medical unit at Martindale School is in hand. These special clinics have been available to all children in the western half of the county and their future use will have to be considered in relation to the proposed local government changes. The occurrence of lice and/or nits in school children is much less prevalent than it used to be. Regular cleanliness surveys are no longer carried out in the schools by the school nurses. Such surveys are now done at the request of the Head Teacher or whpre there are reasons for considering such an inspection advisable. A hard core of infestation remains and seems to be centred in certain families whose children are persistent offenders and in whom no advice, persuasion or threat seems to have any effect. Since the National Health Service started it has been difficult to recruit staff for the local authority dental service. A study of the records of the service for 1939-43 and 1959-63 shows a slight fall in the treatment provided for school children and a marked fall in that given to expectant and nursing mothers and children under school age. Many mothers who previously looked to the local authority dental service for attention to their own and their children's teeth are now using the general dental service provided by the National Health Service. The Borough was the first local authority to provide orthodontic treatment and this section of the service has continued without curtailment. Dental caries is one of the failures of preventive medicine. Its causes are still a matter for discussion and the preventive measures (tooth brushing, "end a meal with an apple", avoidance of sweets, vitamins, school milk, etc.) advocated for many years have produced no visible effect. At routine dental inspections, some 50-60 per cent. of pupils are still found to need treatment, yet fluoridation of water, the only known method of reducing dental caries in children is still awaited. The home nursing service which used to be provided by the Heston and Isleworth District Nursing Association was taken over by the County Council in 1948. These nurses work in close association with the general medical practitioners and carry out general nursing care, dressings, injections etc. in the homes of the patients. The average number of visits made annually has risen from 31,292 in 1939-43 to 35,140 in 1959-63. Disposable sterile needles and syringes are now in general use, but to an increasing extent the nurses are giving general nursing care to the aged and infirm. By arrangement with the County Council the British Red Cross Society maintains a depot from which items of nursing and sick-room equipment may be issued on loan. The demand on the services of domiciliary midwives has been influenced by the increasing preference of mothers to be confined in hospital. The average annual number of domiciliary confinements conducted by midwives has fallen from 607 in 1939-43 to 422 in 1959-63 and there has been a corresponding increase in the proportion of births occurring in hospital. The pressure on maternity beds due to the rising birth rate will mean more work for domiciliary midwives either directly through more confinements having to take place at home or indirectly through maternity hospitals discharging patients after a few days instead of retaining them for 10 to 14 days as used to be the custom. The centenary of health visiting occurred in 1962. Initially, health visitors devoted their time to advising mothers at home and in clinics on the care of children. The introduction of the school health service extended the contact of health visitors with families and since the introduction of the National Health Service the scope of health visiting has been extended to include the handicapped and aged. Health visitors give special attention to problem families. Their training in nursing, midwifery and social work is long and in the increasing demand for social workers, some discussion has arisen as to how to make the best use of health visitors. By the use of clinic nurses they have been relieved of certain routine nursing work so that the maximum of time may be given to the duties for which they have had special training. In some areas they have been attached to the practices of one or more general practitioners, but this is difficult to arrange in built-up urban districts. Here they are encouraged to maintain contact with general practitioners re family problems found on their district visits, and on request from a general practitioner a health visitor will co-operate in dealing with individual cases or families. During the war four day nurseries were started in the Borough, but only one (Nantly House) of these continues in operation. This nursery is approved for the training of nursery nurses. It is open from 7.30 a.m. to 6 p.m. Mondays to Fridays and a charge is made 8 for this service on a sliding scale based on the income of the parents. Broadly speaking admission of children is restricted to (a) those whose mothers are the sole support and have to go out to work and (b) those whose health is, or may be affected by adverse home conditions. On medical recommendation handicapped children may be admitted and in such cases no charge is made. Anyone who undertakes the daily care of more than two children must be registered under the Nurseries and Child Minders Regulation Act and at the end of 1963 there were in the Borough one registered private day nursery and six registered child minders. It is known that a number of women undertake the daily care of one or two children They do not require to be registered but where they agree to the inspection of their home and the children by health visitors and to bring the minded children at least once a month to see the doctor at the infant welfare clinic, a fee of 1/- per child per day minded is paid. In 1919 the Borough started a home help service for women at the time of confinement as part of their maternity and child welfare service. In 1927 the service was extended to families needing help during influenza outbreaks and in 1945 was further extended to cover domestic emergencies arising from illness and infirmity. Now the service is given to 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 and a charge is made on a sliding scale. This service which was designed originally to deal with temporary domestic crises has changed slowly but steadily and is now largely devoted to the care of the aged and chronic sick. The growth of the service has been remarkable (average annual number of households assisted has risen from 54 in 1939 43 to 898 in 1959-63) and demand shows no sign of falling off. Where formerly help might be needed for two or three weeks to cover a domestic emergency continuous care of the elderly and infirm is now the order of the day. The records show a number of current cases who have been receiving help for 20 years. It is not easy to find women who are prepared to work in any home to which they may be sent and possibly to tackle problem families, rubbish accumulated over years, incontinence and the occasional old person who is dirty in person objectionable in habit, obscene and defiant in speech and resistant to all attempts at improvement. The Borough laundry scheme does help with the laundry of the incontinent but as it is a weekly service, considerable washing and laundering still has to be done by the home helps. This is a real problem especially in regard to drying facilities and in an effort to ease the burden incontinence pads are now being tried. Some old people can manage with help in lighting fires, shopping and tucking up in bed at night and where a neighbour is willing to do this regularly and keep a friendly eye on the case, they are engaged as "neighbourly helps" and paid for their services. Under the stimulus and example of Mrs Chapman, Home Help Organiser the service here has gained a high reputation and no case seems too difficult to be tackled. Many of the home helps view their work as a vocation and not just as a job and the amount of help given voluntarily by them and often by their husbands, at weekends and holiday times to the old people and families under their care is very considerable. In 1962 the County Council started a chiropody service for the elderly physically handicapped school children and expectant and nursing mothers. Chiropody sessions are held at clinics and where necessary the chiropodist makes home visits. The shortage of suitably qualified staff has regarded the growth of this service and contributions continue to be paid to voluntary organisations running a chiropody service for the aged. Health education is a difficult subject. Its object can be said to be (a) "to ensure that health is regarded as a valued community asset and (b) to equip the individual with knowledge which he can use to recognise and possibly to solve his own health problems". The educator has to be certain of his facts - our knowledge of the source of and of the factors influencing diseases is steadily increasing - and has to devise effective ways and means of spreading the information. This is the real problem and a series of "dont's" does not get very far. Staff are encouraged to do what they can in the way of health education in their daily contacts with the public. Use is made of leaflets, posters, talks, etc. but is is difficult to judge the impact of these. The new medium of television enables facts about health to be presented with vivid reality and there are signs that this opportunity is being explored. Democracy is a way of life based on personal responsibility and health is one of these responsibilities. Prior to the National Health Service, medical attention to mothers and children was subject to an individual charge and it was only natural that many sought the services of local authority clinics where there was no charge for advice or treatment. The impact of this new service has shown itself in reduced attendances at ante-natal, infant welfare, school eye orthopaedic clinics, etc, but this has been accompanied by an increased demand for home nursing, midwifery, health visiting, home help chiropody, etc., - i.e. of the servies ancillary to medical care It is all to the good that general practitioners should be taking an increase share in the work formerly left largely to the local authorities. During the last 25 years, there has been a tendency to consider environmental hygiene infectious disease control, medical examination of school children etc. as of lessening importance while pleading for more action in regard to mental health, prevention of maladjustment and neurosis care of the aged and supporting services for the frail and handicapped. If we are to hold what we have gained the existing and well tried measure of the past must not be dropped and this must be borne in mind in planning health and welfare services. The largest stumbling block to developing the widening the scope of local authority services looks like being inability to recruit adequate and suitable staff. 9 One of the most rewarding duties of the head of a department is to provide for staff conditions and facilities to explore and develop interests and ideas. During these 25 years Dr. Guy Bousfield published 23 articles on immunisation, based wholly or partly on work carried out locally and other staff have contributed a further 17 articles to medical and dental journals. While this patchy review of the local health services shows progress and improvement in many directions, the satisfaction arising therefrom must be tempered by consideration of the many problems still awaiting solution. Complacency is impossible in the face of road accidents; chronic degenerative diseases; rising consumption of alcohol and tobacco; increase in illegitimacy, more venereal disease especially in young people; increased indulgence in barbiturate, tranquillisers and "purple hearts"; litter; malicious damage; crimes of violence and all the signs of social sickness in our family and communal life. To those concerned with local health services, progress may be slow and sometimes disheartening, but a backward look may provide encouragement and stimulus to continued effort. A Health Department cannot work in isolation and it has close contacts with the Education, Welfare and Children's Departments. It would be to the advantage of the public if the departments providing personal services were housed on the same site and this would also facilitate the personal contacts between officers of departments which are necessary for real and effective co-operation. A Medical Officer of Health cannot plough a lone furrow and I owe much to the ready co-operation of my colleagues in other departments, head teachers and voluntary organisations. I have been fortunate in having a loyal and competent staff who have helped greatly to weather the trials of civil defence, changes in the administration of the services and the complexities of new legislation. To the members of the Council and especially to the Chairmen of the various committees, I am deeply grateful for encouragement and support, I remain, Your obedient Servant, A. ANDERSON, Medical Officer of Health. 10 GENERAL STATISTICS Year-1963 Area in acres 7,261 population (Registrar-General's estimate) 101,860 Number of habitable premises (rate books) 31,432 Number of houses erected during year 138 Rateable value of Borough £6,692,499 Sum represented by a penny rate £27,720 Live Births - male 778 Live Births - female 709 Birth rate per 1,000 population 14.6 Birth rate per 1,000 population(England and Wales) 18.2 Stillbirths - male 8 Stillbirths - female 13 Stillbirths rate per 1,000 (live and still) births 13.9 Deaths - male 611 Deaths - female 539 Death rate per 1,000 population 11.3 Death rate per 1,000 population (England and Wales) 12.2 Infant Mortality rate 11.4 Infant Mortality rate (England and Wales) 20.9 Neo-natal Mortality rate 8.1 Perinatal Mortality rate 19.1 Maternal Mortality rate 0.0 Maternal Mortality rate (England and Wales) 0.22 VITAL STATISTICS POPULATION. The Registar-General's mid-year estimate of the population of the Borough Borough for the year is 101,860. The report on the 1961 census for the County of Middlesex was published in June and the following information concerning the Borough has been extracted or compiled from that report. The population of the Borough had fallen to 103,013 from the 106,847 enumerated at the 1951 census. There has been a further change in the age distribution as shown in the following table:- Percentage age distribution of population at census Census Age in Years 0-4 5-9 10-14 15-19 20-29 30-39 40-49 50-59 60-69 70-79 80- 1901 11.1 11.4 11.5 9.9 16.8 13.6 10.0 7.0 5.3 2.5 0.9 1921 8.0 9.5 11.0 10.0 15.8 14.1 13.3 9.2 5.2 3.0 0.9 1951 7.0 6.4 6.2 6.3 14.2 14.1 17.1 13.8 8.6 4.7 1.5 1961 6.3 5.8 7.2 6.9 12.4 13.0 14.3 16.0 10.6 5.4 2.0 It will be noted that the age preponderance has moved from the 0-14 year group to the 45-59 year group. Between the 1951 and 1961 census the number of residents aged 65 years and over rose from 10,567 to 12,190 and those aged 80 years and over from 1567 to 2013. At age 65 years and over the ratio of females to males is 1.6 to 1. The acreage of the wards ranges from 390 (Hounslow Central) to 1610 (Spring Grove) and the population was distributed in the wards as under:- Ward Male Female Persons Persons per acre 1961 1951 Cranford 7,207 7,373 14,580 10.9 9.9 Heston 5,452 5,706 11,158 20.4 21.6 Spring Grove 4,438 4,810 9,248 5.7 5.8 Isleworth North 5,071 5,882 10,953 15.8 17.8 Isleworth South 5,417 6,305 11,722 19.8 20.6 Hounslow Heath 6,907 7,119 14,106 19.7 19.5 Hounslow West 5,331 5,681 11,012 12.5 13.2 Hounslow Central 4,645 5,038 9,683 24.9 28.1 Hounslow South 5,114 5,437 10,551 23.7 25.2 Borough 49,582 53,431 103,013 14.3 14.8 The distribution of private households and dwellings in the wards is shown below:- 11 Ward Private Households Population in private households Structurally separate dwellings occupied Rooms occupied Persons per room Percentage of persons at more than 1½ per room Cranford 4,505 14,490 4,431 20,832 0.70 2.4 Heston 3,664 11,144 3,554 17,450 0.64 2.1 Spring Grove 3,078 8,763 2,874 15,373 0.58 1.6 Isleworth North 3,204 9,816 3,081 14,363 0.69 5.4 Isleworth South 3,692 11,176 3,533 16,311 0.69 8.1 Hounslow Heath 4,270 13,825 4,162 19,578 0.71 4.9 Hounslow West 3,691 10,728 3,512 16,986 0.64 3.5 Hounslow Central 3,443 9,626 3,179 15,152 0.64 4.6 Hounslow South 3,452 10,489 3,274 16,281 0.65 2.6 Borough 32,999 100,057 31,609 153,326 0.66 3.9 At the 1951 census the number of persons per room was 0.74 and the percentage at more than 1½ persons per room was 6.9, so during the intercensal period over-crowding had been reduced. There has been a change in the size distribution of households as under:- No. of Persons Percentage of all households 1921 1951 1961 1 4.7 7.6 10.0 2 16.8 27.3 31.3 3 19.5 26.5 24.6 4 19.8 21.0 19.5 5 15.5 10.4 9.1 6 9.7 4.2 3.4 7 6.1 1.8 1.2 8 4.1 0.6 0.5 9 2.1 0.3 0.2 10 or over 1.7 0.3 0.2 The steady increase in the proportion of one and two person households should be noted. Of the occupants of these 1 and 2-person households, 8,301 were of pensionable age. Of the total households, 7.8 per cent were in shared dwellings and this compares favourably with the 19 per cent recorded at the 1951 census. Of the 2,580 households in shared dwellings, 954 were without exclusive use of cooking stove and sink. The tenure of dwellings in the Borough was:- Owner occupied 19,501 Held by virtue of employment 928 Rented with farm or business premises 277 Rented from local authority 4,414 Rented unfurnished from private person or company 5,465 Rented furnished from private person or company 725 Included in these dwellings were 45 caravans and 11 houseboats. At the date of the census 2,942 inhabitants of the Borough were in hotels, hospitals, homes for aged and disabled, children's homes, educational establishments, defence establishments, ships, etc. There has been a noticeable movement of population from other countries into England and Wales in recent years, and the extent of this in the Borough between 1951 and 1961 is shown below:- Birthplace Males Females 1951 1961 1951 1961 British Isles 49,384 47,431 54,177 51,184 England and Wales 47,677 45,235 52,224 48,854 Scotland 815 942 817 910 Northern Ireland 165 236 199 270 Irish Republic 647 816 840 962 Outside British Isles 1,458 1,934 1,727 2,021 Commonwealth Countries 489 958 550 820 Colonies, Protectorates, etc. 127 171 113 163 Foreign Countries 842 805 1,062 1,038 12 The numbers born in Scotland. Ireland, Commonwealth Countries and Colonies all show an increase. The birtnplaces or those trom commonwealth counties, colonies, Protectorates, etc. was recorded as under:- Male Female South Africa 58 79 Canada 84 53 Cyprus 44 20 India 565 505 Pakistan 55 36 Other parts of Asia 56 38 Australia 50 51 Malta 52 44 African Colonies 34 18 West Indies 43 67 Elsewhere 88 72 Of those from foreign countries the largest numbers recorded were 340 from German, 224 from Poland and 200 from Africa. At the 1961 census, information was again collected about the availability of certain household arrangements and the results are shown below:- 1951 1961 Households sharing piped cold water 5,529 2,583 do. without piped cold water 80 70 do. sharing piped hot water * 1,009 do. without piped hot water * 3,439 do. sharing fixed bath 4,455 2,317 do. without fixed bath 4,645 3,037 do. sharing water closet 4,528 2,066 do. without water closet 83 242 * not recorded In 1961 unless the water closet was in or attached to the house, it was not recorded and this accounts for the difference in the 1951 and 1961 figures. Conditions in regard to these household amenities have changed considerably during the intercensal period, but there are still many houses in need of improvement to bring them up to an acceptable standard of amenities. RATEABLE VALUE. The Rateable Value of the Borough for 1963 was £6,692,499 and the sum represented by a penny rate was £27,720. INHABITATED HOUSES. According to the rate books the number of habitable houses, flats and shops with living accommodation at the end of the year was 31,432. LIVE BIRTHS. The number of live births in 1963 was 1,487 as compared with 1,417 in 1962. The birth rate was 14.6 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 14.9 as compared with the birth rate of 18.2 per 1,000 population for England and Wales. The number of illegitimate births was 104 as compared with 91 in 1962. 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 - 59 3.8 1935 - 39 2.9 1960 4.4 1940 - 44 4.6 1961 4.9 1945 - 49 5.1 1962 6.3 1963 7.0 Of the total live and still births, 71% occurred in hospital. STILLBIRTHS. The number of stillbirths in 1963 was 21. The proportion of stillbirths per 1,000 total (live and still) births in recent years is shown below:- 13  No. of Stillbirths Rate per 1,000 total births 1930 - 34 214 31.2 1935 - 39 224 29.4 1940 - 44 200 27.7 1945 - 49 198 23.8 1950 - 54 129 20.6 1955 - 59 94 14.8 1960 24 17.1 1961 27 18.8 1962 23 16.0 1963 21 13.9 DEATHS. The deaths of residents of the Borough during 1963 were 1,150 (611 male, 539 female). This represents a death rate for the Borough of 11.3 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 camparison, 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 12.4 as compared with a death rate of 12.2 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 273 cases. A progressive change is taking place in the percentage age distribution of deaths, and this is shown in the following table:- 1910-14 1950-54 1955-59 1963 Under 1 year 21.8 2.4 2.2 1.5 1-4 years 8.4 0.5 0.3 0.5 5 - 14 years 3.8 0.5 0.4 0.3 15 - 24 years 3.7 0.8 0.8 0.9 25 - 64 years 30.8 31.6 28.8 29.1 65 years and over 31.5 64.3 67.5 67.7 The chief causes of death were heart and circulatory diseases; cancer; bronchitis and pneumonia; cerebral haemorrhage. In females 55 per cent. of deaths occurred at 75 years and over as compared with 36 per cent. in males. The Secretary of the Road Safety Committee informed me that during 1963 there were in the Borough 765 road accidents which resulted in 13 deaths, serious injury to 137 persons and slight injury to 830 persons. 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 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 1959 ­ 1 5 8 14 1 ­ 7 8 16 1960 ­ 1 11 5 17 ­ ­ 6 10 16 1961 ­ 1 10 8 19 1 1 4 7 13 1962 1 ­ 6 3 10 ­ 2 10 11 23 1963 ­ 1 10 4 15 1 ­ 9 13 23 Total 3 9 82 52 146 6 4 68 107 185 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 1963 there were 17 deaths of children under the age of 1 year. This represents an infant mortality rate per 1,000 live births of 11.4 as compared with 20.9 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:- 14  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 1958-1962 6,740 131 18 1963 1,487 17 11 These infant deaths can be viewed more closely by looking at the rates according to age at death:- Total infant mortality rate per 1,000 live births (deaths under 1 year) 11.4 Neo-natal mortality rate per 1,000 live births (deaths under 4 weeks) 8.1 Early neo-natal mortality rate per 1,000 live births (deaths under 1 week) 6.1 The infant mortality rate of illegitimate infants was Nil compared with 12.3 for legitimate infants. It is thought that the same factors are probably in operation in relation to stillbirths and early infant deaths, and that it is a matter of degree or chance whether the child dies before or soon after birth. This loss of infant life can be expressed collectively in what is called the perinatal mortality rate (stillbirths and deaths under 1 week combined per 1,000 total live and still births). For 1963 the Borough perinatal mortality rate was 19.1 as compared with 29.2 in 1962. MATERNAL MORTALITY. No death was 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 1955-1959 - 0.2 0.2 1960 - - - 1961 - 0.7 0.7 1962 - - - 1963 - - - 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 are 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, anthrax 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, 961 were so endorsed. INCIDENCE 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. 15 SMALLPOX. No case of smallpox occurred in the Borough during 1963. 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, 325 children under the age of one year were vaccinated in 1963 as compared with 671 in 1962. Modern travel is such that the risk of importing smallpox is ever present. SCARLET FEVER. This disease was less prevalent - 13 cases notified as compared with 22 in the previous year. This disease continued to be mild in character. DIPHTHERIA. The Borough's freedom from diptheria was maintained during the year. The number of children under the age of one year who were immunised during 1963 was 469 as compared with 451 in 1962. ERYSIPELAS. Eleven notifications of this disease were received. PNEUMONIA. Notifications of pneumonia were 18 as compared with 14 in 1962. Of the total pneumonia deaths, 85 per cent occurred at age 65 and over. MENINGOCOCCAL INFECTION. One case was notified during the year. ACUTE ENCEPHALITIS. No notification was received during the year. POLIOMYELITIS. No case was notified during the year. Inoculation against poliomyelitis was continued during the year and the use of oral vaccine was started. Three doses of oral vaccine were given to 1,501 persons, one dose following two injections to 332 persons, 2 injections to 78 persons and third injection to 130 persons. 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 34 cases were notified. 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 39 notifications of pulmonary tuberculosis, and 11 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 79.0 1935-1939 62.3 8.2 70.5 1940-1944 55.8 7.4 63.2 1945-1949 39.1 6.7 45.8 1950-1954 18.9 1.1 20.0 1955-1959 8.4 0.3 8.7 1960 3.8 0.0 3.8 1961 10.7 0.0 10.7 1962 3.9 1.0 4.9 1963 6.8 0.1 6.9 A permanent mass X-ray unit has been established at West Middlesex Hospital and is open to the public without appointment. During the year 736 children were inoculated with B.C.G. vaccine as a protection against tuberculosis. A mobile mass X-ray unit visited the Borough in November. Arrangements were made with 12 factories and sessions open to the public were held at Cranford, Heston, Isleworth and Hounslow. The response by the public was very poor and only 1,871 attended these public sessions. OPHTHALMIA NEONATORUM. No case was notified during the year. 16 PUERPERAL PYREXIA. During the year 127 cases were notified as compared with 95 cases in 1962. No woman died from puerperal or post-abortion sepsis and none of the infections was severe. All the cases, except three, arose in hospital. MEASLES. This was a year of measles prevalence and 886 cases were notified as compared with 207 in 1962. WHOOPING COUGH. There were 59 cases of whooping cough notified as compared with 3 cases in 1962. Facilities for immunisation against this disease are available, and 401 babies 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 the protection, if not complete, does mitigate the severity of the attack. MALARIA. Two cases of malaria were notified during the year and the patients had recently returned from overseas. INFLUENZA. Influenza caused 4 deaths as compared with 9 deaths in 1962. MUMPS, CHICKENPOX 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 109, Chickenpox 128, and German Measles 39. 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, 195 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. in cases of smallpox is done at the South Middlesex Infectious Diseases Hospital, while the disinfection of homes and bedding in other cases is carried out by the disinfectors on the Health Department staff. During the year 4 rooms and 1 lot of bedding were disinfected and 7 lots destroyed Six 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 1963 was 609. The number of specimens sent to the laboratory is governed largely by the incidence of gastro-intestinal illnesses. FOOD POISONING. During 1963 notifications of the occurrence of food poisoning in 77 persons were received, but after investigation only 20 were accepted as food poisoning. In two cases the infecting organisms were isolated. No death was associated with food poisoning. During the year salmonella infection, not food borne, was found in 2 persons. HEALTH SERVICES PROVIDED BY OTHER AUTHORITIES NORTH-WEST METROPOLITAN REGIONAL HOSPITAL BOARD. Two general hospitals (West Middlesex, 1,150 beds and Hounslow, 81 beds) and one fever hospital (South Middlesex, 140 beds) are situated 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 of 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 Monday morning and Thursday 92 Bath Road, Hounslow afternoon Busch Corner, Isleworth Tuesday afternoon New Heston Road Thursday afternoon (b) Infant Welfare Clinics Tuesday, Wednesday, Thursday 92, Bath Road, Hounslow and Friday afternoons Busch Corner, Isleworth Monday and Wednesday afternoons 17 New Heston Road Monday, Tuesday and Wednesday afternoons Cranford (Holy Angel's Church Hall, Bath Road) Friday afternoon (c) Immunisation and vaccinnation clinics 92, Bath Road, Hounslow ) Busch Corner, Isleworth ) By appointment New Heston Road) (d) Artificial Sunlight Clinics (winter months) 92. Bath Road, Hounslow Tuesday and Friday afternoon Busch Corner Isleworth Tuesday and Friday afternoon (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 at domiciliary confinements. Gas and air and trilene 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 Help 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 disordered, 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 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. (l) Ambulance Service Provision is made for the conveyance of sick, accident and emergency cases. Accident and emergency ambulances are stationed at the Fire Station, Isleworth and the Ambulance Depot in Mogden Lane, Isleworth. The sick removal service operates from the Ambulance Depot in Mogden Lane only. (m) Mental Health This service provides for the ascertainment of cases of mental illhealth and mental disorder, the statutory supervision and guardianship of mentally disordered persons 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. 18 MIDDLESEX COUNTY COUNCIL - EDUCATION DEPARTMENT. The School Health Service is staffed by the County Health Department and provides the following services:- (a) periodic medical inspection of pupils. (b) cleanliness surveys of pupils when required. (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 Busch Corner, Isleworth New Heston Road (ii) Medical consultation 92, Bath Road, Hounslow Busch Corner, Isleworth New Heston Road (iii) Eye Clinic 92, Bath Road, Hounslow Busch Corner, Isleworth (iv) Allergy Clinic 92, Bath Road, Hounslow (v) Orthopaedic Clinic 92 Bath Road, Hounslow (vi) Physiotherapy 92 Bath Road, Hounslow (vii) Dental Clinic (viii) Artificial Sunlight Clinic (ix) Immunisation Clinic (x) Child Guidance Clinic (xi) Speech Therapy Monday to Friday mornings Monday to Friday mornings Monday to Friday mornings Friday morning Monday morning Friday morning Monday and Wednesday afternoons Monday morning Thursday morning Friday afternoon 2nd Monday afternoon in month Wednesday and Thursday afternoons Thursday morning see under Health Department Old Town School, Hounslow, by appointment 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, adopticn 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. FAMILY PLANNING ASSOCIATION. This voluntary organisation holds sessions at 92, Bath Road Hounslow, on Monday, Tuesday and Thursday evenings. About 6,000 patients attended during 1963. MARRIAGE GUIDANCE COUNCIL. The Borough Council makes a contribution to the Thames Valley Marriage Guidance Council, and enquiries should be made to Mrs. M.M. Jolliffe, 25, Paradise Road, Richmond. 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 19 until at North Hyde it is about 100 feet above sea level. The sub-soil 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 acres Church Meadow, Bath Road 9.20 acres Children's Playground, Sutton Lane 0.60 acres Kingsley Road Playing Field 0.95 acres Greenhams Land, London Road 14.75 acres St. John's Gardens, Isleworth 5.73 acres Riverside Walk, Isleworth 0.75 acres Children's Playground, Northcote Avenue 0.85 acres Playground London Road 1.84 acres Bowling Green Jersey Gardens 0.59 acres Isleworth Promenade 1.00 acres Heston Park 14.29 acres Lampton Park 24.20 acres Beaversfield Park 9.77 acres Inwood Park 10.25 acres Redlees Park 16.47 acres Jersey Gardens 7.87 acres Football Ground, Denbigh Road 3.70 acres Midsummer Children's Playground 1.52 acres 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 Southwest Suburban Water Company. There are in the Borough 41 shallow and 3 artesian wells serving 37 premises and of these, 1 house and 2 business premises are without an alternative supply. The following work in connection with water supplies was carried out during the year:- Supplies provided or reinstated 19 Cisterns cleansed, repaired, etc. 2 Service pipes or taps repaired 8 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 1963:- Drains exposed for examination 225 Drains unstopped, repaired, etc. 210 Waste Pipes repaired, trapped, etc.6 Soil pipes repaired, etc. 5 Fresh Air Inlets repaired, etc. 3 Gully traps inserted or repaired 12 Disconnecting traps inserted or repaired 3 Disconnecting and inspection chambers provided 7 Disconnecting and inspection chambers repaired, etc. 28 Drains constructed or repaired 21 Total length (ft.) of drain pipes laid - (a) 4" 175 (b) 6" 4 Drain tests applied 33 Other works executed 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. Extensions to the Mogden Disposal Works are nearing completion. RIVERS AND STREAMS. No complaint of pollution was made to the Health Department during 1963. 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 the odd house on the outskirts of the Borough has a pail or chemical closet. The following works were carried out during the year:- Water closets constructed or rebuilt 2 Water closets where walls cleansed 12 Water closets fitted with new flushing apparatus 12 Water closets repaired or improved 25 New pans or pedestals provided 16 Water closets blockages unstopped 15 Urinals constructed, rebuilt or repaired 2 Ventilated lobbies provided 2 20 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, 15 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:- 1959 1960 1961 1962 1963 Paper (tons) 1,069 1,364 1,379 1,101 1,119 Scrap metal (tons) 48 27 13 7 14 Textiles (tons) 5 53 50 43 39 Batteries - 43 - - - Total income £8,364 £13,268 £11,326 £9,410 £9,311 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 nuisances and dealing with contraventions of the Public Health Acts. 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:- Number of complaints received 921 Number of premises at which nuisance etc, were located 768 Number of premises where nuisances abated or defects remedied:- (a) by owners or occupiers 281 (b) by Council in default 1 (c) public sewers repaired by Council 49 (d) public sewers cleared and cleansed by Council 343 Informal notices issued 291 Written reminders issued 220 Statutory notices served 67 Total number of inspections and re-inspections 19,490 Inspections of stables 4 Inspections of urinals 13 Premises licensed for public entertainment 40 Visits re infectious diseases, etc. 502 Sinks provided or repaired 7 Roofs repaired 28 Gutters repaired or renewed 39 Brickwork, sills etc. repaired or renewed 36 Premises provided with damp-proof courses 3 Yards and forecourts paved or drained 4 External painting 4 Rooms stripped, cleansed and redecorated 24 Floors, walls and ceilings repaired or renewed 88 Windows repaired or renewed 50 Doors and other woodwork repaired or renewed 14 Staircases replaced or repaired 2 Grates provided or repaired 3 Instances where ventilation under floor provided or improved 6 Food stores provided or repaired 1 Verminous condition abated 5 Offensive accumulations removed 73 Other repairs carried out or nuisances abated 34 Dung pit renewed 1 Complaints continue to be received of nuisance caused by pigeons. The Public Health Act, 1961, now gives a local authority power to take steps for the purpose of abating or mitigating any nuisance, annoyance or damage caused by the congregation in any built-up area of house doves or pigeons or of starlings or sparrows.' The seizure and destruction of any birds must be carried out humanly and any action taken must not contravene the Protection of Birds Act, 1954. Action taken at 24 sites in the Borough resulted in the destruction of 588 pigeons, but while food is liberally provided by the public there is little prospect of keeping the numbers down. EXCHANGE OF ARTICLES FOR RAGS. Under the Public Health Act, 1961, 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. CLEAN AIR. During the year the Public Health Inspectors made 93 smoke observations and paid many visits to premises in regard to which complaints of smoke nuisance 21 had been received. One notice was served under Section 30 of the Clean Air Act, 1956. The Council continues to co-operate with the Department of Scientific and Industrial Research by measuring atmospheric pollution in the Borough and forwarding monthly returns. The monthly average, highest daily reading and lowest daily reading are shown in the table on page 22. The point to be noted is the wide range of pollution that can occur. To date the indications are that these wide variations are linked to meteorological conditions and the influence of fog is show in the month of January. Work continued on the Council's programme of Smoke Control Orders and progress to 31st December, 1963 is shown in the table. SMOKE CONTROL AREAS No. 1 No. 2 No. 3 No. 4 No. 5 No. 6 No. 7 No. 8 Council resolution 25.11.58 7.12.59 27.6.61 28.11.61 27.3.62 25.9.62 30.4.63 29.10.63 Ministry enquiry 7.4.59 14.4.60 ­ - - - - - Ministry confirmation 25.6.59 15.8.60 31.10.61 23.3.62 15.6.62 27.12.62 17.7.63 - Date of operation 1.10.60 1.9.61 1.10.62 1.10.62 1.10.63 1.10.63 1.10.64 - Acres 186 130 335 200 100 365 140 135 Total dwellings 1,602 1,060 804 1,141 880 987 1,082 780 Council houses 418 5 682 182 - 379 79 2 Estimated number of dwellings ranking for grant 1,370 911 739 979 773 766 1,039 732 Number of dwellings where estimates of cost of conversion or adaptation were approved 1,147 561 646 585 393 607 95 ­ Number of claims for grant checked and approved for payment 1,062 517 438 503 234 75 18 ­ Gross cost to 31.12.63 £14,336 £8,700 £5,095 £11,720 £6,431 £1,443 £365 ­ Nature of works carried out:- (a) new appliances 974 632 424 734 307 106 24 - (b) adaptation of existing appliances 445 200 106 178 64 16 ­ ­ (c) gas or electric kindling provided 757 399 459 595 270 44 5 - TENTS, VANS AND CARAVANS. There are six 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. Seven other sites are occupied by one or more caravans. During the year, the inspectors made 576 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 Caravan Sites and Control of Development Act, 1960, two site licences were renewed for a limited period. 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 24 inspections during the year. FACTORIES WORK-PLACES, ETC. The Factories Act placed on the Council certain duties in regard to (a) outworkers; (b) employment of persons in unwholesome premises; (c) basement bakehouses; (d) provision of sanitary conveniences in all factories, and (e) cleanliness, over-crowding, ventilation and drainage of floors in the case of factories in which mechanical power is not used. A summary of the work done is given below and in Table IX. 22 23 RESULTS OF VOLUMETRIC MEASUREMENTS OF ATMOSPHERIC POLLUTION Smoke (Micrograms per cu. metre): Sulphur Dioxide (Micrograms per cu. metre) HEALTH DEPARTMENT HESTON CLINIC ISLEWORTH CLINIC HARLEQUIN AVENUE Smoke S.0.2 Smoke S.0.2 Smoke S.0.2 Smoke S.0.2 m.a. h.d.r. l.d.r. m.a. h.d.r. l.d.r. m.a. h.d.r. l.d.r. m.a. h.d.r. 1.d.r. m.a. h.d.r. l.d.r. m.a. h.d.r 1.d.r. m.a. h.d.r. 1.d.r. m.a. h.d.r. 1.d.r. January 265 1360 70 469 1607 235 244 1230 40 305 958 77 292 1480 70 525 881 246 242 1170 70 375 1444 54 February 210 390 90 453 978 157 188 360 50 381 869 112 205 400 60 472 1101 146 202 360 70 467 1103 160 March 62 160 30 126 315 51 50 100 10 95 163 29 56 120 20 155 335 74 61 120 30 133 283 74 April 85 180 40 204 541 71 66 190 23 163 506 43 81 140 30 253 583 114 92 260 40 214 752 80 May 27 70 10 58 149 6 24 60 10 73 157 17 37 70 20 104 177 54 48 80 20 95 192 40 June 24 60 10 86 266 28 20 50 10 69 177 26 21 70 10 95 243 37 40 80 20 85 240 29 July 40 50 30 96 252 54 20 40 10 73 137 46 20 30 10 83 177 29 40 50 10 63 169 46 August 24 70 Nil 85 263 34 24 70 10 70 209 20 27 70 10 97 309 40 46 80 20 98 286 40 September 51 120 10 117 420 46 41 80 20 92 226 34 55 130 10 135 300 46 65 130 30 143 506 51 October 68 170 34 125 272 74 56 100 20 83 203 49 61 160 20 132 272 83 82 120 40 133 283 66 November 128 610 10 184 512 89 117 540 10 113 357 49 114 600 20 198 575 83 135 560 20 195 632 69- December 191 390 70 221 489 14 142 360 40 214 406 31 196 450 80 386 655 183 201 480 40 360 509 217 m.a. - monthly average. h.d.r. - highest daily reading. l.d.r. - lowest daily reading. Inspection of (a) Factories mechanical power 381 (b) Factories - non mechanical power 29 (c) Other premises 65 (d) Outworkers' premises 51 Defects remedied 12 At the end of the year the number of outworkers registered with the Department was 219 and the trades on which they were engaged are shown in Table IX. 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 33 rooms were treated, while 80 wasp nests were destroyed, 9 premises cleared of cockroaches, 6 cleared of ants and 8 of other insects. Treatment of ponds and tanks to prevent the breeding of mosquitoes was carried out as necessary. It is pleasing to record that in the Borough bug-infestations have become a rarity and activity in this sphere is now concerned more with the extermination of other insects. NOISE NUISANCE The sources of noises which were the subject of complaint to the Department during the year were. Factories, industrial premises etc. 8 Private machinery 1 Guests in Motel 1 Barking dogs 2 Motor cycles on waste ground 1 Compressors in street 2 General noise of occupants of houses 2 In most cases, investigation showed some justification for the complaint. With the co-operation of the persons concerned the nuisances were remedied or reduced. 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 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:- 1959 1960 1961 1962 1963 Complaints received 803 652 846 693 828 Block inspections 95 120 107 88 127 Individual inspections and re-inspections 5, 183 5,516 5,634 5,766 4,818 Other Visits 663 693 551 142 798 Premises treated (a) By occupier 31 26 20 - - (b) By local authority 1,318 1,145 1,314 1,236 1,307 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 resonably ventilated, heated and lighted, and there should be suitable and sufficient sanitary and washing facilities for the persons employed therein. In this connection 13 inspections were made during the year. Notices were served following unsuitable sanitary facilities found in two shops. No certificate of exemption re provision of sanitary accommodation was granted. OFFICES SHOPS & RAILWAY PREMISES ACT, 1963. In anticipation of the above Act coming into force. 374 preliminary visits were made by the Inspectors to premises covered by the Act 24 RAG FLOCK AND OTHER PILLING 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, two premises in the Borough are registered and the Public Health Inspectors made 3 visits of inspection. SWIMMING BATHS. Three swimming baths are provided by the Council. The size and extent of usage 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 1963 147,526 241,842 224,068 Maximum number of persons using swimming bath on any one day 906 1,556 1,246 No of private baths Male 15 - 11 Female 9 ~ 11 No of persons using private baths during 1963 32,666 - 20,060 The baths waters are treated by continuous filtration and breakpoint chlorination. While baths' staff do everything to maintain a "safe" standard of bath water: bathers could assist very materially by the observance of strict personal hygiene. During the year 4 samples of baths water, and one from a paddling pool were taken. One sample of baths water was found to be unsatisfactory, but this was quickly remedied. VERMINOUS PREMISES AND ARTICLES. On request, three houses and four lots of bedding, etc. were treated for verminous infestation. VERMINOUS PERSONS. One verminous person was cleansed under the provisions of Section 85 of the Public Health Act, 1936. During the year 34 children in attendance at schools in the Borough were found to be verminous and because of the failure of parents to take necessary action 8 of these children had to be cleansed by the School Health Department 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 7 premises in the Borough have been licensed and 9 visits of inspection were made during the year. INSPECTION AND SUPERVISION OF FOOD MILK. At the end of the year, there were 51 distributors registered under the Milk and Dairies Regulations. During the year 32 inspections were made at dairies and retail purveyors' premises. The Milk (Special Designation) (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'. Six various complaints were received with regard to milk bottles. In no case was formal action possible. 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 257. One application for registration was refused 25 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, 107 inspections of registered premises were carried out. The following results were obtained from the bacteriological examination of samples:- Satisfactory Doubtful Unsatisfactory Ice-Cream 27 1 The percentage of doubtful and unsatisfactory samples was 4.0 as compared with 8.0 in 1962. BAKEHOUSES. There are 18 bakehouses in the Borough and 41 visits of inspection were made during the year. SLAUGHTERHOUSES. 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. 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 72 412 Cafes, Canteens, Clubs, etc. 218 515 Fish Shops 22 154 Greengrocers 83 304 Grocery and Provision 176 478 Hotels, Public Houses, etc. 88 57 Manufacturers, Packets, etc. 14 2 Confectioners, sweets 145 132 flour 20 44 A further 37 inspections were made of vehicles in which food was being conveyed, or from which food was being sold. At retail premises 5,175 lbs., 359 tins and 2,394 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. In connection with complaints about, or notification of the presence of unsound food, 135 special inspections were made. The following foods were brought to the Department because the purchasters were not satisfied that they were fit for human consumption; - Article No. Chicken 1 Luncheon Meat tinned 1 Dripping 1 Frankfurters 1 Baby Food Pudding 1 Bread 7 Chocolate 1 Cereal 1 Steak and Kidney Pie 1 Meat Pie 1 Yoghurt 1 Corned Beef tinned 2 Custard Pie 1 Beef tinned 1 Article No. Sponge 1 Chicken and Ham Pie 1 Tinned Prunes 1 Marmalade 1 Cheese Roll 1 Liver 1 Salmon tinned 2 Steak 1 Iced Bun 1 Iced Pastry 1 Cake 3 Beef Croquette 1 Pork Pie 1 Fruit Pie 1 Cornish Pasty 1 26 The complaints were not substantiated in 29 cases. Two official warnings were issued and proceedings in other cases resulted in fines and costs amounting to £91 12s 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 the end of the year 112 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 35 hawkers were on the register (greengrocery, 21 Fish 7, ice-cream, 7) and 37 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 24 school canteens provided 1,507,431 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. POOD AND DRUGS SAMPLING, This work is carried out in the Borough by the Public Control Department of Middlesex County Council. 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 Food Hygiene Regulations were found at 63 premises and were remedied at 62 premises during the year. particulars of the contraventions found are given below:- Contraventions of Food Hygiene Regulations No of Contraventions Articles/Equipment not kept clean 11 Articles/Equipment not in good order 9 Containers not protected from contamination 1 Pood so placed as to involve risk of contamination 6 Personal cleanliness not observed 1 Water closets not kept clean and in efficient order 14 Absence of 'Wash your Hands' notice in water closets 6 Absence of suitable and sufficient wash-hand basins 17 Absence of hot water at a suitably controlled temperature over wash hand basins 16 Absence of soap nail brushes, clean towels, etc. near wash hand basins 6 Absence of first aid materials 5 Absence of accommodation for clothing not worn during working hours 7 Absence of suitable and sufficient sinks for the washing of food and equipment 8 Absence of hot water at a suitably controlled temperature over sink 8 Absence of soap clean cloths, etc. at sink 1 Absence of suitable and sufficient lighting in food rooms 1 Absence of suitable and sufficient ventilation in food rooms 2 Walls, floors etc. not kept clean 44 Walls floors, etc. not kept in good order 36 Covered receptacle for refuse not provided 5 Accumulations of refuse, etc. 5 Miscellaneous 6 215 There is a continuing need for vigilance in connection with unhygienic practices and personal habits among food handlers. 27 HOUSING The numbers of new houses erected in the Borough in post-war years is shown below:-  1946-59 1960 1961 1962 1963 Heston and Isleworth B.C. 1,828 60 32 70 58 Brentford and Chiswick B.C. 62 _ _ Southall B. C. 64 - - - - Middlesex County Council 6 1 12 - - Ministry of Civil Aviation 77 - - - - Metropolitan Police 29 - - - - Prison Commissioners 18 - - - - War Department 34 - - - - British Waterways - - 1 - - Private Enterprise (a) new houses 1,336 140 34 107 74 (b) reconstructed after war destruction 185 - - - - (c) housing association 429 - - - 6 (d) additional dwellings by conversion 3 - - - - 4,071 201 79 177 138 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 as follows:- 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) 378 (b) Number of inspections made for the purpose 633 (2) (a) Number of dwelling-houses (included under head (1) above) which were inspected and recorded under Housing Regulations, 1925 and 1932 255 (b) Number of inspections made for the purpose 510 (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 7 (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 224 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 29 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 formal notices were served requiring repairs 3 (2) Number of dwelling-houses which were rendered fit after service of formal notices:- (a) by Owner 3 (b) by Lccal Authority in default of owners 1 (b) Proceedings under Public Health Acts (1) Number of dwelling-houses in respect of which formal notices were served requiring defects to be remedied 13 28 (2) Number of dwelling-houses in which defects were remedied after service of formal notices: (a) by Owner 9 (b) by Owner after Court had made a Nuisance Order (c) by Local Authority in default of owners (c) Proceedings under sections 16, 17, 18, 24, 27, 28 and 43 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 re-let for human habitation: (a) to render fit (b) not to use (2) Number of dwelling-houses rendered fit in consequence of Undertakings given by Owners 1 (3) Number of dwelling-houses demolished which were subject to Closing Orders (4; Number of dwelling-houses in respect of which Demolition Orders were made 2 (5) Number of dwelling-houses demolished in pursuance of Demolition Orders 14 (6; Number of dwelling-houses in respect of which Closing Orders were made in lieu of Demolition Orders (7) Number of dwelling houses in respect of which Closing Orders were revoked and Demolition Orders substituted (8) Number of Demolition Orders revoked .. (9) Number of Closing Orders determined, the premises having been rendered fit 1 (10) Number of Closing Orders made in respect of - (a) any part of a building 2 (b) any underground room (11) Number of Closing Orders determined in respect of any part of a building rendered fit (12) Clearance Areas Bath Road (The Lawns) Clearance Order (48 Flats) - Confirmed 17.9.62. The remaining families were rehoused by the Council by the 14th October, 1963. Link field Road (Nos. 14 to 38) Clearance Order (13 Houses) - Confirmed 3.7.63. Eight houses remained occupied on the 31st December, 1963, the Council having previously rehoused four families. 4. HOUSING ACT 1957 - OVERCROWDING. (1) (a) Number of dwellings overcrowded at the end of the year 19 (b) Number of families dwelling therein 29 (c) Number of persons dwelling therein 124 (2) Number of new cases of overcrowding reported during the year 5 (3) (a) Number of cases of overcrowding relieved during the year 10 (b) Number of persons concerned in such cases 91 29 (4) Particulars of any case in which dwelling-houses have again become overcrowded after the Local Authority have taken steps for the abatement of overcrowding 5. OTHER MATTERS: (1) Number of dwelling-houses demolished voluntarily 5 (2) Number of dwelling-houses demolished following issue of certificates of unfitness 15 (3) Certificates of Disrepair: Number of decisions not to issue certificates Number of decisions to issue certificates - (a) in respect of some but not all defects 2 (b) in respect of all defects 4 Number of undertakings given by landlords to remedy defects (Form 'K') 3 Number of certificates issued 3 Number of applications by landlords to Local Authority for cancellation of certificates 3 Number of objections by tenants to cancellation of Certificates Number of certificates cancelled 1 (4) At the end of the year, the following 5 houses, subject to Demolition or Closing Orders or to undertakings not to relet till rendered fit were still occupied: Situation Date of Demolition Order or Undertaking 165, Martindale Road, Hounslow 25.7.50 10, Ivy Road, Hounslow 28.7.55 38, Haliburton Road, Isleworth 29.5.56 150, Linkfield Road, Isleworth 26.3. 63 38B, Bulstrode Road, Hounslow 24.9.63 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 £601,080 for house purchase under the Housing (Financial Provisions) Acts, 1958 and 1959 in relation to 237 houses. (b) improvement grants of £9,112 under section 30 of the Housing (Financial Provisions) Act, 1958 in relation to 35 houses. (c) repairs loans of £7,862 under the Housing (Financial Provisions) Acts, 1958 and 1959 in relation to 30 houses. (d) repair costs of £372 12. Od. under section 9 of the Housing Act, 1957 for work in default in relation to one house. (e) standard grants of £3,225 under Section 4 of the House Purchase and Housing Act, 1959 in relation to 34 houses. 30 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 1963 one burial was arranged in accordance with this section. PUBLIC MORTUARY. The public mortuary situated in the grounds of Holy Trinity Church, has been demolished. The premises were out-of-date and unsuitable for post-mortem examination or the retention of a body for other than a very short time. By arrangement with the Coroner bodies are taken direct 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 157 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 Chief Public Health Inspector engaged in similar activities particularly in those parts of the Borough affected by Smoke Control Orders, 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. The anti smoking unit of the Central Council for Health Education spent 5 days in the Borough visiting secondary schools and teachers' training colleges. PFRSONS 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 participating in this service is increasing. BLOOD TRANSFUSION SERVICE. Sessions for the collection of blood from donors were held as under" - Hounsiow Isleworth 12th, 13th and 14th January 7th April. 3rd March, 25th August 25th, 26th and 27th May. 21st July 5th 6th and 7th October. 31 TABLE 1 Summary of Vital Statistics 1904-1963 Estimated Civilian population (mid-year) Birth Hate per 1, 000 popu1ation Death Rate per 1,000 popu1ation Infant Mortality Rate Neo- natal Mortality Rate Maternal Mortality Rate per 1,000 live and still births Still Birth Rate per 1,000 live and still births Tuberculosis Death Rate per 1,000 population Deaths under 1 yr. per 1,000 1ive births Deaths under 1 mth. per 1,000 live births 1904 32,630 32.3 16.8 169 - - - 1.9 1905 33,194 31.9 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 26.1 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 48,861 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 48,445 24.7 10.9 68 22 - - 1.0 1921 47,290 20.0 11.8 69 40 - 1.0 1922 47,860 18.7 11.8 74 37 - - 1.0 19 23 48,030 17.5 9.8 56 26 - - 0.9 1924 47,700 17.7 10.8 61 27 - - 1.0 1925 48,620 17.4 10.3 73 41 - - 0.7 1926 52,110 17.4 9.1 56 25 - - 0.8 1927 55,870 16.1 10.7 68 36 - -- 1.0 1928 59,730 17.1 9.9 66 27 _ - 0.6 1929 63,070 17. 1 11.5 46 18 - - 0.8 1930 63,070 19.1 9.6 60 25 6.4 36 0.8 1931 76,230 17.6 10.0 49 24 6.0 30 0.7 1932 81,100 17.4 9.7 60 29 2.8 24 0.7 1933 84,460 16.3 9.4 43 19 4.9 34 0.9 1934 87,797 15.1 10.3 48 21 2.9 32 0.8 1935 90,970 15.8 9.0 41 22 4.7 36 0.6 1936 95,000 16.7 9.6 48 20 2.0 30 0.6 1937 99,420 14.9 9.5 40 20 3.3 23 0.5 1938 101,500 14.2 8.6 46 24 2.7 30 0.6 1939 101,100 15.0 8.8 60 23 3.4 26 0.7 1940 97,530 13.7 12.3 68 39 2.3 25 0.6 1941 93,990 12.9 10.3 61 32 2.4 35 0.8 1942 96,600 14.6 10.2 72 43 2.8 32 0.7 1943 95,080 16.3 10.6 47 23 0.6 26 0.6 1944 92,370 16.5 10.4 46 30 1.9 22 0.5 1945 96,100 15.5 9.7 51 33 2.0 26 0.6 1946 104,240 17.8 10.4 29 22 2.2 26 0.6 1947 106,670 17.3 10.5 39 24 0.5 24 0.5 1948 106,200 14.5 8.8 30 20 0.6 25 0.4 1949 106,900 13.6 9.8 17 12 2,0 18 0.3 1950 107,300 11.6 9.9 24 14 0.8 18 0.3 1951 106,400 11.8 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 106,600 11.2 9.6 26 19 0.0 20 0.1 1965 106,600 11.0 10.6 24 17 0.0 17 0.1 1966 105,100 11.1 10.8 18 15 0.0 19 0.1 1967 105,100 12.3 10.3 23 17 0.0 11 0.07 1968 105,100 12.0 10.6 17 13 0.0 13 0.05 1959 105,000 12.1 10.9 17 15 0.8 14 0.07 1960 105,270 13.1 10.3 18 13 0.0 17 0.04 1961 102,680 13.7 11.0 25 19 0.7 19 0.11 1962 102,680 13.8 10.9 21 18 0.0 16 0.05 1963 101,860 14.6 11.3 11 8 0.0 14 0.08 32 TABLE II REGISTRAR-GENERAL'S RETURN OF CAUSES OF DEATH. 1963. Abridged List No. Cause of Death Male Female Total B1 Tuberculosis, respiratory 7 - 7 B2 Tuberculosis, other - 1 1 B3 Syphilitic disease - - - B8 Diphtheria - - - B.9 Whooping Cough - - - B.10 Meningococcal Infections - - - B.12 Acute Poliomyelitis - - - B.14 Measles - - - B.4-7, 11 16-17 Other Infective and Parasitic diseases - - - B.18 Malignant neoplasm, stomach 12 12 24 Malignant neoplasm, lungs 58 11 69 Malignant neoplasm, breast - 23 23 Malignant neoplasm, uterus - 4 4 Other malignant and lymphatic neoplasms 75 46 121 Leukaemia, aleukaemia 3 4 7 B.20 Diabetes 5 3 8 B.22 Vascular Lesions of nervous system 46 79 125 B.26 pt. Coronary disease, angina 133 73 206 B.28 Hypertension with heart disease 9 12 21 B.25 26 pt. 27 Other heart disease 46 90 136 B.29 46 pt. Other circulatory disease 26 22 48 B.30 Influenza 1 3 4 B.31 Pneumonia 40 41 81 B.32 Bronchitis 60 19 79 B.46 pt. Other respiratory diseases 8 3 11 B.33 Ulcer of stomach and duodenum 8 6 14 B.36 43 pt. Gastritis, enteritis, diarrhoea 5 7 12 B.38 Nephritis and nephrosis 1 8 9 B.39 Hyperplasia of prostate 4 - 4 B.40 Pregnancy, childbirth, abortion - - - B.41 Congenital malformations 3 2 5 Residual Other defined and ill-defined diseases 36 44 80 B.E. 47 Motor vehicle accidents 8 7 15 B.E. 48 Ail other accidents 12 11 23 B.E.49 Suicide 5 8 13 R.E.50 Homicide and operations of war - - - Total 611 539 1, 150 33 TABLE III CAUSES OF DEATH (MALES) AT CERTAIN AGES, 1963. Under 1 1-4 6-14 15- 24 25-44 45-64 65-74 75-over Total Tuberculosis, respiratory - - - - - - 4 - 7 Tuberculosis, other - - - - _ - - - - Syphilitic disease - - - - - - - - - Diphtheria - - - - - - - - - Whooping Cough - - - - - - - - - Meningococcal Infection - - - - - - - - - Acute Poliomyelitis - - - - - - - - - Measles - - - - - - - • - - Other Infective and parasitic disease - - - - - - - - - Cancer - Stomach - - - - - 3 9 - 12 lung - - - - 1 34 15 8 58 breast - - - - - - - - - uterus - - - - - - - - - other - 1 - - 4 28 21 21 75 leukaemia - - 1 - - 1 - 1 3 Diabetes - - - - 1 1 3 5 Cerebral Haemorrhage, etc. - - - - 2 14 9 21 46 Coronary disease, angina - - - - - 66 32 36 133 Hypertension with heart disease - 2 3 4 9 Other heart disease - - - 1 2 8 3 32 46 Other circulatory disease - - - - - 3 7 16 26 Influenza - - - - - - - 1 1 Pneumonia - 1 1 - - 3 10 25 40 Bronchitis - - - - - 17 19 24 60 Other respiratory disease - - - - - 4 - 4 8 Dicer of Stomach and duodenum 1 - _ _ _ 3 2 2 8 Gastritis, enteritis, etc. - 1 - - - - 3 1 5 Nephritis and nephrosis - - - - - - - 1 1 Prostatic enlargement - - - - - - 1 3 4 Pregnancy, childbirth, abortion . - - - - - - - - Congenital malformations 1 - - 1 1 - - - 3 Other diseases 6 - - 1 - 7 11 11 36 Motor vehicle accidents - - - 2 1 4 - 1 8 All other accidents .. - 1 - 2 - 5 1 3 12 Suicide - - - - 1 3 1 - 5 Homicide and war operations - - - - — — — ~ Total 8 4 2 7 12 208 152 218 611 Percentage of Total 1.3 0.7 0.3 1.1 2.0 34.0 24.9 35.7 TABLE IV CAUSES OF DEATH (FEMALES) AT CERTAIN AGES, 1963 Under 1 1-4 5- 14 16-24 25-44 45-64 65-74 75- over Total Tuberculosis, respiratory _ _ _ _ - - - - - Tuberculosis, other - - - - - 1 - - 1 Syphilitic disease - - - - - - - - - Diphtheria - - - - - - - - " Whooping Cough - - - - - - - - - Meningococcal Infection - - - - - - - - - Acute Poliomyelitis - - - - - - - - - Measles - - - - - - - - - Other infective and parasitic diseases - - - - - - - - - Cancer - stomach - - - - - 4 2 6 12 lung - - - - - 8 2 1 11 breast - - - - 2 11 7 3 23 uterus - - - - - 2 - 2 4 other - - — - 4 17 13 12 46 leukaemia - - - - 2 ~ - 2 4 Diabetes - - - - - 2 - 1 3 Cerebral Haemorrhage, etc. - - - - - 11 22 46 79 Coronary disease, angina - - - - - 9 23 41 73 Hypertension with heart disease - - - - - - - 12 12 Other heart disease - - - - - 11 12 67 90 Other circulatory disease - - - - - 3 8 11 22 Influenza - - - - - - - 3 3 Pneumonia 2 1 - - - 4 5 29 41 Bronchitis - - - - - 2 9 8 19 Other respiratory diseases - - - - 1 1 - 1 3 Ulcer of stomach and duodenum - - - - - - _ 6 6 Gastritis, enteritis, etc. - - - - - - - 7 7 Nephritis and nephrosis 1 - - 1 - 3 - 3 8 Prostatic enlargement - - - - - - - - - Pregnancy, childbirth, abortion - - - - - - - - - Congenital malformation 2 - - - - - - - 2 Other disease 4 1 1 1 1 6 6 24 44 Motor vehicle accidents - - 1 1 1 1 2 1 7 All other accidents - - - - - 2 2 7 11 Suicide - - - - 4 2 1 1 8 Homicide and war operations - - - - - - - - - Total 9 2 2 3 16 100 114 294 539 Percentage of total 1.7 0..4 0.4 0.6 2.7 18.6 21.2 54.5 35 TABLE V INFANTS' DEATHS ACCORDING TO AGE AND CAUSE, 1963. 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 Nephritis - - - - - - - - - - - - - - - - 1 - - - - 1 Pneumonia - - - - - - - - - 1 - 1 - - - - - - - - - 2 Epilepsy - - - - - - - - - - - - - - - - - - 1 - - 1 Atelectasis and birth asphyxia - 1 1 - - - - - - - - - - - - - - - - - - 2 Congenital malformations - - - - - - - 1 - - 1 - 1 - - - - - - - - 3 Prematurity 2 3 - - - - 1 - - - - - - - - - - - - - - 6 Perforated gastric ulcer - - - - - - - - 1 - - - - - - - - - - - - 1 Rhesus incompatibility 1 - - - - - - - - - - - - - - - - - - - - 1 Total 3 4 1 - - - 1 1 1 1 1 1 1 - - - 1 - 1 - - 17 36 TABLE VI. INFECTIOUS DISEASES, AGE DISTRIBUTION - 1963 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. 46-64 yrs. 65y rs. Age unknown Cases Admitted to hospital Smallpox - - - - - - - - - - - - - - - Typhoid Fever - - - - - - - - - - - - - - - Para-Typhoid - - - - - - - - - - - - - - - Scarlet Fever 13 - 1 1 - 3 8 - - - - - - - 1 Diphtheria - - - - - - - - - - - - - - - Erysipelas 11 - - - - - - - - - 1 7 3 - 5 Puerperal Pyrexia 127 - - - - - - - 11 103 13 - - - 124 Ophthalmia Neonatorum - - - - - - - - - - - - - - Acute Encephalitis - - - - - - - - - - - - - - - Acute Poliomyelitis - - - - - - - - - - - - - - - Meningococcal Infection 1 - - - - - - - - - - 1 - - 4 Pneumonia 18 1 - 1 - - - - 1 - 3 7 5 - 6 Malaria 2 - - - - - - - - - 1 - 1 - 2 Dysentery 34 1 4 1 1 2 8 4 2 3 3 1 - 4 2 Measles 886 27 93 119 110 146 365 16 6 3 1 - - - 33 Whooping Cough 59 6 5 8 5 7 25 3 - - - - - - 6 Food Poisoning 20 1 1 2 - 1 2 2 3 3 1 2 - 2 6 Tuberculosis:Pulmonary 39 - - 1 - - 1. 1 - 3 9 8 9 8 - 5 Non Pulmonary 11 - - - - 1 - - - 5 1 2 2 - 4 NOTIFICATIONS AND DEATHS FROM CERTAIN INFECTIOUS DISEASES HESTON AND ISLEWORTH 1944-1963 TABLE VII Year Small pox Scarlet Fever Diphtheria Erysipelas Pneumonia Meningococcal Infection Epidemic Encephalitis Poliomyelitis and Polioencephalitis Typhoid Fever Paratyphoid Fever Dysentery Measles Whooping Cough Influensa 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 Daath3 Cases Deaths Cases Deaths 1944 - - 130 - 11 1 16 - 50 59 3 2 - 1 3 - - - - - 22 - 219 - 171 3 Not Notifiable 5 184 44 1946 - - 124 - 24 2 16 1 25 37 11 2 1 - 7 - - - - - 28 - 1107 1 110 - 3 157 52 1948 - - 67 - 16 1 19 1 47 53 13 - - 1 1 1 1 - - - 6 - 170 - 170 - 16 217 56 1947 - 62 - 3 - 19 - 56 40 8 1 - 43 5 1 - - - - - 840 2 142 2 8 180 52 1948 - - 159 - 2 - 21 - 41 42 2 - - 1 29 2 - - 3 - 5 - 571 227 - 5 168 43 1949 - - 138 - - - 26 - 52 53 2 1 - 2 14 1 - - - - 2 - 523 - 173 - 6 219 36 1950 - - 92 - 1 - 12 - 64 30 - - - 9 - 3 - 6 - 6 - 881 - 206 - 6 182 37 1951 - - 67 - - - 12 - 59 38 5 1 - - 4 ~ 1 - 1 - 77 - 790 1 220 - 33 185 27 1952 - - 161 - - - 19 1 58 51 5 1 - - 3 - - 7 - 28 1027 - 86 - 4 168 19 1958 - - 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 1959 - - 235 - - - 7 - 47 61 3 1 1 - 1 1 - - - - 42 - 1007 - 46 - 37 56 1 1960 - - 70 - - - 8 - 18 46 1 1 1 - - - - - 1 - 126 - 30 - 199 1 2 54 4 1961 - - 29 - - - - - 17 77 2 - 4 2 1 - - - - - 14 - 1437 - 14 - 7 55 11 1962 - - 22 - - - 6 - 14 55 2 - 2 - - 1 - - - 42 - 207 - 3 - 9 33 5 1963 13 - - - 11 18 81 1 - - - - - - - - 34 886 59 - 4 50 8 TABLE vni(a) METEOROLOGY (Extract from records supplied by the Chief Engineer, Mogden Sewerage Works). Week Ending Barometer Temperature (C°) Days with Rainfall Total Reinfall (inches) Highest Lowe s t Max. Min. Jan. 5th 29.79 29.25 2.4 - 2.5 5 0.42 12th 30.40 29.58 2.5 - 11.0 3 - 19 th 30.44 29.66 2.5 - 9.0 4 0.02 26th 30.74 29.75 5.5 - 11.0 2 0.01 Feb. 2nd 30.73 29.78 5.5 - 6.0 7 0.18 9 th 29.92 29.43 5.0 - 4.0 6 0.05 16th 29,80 29.11 4.5 - 2.0 4 0.08 23rd 30.24 29.38 4.0 - 3.5 6 0.01 Mar. 2a d 30.37 30.21 9.5 - 6.5 _ 9 th 30.26 29.40 16.5 - 1.0 3 0.50 i6th 29.89 28.72 15.0 0.0 7 0.93 23rd 30.46 29.47 13.0 - 2.5 5 0.20 30 th 30.34 29.21 13.5 1.0 7 0.71 Apr. 6th 30.10 29.75 14.5 - 1.0 5 0.18 13th 30.00 28.94 14.5 0.5 4 0.38 20 th 29.90 29.19 17.5 5.0 7 0.83 27 th 30.30 29.55 20.5 4.0 2 0.04 May 4th 30.28 29.44 20.5 2.5 5 0.86 11th 30.01 29.52 18.0 3.0 4 0.30 18th 30.23 29.78 18.5 4.0 4 0.45 26th 30.17 29.55 20.5 5.5 3 0.24 June 1st 30.23 29.84 26.5 7.0 3 0.35 8th 30.00 29.67 26.0 9.5 3 0.07 15th 29.90 29.76 26.5 7.5 4 0.21 22nd 29.97 29.42 22.0 9.0 5 0.43 29th 29.97 29.35 22.0 8.5 6 0.86 July 6 th 30.03 29.76 22.0 9.0 6 1.05 13th 30.00 29.66 20.5 9.0 4 0.42 20 th 30.23 29.80 24.5 9.5 4 0.06 27 th 30.36 29.63 27.0 9.0 2 0.05 Aug. 3rd 30.27 29.61 26.0 11.5 3 0.45 10 th 29.98 29.54 23.5 8.0 5 0.55 17th 29.80 29.43 22.0 8.5 6 0.43 24th 29.83 29.50 22.0 7.5 3 0.35 31st 29.86 29.44 21.0 8.0 4 0.52 Sept, 7th 30.01 29.51 20.0 8.0 7 1.26 14th 30.23 28.88 23.0 6.0 3 0.15 21st 30.20 29.85 24.5 8.0 2 0.01 28th 30.20 29.45 19.5 5.5 5 0.80 Oct. 6th 30.03 29.54 17.0 4,0 5 0.52 12th 30.37 29.44 21.5 5.0 3 0.16 19th 30.23 29.70 18.0 4.5 4 0.19 26th 30 28 29.89 19.5 8.0 3 0.29 Nov. 2nd 30.16 29.19 16.0 5.0 4 0.63 9 th 29.65 29.11 16.0 6.0 7 0.74 16th 29.63 29.01 17.5 1.0 4 0.54 23rd 30.24 29.05 16.0 - 1.0 7 1.85 30 th 30.03 29.25 13.0 1.0 6 1.00 Dec. 7th 30.08 29.68 9.0 • - 0.5 2 0.04 14th 30.18 29.64 7.0 - 3.5 4 0.05 21st 30.44 29.43 5.5 - 6.0 3 0.09 28th 30.66 29.75 8.0 - 6.0 4 0.49 TABLE VIII (b) WIND DIRECTION (Sum. of Daily Records, 52 weeks) N. .. .. .. 10 days N.N. E .. .. .. .. 21 days N. E... .. .. .. .. 24 day s EN. E .. .. .. .. 16 days E . . .. •. .. 32 days E S, E .. .. .. .. 11 days SL E.. .. .. .. . • 10 days S, & E .. .. .. .. 2 days S. .. .. .. .. .. 11 days S. S, W, . „ .. .. .. 14 days S, W, .. 36 days W. S, W„ .. ,. .. .. 38 day s W .. .. . „ .. 34 day s W.N.W. .. .. .. .. 13 days N. W. .. .. .. .. 19 d ay s N. N. W. .. .. .. .. 4 days Calm .. .. .. 68 days No record „„ .. .. 1 day t 40 TABLE IX FACTORIES ACT, 1937 to 1959 PART I OF THE ACT 1. Inspections for purposes of provisions as to health made by Public Health Inspectors. Premies Number on Register Number of Inspections Written Notices Occupiers Prosecuted (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 38 29 - - (ii) Factories not included in (1) in which Section 7 is enforced by the Local Authority 389 381 8 - (iii) Other premises in which Section 7 is enforced by the Local Authority (excluding outworkers' premises) 10 65 1 - TOTAL 437 475 9 -- 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 EM Inspector By H.M Inspector Want of Cleanliness 1 - 1 - - Overcrowding (S. 2) - - - - - Unreasonable temperature (S. 3) - - - - - Inadequate ventilation (S. 4) - - - - - Ineffective drainage of floors (S.6) - - - - - Sanitary Conveniences (St. 7) (a) insufficient 1 - - 1 - (b) unsuitable or defective 9 12 « - - (c) not separate for sexes - - - - - Other offences against the Act (not including offences relating to Outwork) - - - - - Total 11 12 1 1 - 41 £. TABLE IX (Continued) 3. Outwork - Part VIII of the Act. Nature of Work (1) Section 110 Section 111 No. of Outworkers in August list required by Section 110(1) (c) (2) No. of cases of default in sending lists to the Council (3) No. of prosecutions for failure to supply lists (4) No. of inbtances of work in unwholesome premises (6) Notices served (6) Prosecutions (7) Wearing) Making etc, apparel) Cleaning & Washing 173 - - - - - Lace, lace curtains and nets 2 - - - - Curtains and furniture hangings 6 - - - - - Furniture and Upholstery 4 - - - - Artificial flowers 5 - - - - Carding, etc. of buttons, etc. 10 - - - - - Stuffed toys 17 - . - - - Cosaques, Christmas stockings, etc. 2 - - - - - TOTAL 219 - - - - - 42