HES 25 Borough of Heston and Isleworth 1938 ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE Borough of Heston and Isleworth 1938 REPORT ON THE HEALTH OF THE BOROUGH OF HESTON & ISLEWORTH FOR THE YEAR 1938 BY A. ANDERSON, m.d.. d.p.h. Medical Officer of Health Index Airport, Heston 52 Ambulance Facilities 16 Ante-Natal Clinics 16 Area and Social Conditions 10 Artificial Sunlight Clinic 17 Bakehouses 41 Bed Bugs 31 Birth Rates 10 Births 11 Blindness, Prevention of 52 Camping Sites 30 Canal Boats 31, 32 Cancer 51 Cerebro-Spinal Fever 47 Cesspools 29 Chicken Fox 48 Child Life Protection 24 Child Mortality 12 Clinics and Treatment Centres 15 Closet Accommodation 27 Common Lodging Houses 30 Dampness 29 Deaths 11, 53, 54, 57 Death Rates 10 Dental Treatment of Mothers and Children 24 Diphtheria 44, 55 Diphtheria Immunisation 44—47 Disinfection 52 Disposal of the Dead 31 Drains 29 Drainage and Sewerage 27 Dysentery 48 Epidemic Encephalitis 47 Erysipelas 47 Factories Acts 58 Factories, Workplaces, etc. 30 Food and Drugs Adulteration 42 Food, Inspection and Supervision of 41, 42 General Provision of Health Services 14—25 German Measles 48 Health Education 25 Health Visitors 7, 23 Home Helps 23 Hospital Accommodation for Infectious Disease 52 Hospitals 18 Housing 34—39 Ice Cream 41 Infant Mortality 11, 54 Infant Welfare Centres 16 Infectious and Other Diseases 44—57 Influenza 48 Inspection and Supervision of Food 41, 42 Institutional Provision for Mothers and Children 23 Insurance Medical Service 18 Laboratory Facilities 14 Marriages 10 Maternal Mortality 12 Maternity and Child Welfare— Attendances at Centres 16 Centres 15 Dental Treatment 24 Supply of Milk and Other Foods 25 Maternity Sets 23 Measles 48 Measles Prophylaxis 48 Meat 41 Medical Out-relief 18 Midwives 18 Milk 41 Minor Ailments Clinics 18 Municipal Domiciliary Midwifery Service 19-22 Nuisances 29 Nursing Homes 25 Nursing in the Home 16 Nutrition 42 Obstetric Consultant 23 Offensive Trades 29 Open Spaces 31 Ophthalmia Neonatorum 49 Orthopaedic Treatment 18 Overcrowding 35 Pneumonia 48 Poliomyelitis 47 Population 10 Post Natal Clinics 16 Public Cleansing 27 Puerperal Pyrexia 49 Rats and Mice Destruction 30 Refraction Clinic 18 Rivers and Streams 27 Sanitary Circumstances of the Area 27-32 Sanitary Inspection of the Area 28 Scarlet Fever 44 Schools 31 Shell Fish 42 Shops and Offices 30 Sinks 29 Slaughter Houses 41 Smallpox 47 Smoke Abatement 29 Social Conditions 10 Staff 7 Statistics and Social Conditions 10-12 Stillbirths 11 Superannuation Acts 25 Swimming Baths 31 Tents, Vans and Sheds 30 Tuberculosis 18, 51 Typhoid and Paratyphoid 47 Venereal Diseases 18 Voluntary Helpers 24 Water Supply 27 Whooping Cough 48 Public Health Department, 92, Bath Road, Hounslow. To the Mayor, Aldermen and Councillors of the Borough of Heston and Isleworth. Lady and Gentlemen, I beg to present the Annual Report on the health, vital statistics and sanitary circumstances of the Borough and on the work of the various sections of the Health Department for the year 1938. The report is compiled on the lines indicated by the Ministry of Health and for convenience some of the statistical tables are grouped together at the end of the report. As I was in office for only two months of the year under review no attempt has been made to comment on all the activities of the Health Department. There are no special features to record in connection with the health of the Borough and the work of the Health Department continued on the lines described in previous reports. The new Hounslow Health Centre, brought into use in October, is greatly appreciated by staff and patients. I should like to take this opportunity of expressing my thanks for the kindly manner in which I was received when I took up my new duties. To the officials of the various departments and to my staff I am especially grateful. I remain, Your obedient servant, A. ANDERSON, Medical Officer of Health. 5 THE HEALTH COMMITTEE OF HESTON AND ISLEWORTH BOROUGH COUNCIL as on the 31st December, 1938. Councillor H. G. HEARN (Chairman). „ J. E. DILLINGHAM (Vice-Chairman). Alderman H. COLLAR. F. C. GREEN, J.P. (Mayor). C. L. LEWIS. D. RHYS, M.A., J.P. F. SALMON. Councillor Mrs. M. M. ASHDOWN. H. G. BODY. G. RAVENHILL. F. SARD. A. C. TURNER. W. E. WEBB. MATERNITY AND CHILD WELFARE COMMITTEE Councillor F. SARD (Chairman). Councillor Mrs. M. M. ASHDOWN. G. RAVENHILL (Vice-Chairman). „ H. G. BODY. Alderman H. COLLAR. „ J. E. DILLINGHAM. H. G. HEARN. A. C. TURNER. W. E. WEBB. Co-opted Members: Miss E. A. ANKRITT. Mrs. F. M. STEPHENS. 6 STAFF Medical Officer of Health—ELWIN H. T. NASH, M.R.C.S., M.R.C.P., D.P.H. (To 31st Oct., 1938). A. ANDERSON, M.D., D.P.H. (From 1st Nov., 1938). Deputy Medical Officer of Health—Mrs. E. L. ROBERTS, M.B., CH.B., D.P.H., Barrister-at-Law. Senior Assistant Medical Officer of Health—R. H. G. H. DENHAM, M.D., D.P.H. Assistant Medical Officers of Health—L. J. BACON, M.A., M.R.C.S., L.R.C.P., B.Chir., D.P.H. Miss J. C. RONALDSON, M.B., CH.B., D.P.H. (From 1st Sept., 1? Consultant in Puerperal Sepsis and Consultant in Obstetric Emergencies— J. W. BELL, L.R.C.P.I., and L.M., L.R.C.S.I. and L.M. Consultant to Ante-Natal Clinic—K. BOWES, M.D., M.S., F.R.C.S. Medical Officer, Diphtheria Immunisation Clinics—G. VV. J. BOUSFIELD, M.D., B.S. (Part-time). Supervisory Dental Surgeon—I. COHEN, L.D.S., R.C.S. (Eng.). Dental Surgeons—W. A. LILLEY, B.D.S., L.D.S. (Mane.). (To 31st August, 1938). B. COOKE, L.D.S. (Mane.). L. C. MANDEVILLE, L.D.S., R.C.S. (Eng.). Miss C. C. JEFFERSON, L.D.S. (Mane.). A. H. MILLETT, L.D.S., R.C.S. (Eng.). (From 16th August, 1938). Chief Sanitary Inspector—R. H. BUTLER, A.M.I.S.E., Cert., as S.I. and M.I. Deputy Chief Sanitary Inspector—A. B. HAULDREN, Cert, as S.I. and M.I. Sanitary Inspectors— G. W. ASHWORTH, Cert, as S.I. and M.I. G. LATIMER, Cert, as S.I. and M.I. A. H. CORNHILL, Cert, as S.I. and M.I. K. J. SMITH, Cert, as S.I. and M.I. F. G. DAVIES, Cert, as S.I. and M.I. Disinfector and Laboratory Attendant—F. J. COBB. Assistant Disinfector and Laboratory Attendant—F. S. ALLAWAY. Mortuary Attendant—H. ELLIS. Resident Caretakers—Dockwell Hospital—Mr. and Mrs. DOWER. Superintendent Health Visitor, Inspector of Midwives and Supervisor of Nursing Homes— Miss J. M. EVANS, S.R.N., S.C.M., Health Visitor's Diploma of Royal Sanitary Institute, Cert, as Health Visitors and School Nurses— Miss B. N. TETLEY, S.R.N*., S.C.M., H.V. Cert. R.S.I. Mrs. A. E. TYRRELL, S.C.M., H.V. and S.N. Miss M. G. GRIBBLE, A.R.R.C., S.R.N., S.C.M., H.V. and S.N. Miss G. M. CLARE, S.R.N., S.C.M., H.V. Cert. R.S.I. Miss E. I. BARTLETT, S.R.N., S.C.M., H.V. Cert. R.S.I. Miss B. P. MANNING, S.R.N., S.C.M., A.R.S.I., H.V. Cert. R.S.I. Miss S. McCarthy, S.r.n., S.C.M., h.v. Cert. R.S.I. Miss M. O'SULLIVAN, S.R.N., S.C.M., H.V. Cert. R.S.I. Miss E. LLOYD, S.R.N., S.C.M., H.V. Cert. R.S.I. Miss E. C. MIDDLETON, S.R.N., S.C.M., H.V. Cert. R.S.I. Miss L. C. PRICE, S.R.N., S.C.M., H.V. Cert. R.S.I. Miss N. T. ROGERS, S.R.N., S.C.M., H.V. Cert. R.S.I. (From 1st September, 1938). Municipal Midwives— Mrs. M. E. BRASH. Mrs. G. M. JUKES. Mrs. D. T. WOODLEY. Miss E. M. CLARKE. Miss K. POTBURY. Mrs. H. M. YORWARTH. Miss D. M. WESTON. Mi's G. D. E. OSTLER. (From 1st April, 1938). Chief Clerk—B. W. KILBY, Cert, as S.I. and M.I. Clerks— P. T. H. CRANDON. Miss R. MARSHALL, Cert, as S.I. H. L. LAW. J. W. DEAN. M. W. LANGFORD. B. C. MALLABAND. E. E. FORREST. R. POWELL. L. H. HAYWARD. Miss V. D. NICHOLLS. Miss V. GOODBODY. Miss S. M. BALL. Miss M. GARRY. Miss M. A. DIXON. Miss B. E. JAMES. (From 7th June, 1938). G. PITT. R. P. SANGER. (From 16th May, 1938). 7 SECTION A Statistics and Social Conditions Summary of Statistics. Area in Acres 7,219 Population (Census 1931) 76,254 Population (Registrar-General's Mid-year Estimate, 1938) 101,500 Number of inhabited houses (census 1931) 17,124 Number of inhabited houses (rate-books 1938) 27,417 Number of houses erected during 1938 717 Rateable value of the Borough £890,864 Sum represented by a penny rate £3,488 Live Births— M. F. Total. Legitimate 712 690 1402 Birth rate per 1,000 of the estimated resident population 14.18 Illegitimate 17 20 37 Stillbirths— Legitimate 21 22 43 Rate per 1,000 total (live and still) births 30.32 Illegitimate 2 — 2 Deaths 453 423 876 Death Rate per 1,000 of the estimated resident population 8.6 Deaths from Puerperal Causes— Puerperal Sepsis 2 Other puerperal causes 2 Rate per 1,000 total) (live and still) births 2.70 Death rate of Infants under one year of age: — All infants per 1,000 live births 45.86 Legitimate infants per 1,000 legitimate live births 46.36 Illegitimate infants per 1,000 illegitimate live births 27.03 Deaths from Cancer (all ages) 154 „ „ Measles (all ages) 2 „ „ Whooping Cough (all ages) 1 „ „ Diarrhœa (under 2 years of age) 9 Area and Population. The area of the Borough is 7,219 acres and includes 42 acres of water. From the bank of the River Thames the land rises slowly and towards the northern boundary reaches about 100 feet above sea level. The subsoil consists largely of "drift gravels" with some pockets of clay at the western end. The population of the Borough at the 1931 census was 76,254 and the Registrar-General's mid-year estimate of population for 1938 is 101,500. The number of dwelling houses in the area at the 1931 census was 17,124; at the end of 1938, according to the rate books the number was 27,417. Social Conditions. No significant change in the social or industrial condition of the Borough occurred during 1938. The rateable value of the Borough is £890,864 and the sum represented by a penny rate is £3,488. The district is largely a dormitory for workers in the London area but has shared to some extent in the industrial development which has taken place around London in recent years. The total amount of out-relief disbursed to Heston and Isleworth residents during 1938 was £20,830. According to the Ministry of Labour and the Juvenile Employment Bureau the average number of unemployed resident in the Borough during 1938 was 1,244 men, 556 women and 79 juveniles. No evidence has been forthcoming during the year to show that (a) any causes of sickness or invalidity have been specially noteworthy in the area (b) any conditions of occupation or environment have had a prejudicial effect on health or (c) unemployment has exercised any significant influence on the health or physique of children or adults. Marriages. The number of marriages which took place in Heston and Isleworth during the year was 798 and corresponds to a rate of 15.7 persons married per 1,000 of the population of all ages and conditions compared with a rate of 17.5 for England and Wales. 10 Births. The births registered during the year numbered 2,575. Of these 1,359 born to parents not residing in Heston and Isleworth were transferred out while 223 born outside the district to Heston and Isleworth parents were transferred in. This yields a nett total of 1,439 births comprising 729 males and 710 females. Of the 1,216 children born in this district 593 were born in hospitals or nursing homes. The Birth rate for the year was 14.18 as compared with 15.1 for England and Wales. The excess of births over deaths or what is called the "natural increase of population" was 563 as compared with 588 in 1937. The number of illegitimate births in 1938 was 37 as compared with 48 in 1937, 40 in 1936, 49 in 1935 and 48 in 1934. Stillbirths. The number of stillbirths registered during 1938 was 45 as compared with 35 in 1937. These stillbirths represented 3.03 per cent. of the total births as compared with 2.3 per cent. in 1937. The stillbirth rate per 1,000 population was 0.44 as compared with 0.6 for England and Wales. The trend of the stillbirth rate in recent years is shown in the following table:— Year. Heston and Isleworth. England and Wales. 1930 0.69 0.69 1931 0.58 0.67 1932 0.43 0.66 1933 0.58 0.62 1934 0.50 0.62 1935 0.59 0.62 1936 0.48 0.61 1937 0.35 0.60 1938 0.44 0.60 Stillbirths are due to causes acting before birth or during birth. All these causes are not known but all investigations have shown the need for improved ante-natal care and improved midwifery. At the present moment these are the only methods available to prevent this loss of potential additions to the population. Deaths. The number of deaths registered in the district during 1938 was 1,951 but of these 1,217 did not belong to the Borough while 142 residents died outside the Borough. This yields a nett total of 876 deaths made up of 453 males and 423 females. The death rate calculated from this nett total of deaths is 8.6 per 1,000 population as compared with 9.46 in 1937. When this death rate has been adjusted to the age and sex distribution of the population by the use of the area comparability factor supplied by the Registrar General a death rate of 9.0 per 1,000 population is obtained and is statistically comparable with the death rate for England and Wales which was 11.6. The number of deaths from zymotic diseases (smallpox, measles, whooping cough, diphtheria, scarlet fever, enteric fever and diarrhoea) was 14 as compared with 13 in 1937. The chief causes of death during 1938 were heart and circulatory diseases 278, cancer 154, diseases of the respiratory system 61, and tuberculosis 58. Infant Mortality. During 1938 the deaths of infants under one year of age numbered 66. This yields an infant mortality rate of 46 per 1,000 live births as compared with 53 for England and Wales. The infant mortality rates for Heston and Isleworth and for England and Wales since 1930 are shown below :— Year. Heston and Isleworth. England and Wales. 1930 50 60 1931 49 66 1932 60 65 1933 43 64 1934 48 59 1935 41 57 1936 48 59 1937 40 58 1938 46 53 Of the 66 deaths in 1938, 26 or 39 per cent. occurred in infants under the age of one week and 33 or 50 per cent. in infants under the age of one month. Deaths under the age of 11 one month are due almost wholly to prematurity, congenital malformations or congenital debility and it is hoped that as ante-natal care and supervision of the health of the expectant mother improve a reduction in these neo-natal deaths will ensue. Child Mortality. During 1938 there were 20 deaths of children between the ages of one and five years. The chief cause of child mortality during the year was pneumonia. Maternal Mortality. During 1938 there occurred 4 deaths due to causes associated with pregnancy or childbirth. This yields a maternal mortality rate of 2.70 per 1,000 total (live and still) births as compared with 2.97 for England and Wales. The maternal mortality rates for Heston and Isleworth and England and Wales since 1930 are shown below: — Year. Heston and Isleworth. England and Wales. 1930 6.40 4.22 1931 5.06 3.95 1932 2.76 4.04 1933 4.89 4.32 1934 2.93 4.41 1935 4.66 3.94 1936 1.95 3.65 1937 3.29 3.11 1938 2.70 2.97 In any small area considerable variation in this rate is liable to occur and serves to emphasise the need for skilled supervision of pregnancy and labour. 12 SECTION B General Provision of Health Services Hounslow Health Centre. This new building came into use at the beginning of October. It provides central administrative offices for all the local health services and clinic facilities to serve the Hounslow area of the Borough. The building consists in essence of a large central waiting hall surrounded by consulting rooms, dental surgeries, etc., over which the offices, staff accommodation and laboratory are situated. In the basement are boiler room, storerooms and media-preparation room. Heating is by low temperature hot water panels concealed in the ceilings and the hot water supply is provided from a calorifier heated by a separate boiler. All boilers are cokefired. The general lay-out of the building is shown in the accompanying plans. Staff. Full particulars of the staff of the Health Department are given at the beginning of the report. Laboratory Facilities. Certain routine bacteriological work is carried out at the Health Department Laboratory. Where more detailed investigation is required specimens are sent to the Clinical Research Association or to the Camberwell Research Laboratory. The following specimens were examined during 1938:— Specimen. Public Health Laboratory. Clinical Research Association. Camberwell Research Laboratory. Other Laboratories. No. Pos. No. Pos. No. Pos. No. Pos. Swabs for Diphtheria sent by Medical Practitioners 213 1 16 2 – – – – Swabs for Diphtheria from contacts, schools, etc. 716 8 – – – – – – Sub-cultures examined for Diphtheria 20 2 – – – – – – Swabs for Diphtheria from Staines Joint Isolation Hospital 302 40 14 4 – – – – Diphtheria virulence tests (1 from Staines) – – 4 2 – – – – Blood, for Enteric Widal Tests (1 from Staines) ... – – 5 1 – – – – Blood, for Wassermann Tests – – – – 8 – – – Cerebro-Spinal Fluid (2 from Staines) – – 2 – – – – – Faeces (2 from Staines) – – 9 – – – – – Swabs for organisms other than Diphtheria Bacilli (4 from Staines) – – 13 8 – – – – Swabs for Haemolytic Streptococci – – – – – – 44 11 Sputum for Tubercle Bacilli sent by Medical Practitioners 90 12 – – – – – – Sputum for Tubercle Bacilli taken at Clinics 1 – – – – – – – Hairs for Ringworm taken at Schools or Clinics 3 1 – – – – – – Urines 3512 – – – – – – – Discharge 4 – – – – – – – Milk 2 – – – – – – – Preparation of Materials— Tubes of Serum 1150 – – – – – – – Throat Swab Outfits 1050 – – – – – – – Sputum Outfits 200 – – – – – – – 14 HOUNSLOW HEALTH CENTRE. 15 CLINICS AND TREATMENT CENTRES, 1938. Clinics and Treatment Centres. Address. Day. Time. Provided by Ante-Natal Clinics Isleworth Health Centre, Busch Corner, Isleworth. Monday, Tuesday and Wednesday. 9.30 a.m. Heston and Isleworth Borough Council. Artificial Sunlight Clinic Isleworth Health Centre. Monday and Friday. 2.0 p.m. ft Diphtheria Immunisation Clinics Hounslow Health Centre, 92, Bath Road, Hounslow. Monday and Tuesday. 10.30 a.m. " Infant Welfare Centres Isleworth Health Centre. Friday. 10.30 a.m. >> Hounslow Health Centre. Monday and Tuesday, 2.0 p.m. Wednesday and Thursday, 10.0 a.m. and 2.0 p.m. tt Friday. 2.0 p.m. tt Isleworth Health Centre. Monday, Wednesday and Friday. 2.0 p.m. ff Heston Village Hall, New Tuesday, 2.0 p.m. tt Heston Road, Heston. Friday. 10.0 a.m. tt Cranford Memorial Hall, High Street, Cranford. Monday and Friday. 2.0 p.m. tt Maternity and Child Welfare Dental Clinics Hounslow Health Centre. Isleworth Health Centre, Same days as School Dental Clinics. (See below). Minor Ailments Clinics (Nurse only present) Hounslow Health Centre. Every week-day. 9.0 a.m. tt Isleworth Health Centre. Every week-day. 9.0 a.m. tt Heston Village Hall. Every week-day. 9.0 a.m. tt (Cranford Junior School. (During School term). Every week-day. 9.0 a.m. tt Ophthalmic Clinics Hounslow Health Centre. Monday, Wednesday and Thursday. 2.0 p.m. tt Isleworth Health Centre. Thursday. 2.0 p.m. School Clinics (Medical Officer present) Hounslow Health Centre. Tuesday. 10.0 a.m. and 2.0 p.m. Friday. 10.0 a.m. tt Isleworth Health Centre. Monday and Thursday. 10.0 a.m. tt Heston Village Hall. Thursday. 10.0 a.m. tt Cranford Junior School. (During School term). Thursday. 10.0 a.m. tt School Dental Clinics Hounslow Health Centre. Monday to Friday. 9.0 a.m. to 2.0 p.m. „ Isleworth Health Centre. Saturday. 9.0 a.m. „ Speech Training Class Hounslow Health Centre. Monday and Thursday. 9.30 a.m. Tuberculosis Dispensary ... 28, Bell Road, Hounslow. Monday and Tuesday, 9.30 a.m. Middlesex C.C. First and third Wednesdays in month. 6.30 p.m. „ Thursday. 2.0 p.m. tt Venereal Diseases Clinic ... West London Hospital, Monday to Saturday. 7.30 a.m. to 7.30 p.m. mersmith. Facilities are also provided at other London Hospitals. Sunday. 10.0 a.m. to 12 noon. Ambulance Facilities. The Joint Hospital Committee provides a motor ambulance for the removal of cases of infectious diseases other than smallpox, ophthalmia neonatorum and puerperal pyrexia. Cases of the latter infectious diseases are removed to other hospitals by special arrangements. For non-infectious and accident cases the council provides two motor ambulances at the Central Fire Station. Middlesex County Council provides an ambulance service in connection with West Middlesex County Hospital. These ambulance facilties are adequate for the Borough. Nursing in the Home. The Isleworth District Nursing Association and the Osterley, North Hounslow and Heston Nursing Association each employ four nurses whose services are available for home nursing and treatment but not for maternity cases. During 1938 these nurses paid 25,834 visits. The Council makes a contribution to the funds of these Associations. The British Red Cross Society maintains a loan depot from which invalid chairs, air rings, etc., can be hired. Treatment Centres and Clinics. (a) INFANT WELFARE CENTRES. Infant Welfare Centres have been established at Hounslow, Isleworth, Heston and Cranford, and sessions are held each week. The Cranford centre was opened in April. At each infant welfare session there are in attendance a medical officer, two health visitors, lay assistants and voluntary helpers. The following attendances were made at these centres during 1938:— Hounslow Isleworth. Heston Cranford Total. No. of sessions 340 149 101 78 668 Attendances :— (a) under 1 year 10,659 5,884 3,936 2,370 22,849 (b) 1 to 5 years 10,631 6,583 3,017 2,099 22,330 (c) all ages 21,290 12,467 6,953 4,469 45,179 Average attendance per session 63 81 69 57 68 No. of individual babies who attended :— (a) under 1 year 424 256 170 84 934 (b) 1 to 5 years 1,494 816 402 286 2,998 (c) all ages 1,918 1,072 572 370 3,932 Average attendances per child 11 12 12 12 11.5 No. of consultations with medical officer:— (a) under 1 year 3,909 1,540 1,098 668 7,215 (b) 1 to 5 years 2,938 1,402 708 658 5,706 (c) all ages 6,847 2,942 1,806 1,326 12,921 Average consultations per session 20 20 18 17 19 The work of the centres is almost wholly of an advisory nature and advice is given on diet, nurture, hygiene and on the treatment of minor disturbances of health in infants and young children. When further measures of treatment are required the children are referred to private practitioners, hospitals or the appropriate municipal clinic. Ante-Natal and Post-Natal Clinics. During the year three sessions have been held weekly at Isleworth Health Centre. Midwives are encouraged to bring their own cases to these clinics and the municipal midwives assist at these clinics as far as their other duties permit. No alteration or extension of this 16 service was introduced during 1938. The work of these clinics is shown in the following tables:— 1937 1938. No. of sessions 134 150 Total attendances 2,582 3,382 Average attendance per session 19.3 22.5 Number of individual ante-natal cases 794 976 Number of individual post-natal cases 31 28 Number of individual gynaecological cases 17 16 Number of expectant mothers who attended shown as a percentage of the total notified live and still births 54.6 68.6 Of the total ante-natal cases 43.7 per cent. were primipara. From West Middlesex County Hospital 477 expectant mothers were referred to the clinics for ante-natal supervision. The remaining cases were referred by midwives, medical practitioners and health visitors or attended of their own accord. Diseases or abnormalities found in ante-natal cases are treated at the clinics or referred to doctors, hospitals, etc. The conditions encountered and the methods by which treatment was obtained are shown below:— Treated at Clinic. Referred for treatment to Total. Hospital. Private Practitioner. District Nurse. Albuminuria 67 23 12 – 102 Toxaemia – 2 – – 2 Diabetes – 1 1 – 2 Ovarian cyst – 2 – – 2 Breast abscess – 1 1 – 2 Thyroid disease – 1 – – 1 General debility – 3 1 – 4 Haemorrhoids – 1 – – 1 Vaginal discharge – 4 – 3 7 Cough – 1 1 – 2 Pyelitis – 1 1 – 2 Swelling of leg – 1 – – 1 Pain in hands – 1 – – 1 Backache – 5 – – 5 Tuberculosis – 1 – – 1 Abdominal pair – 1 – – 1 Varicose veins 10 1 2 – 13 Skin disease – 1 – – 1 Placenta prævia – 1 – – 1 Inguinal hernia – 1 – – 1 Rectocele – 1 – – 1 Wassermann blood test – 2 – – 2 Dysuria – – 1 – 1 Sickness – – 3 – 3 Threatened abortion – 1 1 – 2 Urea concentration test – 1 – – 1 Anaemia 90 – – – 90 Breech presentation 24 7 – – 31 Referred for X-ray – 41 – – 41 191 106 24 3 324 The attendance of post-natal cases is disappointing. Practically all cases attended on account of discomfort or some other symptom. Five cases were referred to their own doctor, thirteen cases to hospital and two cases to the district nurse for treatment. Continuous propaganda by midwives, health visitors, doctors, etc., is necessary to encourage mothers to attend for routine post-natal examination. The 16 gynaecological cases who attended were given advice as to their condition and as to how and where treatment might be obtained. Artificial Sunlight Clinic. Treatment by artificial sunlight was started at Isle worth Health Centre on 17th October, 1938. The source of ultra-violet rays is a "Centrosol" quartz mercury-vapour lamp which is 17 reinforced by four "Sollux" lamps for infra-red radiation. Two treatment sessions are held weekly and at the end of the year 14 children under school age were receiving treatment. Orthopaedic Treatment. No municipal orthopaedic clinic is available. Cases encountered at the welfare centres are referred to the Royal National Orthopaedic Hospital or other hospitals for treatment. The following cases were referred from the welfare centres during 1938. Condition. Age. Hospital. Genu valgum. 3 4/12ths. Royal National Orthopaedic Hospital. R. calcaneo-valgus. 1 6/12ths. do. Genu valgum. 4 9/12ths. do. Genu valgum. 2 3/12ths. do. Pes plano-valgus. 2 5/12ths. do. Genu valgum. 2 9/12ths. do. Pes plano-valgus. 1 6/12ths. Children's Hospital, Gt. Ormond Street Metatarsal varus. 2 7/12ths. West Middlesex County Hospital. Refraction Clinic. During 1938 25 children under school age were examined at the refraction clinic and spectacles were prescribed in 14 cases. The cost of spectacles, spectacle repairs, etc., is assessed on the same scale as for school children and in 12 cases the spectacles were obtained under this scheme. Minor Ailments Clinics. The minor ailment clinics provided by the Education Committee are open to children under school age. During 1938, 20 children under school age were treated. Medical Out-relief. This is carried out by the District Medical Officers appointed by Middlesex County Council. Venereal Disease. Facilities for the diagnosis and free treatment of venereal diseases are provided by Middlesex County Council. No treatment centre exists in the Borough and the nearest one is at the West London Hospital. In necessitous cases fares are paid by the County Council. Tuberculosis. The diagnosis and treatment of tuberculosis is undertaken by Middlesex County Council and the dispensary serving this area is at 28, Bell Road, Hounslow. School Medical Service. This service is administered by the Heston and Isleworth Education Authority and a separate report on this service has been submitted. Insurance Medical Service. The number of persons resident in Heston and Isleworth who are entitled to Medical benefit under the National Health Insurance Acts is not known. During 1938, 3,390,331 prescriptions were issued to insured persons in the County of Middlesex and at 31st December, 1938, the number of insured persons in Middlesex was 864,749. Hospitals. The Hounslow Hospital in Staines Road is a voluntary hospital with 72 beds. During 1938, 1,336 in-patients and 5,920 out-patients were treated. The West Middlesex County Hospital in Twickenham Road, Isleworth, has 1,365 beds and admits medical, surgical, chronic sick, maternity and mental cases. Accommodation fori cases of tuberculosis is provided by Middlesex County Council and for cases of infectious diseases by the South Middlesex and Richmond Joint Hospital Board at Mogden Hospital, Isleworth. Hospitals in London and neighbouring districts are used also by residents of Heston and Isleworth. Midwives. At the end of 1938 the number of midwives practising in the Borough was 28; of these 8 were municipal midwives, 7 were ambulance midwives attached to West Middlesex County 18 Hospital and 3 were employed in Maternity Homes. The inspector of midwives made 224 visits during the year. It was not found necessary to report any breach of the rules to the Local Supervising Authority or to the Central Midwives Board. The annual returns received from midwives were as follows:— Medical Aid records 148 Notice of liability to be a source of infection 24 Laying out of the dead records 5 Notice of death of mother or child— children 6 mothers nil Still-birth records 6 Notice re artificial feeding 5 The records show that 766 cases were attended by midwives during 1938. In 513 cases the midwife attended alone and in the remaining 253 both doctor and midwife were in attendance. The midwives summoned medical aid in 29 per cent, of the cases attended by them. The chief causes for requesting medical help were:— Mother. Ante-natal debility, malaise, etc. 3 Ante-partum haemorrhage 12 Placenta praevia 3 Albuminuria 1 Varicose veins, haemorrhoids, etc. 6 Premature labour 2 Malpresentations 10 Prolonged or difficult labour 24 Retained placenta 4 Post-partum haemorrhage 3 Pyrexia 5 Ruptured perineum 48 Child. Discharge from eyes 13 Feebleness, asphyxia, etc 21 The total fees paid to medical practitioners in respect of emergency cases in accordance with Section XIV of the Midwives Act, 1918, amounted to £155 18s. Od. in respect of 119 claims. The arrangements made in 1937 whereby midwives practising in the Borough were enabled to attend post-certificate lectures and demonstrations organised by the London and Middlesex County Councils continued during 1938. Municipal Domiciliary Midwifery Service. Eight midwives are employed by the Council for this service. Their time is devoted primarily to domiciliary midwifery but as opportunity permits they assist at ante-natal and child welfare clinics. A summary of their work during 1938 is given below :— MIDWIFE Cases Booked Cases Completed Cases Cancelled Visits to Patients Attendances with Patient at AnteNatal Clinic Other Attendances at Clinics Midwifery Maternity Midwifery Maternity Miscarriage AnteNatal PostNatal "A" 73 11 59 13 1 5 492 1326 15 34 " B " 59 12 51 12 – 2 428 1278 20 29 "C" 109 8 92 6 1 9 396 1389 32 15 "D" 16 2 9 1 – 2 75 654 23 92 " E" 69 15 57 14 – 6 545 1287 10 5 "F" 69 20 51 16 2 10 346 1135 12 39 " G" 70 8 62 7 – 8 293 944 19 34 " H " 31 6 28 4 1 3 191 645 17 31 TOTAL 496 82 409 73 5 45 2766 8658 148 279 19 Midwife "C" is stationed at Isleworth and Midwives "D" and "H" at Cranford and the southern portion of Heston. The greatest demand for the services of municipal midwives occurs in the Isleworth area and a midwife should be transferred to that area from the western section of the Borough. Many expressions of appreciation of the services of the municipal midwives have been received. On several occasions both the midwife booked for the case and her relief were not available when required and the services of the second relief had to be obtained. This unavoidable delay is reduced to a minimum by the use of the telephones supplied to midwives. In September, 1937, the Council adopted a scheme whereby a woman engaging a midwife could, by payment of a premium of five shillings, insure against having to pay the fees of the doctor who might be called in a case of emergency by the midwife. Where advantage is not taken of the above insurance scheme the doctor's fee is charged, wholly or in part, to the patient according to her financial circumstances. Where, according to the Council's scale, no charge is made for the services of a municipal midwife no application is made to the patient for the recovery of the doctor's fee and the patient is not considered to be able to afford to pay the insurance premium. A form explaining the insurance scheme is issued to midwives for distribution to their patients. In considering the above scheme the patients who booked a midwife must be divided into three groups namely (1) cases paying the insurance premium (2) cases considered unable to afford the insurance premium and (3) cases able to insure but not electing to do so. Table I opposite illustrates the working of the scheme during 1938. From this table the following points should be noted:— (a) Less than 20 per cent. of the cases took advantage of the insurance scheme. It is possible that as the insurance scheme becomes more widely known and understood a larger percentage of cases will insure. (b) Provided all the sums reclaimed from patients are recovered the cost per claim to the Council will be less in the uninsured than in the insured. (c) In actual practice the whole of the sums reclaimed are not recovered and therefore the cost per claim to the Council may be greater in the case of the uninsured. (d) If medical aid had been summoned as frequently among the non-insured as in the insured, the total number of medical aid summons would have been 283 as against 146 and the total amount of fees, calculated on the average per claim, would have been £310 18s. Od. as against £160 9s. 0d. (e) No account has been taken of the cost of clerical and other work in the Health and Borough Treasurer's Departments in connection with the apportionment and collection of the sums to be reclaimed from noninsured cases. (f) The summoning of medical aid occurred more frequently in the insured than in the uninsured. Any question of a varying standard of midwifery in the three groups can be discounted. The probable causes are (1) the insured group may contain a larger proportion of primipara or of women with a bad obstetric history who might anticipate a need for medical aid and (2) the insured woman, knowing that she incurs no further financial liability, may more readily press the midwife to seek medical aid and the midwife for the same reason may be more inclined to seek medical aid or to concur in the patient's request for such aid. Of the 102 insured cases 73 attended the ante-natal clinic and a study of the clinic records fails to reveal an undue percentage of primipara (26%) or of patients with conditions or obstetrical histories warranting an assumption that medical aid would be required. The reasons given by the midwives for seeking medical aid in the three groups of patients are shown in Table II overleaf. The available evidence suggests that the second of the causes given above accounts largely for the greater incidence of medical aid summons in the insured group. The scheme has not been in force for a sufficient length of time to assess its value. The increased demand for medical aid among the insured does not appear to be warranted wholly on clinical grounds and if a larger proportion of expectant mothers take advantage1 of the scheme there would be a risk of increased cost to the Council. 20 21 Table I. Insured. Not insured. Unable to afford insurance. Total not insured. No. of cases (confinements during 1938) 102 300 111 411 Percentage of total cases 19.9 58.5 21.6 80.1 No. of cases where medical aid was summoned 47 78 21 99 Percentage of cases where medical aid was summoned 46.1 26.0 18.9 24.1 No. of cases where doctor submitted claim for fees 40 60 19 79 Total amount of doctor's claims £57 0 0 £77 15 0 £25 14 0 £103 9 0 Average amount of claim £1 8 6 £1 15 11 £1 7 0 £1 6 2 Average amount chargeable to patient 17s. 8d. Nil 13s. 5d. Average amount recovered from patient to date *12s. 9d. 11s. 11d. Nil 9s. 0d. Expected cost to Council per claim 15s. 9d. 8s. 3d. £1 7 0 12s. 9d. Actual cost to Council per claim to date 15s. 9d. 14s. 0d. £1 7 0 17s. 2d. *Total premiums divided by number of claims. 22 Table II. Reason given for seeking Medical Aid. Insured 102 cases. Not insured 300 cases. Unable to afford insurance 111 cases. Total not insured. 411 cases. No. % No. % No. % No. % Ante-Natal debility, malaise, etc 1 0.98 1 0.33 1 0.90 2 0.49 Ante-Partum haemorrhage 4 3.92 5 1.66 3 2.70 8 1.96 Albuminuria — — 1 0.33 — — 1 0.24 Varicose veins, haemorrhoids, etc. — — 5 1.66 1 0.90 6 1.46 Premature labour 1 0.98 1 0.33 — — 1 0.24 Placenta praevia — — 3 1.00 — — 3 0.74 Malpresentations 2 1.96 7 2.33 1 0.90 8 1.96 Delayed labour 10 9.80 8 2.66 6 5.40 14 3.41 Retained placenta 2 1.96 2 0.66 — — 2 0.49 Post-partum haemorrhage 1 0.98 1 0.33 1 0.90 2 0.49 Puerperal pyrexia and phlegmasia 2 1.96 3 1.00 — — 3 0.74 Ruptured perineum 19 18.62 25 8.33 4 3.60 29 7.05 Discharge from baby's eyes 3 2.94 8 2.66 2 1.80 10 2.43 Asphyxia, etc., in baby 6 5.88 13 4.33 2 1.80 15 3.65 Maternity Sets. Sterile maternity sets are supplied to midwives from whom they can be purchased at a cost of three shillings. During the year 184 sets were sold. Obstetric Consultant. The services of the obstetric consultant can be obtained by general practitioners on request for obstetric emergencies or cases of puerperal pyrexia. These services were utilised in three cases during 1938 and no charge was made to the patient. A panel of consultants should be provided for this work in an endeavour to ensure that one will be available when required. Home Helps. Home helps are provided by the Council in necessitous maternity cases. During 1938 home helps were provided for 59 cases as compared with 43 in 1937. Institutional Provision for Mothers or Children. No homes for mothers and babies, convalescent homes for mothers or children or day nurseries have been established in the Borough by the Council or voluntary associations. During the year four mothers, three accompanied by babies, and three children were sent by the Council to convalescent homes. Health Visitors. Twelve health visitors who are also school nurses are employed by the Council. Their work as health visitors consists of home visiting of mothers and children, attendance at infant welfare, ante-natal and diphtheria immunisation clinics, visits re infectious disease in young children, etc. A summary of the work of the Health Visitors is given below :— Attendances at Infant Welfare Centres Attendances at Ante-natal Clinics Attendances at Diphtheria Immunisation Clinics Visits to expectant mothers—first subsequent post natal Visits to children under 1 year—first subsequent Visits to children 1 to 5 years Visits re stillbirths Visits re infant deaths Visits re discharge from babies' eyes Visits re infectious disease in children under 5 years Child Life Protection visits Miscellaneous visits—M. & C.W. Public Health 854 292 254 197 85 24 1,342 2,885 4,370 43 50 18 407 663 261 428 No matter what clinic or treatment facilities a Welfare Authority may provide there will always be need of home visiting by health visitors. Effective home visiting by efficient health visitors is of primary importance in maternity and child welfare work. Without an appreciation of the environmental conditions the best advice cannot be given. Moreover the careless and indifferent mother, at the best an infrequent attender at centres or clinics, can only be reached through home visiting. Poverty, ignorance, bad management, etc., can be discovered more easily and tackled more effectively by home visits. Again a mother will discuss her difficulties with the health visitor more freely in her own home than in a busy welfare centre. To meet the needs of the rapidly increasing population of the Borough new centres and clinics and additional sessions at others have been established and the staff of Health Visitors 23 has been increased. The effect of this on the number of routine home visits as is shown below :— Year. Estimated Resident Population. No. of Health Visitors. No. of routine home visits to children. 0-1 years. 1-5 years. 1932 81,100 9 4,053 2,007 1933 84,460 9 3,919 3,527 1934 87,797 9 3,566 2,820 1935 90,970 9 4,206 2,587 1936 95,000 9 3,959 2,800 1937 99,420 12 4,452 4,419 1938 101,500 12 4,509 4,978 Since the staff of health visitors was increased the time available for home visiting has been reduced by the provision of the open-air school, an additional session at Cranford welfare centre, the artificial sunlight clinic and ante-natal clinics at Hounslow. One health visitor devotes the whole of her time to the open-air school and the remaining 11 health visitors devote on an average half of their time to maternity and child welfare work. This is equivalent to 121 sessions per fortnight but so great is the call on their time for clinics, etc., that only 40 sessions per fortnight are available for home visiting. No allowance for holidays or sick leave has been made in this calculation and if systematic home visiting is to maintain its true place in maternity and child welfare work additional staff will be required. Child Life Protection. The Health Visitors undertake the duties of Child Protection Visitors and during 1938 they made 663 visits in connection with this work. At the end of the year 56 persons were receiving for reward 62 children as compared with 64 persons and 81 children at the end of 1937. No legal proceedings were taken under the Acts relating to Child Life Protection. One foster child died during 1938 but no inquest was held. Certificates of exemption were granted to the Royal School for Naval and Marine Officers' Daughters, Nazareth House and Gumley House. Dental Treatment of Mothers and Children. Dental treatment is available for expectant and nursing mothers and for children under school age. Cases are referred from the Ante-Natal and Child Welfare Clinics and the work is carried out by the School Dental Officers at the dental clinics. No separate sessions are arranged for such cases. The following details of the work have been supplied by the Supervisory Dental Officer:— Attendances—mothers and children Number of extractions—mothers—general anaesthetic local anaesthetic Number of extractions—children—general anaesthetic local anaesthetic Fillings—Mothers, 480; Children, 284 Number of dentures supplied to mothers—upper lower Number of individual mothers supplied with dentures Administrations of general anaesthetic Dressings Number of impressions taken Number of cases charted and estimated Silver Nitrate treatment Scaling and polishing Treatment of gums Advice re dental condition and care of teeth, etc. 3,776 1,841 49 989 31 764 125 112 132 739 233 277 390 530 101 48 262 Expectant mothers who require dental treatment and whose general or dental condition is such that they require in-patient treatment are sent to the Eastman Dental Clinic and 5 cases were referred there for treatment during 1938. Voluntary Helpers. At all Ante-Natal and Child Welfare Clinics the Department is fortunate in having the assistance of a number of voluntary workers. The help of these ladies and their gifts of toys, clothing, etc., are greatly appreciated. 24 Supply of Milk and Other Foods. Milk or dried milk is supplied free or at a reduced rate to expectant and nursing mothers and to children under 5 years of age, if the income falls within the scale adopted by the Council. Milk may be supplied to expectant mothers from the fourth month of pregnancy. Pasteurised milk is the only type of liquid milk supplied. Dried milks and other preparations can be purchased at cost price at the child welfare clinics. The following quantities were supplied during 1938:— Free or at reduced price. At cost price. Pasteurised milk 11,943 galls. Nil. Dried milk 2,830 lbs. 17,500 lbs. Virol 303 lbs. 1,282 lbs. Sugar of milk 3 lbs. 12 lbs. Cod Liver Oil and Malt 642 lbs. 1,040 lbs. Lactagol 239 tins. 115 tins. Cod Liver Oil Emulsion (8 oz.) 1,120 bots. 4,228 bots. Bemax 214 tins. 2,403 tins. Adexolin (½ oz.) 688 phials. 1,938 phials. Cod Liver Oil and Malt with iron 487 lbs. 872 lbs. Kalzana 1,790 tabs. 4,690 tabs. The above pasteurised and dried milk, supplied free or at reduced cost, was distributed among 448 families. Health Education. No part was taken in the National Campaign to secure a wider use of the Health Services. The use of E.M.B. posters continues and throughout the year efforts were made to enlighten the public in regard to Diphtheria Immunisation. Though no special action was taken during the year the staff do what is possible, to educate the public as to the prevention of ill-health and the importance of early treatment. Nursing Homes. Periodic inspections of registered homes are carried out by the Superintendent Health Visitor. Before any application for a certificate of registration of a home is granted, full enquiry is made as to the suitability and qualifications of the applicant and an inspection of the premises is carried out to ensure conformation to the necessary standard. Particulars of this work are given below:— Nursing Homes. Maternity. Homes. Nursing and Maternity Homes. No. of new applications for registration during 1938 — — — No. of homes registered at 31/12/38 3 1 1 No. of orders made refusing registration — — — No. of orders made cancelling registration — — — No. of appeals against such orders — — — No. of homes discontinued — 1 — No. of visits of inspection 6 7 13 Superannuation Acts. During 1938 the Medical Officers examined 59 employees or candidates for employment in the service of the Council. 25 SECTION C Sanitary Circumstances of the Area Water Supply. The water supply of the Borough is derived almost wholly from the Metropolitan Water Board. A small portion of the Cranford area is supplied by the South West Suburban Water Company. There are 71 shallow wells in use in the Borough. In 45 of these cases an alternative supply from the mains is available. During the year samples of water from 3 shallow wells were analysed. In two cases the water was unwholesome and the wells were closed. There are three deep wells in use in the Borough. The depth of these wells is 400, 600 and 1,500 feet respectively. Regular bacteriological examinations are made of the water from the first two and copies of the report are forwarded to the Medical Officer of Health. No evidence of pollution was revealed by these examinations. The water from the third well is used solely for trade purposes. In another case a bore was sunk to 647 feet but as the quantity of water found was insufficient the bore was discontinued and sealed with cement. During 1938 the following work in connection with water supplies was carried out:— Number of supplies provided or reinstated 3 Number of cisterns cleansed, repaired, covered, etc. 7 Number of draw taps connected direct to the main 32 Number of water service pipes or taps repaired 16 Number of cases where main supply substituted for well supply 2 Number of samples taken for analysis from local wells 3 Number of samples found polluted or impure 2 Number of wells abolished 2 Drainage and Sewerage. The sewerage of almost the whole of the Borough is arranged on the "separate" system and forms part of the West Middlesex Sewage Scheme. During the year sewers have been extended by the construction of 4,490 lineal yards of foul water sewer and 5,142 lineal yards of surface water sewer. Rivers and Streams. The rivers and streams in the Borough are maintained by the Middlesex County Council. No case of pollution was brought to the notice of the Health Department during 1938. Closet Accommodation. The closet accommodation of the Borough consists almost wholly of water closets connected to the sewers. There are in the district 104 known premises which do not drain into the sewers. These are made up as follows:— Water closets draining to cesspools 44 Water closets draining to septic tanks 6 Pail closets 43 Privies 1 Chemical closets 10 The following works in connection with closets were carried out during the year:— Number of water closets constructed or reconstructed 24 Number of water closets provided in lieu of dry receptacles 1 Number of water closets cleansed or unstopped 54 Number of water closet walls, etc., cleansed 26 Number of water closets provided with new flushing apparatus 16 Number of water closets provided with new pans or pedestals 90 Number of water closets supplied with water or otherwise repaired 195 Public Cleansing. The cleansing of streets and the collection and disposal of refuse is carried out by the Local Authority and is under the control of the Borough Surveyor. During 1938 the collection of house refuse continued weekly as before and the refuse was disposed) of by " controlled tipping " on a site in Staines Road, Hounslow. Eight electric and four petrol driven vehicles are used for the collection of refuse. During the year, as a result of action taken, 69 new dustbins were provided. 27 Sanitary Inspection of the Area. The work of the Sanitary Inspectors has continued to grow with the further increase in population and new legislation has added to the responsibilities of the department. The total number of inspections and re-inspections carried out during 1938 was 30,118. Comparative statistics in regard to nuisances, defects, etc., for the years 1936, 1937 and 1938 are given in the following table:— 1936 1937 1938 Number of complaints received 738 698 709 Number of premises at which nuisances, etc., were located 603 595 688 Number of informal notices served 616 646 703 Number of reminders and letters issued 865 1105 1051 Number of statutory notices served 46 56 104 Number of premises where nuisances, etc., were outstanding at beginning of year 398 463 497 Number of premises where nuisances, etc., were remedied during the year 538 561 897 Number of premises where nuisances, etc., were outstanding at end of year 463 497 288 It is gratifying to record a considerable reduction in the number of nuisances, etc., outstanding at the end of the year. In the following table a summary of the general work of the Sanitary Inspectors in regard to nuisances, etc., is given. The work of the Sanitary Inspectors in regard to other matters is dealt with in the appropriate sections of this report. Inspections, etc., re Nuisances, etc.: Number of premises, etc., inspected on complaint Number of primary inspections re nuisances, etc. Number of subsequent inspections re nuisances, etc. Number of visits to work in progress Number of interviews with owners, builders, etc. Number of inspections of piggeries Number of inspections of stables Number of inspections of urinals Number of premises, etc., where defects, etc., were remedied— (a) by owners or occupiers (b) by Local Authority in default of owner or occupier (c) public sewers cleansed by Local Authority (d) public sewers repaired by Local Authority Number of cautionary notices given— (a) verbal (b) written 879 1,270 3,735 2,572 2,091 102 194 51 892 5 22 12 215 488 Drainage and Sanitary Condition, etc., of existing Buildings— Sinks: Number of new sinks provided Number of sinks repaired 57 15 28 Drains : Number examined, exposed, etc. Number unstopped, repaired, trapped, etc. Number of waste pipes provided, repaired, trapped or unstopped Number of soil pipes provided or repaired Number of ventilating shafts provided or repaired Number of fresh air inlets provided or repaired Number of rain water pipes disconnected from drain Number of gully traps provided or repaired Number of disconnecting traps provided or repaired Number of disconnecting or inspection chambers provided or repaired Number of drains constructed or repaired Number of drain tests Number of other works executed Total length of drain pipes laid (4 in.—2,039 ft., 6 in.—609 ft.) 71 141 93 5 14 18 2 158 5 99 36 480 10 2,648 ft. Cesspools: Number repaired Number abolished and drains connected to sewer 1 3 Dampness: Number of roofs repaired Number of gutters and rain water pipes provided or repaired Number of cases where external brickwork, sills, etc., repaired Number of cases where damp-proof course provided Number of sites covered with impervious material Number of yards paved, repaired or drained Number of forecourts paved, repaired or drained 200 174 591 82 1 105 11 Interior Work : Number of rooms stripped and cleansed Number of floors, walls and ceilings repaired or renewed Number of rooms in which ventilation was provided or improved Number of rooms in which lighting was provided or improved Number of staircases repaired Number of staircases in which lighting was provided or improved Number of handrails and balustrades to staircases provided or repaired Number of window frames and sashes repaired Number of doors or other woodwork renewed or repaired Number of stoves or grates provided or repaired Number of washing coppers provided or repaired Number of premises where ventilation under floors provided or improved Number of foodstores provided or repaired Number of other repairs Sundry Nuisances, etc.: Number of cases where domestic cleansing enforced Number of cases of improper keeping of animals abated Number of offensive accumulations removed Number of pigstyes cleansed or repaired Number of stables cleansed or repaired Number of urinals provided, repaired or cleansed Number of manure pits provided or repaired Number of other nuisances or contraventions abated 462 1,079 55 19 47 64 42 943 147 228 67 64 82 31 20 5 55 8 10 13 3 237 Infectious Disease, etc. t Number of visits ... ... ... ... ... ... ... 911 In 6 instances dealers in rags, etc., were found giving articles to children under 14 years of age in exchange for rags, old woollens, etc., contrary to section 154 of the Public Health Act, 1936. In two cases the offender was prosecuted and fined 2s. 6d. In the other cases the offenders gave false addresses and could not be traced. Smoke Abatement. During the year 352 smoke observations were carried out and 13 nuisances were proved in connection with 8 premises. It was necessary to serve four statutory notices with respect to the emission of black smoke for more than two minutes per half-hour permitted by the byelaws. The general policy in regard to smoke abatement is to offer advice with a view to preventing this nuisance rather than to obtain abatement by legal action. Offensive Trades. The only trade carried on in the Borough which is classified as " offensive " is fish-frying, 29 and 22 premises are registered for this purpose. During the year 140 inspections of these premises were made and three contraventions of the byelaws were remedied. Rats and Mice Destruction. No special action was taken in regard to the destruction of rats and mice. During 1938, 29 complaints of infestation by rats or mice were forwarded to the Superintendent of Rat Destruction of Middlesex County Council. Tents, Vans and Sheds. During the year 97 inspections were made of tents, vans or sheds used for human habitation and 44 contraventions of the byelaw; were found and remedied. Under section 55 of the Middlesex County Council Act, 1934, proceedings were taken against the owner of a yard and the occupiers of two caravans situated therein. The owner of the land was fined 20s. and the occupiers of the caravans had to pay 4s. costs and remove the caravans immediately. Common Lodging Houses. There are two common lodging houses in the Borough and both provide accommodation for men and women. Eleven visits of inspection were made during the year and no contravention of the byelaws was noted. Cimping Sites. No sites in the Borough were used for camping purposes during 1938 and no sites were licensed under section 269 of the Public Health Act, 1936. Shops and Offices. During the year 71 visits were made to shops in regard to sanitary conveniences and washing facilities. In 17 shops the sanitary accommodation, and in 2 shops the washing facilities, were found to be insufficient. During the year additional sanitary accommodation was provided at 4 shops and additional washing facilities at 2 shops. Six certificates of exemption in regard to the provision of sanitary accommodation were issued and at the end of the year 15 contraventions of the sanitary provisions of the Shops Act, 1934, were outstanding. Attention to the heating, lighting and ventilation of shops has been given by the Shops Inspector attached to the Town Clerk's Department. During 1938, 170 inspections were made. In ten cases deficient heating was found and in 2 cases poor facilities for the taking of meals in the shop. The attention of the occupier of these premises was called to the necessity for improvement and in all cases steps were taken to comply with the requirements. No special attention has been given to sanitary accommodation in offices. It should be noted that under section 43 of the Public Health Act, 1936, plans of new offices can be rejected if they do not show the provision of adequate sanitary accommodation. Further, section 46 of the same Act requires that sufficient sanitary accommodation be provided in existing offices. Factories, Workplaces, etc. The number of factories, etc., and the inspections made by the Sanitary Inspectors during 1938 are shown below:— Premises. Number on Register. Number of. Inspections. Written Notices. Occupiers Prosecuted. Factories with mechanical power (excluding bakehouses) 164 454 19 — Factories without mechanical power (excluding bakehouses) 109 346 6 — Other premises under the Act 12 2 — — Workplaces (other than Outworkers' premises) 76 137 19 — Outworkers 60 118 — — Total. 421 1057 44 — 30 During the year 66 defects or contraventions of the Factory Acts were remedied. Swimming Baths. One private and two municipal swimming baths are situate in the Borough and are open to the public. The private bath and one of the municipal baths have filtration and chlorination plants. The other municipal bath has no filtration or chlorination plant and was closed in September, 1938. Two new municipal baths are in the course of erection and will be completed during 1939. Eradication of Bed Bugs. (a) Number of Council houses— (1) found to be infested 34 (2) disinfested 34 (b) Number of other houses— (1) found to be infested 141 (2) disinfested 122 The Housing Department is responsible for the disinfestation of Council houses and various insecticides such as Cescones, Bono and Ris are used. If the infestation is severe a contractor is employed to fumigate the house with hydrogen cyanide. Disinfestation of other houses is carried out by the Health Department at the request of the owner or occupier. This work is done by the disinfectors and Zaldecide is the insecticide used. A contractor is employed to disinfest verminous furniture with hydrogen cyanide and the bedding is treated by steam disinfection prior to the tenants' removal to Council houses. Tenants of houses are given general advice on the methods to be adopted to prevent reinfestation. Schools. All schools in the Borough have an adequate water supply from the mains and as many of them are of recent construction their sanitary condition is satisfactory. No schools were closed during 1938 with a view to preventing the spread of infection but contacts and cases of infectious disease were excluded in accordance with the Memorandum on Closure of and Exclusion from School, 1927. Open Spaces. The following facilities for open-air exercise and recreation are available in the Borough :— Corporation Public Parks and Recreation grounds 201.4 acres School and Private Sports Grounds 299.5 „ Allotments 100.8 „ Disposal of the Dead. The available accommodation is sufficient to meet the needs of the Borough. During 1938, 61 bodies were deposited in the Public Mortuary and 28 post-mortem examinations were carried out there. A new and up-to-date Public Mortuary is required. Canal Boats. The Sanitary Inspectors carry out the duties of Canal Boat Inspectors under the Public Health Act, 1936. The work done during 1938 is shown below :— No. of Inspections, etc.: Number of inspections made 85 Number of canal boats inspected 82 Number of boats found in order 76 Number of boats with one infringement 3 Number of boats with two infringements 3 31 Nature of Contraventions : Certificates not produced 2 Certificates not in possession of master 2 Cabins not weatherproof 2 Periodical painting not carried out 3 Action Taken : Number of contraventions outstanding from previous year 15 Number of contraventions found 9 Number of contraventions remedied 24 Number of contraventions outstanding at end of year — Legal Action: Nil. Infectious Disease among Canal Boat Population : Nil. 32 SECTION D Housing HOUSING STATISTICS 1. GENERAL. Number of new houses erected during the year:— Number of Dwellings. (a) By private enterprise—Houses and flats 637 (b) By local authority 80 717 2. INSANITARY AND UNFIT DWELLING HOUSES. 1. INSPECTION OF DWELLING-HOUSES DURING THE YEAR. (1) (a) Total number of dwelling-houses inspected for housing defectsi (under Public Health or Housing Acts) (b) Number of inspections made for the purpose (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 (b) Number of inspections made for the purpose (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation (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 2. REMEDY OF DEFECTS DURING THE YEAR WITHOUT. SERVICE OF FORMAL NOTICES Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 3. ACTION UNDER STATUTORY POWERS DURING THE YEAR A. Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936:— (1) Number of dwelling-houses in respect of which notices were served requiring repairs (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners (b) By local authority in default of owners B. Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners (b) By local authority in default of owners C. Proceedings under Sections 11 and 13 of the Housing Act, 1936:— (1) Number of dwelling-houses in respect of which Demolition Orders were made (2) Number of dwelling-houses demolished in pursuance of Demolition Orders (3) Number of dwelling-houses rendered fit in consequence of undertaking given by owner (4) Number of dwelling-houses in respect of which undertaking from owners accepted, not to re-let houses for human habitation D. Proceedings under Section 12 of the Housing Act, 1936:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made 526 626 138 238 97 139 310 16 11 3 5 8 2 81 74 15 33 1 34 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit E. Housing Act, 1936. Overcrowding :— (1) (a) Number of dwellings overcrowded at the end of the year (b) Number of families dwelling therein (c) Number of persons dwelling therein (2) Number of new cases of overcrowding reported during the year (3) (a) Number of cases of overcrowding relieved during the year (b) Number of persons concerned in such cases (4) Particulars of any cases in which dwelling-houses have again become crowded after the Local Authority have taken steps for the abatement of overcrowding F. Other Matters :— (1) Number of dwelling-houses demolished voluntarily 105 105 694 17 258 1,419 1 22 Overcrowding. All dwellings found to be overcrowded at the time of the original survey have been visited during 1938 and overcrowding was found to be abated in 258 cases. The position with regard to overcrowding as far as it is known is as follows :— No. of cases of overcrowding at the beginning of the year. No. of cases abated during the year. No. of new cases of overcrowding found during year. No. of cases of overcrowding at end of year. Heston and Isleworth Council Houses. 87 46 1 42 Brentford and Chiswick Housing Estate. 59 29 1 31 Other Houses 200 183 15 32 Totals. 346 258 17 105 In the course of their routine work the Sanitary Inspectors keep a watch for new cases of overcrowding and during 1938 they measured the rooms of 723 houses so that the owners might be provided with the " permitted number " for the houses. Three cases of overcrowding were relieved by action under section 11 of the Housing Act, 1936. Table showing progress made during 1938 in dealing with dwelling-houses represented as unfit for human habitation. Premises. No. of houses represented as unfit. Dates of representations. Dates undertakings to render fit accepted. Dates houses rendered fit in accordance with undertakings. Dates undertakings accepted that houses would not be re-let for human habitation Dates Demolition Orders made. Dates Demolition Orders obeyed. Dates Demolition Orders enforced. 15, South Street, Isleworth 1 11/1/15 ... ... ... 23/11/15 ... ... 78, South Street, Isleworth 1 6/3/34 ... ... ... 24/4/34 ... ... 5 and 7, North Street, Isleworth 2 5/6/34 ... ... ... 25/9/34 ... ... 6, The Square, Isleworth 1 5/6/34 ... ... ... 28/12/34 ... 64, High Street, Hounslow 1 10/7/34 ... ... ... 25/9/34 ... ... 42, 44, 46 and 48, London Road, Brentford End 4 10/7/34 ... ... ... 25/9/34 ... ... 83, 85, 87, 89, 91, 93, 95, 97, 99 and 101, London Road, Brentford End 10 9/10/34 ... ... ... 28/12/34 25/8/38 ... 142, Linkfield Road, Isleworth 1 9/7/35 ... ... ... 24/9/35 ... ... 60 and 62, South Street, Isleworth 2 12/11/35 ... ... ... 30/12/35 2/6/38 ... 70, South Street, Isleworth 1 12/11/35 ... ... ... 30/12/35 ... ... 157 and 159, Twickenham Road, Isleworth 2 12/11/35 ... ... ... 30/12/35 ... ... 72, South Street, Isleworth 1 10/12/35 ... ... ... ... ... ... 76, South Street, Isleworth 1 10/12/35 ... ... ... 28/1/36 ... ... 80, South Street, Isleworth 1 10/12/35 ... ... ... 25/2/36 ... ... 82, South Street, Isleworth 1 10/12/35 ... ... ... 28/1/36 ... ... 12, 14, 16, 18, 20, 22 and 24, North Street, Isleworth 7 7/1/36 ... ... ... 27/4/37 23/5/38 ... 11, The Square, Isleworth 1 7/1/36 29/6/37 2/3/38 ... ... ... ... 12, The Square, Isleworth 1 5/5/36 ... ... ... 29/12/36 ... ... 109, Wellington Road North, Hounslow 1 5/5/36 ... ... ... 30/6/36 2/3/38 ... 15 and 17, North Street, Isleworth 2 8/9/36 ... ... ... 25/5/37 ... ... 2, 4, 6, 8, 10 and 12, Linkfield Road, Isleworth 6 6/10/36 23/2/37 30/8/38 ... • •• ... ... 69 and 71, Staines Road, Hounslow 2 6/10/36 ... ... ... 24/11/36 ... ... "Somerset Lodge," North Street, Isleworth 1 6/10/36 21/6/38 ... ... ... ... Bungalow adjoining " Lyndhurst," Green Lane, Hounslow 1 10/11/36 ... ... ... 29/12/36 14/2/38 ... 89, 91, 93, 95, 97 and 99, High Street, Hounslow 6 5/1/37 ... ... ... 23/2/37 18/6/38 ... 9, South Street, Isleworth 1 5/1/37 ... ... ... 23/2/37 2/5/38 ... 10, Hartland Road, Isleworth 1 2/2/37 27/4/37 14/1/38 ... ... ... ... 12, 14 and 16, Hartland Road, Isleworth 3 2/2/37 27/4/37 5/4/38 ... ... ... ... 36 Continuation of Table showing progress made during 1938 in dealing with dwelling-houses represented as unfit for human habitation. Premises. No. of houses represented as unfit. Dates of representations. Dates undertakings to render fit accepted. Dates houses rendered fit in accordance with undertakings. Dates undertakings accepted that houses would not be re-let for human habitation. Dates Demolition Orders made. Dates Demolition Orders obeyed. Dates Demolition Orders enforced. 137, Bath Road, Hounslow 1 9/3/37 25/5/37 ... ... ... ... ... 21, Wellington Road North, Hounslow 1 9/3/37 28/9/37 7/6/38 ... ... ... ... 186, Linkfield Road, Isleworth 1 9/3/37 ... ... ... 27/4/37 20/9/38 ... 188, 190, 192 and 194, Linkfield Road, Isleworth 4 9/3/37 ... ... ... 27/4/37 ... ... 46, Station Road, Hounslow 1 9/3/37 ... ... ... 27/4/37 25/1/38 ... 4, 6, 8, 10, 12, 14 and 16, Gloucester Road, Hounslow 7 6/4/37 ... ... ... 29/6/37 ... ... 18, 20, 22, 24, 26, 28, 30 and 32, Gloucester Road, Hounslow 8 6/4/37 ... ... ... 25/5/37 ... .... 61, 63 and 65, South Street, Isleworth 3 6/4/37 ... ... ... 29/6/37 3/2/38 ... 67, 69, 71, 73 and 75, South Street, Isleworth 5 6/4/37 ... ... ... 25/5/37 16/4/38 ... 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14 and 15, Downton Place, Isleworth 14 6/4/37 ... ... ... 25/5/37 23/5/38 ... 9, The Square, Isleworth 1 6/4/37 ... ... ... 25/5/37 23/5/38 ... 105, 107 and 109, St. John's Road, Isleworth 3 4/5/37 ... ... ... 29/6/37 23/5/38 ... 1, 2, 3, 4, 5 and 6, Mitchells Cottages, Worton Road, Isleworth 6 8/6/37 ... ... ... 27/7/37 24/6/38 ... 78 and 80, Twickenham Road, Isleworth 2 7/9/37 ... ... ... 26/10/37 6/12/38 ... 19, Inverness Road, Hounslow 1 5/10/37 ... ... ... 25/1/38 ... ... 1, 2, 3 and 4, Clarks Cottages, Cranford Lane, Heston 4 16/11/37 ... ... ... 25/1/38 ... ... 1, Brickfield Yard, Field Lane, Brentford End, Isleworth 1 16/11/37 26/7/38 ... ... ... ... ... 13, Inverness Road, Hounslow 1 16/11/37 ... ... ... 25/1/38 ... ... 43, 45, 47, 49, 51, 53 and 55, London Road, Brentford End, Isleworth 7 16/11/37 ... ... 25/1/38 ... ... 1, 2 & 3, Rose and Crown Lane, Isleworth 3 16/11/37 ... ... 25/1/38 ... ... ... 99, 101, 105 and 107, Twickenham Road, Isleworth 4 16/11/37 ... ... 25/1/38 ... ... ... 90, Whitton Road, Hounslow (Underground rooms) 1 16/11/37 ... ... ... 22/2/38 (Closing Order) ... 66, 68, 70, 72, 74, 76, 78, 80, 82, 84, 86, 88, 90, 92 and 94, Pears Road, Hounslow 15 7/12/37 ... ... 25/1/38 ... ... ... Fern Lane Cottage, Fern Lane, Heston 1 4/1/38 ... ... ... 22/2/38 7/11/38 ... 37 Continuation of Table showing progress made during 1938 in dealing with dwelling-houses represented as unfit for human habitation. Premises. No. of houses represented as unfit. Dates of representations. Dates undertakings to render fit accepted. Dates horses rendered fit in accordance with undertakings. Dates undertakings accepted that houses would not be re-let for human habitation. Dates Demolition Orders made. Dates Demolition Orders obeyed. Dates Demolition Orders enforced. 1 and 2, Boat Inn Cottages. Hayes Road, North Hyde 2 4/1/38 ... ... ... ... ... ... 1, 2, 2a, 3, 4, 5, 5a, 6, 7 and 8, Richmond Cottages, Hayes Road, North Hyde 10 4/1/38 ... ... ... ... ... ... Richmond House, Hayes Road, North Hyde 1 4/1/38 ... ... ... ... ... ... 307, Norwood Road, Heston 1 4/1/38 ... ... ... 29/3/38 29/8/38 ... 309, Norwood Road, Heston 1 4/1/38 ... ... ... 29/3/38 26/10/38 ... 95, 97, 99 and 101, Pears Road, Hounslow 4 4/1/38 26/7/38 ... ... ... ... ... 1, 2, 3 and 4, Florence Cottages, Bath Road, Hounslow 4 1/2/38 ... ... ... 29/3/38 ... ... 4, Jamieson Cottages, Fern Lane, Heston 1 8/3/38 ... ... ... 27/9/38 ... ... 3 and S, Brickfield Yard, Field Lane, Brentford End 2 8/3/38 ... ... ... 26/7/38 ... ... 1 and 2, Retreat Cottages, Field Lane, Brentford End 2 8/3/38 ... ... ... 26/7/38 ... ... 1 and 2, Vine Cottages, Field Lane, Brentford End • 2 8/3/38 26/7/38 ... ... ••• ... ... 156, Linkfield Road, Isleworth 1 8/3/38 ... ... 31/5/38 ... ... ... 9, North Street, Isleworth 1 8/3/38 ... ... 26/4/38 ••• ... ... 45 and 47, Pears Road, Hounslow 2 5/4/38 ... ... ... 31/5/38 ... ... 49, 51 and 53, Pears Road, Hounslow 3 5/4/38 ... ... ... 28/6/38 ... ... 233, Twickenham Road, Isleworth 1 5/4/38 ... • •• 31/5/38 ... ... ... 6 and 8, Inverness Road, Hounslow 2 10/5/38 ... ... ... 25/10/38 ... ... 12 and 14, Inverness Road, Hounslow 2 10/5/38 26/7/38 ... ... ... ... ... " The Nest," 23, Penderel Road, Hounslow 1 10/5/38 ... ... ... 28/6/38 11/10/38 ... 1, 2, 3 and 4, Redlees Cottages, Worton Road, Isleworth 4 10/5/38 ... ... ... 28/6/38 ... ... 7, 9, 11, 13 and 15, Brickfield Yard, Field Lane, Brentford End 5 7/6/38 ... ... ... 26/7/38 ... ... 17, 19, 21, 23, 25, 27, 29, 31, 33 and 35, Brickfield Yard, Field Lane, Brentford End 10 7/6/38 ... ... ... 26/7/38 ... ... 3 and 4, Rose Cottages, Worton Road, Isleworth 2 7/6/38 ... ... ... ... ... ... The Forge, Bath Road, Cranford 1 5/7/38 ... ... 27/9/38 ... ... ... 38 Continuation of Table showing progress made during 1938 in dealing with dwelling-houses represented as unfit for human habitation. Premises. No. of houses represented as unfit. Dates of representations. Dates undertakings to render fit accepted. Dates houses rendered fit in accordance with undertakings. Dates undertakings accepted that houses would not be re-let for human habitation Dates Demolition Orders made. Dates Demolition Orders obeyed. Dates Demolition Orders enforced. 7, 9, 11, 13 and 15, Wellington Road North, Hounslow 5 5/7/38 ... ... 25/10/38 ... ... ... 1 and 2, Rose Cottages, Worton Road, Isleworth 2 5/7/38 ... ... 27/9/38 ... ... ... 12, 14, 16 and 18, Brickfield Yard, Field Lane, Brentford End 4 6/9/38 ... ... ... 25/10/38 ... ... 1, Prince Regent Road, Hounslow 1 6/9/38 ... ... ... 25/10/38 ... ... Neno Cottage, Worton Road, Isleworth 1 6/9/38 ... ... ... 25/10/38 ... ... Old " Coach & Horses," Worton Road, Isleworth 1 6/9/38 ... ... ... 25/10/38 ... ... 206, Grove Road, Hounslow 1 4/10/38 ... ... ... 28/12/38 ... ... Cottage in the Garden, North Hyde Lane, Heston 1 4/10/38 ... ... ... 28/12/38 ... ... Old Park Cottage, Watersplash Lane, Cranford 1 4/10/38 ... ... ... 28/12/38 ... ... 1, 2, 3 and 4, Park Cottages, Watersplash Lane, Cranford 4 4/10/38 ... ... ... 28/12/38 ... ... 75 and 77, Bath Road, Hounslow 2 15/11/38 ... ... ... ... ... ... 10, 12 and 14, Derby Road, Hounslow 3 15/11/38 ... ... ... ... ... ... 134, North Hyde Lane, Heston 1 15/11/38 ... ... ... ... ... ... 11, 13, 15 and 17, Tivoli Road, Hounslow 4 15/11/38 ... ... ... ... ... ... In two cases owners appealed against the requirements of notices served under section 9 of the Housing Act, 1936. In one case the appeal was dismissed with costs to the Council and in the other the appeal was dismissed with the exception of three items in the notice and costs less one-third awarded to the Council. 39 SECTION E Inspection and Supervision of Food Milk. The inspection of cowsheds, dairies and retail purveyors' premises is carried out by the Sanitary Inspectors and during the year 620 visits of inspection were made. Four cowsheds, 18 dairies and 147 retail purveyors are on the registers. During the year 15 contraventions of the Milk and Dairies Orders were remedied. Under the Milk (Special Designations) Orders licences were issued as follows :— For the sale of "accredited" milk 1 (1 shop) For the sale of "tuberculin-tested" milk 7 (13 shops) For the sale of "pasteurised" milk 18 (34 shops) Pasteurising plant 1 The following report has been received from the County Medical Officer with regard to the action taken to safeguard the milk supply in the Borough. " During the year 1938, 60 samples of milk were taken from retailers in the district. These samples were submitted to the Lister Institute for animal inoculation tests and in one case the presence of tubercle bacilli was demonstrated. In this case the sample was traced to a farm in Berkshire but the result of the examination of this herd has not yet been received. During the year no cows were reported by owners as showing symptoms suspicious of tuberculosis. On the 1st April, 1938, the inspection of all herds in the County was taken over by the veterinary inspectors in the service of the Ministry of Agriculture and Fisheries." The advocacy of clean methods of milk production, handling and retailing continues but will be successful only when it receives the full support of the general public. Ice Cream. A register is kept of premises in the Borough which are used for the manufacture or sale of ice cream. There are 145 premises on the register and 465 inspections were made during 1938. Bakehouses. There are 32 bakehouses including one underground bakehouse in the Borough. The Sanitary Inspectors paid 205 visits of inspection and 15 contraventions were remedied during the year. Slaughter-Houses. There is no public abattoir in the Borough. Of the eight private slaughterhouses in the Borough 4 are registered and 4 are licensed and there is one licensed knacker's yard. During the year 472 visits of inspection were paid to these premises and 11 contraventions were remedied. The humane killer is used for all animals. During the year 17 slaughtermen were licensed. Inspection of Meat and Other Foods. All animals killed in slaughterhouses in the Borough are inspected after slaughter. As circumstances permit they are also inspected in the lairs previous to slaughter. During 1938, 698 visits to slaughterhouses were made for the purpose of inspecting meat. Premises where food is sold or prepared were submitted to frequent inspection. At these visits the premises and the food are inspected. During 1938 inspections were made as follows :— Meat 1,058 Fish 213 Provisions 73 Greengroceries and Fruit 230 Hawkers' Food Stuffs 44 Other foods 451 Food preparation premises 76 Contraventions of the Public Health (Meat) Regulations, 1924, are encountered and in the majority of cases are rectified following verbal or written notice. Proceedings were taken against a butcher for having in his possession an unsound carcase, for failing to give notice of slaughter and for failure to notify the diseased condition. He was fined £5, the slaughterman was fined £2 and the Council awarded five guineas costs. Out of a total of 74 butchers' shops in the Borough 59 are provided with fixed windows, 4 with fixed and open windows and the remaining 11 have windows made to open. 41 The following quantities of unsound food were surrendered during the year :— Tons. Cwts. Qrs. lbs Meat (tuberculous) 1 0 3 18 Meat (unsound and other than above) — 8 — 2 Poultry — — 13 Rabbits — 2 3 11 Cake — — — 1 1 11 3 17 Several tins of various canned food were also surrendered. No unsound food was found exposed for sale. The extent to which disease was found in carcases inspected at the local slaughterhouses is shown in the following table :— Cattle excluding Cows. Cows. Calves. Sheep and Lambs. Pigs. Number killed 100 15 3 359 1621 Number inspected 100 15 3 359 1621 All Diseases except Tuberculosis : Whole carcases condemned — — — — 3 Carcases of which some part or organ was condemned 24 3 1 15 55 Percentage of the number inspected affected with disease other than tuberculosis 24.0 20.0 33.3 4.2 3.6 Tuberculosis only : Whole carcases condemned 2 — — — 6 Carcases of which some part or organ was condemned 6 — — 163 Percentage of the number inspected affected with tuber culosis 8.0 — — — 10.4 Food and Drugs Adulteration. The County Medical Officer reports that during 1938 the following samples were purchased in the Borough for analysis :— Milk 299 (32) Dover sole 1 Gin 9 (2) Minced beef 2 Whisky 10 (3) Mincemeat 2 Lamb's liver 8 (3) Preserves 1 Hake 2 (2) Rum 3 Sausages 6 (3) Tincture of Iodine 1 Butter 2 White Precipitate Ointment 1 Cream 1 Number of samples found to be adulterated shown ( ). Six prosecutions were undertaken and two convictions obtained. Shell-Fish (Molluscum). There are no shell-fish layings in the Borough. Nutrition. No special efforts have been made to increase public knowledge in regard to nutrition and no special investigations have been undertaken. 42 SECTION F Prevalence of, and Control Over, Infectious and Other Diseases Incidence of Notifiable Disease. The number of cases of notifiable disease notified during the last five years are shown in the following table :— 1934 1935 1936 1937 1938 Smallpox — — — — — Scarlet Fever 386 213 224 242 314 Diphtheria 99 72 21 18 40 Erysipelas 82 25 51 45 43 Pneumonia 205 116 70 124 159 Cerebro-Spinal Fever 3 1 1 5 8 Epidemic Encephalitis 1 2 — — 1 Poliomyelitis and Polioencephalitis 2 — 9 3 3 Typhoid and Paratyphoid Fevers 2 4 2 6 4 Dysentery — — — 53 2 Tuberculosis 113 129 112 102 113 Ophthalmia Neonatorum 15 6 2 12 10 Puerperal Fever and Pyrexia 64 56 78 83 66 More detailed analyses of the notifications for 1938 are given in tables at the end of the report. Scarlet Fever. During 1938, 314 cases of Scarlet Fever were notified. Where satisfactory treatment and isolation can be obtained at home the patient need not be admitted to hospital. The percentage of cases removed to hospital during 1938 was 85.0. The type of disease continues to be mild and caused no deaths during 1938. Diphtheria. During 1938 there was an increase of 22 in the number of notifications of diphtheria as compared with 1937 and during the year there were two deaths from diphtheria. The position is not so satisfactory as in 1937 but still compares favourably with other parts of the country as shown below :— Rate per 1,000 Population. Cases. Deaths. 1937 1938 1937 1938 England and Wales 1.49 1.58 0.07 0.07 126 County Boroughs and Great Towns including London 1.81 1.85 0.08 0.07 148 Smaller Towns 1.38 1.53 0.05 0.06 London Administrative County 1.93 1.90 0.05 0.05 Heston and Isleworth 0.18 0.39 0.01 0.02 In addition to the 40 notified cases there were 8 cases in whom the diagnosis of diphtheria was not confirmed clinically though diphtheria bacilli had been found in throat swabs. The age of the cases who died were 1 year and 9 years respectively and both were admitted to hospital. Early diagnosis is essential if treatment is to be effective. To obtain this parents must seek medical advice at once for all throat conditions in children, and doctors must exercise clinical judgment. A throat swab can only tell whether or not diphtheria bacilli are present; the diagnosis of diphtheria is made by a careful clinical examination. The diphtheria immunisation clinic continued throughout the year and each week two sessions were held at Hounslow and one at Isleworth. During the year 1124 children completed or received the full course of immunisation and the total number of attendances was 6,247. Recently there has been a reduction in the applications for immunisation. This is to be regretted and parents must not be lulled into a sense of security by the comparative freedom from diphtheria 44 in the Borough during recent years. The following table shows the extent of susceptability to diphtheria among the children submitted to a primary Schick Test during the year :— Age. No. of children submitted to primary Schick Test. No. of positive Schick Tests readings. Percentage of children showing positive Schick Test. Under 1 year 6 6 100.0 1-2 years 91 91 100.0 2-3 years 75 75 100.0 3-4 years 80 79 98.7 4-5 years 111 109 98.2 5-6 years 148 143 96.6 6-7 years 113 107 94.7 7-8 years 93 89 95.7 8-9 years 115 107 93.0 9-10 years 98 81 82.6 10-11 years 94 80 85.1 11-12 years 77 64 83.1 12-13 years 24 15 62.5 13-14 years 24 17 70.8 14-15 years 11 6 54.5 This high degree of susceptability to diphtheria in the infant and school population shows the need for immunisation. The Council has provided the facilities for this protection but the responsibility lies with parents and without the continued co-operation of parents the scheme cannot succeed. Dr. Bousfield submits the following report on the work of the diphtheria immunisation clinic for the year 1938:— "Public support for the diphtheria immunisation scheme continued to be very good during the year. The total number of attendances was 6247. Of these, 4321 attended the two clinics held at Hounslow and 1926 used the one weekly clinic at Isleworth. The number of new cases tested during the year was 1228. As regards the natural Schick-negative rate obtaining in the district at the present time, the following figures are available :— Total cases which presented themselves for primary Schick readings 1196 Number giving Schick-positive readings 1097 Natural Schick-negative cases 99 The natural Schick-negative rate is therefore 8.27% Certificates of immunity, either natural or artificially produced, were issued to 908 children. Of these, 84 were naturally immune and the remaining 824 were artificially immunised. It should be pointed out that no certificate of natural immunity is issued to a child on the evidence of a single Schick Test. The result is always confirmed at an interval of from 3 to 5 months by means of another test before the certificate is given. Experience has shown that there is a greater variability in the state of natural immunity than is supposed by many, and the importance of repeating the primary Schick Test in negative cases is very evident. During the years in which immunisation has been practised in this Borough, various antigens have been employed, the search for the best and most practical methods being constantly pursued. In the past we have determined the effect of T.A.M. by different modes of administration as regards dosage. This was followed by the investigation of various types of alumprecipitated toxoid as a single injection and as two injections with an interval of 14 days between the injections. In addition, the permanency of the artificial immunity produced by the various methods has been continually under review. Cases immunised from 2 to 8 years ago are being constantly tested to verify the validity of the certificates issued to them at the time of the ' postimmunisation ' Schick Test. The results of the work on T.A.M. have been fully reported in the past and need not be repeated here, but a summary of the work done with Alum-precipitated toxoid (Eli Lilly & Co.) during the period from 1937 to the end of February, 1939 will be of interest. Antigen. Eli Lilly & Co. Alum-precipitated toxoid. Method. A single injection of 0.5 c.c. 45 Of 400 children treated by these means (all originally Schick-positive) 364 attended from 3 to 5 months later for a post-Schick Test. The results were as follows :— Number successfully immunised 266 Still Schick-positive 98 Percentage failure to immunise 26.9 All cases not successfully immunised received further injections and were, when they presented themselves, re-tested, and given certificates of immunity. At the present time, the early cases treated by the above method of a single injection of A.P.T. are being investigated as regards the durability of their immunity. Contrary to experience in other areas and with different brands of A.P.T. the cases which were successfully immunised by the single injection maintain their immunity well, as far as the present results go, but the figures are not yet sufficient to record. It appears therefore that the single injection method is far too inefficient as regards conversion rate for it to be of practical use, but that the immunity produced in the cases which were successfully immunised remains more permanent than might have been anticipated from other experience. The next investigation was based on the use of two injections of alum-precipitated toxoid given at 14 days' interval. Antigen. Ely Lilly & Co. A.P.T. Dosage. 0.2 and 0.5 or 0.5 and 0.5 c.c. at 14 days' interval. Number of Schick-positive children treated by this method 505 Number attending for post-Schick and reading 447 Cases successfully immunised 432 Still Schick-positive 15 Percentage failure to immunise 3.3 (The figure of 26.9% failure to immunise by the single injection method may be borne in mind, and compared with the above figures). At the present juncture there has been no time to investigate the permanency of the immunity produced by the two injections of A.P.T. on the above scries, but it is reasonable to expect that it will be at least as good, and probably far better, than that produced by the single injection. A further brand of Alum-precipitated toxoid is under investigation at the present time. This is the product of Messrs. Evans, Sons, Lescher & Webb. Antigen. Evans, Sons, Lescher & Webb. A.P.T. Dosage. 0.2 and 0.5 or 0.5 and 0.5 c.c. at 14 days' interval. Number of Schick-positive children treated by this method 759 Number attending for post-Schick and reading (to date) 329 Cases successfully immunised 315 Still Schick-positive 14 Percentage of failure to immunise 4.2 These results are not quite as good as those obtained when using the Eli Lilly product, but a longer series may show that there is no appreciable difference between the results which may be expected. In regard to the confirmation of the efficiency of immunity after periods varying from 2 to 8 years, the following figures are available. Confirmatory Schick Tests Performed From 2 to 8 Years After Immunisation. Antigen. Burroughs Wellcome Toxoid Anti-toxin Mixture. Dosage. Three injections of 1 c.c. given at 0-7-21 days. Number of cases re-tested and inspected 678 Still Schick negative 596 Reverted to Schick-positive state 82 Percentage of failure to retain full immunity 10.6 Antigen. Burroughs Wellcome T.A.M. Dosage. Three injections. The first two are of 1 c.c. at a weekly interval. The third injection is of 1.5 c.c. 14 days after the second. Number of cases re-tested and inspected 947 Still Schick-negative 906 Reverted to Schick-positive state 41 Percentage of failure to retain full immunity 4.3 (The above figures are extremely satisfactory). Antigen. Burroughs Wellcome T.A.M. Dosage. Three injections. Initially 1 c.c. then two injections of 1.5 c.c. at 14 days' interval. Number of cases re-tested and inspected 125 Still Schick-negative 107 Reverted to Schick positive state 18 Percentage of failure to retain full immunity 14.4 46 The above series is far too short for any inference to be drawn from these unsatisfactory figures, which may be purely coincidence. There can be no doubt at all as to the merits of the previous method, i.e., 1 c.c., 1 c.c. and 1.5 c.c. at 0-7-21 days' intervals. On the subject of these reverted cases, one must bear in mind that many of these children who have reverted to some degree of Schick-positive reaction have still a marked latent immunity which is ready to awaken at the first onslaught of diphtheria infection. All the cases which were found to be again susceptible in the above series received further injections of diphtheria antigen. Some time ago the additional injections given were of T.A.M. Latterly supplementary injections have been of A.P.T. which is the antigen now in use, except for the occasional hypersensitive case requiring the use of the milder antigen, Toxoid-Antitoxin floccules. As regards reactions, little complaint has been made by parents on account of any reactions either local or general, in the use of the two brands of alum-precipitated toxoid with which we have worked at our clinics. It is quite exceptional for us to have to change over to T.A.F. on account of severe reaction to A.P.T. General Remarks. A satisfactory feature of the clinics is the extreme youth of the greater number of the children now brought for testing and immunisation. A marked inclination to bring children between the ages of 9 months and five years is obvious, and this requires no further comment. Only one case of diphtheria in a child believed to be immune has to be recorded during the year. This child had received prophylactic injections in the U.S.A. some years previously. On presentation of the child at our clinic for a post-Schick test, the result was found to be negative. Ten weeks later the child was notified as suffering from diphtheria. The case was regarded as one of clinical diphtheria by the Medical Officer of the South Middlesex Fever Hospital, who kindly provided a very full report. The situation may be best described in his own words. "As will be seen from the chart, the patient suffered from no complications whatsoever; the pulse rate remained quiet and steady throughout the illness and the girl made an excellent recovery." The occurrence of these occasional cases of diphtheria among immunised children is denied by no clinician of experience. The point is that such attacks are nearly always extremely mild and devoid of complications. The reason for their occurrence is probably a temporary waning of immunity of the subject, coupled with a mass infection by diphtheria bacilli, or produced as a result of infection by a very virulent strain. It is known that the bare Schick-negative level may not afford complete protection against occasional heavy infections of the gravis or intermediate strains of the Diphtheria bacillus. If the large number of children immunised in this Borough during recent years has only produced one case of uncomplicated diphtheria during the year, and of course no fatal cases as far back as our records go, it would appear that the value of the procedure is becoming increasingly obvious." GUY BOUSFIELD, M.D., B.S.Lond. Boxes containing diphtheria antitoxin, a sterile syringe and the necessary dressings are kept at Hounslow Police Station and are available to doctors in case of emergency. During 1938, 16 vials, each containing 8,000 units of antitoxin, were supplied to medical practitioners. Smallpox. No cases were notified during 1938. Typhoid and Paratyphoid Fevers. Two cases of typhoid and two cases of paratyphoid fever were notified during 1938. Three of these cases were notified from West Middlesex County Hospital and two were not usually resident in the district. No source of infection was traced in the two cases who were residents in the Borough. Erysipelas. Forty-three notifications of this disease, including 17 from the West Middlesex County Hospital, were received during the year. Fourteen of the cases were non-residents. Epidemic Encephalitis. One case was notified from the West Middlesex County Hospital but the patient was not a resident of the Borough. Cerebro-Spinal Fever. Eight cases were notified. Two of the cases notified from the West Middlesex County Hospital were non-residents. Poliomyelitis. Three cases were notified and were removed to the West Middlesex County Hospital for treatment. 47 Pneumonia. Including 129 from the West Middlesex County Hospital, 159 notifications of pneumonia were received. Ninety-nine of these cases were non-residents. Dysentery. Two cases were notified, one of whom was a non-resident. No source of infection was traced. Influenza. No epidemic of influenza occurred during 1938. Six deaths were certified as due to influenza. This yields an influenza death rate of 0.06 per 1,000 population as compared with 0.38 in 1937. Non-Notifiable Diseases. Cases of non-notifiable infectious disease are brought to the notice of this department by health visitors, teachers and school attendance officers. The following table sets forth the numbers of such cases among elementary school children during the last five years:— 1934 1935 1936 1937 1938 Measles 901 10 1352 174 861 German Measles 66 6 15 18 45 Chicken Pox 417 537 161 634 512 Mumps 153 113 306 1538 35 Whooping Cough 144 232 366 276 300 According to information obtained by health visitors the extent to which these cases were under medical care was as follows:—measles—83.12%; german measles—45.62%; chicken-pox —49.0% ; mumps—51.20% and whooping cough—68.0%. During 1938 one death was certified as due to whooping cough and two deaths as due to measles. Measles Prophylaxis. During the early months of 1938, measles serum was issued as follows:—150 c.c. to medical practitioners; 100 c.c. to West Middlesex County Hospital and 80 c.c. to the South Middlesex Fever Hospital. Apart from Dr. Rankin's report which follows, no records are available in the department to show the effect of the serum in regard to prophylaxis or attenuation. SERO-PROPHYLAXIS OF MEASLES, 1938. Details of Exposure. Group 1. A case of measles, wrongly notified as scarlet fever, admitted to a scarlet fever ward on 14th March resulted in the exposure of six children (ages 14, 2, 3, 4, 4 and 13 years) who had not suffered from measles previously. On the second day of exposure each child was injected with 10 c.c. of measles serum intramuscularly. Measles did not develop in any of these six children within a period of twenty-six days from the last exposure. Group 2. Two children, 6 and 7 years of age respectively, were exposed to infection with the measles virus in a scarlet fever ward on 14th April. One of these children occupied a bed adjacent to the infecting case, whilst the other child was more distant. The day following exposure each child received 10 c.c. measles serum intramuscularly. Neither child developed measles during the period of observation of twenty-six days from the last exposure. Group 3. A child admitted to Hospital on 12th May suffering from scarlet fever developed measles on the fourth day after admission. Five children from one to seven years of age (1, 2, 4, 5 and 7 years) who had not suffered from measles previously, were exposed to infection from the above case. On the third day of exposure, four of these children were injected with 10 c.c. of measles serum intramuscularly. There was no evidence of measles in three of these cases up to the date of discharge, which was a minimum of twenty-six days from the last exposure. One child, a girl (aged 7 years) developed measles which was nrld and uncomplicated. On going into the history of this case it was found the patient had been in contact with a case of measles at school four or five days before admission to hospital. She accordingly had received the measles serum on the 8th day following the first exposure. 48 The fifth child, a girl aged four years, received 10 c.c. ot measles serum on the fourth day of exposure. Twelve days later symptoms of measles appeared. The abortive character of the attack from which the child suffered is noteworthy—a trivial catarrh, of some twentyfour hours duration, was succeeded by a flutter of temperature to 100 degrees F., which fell to normal within twenty-four hours. There were very few Kopliks spots, and the exanthem consisted of a scanty crop of small pink macules on the trunk and proximal parts of the limbs. No complications ensued. Summary. Of 13 susceptible children from 1 to 13 years of age exposed to infection with the measles virus, 11 escaped infection subsequent to passive immunisation with adult measles serum, whilst two developed modified forms of the disease. The 11 children who escaped infection received their prophylactic injection of serum on, or before, the third day of exposure. Of the children who developed very mild attacks of measles, one did not receive the injection of 10 c.c. of measles serum until the fourth day of exposure, whilst the other received the serum as late as the eighth day of exposure. Conclusions. The results obtained with the Sero-Prophylaxis of measles have been extremely satisfactory. In Hospitals and other institutions for children it is of the greatest importance to check an outbreak of measles, and Sera-Prophylaxis by rendering exposed susceptible children completely immune, is the most effective method of controlling the disease. A. L. K. RANKIN. Ophthalmia Neonatorum. Ten cases of ophthalmia neonatorum were notified during 1938. Seven of these were non-residents notified from the West Middlesex Hospital. Of the remaining cases two were treated at home and the other at St. Margaret's Hospital by arrangement with London County Council. All made a complete recovery with no impairment of vision. Puerperal Pyrexia. Sixty-six cases of puerperal pyrexia were notified. Fifty-seven cases, including 32 nonresidents, were notified from West Middlesex County Hospital. Of the other 9 cases 3 were treated at Queen Charlotte's Hospital, 1 at St. Thomas's Hospital, 2 at West Middlesex Hospital and 3 were treated at home. A small outbreak of puerperal pyrexia occurred in a nursing home during the month of June. It was dealt with by Dr. Roberts who submits the following report:— Three cases of puerperal pyrexia occurred in a nursing home between June 6th and June 25th. The cases were of sufficient severity tc require removal to hospital. The home is registered to take seven maternity cases and ten other cases, has a small operating theatre, is adequately equipped and satisfactorily staffed and managed. The nurses at this home do not act as midwives. Practically all midwifery in the home is done by medical practitioners. Any other midwifery is undertaken by the proprietress. The history of the three cases is as follows:— Mrs. " A". Delivered by Dr. "Z" On 3.6.38; forceps applied; manual removal of placenta; two perineal sutures. Onset of pyrexia 6.6.38. Consultation with consulting obstetrician 14.6.38. Removed to Isolation Block, Queen Charlotte's Hospital, 15.6.38. Notification dated 14.6.38. Notification received at Public Health Department 15.6.38. Mrs. "B". Delivered by Dr. "Y" 16.6.38; forceps applied; no perineal tear. Onset of pyrexia 22.6.38. Consultation with consultant obstetrician and vaginal smear taken 22.6.38. Removed to St. Thomas's Hospital 24.6.38. Notification dated 25.6.38. Notification received at Public Health Department 27.6.38. This notification was not made on the special form for such cases. No date of confinement was given and the home address of the patient given instead of the place of delivery. It was therefore not connected up with the Nursing Home till two days later when a routine visit re puerperal pyrexia was made. 49 Mrs. "C". Delivered by Dr. "X" 18.6.38. Onset of pyrexia 21.6.38 with symptoms of mania. Consultation with consulting obstetrician 24.6.38. Removed to West Middlesex County Hospital 25.6.38. Notification from Hospital dated 28.6.38. Notification received at Public Health Department 29.6.38. No notification was received from Dr. " X " so that here again the case was not immediately connected up with the Nursing Home. Owing to the failure of the practitioners to notify the cases promptly and supply the required information on the notifications the Medical Officer of Health was not aware till July 2nd of the occurrence of three cases of puerperal pyrexia in a Nursing Home. Since in each case a different doctor delivered the patient it seemed probable that the source of infection might be in the staff of the home. The home was prohibited from taking further maternity cases and on July 2nd all the staff, nursing and domestic, was swabbed by Dr. Murray, Pathologist to the Richmond Hospital, and the practitioners concerned were invited to be swabbed. All rooms in which the patients concerned had been were disinfected. A smoke test showed the drains to be defective and the necessary repairs were carried out. On July 5th the results of the swabbing showed that haemolytic streptococci were present in the throats of three nurses. A profuse growth of staphylococcus aureus was obtained from the throat swab of a probationer nurse and a few doubtful haemolytic streptococci from the throat swab of the cook. Nurse " D" with a heavy growth of haemolytic streptococci, showed no clinical symptoms and had just returned from holiday. She had been in contact with Mrs. "A" but not with the other cases. She was suspended from duty. Nurse "E" had been employed as a temporary nurse from 15th June. On 24th June she developed a sore throat and was sent home. She had been in contact with Mrs. " B " and Mrs. " C Her throat swab showed many haemolytic streptococci. Instructions were given that two negative swabs must be obtained before she returned to work. In the case of Nurse "F" the swab revealed a few haemolytic streptococci. She went on holiday on 4th July and instructions were given that she should not resume duty till two consecutive negative swabs were obtained. The probationer nurse and the cook were not suspended from duty but were debarred from contact with any maternity cases pending the examination of further swabs. On July 5th the home was allowed to take in new maternity cases as the probable sources of infection had been removed. The various members of the staff were allowed to return to work in each case after obtaining negative results from two consecutive swabs. The attention of the doctors concerned was drawn to the requirements of the Puerperal Pyrexia Regulations. There appeared to be no corelation between the bacteriological findings. The swab in the case of Mrs. "A" showed haemolytic streptococci, group A. At my request the Ministry of Health Pathological Laboratory endeavoured to type the strain but were unable to do so. The haemolytic streptococci obtained from Mrs. " B " were considered to be Group A but no typing was carried out. No swabs were taken from Mrs. " C" as her pyrexia was considered to be due to mania and not to infection. The haemolytic streptococci in the cases of Nurse "D" and Nurse " E " were not of the type usually associated with puerperal infection. On one occasion a swab from the probationer nurse showed haemolytic streptococci, group A, type 12. This does not correspond with the type found in Mrs. "A" The probationer had not attended any of the patients though the possibility of her having been in their rooms could not be excluded. Negative results were obtained from the swabbing of Drs. "Z" and " Y Dr. "X" was not swabbed. The source of the infection of Mrs. "A" and "B" was not traced. No proof of infection was obtained in the case of Mrs. " C No further cases occurred in the home. E. L. ROBERTS. 50 Tuberculosis. The following table shows the new cases notified and the deaths from tuberculosis during 1938:— Age Periods. New Cases. Deaths Pulmonary. Non-Pulmonary. Pulmonary. Non-Pulmonary. M. F. M. F. M. F. M. F. 0—1 ... ... ... ... ... ... ... ... 1—5 ... 1 ... 1 ... ... ... 5—10 2 1 4 10—15 3 4 2 1 15—20 4 11 2 3 4 1 20—25 5 14 2 3 25-35 8 14 2 2 7 7 ... ... 35—45 12 4 1 1 11 4 1 45—55 7 1 ... ... 3 3 ... ... 55—65 3 ... 1 ... 2 3 1 ... 65 and over 1 ... ... ... 1 ... ... ... Total: 45 49 9 10 28 24 3 3 Eight of the deaths from pulmonary tuberculosis and 3 of the deaths from non-pulmonary tuberculosis occurred in persons who had not been notified as suffering from tuberculosis. The number of cases of tuberculosis on the register at the end of 1938 was 469. No action was taken under the Public Health (Prevention of Tuberculosis) Regulations, 1925, as no notified case was known to be employed in the handling of milk. No case was removed compulsorily to hospital under Section 172 of the Public Health Act, 1936. The following table shows the number of notifications, the number of deaths and the death rate from tuberculosis per 1,000 population for the last 9 years:— Year. Pulmonary. Non-Pulmonary. Notifications. Deaths. Death Rate. Notifications. Deaths. Death Rate. 1930 71 40 0.64 14 8 0.13 1931 83 47 0.62 31 7 0.09 1932 88 51 0.63 17 7 0.09 1933 113 68 0.81 27 8 0.09 1934 77 58 0.66 21 14 0.16 1935 105 44 0.48 24 9 0.09 1936 99 49 0.51 13 12 0.13 1937 88 46 0.46 14 7 0.07 1938 94 52 0.51 19 6 0.06 Cancer. The deaths from cancer during 1938 numbered 154. The cancer death rate per 1,000 population in 1938 was 1.51 as compared with 1.27 in 1937, 1.36 in 1936 and 1.32 in 1935. Reasonable facilities for modern methods of diagnosis and treatment are available in the district. 51 Prevention of Blindness. In September by arrangement with Middlesex County Council in connexion with Circular 1621 on Prevention of Blindness a scheme was started whereby any elementary or secondary school child suffering from a defect of vision requiring continued supervision may continue to attend the School Refraction Clinic after leaving school. Heston Airport. The Public Health (Aircraft) Regulations, 1938, came into force on 1st July, 1938, and the defined duties were undertaken by the Council. Arrangements were made for a medical officer to be available at any time; for a sanitary inspector to be available as required; for the removal, isolation and treatment of cases of infectious disease; for the disinfection of aircraft; laboratory facilties, etc., The medical officers were appointed Medical Inspectors of Aliens. During 1938 the medical officers paid 20 visits to the Airport. Two aliens were examined and 5 persons were placed under surveillance as having come from " infected " areas. This work, which is steadily increasing with development of the airport, has been greatly facilitated by the co-operation of the Airport Authority, the Immigration Officers and the Customs Officers. Disinfection. Two men are employed for carrying out disinfection, drain testing, etc. Disinfection of rooms is carried out in connexion with tuberculosis and certain infectious diseases. During 1938, 523 rooms were disinfected by means of sulphur or formalin. Bedding is removed to the South Middlesex Fever Hospital for disinfection by steam. Hospital Accommodation for Infectious Disease. Hospital accommodation for cases of infectious disease is provided at the South Middlesex Fever Hospital. Other Hospitals are used for certain infectious diseases. The following table shows the hospitals where cases of infectious disease were treated during 1938:— Disease. South Middlesex Fever Hospital. West Middlesex County Hospital. Queen Charlotte's Hospital. St. Margarets St. L.C.C. Thomas's Hospital. Hospital. Other Hospitals. Scarlet Fever 276 3 Diphtheria 37 3 Diphtheria Carriers 8 Typhoid Fever, etc. 3 1 Dysentery 1 1 Erysipelas 7 18 Pneumonia 1 140 1 Cerebro-Spinal Fever 1 7 Epidemic Encephalitis 1 Poliomyelitis 3 Ophthalmia Neonatorum 7 1 Puerperal Pyrexia 59 3 1 German Measles 4 Epidemic Parotitis 1 Whooping Cough 3 Measles 15 The following table shows the final diagnosis in 28 caseS which were admitted to the South Middlesex Fever Hospital as suffering from infectious diseases. 7 Haemolytic Streptococcal Tonsillitis. 1 Bronchitis. 3 Tonsillitis (non-haemolytic mixed infections). 1 Paranasal Sinus Suppuration. 1 Acute Cellulitis of face and Haemolytic Streptococcal Septicaemia. 3 Adventitious Erythema. 1 Otitis Media. 1 Intestinal Carcinoma. 1 Tonsillo-Pharyngitis. 1 Acute Ulcerative Colitis. 1 Acute Ulcerative Tonsillitis. 1 Pediculosis Capitis. 1 Peritonsillar Abscess. 1 Rheumatic Carditis. 1 Acute Streptococcal Laryngitis and Broncho-Pneumonia. 1 Furunculosis. 1 Acute Ascending Paralysis (Landry). 1 Lobar Pneumonia. 52 53 According to figures furnished by the Registrar-General. Table of Causes of Deaths during 1938. Causes of Death. Civil Residents, all ages. Male. Female. All causes 453 423 1 Typhoid and paratyphoid fevers — — 2 Measles — 2 3 Scarlet Fever — — 4 Whooping Cough — 1 5 Diphtheria 2 — 6 Influenza 3 3 7 Encephalitis Lethargica — — 8 Cerebro-Spinal Fever 2 3 9 Tuberculosis of Respiratory System 28 24 10 Other Tuberculous Diseases 3 3 11 Syphilis 4 2 12 General Paralysis of the Insane, Tabes Dorsalis 2 1 13 Cancer, Malignant Disease 74 80 14 Diabetes 5 4 15 Cerebral Haemorrhage, &c. 17 17 16 Heart Diseases 115 128 17 Aneurysm 1 2 18 Other Circulatory Diseases 23 9 19 Bronchitis 11 7 20 Pneumonia (all forms) 19 17 21 Other Respiratory Diseases 4 3 22 Peptic Ulcer 10 2 23 Diarrhoea, &c. (under 2 years) 6 3 24 Appendicitis 3 3 25 Cirrhosis of Liver — 1 26 Other Diseases of Liver, &c. — 2 27 Other Digestive Diseases 8 5 28 Acute and Chronic Nephritis 10 13 29 Puerperal Sepsis — 2 30 Other Puerperal Causes — 2 31 Congenital Debility, Premature Birth, Malformations, etc. 25 15 32 Senility 9 19 33 Suicide 6 2 34 Other Violence 20 11 35 Other Defined Diseases 43 37 36 Causes Ill-defined or Unknown - .- Special causes (included in No. 35 above) Small-pox - - Poliomyelitis 1 - Polioencephalitis — - INFANTILE MORTALITY DURING THE YEAR 1938. Nett Deaths from stated Causes at various Ages under 1 Year of Age. Cause of Death. Under 1 week. 1-2 weeks. 2-3 weeks. 3-4 weeks. Total under 4 weeks. 4 weeks and under 3 mths. 3 mths. and under 6 mths. 6 mths. and under 9 mths. 9 mths. and under 12 mths. Total Deaths under 1 year. Smallpox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... 1 ... 1 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... 1 1 Convulsions ... ... ... ... ... ... 1 ... ... 1 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... 1 ... ... ... 1 Pneumonia (all forms) ... ... ... ... ... 4 2 ... 1 7 Diarrhoea ... ... ... ... ... 1 ... ... 1 2 Enteritis ... ... ... 1 1 2 2 1 1 7 Gastritis ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlaying ... ... ... ... ... ... ... ... ... ... Injury at Birth 2 ... ... ... 2 ... ... ... ... 2 Atelectasis 2 ... ... 1 3 ... ... ... ... 3 Congenital Malformations 5 2 2 ... 9 2 1 ... ... 12 Premature Birth 15 ... ... ... 15 2 ... ... ... 17 Atrophy, Debility and Marasmus ... ... ... ... ... 1 ... ... ... 1 Other Causes 2 ... ... 1 3 3 2 2 1 11 26 2 2 3 33 16 8 4 5 66 54 \ INFECTIOUS DISEASES, 1938, CASES NOTIFIED. Scarlet Fever. Diphtheria. Enteric Fever. Erysipelas. Cerebro-Spinal Fever. Encephalitis Lethargica. Poliomyelitis. Pneumonia. Respiratory Tuberculosis. Other forms of Tuberculosis. Ophthalmia Neonatorum. Puerperal Pyrexia Dysentery January 36 2 1 7 2 ... ... 22 8 3 ... 8 ... February 41 3 ... 5 ... ... ... 13 12 2 3 7 ... March 34 1 ... 1 ... ... ... 28 5 3 ... 3 ... April 30 4 I 4 2 ... ... 20 7 1 1 4 ... May 25 3 ... 5 1 ... ... 22 8 1 ... 2 ... June 21 2 ... 4 2 ... 1 11 3 1 3 8 ... July 20 1 ... 2 ... ... ... 16 11 2 2 5 ... August 12 2 1 3 ... ... 1 5 6 1 ... 10 ... September 28 4 ... 2 ... ... ... 4 12 3 ... 6 ... October 22 4 1 2 ... ... ... 6 8 2 1 5 ... November 23 8 ... 6 ... 1 1 4 6 ... ... 4 2 December 22 6 ... 2 1 ... ... 8 8 ... ... 4 ... Totals 314 40 4 43 8 1 3 159 94 19 10 66 2 DIPHTHERIA, 1938 (including Bacterial cases, 8 in number). Month WARD. Elem. School Chldren Other School Chldren Other Cases Total Hstn. Houn. Cent. Houn. Hth. Houn. Sth. Houn. West Islewth N. Islewth S. Spng. Grve. Jan. 3 ... ... 2 ... ... 1 ... ... 1 ... 2 Feb. 3 ... ... ... ... 1 ... 2 ... 2 ... 1 Mar. 2 ... ... 1 1 ... ... ... ... ... ... 2 Apr. 5 ... ... 4 ... 1 ... ... ... 3 ... 2 May 4 ... ... ... ... 1 2 1 ... 1 1 2 June 3 ... ... 1 1 ... ... 1 ... 2 ... 1 July 2 ... ... ... ... ... 2 ... ... 1 ... 1 Aug. 3 1 2 1 ... 2 Sept. 4 ... ... ... ... ... 2 2 ... 4 ... ... Oct. 5 ... ... 1 ... 2 2 ... ... 2 1 2 Nov. 8 ... ... 3 1 ... 2 1 1 6 1 1 Dec. 6 ... 1 ... ... ... 3 1 1 1 ... 5 Totals 48 1 1 12 3 7 14 8 2 24 3 21 55 Notifiable Diseases during 1938. Disease. Total Cases Notified. Total all ages. Cases admitted to Hospital. Under 1 year 1-2 years. 2-3 years. 3-4 years. 4-5 years. 5-10 years. 10-15 years. 15-20 years. 20-35 years. 35-45 years 45-65 years. 65 years and over. Small-pox ... Enteric Fever 1 1 2 4 4 Scarlet Fever 7 10 19 28 165 53 11 12 7 1 1 314 279 Diphtheria 2 1 3 20 6 2 5 1 40 40 Erysipelas 1 1 3 8 6 19 5 43 25 Puerperal Pyrexia 3 54 9 66 63 Ophthalmia Neonatorum 10 ... 10 8 Poliomyelitis 1 1 1 3 3 Cerebro Spinal Fever ... 1 1 1 1 1 1 1 1 8 8 Pneumonia 9 7 11 3 3 20 11 6 38 20 23 8 159 142 Dysentery 1 1 2 2 Encephalitis Lethargica 1 1 1 56 For Tuberculosis Notifications—see other Table. DEATHS FROM NOTIFIABLE INFECTIOUS DISEASES, 1935. Age Groups. Under 1 year. 1 yr- 2 yrs. 3 yrs. 4 yrs. 5 yrs. 10 yrs. 15 yrs. 20 yrs. 35 yrs. 45 yrs. 65 yrs. and over. Total all Ages. Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria ... 1 ... ... ... 1 ... ... ... ... ... ... 2 Enteric Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Pyrexia ... ... ... ... ... ... ... ... 1 1 ... ... 2 Pneumonia 7 5 1 ... ... 1 ... 1 3 2 6 10 36 Poliomyelitis ... ... ... ... ... ... ... ... ... ... ... ... 1 Polio- Encephalitis ... ... ... ... ... ... ... ... ... ... ... ... ... Encephalitis Lethargica ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebro-Spinal Fever 1 ... ... ... ... ... ... 1 1 ... 2 ... 5 Erysipelas ... ... ... ... ... ... ... ... ... ... 1 ... 1 Total 8 6 1 ... ... 2 1 2 5 3 9 10 47 For Tuberculosis Deaths—see other Table. The table hereunder gives the number of cases of infectious diseases that were notified from the several institutions in the district during 1938 Enteric Fever Scarlet Fever Diphtheria Pneumonia i (all forms) Erysipelas Puerperal Pyrexia Cerebro-Spinal Fever Ophthalmia Neonatorum Pulmonary Tuberculosis Other Tuberculosis Encephalitis Lethargica Acute Poliomyelitis Dysentery Total West Middlesex Hospital 3 6 5 129 17 57 6 7 12 8 1 1 252 Hounslow Hospital 1 3 1 3 ... 8 Hounslow Barracks 3 3 *St. Mary's School ... Nazareth House 16 2 18 Totals 3 26 5 131 20 57 6 7 13 11 1 1 281 *Closed in June, 1938. 57 COPY OF ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1938. On the administration of the Factory and Workshops Act, 1901 and the Factories Act, 1937 (which superseded the Act of 1901 on 1st July, 1938). 1. INSPECTIONS for purposes of provisions as to health. Including inspections made by Sanitary Inspectors. Premises. (1) Number of Inspections. (2) Written Notices. (3) Occupiers Prosecuted. (4) FACTORIES with mechanical power 454 19 — FACTORIES without mechanical power 346 6 — *OTHER PREMISES under the Act (including works of building and engineering construction but not including out-workers' premises) 2 - - *Electrical Stations should be reckoned as factories Total 802 25 Nil. 2. DEFECTS FOUND. Particulars. No. of Defects. Number of defects in respect of which prosecutions were instituted. Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) (5). Want of cleanliness (S.l) 6 5 — — Overcrowding (S.2) — — — — Unreasonable temperature (S.3) — — — — Inadequate ventilation (S.4) 1 1 — — Ineffective drainage of floors (S.6.) — — - — Sanitary Conveniences (S.7)— Insufficient 4 4 — — Unsuitable or defective 46 38 — — Not separate for sexes 2 — — — Other Offences— (Not including offences relating to Home Work or offences under the Sections mentioned in the Schedule of the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921, and re-inacted in the Third Schedule of the Factories Act, 1937) - - - - Total 59 48 Nil. Nil. OUTWORK IN UNWHOLESOME PREMISES. (Section 108 of Act of 1901; Section 111 of Act of 1937). Number of instances Nil. 58 McGowan & Barber Ltd. (T.U.) 77, Hanworth Road Hounslow.