library HES31 Borough of Heston and Isleworth of the Medical Officer of Health 1944 Public Health Department, 92 Bath Road, HOUNSLOW. To the Mayor, Aldermen and Councillors of the Borough of Heston and Isleworth. Ladies and Gentlemen, I beg to submit my Annual Report for the year 1944. A separate report has been submitted on the School Medical Service and as has been the practice in recent years this Report consists largely of a tabulated summary. Comment is submitted on certain aspects of the work and vital statistics. The upward trend of the birth rate has been maintained: 16.5 as compared with 16.3 in 1943 and 14.6 in 1942. The number of illegitimate births was 85 as compared with 90 in 1943 and 59 in 1942. Special attention has been given to the care of unmarried mothers and illegitimate children. Efforts are made to contact the mother before the birth of the child and to assist her, where necessary, in regard to pre-natal care, arrangements for confinement and accommodation for herself and the baby after the confinement. In these matters we have had the co-operation of hospital almoners and moral welfare workers. Contact was made in 60 cases and the final arrangements were as follows:- Mother and child living with father of the child 25 Mother and child living with grandparents 15 Mother and child living together (allowance from father) 1 Mother and child left the Borough 8 Child placed with foster-mother 1 Child placed for adoption 4 Child placed in residential nursery 1 Child in day nursery while mother at work 1 Child died in hospital 4 Where the mother and father are living together marriage is impossible in most cases as one or other of the partners is already married. When the mother and child leave the Borough and the address or district to which they have gone is known the particulars are forwarded to the Medical Officer of Health. In conjunction with the Middlesex County Council arrangements have been made to provide, under the Public health Act, pre-natal and post-natal residential accommodation. No cases from the Borough were admitted during 1944. The Adoption of Children (Regulation) Act, 1939 came into force on 1st June, 1943, and is designed to ensure that as far as is practicable the adoption of any infant shall be oarried out in a manner most beneficial to the child and to prevent the trading In young children by a third party whose sole object is to make money by this traffic in young lives. Adoption Societies have to be registered and must not practice for gain and all their activities are subject to scrutiny. Under Section 7 of the Act it is the duty of any person (other than the child's parents or guardian), who participate in the arrangements for the placing of the child for adoption, to notify in writing the welfare authority of the area in which the child is to be placed. The number of such notifications received is not as high as might-be expected and this is no doubt due to the purpose of the Act not bfeing fully understood by doctors, mldwives, hospital matrons, almoners, clergymen, moral welfare workers, etc. In 1944 Health Visitors made visits of enquiry or supervision as under in connection with dhildren placed for adoption :- Visits in connection with notification of children placed for adoption and to provide reports for use of the oourt 136 Visits at request of adoption societies or others 15 Post-adoption visits at request of adoption societies or others 11 1 The death rate was 10.3 per 1000 as compared with 10.6 In 1943 and 10.2 in 1942. This rate is based on the civilian population. The percentage of the total deaths occurring in persons aged 65 years and over was 54.5 as compared with 50.2 in 1943 and 52.0 in 1942. The percentage age distribution of deaths during 1910-14 and 1940-44 is shown below : - 1910-14 1940-44 Under 1 year 21.8 7.8 1-4 years 8.4 1.4 5-14 years 3.8 1.8 15 - 24 years 3.7 2.8 25 - 64 years 30.8 35.2 65 years & over 31.5 51.0 There has been a change in the age distribution of the population during these 30 years and during 1940-44 many men and women of military age have not been included in the civil population but the figures indicate the improving survival rates of the younger age groups. There are indications that the presence in the population of many elderly persons produces peculiar and special social problems and that "old age" welfare will have to be undertaken. The chief causes of death during 1944 were heart disease (230), cancer (152), cerebral haemorrhage (82), violence including air raids (66) and pneumonia (56). In 1944 the infant mortality rate was 46.0 as compared with 46.8 in 1943 and 72.1 in 1942. The percentage of the total infant deaths occurring in children under 4 weeks was 65 as compared with 49 in 1943 and 58 in 1942. Certain comparisons in connection with infant mortality for two five year periods 1910-14 and 1940-44 are shown below j - 1910-14 1940-44 Total Infant deaths 559 394 Infant mortality rate 111.8 56.0 Age of greatest risk 3 - 5-mths. Under 1 day % of deaths at ages under 3 mths. 54,7 76,6 Numerical order of chief causes of death enteritis (137). Prematurity (107). Gastro - Prematurity (114). enteritis (79). Bronchitis 3c Bronchitis & pneumonia (112). pneumonia (62). Congenital Congenital debility (79). debility (38). Whooping Congenital cough (28). malformation( 17). Congenital malforma- Whooping tion (19). Cough (6). Measles (17). Tuberculosis (4). Tuberculosis(13). Measles (2). It will be seen from the above that (a) the reduction In infant mortality is due almost wholly to fewer deaths from infections (b) more than three quarters of the deaths now occur before the age of 3 months when prematurity and congenital debility are most likely to contribute to a fatal issue and (c) the greatest risk Is now in the first 24 hours after birth. While efforts to find the causes and to improve the treatment of prematurity and congenital debility are needed there must be no slackening in the work to reduce further the deaths from infections (improved parental care, better domestic hygiene, less overcrowding, loss poverty, etc.). In the case of the 20 children who died from prematurity the place of birth and death was, home 2 (1 outside the Borough), nursing home 1 and hospital 17. The maternal mortality rate was 1.9 per 1000 (live and still) births as compared with 0.62 in 1943 and 2.76 in 1942. The stillbirch rate per 1000 total births was 22 as compared with 26 in 1943 and 3? in 1942. 2 In general infectious disease was less prevalent than in 1943. , Soarlet fever continues of a mild type and there were no deaths. There were 12 cases of diphtheria with 1 death as compared with 5 cases and no deaths in 1943. This increased incidence was accompanied by an increase in the severity of the disease and if the Borough is to be protected against this severe type of diphtheria a greater number of children must be immunised. There was a decided reduction in the acccptance of immunisation and at the end of the year 37.3 per cent, of the population under 5 years of age and 65.1 per cent, of the population between 5 and 15 years were immunised as compared with 38.0 and 77.2 at 31st December, 1943. Parents must not be lulled into a false sense of security by the low incidence of diphtheria - this low incidence can be maintained only if a high proportion of the child population is protected and the best time for immunisation is at the age of one year, A small outbreak of dysentery occurred in one of the day nurser.es and cleared up fairly quickly with no deaths. The reduction in tuberculosis incidence and mortality continues. The average tuberculosis death rate for 1940-44 was 63.2 per 100,000 population as compared with 60.4 in 1935-39 and 78.9 in 1930-34. There is evidence that scabies was not as prevalent as in 1942 and 1943 and it is hoped that the peak of incidence has been passed. Difficulty is still met in getting all members of infected families to accept treatment. The same difficulty occurs in dealing with lousiness where school children are re-infested by other members of the family. The four wartime nurseries, with accommodation for 189 children, continued in operation throughout the year and, apart from a short period when the evacuation scheme was in full opsration, there was always a number of children awaiting admission. Shortage of and illness among the nursing and domestic staff have been the chief problem in maintaining this service. Throughout the year the proportion of the necessary nursing staff on duty in any week varied from 66 to 94 per cent. (average 79 per cent.) and of the necessary domestic staff from 64 to 100 per cent. (average 86 per cent.), Had the average attendance of children been high the problem would have been much more serious. Actually throughout the year the average attendance of children was 70 per cent. of the number on the registers. Apart from a small outbreak of dysentery (Sonne) affecting 12 children in one nursery the nurseries generally were free of serious illness or epidemics and the poor average attendance was due largely to minor illness, colds, catarrhs, etc. and to some extent to the prevalence of whooping cough and measles at the end of the year. Any physical benefit a child derives from attendance at a day nursery is due to adequate and suitable accommodation, a sufficient and suitable diet and care and attention from trained staff. Much is heard of schemes to provide, after the war, good housing and freedom from want but little of the equally important matter of training the mothers of the future in domestic science and mothercraft. Whatever may be the need or desire for day nurseries and nursery schools such institutions can never be a substitute for good mothercraft. In any long term plan to benefit the children of the future a comprehensive scheme of training in domestic science and mothercraft is more important than nursery schools. The social unit is the family and good mothercraft is the keystone of good family life. Only through the schools can we see that every potential mother (and father) receives a basic training and the matter should not be sidetracked in favour of more spectacular but less effective methods or left to other ageneies. Throughout the year full use has' been made of the various clinic services. The distribution of dried milk and vitamin preparations has been maintained. Through the kindness of the Grand Union Canal Carrying Company a depot has been established at Bull's Bridge Wharf where dried milk and vitamins can be supplied to expectant and nursing mothers and young children living on canal boats. The amount of dried milk and vitamin preparations supplied free or at a reduced cost shows a reduction but there is an increase in the gross sale and In the issue of vitamin preparations supplied by the Ministry of Pood. 3. The extent to which the domiciliary midwifery service Is being used is shown in the following table:- Year Total Births Domiciliary confinements in Borough Nursing home & hospital confinements in Borough Confinements outside Bo rough No. % W. M.H. N. H. Total % No. % 1933 1484 611 41.2 516 84 600 40.4 273 18. 4 1939 1566 650 41.5 479 114 593 37.9 323 20.6 1940 1368 633 46.3 425 70 495 36.2 240 17.5 1941 1261 573 45.4 323 94 417 33.1 271 21.5 1942 1447 597 41.2 542 135 677 46.8 173 12.0 1943 1600 580 36.3 476 189 665 41.6 355 22.1 1944 1556 478 30.7 480 185 665 42.8 413 26.5 It will be seen that an Increasing proportion of confinements take place elsewhere than in the mother's home. One of the causes contributing to this is certainly the difficulty of obtaining domestic assistance or the assistance of friends and relatives. The number of maternity cases given assistance under the Council's home-help scheme was 77 as compared with 51 in 1943 but owing to the shortage of suitable women for this work the demand could not be met in full. Foster-mothers are still in demand and careful watch has to be maintained to see that the children receive adequate care and attention and that overcrowding of foster homes in relation to staff or space is avoided. The water supply of the Borough is adequate and constant and apart from a few isolated cottages every house has a supply direct from the mains. The Sanitary Inspectors continue to give attention to food supplies and environmental conditions. Shortage of labour and materials continues to restrict the repair and maintenance of dwelling houses and deterioration and overcrowding are prevalent. At the end of the year 33 houses, subject to Demolition Orders, were still occupied. Complaints of milk being supplied in dirty bottles continue to be received. The shortage of bottles and labour has been prevalent in the milk trade but too many members of the public fail to apply the most elementary rule of hygiene in handling of milk bottles: a milk botule should be rinsed as soon as it is emptied and should not be used for other purposes. There is no evidence of a reduction in the misuse of milk bottles and the remedy would appear to be in the replacing of bottles by containers which can be used once only. In February 1944 Middlesex County Council delegated to the local Council their powers and duties under the Rats and Mice (Destruction) Act, 1919. To deal with this a Rodent Officer and one operator were appointed and work commenced in May. The responsibility for keeping premises free of rats and nice rests with the occupier. Some occupiers have expressed the view that the Council should make no charge for work done under the above Act. By whatever means rats and mice gain access to premises their continued presence there is generally due to conditions at the premises and it is proper that the occupier should be required to do something about it. During the year nuisance due to the emission of smoke and grit from factory chimneys has received attention. This nuisance has been severe on occasion and in each case the advice and assistance of the Ministry of Fuel and Power has been sought as the type of fuel supplied was given as the cause. The fuel has not always been the most suitable for the type of furnace but careless firing has been a contributory factor. In many factories the boiler attendant is given too many other duties with the result that the boiler firing does not get the regular attention necessary to reduce the emission of smoke to the minimum. The quantity of unsound food mentioned in the report as seized or surrendered refers to food from retail premises in the Borough, It does not include unsound food from N,A.A.F.I, or Govern- 4. merit bulk stores which is disposed of by the salvage section of the •Ivlinistry of Food. In addition to this 11,399 lbs. and 1051 tins were condemned following damage by enemy action. In August a small outbreak of food poisoning was reported. The onset of symptoms occurred 3-4 hours after taking lunch in a factory canteen in 10 out of 152 persons who had partaken of the meal. The illness was sufficiently acute in 2 cases to warrant admission to hospital but all made complete recoveries. Investigation suggested that roast lamb was the source of the trouble. Fingers, flies and filth are the main factors in the contamination of food and of these the most important is probably fingers: scrupulous cleanliness of the hands should be observed by all persons engaged in the handling, preparation, cooking and serving of food. A consideration of this Report will show that the general health of the inhabitants of the Borough has been naintained and even improved as compared with previous war years. A large volume of work has been carried out by the Department and my staff have given loyal and generous service. I.Iy thanks are due to the Chairmen and Llembers of the Committees for their support and consideration and to my colleagues in other Departments for their ready co-operation. I remain, Your obedient servant, A. AND2RS0N, Medical Officer of Health. 5 GENERAL STATISTICS. 1944 1943 population (Registrar-General's estimate). 92,370 95,080 Number of inhabited houses (rate books). 27,540 27,630 Number of houses erected during year. Rateable value of Borough. £944,922 £941,785 Sura represented by a penny rate. £3,908 £3,825 Live Births - legitimate - male. 737 748 - female. 700 721 illegitimate - male. 37 47 - female. 48 43 Birth rate per 1,000 population. 16.5 16.3 Birth rate per 1,000 population (England and Wales). 17.6 16.5 Still Births - legitimate - male. 21 17 - female. 11 18 illegitimate - male. - 3 - female. 2 3 Stll Birth Rate per 1,000 (live and still) births. 21.8 25.6 Deaths - male. 543 514 - female. 417 490 Death Rate per 1,000 population, 10.3 10.6 Death Rate per 1,000 population (England and Wales). 11.6 12.1 Infant Mortality Rate. 45.9 46.8 Infant Mortality Rate (England and Wales). 46 49 Maternal Mortality Rate. 1.9 0.62 Maternal Mortality Rate (England and Wales). 1.9 2.29 Out-relief disbursed to Heston and Isleworth residents. £16,166 £15,916 GENERAL PRO VISION 0F HEALTH SERVICES. 1944 1943 Laboratory facilities - specimens examined. 734 551 District Nursing - visits paid. 32,610 36,125 Ambulance Service - journeys re accident. 585 649 " " sickness. 2,499 1,710 Insluin - No. of vials dispensed, 884 670 6. GENERAL PROVISION OF HEALTH SERVICES. ( Continued) 1944 1945 Infant Welfare Centres - no. of sessions. 558 561 - attendances, (a) under 1 year. 18,423 20,438 (b) 1-5 years. 8,861 10,278 (c) all ages. 27,284 30,716 Ante-natal and Post-natal Clinics. Routine clinics - sessions. 250 257 - attendances. 5,225 5,089 Consultant clinics - sessions. 47 51 - attendances. 428 619 Total attendances. 5,653 5,708 Artificial Sunlight Clinic - children treated. 73 67 Orthopaedic Treatment - children treated. 41 38 Refraction Clinic - children examined. 48 48 Minor Ailments Clinic - children treated. 49 39 Speech Clinic - children treated. 6 2 Midwives - number notifying intention to practice. 43 46 - cases attended as midwife. 403 479 - cases attended as maternity nurse. 268 412 - percentage of cases where medical aid summoned. 29.5 38 - fees paid to medical practitioners. £123 £239 Municipal Domiciliary Midwife Service. No. of municipal midwives. 10 10 No. of cases booked - as midwife. 445 518 - as maternity nurse. 96 92 No. of cases completed - as midwife. 392 458 - as materniity nurse. 73 105 No. of visits - ante-natal. 3,495 2,777 - post-natal. 8,400 9,287 Home Helps - no. of cases where home help provided. 77 51 Convalescent Homes - no. of mothers sent. - no. of children sent. 1 7. GENERAL PROVISION OF HEALTH SERVICES. ( Continued) 1944 1943 Health Visitors - no. employed. 12 12 - attendances at M 6c O.W. clinics, etc. 1,670 1,673 - visits to mothers and children. 12,557 14,700 Child Life Protection. No. of foster children on register. 52 67 No. of visits by Health Visitors. 452 591 Dental Treatment of Mothers and Children. Total attendances of mothers and children. 2,644 2,612 No. of extractions - mothers. 1,502 2,069 - children. 232 310 No. of fillings - mothers. 703 402 - children. 54 135 No. of dentures supplied to mothers. 231 241 Milk and Other Poods Supplied Free or at Reduced Cost. Dried Milk (lbs.). 434 532 National Dried Milk (lbs.). 1,486 1,622 Virol (lbs.). 3i 11 Groats (tins). - 4 Cod liver oil (4 oz.). - 3 Cod liver oil emulsion (8 oz.). 1 23 Cod liver oil and malt (lbs.). 6 1 Lactagol (tins). 29 59 Bemax (tins). 76 109 Adexolin (-| oz.). 3 22 Adexolin Capsules. Cartons of 14. 5 11 Cod liver oil 8c malt with iron (lbs.). 9 36 Kalzana (tablets). 60 910 Celin (pkts. containing 30 tablets). - 6 Receipts from sales at cost price. £3,139 £3,051 Vitamin preparations distributed under Ministry of Food Scheme. Orange juice (bottles). 130,114 116,991 Cod liver oil (bottles). 14,161 15,251 Cod liver oil tablets. (packets). 3,230 2,526 8. GENERAL PROVISION OF HEALTH SERVICES. ( Continued) 1944 1943 Municipal Restaurants. 3 3 Meals supplied at municipal restaurants. 237,791 263,809 " " " school canteens. 756,645 901,391 Nursing Homes. No. registered at end of year, - nursing homes. 1 1 - maternity homes. - 1 - nursing and maternity homes. 2 1 Superannuation Acts. No. of employees examined. 3 6 Wartime Day Nurseries. No. of nurseries provided. 4 4 Accommodation for children (6-5 years). 189 189 Average daily attendance. 128 120 Scabies Clinics. No. of persons called for examination. 201 798 No. of above who attended. 96 518 Total no. of persons who attended. 1,042 1,566 No. of persons found to be suffering from scabies. 666 1,030 No. of persons who completed treatment, (a) under school age. 69 100 (b) school children. 325 536 (c) over school age. 249 338 No. of persons who did not complete treatment. 23 56 No. of persons in whom scabies recurred. 12 39 SANITARY CIRCUMSTANCES OF THE AREA. There was no significant change in the sanitary circumstances of the area as compared with 1943. A summary of the work of the inspectors in regard to general sanitation is given below 1944 1943 Visits and re-visits re complaint or remedy of nuisances. 12,902 15,974 Inspections of piggeries. 32 41 Inspections of stables, 53 197 Inspections of urinals. 12 11 9. SANITARY CIRCUMSTANCES OF THE AREA. (Continued) 1944 1943 Visits re infectious disease. 658 1,289 Smoke observations. 7 23 Inspections re offensive trades. 8 53 Inspections of tents, vans and sheds. 75 86 Inspections and re-inspections of shops re sanitary arrangements. 12 Inspections of factories, workplaces, etc. 474 1,342 Houses disinfested, 21 32 Inspections of canal boats. 7 31 Rats and Mice (Destruction) Act, 1919. Visits to premises re infestation. 886 No. of premises treated. 277 Estimated no. of rats killed. 4,305 HOUSING. 1944 1943 No. of new houses erected - by private enterprise. - by local authority. No. of houses inspected for .housing defects. 249 380 No. of houses found unfit for human habitation. - 9 No. of houses rendered fit by informal action. 162 266 No. of houses rendered fit by formal action. 37 46 No. of houses demolished in pursuance of Demolition Orders. - 9 No. of houses rendered fit in pursuance of undertaking. No. of houses where undertaking not to re-let accepted. - 9 No. of underground rooms closed. No. of houses known to be overcrowded at end of year. 73 74 No. of new cases of overcrowding found during year. 2 8 No. of cases of overcrowding relieved during year. 3 8 No. of houses demolished voluntarily. INSPECTION AND SUPERVISION OF rOOD. Inspections of dairies, etc. 88 214 Inspections of ice cream premises. 1 5 10. INSPECTION AND SUPERVISION OF FOOD. (Continued) 1944 1943 Inspections of bakehouses. 104 196 Inspections of slaughterhouses. - 3 Inspections of premises where food is sold or manufactured, - neat. 246 824 - fish. 83 225 - provisions. 909 1,161 - greengrocery and fruit, 285 665 - hawkers. 120 160 - food preparation. 535 912 - other foods. 47 114 Unsound food seized or surrendered (lbs.). 2,604 3,603 Unsound tinned food seized or surrendered (tins). 4,387 5,757 PREVALENCE OF INFECTIOUS AND OTHER DISEASES. 1944 Cases Notified. Deaths. 1943 Cases Notified. Deaths. Smallpox. - - - - Scarlet fever. 130 - 280 - Diphtheria. 11 1 5 - Erysipelas. 16 - 21 - Pneumonia. 50 56 116 63 Cerebro-spinal fever. 3 2 - 1 Epidemic encephalitis. - 1 - 1 Poliomyelitis and polioencephaliti s. 3 - - - Typhoid fever. - - 1 - Paratyphoid fever. - - - - Dysentery. 22 - - - Malaria. 1 - - - Tuberculosis. 186 44 203 49 Ophthalmia Neonatorum. 5 - - - Puerperal pyrexia. 87 - 105 1 Measles. 219 - 636 1 Whooping cough. 171 3 134 1 11. PREVALENTCE OF INFECTIOUS AMD OTHER DISEASES. (Continued) 1944 1943 Non-notifiable Infectious Diseases. German Measles. 603 45 Chicken Pox, 578 401 Mumps, 325 139 Disinfection - no. of rooms disinfected. 206 305 Hospital Treatment of notifiable Infectious Diseases. Total cases treated in hospitals. 223 348 Diphthiria Immuni sation. No. of attendances at clinics. 9,299 15,886 No. given certificates after immunising. 1,064 2,461 No. submitted to primary Schick test. 1,090 2,070 - Schick positive. 1,047 1,889 - Schick negative, 43 163 No. of cases of diphtheria in immunised persons. 2 No. of deaths from diphtheria in immunised persons. TABLE OF CAUSES OF DEATHS DURING 1944. (According to figures furnishti. by that Registrar General) Causes of Death Civil Residents al1 ages. Male Female. ALL causes 543 417 1 Typhoid and paratyphoid fever - - 2 Cerebro-spinal fever 1 1 3 Scarlet fever - - 4 Whooping co ugh 2 1 5 Diphtheria 1 - 6 Tuberculosis of respiratory system 30 11 7 Other forms of tuberculosis 2 1 8 Syphilitic diseases 2 2 9 Influenza 5 0 10 Measles - - 11 Acute polio-myelitis and polio-encephalitis - - 12 Acute infectious encephalitis 1 0 13m Cancer of buccal cavity and oesophagus 8 - 13f Cancer of uterus - 9 14 Cancer of stomach and duodenum 18 11 15 Cancer of breast - 14 16 Cancer of all other sites 54 38 17 diabetes 4 3 18 Intro-cranial vascular lesions 36 46 19 Heart disease 125 105 20 Other diseases of circulatory system 17 16 21 Bronchitis 35 14 22 Pneumonia 33 23 23 other respiratory diseases 8 4 24 Ulcerationl of stomach or duodenum 12 3 25 Diarrhoea under 2 years 3 1 26 Appendicitis 1 1 27 Other digestive diseases 9 11 23 Nephritis 10 6 12. TABLE OF CAUSES OF DEATHS DURING 1944. (Continued) Causes of Death Civil Residents all ages Male. Female. 29 Puerperal and post-abortive sepsis - - 30 Other maternal causes - 3 31 Premature birth 10 10 32 Cong, malformations, birth injury, etc. 14 11 33 Suicide 3 2 34 Road Traffic Accidents 14 4 35 Other violent causes 34 32 36 All other causes 51 31 13