AC 4399 SOUTHALL BOROUGH OF SOUTHALL ANNUAL REPORT OF THE Medical Officer of Health for the Year 1953 MARGARET A. GLASS, Medical Officer of Health KING AND HUTCHINGS, LTD., PRINTERS, SOUTHALL BOROUGH OF SOUTHALL ANNUAL REPORT OF THE Medical Officer of Health for the Year 1953 MARGARET A. GLASS, Medical Officer of Health INDEX page Ambulance Service 8, 22 Anti-Litter Campaign 4, 24, 25 Antitoxin 19 Area of Borough 5 Atmospheric Pollution 4, 34, 35. 36, 37. 38, 47 B.C.G. Vaccination 4 Bed bugs 26, 47 Births and birth rate 3, 10, 39. 41. 42 British Red Cross Service 22 Bulletin of infectious disease 12 Canal boats 26, 47 Cancer 3, 9, 16, 17, 18, 39, 4°. 43 Carbide 28 Care and after care 8 Catering establishments 4, 31 Cattle market 28 Causes of death 40, 42 Celluloid and Cinematograph Film Act 28 Chest Clinic 7 Children's welfare 8 Chiropody 4, 21, 25 Chlorination 6 Civic News Sheet 24 Community Centre 23 Cripples' Club 23 Day Nurseries 7 Deaths and death rates 3, 9, 39, 41, 42, 43 Deaths in wards 40 Demolition 28,48 Diphtheria 3, 9, 14, 24, 40, 41 Disinfection 18 Dysentery 12, 44, 43 Employees' medical examinations 25 Factories Act, 1937 26, 27, 47 Fog 4 Food handlers' hygiene and inspection of 29 Food hygiene 29 Food inspection 31 Food poisoning 29, 41, 43, 44 Food sampling 30, 32 Food shops 31,47 Foot health 25 Free washing facilities 29 Graphs 10, 17, 35, 36, 37 Health propaganda 4, 24 Health visitors 7 Heart disease 3, 9, 40 page Holidays for old people 4, 21 Holiday rest homes 8 Home accidents 12,24,49 Home helps 8,20 Home nursing 7, 22 Home visiting 21 Hospital services 7 Houses—number inhabited 5 Housing 4, 16, 28, 47, 48 Hygiene of food 4, 29 Hygiene—personal 29 Ice-cream sampling 30, 31, 47 Immunisation 3, 8, 14, 24 Infant mortality 3, 10, 39, 40, 41, 42 Infectious diseases, prevalence and control of 3, 12, 13, 14, 15, 16, 17,41, 43, 44, 47 Influenza 3, 13, 40 Inspection and supervision of food 24 Inspection of sanitary accommodation in factories 27 Laboratory facilities and work 30 Markets 28 Mass X-ray 4, 12, 15, 16, 24 Massage, establishments for 25 Maternal morbidity 11 Maternal mortality 9, 39, 40, 41 Maternity and Child Welfare 7 Meals sampling 32 Meals on Wheels 4, 20 Measles 3, 9, 12, 39, 40, 41, 43. 44 Meat and other foods 31 Medical examinations 25 Mental health 8 Middlesex County Council Services 7 Midwifery service 7 Milk licences 29 Mortuary 26 National Assistance Act, S.47 21 Notifiable diseases 3, 9, 12, 13. 14. 15. 16, 41. 43. 44 Noise nuisance 33 Nursing equipment 7, 22 Old People's Survey 20, 21 Old People's Welfare 4, 12, 20 Old People's Welfare Committee 4,20 Ophthalmia neonatorum 14 page Outworkers 27,47 Overcrowding 4, 16, 28, 47, 48 Parks and open spaces 5, 6 Pet Animals Act 28,47 Petroleum Acts 28, 47 Physical features of the district 5, 6 Poliomyelitis 3, 9, 12, 13, 40, 41. 43. 44 Population 5 Premature infants 3, 11 Propaganda—Health 4, 24 Public Health Committee 3 Puerperal pyrexia 12, 41, 43, 44 Rag Flock and Other Materials Filling Act 27 Rateable Value 5 Rats and mice 33.47 Rehousing 28, 48 Respiratory diseases 3, 13, 40, 42 Rivers—Pollution 38 Road accidents 9, 40 St. John Ambulance Service 22 Sanitary circumstances 26 Sanitary inspection 26, 47 Sanitation in schools 26, 47 Scabies19 Scarlet fever 3, 14, 41, 43, 44 School medical service 8 Shops Acts 28, 47 Smallpox 8,13 Smoke pollution 24,47 Social conditions 5, 6 S.O.S. cards 4, 21 Staff 4, 5 Statistics—General and Vital 5, 8, 39, 41, 48 Statutory action 48 Stillbirths 39 Sulphur dioxide pollution 34, 35. 36, 37. 38 Swimming bath 6 Tuberculosis 3, 4, 7, 9, 15, 17. 4°. 44. 45 Unfit houses 48 Vaccination 3, 8, 13, 14 Vaccine lymph 19 Verminous persons 4, 19, 46 Vital statistics 9, 39, 41 Water supply and service 26, 47 Welfare—General and Old People's4, 22, 23 2 THE COUNCIL OF THE BOROUGH OF SOUTHALL, 1953 HIS WORSHIP THE MAYOR *Councillor J. G. P. Dormer, J.P. Deputy Mayor: Councillor J. Salmon. Aldermen: *Dane, A. T. Douglas, H. C. *Gardner, F. E. f*LowE, J. {Chairman). Hopkins, W. H. Marks, F. J., J.P. Councillors: *Barrett, J. †*bldwell, S. J. *Cavell, Mrs. I., J.P. Dormer, J. G. P., J.P. *Errington, F. G. Godman, A. S. Haigh, J. Hook, R. E, Love, P. J. Lye, A. E. *Salmon, J. †*SHEIL, E. J. Shepherd, A. H. Southey, P. G. Steele, T. J. *Ward, J. H. White, H. J. *Williams, Mrs. V. G. I. *Members of the Public Health Committee. †Members of the Area Health Committee (Area No. 9). To the Mayor, Aldermen and Councillors of the Borough of Southall. MR. MAYOR, LADIES AND GENTLEMEN, I have the honour to present the 57th Annual Report on the health and circumstances of the population of the Borough of Southall for the year 1953. The health of the people continued to be good. The birth rate, which has been falling annually since 1946, rose in 1953 to 13.22 from 12.94 in 1952 The death rate fell from 9.33 in 1952 to 9.18 in 1953. Both of these rates are exclusive of deaths occurring within the long-stay institutions inside the Borough. Heart disease, coronary disease and cancer were the principal causes of death. There was an increase in the number of infant deaths in 1953, giving an infant mortality rate of 29.45 Per thousand live births, as against 19.83 the previous year. The fact that 9 of these infants were born prematurely, one died of birth injury, and one of whooping cough, combined with the fact that there was an increase in the number of premature still births, and of premature infants born alive, suggests that more ante-natal care, and more instruction in pre-natal hygiene and in the prevention of infectious disease are required for expectant mothers. The total number of infectious disease notifications was higher than during the previous year. This was principally due to measles and whooping cough. No case of diphtheria has been notified in the Borough of Southall since 1950. The number of notifications of scarlet fever has increased for the second year in succession, and it was noteworthy that in 10 instances secondary cases occurred where the child was nursed at home, home isolation having been insufficient to prevent the spread of the infection. There was a decrease in the number of cases of poliomyelitis, only four occurring, but of these two were rapidly fatal. A nation-wide outbreak of influenza occurred during the early part of 1953, and nine deaths from this cause were reported in Southall. The number of infants brought for vaccination showed a considerable increase during 1953, and arrangements were made by Middlesex County Council for the provision of facilities for vaccination at County Clinics. The anti-diphtheria immunisation figures remained steady, showing neither an increase nor a decrease. There was a fall in the number of notifications of tuberculosis from 123 in 1952 to 91 in 1953; the number of deaths, however, from this cause rose from 9 in 1952 to 12 in 1953. 3 During the latter part of the year, a very successful visit was paid by the Mass X-ray Unit to Southall. During the three weeks of their visit, 9,929 persons were X-rayed, and thanks were due to the many voluntary associations who gave help in various ways before and during this visit. Two schemes of investigation and research concerning tuberculosis, one inaugurated by the Medical Research Council on the usefulness of B.C.G. vaccination for school leavers, and the other by the Mass X-ray Unit for the investigation of the occurrence of tuberculosis in adolescent workers, have been begun and in each of the schemes Southall has been allowed to take part. The work is done on volunteers from amongst the children about to leave school, and the response has been very good. Requests for help in the safeguarding of the welfare of old people have continued to come in during the year, and the work of die Department in this connection has been made lighter by the increasing facilities available, through the visits and schemes of the Old People's Welfare Committee, for the discovery and rehabilitation of old people before they develop into cases requiring hospital attention. The work done in providing holidays, meals, chiropody and home visiting increased during the year, and a new scheme was instituted for the provision of S.O.S. cards to be used in the windows of homes where old people living alone might become suddenly in need of help. Particular features of the health propaganda programme for the year were the Anti-Litter Campaign designed to educate the public in maintaining the cleanliness of the district, particularly from the public health point of view, the Anti-Diphtheria Immunisation Campaign, which was part of a nation-wide scheme for the improvement of the attendance for immunisation of the parents of young children, and the Mass X-ray publicity in preparation for the visit of the Unit. It appears from the statistics concerning infestation with vermin or scabies that it may be reasonable to assume a great improvement in the amount of infestation throughout the district. Atmospheric pollution has been much in the public mind since the occurrence of the great fog of December, 1952, and complaints with regard to offending chimneys necessitated a considerable amount of investigation, as will be seen from the table of sanitary inspections. The problems of overcrowded houses, of increasing dilapidation of property through neglect because of the cost of repairs, and of maintaining a high standard of hygiene in food shops and catering establishments, continued to absorb the major part of the time of the sanitary inspectorate, while the high number of visits paid in connection with rat infestation suggests that, since the end of rationing, not enough care is being taken by members of the community, whether householders or food factory or shop employees, with regard to food waste or spillage, and so our gardens and yards and even our streets begin to supply the nourishment which could attract vermin and encourage their breeding. Acknowledgements are due to those who have so kindly supplied information for use in this Report—the County Medical Officer, the Area Medical Officer, the Secretary of the Uxbridge Group of the North-West Metropolitan Regional Hospital Board, the Medical Superintendent of St. Bernard's Hospital, the Physician of Uxbridge Chest Clinic, the County Public Control Officer, Chief Officers of the Borough Council, the directors of many local organisations devoted to social service, officers of the Fuel Research Station, and the general practitioners of Southall. I should also like to extend my sincere thanks to the Chief Sanitary Inspector and to all members of the Departmental Staff in acknowledgment of their help in the preparation of this Report, and also for their loyal support at all times. I am, your Worship, Ladies and Gentlemen, Your obedient Servant, Manor House, Southall. Medical Officer of Health. 4 HEALTH DEPARTMENT STAFF for the year 1953 Medical Officer of Health: Margaret A. Glass, B.Sc., M.B., Ch.B.(Glasgow), D.P.H.(Cantab.). Sanitary Inspection Staff: Chief Sanitary Inspector: R. W. McDonald, Cert. S.I.B., Cert. M. & F. Deputy Chief Sanitary Inspector: S. Sadler, Cert. S.I.B., Cert. M. & F., R.S.I. Smoke Certificate. District Sanitary Inspectors: R. Stockley, Cert. S.I.B., Cert. M. & F., R.S.I. San. Sc. D. G. Martin, Cert. S.I.B., Cert. M. & F. (Resigned 31.5.53.) F. G. S. Hill, Cert. S.I.B., Cert. M. & F., Cert. I. San. E., R.S.I. San. Sc. B. J. Parsons, Cert. S.I.B., Cert. M. & F. (Promoted District Sanitary Inspector from 1.6.53.) Additional Sanitary Inspector: B. J. Parsons, Cert. S.I.B., Cert. M. & F. (Until 1.6.53.) General Assistant: B. J. Tolworthy. (Resigned 17.10.53.) B. E. Coleman. (Appointed 19.10.53.) Clerical Staff: Senior Clerk: Mrs. K. Jones. Clerks, Shorthand-Typists: Mrs. W. M. Crosfield. Miss S. McAllister. (Resigned 2.5.53.) Miss K. M. Thorpe. (Resigned 16.5.53.) Miss J. E. Castell-Evans. (Appointed 15.6.53.) Mr. N. D. Tarsey. (Appointed 13.7.53, resigned 30.11.53.) (National Service.) Mrs. K. N. Malam. (Appointed 23.11.53.) GENERAL STATISTICS AND SOCIAL CONDITIONS OF THE BOROUGH Area (acres) 2,607762 Population—Registrar-General's estimate (Mid-1953) 54,910 Number of inhabited houses according to Rate Book 14,536 Average number of occupants per house 3-78 Sum produced by a penny rate £1725 The Council control the following parks and open spaces:— Brent Meadow 4.70 acres Cranleigh Gardens 2.00 acres Dormers Wells Housing Site 2.99 acres Dudley Road Island 0.13 acres Durdans Park 29.55 acres Football Ground, Western Road 3.51 acres Frogmore Green 0.35 acres Jubilee Park 11.13 acres 5 GENERAL STATISTICS AND SOCIAL CONDITIONS OF THE BOROUGH—continued. Lady Margaret Road 0.25 acres Lea Road 0.13 acres North Road Island 0.35 acres Norwood Green 7.25 acres Queens Road 0.13 acres Recreation Ground 18.00 acres Southall Municipal Sports Ground 19.78 acres Southall Park 26.77 acres Swimming Bath Site, Dormers Wells 10.50 acres The Manor House 2.00 acres Viaduct Field 4.22 acres West Middlesex Golf Course 108.00 acres Western Road 0.17 acres Wolf Fields 3.33 acres Wolf Green 0.18 acres Total 250.71 acres For general administration purposes and for the main statistical purposes of this report, the district is divided into six wards, Waxlow Manor, Northcote, Hambrough, Dormers Wells, Glebe and Norwood Green. The majority of the houses in the district are occupied by good-class working people, chiefly engaged in the local factories and workshops. These include food, jam, and chemical works, engineering, medical and toilet preparations, paint, dye, and wood works, laundries, etc. There are no trades carried on which are at present scheduled as offensive trades. Southall Borough Council maintains a swimming bath situated in the Recreation Ground, Southall, which is one of the public parks. The surface area of the bath is 3,600 square feet (120 feet by 30 feet), cubic capacity 16,500 cubic feet (110,000 gallons). The water is treated by break point chlorination, and a normal chlorine content of 1 -o parts per million at the shallow end, and 0-7 at the deep end is maintained. During peak periods this is increased to 4-0 parts per million at the shallow end in order to obtain 2-0 parts per million at the deep end. Three samples of the water are taken daily by the staff for chlorine and other chemical testing. As this bath is an open one, the attendance varies to a great extent according to weather conditions. During 1953, the total number of persons using the bath was 39,020. The average number of persons attending per day (wet or fine) was 255. The maximum number at any one session was 500. 6 HEALTH SERVICES PROVIDED BY OTHER AUTHORITIES North-West Metropolitan Regional Hospital Board Through the Uxbridge Group Management Committee this authority maintains two hospitals in Southall, the Southall-Norwood Hospital (30 beds) for treatment of general medical and surgical cases and casualties, and Mount Pleasant Hospital (79 beds) for the treatment of male patients suffering from tuberculosis. St. Bernard's Hospital is managed by its own Committee and is for the reception of cases of mental and nervous disorders; it has 2,421 beds and takes patients from an extensive area, comprising parts of Berkshire, Buckinghamshire and Middlesex, including the Borough of Southall. Voluntary, temporary and certified patients of all types are admitted, and all modern forms of treatment are carried out. Other hospitals outside the Borough which are used to a considerable extent by patients from Southall are Hillingdon Hospital, West Middlesex Hospital, and King Edward Hospital, Ealing. The Uxbridge Chest Clinic is the regional centre to which residents of the Borough of Southall may be referred regarding chest disorders. It is also the regional centre for the diagnosis, treatment, after-care and prevention of tuberculosis (both pulmonary and non-pulmonary). Persons may be referred there by their own doctors, from Borough Clinics, etc. Special " X-ray only " Clinics are available without appointment, otherwise persons are seen by appointment. There are female beds under the surveillance of clinic physicians at Hillingdon Hospital and male beds at Mount Pleasant Hospital. At this latter Hospital special treatment clinics are available for the convenience of Southall patients. County Council of Middlesex—Health Department The County Council of Middlesex is the Local Health Authority under the National Health Service Act, 1946, and provides the following services in the Borough. (a) Care of Mothers and Young Children Ante-Natal Clinics Infant Welfare Clinics Jubilee Gardens Centre, Northcote Avenue, and Featherstone Road School Clinics. Diphtheria Immunisation, Vaccination and Whooping Cough Immunisation Clinics Jubilee Gardens Centre and Featherstone Road School Clinics. Ultra Violet Light Clinic Northcote Avenue Clinic. Day Nurseries No. 2. Recreation Ground. No. 4. Spikes Bridge, Municipal Sports Ground. Priority Dental Service for expectant and nursing mothers and children under school age. (b) Midwifery Service Certified Midwives are employed, for attendance on women in their homes in the Borough, as midwives or as maternity nurses during childbirth. (c) Health Visitors Health Visitors are employed to undertake home visiting for the purpose of giving advice on the care of young children, to persons suffering from illness, to expectant and nursing mothers, and on the measures necessary to prevent the spread of infection. (The Health Visitors also act as school nurses.) (d) Home Nursing and Nursing Equipment Home Nurses are employed to undertake the nursing of persons in their own homes. (This work was formerly undertaken by " District Nurses.") 7 Where nursing equipment is required for use in the home, it is available on loan through the British Red Cross Society. [e) Vaccination and Immunisation In addition to the vaccination and immunisation of infants and young children carried out at the clinics already referred to, vaccination against smallpox and immunisation against diphtheria is carried out by those general practitioners who have agreed to co-operate in the County Council scheme. (/) Prevention of Illness, Care and After Care The County Council's scheme includes provision for the admission of suitable cases to recognised recuperative homes. (Such cases should not be in need of medical or nursing care.) The care and after care of tuberculous persons is dealt with through the Welfare Officer at the Chest Clinic. (g) Domestic Helps Home Help for householders where this is required owing to the presence of a person who is ill, lying in, an expectant mother, mental defective, disabled or aged, or a child not over compulsory school age within the meaning of the Education Act, 1944, is provided under the County Council's scheme. ([h) Ambulance Service An Ambulance Service is provided for the removal to hospital, where necessary, of accident and sickness cases. This service is organised in association with the Fire Service. There is one Ambulance Sub-Station situated in Southall beside the Town Hall. (i) Mental Health Service The Mental Health Service deals with persons suffering from mental deficiency or mental illness. (/) School Medical Service Medical inspection and dental inspection of school children are arranged by the County Council through the Southall Divisional Executive. Medical treatment and dental treatment are provided by the County Council in the Borough as follows:— Minor ailments treatment Northcote Avenue and Featherstone Road School Clinics. Orthopaedic treatment Northcote Avenue Clinic and Jubilee Gardens Centre. Ophthalmic treatment Northcote Avenue Clinic. Physiotherapy Northcote Avenue Clinic and Jubilee Gardens Centre. Ultra Violet Light treatment Northcote Avenue Clinic. Northcote Avenue Clinic. 13 King Street. Talbot Road School. County Council of Middlesex—Children's Department The County Council, through the Children's Department, is also concerned in caring for children deprived of a normal home life. Area Children's Officers have been appointed to deal locally with such cases as they arise. 8 VITAL STATISTICS Whole District Total deaths, 731. (Males 337; Females 394.) Crude Death Rate, 13.31 (including deaths in St. Bernard's Hospital, Norwood Hall and Vine Cottage); 9.18 (excluding these deaths). For extracts from vital statistics and causes of death, see Appendix, Tables I and II. Deaths and Death Rate A new system of allocation by the Registrar-General of deaths in districts commenced on the 1st January, 1953. Deaths occurring in long stay hospitals are now included as local deaths, even though the persons concerned may still have private addresses in other districts or in other parts of the country. As we have in Southall a very large mental hospital and two homes for chronic sick or aged persons, the new allocation causes a large increase in the calculated death rate, and there are no means of comparing this with figures for previous years. However, by subtracting these institution deaths from the total, a reasonably accurate figure can be obtained for the purpose of comparison with the 1952 crude death rate of 9.33, and this figure was 9.18, therefore, there was a reduction in the death rate for Southall residents other than those in institutions. Heart disease, coronary disease and cancer were the principal causes of death, and, owing to the inclusion of institution deaths, there was a substantial increase in the figures for each of these, but it must be remembered that the average age of the occupants of St. Bernard's Hospital, of Norwood Hall, and of Vine House, is likely to be well above that for the rest of the Borough, and, in fact, deaths from these causes occurring in the institutions amounted to 48 heart disease, 24 coronary disease and 14 cancer, respectively. It is pleasing to be able to record another year without a death from diphtheria. Less happy is it to note that measles and whooping cough each claimed one victim by death, that one mother died in hospital following her confinement, and that the number of deaths from tuberculosis rose from 9 in 1952 to 12 in 1953. Two died of poliomyelitis, both deaths occurring shortly after hospital admission, and after sudden onset of the disease. There were 7 who died after involvement in accidents on the roads, 1 more than last year. The number of outside deaths, i.e. of Southall residents who died in Hillingdon Hospital, other Middlesex hospitals and hospitals outside the County boundaries, including various London Hospitals, was 231 (males 135 and females 96). Deaths of institution inmates (including patients from Southall addresses and from outside areas) number as follows: St. Bernard's Hospital, 190 (males 69 and females 121); at Mount Pleasant Hospital, 2 (all male); Southall-Norwood Hospital, 9 (5 male and 4 female); Norwood Hall, 35 (2 male and 33 female); Vine House, 3 (all female); in addition 21 deaths (17 male and 4 female) occurred of persons belonging to other districts and residing temporarily in Southall. Of the 5 persons killed in road accidents in Southall during 1953, 2 were pedal cyclists, 2 motor cyclists and 1 a pedestrian. Although there was no particular black spot in which several fatal accidents occurred, it was noteworthy that of the 5, 4 happened on the main arterial road from east to west, and 3 of these at sections of the road where the dual carriage way would seem to offer more prevendon, because of one way traffic and islanding of the road. To make an approximate allowance for the way in which the sex and age distribution of the local population differs from that of England and Wales as a whole, the crude death rate is multiplied by a comparability factor supplied by the Registrar-General. This then gives a comparative death rate of 14.24 including institutional deaths, or 9-82 excluding these, compared with the rate for England and Wales as a whole, i.e. 11.4. For distribution of deaths in the various wards, see Appendix, Table III, and for the comparison of general birth and death rates and rates of maternal mortality, see Appendix, Table IV. 9 b Births and Birth Rate. (Figures for 1952 are given in brackets.) The total number of registered births in the district fas notified under the Births and Deaths Registration Act) was 145 (136). The total number of live births belonging to the district, whether occurring within or outside the district was 713 (706). The illegitimate live births were 31 (26). There were 13 stillbirths (11), of these 10 were legitimate and 3 illegitimate. A slight rise in the birth rate (live and still births) is recorded from 12.94 1952 to 13.22 in 1953. This is the first increase in a rate which has been falling annually since 1946. To make an approximate allowance for the way in which the sex and age distribution of the local population differs from that for England and Wales as a whole, the birth rate is multiplied by a comparability factor supplied by the Registrar-General. This gives a live birth rate of 12.85 to compare with the corresponding rate for the whole of England and Wales, which was 15.5. Infant Mortality The fall in the infant mortality which was so noteworthy and so gratifying in previous years has suffered an abrupt check during 1953. 21 infants died during that year, as Infant Mortality Rate from 1900 to 1953 10 compared to 14 during 1952, giving an infant mortality rate of 29.45 Per 1,000 live births, as against 19.83 in 1952. Of these 21 deaths, 3 died at home and 18 in hospital. 16 infants (8 male and 8 female) died within the first 4 weeks after birth. In Table VI, which gives the causes of infant deaths under the age of 1 year, it can be seen that 9 of these infants were born prematurely, 1 died of birth injury and 1 died of whooping cough. All of these cases can be considered as preventable. 2 infants who died from other causes had also been born prematurely and the question arises with regard to the premature infant deaths as to whether ante-natal care had been insufficient to prevent this occurrence. Graph A, on infant mortality rates, shows the trend of the infant mortality rate since 1900. The infant mortality rate for England and Wales as a whole was 26.8. Premature Infants Forty-eight premature infants were born during the year and there were 9 premature still births. 38 of these premature infants were surviving at the end of 1 month. Out of the 48 born alive, 44 were born in hospital, 3 at home and 1 in a nursing home. Of the premature still births, 7 were born in hospital and 2 at home. The classification of a premature infant is given to a child born prematurely or which weighs less than 5½ lbs. at birth. Maternal Morbidity Seven cases of puerperal pyrexia were notified. There was 1 maternal death, postoperative, the first since 1950, and no deaths associated with abortion. 11 PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES During 1953, the only new legislation with regard to infectious disease was the issue of the Public Health (Infectious Diseases) Regulations, 1953. The purpose of these Regulations was to amplify the precautionary measures to be taken in cases of typhoid fever, paratyphoid fever, other salmonella infections, dysentery and staphylococcal infection likely to cause food poisoning; to give increased power with respect to persons who are carriers of these diseases as well as to persons suffering from them; to prevent the entry into employment involving the handling of food of such carriers, and to empower the Medical Officer of Health to issue emergency notices when a risk of the spread of these diseases seems likely. The total number of infectious disease notifications received during the year was higher than in 1952, being 1,836 compared with 844 the previous year. This year's figure is practically identical with that for 1951—the main part of the increase being due to measles and whooping cough in both years. An increase in the number of notifications from scarlet fever was observed for the second year in succession. Infection was not severe but secondary cases occurred in 10 instances where children were nursed at home, and in each of 3 homes 2 cases of secondary infection occurred. It seems reasonable to consider that some of the secondary infection might not have occurred if hospital isolation had immediately been available for the primary cases. Notifications of puerperal pyrexia were 7, as compared with 7 in 1952. Particulars with regard to measles and poliomyelitis are mentioned specially under separate headings. Monthly Bulletins of Incidence of Infectious Disease These bulletins were circulated monthly to all general practitioners in the Borough, and, in addition to information with regard to infectious diseases occurring during the previous month, any topical matter, or incident of mutual interest to general practitioners and the Public Health Service, was also included; for instance, Home Accidents statistics, Old People's Welfare information, advance notice and request for assistance with Mass X-Ray Unit visit, etc. Measles Notifications of measles rose during the year 1953, being 931 as compared with 528 the previous year. There was 1 death from measles. The following table shows the trend of notifications during the past 10 vears. Year No. of Cases Deaths 1944 367 ... 1945 500 1 1946 21 ... 1947 334 - 1948 825 1 1949 194 - 1950 701 ... 1951 1,129 - 1952 528 - 1953 931 1 Poliomyelitis Six notifications were received of acute anterior poliomyelitis; of these 4 were subsequently confirmed as poliomyelitis, 2 paralytic and 2 non-paralytic. 2 deaths occurred from this disease, 1 of a notified paralytic case and 1 of a notified non-paralytic case. Particulars of the paralytic cases notified in 1953 and of those notified during the past 5 years and known to be still showing paralysis in 1952 are as follows:— 12 1953 : Case A. Paralysis of left Girl aged 9. Full recovery. leg. 1952: Case B. Paralysis of both Adult male. Full recovery. legs. Case C. Paralysis of left Boy now aged 2 years. Paralysis persists and growth of leg leg. is retarded. Continuing physiotherapy. Case D. Paralysis of both Boy now aged 4 years. Very great improvement. Full legs. recovery of power. Some shortening of right leg and foot for which a special boot is to be made and physiotherapy continued. Case F. Paralysis of limbs Adult female. Continues to make progress, but slowly. and trunk. Both legs paralysed, both arms weak. Attends hospital for physiotherapy. Case G. Paralysis of both Boy now aged 13 years. Continues to make progress, legs. Walks well. Wears caliper for right leg. 1950: Case A. Paralysis in left Adult male. Residual partial paralysis left leg. At work, leg- Case B. Paralysis in both Boy now aged 6 years. Continues to improve. Still slight legs. weakness left leg. Case C. Paralysis in arms, Girl now aged 18 years. Continues to make slight progress. etc. Residual paralysis in legs—but has increased muscle tone in toe muscles, quadriceps. Continues physiotherapy treatment and travels in motor wheel chair. 1949: Case B. Paralysis anterior Girl now aged 13 years. Almost full recovery. Physiotibials, etc. therapy not required. Influenza There was a considerable amount of influenza during the early part of the year 1953, many cases being known to be due to Virus A and of serious character. 9 deaths from influenza were reported, 3 male, 6 female. The ages at death varied from 41 to 84, and these deaths occurred between 21st January, 1953, and 12th March, 1953. It is likely that this was yet another sequel to the great fog of December, 1952, in that lowered resistance and resultant bronchitis or pneumonia made the patients succumb to the further attack by influenza virus. Smallpox (Variola) No patients with smallpox, but 2 contacts of cases of smallpox were notified to the Department from the Port Authorities during the year. Observations were maintained on the 2 contacts during the incubation period in which symptoms of the disease might develop. Vaccination Against Smallpox It is very satisfactory to be able to report, for 1953, a considerable improvement of the vaccination figures. The details are shown in the table below with the comparative table for 1952, and from this it will be seen that the rise in the total number of primary vaccinations amount to 66% over the 1952 figure. Of 713 children born, 310 received vaccination during the first year of life, and this is the highest figure recorded for many years. It is interesting to speculate how much of this increase may have been due to the nation-wide publicity campaign carried out by the Ministry of Health in co-operation with the local health authorities and local sanitary authorities, and how much to the institution of facilities at County Council Clinics for the vaccination of children. Figures supplied by the Area Medical Officer show that 135 children under the age of 5 received primary vaccination at County Council Clinics in Southall from April to December, 1953. 1953 Age Groups Under 1 year 1-2 years - 4 years 5-14 years 15 years and over Total Primary Vaccination 310 24 22 33 24 413 Re-vaccination - - 4 9 88 101 13 1952 Age Groups Under 1 year 1-2 years 2-4 years 5-14 years 15 years and over Total Primary Vaccination 195 8 15 25 30 273 Re-vaccination 3 1 2 20 94 120 Scarlet Fever (Scarlatina) The number of notifications received during the year was 131 as compared with 104 for the previous year. 16 cases were admitted to hospital for isolation and treatment, and 115 were nursed at home. Secondary cases occurred in 13 instances where the first case was nursed at home, 3 of these households had each 3 members suffering from scarlet fever. Diphtheria No cases of diphtheria were notified to the Department. The following information supplied by the County Medical Officer shows the number of children immunised against diphtheria during the year. Number of Children who completed a full course of Primary Immunisation in Southall during the year Number of Children who were given Secondary or Reinforcing Injection during the year (i.e. having in a previous year received a complete full course) Age at Date of Final Injection Under 1 1-4 5-14 Total 235 274 27 536 585 In the following table is shown the number of children at 31st December, 1953, who had completed a course of immunisation against diphtheria at any time before that date:— Age at 31.12.53: Under 1 1-4 5-9 10-14 Total under 15 Number immunised 83 1,939 3,868 2,982 8,872 The number of children immunised for the first time during 1953 was 536 as compared with 540 in 1952. The percentage of children receiving primary immunisation against diphtheria appears not to have fallen as compared with 1952, although the figure is not so high as in years previous. The number of children obtaining reinforcing injections increased considerably from 317 in 1952 to 585 in 1953, and the figures as a whole are satisfactory, though an increase in the number of children protected by immunisation against diphtheria is still desirable. Ophthalmia Neonatorum No cases of ophthalmia neonatorum were notified during the year. Distribution of Infectious Disease Notifications For the incidence of various infectious diseases notified during the year, under age groups and locality see Appendix, Tables VIII and IX. 14 Infectious Disease Visits During the year, the Sanitary Inspectors paid 423 visits with reference to cases of infectious disease. In addition, the County Health Visitors did a certain amount of home and school visiting in connection with infectious diseases. Tuberculosis Pulmonary Tuberculosis The number of new cases notified during the year was 88. Other Forms of Tuberculosis The number of new cases notified during the year was 3. Of the total notifications 6 were received from Medical Practitioners; 63 from the Uxbridge Chest Clinic; 7 from General Hospitals; 2 from Special Hospitals; 12 from St. Bernard's Hospital; and 1 from Hammersmith Chest Clinic. Deaths from Tuberculosis Tuberculosis of the respiratory system, 12; other forms, nil. For details of new cases notified and deaths in 1953, see Appendix, Table X, and for the occupation of new cases see Appendix, Table XI. Public Health (Prevention of Tuberculosis) Regulations, 1925 Public Health Act, 1936, Section 172 Action under these powers was not necessary during the year. The number of new notifications fell from 123 in 1952 to 91 in 1953. This, while a considerable improvement, did not constitute a record low figure for notifications—as in 1951, the number was down to 80. The number of deaths from tuberculosis was 12, 4 of which occurred in St. Bernard's Hospital, the corresponding number for 1952 being 9, excluding St. Bernard's Hospital deaths. Of the 12 deaths 3 had not previously been notified as cases of tuberculosis. It appears, therefore, that there are still cases of tuberculosis who seek treatment or are discovered too late for medical skill to be effective in saving their lives, and the use of the Mass X-ray Unit for periodic review should limit the likelihood of this occurring. The Mass X-ray Unit of the North-West Metropolitan Regional Hospital Board paid a visit to Southall from 28th September until 15th October, in 1953. Careful and extensive preliminary publicity was arranged for, the first step in this being to convene a meeting of representatives of voluntary organisations in the Town Hall with the Mayor as Chairman, and with the Medical Director and Liaison Officer of the Mass X-ray Unit as speakers. At this meeting, the representatives were asked to assist in every way they and their organisations could with publicity of the forthcoming visit, in order that the greatest attendance possible of the general public should be obtained during the Unit's stay. The local Press was extremely generous with its space both in reporting this meeting and in giving pubUcity at other times prior to and during the visit of the Unit. Propaganda leaflets were delivered into each household by members of the various organisations and poster publicity was also used. A number of booking offices were made available by the Borough Council, by voluntary organisations, namely the British Red Cross, the Women's Voluntary Service, the Church Army, and the authorities of St. George's Parish Church and also by the Middlesex County Council, whose Clinics were made available for booking purposes. The effect of this advance publicity and the making of convenient centres for booking was that a splendid response was obtained and during the visit of the Mass X-ray Unit there was an unprecedented number of bookings obtained, so that the Unit carried out more work per session than it had previously been required to do in any district. The total numbers attending at the King's Hall, which was used for the actual work of the Unit, 15 and kindly made available by the authorities of the King's Hall Methodist Church, was 7,234, 3,168 male and 4,066 female. Of these, 85 in all were recalled for further investigation and out of this number positive cases found were 3 male and 6 female. Cancer of the lung was also discovered in 4 cases, 3 male and 1 female. At the end of the visit, the Unit went to the Associated Equipment Company's premises in Southall in order to carry out a survey of employees of that factory; 2,695 persons were examined there in all, 2,425 male, 270 female; and 1 male was found to be positive. It will be seen that the total number of persons examined during the 3 weeks was, therefore, 9,929, and the number of cases of active tuberculosis found amongst Southall residents and people working in Southall was 10, i.e. less than 1 per thousand. This is quite a satisfactory figure. The analysis of the housing conditions of new cases shows that in 70 of 78 notified patients living in Southall, exclusive of the St. Bernard's Hospital notifications, housing conditions were good in 59 instances. 8 patients were living in overcrowded homes, in 4 cases amounting to statutory overcrowding, and 3 were found to be living in houses affected with dampness of a remedial nature, to which attention was given at once. In 9 instances the homes of the newly notified cases already contained cases of tuberculosis, in 3 of these homes there were already 2 cases, and in 1 the new notification was the fourth in the same household. In 2 of these cases of multiple notifications overcrowding was present. The housing conditions of the remaining 8 notified cases were not available, either because the case was an inward transfer from another district, or because removal occurred too soon for a visit to be paid by the Chest Clinic Officer, or for some other similar reason. Tuberculosis Vaccine Clinical Trial—Medical Research Council Scheme. At Easter, 1951 j young people attending secondary schools in Southall were invited to volunteer to join this trial which was for the purpose of determining the value of tuberculosis vaccines if used for the general population in the same way as diphtheria immunisation. Until Easter, 1952, all young people in their last two terms at the secondary modern schools were invited to join, and if they agreed each volunteer was given an X-ray, and skin test, and those giving unsatisfactory results were vaccinated with B.C.G. vaccine. All the young people concerned are being followed up to determine the value of the vaccine. The follow up consists of a postal form sent to each volunteer once a year, a visit from the Health Visitor, and an annual chest X-ray. Those who moved to other districts are followed up if possible, and even those who emigrate can be kept in touch. This is all part of a larger scheme for volunteers in London, Birmingham and Manchester and including 54,000 young people. It is too early yet to obtain results from the follow-up of these cases, but it is hoped that much interesting information will be available for a subsequent report. Research into incidence of new tuberculosis in the adolescent. A trial scheme for the investigation of high incidence of tuberculosis amongst young adults, by means of an examination of school leavers, and an annual review of those subsequently volunteering to enter the scheme, was begun in October, 1952, by the staff of the Mass X-ray Unit. Part of the scheme also consists in preliminary propaganda in the schools and the distribution of explanatory letters to parents. Ten education areas in Middlesex were brought into this scheme, including Southall, and in this Borough 855 school leavers were invited to take part (440 boys and 415 girls). Of these, 523 consented to do so (258 boys and 265 girls). This response is very good indeed and is much higher than that obtained in any other of the education areas concerned. The full results of this scheme will not, of course, be available for a number of years as it is designed to cover a ten year age group, i.e. 15 to 24, and the incidence of tuberculosis morbidity during the 10 years after leaving school, and the value of these results will depend, to a great extent, on the continued co-operation of the individuals concerned in the survey. Graph B is a pictorial representation of the statistics of tuberculosis in the Borough from 1930 to 1953. 16 Tuberculosis (All Forms)—Notifications and Deaths from 1930 to 1953 Notifications Deaths Cancer It will be seen by the table of causes of death (page 40) that in 1953 120 cases (63 males and 57 females) died from cancer. (See Appendix, Table VII.) Below is set out in tabular form a classification of the cancer deaths according to the site of the primary growth and in ages. 17 c Age Groups—Male Site total 10-20 20-30 30-40 40-50 50-60 60-70 70-80 80 + '52 '53 '52 '53 '52 '53 '52 '53 '52 '53 '52 '53 '52 '53 '52 '53 '52 '53 Lung 15 27 - - - - - - 1 3 7 9 7 7 - 7 - 1 Stomach 12 6 - - - - - - 2 — 5 1 3 2 2 3 — — Intestine 7 6 - - - - - - 1 - - 2 2 1 2 2 2 1 Bladder 3 2 - - - - - - - - 1 1 2 - — - - 1 Prostrate 4 6 - - - - - - - - - - - 2 2 1 2 3 Other 13 16 - 1 - - - 1 2 1 4 5 2 4 4 2 1 2 Totals 54 63 - 1 - - - 1 6 4 17 18 16 16 10 15 5 8 age groups—female site Total 10-20 20-30 30-40 40-50 50-60 60-70 70-80 80 + '52 '53 '52 '53 '52 '53 '52 '53 '52 '53 '52 '53 '52 '53 '52 '53 '52 '53 Breast 18 13 - - - - - - 3 1 5 3 3 3 5 4 2 2 Lung 3 4 - - - - - - - - 1 1 1 2 - - 1 1 Stomach 7 9 - - - - - - - 1 1 - 2 2 4 3 - 3 Uterus 5 4 - - - - - - - - - 1 2 - 2 1 1 2 Intestine 6 12 — — - — — — 1 - — 1 3 3 1 5 1 3 Bladder - - - - - - - - - - - - - - - - - - Other 18 15 - - 1 - - - 1 3 3 3 6 4 6 4 1 1 Totals 57 57 - - 1 - - - 5 5 10 9 17 14 18 17 6 12 The figures for both years are inclusive of the deaths occurring at St. Bernard's Hospital, Norwood Hall and Vine Cottage. The smallness of the numbers of cases makes it somewhat difficult when the total is broken down into individual sites, to suggest that the relative proportion of any one site is particularly great and as cancer is often a slow-growing development in the human body, the comparison of 2 years totals does not give information which could be considered of great significance, though the figure for lung cancer in males is appreciably higher. On comparing the figures with those for the previous years of 1951 and 1950, there appears to be no extraordinary increase in cancer occurring in any particular site. Disinfection In cases of infectious disease, rooms, clothing, etc., were disinfected—rooms by sealing and fumigating with formalin preparation; clothing, bedding and other infected articles by removal for disinfection in the Council's disinfector at Havelock Road. List of premises, articles, etc., disinfected during the year:— Rooms 20 Eiderdowns 9 Beds 17 Pillows 8 Blankets 57 Plimsolls (routine disinfection Mattresses 15 during holiday for Feather- Sheets 38 stone School) (pairs) 50 Books 131 Miscellaneous articles 7 Smallpox Disinfection. In the event of smallpox occurring within the district and disinfection being required on a considerable scale, arrangements have been made whereby this could be carried out. An agreement was made with the North-West Metropolitan Regional Hospital Board whereby in such an event the staff of St. John's Hospital, Uxbridge, would carry out this work. 18 Provision of Antitoxin and Vaccine Lymph The Council provides diphtheria antitoxin and tetanus antitoxin free to local practitioners in the district. These antitoxins are obtainable from the Public Health Department during office hours and by direct request to the Medical Officer of Health at other times. In the event of emergency supplies of vaccine lymph being required, they are obtainable at very short notice. Vermin and Scabies During 1953, only 2 cases of vermin infestation were brought to the Public Health Department for cleansing. These were treated at Hammersmith Cleansing Station by courtesy of Hammersmith Borough Council. The figures appear to suggest a satisfactory state of freedom from infestation in Southall, and this is also indicated by the fact that according to the findings in Table XII, more children were examined for vermin in the schools and very many fewer found to be infested as compared with 1952. This information is available by courtesy of the County Medical Officer. The percentage of children found to be verminous in Southall, i.e. .18, compares very favourably with the overall County percentage of .55 requiring cleansing. 19 OLD PEOPLE'S WELFARE The needs of 20 cases of old people living in difficult circumstances were investigated during 1953, and the action taken is recorded in the following list:— Removed to hospital 3 Removed to hospital (under National Assistance Act powers) Removed to mental institution - Removed to old people's home 1 Died at home 2 Remained at home 14 (a) Home Help provided 3 (.b) Refused to enter home or accept Home Help 6 (c) No help required 5 The difficulties of the old persons recorded on this list were brought to the notice of the Public Health Department either by interested relations, neighbours or friends, or by complaint by one or other of the statutory authorities. Following the receipt of a complaint, a visit would be made by the District Sanitary Inspector or the County's Home Help Organiser, in order that the needs of the particular individual could be ascertained. These needs vary in the same individual from time to time, as at one time the requirement might be for provision of Home Help, District Nursing or Home Comforts, while later in the same year the need might be for urgent removal to a home or to a hospital. The number actually brought to our attention during 1953 was lower than during the previous year, and this may be attributed possibly to the work, which is reported later, done by the Old People's Welfare Committee, but each case involves the Department staff in many visits and telephone calls. On one particular emergency case alone, in one day 4 visits and 9 telephone calls were required. Of the 20 cases reported above, it can be seen that 6 were persistent in their refusal throughout the year to accept any type of help whatever, and these cases required to be kept under fairly frequent supervision in order to judge of any deterioration of the home or of the old person. It has been ascertained from the Area Medical Officer that 302 Southall people were given Home Help during the year and of these 217 consisted of chronic sick or aged persons. There was a great increase in the amount of voluntary work carried out to help the aged during 1953, and many voluntary associations contributed to provide Christmas parcels or special comforts for old people. Meals on Wheels Service This service, very ably controlled by the Women's Voluntary Service Association, continued to provide meals to old people at a cost of 9d. per meal to the recipient. Those in necessitous circumstances were able to have their meals free of charge. The members of the Women's Voluntary Service cooked and transported the meals to the persons receiving them, and during the year 2,351 meals were supplied to 55 individual persons. This is an increase over the numbers in 1952, when 1,832 meals were supplied to 51 individual persons. Up till now it has been impossible to obtain provision of these meals for more than one a week per person, but it is hoped that this will be substantially increased during 1954—the purpose of these meals being to prevent malnutrition in persons who are unable to obtain cooked meals by their own efforts, a one day a week service, while better than nothing, is unlikely to be sufficient to provide full nourishment and a balanced diet. Old People's Welfare Committee During 1953, this Committee carried out a survey on approximately half of the Borough in order to obtain information regarding all the persons of pensionable age living in the area covered by the survey, and to ascertain also the needs, if any, of these people. 20 Following the visit by volunteers to the old people of this part of the Borough, a card index system was set up in order that the information could be maintained, and renewed from time to time as further visits were paid. The number of old people covered by the canvass was 760, of whom 489 required no help, 83 asked for a further call to be made after 6 months, and 192 required help, details of the help asked for or seeming to be necessary in these cases, are as follows:— Chiropody 64 Old people's clubs 3 Home visiting 33 Old people's bungalows 3 Home Help service 30 Employment 2 Mobile Library 15 Medical appliances 2 Meals on Wheels 10 District Nurse 3 Shopping 6 Gardening 1 General welfare 9 Financial relief 5 Transport 6 Holidays 2 Alternative accommodation 4 Chiropody Service for Old People This service was continued throughout 1953, and during the year a total of 33 house-bound people received 143 visits in their homes for chiropody, and 111 old people attended on 783 occasions the establishments of the chiropodists taking part in the scheme for provision of cheap or free chiropody. Holidays for Old People The holiday scheme whereby old people could get a seaside holiday during off season months of May and September, at reduced rates, continued during 1953, and, in addition, the Old People's Welfare Committee sent 10 individuals for a holiday recommended by their doctors. This was the Coronation tribute given by the Committee. S.O.S. Cards Scheme The Borough Council gave consideration to a scheme whereby S.O.S. cards could be prepared and given out to old people living alone, for their use in emergency. These cards were to be completed with any important information, such as name of next-of-kin, name of doctor, ambulance, police, telephone numbers, name of Old People's Club attended, if any. On distribution of these cards, old people would be instructed in their completion and use in emergency. The Council are agreed that this scheme is likely to be a useful one and suggested that the working out of detail of the distribution of the cards should be undertaken by the Old People's Welfare Committee if they were willing to take on the work, while the Borough Council would pay for the cost of preparing the cards. These cards were then printed and then passed over to the Old People's Welfare Committee and distribution was begun at the time of the survey referred to above in the report. It is hoped that by the use of these cards in emergency help may be obtained for old people in sudden distress or illness more quickly than might otherwise be the case. Home Visiting A special sub-committee of the Old People's Welfare Committee arranges for visits to be paid to lonely and house-bound old people who desire such attention. This is a very valuable service and much appreciated by the persons visited. During 1953 approximately 1,000 visits were paid in this way by a number of visitors totalling about 20. This work is a very fine one and it is hoped that the number of persons volunteering to carry it out will increase during the years. National Assistance Act, 194S, Section 47 National Assistance (Amendment) Act, 1951 No case was dealt with under these powers during 1953. 21 WELFARE—GENERAL A considerable amount of Welfare Work is carried out by the organisations of the St. John Ambulance Association and the British Red Cross Association. The local headquarters of the St. John Ambulance Association are situated at Harrington Road, Southall, and the honorary officers are Dr. C. J. P. Seccombe, 20, Western Road, Southall, Divisional Surgeon; Miss F. M. Gibbs, 41, Waxlow Crescent, Divisional Superintendent; and Mr. H. S. King, 44, Northcote Avenue, Southall, Divisional Superintendent, Ambulance Division. The work carried out is as follows:— Home Nursing and Nursing Equipment. The St. John Ambulance Nursing Division has been trained in Home Nursing. It also loans out nursing equipment for use in the home from its Medical Comforts Depot in Harrington Road. Ambulance Services. The St. John Ambulance Brigade maintains an ambulance that is available for private hire, and which is also used on public duties in connection with the St. John Ambulance Brigade. Welfare—General. Medical Comforts Depot, Harrington Road, Southall. The St. John Ambulance Nursing Division has voluntarily staffed, without pay, this depot every weekday evening for the past 25 years. During the year 534 articles—chairs, crutches, bed-pans, back rests, bed tables, rubber sheets, etc., were loaned to the general public. Calls for help in providing equipment were received and answered from hospitals and individuals in many parts of London and the home counties. Every article loaned is cleaned and disinfected on return to the depot. A small loan charge is made to cover this service and the cost of repairs and replacements. The Nursing Division exists for service to others, and throughout the years has taken an interest in the welfare of the sick. It teaches the art of home nursing and spreads a knowledge of First Aid and accident prevention. During the year some 9,000 cases were treated by members who had had their training in the Southall Division. The Division was able to send trained members to help in the flood disaster at Canvey Island, as well as to cover the First Aid requirements of many public gatherings. In addition to this it provided voluntary aid in hospital wards. The headquarters of the British Red Cross Society, Ealing Area Division, which includes Southall, is Florence Nightingale House, 85, Uxbridge Road, Ealing, W.5. The Divisional Director is Mrs. E. V. Bruce, and the work carried out is as follows:— Training Red Cross Juniors and Seniors in First Aid and Home Nursing, and also training candidates for the National Hospital Service Reserve. Occupational Therapy when requested for the disabled ex-service pensioners and for Chest Clinic cases. Hospital duty during epidemics. Provision and carriage of books to T.B. home-bound patients. Welfare visits which are increasing. Hospital Library facilities and Picture Library. Nursing Aid. Nursing in the home. Escort duty to and from hospitals for the sick, aged, blind people and children. Medical loan, providing comforts for sick people. Transport for the sick when requested. Blood transfusion. Civil Defence basic first aid training. Accommodation in Red Cross Homes for chronic aged and sick. 22 Club for Disabled Persons. An interesting project commenced during the latter part of 1952 continued and increased its usefulness during 1953. This was the formation of a club for disabled persons, at first organised by the warden of the Community Centre, but later managed almost completely by the members of the Club. This Club is a social and recreational one, and transport is provided for those members who are unable to make their own way to the Club premises, which are at the Southall Community Centre. The membership has grown and now has reached the number of 24, testifying to the appeal of the Club. 23 HEALTH PROPAGANDA The importance of the education of the public in matters of health has become increasingly realised during the past few years, and there are many new methods of propaganda which have been devised to reach the public ear or eye. Throughout the year the Staff of the Department continued this work and poster publicity, talks to individuals, talks to small groups, talks to larger groups, some of them illustrated with film strip pictures, were continuous throughout the year. Special subjects for poster publicity were influenza, smoke abatement, anti-diphtheria immunisation and clean food, as these points became topical. A campaign in the spring of the year was organised by the Ministry of Health for a nation-wide drive for anti-diphtheria immunisation, because of the dangerous drop in the numbers of parents bringing their children to be immunised. The local health authority co-operated with the local sanitary authority in this, and new posters, film slides, and leaflets on the subject were given as wide distribution as possible. The question of smoke abatement having become very urgent as a result of the great fog of December, 1952, part of the year was devoted to special work in the education of the public against unnecessary smoke emission, the use of smokeless fuel and special appliances for burning this material were advocated and advice given to boiler house stokers and railway engine firemen in an effort to reduce smoke from factories and railway sidings. There was a continued drive for the improvement of the food handling and distribution in the Borough, and shops, canteens, catering establishments, and hawkers were encouraged to bring their standards not only up to those recommended in the bye-laws for this purpose but beyond. At a seminar held by the Central Council for Health Education in London, Medical Officers from all types of authorities gathered to exchange information and ideas on the subject of health education in a sanitary authority. It was interesting to compare the results obtained by different methods of approach to health education and many helpful suggestions have since been adopted within this Borough. It is believed that certain ideas of our own were useful to other authorities. Public Health information continued to be published in the Council's Civic News Sheet in the form of an alphabet of hygiene. This magazine, which is issued free of cost, has a considerable circulation, as it is sent to all voluntary organisations in addition to being available to those members of the public who wish to receive it. For the Mass X-ray Unit visit publicity was concentrated during some weeks prior to the date of commencement to give notice of the facilities offered; handbills were delivered to every household, poster publicity and newspaper publicity were also used for this campaign. The very high figures for home accidents which had been recently publicised gave rise to concern about this matter. As all home accidents are preventable, this seemed a very important subject for health education, and a request was made to the local medical practitioners, to the medical directors of local hospitals and to other persons likely to have knowledge of accidents occurring in the home and resulting in disability of slight or serious nature or even in death to notify the Public Health Department of such cases coming to their knowledge. The response was fair but rather uneven and it would be difficult to express any opinion on the results of the notifications supplied as yet. Of 42 home accidents reported, no less than 13 were burns or scalds, mostly due to pulling over a teapot or boiling kettle or milk saucepan, 11 were fractures caused by falls in the home, and 3 of these resulted in death. 3 were drug poisoning cases. It seems most probable that every one of these burns and fractures and several of the other accidents, as detailed in the home accidents table, page 49, were due to a little carelessness or a little haste, too much polish on a floor causing someone to fall down stairs, or some other easily preventable occurrence, and it seems there is a considerable need for continuous education in this field. An Anti-Litter Campaign was suggested by the Public Health Committee as a suitable method of obtaining cleaner streets. The gross carelessness of the public with regard to the keeping of the streets clear from Utter, while not always likely to cause danger to health, may do so in a number of ways, as cartons and paper wrappings of food dropped 24 may drift into corners where they may escape notice for long enough for putrefaction to commence and fly breeding to take place, while the dropping of skins of fruit and other slippery objects may, and very often does, become a source of danger to disabled or elderly persons and may result in loss of life or increased disablement. It was decided that a public appeal should be made by the Mayor and Chairman of the Public Health Committee, letters were inserted in the Press and in the Civic News Sheets and an individual letter was sent to every class in each of the schools in the Borough exhorting the children to help in the maintenance of cleanliness in the streets. This campaign is one which will require to be kept continuously to the forefront as a temporary improvement was observed following the mass appeal, but this could not be said to have really been maintained for a lengthy period. National publicity on the same theme was instituted shortly after the commencement of the Southall campaign and this, no doubt, assisted to remind the public of Southall of the appeal which had been made to them previously. Care of the feet. As the health of the feet plays a major part in the well-being of the individual, and as information concerning the foot defects in adult life is difficult to obtain, a request was made to the local chiropodists to co-operate in an investigation into the causes of foot defect as found by them. Several chiropodists very kindly supplied figures concerning the persons coming to them for the first time during 1953, the figures are not in a sufficiently uniform pattern for a real statistical analysis to be made, but a rough deduction which can be made from them is that out of 298 new patients attending chiropodists in Southall, approximately 33% were suffering from hallux valgus, 53% corns and callouses, and 87% from infections of the feet, including plantar warts, athletes foot, etc. The remaining 5.3% consisted of hammer toes, soft corns, dropped metatarsal arches, metatarsalgia, and ankle strains. These complaints are mostly of a preventable nature, the corns and callouses having been caused by faulty footwear, the hallux valgus, though to a certain extent possibly a congenital condition, being aggravated by faulty footwear, and infections of the feet, such as athletes foot, being caused by insufficient care in the hygiene of the feet. There is here a fruitful field for health propaganda not only amongst the general public, but amongst the shoe manufacturers, and shoe fitters in particular. A great responsibility lies on those who have the task of fitting the feet of small children, as untold damage may be done by the provision of shoes which are too tight, too narrow, too short, or which have been made in such a flimsy manner that nails or sewing of the material can cause corns or pressure. ESTABLISHMENTS FOR MASSAGE AND SPECIAL TREATMENT Ten establishments were inspected for licence under this heading and all were found satisfactory for the purpose which was intended. Details are as follows:— Purpose No. of Licences Chiropody only 5 Massage, Chiropody and Electrical Treatment 5 MEDICAL EXAMINATION OF BOROUGH COUNCIL EMPLOYEES During 1953, a total of 83 medical examinations were carried out on members of the Borough Council staff. These examinations were carried out with regard to suitability for employment on the Council's permanent staff, for entry into the Sickness Pay Scheme, and Temporary Superannuation Scheme, or Sickness Pay Scheme Regulations. 25 SANITARY CIRCUMSTANCES OF THE BOROUGH Water Supply and Water Services Water is supplied to nearly the whole of the district by the South-West Suburban Water Company. The Metropolitan Water Board supplies a small area in the southern part of the district, and the Rickmansworth & Uxbridge Valley Water Company a small area in the northern part. The supply is satisfactory, both in quality and quantity. Reports on sampling carried out by the Metropolitan Water Board are issued from time to time. Five samples of drinking water were taken from 2 premises during the year for bacteriological and chemical examination and reported as satisfactory. All inhabited houses are supplied from public water mains and there are no standpipes in use on mains. Sanitary Inspections of the District The total number of inspections of premises made during the year by the Sanitary Inspectors was 10,239. Notable differences in figures from 1952 are those for atmospheric pollution and food hygiene. The increase of inspections for atmospheric pollution was due to concentration on observations and analyses of smoke emission to obtain sufficient information to use in an effort to secure the maximum reduction in pollution. The reduction in the number of inspections in food hygiene points to improvements already established, as a result of former work done by the Inspectors, now requiring fewer visits. Table XIII gives an analysis of the number and nature of such inspections. School Sanitation Routine inspections were carried out during the year of sanitary accommodation in schools, often in conjunction with inspections of school canteens. Verbal notices were given to school caretakers with regard to any deviation from maintenance of full cleanliness. Eradication of Bed Bugs Statistics for the year:— (1a) Number of Council houses (1) Found to be infested 6 (2) Disinfested during the year 6 (b) Number of other houses Total 17 (1) Found to be infested 11 (2) Disinfested during the year 11 Canal Boats Visits were paid to the canal, and 3 boats were inspected. The condition of boats and occupants was satisfactory. There were no complaint notices issued by other authorities. Mortuary and Post-Mortem Room The mortuary, situated in Havelock Road, provides adequate accommodation for the Borough. Four bodies were deposited in the mortuary during the year. Factories Act, 1937 The following tables give details of the work done in connection with the factories and outworkers in the Borough:— 26 Inspections Factory Premises Number on Register Number of Inspections Written Notices Occupiers Prosecuted Non-Mechanical 13 30 Mechanical 163 177 13 — Totals 176 207 13 — Defects Found Particulars Number of cases in which defects were found Found Remedied Referred Number of cases in which Prosecutions were instituted To H.M. Inspector By H.M. Inspector Want of cleanliness 9 8 Overcrowding — — — — Unreasonable temperature — — — — — Inadequate ventilation 1 2 — — — Ineffective drainage of floors — — — — — Sanitary Conveniences— (a) Insufficient 4 5 — — — (b) Unsuitable or defective 18 27 — 1 — (c) Not separate for sexes — — — — Other offences against the Act (not including offences relating to work) 2 2 — — — Totals 34 44 — 1 — Outworkers Nature of Work Section 110 Section III No. of outworkers in August List required by Section 110 (1) (c) No. of Cases of Default in sending Lists to the Council No. of Prosecutions for failure to supply Lists No. of Instances of Work in Unwholesome Premises Notices served Prosecutions Wearing Apparel—Making 10 — — T oys—Making 2 — — — — — Loose Covers 1 — The Rag Flock and Other Filling Materials Act, 1951 There are no premises in the Borough subject to registration or licence under this Act. Premises where upholstery is reconditioned and secondhand articles are sold are included in the list of general inspections. 27 Petroleum and Carbide During the year licences were in force in respect of 61 installations for petroleum, and 4 for carbide of calcium. Celluloid and Cinematograph Films Act, 1922 There are 2 licences in force for the purpose of stripping and making celluloid solution from cinematograph films. Inspections have revealed no infringements. Housing Rehousing of the occupiers of the 8 houses in respect of which Demolition Orders were made in 1952 was not provided by the end of 1953. Steps taken to abate overcrowding show a marked improvement over previous years, the number finding rehousing being well in excess of new cases, i.e. 64 overcrowding cases known to the Public Health Department were rehoused as against 55 new cases found to be living in conditions of statutory overcrowding. No Demolition Orders were made during the year. The following details have been supplied by the Borough Engineer, detailing the complete amount of house building for Southall since the end of the war. Built by Southall Borough Council During the Year 1953 Since the end of the War (including 1953) Within the Borough Outside the Borough Within the Borough Outside the Borough Old People's Dwellings 8 — 35 Houses 1 — 101 40 Flats 80 12 193 48 Prefabs 299 Built by Private Enterprise During the Year 1953 Since the end of the War (including 1953) Within the Borough Outside the Borough Within the Borough Outside the Borough New Rebuilds Old People's Bungalows — — 13 — Houses 2 — 140 70 — Flats — 44 4 Prefabs - — — Administration of the Shops Acts Detailed improvements were secured in the prescribed amenities for workers and fuller compliance with records and notices was enforced. Markets The general sanitary conditions at the livestock market, held once weekly, were kept under supervision. There is no other market in the Borough. Pet Animals Act, 1951 Seven establishments were licensed during the year. Compliance with the schedule of conditions of the Royal Society for the Prevention of Cruelty to Animals was secured and no formal action was necessary. 28 Food Poisoning HYGIENE OF FOOD One episode occurred in which staff and children attending a school in the Borough developed symptoms suggesting food poisoning. The symptoms were vomiting and diarrhoea occurring 6 to 12 hours after the mid-day meal. All the cases were mild in character lasting at the most 48 hours. It was suggested that meat minced and reheated and subsequently used as meat pie and cornish pasty was the likely source of infection. Out of 300 consumers at risk 175 developed the symptoms to a greater or lesser degree. At the school canteens samples of all foods are retained for inspection for 48 hours after each meal and specimens were taken from the suspect meat and the other foods consumed on that day and investigated for pathogenic organisms, but all returned a negative result. In addition fasces specimens were taken from four of the cases and from all the canteen workers, 13 in number, but no pathogenic organisms were discovered, and no case was notified by medical practitioners as food poisoning. In addition to faeces specimens, throat and nose swabs were taken from the canteen workers, and each was medically examined to make certain that there were no cuts or sores or infectious symptoms. No other outbreak of food poisoning occurred in the Borough during 1953. The total number of persons notified as cases of food poisoning by general practitioners was 66, and, of these, 6 were discovered subsequently to have faeces containing food poisoning organisms, these were: In 4 cases salmonella typhi murium, in 1 salmonella newport and in 1 salmonella thompson. Personal Hygiene The free washing facilities in the public conveniences, which were brought into operation in September, 1950, continued to be available throughout 1953. During that period, 5,600 paper towels were issued free, and also 3,804 linen towels, which are provided at a cost of 2d. per person. The total issue of towels is much lower than in 1952, and the use of paper towels is half the number used during that year. The linen towel issue has, however, increased from 3,161 in 1952. The drop in the total figure is somewhat disappointing and indicates that further publicity of the free washing service appears to be necessary. Examination of Food Handlers During the year synthetic cream became suspect in certain areas of the country as a possible source of food poisoning and paratyphoid fever. In order that the purity of the local product should be above suspicion, an examination was made of all the employees working in the factory making this cream. Investigations included examination of the throat and nose, with the taking of swabs for bacteriological testing; tests were taken from under the nails of each worker; and specimens of faeces and urine were also sent for investigation. Information on results obtained was kept entirely confidential to the employee concerned, and, while no dangerous infective organisms were found, in one or two cases common cold organisms were found in the nose or throat and in others the nail scrapings produced a few organisms. Those found to have any bacterial infection whatever were re-examined until they could be pronounced completely clear, and the opportunity was taken for renewed propaganda on personal hygiene for food handlers. This cream is also subject to weekly routine bacteriological examinations, and the results obtained from these frequent investigations, done without previous arrangement, and from any part of the factory concerned, have been uniformly good. Milk The following licences under the Milk (Special Designation) (Raw Milk) Regulations, 1949 and 1950, and Milk (Special Designation) (Pasteurised and Sterilised Milk) Regulations, 1949 and 1950, were issued:— for the sale of Tuberculin Tested Milk 12 for the sale of Pasteurised Milk 22 for the sale of Sterilised Milk 20 Supplementary Licences 25 Total 79 29 Food Sampling The bacteriological analyses of 313 food samples taken during the year were carried out by the Public Health Laboratory Service. Ninety-eight of these specimens were ice-cream samples, covering 18 makes of ice-cream, and following bacteriological analyses the ice-creams were graded as follows:— Grade I 90 Grade II 4 Grade III 4 Grade IV - Ice-cream was manufactured locally at 3 premises during the year. Premises and plant were inspected and checked and no infringement of the Ice-Cream (Heat Treatment, etc.) Regulations, 1947-52, was recorded. Closer liaison has been maintained during the year with the County Public Control Department and the report on the work carried out in Southall by the staff of that Department is as follows:— Article Total Samples procured Unsatisfactory Milk (various) 75 7 Milk, New 195 48 Arrowroot 2 - Baking Powder I - Cakes 11 — Coffee and Chicory Essence 2 - Cooked Meat I — Cream 3 — Dried Milk 1 _ Drugs (various) 5 - Fish 17 - Fruit Cordial 1 — Ground Almonds 1 _ Ice-Cream 3 — Ice-Cream Mix 1 1 Lemon Curd 1 — Marzipan 2 - Meat Pie 1 — Milk Chocolate 1 — Minced Meat 11 — Mincemeat 1 — Pineapple 1 - Sausages and Sausage Meat 12 - Soups (tinned) 2 1 Sweets 2 — Suet 1 _ Tinned Milk 2 _ Tomato Sauce 2 1 Victoria Plums 10 — Vinegar 16 2 Whisky 3 - Totals 387 60 30 Milk. The 7 unsatisfactory samples were all of hot milk obtained from 3 cafes. Samples from 1 of these were found to contain added water and the Company was prosecuted but was given an absolute discharge on payment of 5 guineas costs. The other 4 unsatisfactory samples were all deficient in milk-fat and subsequent follow-up samples were all genuine. New Milk. The 48 unsatisfactory samples of new milk were obtained from churns of milk sent by 7 various farmers into Southall. All these samples were deficient in milk fat content and letters were addressed to 5 of the farmers concerned, drawing their attention to the deficiencies and suggesting they may wish to seek technical advice to improve the quality of the milk produced from their cows. No further action was taken in respect of the remaining 2 farmers since the unsatisfactory samples were from a small proportion of the churns of milk delivered. Ice-Cream Mix. This sample contained no milk-fat although called " Milkreem." A follow-up sample was procured early in 1954. Soups. A sample of cream of tomato soup was found to be 78% deficient in fat and a letter of warning was addressed to the retailer, who undertook to amend, suitably, the description of this food as given on the containers. Tomato Sauce. This sample contained 50% of apple puree and an official caution was despatched to the manufacturers. Vinegar. In both cases non-brewed condiment was supplied and the retailer was prosecuted and fined £5 and 3 guineas costs. The following brief notes relate to other activities of Middlesex County Council by virtue of their duties as Food and Drugs Authority. Special Designated Milk. During the year 2 dealer processors were licensed to use the special designation " pasteurised " in connection with milk processed at their premises. 23 inspections were made of these premises and 104 samples of "pasteurised" milk were procured, all of which passed the prescribed tests. Merchandise Marks Acts, 1887-1926. During the year particular attention has been paid to ensure compliance with the provisions of the Merchandise Marks Act, 1926, which require certain imported foodstuffs, when exposed for retail sale, to bear a clear indication of the country of origin. 175 premises were visited and 1,397 head of poultry, displays of meat, and stacks of apples, tomatoes and dried fruits were examined. One trader was prosecuted in respect of imported poultry not marked with the country of origin and he was fined £5 and 3 guineas costs. Labelling of Food Order, 1953. 11 premises were visited during the year and 47 different articles of food were examined to ensure compliance with this Order. No infringement of substance was discovered. Meat Inspections Inspections are made of the carcases of slaughtered animals at St. Bernard's Hospital slaughterhouse and pig clubs, and of premises where meat and other foods are sold or prepared for sale. There is no registered slaughterhouse or public abattoir in the district, and most of the meat supplied comes from the Ministry of Food Distribution Centre. FOOD INSPECTIONS Food Premises The number of food premises in the Borough by type of business is shown as follows:— Shops 327 Catering Establishments 120 Factories 22 31 Premises required to be registered are as follows:— Food and Drugs Act, 1938, Section 14. Fish Curing 9 Manufacture of Sausages or Preserved Food 54 Manufacture of Ice-Cream 5 Sale only of Ice-Cream 125 Manufacture and sale of Iced Lollies 5 Middlesex County Council Act, 1950, Section 11. Premises of Street Traders 24 Milk and Dairies Regulations, 1949. Dealer/Processors 2 The number of inspections of registered food premises during the year was 715. Standards found on inspection are high, with the exception of storage premises of street traders, which require constant checking. No new educational activity was inaugurated during 1953. Established methods of education in food handling were pursued. Frequent inspections and direct talks take the place of clean food guilds. Up-to-date film strips were shown. Canteens in schools and certain factories were supplied with bacteriological sampling jars for each meal component to be kept 48 hours and so be available for analysis in the event of food poisoning symptoms in consumers being reported. The following table shows the quantity of food examined and the disposal of condemned food. Total Inspected (lbs.) Sound Unsound Total (lbs.) Stock (lbs.) Production (lbs.) Consumption (lbs.) Total (lbs.) Animal Feeding (lbs.) Byproducts (lbs.) Destruction (lbs.) Canned 107,948 544 544 — — 107,404 86,715 — 20,689 Raw 46,439 5,227 49 2,711 2,467 41,212 35.791 1,500 3,921 Totals I54>387 5.77* 593 2,711 2,467 148,616 122,506 1,500 24,610 32 The following table shows items of unsound food which were investigated during the year. Article Vendor Condition Action Cheese cake Local baker Mice excreta (slight) Warning letter to baker Bread loaf Local baker Particle seed oil No action Sliced bread loaf Outside Southall Mice excreta (slight) Warning letter to baker Australian beef Local shop Tuberculosis Representationsto istry of Food and Trade Commissioner, Commonwealth of Australia Pork pie Local shop (made outside Southall) Mould Warning letter to local shop Bread loaf Local baker ... Grease... Warning letter Chocolate marshmallow Supplied by local shop Mould... Surrender of 51 dozen tea cakes (made and sold outside Southall) cakes at local shop Haricot beans Delivered to local factory Dead beetles (spermophagus) Referred to Ministry of Agriculture and Fisheries Chocolate cake Local shop (made outside Southall) Mould Prosecution: Fine £5 and £3 costs Butter Local shop Embedded false tooth Letter to packers Shelled nuts Local shop Fragments of glass Stock surrendered and destroyed Bread loaf Local baker Piece of wood Warning letter Irish beef Local shop Tuberculosis Referred to Smithfield Market and Ministry of Food Jelly sweets Local shop Piece of needle Letters to wholesalers and manufacturers Mincemeat Local factory Human hair Not confirmed—no action Chocolate powder Local shop (made outside Southall) Maggot Letter to manufacturers Fruit pie Local cafe Alleged rodent hairs Allegation not confirmed RODENT CONTROL There was no change during the year in the Council's policy of carrying out work free of cost at domestic premises; offering technical services to business and industrial premises where a commercial operator is retained, or carrying out the work at economic charge where it was within the scope of the Council staff. Sewers were test baited twice during the year, in June and December. 10 per cent. of the total sewer manholes were tested and maintenance (i.e. pre-baiting and poisoning) treatments were carried out immediately after each test. Infestation of the sewers by rats remains slight. Opportunity was taken throughout the year to extend the area of inspection to cover neighbouring properties when investigating infestations of rats or mice at both domestic and business premises. NOISE NUISANCE During 1953 complaints of noise nuisances were received concerning 5 firms. In 2 cases no nuisance was established, in 2 cases the nuisance was remedied, and in 1 case (stonemason's yard), although a nuisance was confirmed, no remedy was possible. 33 ATMOSPHERIC POLLUTION The figures on atmospheric pollution in the Borough of Southall, as obtained from the lead peroxide gauge at Jubilee Gardens, the lead peroxide gauge at Recreation Ground, and the deposit gauge at Hortus Cemetery, are not very satisfactory for 1953. It appears that although there was only one high peak of pollution as recorded at Hortus Cemetery in March of 1953, the general average of pollution there was considerable, and there was an increase in the maximum pollution results recorded on both the Jubilee Gardens and the Recreation Ground gauges. Again these peaks were in March, which appears to have been a very bad month for atmospheric pollution. One reason for this will have been the fact that there was an abnormally low rainfall for that month, i.e. 10 mm. of rain for the whole month as compared with 56 for the corresponding month in the previous year. It is, however, rather disturbing to note that for all the work that is done in this district, with regard to atmospheric pollution following on complaints received concerning particular sites, the net result is on the whole poor. It is particularly unsatisfactory to have to report this after two years of gradual but noticeable improvement in the figures, and the reasons for the deterioration must be sought. The number of complaints concerning individual factories and railway sidings has increased during the year, and particulars of the observations kept on various sites are to be found in the table on page 38. Conditions in the north side of the Borough are recorded by the apparatus in Jubilee Gardens, and are obviously considerably worse than in the south side of the Borough, although the latter is more industrialised, but this is probably due to the fact that the prevailing winds in this area are westerly or south-westerly, and smoke from the more industrial parts of the town is likely to drift into the north part of the Borough. It would seem, however, that there is without doubt a good deal of blame to be attached to private households still, as the mid-summer drop in pollution reported in previous years is again apparent, though not so marked on the Hortus Cemetery results as in former years. The weather was extremely cold in March, and it is possible that coal dust was still being used to bank up fires in households, also a considerable number of persons were installing all night burning grates, as a result of publicity for these appliances. The use in these grates of ordinary fuel instead of smokeless fuel is likely to exaggerate the amount of atmospheric pollution, particularly by night. The following table gives an analysis of the results as compared with those obtained in 1952. Graph C and Graph D demonstrate results pictorially, and Graph E is a representation of the comparative figures for pollution with oxide of sulphur for Southall, Central London, a northern industrial town and Godalming, Surrey, which constandy returns the best figures throughout the year. 34 Atmospheric Pollution Estimation Years 1953/1952 Sulphur Trioxide.Lead Peroxide method. Milligrams per day per 100 square centimetres deposit gauge hortus cemetery Month of Year Jubilee Gardens Recreation Ground Rainfall Tons per square mile per month mms. Insoluble Soluble Total January 1953 1952 1953 1952 1953 1952 1953 1952 1953 1952 1953 1952 1.62 1.75 2.03 1.76 21 45 4.23 4.26 2.80 3.98 7.03 8.24 February 1.56 191 2.29 1.27 31 19 9.19 8.59 3.59 3.15 12.78 11.74 March 2 09 1.49 3.17 1.76 10 56 11.66 11.45 4.88 4.96 16.54 16.41 April 093 087 1.48 1.07 59 42 8.06 2.04 4.69 5.08 12.75 7.13 May 0.56 0.73 0.92 0.97 31 29 6.76 6.46 3.55 3.44 10.31 9.90 June 034 046 0.58 0.58 47 41 6.42 11.67 2.72 5.66 9.14 17.33 July 0.30 0.57 0.31 0.31 77 10 8.00 3.20 4.44 2.45 12.44 5.65 August 045 046 0.55 0.60 52 62 7.43 10.08 3.26 6.07 10.69 16.15 September 1 07 059 0.83 0.99 51 68 7.54 9.30 3.41 4.87 10.95 14.17 October 1.01 099 1.88 1.66 88 58 7.01 6.64 5.04 5.06 12.05 11.70 November 163 280 1.70 2.83 14 81 2.89 6.82 3.11 6.02 6.00 12.84 December 1'54 1.88 No 2.91 14 67 3.48 6.94 3.92 4.94 7.40 11.88 figures available Average for Year 1.09 1.21 1.43 1.39 41 48 6.89 7.29 3.78 4.64 10.67 11.93 Graph C Atmospheric Pollution by Sulphur Oxides (Lead Peroxide Method) Lead Peroxide Gauge at Jubilee Gardens [Atmospheric Sulphur Dioxide SO3(Mgs/Day/1oo Cms1)] — Lead Peroxide Gauge at Recreation Ground [Atmospheric Sulphur Dioxide SO,(Mgs/Day/1oo Cms2)] 35 Total Solids, Soluble or Insoluble (Tons per Square Mile) 36 Graph E Atmospheric Pollution by Sulphur Oxides Determined by the Lead Peroxide Method Comparison with Other Districts (Year 1953) Godalming Westminster (average of 4 observation points) Sheffield (average of 22 observation points) Southall (average of 2 observation points) These figures are printed with the permission of the authorities concerned. Details of the observations made because of particular subjects of complaint and the results of these observations can be seen in the following table. On no occasion was black smoke observed to continue long enough to be considered as a statutory nuisance. While no structural alterations or additions to plant were requested throughout the year, technical 37 advice to boiler house stokers, and discussions with managements of factories on individual causes of pollution had some good effect. Number of sites of observation 3 (1 atmospheric pollution gauge and 2 lead peroxide gauges) Number of complaints of nuisance from smoke, smell or grit and number of premises concerned 26 complaints re 7 premises Number of places kept under observation 20 Number of half-hour observations made 159 Number of times black smoke was detected 12 Total time of black smoke emissions 12½ minutes Number of times moderate smoke observed 65 Total time of moderate smoke emissions 759½ minutes RIVER POLLUTION The increasing urbanisation of the County of Middlesex and the growing numbers of factory buildings situated on or near the River Brent has given rise to serious doubts concerning the purity of water of the River. As a portion of the river flows through Southall, it was important to us that any public health risks in our own area should be minimised and Medical Officers of Health of other districts bordering on the stream felt the same about their own areas. As a result, a meeting between the Officers of the Middlesex County Council, which is the authority for Rivers Inspection and the Borough Engineers and Medical Officers of Health of the various districts bordering on the River Brent, was held at the latter end of 1952, and the whole matter was discussed thoroughly. Following this it was arranged that monthly reports would be submitted by the County Engineer to the Borough Engineers and Medical Officers of Health of the appropriate authorities, containing the results of analyses of the River water samples taken at various points along its course, and these have been submitted regularly ever since. Results have fluctuated from good to doubtful, and whenever doubtful results were obtained, the officers of the local authority concerned communicated with the Middlesex County Council Officers and an endeavour was made to pinpoint the source or sources of any offending matter being allowed to enter into the stream. As a result of this much good work has been done in the reducing of pollution, a matter of particular concern to the local authorities, such as Southall, situated at the receiving end of the River. 38 APPENDICES EXTRACTS FROM VITAL STATISTICS Table I. Total Male Female Comparative Figures for 1952 Live Births—Legitimate ... 682 359 323 680 Illegitimate ... 31 13 18 26 Stillbirths—Legitimate ... 10 5 5 16 Illegitimate ... 3 2 1 — Deaths ... 731 337 394 517 Birth rate (live and stillbirths) per 1,000 of the estimated population 1322 1294 Stillbirth rate per 1,000 total (live and still) births 17.91 1534 Crude death rate per 1,000 of the civilian population 13.31 933 Deaths from Puerperal Causes (Heading 30 of the Registrar-General's Short List) :— Deaths Rate per 1,000 total (live and still) births No. 30. Pregnancy, Childbirth, Abortion 1 1-38 — Death rate of infants under 1 year of age:— All infants per 1,000 live births 2945 19.83 Legitimate infants per 1,000 legitimate live births 3079 17.65 Illegitimate infants per 1,000 illegitimate live births — 76.92 Deaths from cancer (all ages) 120 95 Deaths from measles (all ages) 1 — Deaths from whooping cough (all ages) 1 — Deaths from diarrhoea, etc. (under 2 years of age) — — 39 Causes of Deaths, 1953 Table II Male Female Total 1953 Total 1952 1. Tuberculosis, respiratory 8 4 12 8 2. Tuberculosis, other — — 1 3. Syphilitic disease 2 1 3 2 4. Diphtheria — — — 5. Whooping cough i — 1 — 6. Meningococcal infections — — — — 7. Acute poliomyelitis 1 1 2 — 8. Measles 1 — 1 — 9. Other infective and parasitic diseases 1 — 1 3 10/15. Cancer (all forms) 63 57 120 95 16. Diabetes 5 5 3 17. Vascular lesions of nervous system 26 49 75 71 18. Coronary disease, angina 50 31 81 68 19/20. Heart disease 45 88 133 80 21. Other circulatory disease 18 39 57 36 22. Influenza 3 6 9 1 23. Pneumonia 20 30 50 35 24. Bronchitis 34 23 57 33 25. Other diseases of respiratory system 1 2 3 5 26. Ulcer of stomach and duodenum 1 1 2 6 27. Gastritis, enteritis and diarrhoea 1 4 5 1 28. Nephritis and nephrosis 1 3 4 2 29. Hyperplasia of prostate 6 — 6 4 30. Pregnancy, childbirth, abortion — 1 1 — 31. Congenital malformations, birth injuries, etc. 6 5 11 5 32. Other defined and ill-defined diseases 31 25 56 41 33. Motor vehicle accidents 5 2 7 6 34. All other accidents 9 13 22 11 35. Suicide 3 4 7 — 36. Homicide and operations of war — — — — Total Deaths 337 394 731 517 * The 1952 figures in this table are exclusive of long stay hospital deaths. Deaths in Wards Table III Ward Male Female Total Waxlow Manor 44 29 73 Northcote 32 36 68 Hambrough 43 59 102 Dormers Wells 119 146 265 Glebe 63 41 104 Norwood Green 36 83 119 Total 337 394 731 40 Table IV Vital Statistics compared with other Areas birth rates, death rates, analysis of mortality, maternal mortality and case-rates for certain infectious diseases in the year 1953. (Provisional Figures based on Quarterly Returns) England and Wales 160 County Boroughs and Great Towns including London 160 Smaller Towns (Resident Population 25,000 to 50,000 at 1951 Census) London Administrative County Southall Rates per 1,000 Home Population Births : Live 15.5 17.0 15.7 17.5 12.85 Still 0.35 0.43 0.34 0.38 0.23 22.4 (a) 24.8 (a) 21.4 (a) 21.0 (a) 18.05 (a) Deaths : All causes 11.4 12.2 11.3 12.5 14.24 Typhoid and paratyphoid 0.00 0.00 Whooping cough 0.01 0.01 0.00 0.00 0.02 Diphtheria 0.00 0.00 0.00 — — Tuberculosis 0.20 0.24 0.19 0.24 0.23 Influenza 0.16 0.15 0.17 0.15 0.17 Smallpox 0.00 0.00 0.00 Acute poliomyelitis (including polioencephalitis) 0.01 0.01 0.01 0.01 0.04 Pneumonia 0.55 0.59 0.52 0.64 0.97 Notifications (Corrected) : Typhoid fever 0.00 0.00 0.00 0.01 — Paratyphoid fever 0.01 0.01 0.01 0.01 — Meningococcal infection 0.03 0.04 0.03 0.03 0.04 Scarlet fever 1.39 1.50 1.44 1.02 2.39 Whooping cough 3.58 3.72 3.38 3.30 10.25 Diphtheria 0.01 0.01 0.01 0.00 — Erysipelas 0.14 0.14 0.13 0.12 0.36 Smallpox 0.00 0.00 0.00 — — Measles 12.36 11.27 12.32 8.09 22.78 Pneumonia 0.84 0.92 0.76 0.73 2.28 Acute poliomyelitis (including polioencephalitis) : Paralytic 0.07 0.06 0.06 0.07 0.04 Non-paralytic 0.04 0.03 0.04 0.03 0.04 Food poisoning 0.24 0.25 0.24 0.38 0.24 Puerperal Pyrexia 18.23 (a) 24.33 (a) 12.46 (a) 28.61 (a) 9.64 (a) Rates per 1,000 Live Births Deaths : All causes under 1 year of age 268 (b) 30.8 24.3 24.8 29.45 Enteritis and diarrhoea under 2 years of age 1.1 1.3 0.9 1.1 — (a) Per 1,000 Total (Live and Still) births. (b) Per 1,000 related Live Births. Figures in Southall column have been converted from crude rates by the use of the comparability factor. 41 Table V Monthly Registration of Births. The monthly registration of births classified as to Wards is given in the following table :— Waxlow Manor Northcote Ham— brough Dormers Wells Glebe Norwood Green Total January 4 1 3 3 2 1 14 February 1 1 2 1 1 — 6 March 1 3 2 1 2 4 13 April 1 5 2 5 — 3 16 May 4 3 — 1 4 2 14 June 1 1 1 — 3 3 9 July 4 5 4 1 3 2 19 August 2 — 2 4 2 10 September — 2 3 1 5 1 12 October — 2 4 1 1 8 November 2 1 1 3 2 2 11 December 3 1 2 4 3 — 13 Total 23 25 20 26 30 21 145 Table V1 Causes of Death Under One Year of Age. Certified Causes of Death Under i week 1—2 weeks 2—3 weeks 3—4 weeks Total under 4 weeks 1—3 months 3—6 months 6—9 months 9—12 months Total deaths under 1 year Asphyxia Bronchitis, pneumonia, etc. — — — — — — 1 — — 1 Congenital malformations 4 1 — 1 6 2 — — 1 9 Gastro—enteritis, diarrhoea, etc. — — — — — — — _ — — Prematurity 8 1 — — 9 — — — — 9 Birth injury 1 — — — 1 — — — — 1 Whooping cough — — — — — — 1 — — 1 Total 13 2 1 16 2 2 1 21 Live Births. Legitimate 682 Illegitimate 31 42 Infant Deaths. Legitimate 21 Illegitimate - Table V11 Deaths from Cancer Year Male Female Total Estimated Population Rate per 1,000 population 1928 18 27 45 35,340 1.27 1929 12 10 22 35,370 0.62 1930 17 29 46 37.560 1.22 1931 20 28 48 39,280 1.22 1932 22 23 45 41,530 1.08 1933 23 28 51 44,780 1.13 1934 22 27 49 46,693 1.04 1935 30 27 57 48,270 1.18 1936 22 30 52 49,550 1.05 1937 42 28 70 51,560 1.35 1938 27 30 57 52,400 0.51 1939 33 41 74 52,430 1.41 1940 28 36 64 51,670 1.23 1941 34 37 71 50,280 1.41 1942 34 38 72 50,350 1.43 1943 51 46 97 49,730 195 1944 37 32 69 48,970 141 1945 39 44 83 49,880 1.88 1946 40 54 94 54,440 1.64 1947 45 32 77 56,240 1.36 1948 48 36 84 56,130 149 1949 46 54 100 56,350 1.77 195° 52 38 90 56,310 160 1951 48 46 94 55,620 1.69 1952 46 49 95 55,430 201 1952 including long stay hospital deaths 54 57 111 63 57 120 54,910 2.19 1953 Table V111 Notifiable Diseases during the Year (other than Tuberculosis) Diseases Ages Total cases notified Deaths Under i year 1 to 2 2 to 3 3 to 4 4 to 5 5 to 10 10 to 15 15 to 25 25 to 35 35 to 45 45 to 65 65 and over Dysentery . 1 _ 1 _ 3 _ _ 1 1 1 4 12 — Encephalitis — — — — — — — 1 — — — — 1 — Erysipelas — — — — — — — 2 1 2 6 3 14 — Food Poisoning . 3 3 2 2 10 4 7 10 9 10 6 66 — Malaria — . . — . — . 1 — — — — 1 — Measles 26 73 126 117 124 449 11 3 2 — — — 931 1 Meningococcal 1nfection — — — — — 1 — — — — — — 1 — Paratyphoid — — — — — — — — — — — — — — Pneumonia 3 3 6 5 2 11 2 6 7 10 28 20 103 50 Poliomyelitis: Paralytic .— — —. — — 1 —. 1 — —. —. —. 3 1 Non.Paralytic .— — —. — — 1 *2 .— .— —. —. .— 3 1 Puerperal Pyrexia —. .— — — — — — 3 3 1 — — 7 —. Scarlet Fever . 4 7 11 8 87 9 3 1 — 1 — 131 — Whooping Cough 37 37 41 46 66 300 13 6 9 8 — — 563 1 Total 66 121 183 182 203 863 41 33 34 31 46 33 1,836 54 *One case diagnosed subsequently as intra cranial tumour. †Not confirmed. 43 The number of cases of infectious diseases (including Tuberculosis) notified during the year, according to the locality, are shown below :— Table IX Diseases Total Waxlow Manor Northcote Hambrough Dormers Wells Glebe Norwood Green Total Deaths Dysentery 12 1 1 1 7 2 _ — Encephalitis 1 - - - 1 - - - Erysipelas 14 3 4 - 1 4 2 — Food Poisoning 66 2 4 6 28 16 10 — Malaria i — — — — 1 — — Measles 931 218 159 108 156 187 103 1 Meningococcal Infection 1 1 _ _ - - - - Pneumonia 103 5 12 5 20 50 11 50 Poliomyelitis: Paralytic 3 — †1 1 1 — — 1 Non-Paralytic 3 — *1 2 — — — 1 Puerperal Pyrexia 7 _ 1 3 1 - 2 - Scarlet Fever 131 22 15 24 35 28 7 — Tuberculosis 91 11 10 19 28 14 9 12 Whooping Cough 563 100 93 80 108 110 72 1 Total 1927 363 301 249 386 412 216 66 *One case diagnosed subsequently as intra-cranial tumour. fNot confirmed. Table X Tuberculosis Notifications—Ages and Classifications Age Periods New Cases Deaths Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary Male Female Male Female Male Female Male Female 0-1 - - - - - - - - 1-5 - 1 - - — - — - 5-10 - 2 — — - — — — 10-15 1 1 - - - - — — 15-25 11 8 - - - — - — 25-35 18 13 - 1 - — — — 35-45 9 7 — 1 1 2 — — 45-65 10 4 — — 5 — — — 65+ 3 — 1 — 2 2 — _ Total 52 36 1 2 8 4 - - 44 Table X1 The occupations of the new cases are as follows :— Occupation Pulmonary Non-Pulmonary Male Female Male Female Apprentice Plater Riveter 1 - - - Assistant Nurse — 1 - - Blind Patient - 1 - - Book-keeper 1 — - - Butcher 1 — - Cabinet Maker 1 - - - Canteen Assistant - 1 - - Carpenter 1 - - - Cine Film Printer 1 - — - Clerk 2 2 - - Driver's Assistant 1 - - - Engineer 2 - - - Engineering 1nspector 1 - - - Ex-Army 1 — — - Electrician's Mate 1 - - — Fashion Artist 1 - - - Fitter 2 - - - Greengrocer 1 - - — Housewife — 12 - 1 1nspector 1 - - — Jam Jar Washer 1 - - - Jelly Wrapper - 1 - - Labourer 4 - — — Lorry Driver 1 - — - Manageress, Public House — 1 - - Medical Officer 1 - — - Mental Patient 6 6 - - Motor Mechanic 1 - - - Music Teacher - - - 1 National Serviceman 2 - - - Packer — 1 - - Postman 1 - - - Pre-schoolchild - 1 - - Printer 1 - - - Quantity Surveyor 1 - - - Retired 4 — - — Road Sweeper 1 - - - Sawmill Checker 1 — - - Schoolchild 1 4 - - Schoolteacher - 2 - Self-employed 1 - - - Shop Assistant — 1 - - Shorthand-typist - 1 - - Storekeeper 1 — — - Trolley-bus 1nspector 1 - - - Turner 1 - - - Unknown 3 1 1 - Total 52 36 1 2 45 Table XII Examinations for Verminous Conditions and Children Found to be Verminous Attending Maintained Schools in Southall during 1952 and 1953. School Total number of examinations Total number of individual pupils found to be infested for the first time during the year Total number of instances of infestation among pupils Number of individual pupils in respect of whom cleansing notices were issued Number of individual pupils in respect of whom cleansing orders were issued 1952 1953 1952 1953 1952 1953 1952 1953 1952 1953 Beaconsfield Road, J.M. 1,087 1,309 — — — — — — — — Beaconsfield Road, I. 543 832 3 — 3 — 3 — 2 — Clifton Road, J.M. 910 1,033 8 7 11 9 8 5 4 3 Featherstone Road, J.M. 1,012 1,037 4 1 6 1 4 1 3 — Featherstone Road, I. 704 842 2 1 2 1 2 1 1 — Lady Margaret Road, J.M. 1,497 1,616 8 — 11 — 7 — 3 — Lady Margaret Road, I. 1,190 1.257 1 2 1 2 1 2 1 1 North Road, J.M. 1.374 1.375 11 1 11 1 10 1 4 - North Road, I 866 777 — — — — — — — St. Anselm's R.C., J.M. 1,195 1.417 4 1 4 1 4 1 4 - Tudor Road, J.B. 421 702 - — — - - Tudor Road, J.G. 405 723 1 4 1 7 - 5 - 3 Tudor Road, I. 1,213 1,236 1 i 1 1 — — Western Road, J.M. & I. 1,183 1,099 9 4 9 4 8 4 5 2 Dormers Wells, S.B. 963 1,386 3 3 i 1 — Dormers Wells, S.G. 1,614 1.592 15 4 18 4 11 2 5 - Featherstone Road, S.B. 978 995 — — — — Western Road, S.G. 686 969 3 1 3 i 3 — 1 - Talbot Road, Special 379 360 2 3 6 4 2 3 2 1 Clifton Road, I 756 859 2 2 2 3 2 2 2 — George Tomlinson 222 — - - Routine Medical Inspections 5 5 5 3 - Total 18,981 21,638 82 32 97 39 69 27 38 10 46 Table XIII Sanitary Inspections—Classification of Visits Houses, Public Health Act, 1936 4,520 Houses, Housing Act, 1936 280 Overcrowding 564 Disinfestation 134 Pet Animals Act, 1951 1 Vans, Sheds 28 Shops Act, 1950 527 Food Shops 845 Fried Fish 28 Cafes, etc 308 Factories (Mechanical) 177 Factories (Non-Mechanical) 30 Outworkers 44 Food Factories 183 Smoke 249 Offensive Trades r Bakehouses 75 Dairies 11 Water Sampling 19 Ice-cream Sampling 105 Other Foods Sampling 144 Schools 26 Stables 16 Offensive Accumulations 33 Hairdressers 4 Petrol 78 Canal Boats 3 Slaughterhouses 26 Rats and Mice 1,132 Infectious Diseases 423 Atmospheric Pollution 225 10,239 47 Table XIV Statistics HOUSING-GENERAL 1. Inspection of dwelling-houses during the year:— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 1,171 (b) Number of inspections made for the purpose 4,165 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 221 (b) Number of inspections made for the purpose 242 (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 ceding sub-head) found not to be in all respects reasonably fit for human habitation 644 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 540 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 164 (2) Number of dwelling-houses in which defects were remedied after service of formal notices (a) By owners 206 (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 — (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 — (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement room having been rendered fit — 4. Housing Act, 1936—Overcrowding:— (a) Number of dwellings known to be overcrowded at the end of the year 109 (1b) Number of new cases of overcrowding reported during the year 55 (c) (1) Number of cases of overcrowding relieved during the year 64 (2) Number of persons concerned in such cases 372 (d) Particulars of any case in which dwelling-houses have again become crowded after the local authority have taken steps for the abatement of overcrowding — 48 Table XV Home Accidents, 1953 Age Nature of Injury Cause of Injury Known to have Died, i.e. in hospital, at home 4 years Burn Iron 4 years Burn Poker 2 years Scald Teapot 1 year Burn Milk 1 year Burn Tea 2 years Injury to left eye Crockery 75 years Burn Clothes caught fire 16 years Burn Fire West Middlesex Hospital 80 years Cut head Fell down stairs 3i years Concussion Fall 80 years Fractures Fell down stairs 68 years Fractures Fell out of bed Hillingdon Hospital 81 years Fractures Fall 4 years Foreign body in ear Not known 80 years Fractures Fell out of bed 90 years Fractures Fell down stairs Hillingdon Hospital 69 years Haemorrhage of brain Fall King Edward's Hospital 70 years Burn Saucepan of water 72 years Injured back Fall 63 years Fractured skull Fall 86 years Concussion Fall 3 years Burn ? 2 years Scratched by dog 3i years Lacerated lip Fall 77 years Fractured femur Fall 2 years Camphorated oil poisoning 15 years Fracture Fall 56 years Scald Cup of water 1 year Burn Electric iron 92 years Bruising Fall 34 years Scald Boiling kettle 71 years Fractured femur Fall 5 years Cut head Fall 63 years Fracture Fell on stairs 3 years Fracture Fell on kerb 9 years Barbiturate poisoning 48 years Barbiturate poisoning 1 year Burn Fell on electric fire 65 years Bruise Fall 86 years Dislocation Fall 73 years Wound of hand Chopping firewood 14 months Burn Electric fire 49