AC 439(1) SOUT 32 Cuk'd BOROUGH OF SOUTHALL ANNUAL REPORT OF THE Medical Officer of Health for the Year 1964 MARGARET A. GLASS, Medical Officer of Health KING & HUTCHINGS LTD., THE HILLINGDN PRESS, UXBRIDGE AND SOUTHALL BOROUGH OF SOUTHALL ANNUAL REPORT OF THE Medical Officer of Health for the Year 1964 MARGARET A. GLASS, Medical Officer of Health THE COUNCIL OF THE BOROUGH OF SOUTHALL THE WORSHIPFUL THE MAYOR *Alderman A. T. Dane, J.P. Deputy Mayor: *Councillor P. G. Southey Aldermen: Cavell, Mrs. I., J.P. Douglas, H. C. Hopkins, W. H., J.P. *Dane, A. T., J.P. *Haigh, J., J.P. Love, P. J. Councillors: Aspell, T. J. A. Hook, R. E. *†Southey, P. G. *Barton, A. J. *Johnston, J. Steele, T. J. *Berry, W. M. D. *Jones, Mrs. E. W. (Chairman) *†Thornton, C. B., Ph.D. Day, F. R. Lamb, W. G. Ward, E. Errington, F. G. *Rockhill, F. R. J. *Ward, J. H. *Griffiths, Mrs. M. C. *†sheil, E. J. Woodruff, J. A. T., J.P. *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 74th and last report on the health of the population of Southall Borough, as the amalgamation of the Borough with Ealing and Acton to form the new London Borough of Ealing takes place on 1st April, 1965. This Report has had to be prepared without correlation with the calculated statistics from the Registrar-General or the Department of Scientific and Industrial Research because the book had to be finished before 31st March and these statistics are not available so early in the year. But any variation is likely to be of small importance. The health of the people has continued to be good. The birth rate fell a little below the alarmingly high rates of recent years, the death rate and infant mortality rate both fell considerably, and there was no outbreak of infectious disease. Southall has maintained throughout the years of its existence a good record with regard to infectious disease, national waves of infection usually arriving, if they reached the Borough at all, later than to the neighbouring Boroughs, and finishing sooner. Work has been routine during the year and comment on individual sections of the service can be found in the appropriate chapters. At this moment it seems a good thing to study the progress of public health in the Borough since the onset of the last War—a period of 25 years. From 1939-1946 the Public Health Department controlled the Environmental Service, the Maternity and Child Welfare Service, the Ambulance Service, and a small Infectious Disease Hospital, and in addition from 1946-1948, the School Health Service. In 1948, resulting from the National Health Service Act, the Maternity and Child Welfare Service, the Ambulance Service and the School Health Service control was taken over by the County Council and managed in Areas, Southall being included in an area having also Heston & Isleworth and Brentford & Chiswick. The Ambulance Service was taken by the County Council and the Hospital by the Regional Hospital Board. On the credit side, there has been steady improvement in the services for the control of infectious disease, for the inspection and improvement of the homes and workplaces of 1 the people, for the supervision of hygienic production, importation and handling of food, so as to prevent dirty or diseased food causing disorder or disease to the people. These services were disrupted neither by War nor by the National Health Services Act. But the Maternity and Child Welfare Services and the School Health Service, which had continued triumphantly and successfully through the War years in spite of air-raids, limited amount of time in Winter because of black-out requirements, and need of staff to carry out supplementary duties of many kinds because of the demands of War, were shattered by the impact of the new legislation. While parents were still ready and anxious to take their children to be treated for abnormalities of health to general practitioners, hospitals, or even to local health authority clinics, that wish, carefully cultivated by devoted Health Visitors through the years, to have attention and advice about healthy children to prevent disability or disease, became limited to the more devoted mothers only, particularly when Health Visitors became scarce because of lack of training facilities, and the creation of too many supervisory grades. Ante-Natal Clinics where expectant mothers had been used to attend as often as they liked, and by appointment weekly during the final two months of their pregnancies, and which were combined with Mothercraft training, talks and tea meetings, where also the midwives could meet their patients, faded out, and the expectant mothers either travelled several miles to hospital clinics, or visited their private doctors, two or three times during the whole of their pregnancies. Whereas in 1945, to take a year at random, out of 547 ante-natal mothers attending the ante-natal clinic 276 came on more than 6 or more occasions. The fourth clinic which was already designed for Northcote Avenue as a two-storey building for later expansion, became a bungalow building replacing one of the existing three clinics, and the fifth clinic was never built in Norwood Green. The Clinic Service began to recover after some years, and started again to attract keen young Health Visitors, who have been doing very fine work particularly with the new immigrant population. The use of voluntary helpers was a feature of our old service, there was a special Association of Clinic Workers. They were absolutely discouraged in the new regime of 1948, but lately increasing use appears to be made by the County Council of W.V.S. helpers, whose presence in the clinics makes for friendliness. There should be a vast number of potential voluntary workers in Ealing, women with nothing to do, and men newly retired from active life, but they need stimulating (and I think this is the duty of the Medical Officer of Health). It was with some astonishment that I learnt that the Old People's Welfare Committee which we founded from the Ealing Branch of the Red Cross soon after the War, faded away, presumably through lack of helpers—it could not be through lack of work to do—and that in recent years efforts have been made to get a committee working on Southall Old People's Welfare Committee lines. And now for the future. At last the Public Health Department is to be responsible for the whole service, Environmental and Personal and, unless mistakes are made, at least partly responsible for Welfare and the Children's Services. Here is the opportunity to make atonement for the wasted years, and to make a department in London which can reach the high standards of Preston, Bristol, Newcastle and other excellent provincial towns, which have had the good fortune to retain the unified control of the Public Health Service throughout. Administration must be personal, decentralized and helpful. There must be no more passing of enquiries from poor distressed citizens, who, after all, have to pay for the service, from one department to another. Every member of every section of the Health Department should be willing to try to find the right person to answer any problem, and the repellent words "Sorry, I cannot help you" should be forbidden. The Sanitary Inspection service should continue, as now, to be immediately available to callers with problems of housing, or nuisance, and to maintain good environmental conditions, the safety of food and water, and the control and prevention of epidemic diseases. The Clinics should be brought up to the former standards (and those Clinics situated in the other parts of the new Borough, i.e. Ealing and Acton, should be elevated to the 2 former Southall standards) and an endeavour made to obtain an attendance equal to our previous figures, from which it could be seen that 90-95% of new-born infants attended at least on one occasion at a local authority Clinic. The improvement should be carried out whether they are held in local authority buildings or in private practitioners' premises, and they should all be modernised and made able to provide for group discussions, Parentcraft teaching, physical training classes, and have creches manned by voluntary workers and well equipped with play material where toddlers can be kept amused while they are waiting, and there should be a two-way traffic, with the mutual goodwill of the general practitioners and the local authority doctors, so that health visitors and secretarial staff can be made available for all maternity and child welfare clinics, with the simple condition agreed with general practitioners that appropriate records of those attending such clinics should be available for the use of the Medical Officer of Health for statistical and research purposes. General practitioners should be able to refer directly to special services, i.e. for physiotherapy, chiropody, dentistry and orthodontic treatment, ophthalmic investigation, etc. Day Nurseries and Day Hostels for the Chronic Sick should be provided at the earliest possible opportunity, to help those members of families who are willing and anxious to care for their children or disabled relatives, but who either must work to live (i.e. widows, widowers, unmarried mothers, unmarried sons or daughters of sick persons), or who need some relief from the heavy duty of constant care of children or sick relatives (i.e. when in poor physical health), or when needed in some of the sorely pressed public services because of special qualifications but unable to work because of home ties (i.e. school teachers, nurses). Southall had four Day Nurseries, where children not only had good care and happy companionship, but where many mothers learned a great deal of mothercraft; now it has none, but very many young children spend the days with strangers, unselected, unsupervised, some excellent, some careless, some frighteningly incompetent. The School Medical Service whereby all children are seen in school by a doctor, with parents and the Health Visitor in attendance, and with the opportunity of a case conference with head teacher and class teacher to follow, should be expanded to have routine inspection at ages 5, 8, 11 and 14, and yearly inspections after that age. The Clinics to which children with minor ailments, injuries and emergencies, can be referred direct from the schools should be open every day all day with a doctor either in attendance or on call. This, which was our custom in Southall, saves much distress to school teachers who have to search for working parents, private doctors who are probably out visiting, or to take or send the children to hospital. Equipment in offices and clinics should be brought up-to-date. For offices and clinics good filing systems, plenty of intercommunicating and external telephones, visual aids for Health Education, typewriters and dictographs are needed, while for the department as a whole part of the services of a printing department and of a computer for statistical surveys and reports are most important. More clinic centres need to be provided, but all the existing premises should be kept up-to-date. Old houses used for homes and hostels should be studied and improved, shiny new buildings are most depressing for the homeless and the old, and such new homes as are required should not be obviously modern, and should allow some privacy and decency for the unfortunate dwellers. Mental Health—little has been done as yet for this branch of Public Health in local authorities. One of the first links must be with the Psychiatric Hospital at St. Bernard's, and the Psychiatric Units of the local general hospitals—and home visiting should be shared by hospital psychiatric social workers and local authority mental welfare officers. Day hostels and resident hostels for patients convalescing from mental illness are urgently necessary, and could combine well with the Industrial Training Schemes now in operation in the hospital and in Hanwell. More training centres and greater variety of work opportunities are needed for those handicapped by mental subnormality. Welfare. Since the War, the social conscience has been stirred by the plight of the homeless, the destitute, neglected and abandoned children, the disabled or handicapped and the lonely aged. The work of the Welfare Section is to accept responsibility for all of these, and the Medical Officer of Health has a duty to enlighten the Local Authority on how 3 best to treat, or if possible prevent, these evils. The homeless should be provided with homes —this is the true provision expected from Council housing—to house the needy and the improvident for the sake of their children. The destitute should be gently helped in cooperation with Church or voluntary association members, according to the circumstances, the cause of destitution whether neglect, drink, drugs, mental apathy, or instability, treated, and personality and self respect restored. The little children, needing care because of inadequate or cruel parents, or because of the illness, absence, or death of parents, should be as carefully treated and guarded as if the Department staff were their own parents, and every foster home, or children's home, or family hostel should be subject to frequent and unheralded visiting by Departmental professional staff, such as Health Visitors, who will have the intelligence to recognise unhappiness or fear, or physical signs of indifferent treatment or malnutrition. Those disabled by crippling disease, or by deafness, or by blindness, are enough in number in a Borough of the size of the new one of which Southall will be a part, to require full scale provision of resident, of school, and of training facilities, and the school for educationally subnormal will probably require to be supplemented by the provision of special classes in the day schools, there are still not nearly enough classes for the teaching of reading to children who have fallen behind in this skill, and experiments in the use of the New Alphabet, and the Teaching Machine are desirable. The lonely aged have had a fair amount of attention from the Welfare Department in the last few years—but the new Welfare Section must do much more. The Home Help Service should belong to this section, and should be greatly expanded. Meals for the housebound elderly, clubs and occupation centres to which the over 60's can become attached, should be organised by the Department through voluntary bodies and a central kitchen provided for delivery of meals to these premises. A good night sitter service should be started, and a transport service to convey the disabled elderly to clubs or clinics provided. The Welfare Section needs to provide homes of a completely different character from those at present in use, in which elderly people who can no longer remain in their own homes would have decent privacy, recreation, and occupation if they so desired, and a corner for their best loved possessions. Privacy and possessions—they cherish these and should not be forcibly deprived of them. The Welfare Section and the Housing Department together should organise as soon as possible the building of many blocks of single room flatlets with some community service and warden, or the conversion of big houses into this same type of housing—which is likely to save the need for many old people's homes and saves hospital beds also. The Public Health Department will need also its own Mass X-ray Unit and its own Laboratory, and its Chest Clinic should be expanded for the development of other services of after-care, such as the follow-up of diabetes, gastric ulcer, and other cases discharged from hospital. Research such as is going on now in Southall on the discovery of unknown diabetics, can be carried out with the goodwill of General Practitioners if proper assistance is given. The conditions likely to lead to gastric ulcer, the anaemics, arterio sclerosis and many other major disabilities, can be studied, and as diet is the most decisive factor in the production of a great proportion of the diseases of man, aberrations of diet can be corrected. Training. All this work cannot be carried out without a sensible scheme of service in-training being established from the 1st April, 1965. In-training is required for all types of staff, professional and clerical, and courses of training for every grade of employee from the day of entry into the service can be set up in the local Polytechnic. Thus, before long, there need no longer exist the shortages in every grade of local governmental staff in public health departments. The only exceptions are the doctors' and nurses' basic training, but a scheme of in-training could be prepared even for them so that qualified doctors may acquire the D.P.H., D.C.H., and other diplomas on various subjects relevant to the needs of the Department; while hospital qualified nurses could be given help with training for the Health Visitors Certificate, other social science qualifications in auxiliary medicine, the Midwives Certificate, or a qualification in Mental Health. The new Borough has a wonderful opportunity now to create a Public Health Department which will truly be aiding the people and maintaining Public Health. I had expected 4 to be given the opportunity of guiding this new Department into sound and progressive ways, but as this opportunity has not been granted to me I have given the best advice I can in this limited preamble, and I wish the Department success in prevention of disease and promotion of health in body and mind for everybody. My last word is of gratitude for the wonderful and loyal officers of the Public Health Department, past and present, who have helped me in our work through the years. I have been indeed fortunate in them, and do thank them here and now with great sincerity, and will always be thankful that we worked together. I am particularly grateful to my colleague, the Chief Public Health Inspector, Mr. R. W. McDonald, who has been with me during the whole of my time in the Borough; his exceptional ability and knowledge of sanitary law have enabled us to perform miracles with our tiny staff; and to the Chief Clerk, Mrs. Jones, who has never rebelled even when driven, at the last, almost beyond the point of exhaustion in assisting me to get this Report ready for the printers. I am, Your Worship, Ladies and Gentlemen, Your obedient Servant, Margreat a. Glass Medical Officer of Health. Manor House, Southall. Telephone Numbers: SOU 3621-2. SOU 5060. 5 Acknowledgments to:— The County Medical Officer The County Public Control Officer The Area Medical Officers of Areas 7 and 9 The Area Welfare Officer The Physician Superintendent, St. Bernard's Hospital The Medical Superintendent, Hillingdon Hospital The Secretary, Uxbridge Group, N.W.M.R. Hospital Board The Medical Officer of Health, Cambridge The Medical Officer of Health, Sheffield The Medical Officer of Health, Westminster Dr. J. T. Nicol Roe, Area Chest Physician Dr. G. Z. Brett, Medical Officer of Mass X-ray Unit 5A The Borough Education Officer The Officers of the Department of Scientific and Industrial Research The General Practitioners of Southall The Manager, Southall Office of the Ministry of Labour The Youth Employment Officer The Chief Officers of the Council The Organisers of Voluntary Associations in Southall 6 HEALTH DEPARTMENT STAFF for the year 1964 Medical Officer of Health: Margaret A. Glass, B.Sc., M.B., Ch.B.(Glasgow), D.P.H.(Cantab.). Deputy Medical Officer of Health Robert L. Lindon, M.R.C.S., L.R.C.P., D.P.H., D.C.H. (Until 6.12.64). Ian O. Taylor, M.A., M.R.C.S., L.R.C.P., D.P.H. (From 7.12.64). Public Health Inspection Staff: Chief Public Health Inspector: R. W. McDonald, Cert. S.I.B., Cert. M. & F. Deputy Chief Public Health Inspector: S. Sadler, Cert. S.I.B., Cert. M. & F., R.S.I. Smoke Certificate. District Public Health Inspectors: C. H. Wright, Cert. S.I.B., Cert. M. & F., Cert. Smoke Inspector. P. J. McMahon, Cert. S.I.B., Cert. M. & F. (Until 12.4.64). D. H. Ratliff, Cert. S.I.B., Cert. M. & F., Cert. Smoke Inspector (Until 16.2.64). D. W. Tomlin, Cert. P.H.I.E.B., Cert. M. & F. J. H. Brown, Cert. P.H.I.E.B., Cert. M. & F. (From 2.3.64). J. Hill, Cert. P.H.I.E.B., Cert. M. & F. (From 17.8.64). Trainee Public Health Inspector: M. R. Chaudhry, S.I. Cert. (PAK)., A.R.S.H. General Assistant: J. E. Nixon. Clerical Staff: Senior Clerk: Mrs. K. Jones. Clerks, Shorthand-Typists: Miss C. M. Hately. Mrs. D. A. East. Mrs. K. N. Malam. Miss M. L. Neale. Miss W. M. Osgood (Until 7.8.64). A. J. Jones (From 10.8.64). Interviewing Officer: W. G. V. Hyde. 7 GENERAL STATISTICS AND SOCIAL CONDITIONS OF THE BOROUGH Area (Acres) V2,607.762 Population—1961 Census Year 51,337 Population—Registrar-General's estimate (mid 1964) 57,220 Number of inhabited houses according to the Rate Book at 31st March, 1964 15,049 Average number of occupants per house 3.80 Sum produced by a penny rate (1963/1964) £13,675 Rateable Value (31st March, 1964) £3,345,278 Parks and Open Spaces controlled by the Council:— Brent Meadow 8.92 acres Cranleigh Play Park 2.00 acres Dormers Wells Housing Site 2.99 acres Dudley Road Island 0.13 acres King George's Field 22.48 acres Football Ground, Western Road 3.51 acres Frogmore Green 0.35 acres Glade Lane 27.93 acres Havelock Road Open Space 2.22 acres Jubilee Park 11.13 acres Lady Margaret Road 0.25 acres Land at junction of Windmill Lane and Tentelow Lane 0.48 acres Land on west side of Cranleigh Gardens 1.07 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 8.92 acres The Manor House 2.00 acres West Middlesex Golf Course 108.00 acres Western Road 0.17 acres Wolf Fields 3.33 acres Wolf Green 0.18 acres Land to north-west of Kingsbridge Crescent 0.12 acres Land on north side of Spencer Street 0.31 acres Tentelow Lane Island Site 0.25 acres 279.15 acres Southall is a County District, compact in shape, being almost a square, with water boundaries on three sides—the River Brent on part of the east, the Grand Union Canal and the Yeading Brook on the west and the Grand Union Canal on part of the south. The Borough is highly industrial, containing large factories for food processing and engineering, and many smaller factories producing a great variety of semi-finished or finished products. The development of the Borough has been rapid, mainly within the present century, and so there has been little slum clearance to deal with, but there is still a good deal of sub-standard housing, i.e. houses without baths or without hot water supply, and some without indoor sanitary accommodation. The problem of multi-occupation of such houses by members of the same family or by different families brings problems of cleanliness and the maintenance of freedom from infectious disease and from diseases encouraged by faulty hygiene. Areas of land in two neighbouring Boroughs have been used 8 for Southall Council house building because of the shortage of land within the Borough and to assist with the housing needs of the people of Southall, and use is also made of New Town housing. Employment Statistics The Manager of the Southall Employment Exchange has kindly submitted the following information showing the general trend of the employment position in Southall during the year:— Men Women Number of persons registered as unemployed at Southall Employment Exchange on— 10th December, 1962 275 42 9th December, 1963 249 40 7th December, 1964 87 21 Number of unfilled vacancies as at— 5th December, 1962 90 87 4th December, 1963 151 86 2nd December, 1964 463 146 The Youth Employment Officer obliged by giving information as follows:— Boys Girls Number of persons registered as unemployed at the Youth Employment Office on— 10th December, 1962 11 4 9th December, 1963 13 8 14th December, 1964 12 3 Number of unfilled vacancies as at— 5th December, 1962 21 33 9th December, 1963 28 37 14th December, 1964 37 43 The Youth Employment Officer also made the following comments:—"There has been a steady demand for labour throughout the year—but even so employers have continued to be selective, and the ability to work at speed has become a necessary requirement even for routine work. For this reason difficulty was experienced in placing certain physicallyhandicapped and educationally sub-normal youngsters. Young people from Approved Schools, those with poor employment records, and coloured boys and girls also presented problems in placing. "One of the three unemployed females was a partially-sighted girl, who is still awaiting admission to Queen Elizabeth's Training College, Leatherhead, for training as a Telephonist. "Among the unemployed boys were— "(1) a deaf lad who is awaiting a vacancy at Queen Elizabeth's for training in Bench Carpentry; "(2) a disabled boy of 17, who recently arrived in this country from India. He has a congenital absence of his right foot, and also deformities of both hands. He is at present unemployable and will remain so until he can be fitted with an artificial limb. 9 "There continues to be a shortage of training facilities for handicapped and disabled youngsters." Swimming Baths The Southall Borough Council maintains an outdoor swimming pool in the Recreation Ground, which is one of the public parks, and this pool is used very fully during the summer months. 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 the normal chlorine content of 1.0 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. A minimum of three samples of the water are taken daily by the Bath Manager's staff for chlorine and pH reading, and from time to time bacteriological testing is carried out by officers from the Public Health Department. At no time during 1964 was the water found to be unsatisfactory for use by swimmers. As this bath is closed during the winter months it can be fully emptied and repaired, if necessary, and cleansed each year before the spring opening. During 1964, the total number of persons using the bath was 39,936 (22,685 in 1963). The average number of persons attending per day was 261. The maximum number at any one session was 350. The comparison of figures of attendance in different years is a clear indication of the type of weather that prevailed during the summer, and these figures are extremely high because 1964 had an exceptional hot, sunny and long-lasting summer. An indoor swimming bath was opened at North Road School in the latter part of 1962 for the use of the pupils. Sampling of the water produced satisfactory results during 1964. There was some difficulty during the Autumn because of the need for decorations and repairs—pieces of dry distemper were falling into the water, and roofing board was loosening so that the pool had to be closed temporarily, until suitable action could be taken. This pool is used by the school children summer and winter. Paddling Pool A paddling pool for young children is available in Cranleigh Gardens Play Park. The capacity of the pool is approximately 15,500 gallons with depth from 1½ inches to 9 inches. The water of the pool is free-running and is treated by continuous chlorination for hygiene purposes. Like the swimming bath, this pool was in constant and very full use during the summer of 1964. Sampling of the paddling pool water gave excellent results for purity throughout the year. School Playing Fields A total amount of approximately 24 acres of land for school playing fields are now available for the children of Southall to enjoy physical training, school games, and recreation. This includes 2½ acres newly acquired as playing field space for the pupils of Dormers Wells Secondary Modern School. In addition, there is much play space in the Borough Parks, and in the Municipal Sports Ground there is a very fine track and field for athletics, part of which can be floodlit when required. School Sports meetings are held here. 10 VITAL STATISTICS Total Deaths, 676 (Males 331; Females 345) Crude Death Rate, 11-81 For extracts from vital statistics and causes of death, see Appendix, Tables I and II. Deaths and Death Rate The death rate, i.e. the number of deaths per 1,000 total population, fell in 1964, and was the lowest rate since 1952. The corrected death rate cannot be calculated for 1964, because of the absence of the comparability factor normally supplied by the RegistrarGeneral, which makes allowances for the way in which the sex and age distribution of the local population differs from that of England and Wales as a whole. This corrected figure has been considerably lower than the crude death rate each year in Southall, so it can be presumed that once again it will be less. Below is shown the comparative figures for the past ten years. Year Crude Death Rate 1955 11.92 1956 12.25 1957 13.02 1958 12.04 1959 12.12 1960 13.15 1961 13.63 1962 13.60 1963 14.38 1964 11.81 The principal causes of death were cancer, vascular diseases, coronary disease, and heart disease, in that order. The figure for cancer deaths rose slightly from 130 in 1963 to 135 in 1964. Lung cancer accounted for 37 of these (32 male, 5 female)—there were 35 in 1963. Thirty-five cases also occurred in the alimentary tract, i.e. 3 sited in the oesophagus, 17 in the stomach, 15 in the intestine. There were no deaths from whooping cough, diphtheria or poliomyelitis. Two deaths were attributed to influenza. There were three deaths from pulmonary tuberculosis. 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 276 (males 161, females 115). Deaths of institution inmates (including patients from Southall addresses and from outside areas) number as follows: St. Bernard's Hospital, 259 (males 94 and females 165); Mount Pleasant Hospital, 31 (males 11 and females 20); Southall-Norwood Hospital, 8 (males 3 and females 5); in addition 4 deaths (all female) occurred of persons belonging to other districts. In 1964, eight people died as the result of motor vehicle accidents, as compared with nine in 1963. The total number of deaths from violent causes was recorded as 39 in 1964, as compared with 38 in 1963. For distribution of deaths in the various wards, see Appendix, Table III. Births and Birth Rate (Figures for 1963 are given in brackets.) The total number of live births belonging to the district, whether occurring within or outside the district, was 1,159 (1,220). The illegitimate live births during the first threequarters of the year were 47—which suggests an improvement over previous years, but the number for the last quarter was not available. The birth rate, which has been rising rapidly each year, fell from 22.96 in 1963 to 20.66 in 1964. There were 23 stillbirths (19), 18 legitimate and 5 illegitimate. The birth rate is the number of births per 1,000 of the total population. 11 12 13 Graph B Infant Mortality Rate from 1900 to 1964 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 normally, but this cannot be done this year, nor can a comparison be made with the rest of the country. But the variation of the corrected from the crude birth rate has never been more than 0.4, which is not a highly significant difference. Infant Mortality Infant mortality, i.e. the number of children dying before reaching the age of one year, fell slightly in 1964. Twenty-one infants died compared with 27 in 1963, giving a rate of 18.12 per 1,000 live births compared with 22.13 in 1963. All died in hospital. Nineteen infants (six male and thirteen female) died within the first four weeks after birth. Twenty-three babies were stillborn in hospital, none at home, making a stillbirth rate of 19.8. Table IV on page 69 gives causes of death in the stillborn. Table V gives the causes of infant deaths under the age of one year. Graph B on page 13 shows the trend of the infant mortality rate since 1900. Premature Infants One hundred and four premature infants were born alive during the year; 101 were born in hospital, and of these, 89 were surviving at the end of one month; 3 were born at home or in a nursing home and all of these were surviving at the end of one month. There were 13 premature stillbirths, all occurring in hospital. Premature Births and Stillbirths during past 8 years Year Born at Home Born in Hospital Births Died within one month Stillbirths Births Died within one month Stillbirths 1957 8 2 - 40 7 6 1958 8 — — 49 8 3 1959 7 — — 48 6 3 1960 15 — 1 45 7 7 1961 12 1 — 63 17 16 1962 6 — — 83 8 10 1963 11 — — 87 11 13 1964 3 — — 101 12 13 Maternal Morbidity Two cases of puerperal pyrexia were notified direct to the Department during 1964; in addition 62 cases were notified to other authorities. The classification of puerperal pyrexia is "any febrile condition occurring in a woman in whom a temperature of 100.4° Fahrenheit (38° Centrigrade) or more has occurred within fourteen days after childbirth or miscarriage." 14 PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES The number of infectious disease cases notified during 1964 was very much reduced. The biennial fluctuation of the measles figures showed in the low figure for 1964; dysentery notifications were 50% lower and most of these were not confirmed as dysentery bacteriologically. The figure for infectious pneumonia was only 10 compared with 58 in the previous year, and whooping cough was also well down. Our only epidemic problem locally was infective hepatitis, although it was not great in extent. See Tables on page 71. 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. Poliomyelitis No notifications of anterior poliomyelitis were received in 1964. Vaccination against poliomyelitis, which is organised by Middlesex County Health Department, continued throughout 1964, and details are as follows:— Number of persons who received 3 oral doses. Born in the following years: 1964 1963 1962 1961 1943-1960 1933-1942 Others Total 49 586 115 35 114 16 13 928 Number of persons who received 2 injections. Born in the following years: 1964 1963 1962 1961 1943-1960 1933-1942 Others Total 3 72 25 16 187 134 101 538 Number of persons who received 3 injections. Born in the following years: 1964 1963 1962 1961 1943-1960 1933-1942 Others Total — 19 56 7 21 6 15 124 Number of persons who received an oral boost after 2 injections. Born in the following years: 1964 1963 1962 1961 1943-1960 1933-1942 Others Total — — 1 — 2 2 1 6 15 29 school children received a fourth injection during the year. 145 school children received an oral boost after 3 injections. Under the age of 40, anyone previously receiving two injections of Salk vaccine is now given two additional doses of oral vaccine. Reinforcing doses of oral poliomyelitis vaccine are offered at school entry period followed by boosts for diphtheria prevention. It will be seen that oral vaccine has practically replaced the Salk vaccine injections. Measles Measles incidence was not considerable during the year 1964. There were no deaths from this cause. The following table shows the trend of notifications during the past ten years, and shows the biennial fluctuation which has come to be considered typical of measles. Year No. of Cases Deaths 1955 1,329 — 1956 61 - 1957 674 1 1958 476 - 1959 674 - 1960 12 - 1961 1,042 1 1962 178 - 1963 898 - 1964 75 - Influenza Influenza was not a considerable problem in 1964—there was a rise in incidence for a short period in January but the infection was not a virulent one. Dysentery Fifty-four notifications for dysentery were received in 1964. Of these, 17 were confirmed bacteriologically; fifteen as Shigella Sonne, one Shigella Flexner, and one was confirmed as Food Poisoning, i.e. Salmonella tennessee. The distribution of cases was scattered—no outbreak occurred. In one family there were three persons affected, and in each of two families two members suffered the illness. Smallpox No case of smallpox was notified in Southall during the year, and indeed no case has seen notified in the Borough since 1930. Vaccinations:— 1963 Age Group Under 1 year 1-2 years 2-4 years 5-14 years 15 years and over Total Primary Vaccination 113 187 29 15 25 369 Re-vaccination — — 4 18 130 152 1964 Age Group Under 1 year 1-2 years 2-4 years 5-14 years 15 years and over Total Primary Vaccination 62 376 123 8 2 571 Re-vaccination — 2 7 11 1 21 16 The figures for smallpox vaccination, after a year in which a large proportion of the population had been vaccinated, dropped heavily in 1963 and continued to be small in 1964, but there was an encouraging increase in the number of infant vaccinations from 300 in 1963 to 440 in 1964. Contacts:— From time to time during the year contacts of suspect cases of smallpox entering or returning to the Borough are notified. The number of these during 1964 was seven such persons who were notified and kept under observation. No smallpox developed. Also eight persons were notified as entering from smallpox areas without valid certificates of successful vaccination. These persons were offered vaccination and kept under surveillance until they could be cleared. Typhoid Fever No cases of this disease were notified during the year. Twice during the year outbreaks of typhoid in other places gave cause for extra observation in Southall. 1. A contact was reported from a case on a liner entering the country from abroad. The contact was kept under observation for the prescribed period, but no symptoms developed. 2. Shortly after, information came in concerning a considerable outbreak of typhoid fever in Aberdeen, the cause of which was unusual as it was alleged to be due to imported corned beef in tins. As this was stated to be the only possible cause of the outbreak, it was necessary to check in the Borough that no tins of the suspect brands should be allowed to go for sale until clearance could be given. Watch was kept for a considerable time, but no case occurred in the Borough. Scarlet Fever (Scarlatina) The number of notifications received during the year was 23, as compared with 5 in 1963, 19 in 1962 and 27 in 1961. In three families there were multiple cases, and in each of these instances there was secondary infection after a period of two weeks, showing that isolation was not good. They were all nursed at home. Diphtheria No cases of diphtheria were notified to the Department in 1964. The last notification of a case of this disease was in the year 1950. The following information supplied by the Area 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) Ages at Date of Final Injection Under 1 1-4 5-14 Total 360 670 67 1,097 601 The figures for immunisation against diphtheria improved greatly for the second year in succession, and the level of protection with immunisation maintained at this rate would be satisfactory. Ophthalmia Neonatorum No cases of ophthalmia neonatorum were notified during the year. 17 Encephalitis Three cases of this disease were notified in 1964, two of which were subsequent to an acute parotitis (mumps) infection. Infective hepatitis In January of 1964, it came to light that sporadic cases of infective hepatitis had been occurring in the district for over two months. In view of the fact that a number of cases were school children, medical practitioners were asked, although the disease was not compulsorily notifiable, whether they would be good enough to give information on cases occurring in their practice recently. The number of cases was significant, and in two of the schools in the Borough there was evidence of infection in single classes, also in each of these schools one of the teachers became seriously ill and was prevented from carrying out duty for some months. Cases continued to occur in different parts of the district. A member of the Medical Research Council was invited to attend to discuss the possible need for immunisation with gamma globulin, but it was decided that the circumstances were not suitable, since this protection is only really effective in a closed community, such as boarding school or residential nursery. Later, because of requests from individual teachers, a certain amount of immunisation was given by the School Medical Department officers. Two deaths during the year were attributed to infective hepatitis, one a female aged 62, and one a female infant aged 1 year and ten months. It was decided to approach the Minister of Health with a request that this disease should be made compulsorily notifiable in Southall, and permission was given by special Order, to take effect from the 1st October, 1964, for a period of three years. From the date of operation of the Order until the end of the year, seven cases of this disease were notified, two adults and five school children. Tuberculosis Notifications Pulmonary The number of notifications received during the year was 83. Other Forms The number of notifications received during the year was 15. Of the total notifications, which include new cases and inward transfers from other districts, 74 were received from the Uxbridge Chest Clinic; 7 from General Hospitals; 14 from St. Bernard's Hospital, and 3 from General Practitioners. The number of new notifications fell from 102 in 1963 to 98 in 1964. Of the 98, 34 were inward transfers, i.e. they were not resident in Southall at the time of development of the disease and, therefore, the actual figure of new notifications of Southall residents was 64, four of which were subsequently diagnosed as non-tuberculous; while in 1963 the number of inward transfers was 37, making the figure for new notifications of Southall residents 65. Deaths Tuberculosis of the respiratory system, 3; other forms, nil. For details of new cases notified and deaths in 1964, see Appendix, Table IX, and for the occupation of new cases, see Appendix, Table X. The notification figures did not rise in 1964, but the proportion of pulmonary cases rose while that of non-pulmonary was reduced. Graph C shows the progress of notifications and deaths since 1930. There were three deaths from pulmonary tuberculosis as compared with three in 1963 and four in 1962. 18 Comparative figures for the last eight years for the occurrence of tuberculosis in Indian residents of Southall follow on the next page. Year New Cases Number Of Indians 1964 64 39* 1963 65 36 1962 40 12f 1961 67 29 1960 47 13 1959 64 12 1958 57 14 1957 61 10 *Three subsequently not confirmed as Tuberculosis. †Two subsequently not confirmed as Tuberculosis. The analysis of the housing conditions of 69 newly notified cases shows that 44 lived in houses; 3 in flats; 22 in lodgings. Information was not available with regard to the other 29 cases for the following reasons:— 2 of the cases were among 4 not confirmed as Tuberculosis; 16 cases were patients in St. Bernard's Hospital; 7 transferred out to other districts after a short stay in Southall; 1 died; 1 could not be traced; 2 were in reality old cases thought to be recurring, but subsequently found to be recovered. Of the 69 cases above, 16 were inward transfers, i.e. did not contract the disease in Southall. There were eleven cases notified from overcrowded houses, eight Indian, one West Indian, one Irish, and one English, and one notification of an English child from a dilapidated house needing urgent repairs. Overcrowding was abated in one instance and some repairs carried out on the dilapidated house. In 17 instances, there were multiple cases. Statutory overcrowding was confirmed in one of these houses. The number of patients was two in fourteen instances, and three in three instances. All cases of overcrowding and dilapidation having a patient notified in 1963 were relieved by the end of 1964, either by rehousing or outward transfer. Three overcrowdings from the 1962 list were still not abated. One patient from the 1960 notifications living in dilapidated property, due to be demolished after the rehousing of the tenants, was still in residence at the same address. Management of Tuberculosis For diagnostic purposes, Southall patients are mostly referred either by general practitioners or from hospital doctors to the Uxbridge Chest Clinic, and if tuberculosis is found, treatment and following-up is instituted from that Clinic. The Tuberculosis Visitor calls at the home of a patient and submits a copy of her report to the Public Health Department. Contacts are seen by the Visitor and they have suitable tests, either tuberculin tests or X-rays, or both, at the Chest Clinic. If sanitary defects or overcrowding are reported, further visiting is carried out from the Public Health Department. B.C.G. Vaccination At St. Bernard's Hospital, cases of tuberculosis are isolated in Adelaide Ward, which has 24 male and 24 female beds. One of the doctors from Uxbridge Chest Clinic continues to carry out tuberculin testing and B.C.G. vaccination of members of the nursing staff of the hospital. All new members of the staff at this Hospital have routine X-ray examination before commencement of duty. 19 Graph C Tuberculosis (All Forms) — Notifications and Deaths from 1930 to 1964 20 B.C.G. vaccination is offered to contacts of cases of tuberculosis, to medical and nursing staffs of tuberculosis wards, and since 1957, as a result of the findings of the Medical Research Council in their Tuberculosis Vaccines Clinical Trial, to children aged 13 and over in Southall schools. Testing with tuberculin is carried out beforehand. The tuberculin test, if positive, shows that infection has occurred at some time during life, and further investigation is undertaken to verify whether this is active, chronic or healed infection, as these all give the same result to the test. When the tuberculin test is negative and in the absence of disease, B.C.G. inoculations are carried out in order to render the individuals tuberculin positive and, therefore, to have immunity to infection by the tuberculous bacillus. Details of work on Southall contacts during 1963 and 1964 at Uxbridge Chest Clinic are as follows:— 1963 Under 1 year 5-15 Over 15 Total Grand Total Tuberculin tests—Positive result 4 - 2 32 38 297 * 1 3 18 203 225 † - 1 3 18 22 ‡ — — — 12 12 Tuberculin tests—Negative result 21 26 14 24 85 168 * 15 26 13 20 74 † 3 1 2 2 8 ‡ — 1 26 — — 1 B.C.G. given 21 14 11 721 143 * 15 26 13 10 64 † 3 1 1 2 — 6 ‡ — — — 1 B.C.G. given—Babies born in hospital 10 20 * 10 *Indians and Pakistanis †West Indians ‡Chinese 1964 Under 1 year 1-1 5-15 Over 15 Total Grand Total Tuberculin tests—Positive result - - 2 12 41 163 * - 8 36 86 130 † - 1 15 3 19 Tuberculin tests—Negative result 16 14 23 3 56 156 * 13 24 42 7 86 † 1 7 6 — 14 B.C.G. given 16 14 23 3 56 147 * 13 21 36 7 77 † 1 7 6 - 14 B.C.G. given—Babies born in hospital 13 21 * 7 † 1 *Indians and Pakistanis †West Indians Under the B.C.G. vaccination in schools scheme, details are as follows:— Number invited to take part in scheme Number of consents received Referred to Chest Clinic Number of Children vaccinated with B.C.G. Contacts Positives 351 282 2 58 154 21 All testing and vaccinating during 1964 under this scheme was carried out in Southall by the Middlesex County Council Staff. Mass X-ray The mobile Mass X-ray Unit paid only two routine visits to Southall factories during 1964, i.e. Taylor Woodrow Ltd. — number X-rayed 845 T. Wall & Sons Ltd. — number X-rayed 332 In these surveys, one active case of pulmonary tuberculosis (not a Southall resident) and two observation cases, i.e. showing signs of old disease but no symptoms, were found. No cancer cases were discovered. Dr. J. T. Nicol Roe, Physician in Charge at Uxbridge Chest Clinic, renews his appeal for continued aggressive action in using this service for the early detection of the new case of tuberculosis. With the further increase in coloured immigrants into Southall this is particularly desirable, for during 1964 there was again an increase in immigrants developing active tuberculosis. Further appeal is made and our thanks expressed to the General Practitioners in Southall for referring newly arrived immigrants and their families for X-ray and/or Tuberculin Testing to the Chest Clinic. Those exhibiting a negative Tuberculin Test are offered B.C.G. vaccination. There are at Uxbridge Chest Clinic X-ray only sessions, to which patients can be referred by their own doctor. In view of the continued attraction of Southall to coloured immigrants, it is our considered opinion that there would be much in favour of a branch of the Chest Clinic being installed in Southall. There they could be X-rayed and Tuberculin Tested more expeditiously and with the prospect of better control of the problem. The installation at London Airport of an X-ray Unit for the compulsory X-raying of immigrants entering the country with a Work Permit is welcomed. Patients in the Southall area, as before, are admitted to Harefield Hospital. Dr. Nicol Roe considers it is still a desirable thing for anti-tuberculous drugs to be initiated in hospital, as a certain risk always exists towards the development of sensitivity reactions. With regard to prevention and early detection of cases, contacts both at home and factory or workshop should have regular X-rays and/or Tuberculin Tests. Full use should continue to be made of the Mobile Mass X-ray Unit's visits to the Borough. In addition, the Static Mass X-ray Unit at West Middlesex Hospital, although primarily intended for the use of hospital patients, extends an open invitation for any member of the public to attend, at any time the Unit is working. This supplements the work done by the Mobile Mass X-ray Unit. In 1964, however, it has been reported that the numbers making use of the static Unit dropped considerably. Non-Europeans referred to the Clinic for X-ray only and skin tested. (Some of these may be domiciled outside Southall) 1964 Under 1 year 1-4 5-15 Over 15 Total Grand Total Tested * - 1 10 561 572 647 † - - 1 74 75 Positive * - - 2 496 498 562 † - - - 64 64 Negative * — 1 8 31 40 46 † — — 1 5 6 B.C.G. Vaccinated * — 1 8 31 40 46 † — — 1 5 6 *Indians and Pakistanis †West Indians 22 Cancer It will be seen by the table of causes of death (page 68) that in 1964, 135 cases (males 77 and females 58) died from cancer. See Appendix, Table VI, for an analysis of cancer deaths since 1936. On page 24 is set out in tabular form a classification of the cancer deaths according to the site of the primary growth and in ages. The total number of deaths from cancer in 1964 rose, being 135 as compared with 130 in 1963. Cancer of the lung in males was the highest individual figure for site of disease, i.e. 36 (31 males, 5 females) compared with 35 (31 males, 4 females) in 1963, and 36 (35 males, 1 female) in the previous 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 VII and VIII. Infectious Disease Visits During the year, the Public Health Inspectors paid 260 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. Laboratory Work Specimens taken for bacteriological or chemical investigations, in connection particularly with infectious disease cases, are brought daily to the Manor House and transported to the Ealing Public Health Laboratory. The necessary investigations are carried out and results reported simultaneously to the Medical Officer of Health and to the doctor who has submitted the specimens from one of his patients. Details of the work carried out in 1964 are as follows:— Faeces specimens 268 Sputum specimens 1 Blood specimens 2 Urine specimens 110 Swabs (nose, throat, aural and vaginal) 22 Disinfection and Disinfestation In cases of infectious disease, rooms, clothing, etc., were disinfected—rooms by sealing and fumigating with a formalin preparation; clothing, bedding and other infected articles remaining in the room for disinfection. List of premises, articles, etc., disinfected during the year:— Rooms 5 Books 23 Beds 5 Eiderdowns 3 Blankets 12 Pillows 10 Sheets 10 List of premises disinfested from vermin during the year:— Bug infestation 24 rooms with beds and bedding Flea infestation 14 rooms with beds and bedding Cockroach infestation 14 rooms Ants 6 rooms Scabies 5 rooms In addition, 18 wasps nests were destroyed. 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. 23 24 CLASSIFICATION OF CANCER DEATHS IN SITES AND AGES Age Groups—Male Site Under 10 10—20 20—30 30—40 40—50 50—60 60—70 70—80 80+ '60 '61 '62 '63 '64 '60 '61 '62 '63 '54 '60 '61 '62 '63 '64 '60 '61 '62 '63 '64 '60 '61 '62 '63 '64 '60 '61 '62 '63 '64 '60 '61 '62 '63 '64 '60 '61 '62 '63 '64 '60 '61 '62 '63 '64 '60 '61 '62 '63 '64 Lung 28 39 35 31 31 - - - - - - - - - - - - - - - - - - - - 3 3 4 1 1 11 6 8 9 10 9 20 14 14 14 5 10 9 6 4 - - - 1 2 Stomach 9 13 5 8 13 - - - - - - - - - - - - - - - - - - - - - - - - 1 1 2 2 4 3 3 2 1 2 4 5 8 2 1 2 - 1 - 1 3 Intestiny 7 6 7 11 6 - - - - - - - - - - - - - - - - - - - - 1 - - 1 - - 1 2 2 2 3 3 3 6 2 - 2 1 1 1 2 - 1 1 1 Bladder - 3 7 4 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 2 3 1 1 - 1 3 2 - - - - - - Prostate 6 9 4 5 3 - - - - - - - - - - - - - - - - - - - - - - - - - 1 2 - 1 - 2 2 2 - - 2 3 1 3 2 1 2 1 1 1 Other 20 19 17 17 23 - - 1 - - - 1 1 2 - - - - - 2 2 - 1 2 1 3 1 2 5 1 5 6 4 1 2 7 4 7 1 8 1 4 - 5 7 2 3 1 1 2 Totals 70 89 75 76 77 - - 1 - - - 1 1 2 - - - - - 2 2 - 1 2 1 7 4 6 7 3 19 17 17 18 17 24 33 30 24 29 13 28 16 18 16 5 6 3 5 9 Age Groups—Female Site Total Under 10 10—20 20—30 30—40 40—50 50—60 60—70 70—80 80+ '60 '61 '62 '63 '64 '60 '61 '62 '53 '54 '60 '61 '62 '53 '54 '60 '51 '52 '63 '64 '60 '61 '62 '63 '64 '60 '61 '62 '63 '64 '60 '61 '62 '63 '64 '60 '61 '62 '63 '64 '60 '61 '62 '63 '64 '60 '61 '62 '63 '64 Breast 8 15 13 11 12 - - - - - - - - - - - - - - - - - 1 1 - 2 2 3 2 - 5 6 2 3 5 - 3 2 1 3 - 1 2 2 2 1 3 3 2 2 Lung 3 5 1 4 5 - - - - - - - - - - - - - - - - - - - - - - - - - 1 1 1 1 2 2 3 - 1 1 - 1 - - 1 - - - 2 1 Stomach 6 8 12 5 3 - - - - - - - - - - - - - - - - 1 - - - - - - - 1 2 1 2 - 3 1 4 1 2 2 1 6 1 1 - 3 1 1 - Uterus 3 4 3 3 2 - - - - - - - - - - - - - - - - - - - - - - 1 1 -- - 1 - 1 1 - - 2 - - 3 2 - - 1 - 1 - 1 - Intestine 9 8 11 10 8 - - - - - - - - - - - - - - - - - - - - 1 1 1 - 1 1 2 1 5 2 3 2 6 2 1 4 2 - 2 1 - 1 3 1 3 Bladder - 3 3 - 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 1 - - - - 2 - - 2 - - 1 Other 19 16 20 21 27 - 1 - - 1 - - - - - - - - 1 - - - - 2 - 1 - - - 3 2 1 4 2 6 5 1 7 10 7 7 6 4 4 8 4 5 5 2 2 Totals 48 59 63 54 58 - 1 - - 1 - - - - - - - - 1 - - 1 1 3 - 4 3 5 3 4 10 13 9 14 16 13 13 22 15 14 16 13 14 9 14 5 15 12 9 9 Provision of Antitoxin and Vaccine Lymph The Council provides diphtheria antitoxin free to local practitioners in the district. This antitoxin is 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. Scabies and Lice During 1964, thirty-four cases of scabies and contacts were brought to the notice of the Department. This figure includes full treatment for whole families. Altogether four families were involved, ten members in one of these, and eight in each of the other three. Cleansing for head lice was needed for one family, but on five different occasions, making 19 individuals requiring cleansing station treatment. There was also one case of pediculosis pubis. Baths and treatment were arranged at Hammersmith Cleansing Station by courtesy of Hammersmith Borough Council. In proportion to the number of children surveyed for cleanliness during the year, there was still a considerable number found to be requiring treatment, although the figure was less than in 1963, i.e. 137 as compared with 166. The number inspected was 12,674 compared to last year's total of 15,211. Treatment of school children is normally carried out by private practitioners or in the ordinary Middlesex County Council Clinics, but on failure of treatment, or in cases of bad infestation, the Borough Council facilities are requested. Details of head inspections in schools are to be found in Table XI, page 73. 25 WELFARE General St. John Ambulance Association: The local headquarters of the St. John Ambulance Brigade are situated at Hartington Road, Southall. There are 24 Ambulance Members (Officer and 2 Non-Commissioned Officers), 22 Nursing Members (2 Officers and 1 Non-Commissioned Officer), 25 Ambulance Cadets and 20 Nursing Cadets (each having one Officer and 2 Non-Commissioned Officers). Both Ambulance and Nursing Divisions have Auxiliary Members. Each section has its own Surgeon; the Nursing Division and Nursing Cadets having a Nursing Officer also. The work carried out is as follows:— Nursing and Nursing Equipment. The St. John Ambulance Brigade Divisions have been trained in Nursing and First Aid to the Injured. They also have a Medical Comforts Depot in Hartington Road, open every evening (except Saturdays, Sundays and Bank Holidays) from 7.30 p.m. to 8.30 p.m. for the issue of articles needed by the public. Both Ambulance and Nursing Members belong to the National Hospital Service Reserve and Nursing Members are attached to the Forward Medical Aid Unit at the King Edward Memorial Hospital, Ealing. Welfare—General. The St. John Ambulance Brigade carried out training in First Aid and Nursing for all who cared to take advantage of the service, and ran special courses for Scouts and Girl Guides. The members of the Nursing and Ambulance Divisions also carried out many other duties including attendance at the local cinema, sports, fairs, Old Folks Clubs, accompanying the old folk on their outings to the seaside, hospital duties, and sick visiting. One Nursing Member regularly attended the Club for the Physically Disabled. Duties were also covered further afield, including theatres, concerts, London Airport and Hampton Court. British Red Cross Society: Membership of the Southall Division of the British Red Cross Society was 350 in 1964, including a large number of cadets, and link members who can join from the age of eight years. The older girls help in hospitals each week and continue to visit the deaf-blind in order to communicate with such people by a special finger language which they have learnt. Courses in first-aid, nursing, and maternity and child welfare were well attended and the Junior Red Cross also attended mothercraft, nursing and first-aid lectures and examinations. The Handicraft Club for the Disabled maintained its membership again. Thirty-five members attended the meetings each week in 1964. There were various outings during the year. Other activities of the local Red Cross included escort duties, medical loan depot, welfare visiting, Blood Donor sessions, first-aid duties at the local Rugby Football ground, the Royal Festival Hall and local functions, and assistance as "casualties" and "casualty fakers" at the Civil Defence exercises at the Hayes training ground. The Physically Disabled Peoples' Club—Southall: A new club for disabled old age pensioners was started in the spring of 1963. The membership grew rapidly and amounted to 120 by the end of 1964. There was also a waiting list because transport is required for all the members and more is urgently needed. A specially constructed coach with lifting arrangements provided by Middlesex County Council came into use in 1963. The Group meets once a month at Shackleton Hall and tea and entertainment are provided. 26 The Hard of Hearing Club: This Club had a successful year in 1964 and continued to be popular and useful to its members, also many persons not actually members of the Club were given help with their hearing aid difficulties. The membership figure rose slightly and there was an average weekly attendance of 40. The officers and committee have been exceedingly busy, and the programmes continued to be educational, entertaining and also helpful to the members in their endeavour to overcome and live with their disability. Four members attended the Old Age Pensioners' Holiday at Bognor, organised by the Welfare Committee of the Middlesex and Surrey League, part of the cost being borne by the League. The group was represented at the National Conferences of the British Association for the Hard of Hearing. An important addition to the Group has been the inauguration of a transport service to convey some of the elderly members who are incapacitated besides being hard of hearing, to the weekly meetings. The cost of this has been borne by the League and the Group, but at the same time a small charge (i.e. normal bus fares) is made to the members. This has proved a great help to those using the transport; at the same time enabling the members to attend more regularly. Diabetic Club: The Southall and District Diabetic Club, a Branch of the British Diabetic Association, continued to function throughout 1964. This Club, formed in 1956, aims to enable diabetics, their relatives and friends, and those interested in diabetic welfare, to meet together socially to have more general discussions, and to hear authoritative talks from speakers who specialise or are particularly interested in diabetes, such as doctors and other health and nutrition experts. Membership by subscription was 71, with a Club Newsletter circulation of 109. The attendance at monthly meetings in the Masons Room of the Holy Trinity Hall averaged 28. The Club has a Committee of 12 members which includes three welfare officers and organisers of various fund-raising activities in aid of the Research Fund of the British Diabetic Association. Social events included a theatre outing, a Christmas party, and a coach trip to the sea. In 1963, the Southall Branch opened a new club in Hounslow, and this has grown rapidly—having a membership in 1964 of 49 with a Newsletter circulation of 86. The clubs were run on a joint basis, this has been useful for the Southall Branch. The Club is a member of the North-West Metropolitan Region which consists of 7 Branches in West London, and inter-club visits are organised. Multiple Sclerosis Society: The Ealing Branch of the Multiple Sclerosis Society, formerly the West London Branch, has four Southall members, and six are attached to the new West Middlesex Branch of the same Society. The Branches arranged social events with transport, and there is much individual help, visiting and advice given to each member. Meetings are held at St. Paul's Hall, South Ealing, and St. Mary's Hall, Bedfont. Swimming is arranged every Saturday at Hounslow Baths; telephone installation and help with provision of clothing or other needs were arranged for individual patients. The West Middlesex Branch possesses a Therapeutic Machine to loan to members for muscle training, lends wheelchairs, and early in 1965 will possess its own Ambulance. Spastics Welfare Society: The Central Middlesex Spastics Welfare Society is a voluntary organisation, having as its primary object the intention of helping as many Spastics as possible within the Borough of Southall and surrounding Boroughs to lead fuller and happier lives. At its Training and Work Centre at Ruislip, 30 Spastics attend daily where they are engaged on light engineering, assembly, printing and other suitable sub-contract work for local firms. A Social Club meets monthly at Perivale, various coach and other outings are arranged and financial help given in cases of extreme hardship. Advice and help is given in 27 providing improved medical and educational facilities, and where possible arrangements are made for short-stay holidays for severely handicapped spastic children unaccompanied by either parent. Some of the Spastics who have had training and experience at the Work Centre have gained sufficient confidence to obtain outside employment; others more severely handicapped have been provided with work at home. Charitable appeals for money are constantly made to ensure the continuation of the Society's work and efforts are being made to secure larger and more permanent premises so that those Spastics who are at present virtually housebound can also be brought to the Society's Training and Work Centre. Negotiations are proceeding for the acquisition of a leasehold site at Northwood Hills for a new large and well equipped Centre, and the Society is appealing to all the local authorities served for financial help with this project. Women's Voluntary Service: The Women's Voluntary Service is very active in Southall and amongst the many services given by its members the following are particularly connected with Welfare:— Clerical work in all three clinics in Southall; provision of a Trolley Shop in both Southall-Norwood and Mount Pleasant Hospitals; issue of batteries for deaf aids in Southall Hospital; making out-patients' teas on Clinic days in Southall Hospital; taking the telephone trolley round Southall Hospital for patients' use; help in the X-ray department with the filing at Southall Hospital; issue of Welfare Foods from W.V.S. Office. Welfare of the Blind and Partially Sighted: The Welfare services for the blind and partially-sighted are the responsibility of the County Council under the National Assistance Act, 1948. In 1964, there were resident in the Borough 116 blind and 20 partially-sighted persons. There were four blind children attending Special Schools. Six blind persons were in fulltime employment, and one in part-time employment. Of these, one was in a Workshop for the Blind. The earnings of this person were augmented by the County Council. Two blind people attended the Cookery Class at Norwood Hall. The County Council's Welfare Department provides a Home Teaching service, the object of which is to enable blind and partially-sighted people to lead full and active lives by assisting them in overcoming the effects of their disabilities. The majority of blind persons are either not able to take employment owing to age or infirmity, or for some reason are not available for employment. Amongst the latter are housewives who may receive instruction from the Home Teachers in carrying out their household duties in their own homes or in special classes or in residential courses of social rehabilitation. The Home Teachers visit all blind and partially-sighted persons in their own homes, in hospitals and in residential homes, advise on all problems relating to their welfare and keep them in touch with available social services. They give instruction in Braille and Moon systems of embossed type, and in handicrafts. Deaf-Blind persons also receive the services of a special Home Teacher for the Deaf-Blind. A handicraft class is held fortnightly at the King's Hall Methodist Church, South Road, Southall. Close co-operation is maintained between the County Council and Voluntary Organisations, including the Social Club for the Blind, which holds fortnightly meetings at the Labour Hall, The Broadway, Southall, and the Middlesex Association for the Blind, which assists individual necessitous blind people and maintains a holiday home at Littlehampton, two holiday caravans at Lancing, and two Residential Homes for the Blind. The Southall Blind Club has a membership of 37 with an average age of 73, and transport to Club meetings is carried out by members of Southall Round Table and Inner Wheel. The Club is social and in 1964 also ran two coach outings and a Christmas party. Blind persons are eligible for the loan of a wireless receiver through the British "Wireless for the Blind" Fund, and the County Council has a scheme for assisting blind and partially-sighted persons with the maintenance of wireless sets. 28 Other services are provided by the County Council either directly or through a registered agency and these include facilities for the placement of blind persons in employment, courses of residential rehabilitation, training courses for mothers with blind babies, the supply of embossed literature, special equipment and handicraft materials, assistance in the disposal of handicrafts and assisted holidays for those in need. Welfare of Handicapped Persons other than Blind: Schemes for the welfare of handicapped persons other than blind and partially-sighted which are operated by the County Council's Welfare Department under the National Assistance Act, 1948, provide welfare services for the deaf and dumb and hard-of-hearing, and other persons who are substantially and permanently handicapped by disease, injury or congenital deformity. Services to the deaf-and-dumb and the hard-of-hearing are provided by appropriate Voluntary Organisations, to which the County Council makes grants in aid. For statutory Welfare purposes, the Borough of Southall now forms part of Area 7, which includes also the Boroughs of Acton and Ealing. Two full-time Social Workers and one half-time Social Worker are included in the staff which has been provided by the County Council's Welfare Department for carrying out social services required, and who visit those suffering from substantial and permanent handicaps. They work from the Local Area Welfare Office and the handicapped persons are visited in their own homes with a view to assisting them to obtain services from statutory or voluntary sources. The County Council supplies aids and appliances not covered by the National Health Service and carries out where necessary adaptations to a house to enable a handicapped person to become more mobile, provides holidays, arranges for the disabled to take part in social activities, including choral and dancing classes, attend handicraft classes, etc. Special coaches with a hydraulic hoist to lift wheelchair cases are available for use for social activities, etc. Advice and guidance regarding personal problems are given and membership of voluntary organisations catering for particular handicaps is facilitated. The Industrial Work Organiser endeavours to procure from industry appropriate assembly work and arranges for this to be carried out by handicapped persons at a Work Centre or in their own homes where this is considered to be suitable and of assistance to the individuals concerned. At 31st December, 1964, 94 residents of the Borough were registered as generally handicapped. Alterations to two houses to make them more suitable for handicapped persons were carried out by the Welfare Department during the year. House: Hand rail on stairs. House: Concrete ramps to front and back doors. Grab rails. In addition, walking aids and hoists, feeding aids and toilet aids were issued to a considerable number of handicapped persons. Under the County provision of Chiropody Service, certain physically handicapped persons received domiciliary chiropody treatment in 1964. Residents of the Borough needing any of the County Welfare Services briefly referred to in this Report should apply to the Area Welfare Officer, Mr. D. C. Davids, Bedford Hall, Bedford Road, London, W.13. Nutrition of School Children: The following figures kindly supplied by the Borough Treasurer give the details of milk and meals acceptance in the various schools in the Borough. 29 The percentage of children having milk in schools was as follows:— School 1960 1961 1962 1963 1964 Primary 96% 96% 96% 97% 96.1% Secondary Modern 72% 73% 72% 75% 71.1% Technica Grammar Technical from 1962 75% 67% 52% 43% 33.1% Grammar 39% 53% Talbot Special 83.5% 87% 78% 87% 84.8% The percentage of children having meals in schools was:— Primary 57.1% Secondary Modem 47.9% Grammar Technical 63.3% Talbot Special 99.0% The percentage of meals served to daily attendances during the Autumn Term gives a guide to the use being made of the School Meals Service during the year. School Autumn Term Average % of Attendance taking meals Average Number taking meals Average attendance 1963 1964 1963 1964 1963 1964 Primary Schools: Beaconsfield Road Junior Mixed 40 50 120 130 297 258 Beaconsfield Road Infants' 45 50 88 82 194 164 Clifton Road Junior Mixed 49 57 68 95 139 166 Clifton Road Infants' 49 50 85 88 174 175 Dormers Wells Junior Mixed 69 78 145 170 211 217 Dormers Wells Infants' 76 85 118 157 156 184 Featherstone Road Junior Mixed 51 48 160 147 313 305 Featherstone Road Infants' 40 43 89 99 224 232 George Tomlinson Junior Mixed & Infants'* 118 70 177 210 294 298 Lady Margaret Junior Mixed 56 60 173 195 307 327 Lady Margaret Infants' 50 56 134 167 266 298 North Road Junior Mixed & Infants' 57 60 233 253 406 422 St. Anselm's R.C. 82 83 327 344 401 414 Tudor Road Junior Mixed 43 48 156 175 362 363 Tudor Road Infants' 39 48 83 101 213 212 Secondary Schools: Southall Grammar/Technical 63 63 496 456 792 726 Dormers Wells Boys' 50 53 206 249 410 465 Dormers Wells Girls' 60 62 256 287 425 463 Featherstone Road Boys' 27 28 165 152 608 532 Western Road Girls' 56 53 227 198 409 374 Special Schools: Talbot Road 99 99 207 209 209 210 *Junior and Infants Schools amalgamated September, 1964. 30 It is interesting and pleasing to be able of children taking school meals:— again to report an increase in the percentage Year Autumn Term 1958 43.69 1959 46.51 1960 50.67 1961 50.95 1962 51.21 1963 54.54 1964 58.28 Old People The needs of 27 special cases of old people living in difficult circumstances were investigated during 1964, and what happened to them is recorded in the following list:— Admitted to hospital 3 Admitted to old people's home 4 Remaining at home 20 (a) Home Help provided 3 (b) Home Help, Home Nurse and Incontinent Laundry Service provided 3 (c) Chiropody provided 3 (d) Home Help and meals provided 1 (e) Awaiting housing for old people 2 (f) Awaiting hospital admission 4 (g) Awaiting admission to Welfare Home 2 (h) Commode provided 1 (i) No action required 1 The difficulties of the old persons recorded on this list were brought to the notice of the Public Health Department staff either by medical practitioners, interested relations, neighbours or friends, or following complaint by one or other of the statutory authorities. The County Council has the duty, under the National Assistance Act, 1948, of providing residential accommodation for aged and infirm persons in need of care and attention which is not otherwise available to them; and it can do this by providing its own homes or by arrangements with recognised voluntary organisations. The County Council's Welfare Department administers the County homes, and the number of persons admitted to such homes from the Borough in 1964 was 18, one of whom had been previously brought to our attention in 1959, one in 1962, and two during 1964. Two old persons were transferred from St. Bernard's Hospital to County accommodation in Old People's Homes. There are still eight cases waiting from previous years, three from 1961, three from 1962, and two from 1963, who were in poor health and in need of old people's housing. It has been ascertained from the Area Medical Officer that 429 Southall people were given home help during the year, and of these 333 consisted of patients over 65 years of age, and of 860 persons who were assisted by the home nurses, 272 were of age 65 or over. Many voluntary associations contributed to provide Christmas parcels or special comforts for old people. Meals on Wheels Service: During the year mid-day meals on four days per week were provided for house-bound old people in need of the service. In 1964, 16,861 meals were delivered (16,456 in 1963). Two hundred and seventy-seven old persons were assisted by means of this scheme during the year. This was again an increase in the number of individual people helped. The maximum 31 number of old people receiving the meals on any one day was 93, so that both vans were working to capacity on many occasions. Special Christmas dinners (frozen packs) were delivered to 96 people and also to them went 96 special parcels to cover the Christmas period when meals were not being delivered; also 12 special parcels for diabetic persons or other invalids requiring special nutrition. Between 400 and 500 parcels of groceries and comforts were sent out by local organisations to housebound elderly on receipt of names obtained and submitted by the Old People's Welfare Organisation. Chiropody Service: This service was continued throughout 1964. Five local chiropodists gave their services at cheap rates for Old Age Pensioners. In 1962, Middlesex County Officers were empowered to proceed with a scheme for the increase in the provision of chiropody as part of the County Health Services and 164 old age pensioners had attention during the year at the Northcote Avenue Clinic, the number of attendances by them at the Clinic being 733. The County Council was able also to offer financial assistance to voluntary organisations providing chiropody, and the Southall Old People's Welfare Committee reported the number of treatments given during the year under this scheme to be 2,043 (1,741 in 1963, 1,222 in 1962), i.e. treatments at surgeries 1,009, and visits to homebound 1,034. The number of Old Age Pensioners receiving treatment under this scheme was 476. The County Council made provision for a limited amount of domiciliary service from 26th October, 1962. Twenty Old Age Pensioners were given 166 visits and treatments under this provision. Incontinent Laundry: For years, the problem of the laundry of incontinent patients has been, though urgently necessary, held back until the new slipper baths for Southall could be built combining two necessary services. During 1964, the Borough Council decided to accept a plan for the site (which had been held available), and it was accepted that laundering could be carried out in these premises when they were completed. In the past, various laundries and other local authorities had been asked to provide facilities but had been unable or unwilling to do so, but a request made to St. Bernard's Hospital Management Committee in the middle of the year was well received and facilities were granted by that Committee very promptly. A supply of washable nylon carriers and laundry books was obtained, and the incontinent laundry service was begun in October, requests for the service being made by doctors, or hospital or County Council staff, with the Public Health Inspector visiting to certify the need. Laundry was collected in the Public Health Department vehicle as often as necessary, taken to St. Bernard's Hospital and collected and returned after service. Between 1st October and the end of the year 83 articles were laundered for three elderly patients. Holidays: The holiday scheme whereby old people get a seaside holiday during off-season months of May and September, at reduced rates, continued during 1964 and was operated by the various Old People's Clubs in the Borough. In addition, the Southall Old People's Welfare Association arranged holidays for 30 housebound and semi-invalid elderly in summer, and 10 at Christmas. In addition, 40 had transport for a day's outing to the sea—all meals arranged; 81 had transport to Annual Luncheon. A further 296 were taken to parties, concerts, carol services, etc. during the year. Clubs: Old Age Pensioners Federation—Southall Branch: This Club had a membership of 140 and met once a week on Monday afternoons for social purposes, the average attendance being about 125. Seaside outings were arranged during the summer, and a party and concert at Christmas. 32 St. Anselm's "Over Sixties" Club: This Club increased its membership in 1964. Approximately 200 members were on the register in 1964 with an average attendance of 150 at each Tuesday meeting. Because of lack of space, there had to be a waiting list for membership of this Club. The Club continued to be a most popular rendezvous on Tuesday afternoons with members of all denominations, although maintained by the Southall Section of the Catholic Women's League. During the year there were three free outings to the seaside, a visit to a pantomime, a birthday party, and a Christmas party. Entertainment was provided each week, birthdays were celebrated with a card and small gift, and sick members were visited. The Silver Threads Group: This Club had a membership of 150, meeting once a week on Thursdays at the Community Centre, with an average attendance of 86. The Club is a social one, and entertainment was provided for the members each week. There were three coach outings, a birthday party, a Christmas party and a harvest festival also arranged. The Darby and Joan Club: This Club met weekly and had a membership in 1964 of 80, with an average attendance at each meeting of about 70. The meetings were social, entertainment being provided and refreshments. A summer outing, a free luncheon, and a Christmas party, including a monetary gift for each member, were arranged. The Allenby Old Age Pensioners Club: This Club met weekly on Wednesdays, had a membership of 135, with an average attendance of over 100. The Club is social, and entertainment and refreshments were provided at each meeting. Five seaside outings were arranged by this Club, the organiser of which takes a special pride in the fact that the Club is entirely self-supporting, and that a small orchestra has been formed by members of the Club. The United Old Folks Club: The average attendance at this Club was 170-200. Meetings were once a week on Mondays and these were social with entertainment provided. The members had several free outings to the seaside, including one special visit to the country for the elderly housebound. At each outing, a gift of five shillings was given to each member, and on one occasion, a High Tea was provided. There was also an Easter Gift of five shillings to every member, and during the year two evening outings were arranged to Twickenham and district, where an entertainment was given and refreshments provided. A Christmas party was held, including a gift for each member of ten shillings and gifts of food, including a voucher for a Christmas fowl. Christmas parcels and gifts for the sick were also provided from this Club, and a free pantomime outing. St. John's Church Old Folks Club: This is a social Club, having 70 members and providing entertainments and outings. The average attendance at the weekly meetings was 56. This club has grown considerably during the year. Other Services: A service for the provision of cheap laundry and a cheap boot and shoe repair service are available for Old Age Pensioners. The North Thames Gas Board offers a free service of inspection of the gas appliances and service pipes in houses of Old Age Pensioners living alone. The reason for this is to reduce the risk of gas poisoning, a frequent cause of home accidents and fatalities in old people. The offer includes, if the financial circumstances warrant this, free replacement of faulty pipes and the free repair of faulty appliances. To take advantage of this offer, lists of old people living alone are submitted from the Public 33 Health Department and in due course the homes of the persons nominated on the lists are visited by the Gas Board Officers. Fresh lists continued to be supplied from time to time. A visiting library service for old people who were housebound was started early in 1959—operated by the Southall Old People's Welfare Committee, and with distribution assisted by various young people's groups. This has proved to be a very successful scheme, not only because the elderly obtain reading material without effort, but because the voluntary visitors, who include young people from the Girl Guides, give pleasure by their interest in the old people, and during 1964 a supply of special printed books for the partially-sighted was added to the library lists. Southall Association for the Occupation of the Elderly: This Association continued to maintain two Work Centres during the year; one situated in the Municipal Sports Ground and one in Featherstone Terrace. The number employed in the two Centres had risen to 70 at the end of the year. The scheme provides for simple factory work to be obtained from industrial concerns, i.e. assembly of small parts, sorting of porcelain fittings, mailing of invoices or advertisements, rubber stripping; and the workers attend for morning or afternoon periods to carry on this work for which they are paid a small wage, irrespective of their ability to work at a fast or slow rate. The purpose of the scheme is mainly for rehabilitation or maintenance of physical and mental well-being for the elderly and lonely, and has proved to be a very happy means of social rehabilitation because of the companionship found in the Centres and the feeling of usefulness which is developed because the workers know that they are taking a useful part in the life of the community. Social activities in the form of outings to the seaside or to factories, parties, etc., are organised, and members visit each other when there is sickness. Any Old Age Pensioner is eligible to apply for work under this scheme and once taken on is kept on whether his or her output can be considered significant or not. Payment is made at the rate of l/2d. per hour with occasional bonuses. Cups of tea are provided for the workers. National Assistance Act, 1948, Section 47: National Assistance (.Amendment) Act, 1951: No case was dealt with under these powers during 1964. 34 HEALTH EDUCATION The importance of never ceasing education of the public in matters of hygiene was high-lighted in 1964 when Aberdeen, one of the cleanest cities in the country, was disgraced by an outbreak of typhoid fever. Although the blame for the original infection has now been allocated to the faulty washing habits of canning factory workers in a foreign country in which corned beef had been tinned, and subsequently sent to this country for sale, it is clear that the second and third waves of infected cases need not have occurred if perfect hygiene had been maintained in the households containing primary cases, or in the canteens, restaurants, or other food establishments where food was handled. For years, emphasis has been placed on the importance of washing the hands before touching food or food utensils; an excellent habit practised ritually by the Indian members of our community. By this means, the spread of all intestinal diseases could probably be prevented absolutely, yet still at this present time regular hand-washing is more notable for its omission than for its performance. Facilities for washing the hands are still not readily available in public places, and efforts to remedy this continue unceasingly. It will be seen that some improvement was obtained in the provision of hand-washing facilities for public conveniences and schools during the year but much more needs to be done, and under the Food and Drugs Regulations new provisions in restaurants, public houses and other places of community association were asked for in 1964, while the new Offices, Shops and Railway Premises Act is likely to produce better washing facilities in such places where workers are likely to eat meals or food brought from their homes. The principal sources of supply of health education material are the Central Council for Health Education, the Royal Society of Health, and the Central Office of Information. Projector slides and cinema films are prepared by quite a large number of private companies, and Government bodies, and sometimes by local authorities direct, on important subjects, and these are used from time to time to accompany talks to organisations or to school children. Of recent months, short health education features have been increasingly presented on B.B.C. television at a useful time in the evening when most people have reached their homes and have not yet had to leave for evening engagements. In January, 1964, the Central Council for Health Education held a Conference, the subject this year being "Community Health". In addition, a four-day Seminar for Medical Officers of Health was held by the same authority in February on the subject of "Occupational Health". During this Seminar, visits were arranged to factories with really upto-date methods of sanitation for the workers whether on the plant or in the office. The needs for the most hygienic methods of hand drying and the proper placing of hand basins in sanitary conveniences or in work rooms were discussed. A bacteriological investigation of methods of hand drying favours the use of the hot air means for drying, or the individual paper towel since even the continuous roller towel using one section for each person could be subject to carelessness in handling. At these Seminars it is always possible to learn about the recent advances in health education methods, and in addition, Medical Officers of Health are able to share information on health education methods as applied in each district. This is a very useful interchange of ideas, for instance in the previous year's Seminar a demonstration of the great possibilities of health education in local television circuits when they shall become country-wide was fully demonstrated by closed circuit viewing at the actual Conference. Local television has yet to come in this neighbourhood. 35 HOME SAFETY The number who died as a result of accident other than motor vehicle accident was 19 in 1964, compared with 21 in 1963 and 14 in 1962. Seven of the accidental deaths were the result of accident in the home, six happened in hospital, one on the railway, three were found drowned, and two were killed at work. Cause of Death Age Sex Fall at home, causing broken neck 63 M Found dead on railway line (unidentified person) 40-55 M Fall in hospital 75 M Struck by falling concrete beam 40 M Fall at home, causing burns from electric fire 83 M Fall—struck by swing door 32 M Found drowned 48 M Found drowned 33 M Found drowned 50 M Acute alcoholism—asphyxia from regurgitated food 35 M Asphyxia—cause unspecified 42 M Electrocuted at home 11 mths M Burns 75 M Injury at work—struck by moving object 35 M Fall in hospital—fracture of femur 88 F Fall in hospital—fracture of femur 74 F Fall at home—fracture of femur 77 F Burns—clothing set alight when smoking 68 F Lead poisoning—swallowed paint at home 4 F There were 8 suicides (8 also in 1963); 4 swallowed drugs; 2 were found hanged, and 2 died from gas poisoning. The ages of these varied from 22 to 75. Education on safety in the home continued in 1964. The new watchdogs for safety, the Consumer's Council, are reinforcing the work done in the past only by Voluntary Women's Societies to help the Medical Officer in the fight against shoddy, cheap, dangerous products, and during the year legislation, i.e. The Children's Nightdresses Regulations, 1964 (made under the Consumer Protection Act, 1961) prohibited the sale of children's nightdresses made of dangerous fabrics easy to catch fire. Unfortunately the legislation did not extend to the sale of fabrics for home dressmaking, and it can be seen that this would probably be impossible to legislate for—so Home Safety Education must continue on this subject. It is encouraging to realise from the figures above that accidents occurring in the home were almost down to one-half as many as in 1963, i.e. 7 compared with 12. But it is difficult to make any estimate of the amount of disability caused in the community because of home accidents, as, so far, no scheme has been successful in obtaining notification of home accidents. Perhaps in the new bigger Borough, staff will be available to check daily with private practitioners and Hospitals on individual accidents and their causes and effects, whether in the home, at work or in the street. As this is probably the biggest cause of long, or even life-long disablement or chronic ill-health, this seems to be a most urgent public health problem. 36 ROAD SAFETY Eight persons (7 adults, 1 child) were killed in street accidents in Southall during 1964. The figure was four in 1963 and three in 1962. Details are as follows:— Persons Killed Type of Road User Cause of Accident Age Sex Pedal Cyclist Fell under goods lorry 84 M Motor Cyclist Collision with private motor car emerging from side road 18 M Pedestrian Came out from behind parked car into path of private motor car 38 M Pedestrian Struck on pedestrian crossing by private motor car 65 F Pedestrian Crushed against wall by skidding car 18 M Private motor car passenger Killed when car swerved and hit lamp post 18 F Private motor car passenger Collision with second private motor car 12 F Scooter rider Collision with lorry 18 F Persons Injured Adult School Age Under 5 Serious Slight Serious Slight Serious Slight Pedestrians 10 41 5 20 - 11 Total 51 Total 25 Total 11 Pedal Cyclists 6 61 1 14 Total 67 Total 15 Riders of Motor-assisted Bicycles - 9 - - Total 9 Private motor-car drivers 8 38 - - Total 46 Public service vehicle drivers — 1 Total 1 Light goods vehicle drivers 1 8 Total 9 Heavy goods vehicle drivers - 1 Total 1 Private motor-car passengers 5 43 — 3 — 4 Total 48 Total 3 Total 4 Public service vehicle passengers - 18 Total 18 Light goods vehicle passengers 2 3 Total 5 Pedal cycle passenger - - 1 - Total — Total 1 Motor cyclists 14 58 Total 72 Scooter riders 6 36 Total 42 Motor cycle pillion passengers — 7 Total 7 Scooter passengers 1 6 Total 7 Public service vehicle conductor - 1 Total 1 Invalid carriage driver - 1 Total 1 Summary Persons killed 7 Adults 1 Child Persons injured: Serious 53 Adults 7 Children Slight 332 Adults 52 Children 385 Adults 59 Children 37 This was a bad year for motor vehicle accidents in Southall. Although the total of persons killed or injured was lower by 25 than in 1963, it was still 37 higher than the previous year, and the number of deaths was doubled and included a child of school age. The number of children injured, however, was slightly lower, i.e. 59 as against 68 in 1963 and 63 in 1962. Five of the eight persons dying as a result of motor accidents in Southall were Southall residents but six Southall residents died as a result of road accidents occurring outside of the Borough. 38 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. All inhabitated houses are supplied from public water mains and there are no stand-pipes in use on mains. Sixteen samples of water from 7 artesian wells; 6 from factory premises and one in St. Bernard's Hospital, gave the following results:— A—Excellent 10—Satisfactory 1—Satisfactory (if chlorinated) 1—Doubtful Under Section 35, Middlesex County Council Act, 1956, provision is made for immediate action to be taken by the Local Authority to restore a water supply which has been cut off for some default. Sewerage Middlesex County Council provides the facilities for purification of sewage from the Borough at the Mogden Sewage Works. The amount of congestion occurring in the drains and sewers of the Borough, partly as a result of increase in the number of houses and shops, partly due to the fact that improved knowledge of hygiene results in an increased use of water for cleanliness, meant that problems arose of overcharging of sewers, and of flooding during periods of heavy rain. Measures to relieve this had to be taken, and the latest position with regard to these improvements is as follows:— A length of surface water relief sewer was under construction in Windmill Lane and was nearing completion at the end of the year. The sewer provides for surface water from the future improvement of Windmill Lane, and from the development of adjoining land. It passes under Uxbridge Road, and under the Railway, to discharge into an existing watercourse. This relief sewer should prevent all risk of future flooding in this vicinity. The only pail closets emptied by the Council are two at "Springdale". There are two cesspools emptied by the Council's gully emptier—one at "Springdale" and one at Wyke Green. Refuse Collection and Disposal Southall Borough Council provides one dustbin free to every separately rated hereditament, the number of bins so supplied is approximately 17,000. The renewal period for these is when the dustbins have worn out, but not more frequently than once in ten years. Weekly collections are made from houses; three times a week from St. Bernard's Hospital; twice-weekly collections are made from other Hospitals and high flats. Weekly collections from shops and industrial premises are generally made, sometimes more frequently. Large amounts are charged for. Special collections from domestic and other premises are made by arrangement. The Council maintains a fleet of vehicles, including 8 freighters on refuse collection, one lorry for special collections. Refuse is picked over for salvage in the Council Depot, salvaged materials being sold, and the residue is either incinerated at the Depot or carried to be tipped at an authorised site at WestDrayton. Street Cleansing The main shopping streets are cleansed daily and other roads are cleansed once, twice or three times a week depending on various conditions. For this purpose, one lorry and one mechanical sweeper-collector are used. There are 14 street orderlies with hand 39 trucks. Sweepings are conveyed to the Depot and subsequently to the tip at West Drayton. In addition, one gully-emptying machine is used to cleanse the street gullies, which number approximately 3,250 in the Borough; each gully being cleansed four times a year. The refuse is tipped at the Council Depot and then carted to West Drayton. Public Conveniences Five public conveniences are maintained by the Borough Council in the Borough in addition to those provided in the public parks. These are sited at the Town Hall, High Street; The Green (Manor House Grounds); Jubilee Gardens; King George's Field, Lady Margaret Road; and Norwood Green. Each convenience provides accommodation for both sexes. No charge is made for the use of the facilities, attendance is provided to some extent, and free washing facilities are available, but a small charge is made for linen towels. For details of use of towels, see page 46. In addition, the public conveniences in the public parks are as follows: Cranleigh Playpark; Municipal Sports Ground, in pavilion; Southall Park (these were increased in number during 1963 by means of renovation plus new building); Recreation Ground, in ground, pavilion and Swimming Bath; Wolf Fields, in pavilion; Hortus Cemetery; and Havelock Cemetery. A survey of the facilities for hand washing in all the Public Conveniences was undertaken in the beginning of the year, and certain deficiencies were discovered, i.e. ten had no washing facilities, thirteen were lacking soap and towels. The Public Health Committee asked for these matters to be brought to the attention of the various Committees concerned —improvements were obtained. Wash hand basins and towels were provided at the Swimming Bath, and attention was given to the provision and maintenance of wash basin plugs, soap and towels, because as a result of vandalism these were often lacking, although sufficient quantity had been previously provided. Daily attention was given to all conveniences not under the care of an attendant. Sanitary Inspection of the District The total number of inspections of premises made during the year by the Public Health Inspectors was 10,343. Table XII gives an analysis of the number and nature of such inspections. The total number of inspections rose again during 1964. There was a very heavy increase in the number of visits made for houses in multiple occupation to assess the sanitary standards and safety in case of fire. The amount of inspection on hygiene of food in shops, food factories and cafes, increased, and a start was made on the inspection of premises registered under the Offices, Shops, and Railway Premises Act, which came into operation in July, 1964. Market There is a market, part open, part covered, in the High Street where a weekly horse and cattle sale is held on Wednesdays and a general sale of market produce and goods is held on Saturdays. Observation requires to be kept on the hygienic provisions and maintenance there. In addition, travelling fairs and circuses spend periods in the Borough, three to four times a year, and require supervision. School Sanitation, Ventilation and Lighting Schemes for the improvement of sanitary conditions in Southall schools made some progress during the year. 40 During 1964, work on providing electrical heating for the protection of the plumbing in all outside toilets at schools was completed. This is very satisfactory, and should be of great assistance should heavy frosts occur—no severe weather occurred to test the efficiency of the new installations during the year. Emergency inside toilet accommodation was provided at Beaconsfield Road Junior Mixed and Infant schools. The Borough Council provides the number of dustbins required for the removal of school refuse. Eradication of Bed Bugs, Fleas and Lice Statistics for the year:— (a) Number of Council houses (1) found to be infested 5 (2) disinfested during the year 5 (b) Number of other houses (1) found to be infested 9 (2) disinfested during the year 9 Total 14 Canal Boats Southall is not a registration authority for canal boats. Inspections are carried out in the Boroughs having mooring depots for these boats as a routine procedure and only rarely is there need for interference by any officer of Southall. No report was necessary during 1964. Mortuary and Post-Mortem Room The mortuary, situated in Havelock Road, provides adequate accommodation for the Borough, but it is not likely to be used for mortuary purposes again, as all bodies from this Borough are now deposited at the Acton and Uxbridge Mortuaries, and the Council makes an annual contribution to the two local authorities concerned. No bodies were deposited in the mortuary during the year. Thirty-two bodies were deposited in the mortuary at Acton and one hundred and thirty-five bodies in the mortuary at Uxbridge, for post-mortem purposes and coroner's inquest if necessary. Factories Act, 1937 The following tables give details of the work done in connection with the factories and outworkers in the Borough:— Inspections Factory Premises Number on Register Number of Inspections Written Notices Occupiers Prosecuted (1) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 10 10 - - (2) Factories not included in (1) in which Section 7 is enforced by the Local Authority 170 143 - - (3) Other Premises in which Section 7 is enforced by the Local Authority (excluding outworkers' premises) - - - - Totals 180 153 — — 41 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 - - - - - Overcrowding - — — — — Unreasonable temperature - — — — — Inadequate ventilation - — — — — Ineffective drainage of floors - — — — — Sanitary Conveniences— (a) Insufficient - - - - - (b) Unsuitable or defective 7 7 - - - (c) Not separate for sexes — — — — — Other offences against the Act (not including offences relating to outwork) — — — — — Totals 7 7 — — — Outworkers Nature of Work Section 110 Section 111 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 42 - - - - - Wig Making 1 — — — - — Artificial Flowers 1 — — — - — Totals 44 — — — — — 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 sold are included in the list of general inspections. Offices, Shops & Railway Premises Act, 1963 This Act came into operation on 1st May, 1964. Owners of premises to which the Act applied were required to register with the Borough Council. The estimated total number of such premises is about 1,000. Applications for registration during the year totalled an estimated 45 %. After inspection of 165 premises, 142 notices were served for deficiencies. The operation on the 1st August, 1964, of the practical requirements of the Act, enabled the department to check deposited plans for new buildings and to bring them into conformity with the Act. Long term arrangements for enforcement of the Act were, of course, affected by London government re-organisation. 42 HOUSING Progress with the modest slum clearance programme continued, in spite of the major claims of houses in multiple occupation. During the year, Nos. 19 and 20, Featherstone Terrace, and Nos. 15-29 (odd numbers inclusive) Norwood Road, were represented for demolition, and Nos. 19 and 21, Norwood Road, were demolished. Nos. 25, 25a, St. John's Road, and in the same building No. 16, Western Road, were represented for demolition, but the Council accepted an undertaking which involved part demolition and major reconstruction. Action on the proposed Area including 1-14, Buckingham Terrace and 1-3, Clear View Cottages, was deferred for the acquisition of additional land for the development of the Area. Improvement Grants (Housing Act, 1949, as amended by the Housing (Financial Provisions) Act, 1958, and the House Purchase and Housing Act, 1959, and the Housing Acts, 1961 and 1964) Thirty-five applications were approved for grant for property improvement. In all, up to the end of 1964, 214 of these Improvement Grants have been approved. Certificates of Disrepair (Rent Act, 1957) During the year, 3 applications were received and approved. One certificate of revocation of a disrepair certificate was approved. Overcrowding Five cases of new overcrowding were confirmed. Thirty-six cases of overcrowding were relieved during the year. The number remaining on the Department's register of overcrowding at the end of the year was 12 dwellings, which is a decrease of thirty-one on last year's figure. For further details, see Table XIII, page 75. Re-Housing of Applicants for Council Dwellings Council Housing within the Borough: The number of families obtaining Council accommodation for the first time in 1964 was 55. Three old persons were rehoused from the waiting list and seven were transferred from larger Council properties to smaller accommodation. New Town Housing: The total number of families removing to New or Expanded Towns: 25 families nominated under the Industrial Selection Scheme up to April, 1956 (since when the Council has had to pay subsidy for every family moving from this Borough to New or Expanded Towns); in addition, 50 families who had found their own accommodation in one of the New Towns were subsequently accepted as Council nominees; the total number of families who have moved to New or Expanded Towns since that date is a further 352, thirty-one families having been rehoused in this way during 1964. Modernisation of Council Houses There were 426 houses built between 1930 and 1936 which stil had old ranges with hot water supply, except where the tenants had installed modern firegrates. A new scheme was commenced for the replacing of obsolescent grates in another section of the town. A total of 442 houses had been modernised up to the end of December, 1964. Bathrooms were provided and new grates and electrical power points were installed in two old persons' bungalows in Saxon Gardens. Bathrooms, modern grates and electrical power points were provided in two purchased houses in Abbotts Road. In eighty-four houses the obsolescent grates were replaced. All old persons' dwellings have been provided with immersion heaters and the hot water cylinders have been lagged. 43 Forty-four converted flats on the Dane Road Estate have had separate cold water systems installed as a precaution against frost damage. New hot water heating by gas has therefore been installed in the twenty-two ground floor flats. Electric power points have been installed in the living rooms in one hundred and seventy-four pre-war houses where no points existed, and it is hoped to complete all outstanding work on this project by the end of March, 1965. Houses in Multiple Occupation At the end of the year, 805 houses had been ascertained to be let in lodgings or occupied by members of more than one family. The Council's policy, adopted towards the end of 1963, of giving a Direction under Section 19 of the Housing Act, 1961, to every house in multiple occupation, was continued during the year, and 552 Directions were made. The effect of a Direction is to fix the maximum number of persons for which a house is suitable, having regard to the facilities available, and in cases where this number is exceeded at the time the Direction is made, it is an offence to replace any individuals who may subsequently leave. Directions are made in connection with every house in multiple occupation, even if the number of occupants is not excessive. Where premises are occupied by excessive numbers, Notices under Section 90 of the Housing Act, 1957, are served so as to obtain a reduction in the number of occupants before a Direction is made. Thirty-nine of these Notices have been served during the year and in 5 cases owners were prosecuted for non-compliance and fined a total of £59 plus £15.15.0 costs. Section 19(9) of the Housing Act, 1961, enables a notice to be served on the occupier of a house in multiple occupation on which a Direction is in force, requiring him to furnish details of occupants. Four hundred and nine of these notices have been served during the year and 3 occupiers who failed to return them were fined a total of £15 with £6.6.0. costs. In 16 cases notices under Section 16 of the Housing Act, 1961, were served. These notices required the provision of adequate means of escape from fire and the works specified were based on the recommendations of the Middlesex County Council Fire Department. A fine of £5 with £2.2.0 costs was imposed under Section 160 of the Housing Act, 1957, for the obstruction of a Public Health Inspector. Middlesex County Council Act, 1944—Section 345 The caravan site at the junction of Regina Road and Pluckington Place continued to be used as the winter quarters of a member of the Showmen's Guild. New Housing The following details have been supplied by the Borough Engineer, outlining the complete amount of house building for Southall since the end of the war:— Built by Southall Borough Council During the year 1964 Since the End of the War (including 1964) Within the Borough Outside the Borough Within the Borough Outside the Borough Old People's Dwellings - - 133 12 Houses - — 332 136 Flats 8 - 487 144 Prefabricated Houses — — 299 - 44 One hundred and six prefabricated bungalows have now been demolished and the tenants transferred to permanent housing, leaving 193 still standing. Built by Private Enterprise During the year 1964 Since the End of the War (including 1964) Old Peoples' Dwellings - 20 Houses 29 338 Flats 51 161 Prefabricated Houses — — Almshouses (Association built) — 4 45 HYGIENE OF FOOD Food Poisoning Two notifications of food poisoning were received during 1964. Both of these were confirmed bacteriologically as being due to infection with the organism Salmonella TyphiMurium, and in addition one case notified as Dysentery was later found to be due to a food poisoning organism, Salmonella tennessee. The contacts were followed up, but no outbreak occurred. No specific foods could be associated with the illness in any of the three cases. Personal Hygiene The free washing facilities in the public conveniences, which were brought into operation in September, 1950, continued to be available throughout 1964. During that period 16,900 (8,500 in 1963) paper towels were issued free, and also 553 linen towels, which were provided at a cost of 2d. per person. Milk The Milk (Special Designation) Regulations, 1960, transferred licensing to the food and drugs authority, which for this area is the Middlesex County Council. Six distributors of bottled milk registered under the Milk and Dairies (General) Regulations, 1959, making a total of 46 on the register. Ice Cream The Ice Cream (Heat Treatment, etc.) Regulations, 1947-1952. There are no manufacturers in the Borough. Sales consist almost entirely of pre-packed ice cream and serving from cans is found only in a few restaurants. Food Sampling The bacteriological analyses of 195 food samples taken during the year, were carried out bv the Public Health Laboratory Service. One hundred and forty-three of these specimens were ice cream samples, and following bacteriological analyses the ice creams were graded as follows:— Table A Bacterial Plate Count Method Table B Methylene Blue Reduction Test Plate Count Grade No. of Samples Classification Time of Reduction Grade No. of Samples Classification Less than 500 I 42 Excellent Fails to reduce in 4 hours I 70 Satisfactory 500 to 20,000 II 8 Satisfactory 2½-4 hours II 13 Fairly Satisfactory 20,000 to 100,000 III — Doubtful ½-2 hours III 6 Doubtful Over 100,000 or Faecal Coli present IV — Unsatisfactory Less than ½ hour IV 4 Unsatisfactory Reduction tests carried out at half-hourly intervals. 46 For some years, up to May, 1964, ice cream samples in this Borough were examined by the bacterial plate count method which gave an accurate picture of the bacteriological condition of the ice cream (Table A). It could also indicate, if there was a poor bacteriological result of the samples, whether the contamination was due to faecal coli which could be attributed to bad personal hygiene of food handlers, or to poor cleanliness of equipment. During 1964, the Public Health Laboratory staff of Ealing unfortunately found it impossible to continue the grading of ice cream by this method and samples from the beginning of June were graded by the Methylene Blue Reduction Test which is considered sufficient by the Ministry of Health Officials and had to be accepted by us. The results of samples taken from June, 1964, are shown in Table B. The Methylene Blue Reduction Test, although giving some indication as to the bacteriological condition of the ice cream samples, does not give any indication of the type of organisms, and, therefore, does not help in the identification of the source of the contamination. It is extremely urgent that the new Borough should provide its own Laboratory quickly in order that sampling to prevent disease and adulteration of food can be quick, thorough and informative. Thirty-four samples were taken of imitation cream. Twenty-four of these were excellent, and ten satisfactory. Other samples taken:— Steak and Kidney Satisfactory 2 Corned Beef Satisfactory 1 Irish Stew Unsatisfactory 1 Prawns Satisfactory 5; Unsatisfactory 3 Shellfish Satisfactory 6 The following information has been obtained by courtesy of the Public Control Officer of Middlesex County Council on work carried out in Southall by staff of that Department. Food & Drugs Act, 1955 Articles Total Samples Taken Unsatisfactory Milk 183 48 Butter and Margarine 18 — Cream 16 — Fish and Fish Products 5 — Fruit 19 1 Ice Cream 9 — Meat 15 — Meat (Minced) 22 1 Sweets 5 — Vinegar 10 — Miscellaneous 18 2 Totals 320 52 47 Premises required to be registered are as follows:— Food & Drugs Act, 1955, Section 16 Fish Curing 5 Manufacturers of Sausages or Preserved Food 36 Manufacture of Ice Cream — Sale only of Ice Cream 180 Manufacture and Sale of Iced Lollies — Middlesex County Council Act, 1950, Section 11 Premises of Street Traders 3 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 2,804½ - - - - 2,804½ - - 2,804½ Raw 20,655¾ — — — — 20,655¾ - - 20,655¾ Totals 23,460¼ — — — — 23,460¼ — — 23,460*¼ 48 5 samples of raw milk contained antibiotics 5 farmers cautioned 43 samples of raw milk contained traces of added water 2 farmers cautioned 1 sample of canned fruit contained mould 1 manufacturer cautioned 1 sample of minced meat contained sulphur dioxide pre- Seller prosecuted, fined servative £10, costs £10.10.0 2 samples of sausages contained sulphur dioxide servative but sold without prescribed notice 2 butchers cautioned The number of unsatisfactory samples taken was greatly increased in 1964. Fortunately out of 48 unsatisfactory samples of raw milk 43 were only due to the addition of water, which is unlikely to be a danger to public health. The new hazard of antibiotic residue in milk means that a very much closer watch on milk needs to be maintained, and the number of samples taken in 1964 by the County Council was 183 compared to 168 in 1963. Meat Inspections No slaughtering of meat is carried on in Southall. Food Premises—Inspection The number of food premises in the Borough, by type of business, is shown as follows Shops 335 Greengrocers 51 Grocers 115 Confectioners 96 Fish Fryers 11 Bakers 15 Butchers 35 Fishmongers 12 Catering Establishments (including Canteens) 135 Food Factories 21 491 Food Hygiene Food & Drugs Act, 1955 Food Hygiene Regulations, 1955-1956 Although the general standard of food premises in the Borough continues to be good, it was necessary in two cases to take proceedings for contravention of the Food Hygiene (General) Regulations. Fines totalling £25.0.0 were imposed, plus costs of £5.5.0. The following table shows details of deficiencies which were found and remedied in food premises. Contraventions Found Remedied Articles/Equipment not kept clean 5 5 Articles/Equipment not in good order — — Containers not protected from contamination — — Food so placed as to involve risk of contamination 6 6 Food placed within 18 inches of ground and not adequately protected 2 2 Waterclosets not kept clean and in efficient order 2 2 Insufficient lighting and ventilation to water closets 4 4 Absence of "Wash your hands" notices in water closets 4 4 Absence of suitable and sufficient wash hand basins — — Absence of hot water at a suitably controlled temperature over wash hand basins - - Absence of soap, nail brushes, clean towels, etc. near wash hand basins 2 2 Absence of First-aid materials 3 1 Absence of suitable and sufficient sinks for the washing of food and equipment - - Absence of hot water at a suitably controlled temperature over sink - - Absence of soap, clean cloths, etc. at sink 2 2 Lack of accommodation for clothing — — Walls, floors, etc. not kept clean 3 5 Walls, floors, etc. not kept in good order 3 2 Covered receptacle for refuse not provided — — Accumulations of refuse, etc 1 1 Rodent infestations 5 3 Miscellaneous 4 2 Totals 46 41 49 Unsound Food The following table shows items of unsound food which were investigated during the year, and the action taken. Subject of Enquiry Action Decomposing tinned corned beef Prosecution pending. Mouldy apple tarts Prosecution pending. Mouldy pork pie Warning letter. Metal in cream biscuit Warning letter. Decomposing shoulder of lamb Prosecution £20.0.0 fine plus £10.10.0 costs. Mouldy chicken pie Prosecution £10.0.0 fine plus £5.5.0 costs. Stale Cornish pasty Prosecution £10.0.0 fine plus £3.3.0 costs. Wood in cake Warning letter. Bolt in Christmas pudding Warning letter. Mouldy bread rolls Warning letter. Food & Drugs Act, 1955—Section 16 A fine of £10.0.0 plus £5.5.0 costs was imposed for preparing pickled food on premises which had not been registered with the Council as required by this Section. Middlesex County Council Act, 1950—Section 11—Hawkers of Food A fine of £1.0.0 plus £1.1.0 costs was imposed for the sale of food from a van, the owner of which was not registered by the Council as a hawker of food. 50 ATMOSPHERIC POLLUTION The amount of smoke, grit and sulphur dioxide in the atmosphere over the Borough of Southall continued to be recorded during the year 1964 at the same sites at which recordings have been carried out for previous years. In addition, the station which was established in 1959 at the Manor House, for the estimation of smoke and sulphur dioxide pollution by the volumetric method, whereby air is drawn through two filters, one dry and one liquid, continuously and the amount of atmospheric pollution calculated every 24 hours from the matter deposited on the filter, and from the amount of sulphur taken up by the liquid, continued to operate during 1964. A new station for volumetric estimations came into operation on 1st October, 1963, for special investigation of a smoke and grit nuisance at Beaconsfield Technical College and was discontinued in July, 1964, the problem having been solved. For 1964 results, see page 52. The results obtained from the five sites (i.e. Recreation Ground and Railway Allotments—lead peroxide method; Hortus Cemetery, New Primary School, Railway Allotments—deposit gauges) are tabulated on pages 53 and 54 and graphs prepared from the figures on the tables are to be found on pages 55, 56, 58, 59. Comparison of ten years' averages at Hortus Cemetery: the figures show satisfactory improvement. Total solids deposited:— 1955 16.94 1960 10.30 1956 12.93 1961 10.86 1957 10.66 1962 11.32 1958 13.83 1963 8.88 1959 13.04 1964 6.47 Comparisons with three other places, i.e. Westminster, Cambridge and Sheffield, still show that Southall is atmospherically much less impure most of the year than a highly industrial area, but the Borough is included in a large ring round and including London itself designated as a black area for atmospheric pollution under the Clean Air Act, 1956. Smoke from industry has caused no special difficulty during the year and excessive or unnecessary emissions have usually been dealt with speedily by informal action. Seventeen complaints of smoke or grit were received. A major grit emission was due to the breakdown of a large plant, but was corrected by emergency repair within 48 hours. Consultation with industry and the fuel Technologist resulted in improvement of one solid fuel (underfeed stoker) installation, in respect of which complaints were recurring. Smoke Control Areas Smoke Control Order No. 5 became operative on 1st July, 1964. The premises covered by operative Orders now total 4,622 houses, 57 industrial premises, 295 commercial premises, and 42 other buildings. Smoke Control Order No. 6 was confirmed at the beginning of 1964 and will become operative on 1st July, 1965. The area covered is 205 acres and includes 1,244 houses, 7 industrial premises, 64 commercial premises, and 9 other buildings. Infringements of Smoke Control Orders There were no infringements in 1964. Volumetric Method The daily mean concentration of smoke and sulphur dioxide is measured by volumetric apparatus in the Manor House, situated on the main road traversing the Borough from north to south and for nine months further estimations were carried out in the Hambrough Ward by means of an apparatus temporarily set up in the Technical College. The term "smoke" is used to denote all fine suspended impurity collected by the test filter and expressed as microgrammes per cubic metre. 51 The term "sulphur dioxide" includes all acid producing gases in the air with the exception of carbon dioxide and is the net acidity of the air calculated as sulphur dioxide and expressed as microgrammes per cubic metre of air. Manor House Month of Year SMOKE Microgrammes per cubic metre SULPHUR DIOXIDE Microgrammes per cubic metre Monthly Average Highest Daily Average Monthly Average Highest Daily Average 1963 1964 1963 1964 1963 1964 1963 1964 January 211 245 556 589 448 475 1,152 1,072 February 207 202 310 555 897 332 434 662 March 65 125 148 310 130 267 248 717 April 77 44 232 268 198 131 757 464 May 43 42 82 78 88 101 148 282 June 38 36 90 85 84 99 235 160 July 27 31 58 69 74 99 151 169 August 40 37 88 98 89 89 279 203 September 72 56 417 192 159 129 585 299 October 59 116 176 233 145 266 275 486 November 132 107 577 292 186 221 605 474 December - 159 362 704 - 243 577 1,356 *Figures not available. Southall Technical College Month of Year SMOKE Microgrammes per cubic metre SULPHUR DIOXIDE Microgrammes per cubic metre Monthly Average Highest Daily Average Monthly Average Highest Daily Average 1963 1964 1963 1964 1963 1964 1963 1964 January 238 589 219 688 February 206 544 224 620 March 122 167 146 272 April 26 26 112 316 May 20 35 56 94 June 31 59 50 72 July — — — — August — — — — September — — — — October 54 — 135 — 84 — 173 — November 87 - 319 - 113 — 291 — December 195 - 321 - 220 - 355 — Technical College discontinued July, 1964. 52 Atmospheric Pollution Estimation Month of Year Sulphur Compounds by the Lead Peroxide Method, as Milligrams S03 per day per 100 sq. cm. Recreation Ground Railway Allotments 1963 1964 1963 1964 January 4.89 3.18 - 3.17 February 4.33 2.82 4.67 3.38 March 2.05 - 3.84 - April 2.12 1.15 2.58 1.82 May 0.81 0.86 1.17 1.34 June 0.56 0.69 1.10 0.88 July 0.66 0.60 1.20 0.73 August 0.55 0.77 0.85 0.84 September 111 1.48 1.21 0.90 October 1.21 1.99 2.02 1.78 November 1.64 2.03 2.03 2.07 December 3.15 2.81 2.65 2.47 Average for year 1.92 1.67 2.12 1.76 *No reading because of damage to equipment. 53 Atmospheric Pollution Estimation DEPOSIT GAUGES Month of Year Rainfall in inches. Tons per Square Mile per Month Soluble Insoluble Total Hortus Cemetery Dormers Wells School Railway Allotments Hortus Cemetery Dormers Wells School Railway Allotments Hortus Cemetery Dormers Wells School Railway Allotments Hortus Cemetery Dormers Wells School Railway Allotments 1963 1964 1963 1964 1963 1964 1963 1964 1963 1964 1963 1964 1963 1964 1963 1964 1963 1964 1963 1964 1963 1964 1963 1964 January 0.47 0.37 0.22 0.16 0.44 0.51 5.97 1.61 5.87 4.81 7.84 5.12 2.19 3.61 1.81 2.86 2.38 8.25 8.16 5.22 7.68 7.67 10.22 13.37 February 0.20 0.23 0.12 0.26 0.20 0.43 2.36 1 32 2.86 309 2.57 5.31 2.16 2.88 1.52 3.22 4.90 7.44 4.52 4.20 4.38 6.31 7.47 12.75 March 2.62 1.31 2.32 0.32 2.45 2.64 6.41 5.28 7.80 3.22 7.80 12.90 13.20 4.44 9.42 2.92 18.45 6 24 19.61 9.72 17.20 6.14 26.25 19.14 April 1.76 1.66 1.91 207 - 2.91 5.00 3.06 5.74 3.80 - 2.49 5.60 5.89 4.60 3.67 - 4.36 10.60 8.95 10.34 7.47 - 6.85 May 1.37 1 .47 1 .25 2.12 1.38 2.12 2.53 2.18 2.11 4.83 6.22 10.48 517 1.48 2.44 5.03 7.05 4.54 7.70 5.66 4.55 9.86 13.27 15.02 June 1.97 2.73 1.68 2.90 1.77 3.26 5.94 7.21 5.32 3.33 4.20 10.87 7.24 0.78 4.15 0.67 12.38 5.77 13.18 7.99 9.47 4.00 16.58 16.64 July 0.98 0.69 0.68 0.75 1.15 0.88 2.13 1.68 2.74 2.83 2.94 5.10 2.03 1.91 1..25 2.22 7.64 2.78 4.16 3.59 3.99 5.05 10.58 7.88 August 2.42 0.46 2 31 - 2.83 0.98 3.91 2.12 4.91 - 5.55 5.40 4.31 3.79 3.83 - 12.16 4.54 8.22 5.91 8.74 - 17.71 9.94 September 1.17 0.01 1.60 0.19 1.63 0.45 3.41 3.07 3.39 3.28 3.65 3.71 2.44 3.26 2.20 4.74 4.34 7.83 5.85 6.33 5.59 8.02 7.99 11.54 October 1.62 0.12 1.40 0.14 1.38 1.04 4.62 2.81 3.67 3.36 1.09 4.71 3.41 1.64 3.12 1.79 9.70 5.13 8.03 4.45 6.79 5.15 12.79 9.84 November 3.40 1.36 2.32 1.17 4.09 1.24 6.87 3.51 5.93 3.16 8.23 7.58 2.59 5.95 2.81 3.21 9.93 5.87 9.46 9.46 8.74 6.37 18.16 13.45 December 0.67 1.27 0.12 0.99 0.71 1.05 4.24 3.65 3.56 3.59 4.99 7.14 2.80 2.52 1.58 4.66 5.20 7.36 7.04 6.17 5.14 8.25 10.19 14.50 Average for Year 1.55 0.97 1.33 10 1.82 1.46 4.45 3.12 4.50 3.57 5.19 6.73 4.43 3.35 3.22 3.18 8.56 5.84 8.88 6.47 7.72 6.75 13.75 12.58 *No result available, bottle damaged. 54 Graph D Atmospheric Pollution by Sulphur Oxides (Lead Peroxide Method) 55 Graph E Atmospheric Pollution Estimation—Deposit Gauges at Hortus Cemetery, Railway Allotments and New Primary School Total Solids, Soluble or Insoluble (Tons per square mile per month). 56 Graph F Atmospheric Pollution by Sulphur Oxides Determined by the Lead Peroxide Method— Comparison with Other Districts These figures are printed with the permission of the Authorities concerned. 57 Graph G Atmospheric Pollution by Sulphur Oxides (Lead Peroxide Method) Daily Average (Milligrams Per 100 Sq. Cm.) for Years 1953-1964 58 Graph H Atmospheric Pollution Estimation by Deposit Gauges—Average Monthly Deposit of Soluble and Insoluble Solids (Tons Per Sq. Mile Per Month) for Years 1953-1964 59 PERSONAL HEALTH Diabetic Survey The survey started at the beginning of February, 1964. In the first three weeks, 400 urines were tested and to date 737 have been tested, excluding the regular ante-natal (150) urines. Of this number, five men and four girls were subjected to further examinations. They have been classified as follows:— Male aged 31 Has low renal threshold. Not diabetes. *Male aged 42 Sub-diabetic, i.e. responds to simple diet. Slight diabetes. *Male aged 40 Sub-diabetic, i.e. subject to review. Slight diabetes. Male aged 39 Normal, i.e.¼ % sugar not repeated. Not diabetes. *Male aged 49 Sub-diabetic, i.e. subject to review. Slight diabetes. Female aged 8 Diabetes mellitus, very unstable. Female aged 4 Normal, i.e. negative on re-test. Not diabetes. Female aged 20 Normal, associated with pregnancy. Not diabetes. *Female aged 50 Sub-diabetic, i.e. responds to simple diet. Slight diabetes. *These cases, though liable to sugar diabetes, responded readily to diet. The main difficulty in this survey has been the inability to follow up suspects and get them to attend surgery. In addition, all the original urines were examined for albuminuria. 11 men and 20 women required further investigation:— Male aged 33 Albumen ++, gross haematuria and pus, still under treatment. Male aged 16 Pyelitis—cured. Male aged 7 Pyelitis—cured. Male aged 82 Albuminuria + + +, acute nephritis at age 32, cured bloodurea 40 mgs %. Male aged 11 Pyelitis—cured. Male aged 5 Pyelitis—cured. Male aged 9 Orthostatic—intermittent blood urea 30 mgs% subject to review. Male aged 14 Albumen +—still under review. Male aged 23 Trace—subject to review. Male aged 22 Pyelonephritis (pinks disease as a child), blood urea 210 mgs%. Male aged 59 Heart failure—chronic cor pulmonale. Female aged 60 Pyelitis—under treatment. Female aged 44 Heart failure with oedema—under treatment. Female aged 47 Cystitis—cured. Female aged 9 Pyelitis—cured. Female aged 34 Cystitis—cured. Female aged 3 Albumen trace—under review. Female aged 6 Albumen trace—resolved. Female aged 26 Pyelitis—cured. Female aged 30 Pyelitis—cured. Female aged 35 Cystitis—cured. Female aged 35 Cystitis—cured. Female aged 38 Cystitis—cured. Female aged 42 Albumen + —resolved. Female aged 58 Hypertension—under treatment. Female aged 67 Hypertension—under treatment. Female aged 69 Hypertension—papilloma of bladder—under treatment. Female aged 74 Cystitis. 60 Female aged 14 Albumen trace—under review. Female aged 14 Rheumatoid Arthritis. Female aged 17 Trace—no comment available. In any collection of figures it is desirable to know the population at risk, but one is surprised at the frequency with which young people suffer from albuminuria. This secondary investigation really proved worth-while. Medical Examination of Borough Council Employees During 1964, a total of 102 medical examinations were carried out on applicants for Borough Council employment or 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, or for review after prolonged periods of sick leave. A survey of sickness absence amongst Borough Council staff during the year is shown in the table below, and the comparable statistics for the five previous years. Members of Indoor Establishment Year Staff Total Requiring Sick Leave Total days sick leave Percentage requiring sick leave 1964 172 80 778 47 1963 171 98 755 57 1962 168 94 1,154 56 1961 165 89 1,187 54 1960 154 74 888 48 1959 157 93 1,295 59 Members of Outdoor Establishment Year Staff Total (Part-time and Full-time) Requiring Sick Leave Total days sick leave Percentage requiring sick leave 1964 252 175 5,061 70 1963 260 136 3,413½ 52 1962 256 149 3,779½ 58 1961 281 127 4,561 45 1960 278 153 4,0771½ 55 1959 282 206 5,5091½ 73 It is disappointing that in a year of such splendid weather the sickness record of the outdoor staff should be so poor. The number of sick was the highest since 1959, and the number of days of sickness even higher. 61 MISCELLANEOUS Noise Nuisance Eleven complaints of noise were received during the year. Particulars of these are given below. Source Result of Investigation Radio etc. in house Remedied. Air compressor in Factory Remedied. Machinery in Factory No nuisance. Machinery in Factory No nuisance. Unloading of Timber No nuisance. Machinery in Factory Remedied. Band music in Public House Remedied. Machinery in Factory No nuisance. Cafe Juke Box Remedied. Air compressor in Factory Remedied. Motor Bike on private land Remedied. Rodent Control The following table gives details of work carried out in accordance with the policy of the Council, as outlined in previous reports. Total notifications of Rats and Mice Confirmed Non-Confirmed 230 230 — Business and Industrial 50 premises treated Domestic 180 „ „ Rats found and cleared in 111 „ Mice ,, ,, ,, ,, 119 ” Total number of visits in 1964—1,701 Sewers Total number of manholes baited 121 Number of poison takes — No takes 121 These figures show a great increase in the amount of infestation by rats in business and industrial premises, and an increase in the sewer rat population. In the Annual Report for 1963, comment was made on the carelessness of the population in depositing litter in the streets and open spaces and the fact that this encouraged the increase of the rat and mouse population by these practices. The same can be said about the people in business and industry and in the factories and workshops unless sweeping is carried out several times a day. All kinds of waste is strewn on yards, floors and staircases, also rat-proofing of basement and ground floor premises is not always watched as carefully as it should be. Food stored in these premises, which are often ill-lit, is piled up close to outside walls, and operatives who lift and move piles from these dark corners do not feel it is their responsibility to report when holes are apparent in rat-proofing. There seems to be a growing impression on the part of the public that as they pay for street sweeping and public highways inspection they should be free to increase the need for street sweeping and supply work for the inspectors. Health education on these points is a slow and tedious business, and although a Litter Act was brought into force in 1958, this has acted as no deterrent. The drivers of private cars set a bad example in this respect. 62 Large numbers of them throw cigarette ends, cigarette packets, sweet papers, fruit skins from their car windows. This can be seen every day, and it is obvious they take advantage of the fact that it would be very difficult to obtain a prosecution under the Litter Act under such circumstances. All these persons are encouraging the growth of the rat population. Pet Animals Act, 1951 Six establishments were licensed during the year. The number of animals kept in each case was small and conditions have remained satisfactory. Administration of the Shops Acts One hundred and ninety-six visits were paid to shops. No more time could be given to the full administration of the Shops Acts, because of the demands of other duties. River Pollution Inspection and sampling of river water from the River Crane, the River Brent and the Canal continued during 1964. In some cases the effluent from certain pipes discharging to the rivers was unsatisfactory and further investigation was carried out in order to ascertain the source of pollution. In one particular case, the pollution was traced to a large factory some distance from the River Crane. Steps were taken by the company concerned to divert the offending discharge to the soil sewer, and also to prevent the entry of solid matter into the surface water sewer, since when there has been a great improvement in the effluent at this point. Establishments for Massage and Special Treatment Six 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 3 Physiotherapy and Chiropody 3 Nuclear Radiation The Metropolitan Water Board gives, with its monthly report on the state of the water coming into public supply, a short notice of the radioactivity as estimated by the Board's Laboratory Staff, and also records the reports of the Atomic Energy Authority on the radioactive content of outfalls into the Thames from the nuclear reactors. No abnormal increase occurred during 1964. The Radio Active Substances Act (1960) provided for the central registration and control of the keeping and use of radioactive materials and the disposal of radioactive waste, and enabled the central authority to notify local authorities of the existence of registered premises within their boundaries. No notifications of this nature have yet been received in the Public Health Department. 63 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 (28 beds) for treatment of general medical and surgical cases and casualties, and Mount Pleasant Hospital (59 beds) for the treatment of geriatric cases. St. Bernard's Hospital is managed by its own Committee and is for the reception of cases of mental and nervous disorders; it has over 2,500 beds and takes patients from an extensive area comprising parts of Berkshire, Buckinghamshire, and Middlesex, including the Borough of Southall. All modern forms of treatment are carried out, including, if appropriate, Industrial Therapy. Patients are now admitted informally (under the Mental Health Act, 1959) and Informal and Compulsory became the sole categories of admissions after 1st November, 1960. 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 Memorial Hospital, Ealing. Southall cases of infectious disease mainly enter St. John's Hospital, Uxbridge, which also has facilities for the treatment of geriatric cases. The greatest number attend Hillingdon, which has all the facilities of an acute general hospital, a geriatric section and a maternity wing, either as outpatients, or as inpatients; in 1964, 3,258 Southall residents had inpatient treatment in Hillingdon compared with 3,351 in 1963 and 2,998 in 1962. This figure includes 1,639 maternity mothers and babies discharged, compared with 1,624 in 1963, and 1,362 in 1962. During 1964, Mount Pleasant Hospital, a 59-bedded geriatric hospital, providing accommodation for 39 female and 20 male elderly patients, admitted 30 patients from the Southall area. The upgrading of the main hospital kitchen and Windle Ward was completed during the summer of 1964, and re-decoration of Elizabeth West Ward is planned for 1965. The trolley shop service continues to be operated by the W.V.S. and the library service by the British Red Cross Society. Southall-Norwood Hospital, an acute general hospital of 28 beds, admitted a total of 583 Southall residents as inpatients during 1964, and the great majority of the 6,588 attendances at the accident and emergency department were also made by Southall people. An additional gynaecological clinic session each month was commenced during 1964. The nurses' quarters in the main hospital were re-decorated during the year. The library service for this hospital continued to be given by the Southall Public Library. The Southall Hospitals Comforts Committee, which came into operation after the Uxbridge Group Hospital Management Committee took over the functions from the voluntary House Committee of the Southall-Norwood Hospital and the administration from the Public Health Department of the Mount Pleasant Hospital, through all these years has been working as a voluntary Committee to keep the two Southall hospitals modern and up-to-date and to provide through a collection of funds for luxury equipment and staff functions not able to be supplied from the official sources. This Committee initiated the provision of television for patients and staff, which was later taken over by the Group Management Committee, and there is no doubt that these two hospitals are attractive to patients and comfortable for staff in a manner that one sees infrequently in London hospitals. It is faintly possible that the tendency to centralise and enlarge in the latest type of glass palaces may be economical in the long run, but unfriendly for patients because of the cold atmosphere. It usually causes difficulty of access for patients because the catchment area required for such places is enormous and public transport services very limited, and also of course, initially the cost is colossal. Meantime, the small local hospitals are giving splendid service to the public of this Borough. 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 nonpulmonary). Persons may be referred there by their own doctors, from Clinics, etc. Special 64 "X-ray only" Clinics are available without appointment, otherwise persons are seen by appointment. There are male and female beds under the surveillance of clinic physicians at:— (1) Harefield Hospital for the treatment of pulmonary tuberculosis; and at (2) Hillingdon Hospital for the treatment of other chest disorders, and (3) Adelaide Ward of St. Bernard's Hospital—24 male and 24 female beds—for tuberculous patients—pulmonary and non-pulmonary. County Council of Middlesex—Health Department The County Council of Middlesex is the Local Health Authority under the National Health Service Act, 1946, and provided the following services in the Borough, which were operated through the Area Health Office, 92, Bath Road, Hounslow, until September, 1964. On 1st October, the personal services were transferred to the management of the Area 7 Medical Officer, to be administered from the Area Health Office, Town Hall, Ealing, London, W.5. (a) Care of Mothers and Young Children Ante-Natal Clinics Infant Welfare Clinics Jubilee Gardens Centre, Northcote Avenue Clinic and 13, King Street. Diphtheria, Whooping Cough and Tetanus Immunisation, Smallpox and Poliomyelitis Vaccination Clinics Jubilee Gardens Centre, Northcote Avenue Clinic and 13, King Street. Ultra Violet Light Clinic Northcote Avenue Clinic. Priority Dental Service for Expectant and Nursing Mothers and Children under School Age Northcote Avenue Clinic and 13, King Street. (b) Midwifery Service Certified Midwives are employed, for attendance on women in their homes in the Borough 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, to the elderly, 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 at the request of general practitioners and hospitals. Where nursing equipment is required for use in the home, it is available on loan, through the British Red Cross Society. (For details, see page 26). (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 and immunisation against the diseases mentioned above are carried out by most general practitioners. (f) 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. 65 (g) Home 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, aged, or of 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 A County Ambulance Service is provided for the removal to hospital, where necessary, of accident and sickness cases. There is an Accident Ambulance Station situated in Southall beside the Town Hall. The Sick Removal Service operates from the Depot in Hanwell under the control of 'C' District Headquarters in Mogden Lane, Isleworth. (Telephone Number POPesgrove 8123.) (i) Mental Health Service The Mental Health Service deals with persons suffering from mental illness. (j) School Health 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 Clinic and 13 King Street Orthopaedic treatment Northcote Avenue Clinic Ophthalmic treatment Northcote Avenue Clinic Physiotherapy Northcote Avenue Clinic and Jubilee Gardens Centre Ultra Violet Light treatment Northcote Avenue Clinic Speech Therapy 13 King Street, Talbot Road School and Jubilee Gardens Centre Dental treatment Northcote Avenue Clinic and 13 King Street Diphtheria, Tetanus and Whooping Cough Immunisation, Smallpox and Poliomyelitis Vaccination Jubilee Gardens Centre, Nortncote Avenue Clinic and 13 King Street (k) Chiropody Service The County Council provides a Chiropody Service at the Northcote Avenue Clinic where expectant mothers, elderly persons and physically handicapped persons may receive treatment. 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. Children's Officers have been appointed to deal locally with such cases as they arise, and operate from the Middlesex County Offices, Great West Road, Brentford. 66 APPENDICES EXTRACTS FROM VITAL STATISTICS Table I Comparative Figures for[ 1963 Live Births 1,159 1,220 Total Male Female Stillbirths—Legitimate 18 11 7 15 —Illegitimate 5 2 3 4 Deaths 676 331 345 776 Crude birth rate (live and stillbirths) per 1,000 of the estimated population 20.66 22.96 Stillbirth rate per 1,000 total (live and still) births 19.8 15.33 Crude death rate per 1,000 of the civilian population 11.81 14.38 Deaths from Puerperal Causes (Heading 30 of the Registrar General's Short List):— Rate per 1,000 total (live and still) Deaths births No. 30. Pregnancy, Childbirth, Abortion 1 0.85 — Death rate of infants under 1 year of age:— All infants per 1,000 live births 18.12 22.13 Deaths from cancer (all ages) 135 130 Deaths from measles (all ages) — — Deaths from whooping cough (all ages) — — Deaths from diarrhoea, etc. (under 2 years of age) — — 67 Table II Causes of Death, 1964 Male Female Total 1964 Total 1963 1. Tuberculosis, respiratory 3 3 3 2. Tuberculosis, other — — - - 3. Syphilitic disease - 1 — 1 — 4. Diphtheria — — — — 5. Whooping cough — — — — 6. Meningococcal infections — — — 1 7. Acute poliomyelitis — — — — 8. Measles — — — - 9. Other infective and parasitic diseases 2 2 4 - 10/15. Cancer (all forms) 77 58 135 130 16. Diabetes 1 1 2 3 17. Vascular lesions of nervous system 26 39 65 62 18. Coronary disease, angina 53 38 91 107 19/20. Heart disease 30 59 89 110 21. Other circulatory disease 22 26 48 55 22. Influenza 2 — 2 11 23. Pneumonia 37 62 99 111 24. Bronchitis 19 5 24 48 25. Other diseases of respiratory system 5 2 7 7 26. Ulcer of stomach and duodenum 1 1 2 4 27. Gastritis, enteritis and diarrhoea 1 1 2 4 28. Nephritis and nephrosis 3 2 5 4 29. Hyperplasia of prostate 1 — 1 1 30. Pregnancy, childbirth, abortion — 1 1 — 31. Congenital malformations 2 3 5 7 32. Other defined and ill-defined diseases 19 32 51 70 33. Motor vehicle accidents 9 3 12 9 34. All other accidents 14 5 19 21 35. Suicide 3 5 8 8 36. Homicide and operations of war — — — — Total Deaths 331 345 676 776 68 Table III Deaths in wards Ward Male Female Total Waxlow Manor 41 35 76 Northcote 40 33 73 Hambrough 39 28 67 Dormers Wells 115 162 277 Glebe 57 52 109 Norwood Green 39 35 74 Total 331 345 676 Table IV Causes of death in the stillborn Accidental haemorrhage 5 Compression umbilical cord 1 Congenital abnormalities 5 Difficult labour—with prolapse of arm 1 —with disproportion 1 Macerated foetus 3 Placenta praevia 1 Pre-eclamptic toxaemia 3 Rhesus incompatability 1 Unknown cause 2 Total 23 Table V Causes of Deaths Under One Year of Age Certified Causes of Death Under 1 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 under 1 year Abortion 1 - - - 1 - - - - 1 Birth injury 1 1 - - 2 - 1 - - 3 Congenital malformation and congenital heart disease 5 1 1 1 8 - - - - 8 Electrocuted—home accident - - - - - - - - 1 1 Jaundice 1 - - - 1 - - - - 1 Otitis media - - — - — 1 - — - 1 Peritonitis - 1 - - 1 - - - - 1 Prematurity 5 — — 1 1 - - — 6 Total 13 3 1 1 18 2 1 - 1 22 69 Table VI Deaths from Cancer Year Male Female Total Estimated population Rate per 1,000 population 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 1.95 1944 37 32 69 48,970 1.41 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 1.49 1949 46 54 100 56,350 1.77 1950 52 38 90 56,310 1.60 1951 48 46 94 55,620 1.69 1952 46 49 95 | 55,430 2.01 1952 including long stay hospital deaths 54 57 111 1953 63 57 120 54,910 2.19 1954 72 43 115 54,440 2.11 1955 60 49 109 53,840 2.02 1956 67 65 132 53,220 2.48 1957 58 55 113 53,000 2.13 1958 91 48 139 52,830 2.63 1959 65 50 115 52,900 2.17 1960 70 48 118 53,150 2.22 1961 89 59 148 52,770 2.80 1962 75 63 138 54,120 2.55 1963 76 54 130 53,960 2.41 1964 77 58 135 57,220 2.36 70 Table VII Notifiable Diseases During the Year 1964 (Other than Tuberculosis) Diseases Ages Total cases notified Under 1 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 5 1 5 1 2 11 2 3 16 3 3 2 54 Encephalitis (Infective) — - — — — 1 — — — — — — 1 Encephalitis (Post-Infectious) — — — 1 — — — 1 — — — — 2 Food Poisoning — — 1 — — — — — 1 — — — 2 Infective Hepatitis — — — — 1 3 1 — — 2 — — 7 Measles 9 13 15 11 10 16 — — 1 — — — 75 Pneumonia 2 — — — — — — 1 — 1 5 1 10 Puerperal Pyrexia — — — — — — — 1 1 — — — 2 Scarlet Fever 1 — 1 1 7 11 1 — — — 1 — 23 Whooping Cough 7 3 5 4 5 8 — 2 1 — — — 35 Total 24 17 27 18 25 50 4 8 20 6 9 3 211 Dysentery 1 case confirmed Shigella flexner by bacteriological examination. 15 cases confirmed Shigella sonnei by bacteriological examination. 1 case originally notified as dysentery confirmed Salmonella tennessee. Food Poisoning 2 cases confirmed Salmonella typhi-murium by bacteriological examination. 1 case originally notified as dysentery confirmed Salmonella tennessee. Puerperal Pyrexia 62 Southall patients developed puerperal pyrexia after confinement in outside hospitals. The number of cases of infectious diseases (including Tuberculosis) notified during the year, according to the locality, is shown below:— Table VIII Diseases Total Waxlow Manor Northcote Hambrough Dormers Wells Glebe Norwood Green Dysentery 54 28 5 4 2 10 5 Encephalitis (Infective) 1 — 1 — — — — Encephalitis (Post Infectious) 2 — 1 — 1 — — Food Poisoning 2 1 — — — — 1 Infective Hepatitis 7 3 1 — 1 1 1 Measles 75 6 15 12 16 14 12 Pneumonia 10 2 — 1 5 — 2 Puerperal Pyrexia 2 — 1 — — — 1 Scarlet Fever 23 1 — — 2 14 6 Whooping Cough 35 9 8 6 3 6 3 Tuberculosis 98 5 10 43 25 9 6 Total 309 55 42 66 55 54 37 Dysentery 1 case confirmed Shigella flexner by bacteriological examination. 15 cases confirmed Shigella sonnei by bacteriological examination. 1 case originally notified as dysentery confirmed Salmonella tennessee. Food Poisoning ... 2 cases confirmed Salmonella typhi-murium by bacteriological examination. 1 case originally notified as dysentery confirmed Salmonella tennessee. Puerperal Pyrexia ... 62 Southall patients developed puerperal pyrexia after confinement in outside hospitals. 71 Table IX Tuberculosis Notifications—Ages and Classifications Age Periods Notifications Deaths Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary Male Female Male Female Male Female Male Female 0-1 - 1 1 — - — — — 1-5 4 3 1 — 1 — — — 5-10 3 - — — - — — — 10-15 — — — — - — — — 15-25 10 7 3 1 - — — — 25-35 17 9 3 — - — — — 35-45 11 6 1 2 - — — — 45-65 7 2 1 — 1 — — — 65+ 2 1 — 2 1 — — — Total 54 29 10 5 3 — — — Table X The occupation of the new cases are as follows:— Occupation Pulmonary Non-Pulmonary Male Female Male Female Bakery hand 1 — 1 — Bar hand 1 — — — Bus conductor 1 — — — Carpenter 1 — — — Council officer 1 — — — Driller — — 1 — Engineer 1 — — — Factory worker 5 1 — — Grocer — — 1 — Housewife — 17 — 4 Interior decorator — — 1 — Labourer 8 — 2 — Laundry worker 1 — — — Licensee 1 — — — Lino worker 1 — — — Machine operator 2 — — — Machinist 1 — — — Mental patient 6 1 — 1 Metal polisher 1 — — — Mirror sandpaperer 1 — — — Moulder 1 — — — Nurse — 1 — — Painter 1 — 1 — Pre-school 6 3 2 — Power press operator 1 — — — Retired 1 — — — Schoolchild 1 — — — Secretary — 1 — — Shop assistant — 1 1 — Storekeeper 2 — — — Student 1 — — — Unemployed 1 — — — Unknown 5 4 — — Weaver 1 — — — Total 54 29 10 5 72 Table XI Examinations for Verminous Conditions and Children Found to be Verminous Attending Maintained Schools in Southall During 1963 and 1964 School Total number of examinations Total 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 1964 1963 1964 1963 1964 1963 1964 1963 Beaconsfield Road I 751 959 8 25 7 17 3 6 Beaconsfield Road J.M. 815 1,247 1 18 2 15 2 8 Clifton Road I 561 485 12 8 3 4 — 1 Clifton Road J.M 449 469 6 7 6 4 4 3 Dormers Wells I. 178 397 — 2 — 2 — 1 Dormers Wells J.M 425 608 — 2 — 1 — — *Dormers Wells S.B — 20 — 2 — 2 — — *Dormers Wells S.G - — — — — — — — Featherstone Road I 669 841 2 1 — 1 — 1 Featherstone Road J.M. 927 1,125 4 7 4 6 2 4 *Featherstone Road S.B. - — — — — — — — George Tomlinson I 380 314 3 1 3 — — — George Tomlinson J.M. 410 502 1 - - - - - Lady Margaret I. 923 1,087 2 1 1 — — — Lady Margaret J.M 608 982 — 1 — 1 — 1 North Road J.M. & I. 1,797 1,244 16 17 11 14 5 10 St. Anselm's R.C.M 739 1,904 7 14 6 8 4 1 Talbot Road Mixed 346 209 25 10 18 7 8 5 Tudor Road I 1,330 1,265 22 23 12 19 3 8 Tudor Road J.M 1,366 1,153 28 21 16 18 13 10 *Western Road S.G — 400 — 6 — 5 — 3 Total 12,674 15,211 137 166 89 124 44 62 *Not inspected during 1963 and/or 1964. 73 Table XII Sanitary Inspections—Classification of Visits Houses, Public Health Act, 1936 4,101 Houses, Housing and Rent Acts, 1936-57 2,294 Overcrowding 369 Disinfestation 19 Clean Air Act, 1956 1,205 Smoke Observations 57 Moveable Dwellings 23 Shops Act, 1950 196 Food Shops 580 Cafes etc. 173 Factories (Mechanical) 143 Factories (Non-Mechanical) 10 Outworkers 46 Food Factories 186 Bakehouses 43 Dairies and Milkshops, Farms 13 Water Sampling 31 Ice-Cream Sampling 190 Other Foods 81 Schools 15 Infectious Diseases 260 Stables and Piggeries 15 Markets— Cattle (Wednesday) 11 General (Saturday) 2 Hairdressers 23 Pet Animals Act, 1951 21 Rats and Mice 71 Offices, Shops and Railway Premises Act, 1963 165 Total 10,343 74 Table XIII HOUSING—GENERAL Statistics Housing Act, 1936—Overcrowding: (a) (1) Number of dwellings overcrowded at the end of the year 12 (2) Number of families dwelling therein 13 (3) Number of persons dwelling therein 63 (b) Number of new cases of overcrowding reported during the year 5 (c) (1) Number of cases of overcrowding relieved during the year 36 (2) Number of persons concerned in such cases 183 (d) Particulars of any case in which dwelling-houses have again become overcrowded after the local authority have taken steps for the abatement of overcrowding - (e) Any other particulars with respect of overcrowding conditions upon which the Medical Officer of Health may consider it desirable to report - 75 INDEX Page Accidents 36, 37, 38,68 Ambulance Service 1,66 Anti-Litter 62,63 Antitoxin 25 Area of Borough 8 Atmospheric Pollution 51-59 B.C.G. Vaccination 19,21,22 Bed Bugs 23,41 Births and Birth Rate 1,11,12,14,67 Blind and partially sighted 4, 28, 29 British Red Cross Society 26, 64,65 Bulletin of infectious disease 15 Canal boats 41 Cancer 11,23,24,67,68,70 Caravans 44,74 Care and after care 65 Catering establishments 48, 74 Cattle Market 40,67 Causes of death 67,68,69, 70, 72 Certificates of Disrepair and Revocation 43 Chest Clinic 4, 19, 21, 22, 64,65 Children's Welfare 2,66 Chiropody 29,31,32,63,66 Circulatory disease 68 Clean Air Act 51,74 Clinics 2,3,64,65,66 Club for Disabled Persons 26 Coronary disease 11,68 Day Nurseries and Hostels 3 Deafness 4,28,29 Deaths and death rate 1,11, 18, 20, 23, 24, 36, 67,68,69,70,72 Deaths in Wards 69 Demolition 43, 45 Deposit gauges 51,54,56,59 Diabetes 27,60,61,68 Diphtheria 11,17,68 Disinfection and Disinfestation 23, 74 Dysentery 15,16,71 Employees' medical examinations 61 Encephalitis 18,71 Factories Act, 1937 41,42,74 First Aid 26 Food & Drugs Act 47,48 Food Hygiene 2,40,46-50 Food Inspection 46,47,48, 49, 50 Food Poisoning 16,46,71 Food Sampling 46, 47,48, 74 Page Food Shops 48,49,74 Free washing facilities 40,46 Graphs 12,13,18,20,55-59 Hairdressers 74 Handicapped persons 26, 29 Hard of hearing 27,29 Health education 3, 35,62,63 Health, personal 60,61 Health visitors 2,3,65 Heart disease 11,68 Holidays for old people 32 Home accidents 36 Home help 31,66 Home nursing 31,65 Hospital services 64,65 Houses, let in lodgings or multiply occupied 8,40,44 Houses—number inhabited 8 Housing 9, 19,43,44,45, 74,75 Housing—Repairs and Rents Act 74 Hygiene of food 2,40,46-50 Hygiene—personal 35,40,46 Ice-cream 46, 47,48, 74 Immigrants 19,21,22 Immunisation 17,65,66 Improvement Grants 43 Infant mortality 1,13,14,67,69 Infectious diseases, prevalence and control of 1,15-25,71,74 Infective Hepatitis 15,18,71 Influenza 11,16,68 Inspection and supervision of food 46,47,48,49, 50 Inspection of sanitary accommodation in factories 41,42,74 Laboratory facilities and work 4, 23,46,47 Laundry, incontinent 31,32 Lice 25,41,73 Markets 40,74 Massage, establishments for 63 Maternal morbidity and mortality 14,67, 68 Maternity and Child Welfare 1,2,64,65 Meals on Wheels 31,32 Measles 15,16,67,68,71 Meat and other foods 46,47,48,49, 50 Medical examinations 61 Medicinal baths 25 Mental health 3,64,66 Middlesex County Council Services 15,16,17, 21, 25, 28,29, 30, 31, 32, 65, 66 INDEX—continued Page Midwifery service 65 Milk 46,48 Miscellaneous 62,63 Mortuary 41 Motor Vehicle Accidents 11,37,38,68 Multiple Sclerosis 27 Mumps 18 National Assistance Act, 1948 31,34 Noise nuisance 62 Nuclear Radiation 63 Nursing equipment 26,65 Nutrition 29, 30, 31 Offices, Shops, and Railway Premises 35,40, 42, 74 Old People's Clubs 32, 33 Old People's Welfare 4,31-34 Ophthalmia neonatorum 17 Outworkers 42,74 Overcrowding 19,43,74,75 Paddling Pool 10 Parks and Open Spaces 8 Personal health 60, 61 Personal hygiene 35,40, 46 Pet Animals Act 63,74 Playing Fields 8,10 Pneumonia 15,68,71 Poliomyelitis 15,16,68 Population 8,70 Premature infants 14,69 Prosecutions 44,48,49,50 Public Control Department 47,48 Public Conveniences 40,46 Public Health Committee 1 Public Health Inspectors 5,7,23,40 Puerperal pyrexia 14,71 Rag Flock and Other Materials Filling Act 42 Rateable value 8 Rats and mice 62,63,74 Refuse collection and disposal 39 Rehousing 43 Respiratory diseases 68 River pollution 63 Page Road Safety 37, 38 St. John Ambulance Service 26 Sanitary circumstances 39-42 Sanitary inspection 2,23, 40,74 Sanitation in schools 40,41,74 Scabies 25 Scarlet fever 17,71 School Medical Service 1,2,3,66,73 School Meals and Milk 29,30,31 School playing fields 10 Sewerage 39 Shops Acts 63,74 Slum Clearance 43 Smallpox 16,17,23 Smoke Control Areas 51 Smoke pollution 51,52,74 Southall Association for the Occupation of the Elderly 34 Spastics 27,28 Staff 5,7,61 Statistics—General and Vital 1,8, 9,10,11,12,13,14,67 Stillbirths 11,14,67,69 Street Cleansing 39,40 Street Traders 48, 50 Sulphur dioxide pollution 51,52,53,55,57,58 Swimming baths 10 Tuberculosis 11,18-22,65,68,71,72 Typhoid fever 17, 35 Unemployment 9 Unsound Food 47, 48,49, 50 Vaccination 15,16,17,19,21,22,65,66 Vaccine lymph 25 Verminous persons 23,25,73 Vital statistics 11,12,13,14 Volumetric machine 51,52 Water supply and services 39,74 Welfare 3,4,26-34 Whooping cough 11,15,67,68,71 Women's Voluntary Service 2,28,64 X-Rays 4,19,22 JR2/68