Twi 5 Borough of Twickenham ANNUAL REPORT OF THE Medical Officer of Health 1937 GEORGE H. DUPONT, M.D., C.M., D.P.H., Medical Officer of Health Twickenham: Printed by Walker & Co. (Printers), Ltd., 6 Heath Road and 162 Colne Road. Borough of Twickenham. Public Health Department, Elmfield House, Teddington. August, 1938. To the Mayor, Aldermen and Councillors of the Borough of Twickenham. Ladies and Gentlemen, Although the enlargement of the Borough, produced by the incorporation of the Urban Districts of Hampton, Hampton Wick and Teddington, did not take place until April 1st, 1937, the report, which I have the honour to submit, applies to the area of the enlarged Borough for the whole year. In consequence of the order of the Minister of Health, the Borough is now nearly three times as large as before, and its population and rateable value are almost doubled. It is not always easy to remember that Twickenham is now one of 125 large towns of England and Wales, and not an aggregation of smaller units. The expansion of the town has involved not merely a proportionate increase in administration, but, at any rate as far as the Health Department is concerned, has also added other duties and responsibilities which have been imposed in consequence of the increased importance of the Borough. Until amalgamation, Twickenham was an autonomous Part III. Education Authority. It was agreed, however, that the education services in the new and enlarged Borough should be administered by the Middlesex County Council. In the ordinary course, the School Medical Service would have been carried out by the Local Education authority, but it was realised that as the care of the health of the school children is an integral part of the public health services of a district, it was undesirable for the School Medical Service to be divorced from the other public health services of the Borough. An agreement was therefore entered into by which the Medical Officer of Health of the Borough was made responsible for carrying out, under the direction and control of the County Medical Officer of Health, the School Medical Services in the. extended Borough. All the local duties of this service are therefore carried out by the medical and nursing staff of the Corporation throughout the entire Borough, including the medical, ophthalmic and dental services for all the elementary and secondary schools and the new Technical College. The duties of the Maternity and Child Welfare Services in Hampton Wick were formerly performed by officers of the Middlesex County Council. These duties have now become part of the health service of the Borough, and are carried out by the medical and nursing officers of the Corporation. As the work of all the branches of the Public Health service is now undertaken by the officers of one Authority, not only has it been possible to reduce the personnel engaged in the duties, but unification of methods, the avoidance of visits to homes by officers of two different authorities, and more satisfactory control have been effected. In October, the Minister of Health issued an order constituting the Corporation the supervising authority under the Midwives Acts. The responsibilities thus imposed included not only the supervision of all midwives practising in the Borough, but also the appointment and direct employment of whole-time midwives under the Midwives Act, 1936. In the same month the Middlesex County Council delegated to the Corporation the duties connected with the registration and supervision of Nursing Homes. The sudden enlargement of the Borough, the imposition of the new and additional duties and the co-ordination and unification of the services formerly carried out in the four separate areas, by five different authorities, have raised problems and difficulties, the solution of which has demanded much consideration and occupied much time, but many of these had been solved, while others were in process of solution at the end of the year. As the office accommodation, occupied by the Health Department at the Municipal Offices at York House, was found to be entirely inadequate for the increased staff, the offices of the Health Department were moved to Elmfield House, Teddington, which was occupied as offices by the Teddington Urban District Council before the abolition of that authority. After certain alterations, this building has proved to be sufficient and satisfactory, apart from the distance at which it is situated from the central offices in Twickenham. As this will be the last annual report which it will be my privilege to submit, I desire to acknowledge with grateful thanks the consideration and courtesy which has always been shown to me by successive Councils and Committees during the past twenty-eight years, and I also acknowledge, to the full, the friendly co-operation and help that I have received at all times from my fellow chief officers. 3 It is, however, to the staff of the Health Department that I desire particularly to convey my appreciation. Only with their loyal and willing help, has it been possible to carry out the duties and, in the particularly arduous and trying time since the enlargement of the Borough, their services have been given unreservedly and uncomplainingly at all times. I desire to include in this tribute, not only those who have served with me for many years, some through nearly the whole term of my office, but all those who have joined the department since amalgamation. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, George .H. Duponk Medical Officer of Health. 4 PUBLIC HEALTH COMMITTEE. Councillor A. Felton Smith (Chairman). Councillor Mrs. M. F. Bligh, B.Sc. (Vice-Chairman). The Mayor, Alderman Edgar Ollis Councillor Rev. A. M. Johnson, M.A. The Deputy Mayor, Alderman J. Bloxham „ Captain D. D. Jones, M.C. Alderman P. H. Durham „ H. W. Peachey V. G. Heptinstall „ S. F. Seward Councillor C. H. Drake „ G. J. Simmons „ H. Field „ Mrs. F. Walton „ Captain B. T. Harding MATERNITY AND CHILD WELFARE COMMITTEE. The members of the Public Health Committee, together with the following co-opted members:— Mesdames F. E. Bloye, R. L. Butcher, D. Iorwerth-Jones, H. A. M. Langdon-Down and N. M. Pearce. STAFF OF THE PUBLIC HEALTH DEPARTMENT. (As on December 31st, 1937). Medical Officer of Health : George H. Dupont, M.D., C.M., D.P.H. Deputy Medical Officer of Health : John Young, M.B., Ch.B., D.P.H. Assistant Medical Officer: Dora F. M. Rose, M.A., M.B., Ch.B., D.P.H. Obstetric Consultant: J. W. Bell, L.R.C.P.I., L.R.C.S.I, (part-time). Ophthalmic Surgeon: C. J. Longworth Blair, M.R.C.S. (part-time). Dental Surgeon: George Woolford, L.D.S., R.C.S. Senior Dental Surgeon: J. V. Bingay, L.D.S., R.C.S. Senior Sanitary Inspector: L. Marsden (a) (b). Sanitary Inspectors : M. V. Sutcliffe (a) (b), C. J. Rabbitts (a) (b), W. F. Newport, (a) (b), W. K. Pickup (a) (b), S. W. S. Scott (a) (b). ()Health Visitor (principal): A. B. Pilkington (c) (d) (e). Health Visitors: E. Dunkley (c) (d) (e), M. G. Heath (c) (d) (e), S. G. Briggs (c) (d) (e), B. Garrett (c) (d) (e), M. Blatchley (c) (d) (e), E. M. Clarke (a) (c) (d), A. M. S. Mathews (c) (d) (e). School Nurse: Laura Manning (e). Dental Nurse: Mrs. Weller (e). Clerks: Walter Brearley (a), H. J. Pugh, Violet Williams, Victoria R. Chaplin, Evelyn F. Elston, G. Coram, Margaret Williams, Eva Williams, E. Lucas, Jeanne Martindell, C. F. Davis. (a) Certificate as Sanitary Inspector. (b) Certificate R.S.I, as Inspector of Meat and Other Foods. (c) C.M.B. Certificate. (d) Health Visitor's Certificate. (e) Trained Nurse. SUMMARY OF CONTENTS. Page Section A. Statistics and Social Conditions 5 Section B. General Provision of Health Services 8 Section C. Sanitary Circumstances of the Area 13 Section D, Housing 16 Section E. Inspection and Supervision of Food 17 Section F. Prevalence of and Control over Infectious Disease 18 5 SECTION A. STATISTICS AND SOCIAL CONDITIONS. Area of district in acres— Twickenham 2,435 Teddington 1,222 Hampton 2,044 Hampton Wick 1,306 7,007 Population at Census, 1931— Twickenham 39,980 Teddington 23,369 Hampton 13,053 Hampton Wick 2,974 79,376 Population estimated by the Registrar General:— Mid-year, 1936—4 constituent areas 90,140 Mid-year, 1937—Enlarged Borough 94,230 Number of inhabited separate dwellings 26,716 Rateable value £979,359 Gross product of a Penny Rate £4,080 Rainfall during 1937 28.63 inches Although the Borough has been almost trebled in area since the incorporation of the districts of Teddington, Hampton and Hampton Wick, the general residential character is still maintained, while the inclusion in the Borough of Bushy Park, Hampton Court Park and the Fulwell Golf Links, together with the very generous provision of public parks provided by the Local Authorities, must surely place Twickenham first among the towns of England in the extent and beauty of its public open spaces. The erection, by private enterprise, of houses and of blocks of flats continues apace, and estimates of a future maximum population of the Borough, made before the erection of flats was contemplated, have become fallacious and must of necessity be entirely conjectural. Population. The population estimated by the Registrar General at the middle of the year 1937 was 94,230, an increase of 4,090 over the combined population of the four constituent areas in the year 1936. This increase has occurred principally in the areas of the former Borough of Twickenham and of Hampton, the increases in Teddington and Hampton Wick being comparatively small. As the natural increase in the population, i.e., the excess of live births over deaths, during the year was 363, the balance, 3,727, consisted of persons who had moved into the Borough from other places. Births. Male. Female. Total Total Births 773 680 1,453 Live Births: Legitimate 713 639 Illegitimate 31 28 1,411 Still Births: Legitimate 27 13 Illegitimate 2 — 42 Increase in total births compared with 1936 ... ... 22 Live birth rate per 1,000 of the population ... .. 14.9 Still birth rate per 1,000 of the population ... ... 0.44 Still birth rate per 1,000 births (live and still) ... ... 28.9 The live birth rate, 14.9 per 1,000 of the population, was exactly equal to that of England and Wales generally, and also to that of the 125 great boroughs and towns among which Twickenham is now included. 6 Deaths. Nett deaths 1048 Increase compared with year 1936 42 Death rate (crude) per 1,000 of estimated population 11.08 Death rate (corrected) 10.96 As in previous years, diseases of the heart and circulation, cancer and tuberculosis were the principal causes of death. Diseases of the heart and circulation and cerebral haemorrhage accounted for 35 per cent., Cancer for 15 per cent., and Tuberculosis for 6 per cent, of the total deaths. CAUSES OF DEATH AT ALL AGES. Year 1937. Registrar General's figures. Causes of Death. Males. Females. Total. All causes 503 545 1048 1. Typhoid and Paratyphoid Fevers 1 - 1 2. Measles — - - 3. Scarlet Fever — — - 4. Whooping Cough 1 1 2 5. Diphtheria 2 — 2 ti. Influenza 15 28 43 7. Encephalitis Lethargica 1 1 2 8. Cerebro-spinal Fever 1 — 1 9. Tuberculosis of respiratory system 31 18 49 10. Other tubercular diseases 1 11 12 11. Syphilis 3 2 5 12. General paralysis of the insane, tabes dorsalis 1 2 3 13. Cancer, malignant disease 69 80 155 14. Diabetes 5 10 15 10. Cerebral haemorrhage, etc. 17 32 49 16. Heart disease 138 134 272 17. Aneurysm 3 2 5 18. Other circulatory diseases 21 30 51 19. Bronchitis 18 19 37 20. Pneumonia (all forms) 34 16 50 21. Other respiratory diseases 6 6 12 22. Peptic ulcer 9 3 12 23. Diarrhoea, etc. (under 2 years) 3 1 4 24. Appendicitis 6 1 7 25. Cirrhosis of liver 3 2 5 26. Other diseases of the liver, etc. — 7 7 27. Other digestive diseases 9 15 24 28. Acute and chronic nephritis 15 19 34 29. Puerperal sepsis — 1 1 30. Other puerperal causes — 3 3 31. Congenital debility, premature birth, malformations, etc. 17 12 29 32. Senility 11 23 34 33. Suicide 2 3 5 34. Other violence 20 14 34 35. Other defined diseases 39 40 79 36. Causes ill-defined or unknown — 1 1 37. Diarrhoea, 2 years and over 1 2 3 Puerperal Deaths. Four women died from conditions associated with pregnancy or childbirth, one of these deaths being due to puerperal sepsis. The maternal death rate was 2.7 per 1,000 total births. Deaths from Certain Diseases. Disease. Number of cases. Rale per 1,000 of population Measles — — Whooping Cough 2 0.02 Scarlet Fever — — Diphtheria 2 0.02 Typhoid Fevers 1 0.01 Influenza 43 0.45 Diarrhoea under 2 years of age 4 0.04 Tuberculosis (pulmonary) 49 0.52 Cancer 155 1.6 7 Infants Deaths. Nett deaths of infants under 1 year of age 50 Legitimate: Male 25, Female 19. Illegitimate: Male 5, Female 1. Infant death rate per 1,000 live births 35.4 Infant death rate per 1,000 legitimate births 32.5 Infant death rate per 1,000 illegitimate births 101.6 The number of deaths of infants under one year of age was unusually small, being eight less than those occurring in the four constituent areas during the preceding year. The Infant death rate for the entire borough for the year 1937 was 35.4, which compares favourably with the rate of 42 for the four constitutent areas during the preceding year. The number of infants who died before the first month of life was 25, giving a neonatal death rate of 17.7 per 1,000 live births. The following table shows the deaths of infants under 5 years of age which occurred during 1937. Causes of death of children under 5 years of age, 1937. CAUSES OF DEATH. 1 week 1-2 weeks i 2-3 weeks 3-4 weeks Total under one month 1-3 months 3-6 months 6-9 months 9-12 months Total under one year 1-2 years 2-3 years 3-4 years 4-5 years Total under five years Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... 1 ... 1 ... ... ... 1 2 Diphtheria ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculosis ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... 2 Bronchitis ... ... ... ... ... ... ... ... 1 1 ... ... ... ... 1 Pneumonia 1 ... ... ... 1 4 ... 1 l 8 1 3 ... 1 13 Enteritis & ... ... ... ... ... 1 1 ... l 3 ... ... ... ... 3 Gastritis Syphilis ... ... ... ... ... ... ... ... ... ... ... • • • ... ... ... Atelectasis 3 ... ... ... 3 ... ... ... ... 3 ... ... ... ... ... Accident or injury at birth 2 ... ... ... 2 ... ... ... ... 2 ... ... ... ... 2 Congenital malformations 3 ... ... ... 3 1 2 ... ... 6 ... ... ... ... 6 Premature birth 10 ... 1 ... 11 ... ... ... ... 11 ... ... ... ... 11 Debility 3 ... ... ... 3 ... 1 ... ... 4 ... ... ... ... 4 Atrophy and Marasmus ... ... ... ... ... 1 2 ... ... 3 ... ... ... ... 3 Other diseases 1 ... ... ... 1 2 1 ... 2 6 2 2 ... ... 10 Violence 1 ... ... ... 1 1 ... ... ... 2 1 ... ... ... 3 Inattention at birth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Total 24 ... ... 25 10 9 2 5 51 5 6 ... 2 64 The total number of deaths under one year of age in this table differs slightly from those in the table of the Registrar General, as the period to which they refer is not identical with that from which these figures were taken. Public Mortuaries. At the date of the enlargement of the borough four mortuaries were in use, one in each of the constituent areas. It was decided to close the mortuaries at Teddington and Hampton Wick and to retain in use, for the time being, the buildings at Twickenham and Hampton. The mortuary at Hampton is of modern construction and ample capacity. That at Twickenham is out of date in construction and insufficient in size for the whole borough, but is fitted with a modern refrigerating chamber. The question of closing the Twickenham mortuary and using the Hampton mortuary exclusively after transference of the refrigeration plant was under consideration at the end of the year. During the year 75 bodies were brought into the mortuaries, and 48 post-mortem examinations were made. 8 SECTION B. GENERAL PROVISION OF HEALTH SERVICES. Laboratory Facilities. As each of the four districts had made arrangements with different laboratories for the bacteriological examinations, it was decided to send all specimens to the Pathological Department at Richmond Hospital. This unified service has been entirely satisfactory, delay in transmission has been avoided and the reports have been received promptly. Ambulance Service. The arrangements for the provision of the ambulance service differed somewhat in each of the districts now comprising the Borough. In the Twickenham area two motor ambulance vehicles were stationed at the fire station and staffed by the fire brigade. In the Teddington district, one motor ambulance was stationed at the Teddington fire station and staffed by the fire brigade. At Hampton, one motor ambulance stationed at the Council offices, was staffed by a part-time. and voluntary personnel. At Hampton Wick there was no ambulance, the services of the Kingston-on-Thames ambulance being requisitioned when necessary. The service has been reorganised in the following manner:— The Hampton ambulance was transferred to Twickenham. In consequence, three ambulances are now stationed at the Twickenham fire station and one at Teddington. The arrangement for the use of the Kingston ambulance has been terminated and all ambulances are now maintained at fire stations and staffed by the fire brigade, the Medical Officer of Health being responsible for the administration of the service. The scales of contribution, which differed in each area, have been unified. Following is a table of the use of the ambulances during 1937. As the figures in all the areas are not available, it is not possible to give comparative figures for the preceding year. Year 1937. Total calls. Patients carried. Mileage 1st quarter 284 277 1509.7 2nd quarter 316 308 2308.7 3rd quarter 361 347 2042.3 4th quarter 306 291 1747.2 1,267 1,223 7607.9 Nursing in the Home. There are 5 home-nursing associations in the Borough, employing nurses as follows:— Twickenham Nursing Association, four nurses. Teddington District Nurse Fund, one nurse. Hampton Nursing Association, one nurse. Hampton Hill Nursing Association, one nurse. Hampton Wick Nurse and Dispensing Fund, one nurse. Each association is a separate voluntary organisation under the management of its own Committee. The total sum subscribed by the four councils of the areas of these associations during the year was £176 5s. 0d. At a joint meeting of representatives of all the associations, various points were considered with a view to securing uniformity of service, a more equal distribution of nursing staff, and the interchange of nurses in emergency. These points were accepted generally by all the associations, who also agreed to co-opt one representative of the Town Council on the Committee of each association. Nursing of Infectious Cases. All the associations have agreed to undertake the home nursing of expectant and nursing mothers, and of children under five years of age, including cases of the following diseases: Pneumonia, Measles, Whooping Cough, Ophthalmia Neonatorum, and Puerperal Pyrexia. 9 CLINICS AND WELFARE CENTRES. Following is a list of the Clinics within the Borough:— Clinics Address Days By whom provided Infant Welfare Centre. York house, Twickenham. Tuesday and Wednesday, 2 p.m. Twickenham Council ditto Hospital Bridge road, Twickenham Monday and Thursday, 2.30 p.m.; Friday, 10 a.m. ditto ditto Adult school, Teddington Tuesday and Thursday, 2.30 p.m. ditto ditto Station road, Hampton Wednesday and Friday, 2.30 p.m. ditto ditto The Baptist Hall, Hampton Wick Friday, 2.30 p.m. ditto Ante-Natal Clinic York house, Twickenham Friday, 2 p.m. ditto ditto Hospital Bridge road, Twickenham. Wednesday, 10 a.m. ditto ditto Elmfield house, Teddington. Monday, 2 p.m. ditto ditto Station road, Hampton Thursday (1st and 3rd), 10.30 a.m. ditto School Clinic, including minor ailment, dental and ophthalmic clinics York house, enham Daily Twickenham Council, and Middlesex Education Committee. ditto Stanley road, Teddington ditto ditto ditto Hospital Bridge road, Twickenham ditto ditto Diphtheria immunization York house, Twickenham Saturday, 10 a.m. Twickenham Council ditto Stanley road, Teddington Monday, 10 a.m. ditto Tuberculosis dispensary 1 Staines road, Twickenham Wednesday, 10 a.m. Middlesex County Council. HOSPITALS. For Infectious Diseases. There is now no hospital for infectious diseases in the Borough. Arrangements for the treatment of Smallpox are made by the Middlesex County Council under the "Prevention and Treatment of Smallpox Regulations, 1928." Other cases of infectious disease are admitted to the Hospital of the South Middlesex Joint Hospital Board in Isleworth. This hospital receives patients from the Boroughs of Heston-Isleworth, Richmond (Surrey), and Twickenham. Other Hospitals. Following are the voluntary hospitals in the Borough; all are "Cottage hospitals, i.e., they are without a resident medical officer:— St. John's Hospital, Twickenham. St. Mary's Hospital, Hampton. The Teddington, Hampton Wick and District Memorial Hospital, Teddington. MIDWIFERY AND MATERNITY SERVICES. The total number of births which were notified as occurring in the Borough was 974. This figure does not include births which occurred elsewhere, but which were subsequently transferred to Twickenham. Of the births which occurred in the Borough, 472, i.e., 48 per cent. were attended by midwives in their capacity as midwives, and 200, i.e., 20 per cent. in their capacity as maternity nurses. Midwives were therefore present in approximately 68 per cent. of all the births which took place in the Borough. 10 Midwives Acts. On account of the increased size and importance of the Borough consequent upon amalgamation, an order was received from the Minister of Health at the end of September, whereby the Corporation became the Local Supervising Authority under the Midwives Acts in place of the Middlesex County Council. This order became operative on October 1st, 1937. The responsibility thus placed upon the Corporation constitutes the most important and extensive addition which has been made to the public health services of the town for many years past.' Not only did the Corporation become responsible for exercising supervision over all midwives practising in the area which duty was formerly carried out by the Middlesex County Council, but at the same time the duty of establishing and maintaining a service of Municipal Midwives, which was imposed upon local supervising authorities by the Midwives Act, 1936, devolved upon the Corporation. The proposals for the establishment of this service which were submitted to the Minister of Health and subsequently approved, included the appointment of 7 whole-time midwives, the arrangements in connection with applications for their services, their duties, control and supervision, salary and superannuation, uniform, residence and other conditions of employment together with the fees chargeable for their services and the contributions payable by those obtaining their services. Arrangements for giving effect to these proposals were being completed at the end of the period covered by this report. While these important additions were being made, the established branches of the Maternity and Child Welfare service were being carried out with increased activity. Care of Expectant Mothers. On account of the increasing numbers of expectant mothers attending the Ante-natal clinics, it was found necessary to increase the number of sessions devoted to this important work by holding a weekly session at the York House Centre in place of one each fortnight, by establishing a weekly session at the Whitton Centre in Hospital Bridge Road, and by holding a weekly session at Teddington. The sessions of the Ante-natal Clinic at Teddington had hitherto been held under somewhat unsatisfactory surroundings at the Adult School hall. This clinic was transferred to Elmfield house, Teddington, which is now occupied by the offices of the Health Department of the Corporation, two rooms on the ground floor being adapted for the purposes of an Ante-natal clinic. The improvement thus effected has been very marked and the conditions are now satisfactory in every way. The increase in the attendances of expectant mothers at the Ante-natal clinics is most striking, as will be seen from the following figures:— Year. Attendances for first time. Total attendances, 1936 355 821 1937 607 1987 The increase, to a considerable extent, was due to the arrangement which has now been brought into effect, whereby the ante-natal supervision of women, who are to be admitted to the West Middlesex hospital for their confinement, is now carried out largely at the Ante-natal Clinics in the Borough and not at that hospital as was formerly the case. At the Ante-natal Clinics, medical or surgical treatment was found to be necessary for 86 expectant mothers and was obtained by 61 of these during the year. The arrangements for providing dental treatment for expectant and nursing mothers which existed in the area of the former Borough were extended to the added districts, in which prior to amalgamation, no provision had been made for this service. Milk was supplied either free or at less than cost price to 37 expectant mothers. On account of the adequate facilities which now exist at the West Middlesex Hospital, expectant mothers for whom special observation or treatment is required are referred to that hospital. Birth Control. Arrangements have been made for women for whom pregnancy is inadvisable for medical reasons to obtain the necessary advice, etc., at one of the Birth Control Clinics in London. Care of mothers during confinement. The Corporation have not established a Maternity Home, and in view of the proximity of the West Middlesex Hospital, no formal agreement has been made with any hospital for the reception of complicated or difficult cases. No request has been received during the year for the services of a consultant in cases of difficult labour. 11 Subsequent to Confinement. Medical practitioners have again been encouraged to send cases of puerperal pyrexia into hospital at an early stage, and the reluctance on the part of women to go to hospital for these conditions is disappearing. Ten cases of puerperal pyrexia were admitted to hospital during the year, 5 to the Isolation Block at Queen Charlotte's Maternity Hospital, 4 to West Middlesex County Hospital, and one to the County Hospital, Uxbridge. The results in some instances have been dramatically satisfactory, cases in which the outlook appeared extremely grave have improved rapidly and recovered completely. No application was received for the services of a consultant in cases of puerperal pyrexia. A special clinic for the examination of mothers after confinement has not been established. The majority of the mothers who have been admitted to the West Middlesex Hospital for their confinement attend that hospital subsequently for examination and consequently the attendances for this purpose at the Ante-natal Clinics in the Borough are relatively small. It was decided, at the end of the year, to spe as many post-natal cases as possible at the ' Ante-natal Clinics, but this was not found to be practicable to any extent as the attendances of expectant mothers at the ante-natal sessions, even although held more frequently, is so great as to render it impossible to see any appreciable number of post-natal cases as well. The question of still further increasing the Ante-natal Clinic sessions will therefore have to be considered. Milk was supplied free or at less than cost price to 51 nursing mothers during the year. Dental Treatment. Before the enlargement of the Borough, no facilities existed for the dental treatment of expectant and nursing mothers in either Teddington, Hampton, or Hampton Wick. The arrangements for this, which have existed in the area of the former Borough for several years, were extended to include the whole area of the enlarged Borough. Dental treatment carried out during the year was as follows:— Expectant mothers 58 Nursing mothers 24 Dentures supplied 5 Institutional Provision for Mothers and Children. No formal arrangements have been made to provide Institutional treatment for mothers and children. Health Visitors. On the completion of the new Clinic at Hospital Bridge Road, one of the Health Visitors who had been engaged on a part-time basis was replaced by a whole-time officer. On the date of the enlargement of the Borough, 3 Health Visitors who were already engaged in duties in Teddington and Hampton were added to the staff, and at the end of the year an additional Health Visitor was engaged, making 8 in all. The duties of nurses under the School Medical Service in the areas of Teddington, Hampton and Hampton Wick, and the duties of Health Visitor and Child Life Protection Visitor in Hampton Wick, were carried out by the Middlesex County Council until the date of the enlargement of the Borough, when these nurses were withdrawn and the duties taken over by the Health Visitors employed by the Corporation. In consequence, the nursing staff in these districts is no longer duplicated and the control has been unified. The visits paid to the homes by the Health Visitors during the year included the following:— To expectant mothers 578 To children under 1 year of age 6,286 To children between the ages of 1 and 5 years 8,789 In addition many visits were paid to children of school age who were reported absent from school on account of suspected infectious disease and for the purpose of following up school children who had been recommended for treatment or for whom observation wrrs required. The Health Visitors also attended when required at the minor ailment and dental clinics. Winter School. Two of the Health Visitors attended a study course during the winter. * 12 Infant Welfare Clinics. The new Clinic at Hospital Bridge Road, Whitton, was used for the first time in April. There are now five centres for Infant Welfare, ten sessions for infant consultation being held weekly. 1 he total attendances of children under 5 years of age at the various sessions numbered 17,792 during the year. The figures for each centre are set out below:— 1937 New Cases York House Centre Whitton Centre Teddington Centre Hampton Centra Hampton Wick Centre Totals Under 1 year 293 279 168 120 36 896 1-5 Years 47 138 63 45 26 319 Mothers 3 2 0 4 0 9 Total Attendances Under 1 Year 3282 3354 1863 2148 435 11082 1-5 Years 1195 1947 1281 1965 322 6710 Mothers 3 3 0 5 0 11 Total attendances at all centres 19027 In addition to the usual advice given as to care and nutrition of the infants attending the centres, medical and surgical treatment was found necessary for 239 children and was obtained by 129 of these. Medical or surgical treatment of nursing mothers was found to be necessary in 43 cases and was received by 29 of these during the year. Dental Treatment of Children under 5 years. This service, which before amalgamation, was not available for children in the Hampton district, is now provided for children throughout the entire Borough. During the year 79 children under 5 years of age received completed dental treatment. Infant Life Protection. All the Health Visitors are appointed Infant Life Protection Officers, and the visits of supervision of foster-children are carried out by them. The details as to registration during 1937 were:— Number of foster children on register at beginning of year 96 Number removed from register 65 Number registered for first time during year 64 Number on register at end of 1937 95 Deaths of foster children 1 Orthopaedic Treatment. No formal arrangement has been made in the Borough for the treatment of children requiring massage, orthopaedic treatment or remedial exercises. The facilities provided by the Middlesex County Council at the West Middlesex Hospital, Isleworth, include the services of an orthopaedic surgeon, and cases can be treated as out-patients or admitted if necessary for operative treatment. While there are also facilities for massage and remedial exercises, for which frequent attendance is required, the distance to be travelled by patients is considerable and the time which is occupied in taking children to the hospital cannot be easily spared by working-class mothers. One child, under 5 years of age, was sent to a convalescent home, and two were admitted to the Royal National Orthopaedic Hospital, during the year, at the expense of the Committee. I NURSING HOMES. The Local Supervising Authority for the Registration of Nursing Homes in the Borough has, hitherto, been the Middlesex County Council, but that Council resolved to delegate their powers to the Corporation from October 1st, and in consequence the duties in connection with the registration and inspection of Nursing Homes are now undertaken by the medical staff of the Corporation. There are 12 private nursing homes in the Borough which are registered. The three voluntary hospitals which receive private patients are exempted from registration. The records received from the Middlesex County Council were filed, the Homes inspected by the Senior Assistant Medical Officer, and arrangements made for periodic inspection to be carried out by the same officer. " 13 SECTION C. Sanitary Circumstances of the Area. Practically every dwelling in the Borough derives its water supply from that of the Metropolitan Water Board, and with few exceptions every house is provided with a water closet. The sewage from the Twickenham and Teddington portions of the Borough is disposed of at the Mogden works of the West Middlesex sewage scheme. That from Hampton is dealt with at the sewage works, Hanworth Road, Hampton, and from the Hampton Wick area at the Kingston sewage works, under agreement with the Kingston Corporation. The collection of house refuse is carried out under the direction of the Borough Surveyor, who informs me that approximately 23,000 tons were collected during the year and disposed of principally by burning in the destructors at Twickenham, Hampton, and Teddington, a portion being disposed of by tipping. The questions of standardisation of the methods and frequency of collection throughout the enlarged Borough were under consideration at the end of the year. Sanitary Inspectors. Before amalgamation, the Borough of Twickenham employed two Sanitary Inspectors. Two were employed by the Teddington Urban District Council, one by that of Hampton, and the duties in Hampton Wick were carried out by an officer who combined the duties of Surveyor and Sanitary Inspector. Six whole-time Sanitary Inspectors are now employed, each being responsible for all the duties in the portion of the Borough allotted to him, and the districts are no longer coterminous with the former boundaries of the constituent districts which now form the enlarged Borough. The system of inspection and of recording has also been reorganised and unified. The complete records of visits paid by Sanitary Inspectors and work carried out in parts of the enlarged Borough are not available for the first quarter of the year, but as far as has been ascertained, the total number of inspections and reinspections carried out during the year was 16,731. The visits paid in respect of each branch of the duties of the inspectors are set out under the appropriate headings. Notices were served on owners or occupiers as follows:— Informal notices served 685 Informal notices complied 550 Statutory notices served 19 Statutory notices complied, including those carried forward from 1936 50 Domestic Sanitation. The duties of visiting premises after complaint, of housing inspections, the investigation of alleged nuisances, the investigation of cases of infectious disease, and the necessary action by way of disinfection of dwellings, together with the multifarious other tasks which confront the Sanitary Inspector in his daily round, have been carried out actively and effectively by the Inspectors. Following is a summary of the visits paid during the year:— Visits to premises after complaint 839 Visits after occurrence of infectious disease 345 Visits under Housing Regulations 351 Total visits and inspections 16,731 The following works were carried out in consequence of the above visits:— Drains tested 93 Drains unstopped and repaired 83 Waste pipes disconnected or repaired 30 Soil pipes provided or repaired 2 Inspection chambers inserted 4 Complete drainage reconstructions 10 Water supply cisterns repaired 11 Draw taps from main provided 32 Gutters repaired 95 Roofs repaired 296 W.c. apartments repaired or rebuilt 39 W.c's repaired 120 Dustbins provided 109 Damp walls remedied 266 Ventilation provided 66 Yards paved or repaired 102 Rooms stripped and cleansed 340 Offensive accumulations removed 26 Other works carried out 1535 14 Offensive Trades. Complaints from individuals and from public associations have been received at times in reference to a factory where bone-boiling, fat-melting and other similar trades are carried on. It has been difficult to convince those who complain of offensive odours that when a trade of this character is established and carried on in accordance with the provisions of the statute, it cannot be removed or closed until further legislation is enacted. Three applications were received for the establishment of the trade of fish-fryer, but were not granted. The following premises where offensive trades have been established were kept under . frequent supervision:— Fish fryers 27 Fat melters 2 Rag and bone dealers 4 The number of visits paid by the Inspectors to these premises was 55. Keeping of Animals. With the exception of certain piggeries, no particular difficulty has arisen in connection with the keeping of animals. It will be remembered that, during the preceding year^ a case taken before the magistrates was dismissed as they apparently were of opinion that the animals were not being kept in such a state as to be a nuisance* This opinion has not been shared by those persons who reside in the neighbourhood, and complaints have continued to be received. Beyond keeping all piggeries under frequent supervision, statutory action has not been taken during the year. Swimming Baths. There are now open-air swimming baths in the Borough at Twickenham, Teddington and Hampton. During the season the total attendances at the baths were 177,132. Bed Bugs. (1) Houses were found to be infested by bugs as follbws:— (a) Council houses 1 (b) Other houses 11 Disinfestation was carried out in the following cases:— (a) Council houses 1 (b) Other houses 11 (2) The methods employed were by extensive and repeated spraying with insecticide solution. Arrangements were made with the owners to remove skirting boards and architraves before spraying was undertaken, where such action was considered necessary, and to repair defects in plaster subsequently. As a rule, spraying repeated two or three times at intervals has proved satisfactory. It is not contended that it is as effective as cyanide or other similar gaseous insecticide, but it is at any rate free from danger to the persons occupying neighbouring rooms or houses and can be carried out without removing the occupants from the house or adjoining houses. (3) No application was received from the Housing Department during the year for action in disinfecting the belongings of persons before their removal to Council houses. (4) The work of disinfestation has been carried out by an employee of the Corporation under the direct supervision of the Sanitary Inspectors. (5) No special measures of education of tenants have been taken. Schools. Twickenham was formerly a Part 3 Local Education Authority, but when the enlargement of the Borough took place the powers as an Education Authority were ceded to the Middlesex County Council. It was recognised, however, that the duties of the School Medical Service were an essential part of the health services of the Borough, and an agreement was entered into between the Corporation and the Middlesex County 'Council whereby the Medical Officer of Health of the Borough became responsible for the school medical service within the Borough. The duties are therefore carried out by the Medical and nursing stall of the Corporation, not only in connection with the children in the elementary schools, but also the pupils in the secondary schools and technical college in the enlarged Borough. Included in these are the Twickenham County School for Girls, the Thames Valley County School for girls and boys, the Hampton Grammar School and the Twickenham Technical College. There are also twenty-six elementary schools comprising 41 separate departments, while the total number of pupils in attendance at all the schools amounts to nearly 11,000. 15 The details of the medical, ophthalmic and dental duties carried out are included in the report of the School Medical Officer for the County of Middlesex. The nurses of the staff of the Corporation visit all infant departments two or three times weekly for the purpose of ascertaining the names of children absent on account of suspected infectious disease and also to deal with any child present in class who appears to be unfit to remain at school or may be suffering from an untreated minor ailment. The nurses subsequently visit the home of a child thus found to be absent on account of infectious disease and advise the parents where necessary. The sanitary conveniences, water supplies, and lavatories of all the schools, both elementary and secondary, have been visited by the Sanitary Inspectors quarterly throughout the year. Petroleum Acts. The Sanitary Inspectors are appointed Inspectors under the Petroleum Acts, and supervise the stores where petroleum spirit and carbide of calcium are kept. There were, in all, 114 premises in respect of which licenses to keep petroleum spirit had been issued. Of these, fourteen were for the storage of petrol in cans, nine for storage of petrol in tanks, and a small supply in cans, the remainder being for storage in underground tanks only. Six licences were granted for the keeping of carbide of calcium. The number of visits paid by the Inspectors in connection with these premises was 229. Factories and Workshops. In accordance with the requirements of the Factory and Workshops Act, 1901, a statement of inspection is submitted, together with the defects found, and the result of action taken. INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES, Including Inspections made by Sanitary Inspectors. Premises. Inspections Number of Prosecutions Written Notices (1) (2) (3) (4) Factories (including Factory Laundries) 244 20 - Workshops (including Workshop Laundries) 282 17 - Workplaces (other than Outworkers'premises) 53 5 — Total 579 42 — DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) (5) *Nuisauces under the Public Health Actr:— Want of cleanliness 3 3 — - Want of ventilation 3 — — - Overcrowding — — — - Want of drainage of floors — 1 — - Other nuisances 21 13 — - Sanitary accommodation— insufficient 1 2 — - unsuitable or defective 34 35 — - not separate for sexes 2 1 — - Offences under the Factory and Workshop Acts:— Illegal occupation of underground bakehouse (s. 101) — — — - Other offences 4 4 - - (Excluding offences relating to out-work and offences under the Sections mentioned in the Schedule to the Ministry of Health (Factory and Workshops Transfer of Powers) Order, 1921) — Total 68 59 — — ♦Including those specified in sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under The Public Health Acts. 16 Shops Acts. A special inspector has been appointed to carry out the duties under the Shops Acts, cases requiring attention in connection with sanitary conveniences, hand-washing arrangements, ventilation and heating being referred to the Health Department for action if necessary. SECTION D. HOUSING. Although much time and thought have been expended in organising and reorganising the work of the inspectors, the duties of inspection of the district for the purpose of discovering dwellings which were wholly or in part unfit for human habitation were continued actively. Over 900 dwellings were inspected for housing defects, of which 12 were found to be so defective as to be incapable of being rendered fit for habitation at a reasonable expense. As in previous years, special attention was paid to basement dwellings, and of the 12 dwellings referred to above, 5 were basement and 7 were houses. Closing orders were made in reference to all the basement dwellings and demolition orders were made in respect of 6 of the houses represented. Seventeen houses, including those in connection with which demolition orders had been made during 1936, were demolished during the year under review. Overcrowding, judged by the standards or the Housing Act, 1936, has not existed in any part of the Borough to the extent that was found in many industrial towns, but still remains a definite problem. At the beginning of the year, 189 overcrowded dwellings were known to exist, involving 192 families, while in addition 17 other cases of legal overcrowding were found during the year. Of these, 12 families were rehoused so that at the end of the year 197 dwellings containing 197 families remained overcrowded. Following is a statistical summary of the housing work carried out during the year:— 1. Inspection of Dwelling-houses during the year:— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 931 (b) Number of inspections made for the purpose 1122 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded, under the Housing Consolidated Regulations, 1925 351 (b) Number of Inspections made for the purpose 468 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 12 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 685 2. Remedy of defects during the year without Service of formal Notices :— Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers. 550 3. Action under Statutory Powers , during the year :— A.— Proceedings under sections 9, 10 and 16 of the Housing Acts, 1936: (1) Number of dwelling-houses in respect of which notices were served requiring repairs 9 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners 38 (ib) By local authority in default of owners Nil B.— Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied , 10 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 12 (b) By local authority in default of owners Nil 17 C.— Proceedings under sections 11 and 13 of the Housing Act, 1936:— (1) Number of dwelling-houses in respect of which Demolition Orders were made 6 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 17 < D.—Proceedings under section 12 of the Housing Act, 1936:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made 6 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit 3 4. Housing Act, 1936. Part 5—Overcrowding. (a) (i) Number of dwellings overcrowded at the end of the year 194 (ii) Number of families dwelling therein 197 (b) Number of new cases of overcrowding reported during the year 17 (c) (i) Number of cases of overcrowding relieved during the year 12 SECTION E. INSPECTION AND SUPERVISION OF FOOD. Milk Supply. The enlargement of the Borough has not resulted in any increase in the register of persons keeping cows. Milk is pasteurised and bottled at one establishment, otherwise the greater part of the milk sold is prepared and bottled in large wholesale dairies outside the Borough. At the end of the year the following were registered:— Cowkeepers 2 Dairymen 26 Purveyors of Milk 82 It was found that the arrangements made for cleaning and sterilising bottles were unsatisfactory in three small dairies. On the attention of the dairymen being drawn to the contraventions of the order, one ceased to bottle milk and the remaining two installed satisfactory apparatus. The following licences for milk sold under special designation were in force during the year:— Tuberculin Tested Milk 22 Pasteurised 32 No application was received in reference to accredited milk. Meat and Other Foods. There are 85 butchers' shops in the enlarged Borough. These were kept under close supervision, 552 visits being paid for this purpose by the Sanitary Inspectors. Although there are 13 registered and 7 licensed slaughter-houses in the Borough, only 10 were in use during the year. Of the remainder, many have not been used for several years. Slaughtering has practically ceased in the area of the former Borough, but it has been actively carried on in Teddington and Hampton. As slaughtering takes place on Sundays as well as week-days and frequently late into the night, it has been necessary to organise a rota of the inspectors to deal with this arduous duty, which included the examination of more than 10,000 carcases of animals killed in the Borough during the year. 4 18 Details of the numbers examined and action taken are set out in the following table:— Beasts Calves Pigs Sheep and Lambs Number Killed 112 1389 6589 2407 Number Inspected 112 1389 6589 2407 All diseases except Tuberculosis— Whole carcases condemned — — 3 1 Carcases of which some part or organ was condemned 12 1 326 38 Percentage of the number inspected affected with disease other than Tuberculosis 10.71 0.07 4.99 1.62 Tuberculosis only— Whole carcases condemned 1 — 2 — Carcases of which some part or organ was condemned 21 13 209 — Percentage of the number inspecteda ffected with Tuberculosis 1.96 0.93 3.20 — There are a number of butchers' shops in which fixed glass windows have not been provided. The attention of the occupiers of each of these was drawn to the necessity of exercising special care to prevent contamination of the meat displayed, and in no case did it become necessary to take further action. Other places in which food was prepared or sold were kept under strict supervision the following visits being paid by the inspectors for this purpose Restaurants and eating-house kitchens and grocers' shops 683 visits. Greengrocers shops 371 visits. Fish shops 223 visits. SECTION F. PREVALENCE OF AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. I he number of cases of notifiable infectious disease which occurred during 1937 is spt out in the following table. The figures include the cases which occurred in the four constituent areas during the first three months of the year and those which occurred in the combined Borough during the remaining nine months. Disease Jan. Feb. Mar. April May June July Aug. Sept. Oct. Nov. Dec. Total Diphtheria 2 1 4 11 2 5 4 3 31 13 19 21 116 Scarlet Fever 17 7 17 10 16 5 7 6 14 13 16 20 148 Puerperal Fever 1 — 1 1 2 1 - 1 - - - - 7 Puerperal Pyrexia — 2 — - 1 - 1 - 2 - 1 - 7 Pneumonia— Primary 9 1 4 7 1 3 1 4 2 1 4 9 46 Pneumonia— Influenzal 15 3 2 - 1 1 - 1 - - 2 4 29 Ophthalmia Neonatorum 1 — 3 - 1 1 - - - - - - 6 Erysipelas — 3 2 3 4 — 2 1 1 3 2 5 26 Enteric Fever — — — — — — — — 2 — — — 2 Dysentery Polio- - - - - - - - - - - 2 - 2 Encephalitis — 1 - - - - - - - - - - 1 EncephalitisLethargica — 1 — - - - - - - - - - 1 19 Ages at Notification. Disease Under 1 1-2 2-3 3-4 4-5 5-10 10-15 15-20 20-25 25-35 35-45 45-65 Over 65, Admitted to Hospital Total Deaths Diphtheria — 1 3 4 5 62 23 4 4 6 4 — — 112 116 2 Scarlet Fever — 2 4 5 9 59 29 17 8 10 3 2 — 123 148 — Puerperal Fever — — — — — — — 1 2 3 1 — — 6 7 1 Puerperal Pyrexia — — — — — — — — 2 3 2 — — 4 7 — Pneumonia:— Primary 1 3 1 1 1 3 3 — 4 3 4 14 8 40 37 Influenzal — — 2 — 1 — — 2 1 4 4 9 6 29 Ophthalmia Neonatorum 6 - - - - - - - - - - - - - 6 — Erysipelas — — — — — — 1 — — 2 4 14 5 2 25 — Dysentery — - — - — 2 — — — — — — — — 2 — Enteric Fever — — — — — — — — — — — 1 1 1 2 1 Polio-Encephalitis - - - - - - - - - 1 - - - - 1 — Encephalitis- lethargica — — — — — — — — — — 1 — — — 1 — Scarlet Fever. The number of cases of scarlet fever (148) which occurred was slightly higher than that for the constitutent districts during the preceding year. The cases were distributed throughout the whole area, arid on the whole were of a mild type. No death occurred from this disease. Cases occurred during each month, the highest number (20) occurring during December. Immunization of children against this disease was not undertaken during the year. Diphtheria. The number of notifications (116) Was nearly double that of the preceding year for the four constitutent areas, when 68 cases were notified. Almost all the cases were admitted to the hospital of the joint Board at Isleworth. Two cases resulted fatally, making a case fatality rate of 1.7 per hundred cases notified. The cases occurred principally in the Teddington area of the Borough during the last four months of the year, the chief focus of infection being a Junior Mixed and Infant School. In addition to the usual measures of frequent inspection of classes and swabbing and exclusion of suspects, the opportunity was felt to be a favourable one to extend to Teddington the arrangements for immunisation against this disease which had been carried out in the area of the former Borough during the preceding three years. Immunisation was therefore offered to each child attending this school and accepted in almost every case. Arrangements were therefore made and immunisation was carried out at the school. This service was also carried out in another school in the affected area, and later in the year a regular weekly session of the Immunisation Clinic was instituted at the Stanley Road, Teddington, clinic, in addition to that already established at the York house, Twickenham, clinic. In consequence, two sessions of the Immunisation Clinic are held weekly, and the service is now available for the entire area of the Borough. The numerical records of persons tested or inoculated or both are set out below. It is gratifying to note that 1,275 persons were dealt with and that, of these, 881 received the first completed course of innoculations, the remainder being in course of treatment at the end of the year. New Cases Ages. 1 2 3 4 5 6 7 8 9 10 11 12 to 15 15 to 20 20 to 25 over 25 1275 100 67 78 91 161 162 157 103 98 106 51 63 4 4 30 20 lst Schick before Innoculation:— Number 130 Susceptible 77 Immune 39 Failed to attend 14 Number receiving first completed course of injections during year 881 2nd Schick Test of those who had completed first course of injections:— Number 220 Protected 203 Susceptible 5 Failed to attend 12 All those found to be incompletely protected after the second Post Schick were re-inoculated. Other Infectious Diseases. One case of paratyphoid and one case of typhoid fever were notified during September. In neither case was the infection contracted in Twickenham. One case proved fatal. One case of polio-encephalitis was notified in February, the patient being a woman 33 years of age, and a notification was received in reference to a case of encephalitis lethargica, in a female patient aged 37 years. The incidence of measles was slight and it was not found necessary to remove patients suffering from either measles or whooping cough to the Infectious Diseases Hospital for treatment. Two notifications of dysentery were received during November, the disease apparently being of bacillary type. No definite source of infection could be traced. Another case of this disease had been admitted to the West Middlesex Hospital from the Borough for treatment a short time previously. All three patients resided in the Whitton area, and on enquiry it was found that mild cases had occurred, but had not been of a sufficiently severe character to require medical attention, and, in consequence, had not been notified. Tuberculosis. Following is a table of the notifications of new cases of tuberculosis received during the year, with the ages at the time of notification and a table of the deaths which occurred as the result of tuberculosis, with the ages at which death occurred. Age Periods New Cases Deaths Pulmonary NonPulmonary v Pulmonary NonPulmonary M. F. M. F. M. F. M. F. Under 1 - - - - - - - 1 1—5 — — — 2 — — — 1 5—10 — 3 - 1 — — — 2 10—15 — 1 1 2 — — — 1 15—20 5 5 2 3 1 — 1 3 20—25 8 5 2 3 2 3 — - 25—35 9 9 3 1 6 5 — 1 35—45 14 5 — 1 o 6 — 2 45—55 9 2 1 — 7 2 — — 55—65 7 — — — 8 1 — — 65 and upwards 2 1 - 1 1 1 - - Totals 54 31 11 14 31 18 1 11 The treatment of cases of tuberculosis is carried out by Officers of the Middlesex County Council, but all cases residing in the Borough were visited at regular intervals by the Health Visitors of the Corporation.