TWI 7 BOROUGH OF TWICKENHAM. Annual Report OF THE MEDICAL OFFICER OF HEALT 1939 JOHN MADDISON, M.D., B.S., D.P.H. Medical Officer of Health. BOROUGH OF TWICKENHAM. PUBLIC HEALTH COMMITTEE CHAIRMAN: Councillor Mrs. N. K. Taylor, B.A. VICE-CHAIRMAN: Councillor Capt. D. D. Jones, M.C. The Mayor, Councillor Councillor C.H.Drake. A. C. Boucher, J.P. A.H.Handel-Dale. The Deputy Mayor, Alderman E. Ollie, J.P. " Capt.B.T.Harding. Alderman V. G. Heptinstall. " R.P.E.Howard-Hodges. " J. H. Knaggs, J.P. " the Rev.A.M.Johnson,M.A. Councillor Mrs.M.P.Bligh, B.Sc. " J.M.Johnson. " Mrs. H. M. Butlin. " G.J.Simmons. " W.A.Cooke. " E.G.Ure-Whyte. MATERNITY AND CHILD WELFARE COMMITTEE. CHAIRMAN: Councillor Mrs.M.P.Bligh, B.Sc. VICE-CHAIRMAN: Mrs.P.Walton. The Mayor, Councillor Councillor A.H.Handel-Dale. A.C.Boucher, J.P. " Capt.B.T.Harding. The Deputy Mayor, Alderman E.Ollic, J.P. " R.F.E.Howard-Hodges, derman V.G.Reptinstall. " the Rev.A.M.Johnson, M.A. " J.H.Knaggs, J.P. " J.M.Johnson. Councillor Mrs.H.M.Butlin, " Capt.D.D.Jones, M.C. " W.A.Cooke, " G.J.Simmons. " C. H, Drake. " Mrs.N.K.Taylor, B.A. " E.G.Ure-VVhyte. Co-opted members:-Mesdames F.E. Bloye, R.M.Butcher, D.I.Jones and N. M. Pearce. TOWN CLERK; EDWIN G.STRAY, Esq. 2 BOROUGH OF TWICKENHAM. STAFF OF THE PUBLIC HEALTH DEPARTMENT. MEDICAL MEDICAL OFFICER OF HEALTH: John Maddison, M.D.,B.S.,D.P.H. DEPUTY MEDICAL OFFICER OF John Young, M.B.,Ch.B.,D.P.H.'(Resigned HEALTH: July,1939). Charles B.Huss,M.R.C.S., L.R.C.P.,M.B.,B.S.,D.P.H. (Commenced August,1939). SENIOR ASSISTANT MEDICAL Dora F. Rose,M.A.,M.B.,Ch.B.,D.P.H. OFFICER OF HEALTH: ASSISTANT MEDICAL OFFICER Sarah Harris,M.B.,Ch.B.,B.A.O.,D.P.H. OF HEALTH: 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 SURGEONS: J.V.Bingay,.L.D.S.,R.C.S.(Senior),M.Cohn,L.D.S.,R.C.S. DENTAL NURSE: Mrs. Weller (e). DENTAL ATTENDANT: Miss M.White (Commenced June,1939). SANITARY INSPECTORS. L.Marsden (a) (b) (Senior),M.V.Sutcliffe (a) (b),W.K.Pickup (a)(b), R.R.Creasey(a)(b),C.W.Baxter(a)(b),H.G.Easter(a)(b). NURSING. HEALTH VISITORS; A.B.Pilkingtqn (c)(d)(e)(Principal),E.Dunkley(c) (d)(e)(Retired April, 1939), M.G.Hea(c)(c)(d)(e), E.M.Clarke (a)(ej(d),B.Garrett (c)(d)(e),A.M.S. Mathews (c)(d)(e),M.Blatchley(c)(d)(e),D.M. White(c)(d)(e),A.Corless(c)(d)(e)(commenced June, 1939.) SCHOOL NURSE: Laura Manning (e). MUNICIPAL MIDWIVES: E.M.Clark(c)(e),E.Jenkins (c)(e),A.E. MacNamara(c),B.Nash(c),D.A.Ponting(c),L.A. Ward (c),E.M.Caddington(c)(e)(commenced March, 1939). CLERICAL. Total.14. Two clerical assistants resigned during the year and were replaced, while two additional female assistants were engaged for the A.R.P.Casualty Service. (a) Certificate as Sanitary Inspector. (b) Certificate R.S.I. as Inspector of Meat and Other Foods. (c) S.C.M. (d) Health Visitor's Certificate. (e) Trained Nurse. 3 Public Health Department, Elmfield House, High Street, TEDDINGTON. To the MAYOR, ALDERMEN AND COUNCILLORS OF THE, BOROUGH OF TWICKENHAM. Ladies and Gentlemen, I have the honour to submit my Annual Report on the health and sanitary condition of the Borough during the year ended 31st December, 1939. The report is drawn up in accordance with. directions issued by the Ministry of Health, and is compiled as an ordinary report. I very much regret' the delay which has occurred in the preparation of this report; the work on it has had to be set aside from time to time on account of urgent and pressing duties brought about by the War. Points of interest in the report are the continued low death rate for the Borough as compared with the Country as a whole;the particularly gratifying low infant mortality rate;the drop in the incidence of diphtheria and scarlet fever as compared with last year; and the welcome increase in the number attending for diphtheria immunization. With the outbreak of war in September, the duties imposed, on the Department by reason of Civil Defence and numerous other matters have proved a heavy burden. I desire to acknowledge with grateful thanks the enormous,amount of work carried out by the staff of the Health Department,who have,at all times been most helpful,willing and loyal. I desire also to acknowledge with thanks the friendly co-operation and help which I have received from my colleagues in other Departments of the Corporation,and the members of the Council who have all been most,ready to assist. I am,Mr.Mayor,Ladies and Gentlemen, Your obedient servant, JOHN MADDISON. Medical Officer of Health. 4 STATISTICAL SUMMARY for the year 1939. Area in acres 7,007 Population (as extended-census 1931) 79,376 Population-estimated to mid-year,1939(a)98,580 (as supplied by the Registrar General) (b) 97,440 Number of inhabited houses(1939) 28,994 Rateable Value (31st December 1939) £1,033,397 Sum represented by a penny rate £3860-13s-ld Total M F Live births:(a) Legitimate 1340 683 657 Illegitimate 63 34 29 (c) Legitimate 1337 682 655 Illegitimate 63 34 29 Birth rate per 1,000 of estimated resident population 14.2 Total M F Still births: Legitimate 52 27 25 Illegitimate 3 2 1 Still birth rate per 1,000 total (live and still)births 37.7 Total M F Deaths: 1020 523 497 Crude death rate per 1,000 of estimated resident population 10.46 Adjusted death rate 10.35 Deaths from puerperal causes: Puerperal sepsis Nil Other puerperal causes 4 Rate per 1,000 total (live and still) births 2.7 Death rate of infants under one year of age:- All infants per 1,000 live births 26.4 Legitimate infants per 1,000 leg. live births 25.4 Illegitimate infants per 1,000 illeg. live births 47.6 Deaths from: Cancer (all ages) 152 Measles (all ages) 1 Whooping cough.(all ages) 7 Diarrhoea (under 2 years of age) 2 (a) For calculation of Birth Rate. (b) " " " Death Rate. (c) " " "Infantile and maternal Mortality Rates. 5 STATISTICS, SOCIAL CONDITIONS AND GENERAL PROVISION OF HEALTH SERVICES FOR AREA. POPULATION. The Registrar General's estimate of the population for the middle of the year 1939 is given as two separate figures,vis.98,580 which is used for the calculation of the birth rate,and 97,440 used for the calculation of death rate or the incidence of notifiable diseases. BIRTHS. The births registered in the borough in 1939 are also given in two forms,one for calculating the birth rate,the other for calculating infantile and maternal mortalities. Males Females Total ! (i) Calculation of birth rater:- Legitimate 683 657 1340 Illegitimate 34 29 63 Total 717 686 1403 (ii) Calculation of Infantile and Maternal Mortality rates:- Legitimate 682 655 1337 Illegitimate 34 29 63 Total 716 684 1400 The birth rate for the year was 14.2 per 1,000 of the population as compared with 15.0 for England and Wales. DEATHS The nett deaths registered in the borough during 1939 numbered 1020,and were made up as follows: males, 523; females 497. The crude death rate per 1,000 of the population for the year was lO.46,the adjusted death rate after use of the Registrar General's comparability factor being 10.35. The death rate for England and Wales was 12.1. 6 CAUSES OF DEATH, 1939. .Registrar General's Official Returns. Causes of Death. Males Females Total All causes 523 497 1020 1. Typhoid and paratyphoid fevers - — - 2. Measles 1 — 1 3. Scarlet Fever - - - 4. Whooping cough 4 3 7 5. Diphtheria 1 2 3 6. Influenza 15 11 26 7. Encephalitis lethargica 1 — 1 8. Cerebro-spinal fever - - - 9. Tuberculosis of respiratory system 36 24 60 10. Other tubercular diseases 2 5 7 11. Syphilis 2 1 3 12. General paralysis of the insane, tabes dorsalis 6 - 6 13. Cancer,malignant disease 77 75 152 14. Diabetes 5 10 15 15. Cerebral haemorrhage,etc. 16 22 38 16. Heart disease 134 160 294 17. Aneurysm 2 1 3 18. Other circulatory diseases 28 34 62 19. Bronchitis 8 10 18 20. Pneumonia (all forms) 19 14 33 21. Other respiratory diseases 6 2 8 22. Peptic ulcer 11 1 12 23. Diarrhoea,etc. (under 2 years) 2 — 2 24. Appendicitis 3 4 7 25. Cirrhosis of liver 2 - 2 26. Other diseases of the liver etc 1 5 6 27. Other digestive diseases 13 7 20 28. Acute and chronic nephritis 11 6 17 29. Puerperal sepsis - - - 30. Other puerperal causes - 4 4 31. Congenital debility,premature birth, Malformations,etc. 12 12 24 32. Senility 10 17 27 33. Suicide 10 6 16 34. Other violence 34 21 55 35. Other defined diseases 51 34 85 36. Causes ill-defined or unknown - - - 37. Diarrhoea,2 years and over - 6 6 MATERNAL MORTALITY. The number of deaths from puerperal causes during 1939 were as follows:- Puerperal sepsis Nil. Other puerperal causes 4. The maternal mortality rate per 1,000 total (live and ill)births was 2.7,compared with 2.82 for England and Wales. INFANTILE MORTALITY. The deaths of infants under one year of age during 39 numbered 37, producing an infantile mortality rate of 26.4 1,000 live births, as compared with 45.8 for the previous The exceptionally low figure is particularly gratifying. rate for England and Wales was 50. Congenital debility, premature birth, malformations, etc. caused 21 (or 64 percent.) of the total infant deaths. 7 BIRTH RATE,DEATH RATE AND ANALYSIS OF MORTALITY DURING 1939. Provisional figures. Rate per 1,000 total population. All causes Annual Death Rate per 1,000 population Rate per 1,000 live births. Live Birth3 Still Births Typhoid & paratyphoid fevers. Small pox Measles Scarlet Fever Whooping cough. Diphtheria. Influenza. Diarrhoea & Enteritis (under 2 years) Total deaths under 1 year. England & Wales 15.0 0.59 12.1 0.00 - 0.01 0.01 0.03 0.05 0.21 4.6 50 126 County Boroughs and great towns, including London. 14.8 0.59 12.0 0.00 - 0.01 0.00 0.03 0.05 0.19 6.3 53 14.8 smaller tcwns (resident popul- ations 25,000 to 50,000 at 1931 1 census) 15.6 0.57 11.2 0.00 - 0.01 0.00 0.02 0.04 0.20 3.0 40 London 12.3 0.44 11.9 0.00 - 0.00 0.00 0.03 0.02 0.18 8.2 48 TWICKENHAM 14.2 0.55 10.46 0.00 0.00 0.01 0.00 0.07 0.03 0.27 1.4 26.4 LABORATORY WORK. Specimens for bacteriological examination were sent to the Pathological Department,Royal Hospital, Richmond, and towards the latter part of the year to the Pathological Department, Victoria Hospital, Kingston-upon-Thames (Ministry of Health Emergency Pathology Service). The arrangements work smoothly and are quite satisfactory, The following table shows the number of specimens examined during the year:- Nature of Specimens. No. Result. Throat and nasal swabs for diphtheria 412 2 positive Sputum,etc. for tubercle bacilli 171 46 " Miscellaneous 5 Total specimens examined 588 AMBULANCE FACILITIES. Infectious diseases. A motor ambulance is provided by the South Middlesex and Richmond Joint Hospital Board. Non-infectious and accident cases. Four motor ambulances are provided by the Council. They are all stationed at Stanley Road Ambulance Station. The facilities are adequate for the needs of the Borough. The following table shows the work done in connection with the borough ambulances during the year 1939:- Year 1939. Total call's. Patients carried. Mileage. 1st quarter 315 292 2377.4 2nd " 309 303 2135.9 3rd " 249 232 1924.0 4th " 234 225 1976.8 1107 1052 8414.1 NURSING IN THE HOME. There are five home-nursing associations in the borough employing nurses- viz., Twickenham Nursing Association, Teddington and District Nursing Association, Hampton Nursing Association, Hampton Hill Nursing Association, and the Hampton Wick District Nursing Association. The Council contributed the total sum of £300 to the associations during the year. 9 CLINICS AND WELFARE CENTRES. The following clinics were being held within « the borough at the end of the year:- CLINICS. ADDRESS. BY WHOM PROVIDED. Infant Welfare Centres York House,Twickenham. Hospital Bridge Road, Twickenham. Art School,Teddington. Station Road, Hampton. Baptist Hall, Hampton Wick. Twickenham Council. Ante-Natal Clinics York House, Twickenham. Hospital Bridge Road, Twickenham. Art School, Teddington. Station Road, Hampton. Twickenham Council. School Clinics ! York House, Twickenham. Hospital Bridge Road, Twickenham. Stanley Road, Teddington. Middlesex County Council. Dental Clinics York House, Twickenham. Stanley Rd.,Teddington. Twickenham Council &Middx.County Cnl. Ophthalmic Clinics York House, Twickenham. Stanley Rd.,Teddington. Middlesex County Council. Diphtheria Immunization York House, Twickenham. Stanley Rd.,Teddington. Twickenham Council. Tuberculosis Dispensary 1, Staines Rd., Twickenham. Middlesex County Council, HOSPITALS. Smallpox. Arrangements for the provision of hospital accommodation are made by the Middlesex County Council. Tuberculosis. Residential institutional treatment is provided by the Middlesex County Council. Puerperal Pyrexia. Until the outbreak of war, cases requiring hospital treatment were sent to the Queen Charlotte's Hospital, Hammersmith. Subsequently, these facilities were not available. In the circumstances, representations were made to the South Middlesex and Richmond Joint Hospital Board for permission to send cases of puerperal pyrexia to Mogden Hospital. The Board agreed to take these cases, subject to the discretion of the Medical Superintendent. 10 Infectious diseases. Other cases of infectious diseases are admitted to the hospital of the South Middlesex and Richmond Joint Hospital Board. OTHER HOSPITALS. The following voluntary hospitals are situated within the borough:- St. John's Hospital, Twickenham, St. Mary's Hospital, Hampton, and the Teddington, Hampton Wick and District Memorial Hospital, Teddington. The total sum of £190 was contributed to these hospitals "by the Council during the year. 11 1 ' I MATERNITY& CHILD WELFARE. « * mm mm mm mm mm — mm mm mmmm**» mm mm MIDWIFERY AND MATERNITY SERVICES. The total number of births which were notified as occurring in the borough was 818; this does not include births which occurred elsewhere, but which were subsequentlytransferred to Twickenham. Of the births occurring in the borough, 457 (55.87%) were attended by midwives in their capacity as midwivei and 361 (44.13%) by doctors. Five hundred and twenty-four births (64.057%) were attended by midwives employed by the borough - 409 in their capacity as midwives and 115 as maternity nurses with a doctor in charge of the case. MIDWIVES ACTS. When the Corporation established a service of municipal midwives in May, 1938, six whole-time municipal midwives were appointed. In March, 1939? an additional midwife was appointed, bringing the total to 7. CARE OF EXPECTANT MOTHERS. The number of sessions devoted to this work were York House Centre One weekly session. Whitton Centre Two weekly sessions. Teddington Centre One weekly session. Hampton Centre One session first and third week of each month. Although the total attendances at ante-natal clinics show a reduction on the previous year, the number of mothers who availed themselves of the advice offered show a large increase on previous years Attendances Total Year. for first time. attendances. 1937 607 1987 1938 638 2406 1939 720 2191 A large part of this increase is due to the work of the Council's Municipal Midwives. Arrangements for dental treatment for expectant and nursing mothers in the borough were continued during the year. Milk and other foods were supplied to expectant mothers for whom special treatment was considered necessary. To necessitous applicants, no charge was made for these supplies No request for the services of a consultant was -made during the year. 12 BIRTH CONTR0L. No "birth control clinic is held in the borough, but women for whom pregnancy is inadvisable for medical reasons are referred to the birth control clinic at Hounslow for the necessary advice, etc. CARE OF MOTHERS DURING CONFINEMENT. The Corporation have not established a Maternity Home and have no formal agreement with any hospital for the reception of complicated or difficult cases. Cases of this nature are referred to the West Middlesex County Hospital. SUBSEQUENT TO CONFINEMENT. Eight cases of puerperal pyrexia occurred during the year and of these four patients were admitted to hospital two to Queen Charlotte's Maternity Hospital, two to West Middlesex County Hospital-and the other four patients were treated at home. All the patients recovered. No application was received during the year for the services of a consultant.in cases of puerperal pyrexia. Post-natal care is carried out at the Ante-Natal clinics, and mothers are urged to attend.' The numbers attending are still not large but show an appreciable increase; 98 post-natal patients attended at Ante-natal and Infant Welfare sessions as against 21 in 1938? an<i this increase must lie largely credited to the persuasion of the midwives and Health Visitors. No maternal deaths occurred in the borough. DENTAL TREATMENT. The following received dental treatment during the year:- Expectant Mothers 58 Nursing Mothers 43 Patients supplied With dentures 32 Dentures supplied 58 HEALTH VISITORS. No change took Place in the number (8) of the Council's Health Visitors who also carry out the duties of school nurses on behalf of the Middlesex County Council. Their visits included the following:- To expectant mothers 375 To children under 1'year of age 4,179 To children between the ages of 1 and 5 years 6,258 In addition, visits were paid in reference to children of school age on account of suspected infectious disease and for folloviwing up those recommended for medical treatment or observation. The Health Visitors also attended as required at minor ailment and dental clinics. > 13 WINTER SCHOOL. The Winter School for Health Visitors and School Nurses has been discontinued owing to the war. INFANT WELFARE CLINICS. There are five Infant Welfare Clinics; ten sessions for infant consultation are held weekly. The total attendances of children at the various sessions during the year numbered24,418. The figures for each session are set out below:- 1939 New cases York House Centre Whitton Centre. Teddington Centre. Hampt on Centre. Hampton Wick Centre. Totals. Under 1 yr. 285 439 202 — 138 74 1138 1-5 yrs 73 127 87 87 40 414 Mothers 5 15 44 8 6 78 Total attendances. Under 1 yr. 3419 6446 2358 1974 1105 15302 1-5 yrs 1405 4011 1617 1564 436 9033 Mothers 5 15 49 8 6 83 Total attendances 4829 10472 4024 3546 1547 244l8 DENTAL TREATMENT OF CHILDREN UNDER 5 YEARS. During the year, 110 children under 5 years of age received completed dental treatment. MILK_0THER_F00DS,ETC. During the year, 1715 applications for assisted supplies of milk and other foods were granted in necessitous cases and supplied free of charge. The total quantity'of milk supplied was as follows:- Liquid milk 6,020¾ ga11s. (Supplied to applicants free of charge) Dried Milk 15,524 lbs. CHILD LIFE PROTECTION. There have "been a few instances where fostermothers have failed to send proper notice of reception or removal of a foster-child. No proceedings were authorised respect of these contraventions but in every instance a warning letter was sent. All the Health Visitors are appointed Child Protection Visitors and the visits of supervision of fosterchildren are carried out by them. Details as to registration during 1939 were:- Number of persons who were receiving children for reward at the end of the year 60 Number of children on register at the end of the year 94 Number of children who died during the year 2 14 I ■ ORTHOPAEDIC TREATMENT. No formal arrangement has he en made in The borough for the treatment of children requiring massaje, orthopaedic treatment or remedial exercises and cases are referred to the West Middlesex County Hospital or other hospitals able to undertake the treatment of such cases. Towards the end of the year, the Middlesex County Council prepared a scheme for the treatment of orthopaedic defects in school children. Under this scheme, children would be seen and treated at a local clinic and, if necessary, referred to the Royal National Orthopaedic Hospital. It was arranged that this service should be available for children under 5 years of age hut owing to the War, this scheme has not been put into operation. Assistance was granted towards the cost of maintenance of two children at convalescent homes during the year and towards the. cost of a special shoe in another case. NURSING HOMES. There were 11 private nursing homes in the borough, all of which Were registered; one was removed from the register during the year on account of the ill health of the proprietress. The proprietress of another home which was registered for both maternity and chronic patients was required to surrender her midwifery certificate; this home therefore no longer takes maternity patients. In December 1939 the Bearsted Memorial Hospital removed from the East End of London to the Hampton Court Hotel, for the duration of the War. The hospital has since been granted exemption from registration. The "Children's Rest" Convalescent Home which was exempted from registration was closed for the duration of the War. The three voluntary hospitals which receive privat patients are exempted from registration. Allthe homes were kept under periodic supervision throughout the year. Special watch is kept on the advertisement columns of the local press etc. with a view to the discovery of unregistered Homes. 15 . " SANITARY ADMINISTRATION. WATER SUPPLY. The Metropolitan Water Board maintained a constant and satisfactory water supply throughout the Borough. There are very few wells, practically every house deriving its water supply from that of the Board. DRAINAGE' AND SEWERAGE. The works necessary to disconnect the sewage from Kingston-on-Thames, where it had been conveyed and treated for many years, and connect it to the Mogden Scheme of the Middlesex County Council were completed. Similar works for dealing with the Hampton area having also been completed, the whole sewage system of the Borough now connects with the Mogden Disposal Works. RIVERS AND STREAMS. No complaints regarding the pollution of the river Thames or streams were received "by the Department during the year. PUBLIC CLEANSING. The scheme submitted to the Ministry of Health for an enlarged destructor did not receive approval and the work proposed was not proceeded with. The arrangements for the disposal of house refuse must, therefore, be regarded as •? /-> mkk m •!- SANITARY INSPECTION OP DISTRICT. During the year three Sanitary Inspectors were at one time or another engaged on Air Raid Precautions work. Despite the resulting disorganisation, every effort was made to keep the essential work under regular supervision. The visits paid in respect of each branch of the work are set out under the appropriate headings. Notices served. Informal notices served 575 Informal notices complied 535 Statutory notices served 20 Statutory notices complied 23 Summary of visits and inspections. Visits to premises after complaint 933 Visits after occurence of infectious disease 347 Visits under Housing Acts 155 Total visits and inspections 15,262 16 Summary of works executed in consequence of visits. Drains unstopped and repaired 60 Waste pipes disconnected or repaired 22 Soil pipes provided 02? repaired 11 Complete drainage reconstructions 5 Water supply cisterns repaired 4 Draw taps from main provided 34 C-utters repaired.99 Roofs repaired 210 W.C. apartments repaired or rebuilt 34 W.0.s. repaired 85 Dustbins provided 133 Damp walls remedied 239 Ventilation provided 26 Yards paved or repaired 41 Rooms stripped and cleansed 244 Offensive accumulations removed 37 Other works carried out 1161 SMOKE ABATEMENT. Very few complaints regarding smoke nuisances were received during the year, but thorough investigation by a Sanitary Inspector was made in each case. It was not found necessary to talc© statutory action under the Public Health Act. SWIMMING BATHS AND FOOLS. In accordance with the usual practice regular inspection was made of the swimming baths during the summer season and samples of water taken for bacteriological examination. ERADICATION OP BED BUGS. (1) Number of Council houses (a) Pound to be infested 3 (b) Disinfested 3 (2) Number of other houses (a) Pound to be infested 17 (b) Disinfested 17 The methods of disinfestation employed were aet out in previous reports. .During the year under review the insecticide solutions used were "Keritox" and "Zaldeeide". No application was received from the Housing Department with regard to the disinfestation of the "belongings of persons before their removal to Council hovjes. COMMON LODGING-HOUSE. There i§ 0^9 Option Lodging-house situated Within tho Borough. Duy&ng YPP-T the premises were kept satisfactorily and The registration was renewed. SCHOOLS. There are in the Borough 26 elementary schools, three secondary schools, and a technical college. Thes.e are regularly visited by the Sanitary Inspectors. No action was necessary with regard to the closure of any of the schools on account of infectious disease among the children. OFFENSIVE TRADES. During the year the Council had under consideration the question of the Order made under the Public Health Acts (Amendment) Act, 1907 so far as the trade of fish frying was concerned. Section 107 (l) of the Public Health Act, 1936, provides that any Order in force immediately before the commencement of the Act (1st October, 1937) declaring the trade or business of fish frying to be an offensive trade shall, at the expiration of three years from that date, cease to have effect, without prejudice, however, to the making and confirmation of a new Order. The Council decided to communicate with the Minister of Health enquiring whether he would he prepared to confirm a new Order declaring the above to be an offensive trade in the Borough. Having regard to the nature of the Minister's reply, the Council called for a full report on the matter, and this was being prepared at the end of the year. PETROLEUM (REGULATION) ACTS, 1928 & 1936. Petroleum spirit and carbide of calcium stores were, as usual, kept under supervision.by the Sanitary Inspectors. Licences were issued in respect of 127 premises during the year. Of these, 6 were for the storage of petrol in cans, 17 for the storage of petrol in tanks and a small supply in cans, the remainder' being for storage in underground tanks. The number of visits paid by the Inspectors was 211. SHOPS ACT, 1934- The relevant provisions of the above Act with regard to sanitary conveniences etc., are carried out by the Health Department. RATS AND MICE (DESTRUCTION) ACT, 1919. The Middlesex County Council are responsible for the administration of the above Act in the Borough. All complaints and enquiries regarding rat infestation received by the Department are sent to the Superintendent of Rat Destruction, County Offices, Great West Road, Brentford. 18 1 * FACTORIES ACT, 1937. Inspections for purposes of provisions as to health. Inspections. Written Notices. Factories with mechanical power 204 16 Factories without mechanical power 137 1 Other premises under the Act 25 - Total 366 17 Summary of defects found. Found. Remedied. Want of cleanliness 5 5 Sanitary conveniences:Insufficient 2 1 Unsuitable or defective 18 19 Not separate for sexes Other offences 3 2 Total 28 27 ESTABLISHMENTS FOR MASSAGE OR SPECIAL TREATMENT. The following applications in respect of establishments for massage or special treatment were granted during the year:- Chiropody 3 Chiropody and massage 3 HAIRDRESSERS' AND BARBERS' PREMISES. A register is being compiled of all Hairdressers' and Barbers' Premises in the Borough and regular inspection is made to ensure the required standard of cleanliness being maintained in conformity with the Byelaws. MIDDLESEX COUNTY COUNCIL (GENERAL POWERS) ACT, 1938. Sections 60 (parents etc. to Notify certain Diseases), 61 (Restrictions on attendance at Schools and places of Assembly), 70 (Notice of Slaughter of Animal Unfit for Food) and 71 (Registration of Hawkers of Meat, Fish, Fruit and Vegetables and Premises) which had been adopted by the Corporation came into operation 01a the 15th February, 1939. At the end of the year twelve persons and twelve premises had been registered under Section 71. HOUSING. It had been my earnest hope that during the year, it would have been possible to commence a drive in connection with the clearing of insanitary dwellings. In the early part of the year I suggested to the Council that consideration should be given to the advisability of dealing with some six insanitary and unhealthy areas. The Borough Engineer and Surveyor was instructed to define the areas on maps, and the 19 I I Borough Treasurer to prepare the necessary report from the financial aspect. A Sub-Committee was also appointed to inspect the areas. With the deterioration of the international situation and the consequent speeding-up of work on Air Raid Precautions, however, progress was impeded. Following the outbreak of war the Minister of Health issued circular No. 1866-"Housing Acts-Postponement of Work" -which was virtually a "stand-still" order so far as Clearance Areas were concerned. Consideration of this matter will, therefore, have to remain in abeyance until after the war. Despite the difficulties experienced owing to the Inspectorial staff being engaged, from time to time, on other duties, every effort was made to carry out inspections under this heading. One noteworthy point was the reinspection of the whole of the cases of overcrowding on the files of the Department, and the result is shown in the figures appearing in the following statistical table. Statistics, 1959. 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) 781 (b) Number of inspections made for the purpose 937 (2) (a) Number of dwelling houses (included under sub-head (l) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 155 (b) Number of inspections made for the purpose 232 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habit- ation 11 (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 575 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 535 3. Action under statutory powers during the year. A. - Proceedings under sections 9, 10 and 16 of the Housing Act,, 1936:- (1) Number of dwelling houses in respect of which notices were served requiring repairs. 15 (2) Number of dwelling houses which were rendered fit after service of formal notices:- (a) By owners 11 (b) By local authority in default of owners 2 20 I I I B.- Proceedings under Public Health Acts:- (1) Number of dwelling houses in respect of which notices were served requiring defects to "be remedied 5 (2) Number of dwelling houses in which defects were remedied after service of formal notices:- (a) By owners 10 ("b) By local authority in default of owners Nil. 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 9 (2) Number of dwelling houses demolished in pursuance of Demolition Orders 12 D.- Proceedings under section 12 of the Housing Act, 1936:- (1) Number of separate tenements of underground rooms in respect of which Closing Orders were made 1 (2) Number of separate tenements or underground rooms in. respect of which Closing Orders were determined, the tenement or room having "been rendered fit Nil. 4. Housing Act, 1936; Part 5 - Overcrowding. (a) (i) Number of dwellings overcrowded at the' ' end of the year 56 (ii) Number of families dwelling therein 56 (iii) Number of persons dwelling therein 415½ (b) Number of hew cases of overcrowding reported during the year 8 (c) (i) Number of cases of 'overcrowding relieved during the year 143 (ii) Number of persons concerned in such cases 793 INSPECTION AND SUPERVISION OP POOD. Milk Supply. During the year, 191 visits were made "by the Sanitary Inspectors to dairies, cowsheds and milkshops within the Borough. Milk (Special Designations) Orders, 1936 & 1938. The following applications for sale of designated milk were granted during the year:- "Tuberculin tested" milk . 17 Accredited 1 "Pasteurised" milk 29 Meat and Other Poods. During the year, 10,527 animals were slaughtered for human consumption within the Borough, every one of which was inspected by the Sanitary Inspectors. This work entails very long and irregular hours, and constant watchfulness is necessary to ensure to the inhabitants a pure and wholesome food supply. 21 1939 UNSOUND MEAT Total Beasts Cows Calves Pigs Sheep No. killed 10327 245 20 1549 5652 3053 No. inspected. 10527 245 28 1549 5652 3053 ALL DISEASES EXCEPT TUBERCULOSIS Whole carcases condorned - -- -- - 5 - Carcases of which some part or organ was condemned -- 32 6 3 405 66 Percentage of number inspected affected with disease other than Tuberculosis - 13.06 21.43 0.194 7.25 2.16 TUBERCULOSIS ONLY. whole carcases condemned - 4 1 • 1 1 - Carcases of which some part or organ was condoned 34 7 . 12 142 - Percentage of number inspected affected with Tuberculosis 15051 28.57 . 0.84 2.52 - Other foods inspected and found unfit for human consumption. 257 Rabbits. 6 stones God Fillets. 14 lbs. Smoked Fillets. 28 lbs. Whiting. ½ case of Eggs. During the year,the following visits were also made to premises upon which food is prepared or sold:- Butchers' shops 403 Restaurants and eating-house kitchens; grocers' shops 389 Greengrocers' shops 146 Fish shops 95 * 1 FOOD AND DRUGS ACT, 1938. The Food and Drugs Act, 1938, came into operation on the 1st October, 1939. The law relating to Food and Drugs (including milk and dairies) slaughterhouses and local authorities market undertakings is consolidated, amended and simplified in some respects; other miscellaneous provisions have been included and a few powers which have been found to be advantageous but have hitherto only been obtained by individual authorities have been made general, 22 Under previous legislation, the Middlesex County Council were the food and Drugs Authority before the Act came into operation, application was made by them to the Minister of Health for Power to continue as the Authority under the new Act in all the areas formerly served The Public Health Committee were of the opinion that it was desirable that the Twickenham Corporation should, be a Pood and Drugs Authority under the Act and objection. to the Middlesex County Council s proposal were accordingly made. After careful consideration of the evidence placed before him, however, the Minister of Health acceded to the application of the Middlesex County Council to continue as one Pood and Drugs Authority in areas formerly served by them. ARTIFICIAL CREAM ACT, 1929. PUBLIC HEALTH (CONDENSED MILK) REGULATIONS, 1923 AND 1927. . PUBLIC HEALTH (DRIED MILK) REGULATIONS, 1923 AND 1927. ' ; ' PUBLIC HEALTH (PRESERVATIVES, ETC., IN POOD) REGULATIONS, 1925 AND 1927. The administration of the whole of the above is carried out by the Middlesex County Council. 23 INFECTIOUS DISEASES. (a) NOTIFIABLE INFECTIOUS DISEASES. Diphtheria. There were 25 cases of diphtheria notified as compared with 70 for the previous year. 22+ cases were admitted to hospital. The number of deaths recorded was three, giving a death rate of 0.03 per 1,000 of the population. The figure for England and Wales was 0.05. Supuly of anti-toxin. All medical practitioners practising in the "borough may at any time obtain a supply of diphtheria anti-toxin from the fire stations at Twickenham or Teddington, free of charge. Di-phtheria immunization. The following is a record of the work carried out at the clinics during the year:- New Oases. Ages 1 2 3 4 5 6 7 8 9 10 11 12 to 15 15 to 20 20 to 25 Over 25 731 218 58 49 61 84 89 60 55 22 14 8 8 1 - 4 , 1st Schick Test before inoculation:- Number 20 Susceptible 4 Immune 10 Failed to attend 6 Number receiving first completed course of injections during the year 711 2nd Schick Test of those who had completed first course of injections;- Number 500 Protected 437 Susceptible 9 Failed to attend 54 All those found to be incompletely protected after the second Post Schick were re-inoculated. The diphtheria prophylactics used were A.P.T. and T.A.F. Scarlet Fever. There were 93 cases of scarlet fever notified during the year as compared with 272+ for the previous year. No deaths were recorded from this disease. The death rate for England and Wales was 0,01 per 1,000 of the population. Smallpox. No case of smallpox was notified during the year. 24 Pneumonia, Malaria and. Dysentery. Pneumonia. There were 72 cases of pneumonia notified as compared with 68 for the previous year. The number of deaths recorded from this disease was 33. Malaria. No case of malaria was notified during the year. Dysentery. No case of dysentery was notified during the year. Acute Poliomyelitis, Acute Polio-encephalitis. No cases of acute poliomyelitis or acute polioencephalitis were notified during the year. Ophthalmia Neonatorum. The following table shows the number of cases notified and result of treatment:- Year Cases notfd. Cases Treated ' Vision Unimpaired. Vision impaired. Total Blindness . Deaths. At home In hosp 1939 7 7 Nil 7 . - - - Puerperal Pyrexia. The Puerperal Pyrexia Regulations 1939 came into force on the 1st April, 1939, and superseded the Public Health (Notification of Puerperal Fever and Puerperal Pyrexia) Regulations, 1926 and 1928. Eight cases of puerperal pyrexia were notified during the year. Two were treated in the West Middlesex County Hospital and two in Queen Charlotte's Maternity Hospital. There were no deaths. Enteric Fever. Two cases of paratyphoid were notified, one of which was admitted to Hospital. No deaths from this disease were recorded during the year. Measles and Whooping; Cough. The Measles and Whooping Cough Regulations 1939 came into operation in October, 1939, and provided for the notification of all cases of measles and whooping cough by medical practitioners to Medical Officers of Health. Since the Regulations came into force, only two cases of whooping cough were notified. The deaths from measles and whooping cough during the year were one and seven respectively. (b) NON-NOTIFIABLE INFECTIOUS DISEASES. Diseases under this heading include chicken-pox, mumps and, up to October, 1939, measles and whooping cough. The number of cases thought to be suffering from these diseases brought to our notice by the Head Teachers during the year were as follows:- Chicken-pox 66 Measles 17 Mumps 3 Who oping cough 102 25 - 26 - DISEASE CASES NOTIFIED AT VARIOUS AGES (YEARS). Total Cases Notfd. I Gases admtd to Hosp. Total Deaths. Under 1 1-2 2-3 i 3~4 i 4-5 5-10 10-15 15-20 20-25 25-35 35-45 45-65 Over 65 Scarlet Fever -- 4 4 3 5 45 11 5 4 7 4 1 - 93 62 — Diphtheria - 1 3 3 1 7 4 2 i — 2 2 - - 25 24 3 Pneumonia Primary 1 - 1 1 3 8 2 3 1 6 8 14 8 56 5 33 Influenzal - - 1 - - - - 1 1 - 4 4 5 16 - Faratyphoid - - - - - 2 - - - - - 2 1 - Ophthalmia Neonatorum 7 - - - - - - - - - - - - 7 - - Puerperal Pyrexia. - - - - - - - - 1 7 - - - 8 4 - Erysipelas - - - * - - - 1 - - 1 7 7 9 5 23 2 Whooping Cough 1 - - 1 - - - - - - - - 2 - 7 27 MONTHLY INCIDENCE OP INFECTIOUS DISEASES DISEASES THE YEAR 1939 DISEASE NUMBER OP CASES- TOTAL ! Jan Feb Mar Apl May June July Aug j Sept Oct Nov Dec Scarlet Fever 16 7 3 12 9 12 r ,, , 16 6 7 2 1 2 93 Diphtheria 4 1 - 2 1 4 4 3 1 2 2 1 - 25 Pneumonia Primary 9 15 3 ' 8 6 1 - 3 3 1 - 3 - Influenzal 1 7 5 2 - l 1 - - - - 15 Ophthalmia Heohatorum — 1 2 - 2 1 - - 1 7 Puerperal Pyrexia 1 - 1 - 1 1 1 2 1 - 8 Erysipelas 6 • 1 1 4 l - 2 1 3 2 - 2 23 Paratyphoid - - - - 2 - - - - 2 Whooping Cough — - - - - - - - - - 2 - 2 I TUBERCULOSIS. The number of new cases of tuberculosis notified during 1939 was slightly lower than the previous year, while the number of deaths showed an increase. The following table prepared from the records in the Department summarises the position. NEW CASES AND MORTALITY. 1939. Age Periods. New Cases Deaths. Pulmonary NonPulmonary Pulmonary NonPulmonary M F M F M F M F Under 1 - - - - - - - 1 1-5 2 3 2 - - . 1 1 1 5-10 2 2 3 - - - 10 - 15 2 3 - - 1 - 1 1 15 - 20 3 3 - 5 3 1 1 - 20 - 25 6 7 1 2 4 6 1 - 25 - 35 12 16 1 2 5 5 - - 35 - 45 10 6 - - 4 4 - - 45 - 55 8 4 - 1 8 2 - 1 55 - 65 10 5 - 1 10 - - 65 and upwards 1 1 1 - 1 4 - Totals 56 50 .8 11 36 23 3 4 Public Health (Prevention of Tuberculosis) Regulations. 1925. During the year under review it was not found necessary to take action under the above Regulations with reference to persons suffering from tuberculosis and employed in the milk trade. Public Health Act, 1936 (Section 172). This section of the Public Health Act is concerned with the compulsory removal to hospital of persons suffering from tuberculosis. It was not found necessary to exercise our powers thereunder during the year. PREVENTION OF BLINDNESS. No action was taken during the year under section 176 of the Public Health Act, 1936, for the prevention of blindness or for the treatment of persons suffering from any disease or injury to the eyes. 28 INDEX Page Ambulance Facilities Ante-Natal Clinics 10, 12 Anti-toxin, Supply of 24 Artificial Cream Act, 1929 23 Births 6, 12 Birth Contro Blindness, Prevention of 28 Care of Mothers during Confinement 13 Care of Mothers subsequent' to Confinement 13 Child Life Protection 14 Common Lodging House 17 Deaths 6,7 Dental Clinics 10 Dental Treatment 13,14 Diphtheria 24 Diphtheria, Immunization Disinfestation 17 Drainage and Sewerage 16 Dysentery 25 Enteric Fever 25 Factories Act, 1937 19 Food, Inspection and Supervision of 21, 22, 23 Food and Drugs Act, 1938 22 Hairdressers 'and Barbers' Premises 19 Health Visiting 13 Hospitals 10, 11 Housing 19, 20 Infantile Mortality 7 Infant Welfare Clinics 10, 14 Infectious Diseases 10, 24, 25, 26, 27 Isolation Hospital Accommodation 11 Laboratory Work 9 kalaria Massage or Special Treatment, Establishments for' 19 Maternity and Child Welfare Committee 2 Maternal Mortality 7 measles 25 Middlesex County Council (General Powers) Act 1938 19 Midlives Acts, Administration of 12 Milk and Other Foods, etc, Provision of 14 Milk Supply 21 Nursing Associations 9 Nursing Homes 15 offensive Trades 18 Ophthalmia Neonatorum 25 Ophthalmic Clinics 10 Orthopaedic Treatment 15 Petroleum (Regulation) Acts 18 Pneumonia 25 Poliomyelitis Polio-encephalitis 25 Population 6 Public Cleansing 16 INDEX - continued Page Public Health Committee 2 Public Health (Condensed Milk) Regulations 23 Public Health (Dried Milk) Regulations Public Health (Preservatives, etc, in Pood) Regulations 23 Puerperal Pyrexia 10, 25 Rats and Mice (Destruction) Act Rivers and Streams 16 ' Sanitary Inspection of District 16 Scarlet Fever 24 Schools 18 School Clinics 10 Shops Acts 18 Slaughtering of Animals 21 Smallpox 10,24 Smoke Abatement 17 Staff 3 Statistics, General and Vital 5, 8 Swimming Baths and Pools 17 Tuberculosis 10, 20 Unsound Pood 22 Water Supply 16 Whooping Cough 25 Winter School for Health Visitors 14