TWI 8 BOROUGH OF TWICKENHAM Annual Report OF THE MEDICAL OFFICER OP HEALTH \ 1940 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, Alderman Councillor C.H. Drake. A.G. Greig, J.P. „ A.H.Handel-Dale. The Deputy Mayor, Councillor A^C.Boucher,J.P. „ Capt.B.T.Harding. Alderman V.G. Heptinstall. „ R.F.E.Howard-Hodges J.H. Knaggs, J.P. „ the Rev.A.M. Johnson, M.A. Councillor Mrs.M.F.Bligh, B.Sc., „ J.M.Johnson. Mrs.H.M.Butlin. „ G.J.Simmons. VV.A. Cooke . „ E.G.Ure-Whyte. MATERNITY AND CHILD WELFARE COMMITTEE. CHAIRMAN: Councillor Mrs. M.F.Bligh, B.Sc., VICE-CHAIRMAN: Mrs. F. Walton The Mayor, Alderman Councillor A.H.Handel-Dale. A.G.Greig, J.P. „ Capt.B.T.Harding. The Deputy Mayor, Councillor A.C.Boucher, J.P. „ R.F.E.Howard-Hodges Alderman V.G.Heptinstall. „ 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-Whyte. i '(•/* • _ ; ;• • i . Co-opted members:- Mesdames F.E.Bloye, R.M.Butcher, D.I.Jones and N.M.Pearce. TOWN CLERK: EDWIN G.STAY, Esq 2 Public Health Department, Elmfield House, High Street, TEDDITGTON. To the MAYOR, ALDERMEN A1TD COUNCILLORS OP THE BOROUGH OP 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 19^-0. 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. The general death rate reported is higher than in 1939 because of the inclusion of deaths due to enemy action during the period of raiding which began at the end of August and continued throughout the remainder of the year. The death rate of infants under one year of age also rose from 26.14 in 1939 to in 1940. The birth rate per 1,000 of estimated resident population was only slightly less than in 1939; the maternal, death rate from pu1.4. Diseases of the heart and blood vessels and cancer continued as causes of the greatest number of deaths. There was a sharp drop in the nuraber of cases of scarlet fever and diphtheria. There was an epidemic of measles rising to a peak in October; 956 cases were notified throughout the year. In spite of the dislocation in the normal routine work of the Department and" the additional and extraneous duties during the raiding period, the volume of work achieved during the year was only a little less than in 1939. In the Maternity and Child Welfare,'School Medical and Sanitary Sections the work continued almost up to normal level. The burden of fork on the staff during some of those months was a heavy one and I desire to acknowledge with many thanks the loyalty of the staff who were most helpful and willing. I desire also to acknowledge with thanks the friendly co-operation and help which I received from my colleagues in other Departments of the Corporation and the members of the Council. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, . JOHN MADDISON. Medical Officer Of Health. STATISTICAL SUMMARY for the year 1940 Area in acres 7,007 Population - estimated, to mid-year, 1940 (as supplied by the Registrar General) 94,070 Number of inhabited houses (1940) 23,736 Rateable Value (31st December 1940) £1,034,930 Sum represented by a penny rate £4,005.3.2. Total M F Live births: (a) Legitimate 1322 672 650 Illegitimate 58 22 36 (b) Legitimate 1316 670 646 Illegitimate 59 22 37 Birth rate per 1,000 of estimated resident population 14.67 Total M F Still births: (a) Legitimate 51 27 24 Illegitimate - - - (b) Legitimate 48 27 21 Illegitimate - - - Still birth rate per 1,000 total (live and still) births 35.6 Total M P Deaths: 1395 701 694 Crude death rate per 1,000 of estimated resident population 14.8 Adjusted death rate 14.9 Maternal Deaths: Puerperal & Post-Abortive Sepsis 1 Other Maternal Causes. 1 Rate per 1,000 total (live and still) births 1.4 Death rate of infants under one year of age:- All infants per 1,000 live births 45.8 Legitimate infants per 1,000 leg. live births. 44.8 Illegitimate infants per 1,000 illeg. live births 67.79 Deaths from: Cancer (all ages) 169 Measles (all ages) 2 Whooping cough (all ages) - Diarrhoea (under 2 years of age) 10 (a) For calculation of Birth Rate, (b) For calculation of Infantile and Maternal Mortality Rates. 4 STATISTICS, social conditions and general provision ' op health services por area. BIRTHS. The births registered in the "borough in 1940 are given in two forms, one for calculating the birth rate, the other for calculating infantile and maternal mortalities. Mal.es Females Total (i) Calculation of birth rate:- • Legitimate 672 650 1322 Illegitimate 22 36 58 Total 636 13.80 - (ii) Calculating of Infantile and Maternal Mortality rates. Legitimate. 670 646 1316 Illegitimate 22 37 59 Total. 692 683 1375 T The birth rate for the year was 14.67 per 1,000 of the population as compared with 14.6 for England and Wales. DEATHS The nett deaths registered in the borough during 1940 were Males 701 Females 694 Total 1395 The crude death rate per 1,000 of the population for the year was 14.8 and the adjusted death rate after use of the Registrar General's comparability factor was 14.9. The death rate for England and Wales was 14.3. The figures, for 1939 were 10.46, 10.35 and 12.1 respectively. The rise in the number of deaths was mainly due to heart disease, intra-cranial vascular lesions, bronchitis, pneumonia and violence. The latter includes deaths from enemy action. The severe spell of cold weather experienced during the year, together with changed modes of living may have contributed to the increase. 5 CAUSES OF DEATH 19*40 Registrar General's Official Returns Causes of Death Males Females Total AllCauses. 701 694 1395 1. Typhoid and paratyphoid fevers — 2. Gerebro-spinal Fever. 3 2 5 3. Scarlet Fever — - - 4. Whooping Cough - - - 5- Diphtheria 1 2 3 6. Tuberculosis of Respiratory System 33 20 53 7. Other forms of Tuberculosis 2 3 5 8. Syphilitic diseases 7 3 10 9. Influenza 11 12 23 10. Measles 2 - 2 11. Acute Polio-myelitis & polio-encephalitis - - - 12. Acute infective encephalitis. 2 1 3 13. Cancer of buccal cavity and oesophagus (M) Uterus (F) . 9 12 21 14. Cancer of stomach & Duodenum 13 11 24 15. Cancer of breast - 23 23 16. Cancer of all other sites 60 41 101 17 Diabetes 2 8 10 18. Intra-cranial vascular lesions 52 74 126 19. Heart disease. 166 191 357 20. Other diseases of' circulatory system 13 12 25 21. Bronchitis 50 45 95 22. Pneumonia. 35 38 73 23. Other respiratory diseases 11 10 21 24. Ulcer of stomach or duodenum 11 3 14 25. Diarrhoea under 2 years 5 5 10 26. Appendicitis 6 4 10 27. Other digestive diseases 13 16 29 28. Nephritis 12 18 30 29. Puerperal & post-abortive sepsis - 1 1 30. Other maternal causes - 1 1 31. Premature Birth 4 5 9 32. Congenital malformations, birth injury, infantile diseases. 16 8 24 33. Suicide 5 8 13 34. Road traffic accidents 10 4 14 35. Other violent causes 91 59 150 36. All other causes 56 54 110 MATERNAL MORTALITY The number of deaths from puerperal causes during 1940 were as follows:- Puerperal and post-abortive sepsis - 1, other maternal causes - 1. The maternal mortality rate per 1,000 total (live and still) births, was 1.4 compared with 2.16 for England and Wales. infantile MORTALITY The deaths of infants under one year during 1940 numbered 63, producing an infantile mortality rate of 45.8 per 1,000 live births, as compared with 26.4 and 45.8 for 1939 and 1938 respectively. The rate for England and Wales in 1940 was 55. Congenital malformations, premature birth, etc. caused 33 (or 52 per cent) of the total infant deaths. 6 BIRTH RATE, DEATH RATE AND ANALYSIS OF MORTALITY DURING 1940 Provisional fiqures Rate per 1,000 total population Annual Death Rate per 1,000 population Rate per l,000 live births Live Births Still Births All Causes Typhoid paratyphoid fevers Small pox Measles Scarlet Fever Whooping Cough I Diphtheria Influenza Diarrhoea & Enteritis (under 2 years). Total deaths under 1 year   ! » [England & Males i 14.6 0.55 14.3 0.00 - 0.02 0 0.00 0.02 0.06 0.32 4.6 155 126 County Boroughs and great towns, including London, j 16.0 0.64. 15.8 0.00 - 0.02 0.00 0.02 . 0.07 0.29 5.9 61 148 smaller towns (resident populations 25s000 to 50,000 at 1931 census). 15.7 0.55 12.8 0.00 - 0.02 0.00. 0.18 0.05 0.30 4.4 54 London Adm. County 13.7 0.44 17.8 0:00 - 0.01 0.00 0.00 0.01 0.1 5.8 50 Twickenham 14.67 < 0.54 14.8 0.00 - 0.02 0.00 0.00 0.03 0.24 7.27 45.8 , LABORATORY WORK Specimens for bacteriological examination were sent to the Pathological Department, Victoria Hospital, Kingston-upon-Thames (Ministry of Health Emergency" Pathology Service). The arrangements are quite satisfactory. The following table, gives the' number of specimens examined during the year:- Nature of Specimens No. Result Throat and nasal swabs for diphtheria 220 4 Positive Sputum, etc. for tubercle bacilli 102 21 Positive Miscellaneous 8 Total specimens examined 330 AMBULANCE FACILITIES Infectious diseases. A motor ambulance is provided by the South Middlesex and Richmond Joint Hospital Board. Non-Infectious and accident cases. Pour motor ambulances are provided by the Council. During the year they were stationed at Stanley Road Ambulance Station. The facilities were adequate for the needs of the Borough. The following table shows the work done by the borough ambulance service during the' year 1940:- Year 1940 Total Calls Patients Carried Mileage 1st auarter 287 278 2359.99 2nd " 256 246 1911.09 3rd " 241 232. 1654.94 4th " 311 3 06 1982.73 1095 1062 7908.75 NURSING IN THE HOME There are in the Borough five home-nursing associations employing nurses - viz., Twickenham Nursing Association, Tedding ton & District Nursing Association, Hampton Nursing Association, Hampton Hill Nursing Association, and the Hampton Wick District Nursing Association. During the year the Council contributed £300 to the funds of the associations. 8 CLINICS AND WELFARE CENTRES The following clinics were being hold within the Borough at the end of the year:- CLINICS. ADDRESS. BY WHOM PROVIDE. Infant Welfare Centres. York House, Twickenham Hospital Bridge Road, Twickenham. Art School, Teddington. Station Road, Hampton. Baptist Hall, Hampton Wick. Twickenham Counr 1 An ue -Natal Clinics. York House, Twickenham Hospital Bridge Road, Twickenham. Art School, Teddington Station Read, Hampton. Twickenham Counc .1 School Clinics. York House, Twickenham Hospital Bridge Road, Twickenham. Stanley Road, Teddington. Percy Road P.A.P., Hampton. Middlesex Cou, Council Dental Clinics York House, Twickenham Stanley Rd. Teddington Twickenham Coi & Middx.County 1. Ophthalmic Clinios House, Twickenham Stanley Rd. Teddington Middlesex Coun Council. Diphohei'is & Typhoid Immunisation . York House, Twickenham Hospital Bridge Road, Twickenham. Stanley Rd. Teddington Percy Rd. P.A.P., Hampton. Twickenham Council Tubofculor-tj Disponsnr;/, I j, "Staines Rd. Twickenham. Middlesex County Council. hospitals. Smallpox Arrangements) for the provision of hospital accommodation arc made Toy the Middlesex County Council. Tuberculosis Residential institutional treatment is provided "by the Middlesex County Council. Puerperal Pyrexia. During the year facilities were available at Mogden Hospital for patients requiring hospital treatment. Admission was subject to the discretion of the Medical Superintendent. 9 Infectious diseases. Other cases of infectious,diseases were admitted, as necessary, to Mogdon Hospital. 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. During the year the Council contributed the total sum of £190 to these hospitals. HEALTH EDUCATION The publication of our local-'edition of "Better Health" continued throughout the year. The dissemination of knowledge on health matters through the medium of this journal' was most useful. — 10 MATERNITY AND' CHILD WELFARE. 1940 MIDWIFERY AID MATERNITY SERVICES The total number of births which were notified as occurring in the Borough was 1193; this does not include births which occurred elsewhere, but which were subsequently transferred to Twickenham. Of the births occurring in the borough, 849 (71.17 per cent) were attended by midwives in their capacity as midwives, and 344 (28.83 per cent) by doctors. Municipal midwives attended 388 births (49.28 per cent)482 in their capacity as midwives and 106 as maternity nurses with doctors in charge. MIDWIVES ACTS. There were seven municipal "midwives on the staff of the Department. CARE OP 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 & third week of each month. Both the total attendances at ante-natal clinics, and the number of mothers who availed themselves of this service showed an increase on previous, years:- Year Attendance for first Time Total Attendance 1938 638 2406 1939 720 2191 1940 750 2998 A large part of this increase is due to the work of the 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. The 'Government scheme for the supply of milk at a reduced rate, to expectant and nursing mothers, came into force in August 1940. No request for the services of a consultant was made during the year. - 11 - ■ • WINTER SCHOOLS The Winter School for Health Visitors and School Nurses was discontinued owing to the War. INFANT WELFARE CLINICS There are five Infant Welfare Clinics; ten sessions for infant consultations are held weekly. The total attendances of children at the various session during the year numbered 21,839. The figures for each centre are set cut below:- 1940 York House Centre Whitton Centre Tedding- ton Centre Hampton • Centre Hampton Wick Centre s Total 1 1st Attendance. Under 1 yr. 255 400 198 148 66 1067 1-5 yrs. 83 121 90 43 41 378 Anothers. 27 41. 50 36 154 subsequent attendances Under 1 yr. 3178 5231 2286 2142 1058 13,895 1-5 yrs. 1555 2760 1655 1231 581 7,782 Anothers 27 41 58 36 162 Total Attendances 4760 8032 3999 3409 1639 21,839 DENTAL TREATMENT OF CHILDREN UNDER 5 YEARS During the year 107 children under 5 years of age received complete dental treatment. MILK AND OTHER FOODS ETC. During the year 1952 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 10,4714 gallons (supplied to applicants free of charge) Dried Milk 19,801 pounds The Government scheme for the supply of milk at a reduced rate to children under 5 years of age came into force in August 1940. The Government issues of cod-liver oil to holders of children's ration hooks, and of fruit juices to children under 2 years of age were made through the Infant Welfare Centres. - 12 - •• i BIRTH CONTROL No Birth Control clinic was held, in the borough. Women for whom pregnancy was inadvisable for medical reasons were referred to the birth control clinic at Hounslow. 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. During October 1940, Section 6 of the Midwives Act, 1936 (forbidding unqualified persons to act as maternity nurses) was applied to Twickenham. SUBSEQUENT TO CONFINEMENT Ten cases of puerperal pyrexia occurred during the year; of those, 3 were admitted to the West Middlesex County Hospital, 3 were treated in a Nursing Home, and 4 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. 71 post-natal patients attended at Ante-natal and Infant Welfare sessions, as against 21 in 1938, and 98 in 1939. Two maternal deaths occurred in the borough. DENTAL TREATMENT The following received dental treatment during the year:- Expectant Mothers 17 Nursing Mothers 19 Patients supplied with dentures 39 Dentures supplied 73 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 338 To children under 1 year of age 3961 To children between 1 and 5 years of age 6360 In addition, visits were paid to homos of children of school age on account of suspected infectious disease, and for following up those recommended for medical treatment or observation. The Health Visitors also attended as required at minor ailment and dental clinics. -13- CHILD LIFE PROTECTION A few foster-mothers failed to send noticed of reception or removal of a foster child. No proceedings were authorised in respect of these contraventions, hut warning letters were sent. All the Health Visitors are appointed Child Protection Visitors, and the visits of supervision of foster-children were carried out by them. Details of registration during 1940 were:- No. of persons who were receiving children for reward at the end of the year 63 No. of children on register at end of year 94 No. of children who died during the year nil. ORTHOPAEDIC TREATMENT No formal arrangement has been made in the borough for the treatment of children requiring massage, orthopaedic treatment, or remedial exercises; patients were referred to the West Middlesex County Hospital, or other hospitals able to undertake the treatment of such cases. Assistance was granted towards the cost of maintenance of one child in a convalescent home during the year, and towards the cost of special shoes for another child. NURSING HOMES There wore 10 private nursing homes in the Borough, all of which were registered. All the homes were kept under periodic supervision throughout the year. Special watch was kept on the advertisement columns of the local press, etc., with a view to the discovery of unregistered Homes. The Bearsted Memorial Hospital which removed from London to the Hampton Court Hotel for the duration of the war, was exempted from registration. The three voluntary hospitals in the borough, which receive private patients, were' also exempted from registration -14- 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, the Board. DRAINAC-E AMD SEWERAGE The sewage, for the whole of the Borough is conveyed to the Mogden Disposal Works ofthe Middlesex County Council for treatment. RIVERS AND STREAMS No complaints of pollution of the river Thames or streams were received by the Department during the year. PUBLIC CLEANSING As the scheme submitted to the Ministry of Health for an enlarged Destructor did not receive approval owing to the War, the three Destructors situate at Twickenham, Teddington and Hampton, were still in use and were able to dispose of the refuse collected, the quantity having greatly diminished owing to the recovery of salvageable materials. SANITARY INSPECTION OF DISTRICT There was no change in the personnel of the Sanitary Inspectorate. During most of the year three of them were engaged whole-time on billeting and A.R.P. duties; the remainder endeavoured to carry out essential visits in addition to A.R.P. work. The visits .paid in respect of each branch of the work are set out under the appropriate headings. Notices served. Informal notices served 46l Informal notices complied 436 Statutory notices served 12 Statutory notices complied 15 Summary of visits and inspections. Visits to premises after complaint 1013 Visits after occurrence of infectious disease 352 Visits to properties under notice and work in progress 3438 Total visits and inspections 10,590 -15- Summary of works executed in consequence of visits Drains unstopped and repaired 147 Waste pipes disconnected or repaired 35 Soil pipes provided or repaired 16 Complete drainage reconstructions 15 Water supply cisterns repaired 28 Draw taps from main provided 34 Gutters . repaired 134 Roofs repaired 206 W.C. apartments repaired or rebuilt 59 W.C's repaired 81 Dustbins provided 46 Damp walls remedied 34l Ventilation provided 13 Yards payed or repaired 44 Rooms stripped and cleansed 179 Offensive accumulations removed 4 Other works carried out 855 SMOKE ABATEMENT It was not found necessary to take statutory action under the Public Health Act with regard to smoke nuisances during the year. SWIMMING BATHS AND POOLS 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. DISINFESTATION Eradication of Bed Bugs (1) Number of Council houses:- (a) Found to be infested 1 (b) Disinfested. 1 (2) Number of other houses:- (a) Pound to be infested 21 (b) Disinfested 21 The methods of disinfestation employed were set out in previous reports. During the year under review the, insecticide solution used was "Keritox" and "Zaldecide". No application was received from the Housing Department for disinfestation of the belongings of persons before their removal to Council houses. Scabies. A gradual increase in the number of cases of scabies occurred during the year. Immediate steps were taken to ensure that facilities for treatment were available as necessary. School children and infants were treated at the school clinics, and medicaments were provided for the use of adults in their own homes Arrangements were made for the steam disinfestation of clothing etc., on the conclusion of the treatment. The co-operation of Sanitary Inspectors, Health Visitor-School Nurses and parents, upon which the success of the scheme depended, was good. The technique of treatment was continually under review and at the of the year further improvements were in hand. - 16 - common lodging house There is one. Common Lodging-house situated, within the Borough. Regular visits were paid to the premises and the condition were found to "be satisfactory. The registration was renewed. SCHOOLS There ore in the Borough 26 elementary schools, four secondary schools, and a technical college. These are regularly visited by the Sanitary Inspectors. No action was necessory with-regard to the closure of any of the schools for infectious disease among the children. OFFENSIVE TRADES A report on-fried fish shops was submitted to the Council. Detailed inspections of all fried fish shops in the Borough were made. After a thorough investigation of the whole question the Council were advised that the trade, as carried on at that time in the Borough, was not necessarily offensive. Further, that the powers of the Corporation under the Public Health Ac 1936 (and byelaws made thereunder), together with any restrictions which might be imposed under the Town Planning Scheme, could be considered to be reasonably sufficient. The Council therefore decided to take no further act: with regard to the application for a new Order declaring the trade or business of fish frying an offensive trade. PETROLEUM (REGULATION) ACTS, 1928 & 1936 Petroleum spirit and carbide of calcium stores were kept under supervision by the Sanitary Inspectors. Licenses were issued in respect of 111 premises during the year. The number of visits paid by the Inspectors was 166, Proceedings were instituted in one case for contravention of the Regulations regarding the storage of Petroleum spirit. The summons was dismissed upon the payment by the defendant of £4.1.0. costs. SHOPS ACT 1934 The relevant provisions of the above Act with regard to Sanitary conveniences etc., are carried out by the Health Department. One certificate was granted exempting certain shop premises from the requirements of Section 10 (2) of the Act, regarding the provision and maintenance of suitable and sufficient sanitary conveniences for the use of persons employed in or about the shop. - 17 - RATS AND MICE (DESTRUCTION) ACT, 1919 The Middlesex County Council are responsible for the administration of this 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. FACTORIES ACT, 1937 Inspections for purposes of provisions as to health. Inspections. Written Notices. Factories with mechanical power 116 5 Factories without mechanical power 57 4 Other premises under the Act. 48 5 Total 221 14 Summary of defects found. Found Remedied Want of cleanliness 4 1 Overcrowding 1 — Sanitary conveniences Insufficient. — — Unsuitable or defective 8 8 Not separate for sexes. — — Other offences. 5 5 Total 18 14 ESTABLISHMENTS FOR MASSAGE OR SPECIAL TREATMENT The following applications in respect of establishments for massage or special treatment were granted during the years- Chiropody 4 Chiropody and massage 3 HAIRDRESSERS' AND BARBERS' PREMISES Hairdressers' and Barbers' Premises in the Borough were kept under supervision to ensure the required standard of cleanliness being maintained in conformity with the Byelaws. RENT AND MORTGAGE INTEREST RESTRICTIONS ACTS 1920 to 1935 During the year nineteen certificates were granted under the above Acts in respect of premises which were not in a reasonable state of repair. -18- HOUSING Work under the Housing Acts-particularly with regard to Clearance Areas etc.,-was practically at a standstill. Shortage of labour and materials were also difficulties which owners of property had to face, out every effort was made by the Department to ensure that urgent works were carried out. The following statistics show the work carried out under this heading:- Statistics 1940. 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) 559 (b) Number of inspections made for the purpose 744 (2) (a) Number of dwelling houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932. 3 (b) Number of inspections made for the purpose 3 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation NIL (4) Number of dwelling houses (exclusive of those referred to under the preceding sub-head) found to bo in all respects not reasonably fit for human habitation 461 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. 436 3. Action under statutory powers during the year. A. Proceedings under sections 9, 10 and 16 of the Housing Act, 1936:- 1 (l) Number of dwelling houses in respect of which notices were served requiring repairs 8 (2) Number of dwelling houses which were rendered fit after service of formal notices:- (a) By owners 13 (b) By local authority in default of owners NIL -19- B.- Proceedings under Public Health Acts:- (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 4 (2) Number of dwelling houses in which defects were remedied after service of formal notices:- (a) By owners 1 (b) By local authority in default of owners 1 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 nil (2) Number of dwelling houses demolished in pursuance of Demolition Orders nil D.- Proceedings under section l2 of the Housing Act, 1936:- (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made nil (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 57 (ii) Number of families dwelling therein 57 (iii) Number of persons dwelling therein 423½ (b) Number of new cases of overcrowding reported during the year 4 (c) (i) Number of cases of overcrowding relieved during' the year 3 (ii) Number of persons concerned in such cases 13½ INSPECTION AND SUPERVISION OF FOOD Milk Supply. During the year, 158 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 20 Accredited 1 "Pasteurised" milk. 33 Meat and other Foods. The Livestock (Restriction on Slaughtering), Order 1940 came into operation on the 15th January 1940. Generally the Order provided that except under the terms and conditions of a licence granted by or under the authority of the Minister of Food., no person should slaughter or cause to be slaughtered for human consumption any livestocks All general slaughtering forthwith ceased in the Borough. -20- The following is a summary of the position with regard to slaughter houses in the Borough, as of affected. by the Food and Drugs Act 1938:- Licences granted 4 Consideration of Applications deferred ponding carrying out of works 3 Applications refused 3 1940 UNSOUND MEAT Total Boasts Calves Pigs Sheep No. killed 527 36 57 318 116 No. inspected 527 36 57 318 116 ALL DISEASES EXPECT TUBERCULOSIS. Whole carcases condemed. - - - - - Carcases of which some part or organ was condemned. - 4 - 5 - Percentage of number inspected affected with disease other than Tuberculosis. - 11.1 - 5.03 - TUBERCULOSIS ONLY. Whole carcases condemned. - - - 1 - Carcases of which some part or organ was condemned. - 4 - 9 - Percentage of number inspected affected with Tuberculosis. - 11.1 - 3.21 - The undermentioned meat and other foods were also found unfit for human consumption:- 82½ lbs. Mutton 769⅞ lbs. Lamb 1237 lbs. Beef 96 lbs. Pork 69 3/4 lbs. Bacon 48 lbs. 10 oz. Ham 21 lbs. Ham and Beef Roll 18 lbs. Corned Beef 5 lbs. Canned roast Beef 56 Rabbits 10 Stone fish 8 Stone Herrings 56 lbs. halibut 1 Case (180) of eggs 73½ lbs. Butter. -21- Daring the year, the following visits were made to premises upon which food is prepared or sold:- Butchers' Shops 331 Restaurants and eating-house kitchens; Grocers' shops 289 Greengrocers' Shops 164. Pish Shops 63 Ice Cream etc., Premises 49 Prosecution. Proceedings were instituted in respect of the sale of an unsound sliced wrapped loaf. The firm responsible were fined £2 and £3.3.0. costs. MIDDLESEX COUNTY COUNCIL (GENERAL POWERS) ACT, 1938 The registration of Hawkers of Meat, Pish and Vegetables together with the Premises used as storage accommodation is required under Section 71 of the above Act. At the end of the year 14 persons and 13 promises had been registered. FOOD AND DRUGS ACT 1938 The Middlesex County Council are the Food and Drugs Authority for the Borough. 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 FOOD) REGULATIONS, 1925 AND 1927. The administration of the whole of the above is carried out by the Middlesex County Council. -22- INFECTIOUS DISEASES (a) NOTIFIABLE INFECTIOUS DISEASES Diphtheria. Daring the year 18 cases of diphtheria were notified as compared with 25 and 70 respectively for 1939 and 1938. 17 cases were admitted to hospital. The number of deaths recorded was again 3, giving a death rate of 0.03 per 1,000 of the population. The figure for England and Wales was 0.06. Supply 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. Diphtheria immunization. In December 1940 the Ministry of Health undertook a national campaign for more* intensive immunization against Diphtheria. This was actively taken up by the Department and the results of the local campaign will be dealt with in my next report. The following is a brief summary of the work carried out during the year;- Total no. of new cases 913 Schick Testing 1st Schick Test (before Inoculation) No. Tested 22 No. Susceptible 7 No. Immune 12 No. Failed to attend 3 2nd Schick Test (after completion of 1st courso of injections). No. Tested 439 No. Protected 377 No. Susceptible 1 No. Failed to attend 6l All those found to be incompletely protected after the second Post Schick were reinoculated. Total No. of attendances for year 2391 The diphtheria prophylactics used were A.P.T. and T.A.F. Scarlet Fever. The incidence of scarlet fever in the Borough during the year was low. Only 38 cases were notified as compared with 93 and 274 respectively for 1939 and 1938. Incases were admitted to hospital. No deaths were recorded from this disease. The death rate for England and Wales was 0.00 per 1,000 of the population. Smallpox. No case of smallpox was notified during the year. -25- Pneumonia, Malaria and Dysentery. Pneumonia. There were 44 cases of pneumonia notified as compared with 72 for the previous year. The number of deaths recorded from this disease was 73. 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. 1940 4 3 1 4 - - - Puerperal Pyrexia. Ten cases of puerperal pyrexia were notified during the year. Three were treated in the West Middlesex Hospital. Enteric fever. Two cases of paratyphoid were notified, both of which were admitted to hospital. There was no apparent connection between each, and no evidence suggesting milk or water supplies as source of infection. Typhoid Immunization. In November 1940 facilities were provided at the school clinics for immunization against Typhoid for those members of the public desiring to avail themselves thereof. At the end of the year 113 people had been immunized. The total attendances at the clinics numbered 259. Cerebro-spinal fever. Sixteen cases of cerebro-spinal fever were notified during the year-the first notifications in the Borough since amalgamation. There were five deaths. The incidence for the country as a whole was high. The increase may be attributable to war-time conditions, since the disease is transmitted by droplet infection and is associated with bad ventilation, overcrowding etc. Measles and Whooping Cough. Measles and Whooping Cough became compulsorily notifiable in October 1939. During the period under review there was a sharp rise in the number of cases of measles notified in September the peak being reached in October. The total number of cases for the year was 956. Two deaths were recorded from this disease, giving a death rate of 0.02 per 1,000 of the population-the same as that for England and Wales. There were 46 cases of whooping cough, and no deaths. -24- (b) NON-NOTIFIABLE INFECTIOUS DISEASES Diseases under this heading include mumps and chickenpox. The exact incidence of these diseases is uncertain but some indication of their prevalence is obtained from the number of intimations received from the Head Teachers of children thought to be suffering from the diseases. The numbers f 1940 were very low. TUBERCULOSIS The number of new cases of tuberculosis notified during 1940 was 126 as compared with 125 for the previous year. The number of deaths recorded from this disease was 58 which showed a decrease. The following table prepared from the records in the Department summarises the position. NEW GASES AND MORTALITY 1940 Age Periods New Cases Deaths Pulmonary NonPulmonary Pulmonary NonPulmonary M F M F M F M F Under 1 _ _ _ _ _ _ _ _ 1-5 2 6 _ 1 _ 1 1 1 5-10 5 4 1 _ _ _ _ 1 10 - 15 _ 1 _ _ _ _ _ 1 15 - 20 5 6 _ 1 _ 2 _ _ 20 - 25 8 9 _ 1 1 1 _ _ 25 - 35 10 12 1 5 4 7 1 _ 35 - 45 16 6 1 1 8 2 _ 1 45 - 55 9 4 _ _ 7 3 _ _ 55 - 65 6 1 _ _ 6 3 _ _ 65 and upwards. 1 3 _ _ 7 1 _ _ Totals 62 52 3 9 33 20 2 3 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. -25- 26 CASES OF INFECTIOUS DISEASES NOTIFIED DURING THE YEAR 1940 DISEASE CASES NOTIFIED AT VARIOUS AGES (YEARS). Total Cases Notfd. Cases admtd. to Hosp. Total Deaths. 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 Scarlet Fever _ 3 _ 1 _ 13 10 5 1 2 3 _ _ 38 14 _ Diphtheria 1 _ 2 1 1 10 _ 1 1 1 _ _ _ 18 17 3 Enteric Fever including Paratyphoid. _ _ _ _ 1 _ _ _ _ _ 1 _ _ 2 2 _ Puerperal Pyrexia _ _ _ _ _ _ _ _ 3 6 1 _ _ 10 3 _ Pneumonia _ 1 4 3 1 _ 1 2 4 3 7 11 7 44 5 73 Erysipelas _ _ _ _ _ _ _ 1 _ 1 3 3 2 10 2 _ Cerebro-spinal Fever. _ 2 l 1 _ 1 2 2 2 1 3 1 _ 16 15 5 Ophthalmia Neonatorum 4 _ _ _ _ _ _ _ _ _ _ _ _ 4 1 1 Measles 18 65 81 91 69 555 40 11 8 14 3 1 _ 956 4 2 hooping Cough 3 l 14 5 7 15 1 _ _ _ _ _ _ 46 1 _ -27- MONTHLY INCIDENCE OP INFECTIOUS DISEASES DURING THE YEAR 1940 DISEASE NUMBER OF CASES TOTAL Jan. Feb. Mar. April May June July Aug. Sept. Oct. Nov. Dec. Scarlet Fever 4 2 2 _ 2 7 3 1 3 5 6 4 38 Diphtheria 4 1 1 _ _ _ 1 1 _ 4 5 l 18 Enteric Fever including Paratyphoid. _ _ _ _ _ _ 1 1 _ _ _ _ 2 Puerperal pyrexia 1 1 2 1 _ 1 1 2 1 _ _ _ 10 pneumonia. 7 11 3 3 1 1 1 _ 1 3 2 6 44 Erysipelas. 3 _ _ _ 1 _ _ 1 _ 2 _ 3 10 Cerehro-suinal Fever. 1 5 2 1 2 _ _ 3 _ 2 _ _ 16 Ophthalmia Neonatorum 1 _ _ _ _ _ _ _ 3 _ _ _ 4 Measles. 3 14 7 2 _ 4 37 64 153 471 130 71 956 Whooping Cough 3 2 3 3 3 _ 2 l 4 3 8 14 46 INDEX. Page Ambulance Facilities 8 Ante-Natal Clinics 9, 11 Anti-toxin, Supply of 23 Artificial Cream Act, 1929 22 Births 5, 11 Birth Control 13 Blindness, Prevention of 25 Care of Mothers during Confinement 13 Care of Mothers subsequent to Confinement 13 Child Life Protection 14 Common Lodging House 17 Cerebro-spinal Fever 24 Deaths 5, 6 Dental Clinics 9 Dental Treatment 12,13 Diphtheria 23 Diphtheria, Immunization 9, 23 Disiniestation 16 Drainage and Sewerage 15 Dysentery 24 Enteric Fever 24 Factories Act, 1937 18 Food, Inspection and Supervision of 20, 21, 22 Food and Drugs Act, 1938 ,22 Hairdressers' and Barbers' Premises 18 Health Visiting 13 Hospitals 9, 10 housing 19, 20 Infantile Mortality 6 Infant Welfare Clinics 9, 12 Infectious Diseases 9, 10, 23, 24, 25, 26, 27 Isolation Hospital Accomodation 10 Laboratory World 8 Malaria 24 Massage or Special Treatment, Establishments for 18 Maternity and Child Welfare Committee 2 Maternal Mortality 6 Measles 24 Middlesex County Council (General Powers) Act 1933 Midwives Acts, Administration of 11 Milk and Other Foods, etc., Provision of 12 Milk Supply pursing Associations 8 Parsing Homes 14 Offensive Trades 17 Ophthalmia Neonatorum 24 Ophthalmic Clinics 9 Orthopaedic Treatment 14 Petroleum (Regulation) Acts 17 Pneumonia 24 poliomyelitis 24 Polio-encephalitis 24 Public Cleansing 15 INDEX-continued Page 2 Public Health Committee 22 Public Health (Condonsed Milk) Regulations 22 Public Health (Dried Mi1k) Reflations 22 Public Health (Preservatives, etc., in Food Regulations 22 Puerperal Pyrexia 9, 24 Rata and Mice (Destruction) Act 18 Rent & Mortgage Interest Restrictions Acts 18 Rivers and Streams 15 Sanitary Inspection of District 15 Scabies 16 Scar let Fever 23 Schools 17 School Clinics 9 Show Acts 17 Slaughtering of Animals 20, 21 Smallpox 9, 23 Smoke Abatement 16 Statistics, General and Vital 4, 7 Swimming Baths and Pools 16 Tuberculosis 9, 25 Typhoid Immunization 9, 24 Unsound Pood 21 Water Supply 15 Whooping Cough 24 Winter School for Health Visitors 12