TWI 9 BOROUGH OF TWICKENHAM Annual Report OF THE MEDICAL OFFICER OF HEALTH 1941 JOHN MADDISON, M.D., B.S., D.P.H. Medical Officer of Health. 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, 1941. 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. In spite of some difficulty experienced during the year through enemy action, the health services wore maintained with a high degree of success. The general death rate reported was higher than in 1939, because of the Inclusion of deaths due to enemy action. The death rate of infants under one year of age, per thousand live births, rose from 26.4 in 1939 to 45.8 in 1940, to 70.95 in 1941. Just under half of these infants died within the first four weeks of life - a proportion higher than that for 1940. Some increase was due to enemy action, but the figures are disturbing and indicate the need for unceasing vigilance and work on this problem. Remarkable success was achieved in the Diphtheria Immunization Campaign; no loss than 4,532 cases were dealt with, a total number of attendances of 16,102. The figures for the previous year were, cases 913, attendances 2,391. There were no serious outbreaks of infectious disease. Prompt action nullified a threat of an outbreak of Trichiniasis. Heavy additional duties wore placed on the staff of my Department during some of the months of this year, especially during the raiding period, but in spite of this, the work in every section continued almost up to normal level. I desire to acknowledge with many thanks the loyalty and devotion of the staff during this difficult period. 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 1941 Area in acres 7,007 Number of inhabited houses (1941) 28,790 Rateable Value (31st December 1941) £1,028,811 Sum represented by a penny rate 1941/1942 £4,116: 3:7 Total M F Live births : (a) Legitimate 1,165 586 579 Illegitimate 69 58 31 (b) Legitimate 1,143 567 576 Illegitimate 69 38 31 Birth rate per 1,000 of estimated resident population 13.4 Total M F Still births : (a) Legitimate 38 17 21 Illegitimate 1 1 - (b) Legitimate 37 17 20 Illegitimate 1 1 - Still birth rate per 1,000 total (live and still) births 30.6 Total M F Deaths : 1,196 553 643 Death rate per 1,000 of estimated resident population 13.0 Maternal Deaths : Puerperal & Post-Abortive Sepsis 1 Other Maternal Causes 1 Rate per 1,000 total (live and still) births 1,6 Death rate of infants under one year of age :– All infants per 1,000 live births 70.95 Legitimate infants per 1,000 leg, live births 69.1 Illegitimate infants per 1,000 illeg. live births 101.45 Deaths from : Cancer (all ages) 183 Measles (all ages) 2 Whooping cough (all ages) 7 Diarrhoea (under 2 years of age) 12 (a) For calculation of Birth Rate. (b) For calculation of Infantile and Maternal Mortality Rates. 3 STATISTICS, SOCIAL CONDITIONS AND GENERAL PROVISION OP HEALTH SERVICES FOR AREA BIRTHS The births registered in the borough in 1941 are 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 rate:- Legitimate 586 579 1,165 Illegitimate 38 31 69 Total 624 610 1,234 (ii) Calculation of Infantile and Maternal Mortality rates:- Legitimate 567 576 1,143 Illegitimate 38 31 69 Total 605 607 1,212 The birth-rate for the year was 13.4 per 1,000 of the population as compared with 14.2 for England and Wales. The figures for 1940 were 14,67 and 14.6 respectively. DEATHS The nett deaths registered in the borough during 1941 were:– Males 553 Females 643 Total 1,196 The death rate per 1,000 of the population for the. year was 13.0. The death rate for England and Wales was 12.9. The figures for 1940 were 14.8 and 14.3 respectively. The main causes of death during the year were heart disease (295) cancer (183) intra-cranial vascular lesions (103) bronchitis (65) pneumonia (64) and tuberculosis (61). MATERNAL MORTALITY The number of deaths from puerperal causes during 1941 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 1.6 compared with 2.23 for England and Wales. 4 INFANTILE MORTALITY During the year 1941, there was a notable increase in the number of deaths of infants under one year, i.e. 86 as compared with 63 for the previous year. The infantile mortality rate was 70,95 per 1,000 live births, that for England and Wales being 59. An analysis of the mortality reveals that neo-natal deaths were responsible for 47.7 per cent of the total deaths, viz . Under 24 hrs. 1 to 7 days 1 to 4 weeks Total under 4 weeks Percentage total infant deaths 13 9 19 41 47.7 Congenital malformations, premature birth, etc. formed a large proportion of those deaths. Although the infantile mortality rate is one which fluctuates from year to year, it appears that the anxiety through which expectant and nursing mothers passed in 1940-1941 had an influence on the rate. 5 6 BIRTH RATE, DEATH RATE AND ANALYSIS OF MORTALITY DURING 1941 Provisional figures Rate per 1,000 total population Annual Death Sate per 1,000 population. Rate per 1,000 live births Live Births Still Births All Causes Typhoid & paratyphoid fevers Small pox Measles Scarlet Fever Whooping Cough Diphtheria Influenza Diarrhœa & Enteritis (under 2 years) Total deaths under 1 year England & Wales 14.2 0.51 12.9 0.00 - 0.03 0.00 0.06 0.07 0.19 5.1 59 126 County Boroughs and great towns, including London l4.7 0.58 14.9 0.00 - 0.03 0.00 0.07 0.08 0.17 7.5 71 148 smaller towns (resident populations 25,000 to 50,000 at 1931 census). 16.4 0.60 13.0 0.00 • 0.03 0.01 0.06 0.06 0.20 4. 6 56 London Adm. County 8.9 0.33 16.3 0.01 — 0.02 0.00 0. 024 0.03 0.15 6.8 68 TWICKENHAM 13.4 0.42 13.0 0.00 - 0.02 0.00 0.07 0.03 0.30 9.9 70.95 LABORATORY WORK Specimens for bacteriological examination were. to the pathological Department, Victoria Hospital, Kings upon-Thames (Ministry of Health Emergency Pathology Sery and occasionally to the Royal Institute of Public Health a Hygiene. 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 292 11 Positive Sputum, etc. for tubercle bacilli 94 12 Positive Miscellaneous 37 Total specimens examined 423 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. During the year Stanley Road Ambulance Station was transferred to the Hollies Depot and the ambulances have since been stationed at the latter. 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 1941:- Year 1941 Total Calls Patients Carried Mileage 1st quarter 262 261 1976.3 2nd quarter 252 250 1784.9 3rd quarter 265 253 2121.7 4th quarter 334 338 2210.6 1113 1102 8093 .5 NURSING IN THE HOME There are in the Borough five home-nursing associations employing nurses - viz., Twickenham Nursing Association, Teddington & 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. 7 CLINICS AND WELFARE CENTRES The following clinics were being hold 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. Porcy Road F.A.P., Hampton. / Middlesex County Council. Dental Clinics York House, Twickenham Stanley Road, Teddington. Twickenham Council & Middlesex County Council Ophthalmic Clinics York House, Twickenham Stanley Road, Teddington Middlesex County Council Diphtheria & Typhoid Immunization York House, Twickenham Hospital Bridge Road, Twickenham. Stanley Road, Teddington. Percy Road F.A,P., Hampton. Twickenham Council HOSPITALS Smallpox Tuberculosis Puerperal Pyrexia Infectious diseases The arrangements for the provision of hospital accommodation or residential institutional treatment wore described in my previous report. 8 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, Toddington. During the year the Council contributed the total sum of £190 to these hospitals, HEALTH EDUCATION Owing to lack of advertising support, tho publication of our local edition of "Better Health" had to be discontinued during the year. 9 ' MATERNITY AND CHILD WELFARE MIDWIFERY AND MATERNITY SERVICES The total number of births notified as occurring in the Borough was 1065. This does not include births which occurred elsewhere, but which were subsequently transferred to Twickenham. Of the births occurring in the Borough, 798 (74.93) were attended by midwives in their capacity as midwives, and 267 (25,07%) by doctors. Municipal midwives attended 469 births (44 per cent). 394 in their capacity as midwives and 75 as maternity nurses with doctors in charge. MIDWIVES ACTS The number of municipal midwives employed by the Borough remains 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 Two weekly sessions Hampton Centre One session first and third week of each month. There was a marked increase both in the total attendances at the ante-natal clinics, and in the number of mothers who availed themselves of the advice offered Year Attendances for first time. Total Attendances 1938 638 2406 1939 720 2191 1940 750 2998 1941 770 3375 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. Certain foods were supplied to expectant mothers for whom special treatment was considered necessary; no charge was made for these supplies in necessitous cases. No request for the services of a consultant was made during the year. BIRTH CONTROL No birth control clinic is hold In the Borough, but women for whom pregnancy is considered inadvisable for medical reasons are referred to the birth control clinic at Hounslow for the necessary advice, etc. 10 CARE OP MOTHERS DURING CONFINEMENT The Corporation has not established a Maternity Home, and has no formal agreement with any hospital for the reception of difficult or complicated cases. Those are referred to the West Middlesex County Hospital. SUBSEQUENT TO CONFINEMENT Nine cases of puerperal pyrexia occurred during the year, and of these three patients wore admitted to the we at Middlesex County Hospital, five were in a nursing home, and one was treated at home. Ail the patients recovered. No application was received during the year for the services of a consultant in a case of puerperal pyrexia. Post-natal care is carried out at the ante-natal clinics, and mothers are urged to attend. The numbers attending show an appreciable increase; 297 post-natal patients attended, as against 71 in 1940, and 98 in 1939; this increase is largely due to the work of the midwives and health visitors, 2 maternal deaths occurred in the Borough. DENTAL TREATMENT The following received dental treatment during the year:– 1941 1940 Expectant mothers 52 17 Nursing mothers 33 19 Patients supplied with dentures 37 39 Dentures supplied 65 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. 1941 1940 Their visits included the following:- To expectant mothers 432 338 To children under 1 year of age 4016 3961 To children between the ages of 1 and 5 years 7834 6360 Visits were also paid to children of school age in cases of suspected infectious disease, and to follow up these recommended for medical treatment or observation. The Health Visitors also attended as required at minor ailment, ophthalmic and cental clinics. WINTER SCHOOL The Winter School for Health Visitors and School Nurses has boon discontinued owing to the war. INFANT WELFARE CLINICS There are five Infant Welfare Clinics; ten sessions for infant consultation are held weekly. 11 The total attendances of children and mothers at the various sessions during the year numbered 21,258. In 1940 the number was 21,839. The figures for each clinic are sot out below. 1941 York House Whitton ton Hampton Hampton Wick. Total First attendance under 1 year 266 359 187 149 39 1000 1-5 years 108 161 72 47 33 421 Mothers 39 37 – 5 — 81 Total attendances Under 1 year 2590 5112 2365 1996 671 12734 1-5 years 2008 3149 1439 1167 670 8433 Mothers 40 43 – 8 — 91 4638 8304 3804 3171 1341 21258 DENTAL TREATMENT OP CHILDREN UNDER 5 YEARS During the year, 127 children under 5 years of age received complete dental treatment. MILK AND OTHER FOODS, ETC. During the year, 481 applications for assisted supplies of milk and other foods wore granted in necessitous cases and supplied free of charge. The total quantity of milk supplied was as follows :- Liquid milk - nil Dried milk - 16,774- lbs. CHILD LIKE PROTECTION There have been a few instances where foster parents failed to send proper notice of reception or removal of a fostor child. Proceedings were instituted in one case in respect of these contraventions, and in other instances a warning letter was sent. All the Health Visitors are appointed Child Life Protection Visitors, and the visits of supervision of foster- children are carried out by them. Details of registration during 1941 were:- Number of persons receiving children for reward at end of the year 88 Number of children on register at end of year 98 Number of children who died during year 2 Proceedings taken during the year 1 12 WAR-TIMS NURSERIES In Juno 1941 a sub-commit too was formed, to deal with the question of opening Day Nurseries for children under 5 years of ago whose mothers are working. ORTHOPAEDIC TREATMENT No formal arrangement has boon made for the treatment in the Borough of children requiring massage, orthopaedic treatment or remedial exercises, and cases are referred to the Middlesex County Council Clinic at Brentford, to the West Middlesex County Hospital, or to other hospitals able to undertake the treatment of such cases. During the year assistance was granted towards the cost of maintenance of one child at a special open-air school and the maintenance of one child in hospital for a prolonged course of ophthalmic treatment. NURSING HOMES There are ten registered private nursing homes in the Borough. All the homes were kept under periodic supervision during the year. The three voluntary hospitals Which receive private patients are exempted from registration, and the Bearsted Memorial Hospital which has removed from the East End of London to the Hampton Court Hotel for the duration of the war, is also exempted. 13 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. DRAINAGE AND SEWERAGE, PUBLIC CLEANSING The arrangements under this heading were as described in my last report. RIVERS AND STREAMS No complaints of pollution of the River Thames or streams wore received by the Department during the year. SANITARY INSPECTION OP DISTRICT There was no change in the personnel of the Sanitary Inspectorate. During the latter half of the year the three, Inspectors engaged whole-time on billeting and A. R,P. duties resumed their normal work in the Department. Little work under the Housing Acts was carried out during the year. Although due allowance is made for shortage of labour and materials, the execution of urgent work is insisted upon. Twenty-five Statutory Notices were served. The visits paid in respect of each branch of the work are set out under the appropriate headings. Notices served Informal notices served 436 Informal notices complied 422 Housing Act 1936; Sections 9 & 10:- Statutory notices served - Statutory notices complied:- (a) By owners 2 (b) By local authority in default of owners 1 Public Health Acts Statutory notices served 25 Statutory notices complied:- (a) By owners 19 (b) By local authority In default of owners - Pood & Drugs Act 1938; Section 13. Statutory notices served 1 Statutory notices complied 1 14 Summary of visits and inspections Visits to premises after complaint 1,175 Visits to properties under notice and work in progress 3,525 Total visits and inspections 10,457 Summary of wrorks executed In consequence of visites Drains unstopped and repaired 7 Complete drainage reconstructions Water supply cisterns repaired Draw taps from main provided Gutters repaired 8 Roofs repaired 17 W.C. apartments repaired or rebuilt 1 W.C's repaired 6 Dustbins provided 4 Damp walls remedied 12 Ventilation provided Rooms stripped and cleansed 98 Offensive accumulations removed 11 Other works carried out 497 Overcrowding.. Housing Act 1936 (a) (i) Number of dwellings crowded at the end of the year 56 (ii) Number of families dwelling therein 56 (iii) Number of persons dwelling therein 422½ (b) Number of new cases of overcrowding reported during the. year 4 (c) (i) Number of cases of overcrowding relieved during the year 4 (ii) Number of persons concerned in such cases 20 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) Pound to be infested 2 (b) Disinfosted 2 (2) Numbor of other houses:- (a) Found to bo infested 58 (b) Disinfested 58 The methods of disinfestation employed were as set out in previous reports. During the year under review the insecticide solution used was "Zaldecide ." 15 Scabies There was an increase in the number of cases of scabies brought to the notice of the Department during the year. Facilities for diagnosis were available at the Public Health Department and school clinics while treatment was available at the latter and five first aid posts. The arrangements worked well, their success being duo to the excellent cooperation between medical officers, private medical practitioners, nurses in charge of first aid posts, sanitary inspectors and health visitors, To strengthen the powers of Local Authorities in combating the increase of scabies, which has resulted from wartime conditions, e.g. overcrowding, etc., the Scabies Order, 1941 was made by the Minister of Health and came into operation in October. 1941. The Order provides for the inspection of premises in which persons found to be verminous are or have been accommodated, for the examination and treatment of any other persons in those premises who may be verminous, and for any necessary cleansing or destruction of articles on the premises. COMMON LODGING-HOUSE There is one common lodging-house situated within the Borough. Regular visits were paid to the promises and the conditions were found to bo satisfactory. The registration was renewed. SCHOOLS There are in the Borough 26 elementary schools,, four secondary schools, and a technical college. These are regularly visited by the Sanitary Inspectors. PETROLEUM (REGULATION) ACTS, 1920 & 1936 Petroleum spirit and carbide of calcium stores were kept under supervision by the sanitary Inspectors, Licenses wore issued in respect of 101 promises during the year. The number of visits paid by the Inspectors was 201. SHOPS ACT 1934 The relevant provisions of the above Act regarding. sanitary conveniences, etc., are carried out by the Health Department. One certificate was granted exempting certain shop promises from the requirements of Section 10 (2) of the Act concerning the provision and maintenance of suitable and sufficient sanitary conveniences for the use of persons employed in or about the shop. 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. 16 FACTORIES ACT 1937 Inspections for purposes of provisions as to health Inspections Written Notices Factories with mechanical power 125 4 Factories without mechanical power 60 6 Other premises under the Act 67 •• Total 252 10 Summary of defects found Found Remedied Want of cleanliness 5 5 Overcrowding - 1 Inadequate ventilation 1 1 Sanitary conveniences- Insufficient 3 1 Unsuitable or defective 6 4 Not separate for sexes 1 - Other offences 2 2 Total 16 14 ESTABLISHMENTS FOR MASSAGE OR SPECIAL TREATMENT Eight applications for licences in respect of establishments for massage or special treatment were granted, during the year. HAIRDRESSERS' AND BARBERS' PREMISES Hairdressers' and barbers' premises in the Borough wore kept under supervision to ensure the required standard of cleanliness being maintained in conformity with the bye-laws RENT AND MORTGAGE INTEREST RESTRICTIONS ACTS 1920 TO 1938 During the year twenty-one certificates wore granted under the above Acts in respect of promises which were not in a reasonable state of repair. INSPECTION AND SUPERVISION OF FOOD Milk Supply During the year, 125 visits were made by the Sanitary Inspectors to dairies, cowsheds and milkshops within the Borough. Milk (Special Designations) Orders, 1956 & 1950 The following licences for sale of designated milk were granted during the year:- "Tuberculin tested" milk 17 "Accredited" 1 "Pasteurised" milk 27 17 Meat and. Other Poods Since the operation of the Livestock (Restriction on Slaughtering) Order, 1940, all general slaughtering in the Borough has ceased. Occasional slaughter has taken place under a licence granted by the Ministry of Food. Pour slaughter-house licences were renewed during the year. In three other cases consideration was deferred pending execution of essential repairs. Number of pigs killed - 13 Number of pigs inspected - 13 The following meat and other foods were found unfit for human consumption 145 lbs. Beasts' heads 113½lbs . Beef 2 Pigs' heads 14 lbs. Pork 18½ lbs. Bacon 20½lbs. Mutton 83½lbs, Lamb 38 Rabbits 165 lbs. Rabbits 25 Chickens 27 Tins meat 338 lbs. Pish 10 doz. Escollopes 300 tins fish roll 9 tins fish 3 lbs. Potatoes 36 tins Vegetables 92 cwt. Oranges 4 tins Fruit 75 lbs. Apples 189 tins Milk 182 lbs. Cake 4 loaves Broad 1,435 Eggs 27 lbs. Cheese. During the year, the following visits were made to premises upon which food is prepared or sold:- Butchers' shops 273 Restaurants and eating-house kitchens; Grocers' shops 197 Greengrocers' shops 96 Pish shops 89 Ice cream, etc. Premises 25 Prosecution Proceedings were instituted in respect of the sale of an unsound sliced Wrapped loaf. The case,was dismissed on payment of £10, 10.0. costs. FOOD POISOMNG Two cases of Trichiniasis occurred in the Borough during the year. The first patient was a girl aged 17½ years, employed in a local metal factory. She was last at work on the 7th November, 1941. The date of onset was 3.11.41. Her doctor visited her for the first time on 12.11.41. and the case was notified to me on 1.12.41. The girl was sent to hospital on 15.11.41. with the diagnosis uncertain. She had eaten raw bacon on 3.11.41. obtained from a shop In Twickenham. The second patient was a married woman aged 50 years, a housewife. She was taken ill on 7.11.41; her doctor's first visit was paid on 13.11.41, and she was notified to me on 3.12.41. She was admitted to a local Nursing Home on 17.11.41. She had eaten pork (presumably undercooked) on 26.10.41. 18 The symptoms in both those cases were marked symmetrical swelling of the. eyelids and upper part of the face, resembling nephritis, and with some discolouration round the eyes; temperature varying from 100 to 104; slight abdominal pains; drenching sweats; tenderness of muscles. The older woman had severe diarrhoea resembling cholera. The girl complained of intense headache at the onset. The older.woman had marked tachycardia and respiratory distress, resembling pneumonia. The girl had an cosinophilia count of 27% and the woman 38%. The diagnosis in the girl was confirmed by muscle biopsy, but this was not done in the case of the woman, although the diagnosis was considered by a specialist to be certain. As soon as it became certain wo had trichiniasis in our area, largo advertisements were inserted in the local newspapers and some notices were printed and displayed in butchers' shops and shops selling sausages, etc. The Ministry of Health sent a representative who saw the patients and continued, investigations as to source. The girl appeared to have boon infected from raw bacon obtained from a branch butcher's shop and the woman from pork obtained from the same shop. At the shop there was difficulty in identifying the exact batch and its source, from which those two customers had been supplied. Subsequent investigation throw no further lighten the matter. MIDDLESEX COUNTY COUNCIL (GENERAL POWERS) act, 1938 The registration of hawkers of meat, fish 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 7 persons and 7 promises were on the Register. FOOD AND DRUGS ACT.1953 The Middlesex County Council are the Food and Drugs Authority for the Borough. 19 INPECTI0US DISEASES (a) NOTIFIABLE INFECTIOUS DISEASES Diphtheria During the year 25 cases of diphtheria were notified as compared with 18, 25 and 70 respectively for 1940, 1939 and 1938. All the cases were admitted to hospital. There were three deaths. 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. During the year an intensive diphtheria immunization campaign was undertaken. Wide publicity was given to the free facilities available. In addition to the special clinics immunization was also carried out by the Medical Officers at a number of schools in the Borough. The following is a brief summary of the useful work carried out:- Total No, of now cases 4,532 Schick Testing:- 1st Schick Test (before Inoculation) No. Tested 557 No. Susceptible 281 No. Immune 258 No. Failed to attend 18 2nd Schick Tost (after completion of 1st course of injections). No. Tested 3,294 No. Protected 2,511 No. Susceptible 474 No. Failed to attend 319 All those found to be incompletely protected after the second Post Schick were re-inoculated. Total No. of attendances for year 16,102 The diphtheria prophylactic used was A.P.T. Scarlet Fever Seventy-eight cases of Scarlet Fever wore notified as compared with 38, 93 and 274 respectively for 1940, 1939 and 1938. Twenty-seven cases were admitted to hospital. There wore no deaths. Smallpox No case of smallpox was notified during the year. Pneumonia, Malaria and Dysentery Pnoumonia There were 81 cases of pneumonia notified as compared with 44 for the previous year. Tho number of doaths recorded from this disease was 64. 20 Malaria; Dysentery. No cases of malaria or dysentery were notified during the year. Acute Poliomyelitis, Acute Polio-encephalitis One case of acute poliomyelitis was notified due the year. There were no deaths. 0phthalmia Neonatorum The following table shows the number of cases notified and result of treatment:- Year Cases notfd. Cases at home treated in hosp. Vision Unimpaired Vision Impaired Total Blindness Deaf 1941 5 2 3 5 - - - Puerperal Pyrexia Nine cases of puerperal pyrexia were notified during the year. Three wore treated in the West Middlesex Hospital. Enteric Fever Seven cases of paratyphoid were notified, all of which were admitted to hospital. There was no evidence suggesting milk or water supplies as source of infection. Typhoid Imrnunization. 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 956 people had boon immunized. The total attendances at the clinics numbered 1968. Cerebro-spinal fever Sixteen cases of cerebro-spinal fever were notified during the year. There were two deaths. Measles and Whooping Cough. During the year 292 cases of measles were notified, as compared with 956 for the previous year. There wore two deaths. Whooping cough became prevalent during the year, 326 cases being notified as compared with 46 for the previous year. The peak period was the month of June, when 68 cases were notified. Seven deaths were recorded from the disease. (b) NON-NOTIFIABLE INFECTIOUS DISEASES During the year information was received from the Head Teachers and otherwise regarding 79 cases of mumps and 22 cases of chickenpox. TUBERCULOSIS The number of new cases of tuberculosis notified during 1941 was 141 as compared with 126 for the previous year The number of deaths recorded from this disease was 61. The following table prepared from the records in the Department summarises the position. 21 New Cases and Mortallity, 1941 New Cases Deaths pulmonary NonPulmonary Pulmonary Non- Pulmonary M F M F M F M F Under -1 3 - 1 - - - 1 1 1-5 3 2 - 1 - — 1 - 5-10 1 - — — - — — - 10-15 2 1 1 — — - — - 15-20 9 10 1 1 2 2 - - 20-25 7 9 2 1 2 3 1 - 25-35 18 13 1 2 3 7 1 1 55-45 16 6 - — 9 5 - - 45-55 10 1 1 — 9 2 1 - 55-65 8 2 1 - 7 1 - - 65 & upwards 4 2 1 - 2 1 - - Totals 81 46 9 5 34 21 5 1 Public Health (Prevention of Tuberculosis) Regulations,1925. Public Health Act, 1936 ( Section 172) No action was taken under the above during the year. PREVENTION OP 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. 22 CASES OF INFECTIOUS DISEASES NOTIFIED DURING 1941 DISEASE CASES NOTIFIED AT VARIOUS AGES (YEARS) Total Cases notfd. Cases admtd. to Hospt. 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 Acute Poliomyelitis - - - — - - - 1 - - - - - 1 - - Cerebro-Spinal Fever - 2 - 1 - 3 1 3 2 2 1 1 - 16 16 2 Diphtheria - - - 1 1 11 5 3 - 2 - 2 - 25 25 3 Erysipelas - - - - - - - - 1 1 1 12 4 19 3 - Measles 5 23 38 34 35 113 24 10 3 2 2 3 - 292 5 2 Ophthalmia Neonatorum 5 - - — — — — — — — — - - 5 3 — Paratyphoid - - - - - - 1 2 3 - 1 - - 7 7 - Pneumonia 6 - 1 1 1 7 1 6 4 8 76 27 12 81 6 64 Scarlet Fever - - 6 2 5 27 16 6 3 8 4 1 - 78 27 - Whooping Cough 23 41 37 37 44 127 5 - - 4 3 3 2 326 7 7 Puerperal pyrexia - - - - - - - - 2 4 3 9 - 24 MONTHLY INCIDENCE OF INFECTIOUS DISEASES DURING THE YEAR 1941 disease ITTLIBEE OF CASES total JAN. feb. MAR. april MAY june july aug. sept. oct. NOV. dec. Acute Polionyelitis - - - - - - - 1 - - - - 1 Cerebro-Spinal Fever 1 - 2 1 1 3 1 1 1 - 3 2 16 Diphtheria 2 5 4 2 3 1 1 3 3 - - - 25 Erysipelas 3 - - - 3 2 1 2 1 4 1 2 19 Measles 66 61 39 34 24 17 6 22 3 1 9 10 292 Ophthalmia Neonatorum - - 1 - - - - - - 1 3 - 5 Paratyphoid - - - 2 3 1 - - - 1 - - 7 Pneumonia 13 20 8 8 7 6 4 1 1 4 5 4 81 Puerperal Pyrexia - 1 - - - - - 1 1 1 1 4 9 Scarlet Fever 4 12 3 10 6 8 2 1 12 9 7 4 78 Whooping Cough 20 17 23 51 33 68 35 24 20 11 8 6 326 INDEX Page Ambulance Facilities 7 Ante-Natal Clinics 8,10 Anti-toxin, Supply of 20 Births 4,10 Birth Control 10 Blindness, Prevention of 22 Care of Mothers during Confinement 11 Care of Mothers subsequent to Confinement 11 Child Life Protection 12 Common Lodging House 16 Cerebro-spinal Fever 21 Deaths 4,5 Dental Clinics 8 Dental Treatment 11,12 Diphtheria 20 Diphtheria, Immunization 8,20 Disinfestation 15 Drainage and Sewerage 14 Dysentery 21 Enteric Fever 21 Factories Act, 1937 17 Food, Inspection and Supervision of 17 , Food and Drugs Act, 1938 19 Food Poisoning 18 Hairdressers' and Barbers' Premises 17 Health Visiting 11 Health Education 9 Hospitals 8,9 Housing 10 Infantile Mortality 5 Infant Welfare Clinics 8,11 Infectious Diseases 8,20,21,23,24 Laboratory Work 7 Malaria 21 Massage or Special Treatment, Establishments fox 17 Maternal Mortality 4 Measles 21 Middlesex County Council (General Powers) Act, 1938 19 Midwifery and Maternity Services 10 Midwives Acts 10 Milk and Other Foods, etc., Provision of 12 Milk Supply 17 Nursing Associations 7 Nursing Homes 13 Ophthalmia Neonatorum 21 Ophthalmic Clinics 8 Orthopaedic Treatment 13 Petroleum (Regulation) Acts 16 Pneumonia 20 Poliomyelitis 21 Polio-encephalitis 21 Public Cleansing 14 INDEX - continued Page puerperal Pyrexia 8,21 Rats and Mice (Destruction) Act 16 Rant and Mortgage Interest Restrictions Acts 17 Rivers and Streams 14 Sanitary Inspection of District 14 Scabies 16 Scarlet Fever 20 Schools 16 School Clinics 8 Shops Acts 16 Slaughtering of Animals 18 Smallpox 8,20 Statistics, General and Vital 3,6 Swimming Baths and Pools 15 Tuberculosis 8,21,22 Typhoid Immunization 8,21 Unsound' Food 18 Wartime Nurseries 13 Water Supply 14 Whooping Cough 21 Winter School for Health Visitors 11