AC 439(1) TWICKENHAM Maddy LIBRARY TWL 10 BOROUGH OF TWICKENHAM Annual Report OF THE MEDICAL OFFICER OF HEALTH 1942 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 OP THE BOROUGH OP TWICKENHAM. Ladies and Gentlemen, I have the honour to submit my Annual Report on the public health and sanitary condition of the Borough during the year ending 31st December, 1942. The report is condensed, partly for economy of time and paper, and partly through the omission of" certain figures and tables. In spite of continued strain of war, overwork, fatigue and Inconveniences, the health of the people remained remarkably satisfactory. Epidemic sickness kept within low limits; only seven cases of diphtheria were notified during the year as compared with twenty-five the previous year, and tuberculosis showed a welcome decrease both in the incidence of new cases and in a lowered mortality. The general death rate fell from 13.0 in 1941 to 11.6 In 1942; the maternal death rate fell slightly; and the infantile death rate fell substantially from 70.95 in 1941 to 53.1 in 1942. There was still a heavy illegitimate infant mortality of 102.3 Infant deaths per 1,000 illegitimate live births. The number of births increased from 1,234 in 1941 to 1,525 in 1942 with a corresponding rise in the birth rate per 1,000 resident population from 13.4 to 16.49. The Diphtheria Immunization Campaign showed continued success. There were 3,802 new cases dealt with a little less than in 1941. The number of oases notified was substantially less than in any previous year, indicating that the effects of the campaign were already being felt. During this year, the volume of work undertaken by the Department continued to grow. Once again I have to acknowledge the great loyalty of the staff and their unfailing willingness. I desire also to record my gratitude to the Chairman and Members of the Public Health and Maternity ard Child Welfare Committees for their helpfulness and support, which were of the greatest encouragement through thi3 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 other 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 1942 Area in acres 7,007 Number of inhabited houses (1942) 28,790 Rateable Value (51st December 1942) £1,031,978 Sum represented by a penny rate £4,160; 5; 0. Total M F Live births: Legitimate 1,437 742 695 Illegitimate 88 43 45 Birth rate per 1,000 of estimated resident population 16.49 Total M F Still births: Legitimate 42 20 22 Illegitimate 5 4 1 Still birth rate per 1,000 total (live and still) births 29.9 Total M F Deaths: 1,075 528 547 Death rate per 1,000 of estimated resident population 11.6 Maternal deaths: Puerperal & Post-Abortive Sepsis Other Maternal Causes 2 Rate per 1,000 Dotal (live and still) births 1.27 Death rate of infants under one year of age:- All infants per 1,000 live births 53.l Legitimate infants per 1,000 leg. live births 50.1 Illegitimate infants per 1,000 illeg. live births 102.3 Deaths from: Cancer (all ages) 203 Measles (all ages) 1 Whooping cough (all ages) 3 Diarrhoea (under 2 years of age) 16 3 STATISTICS, SOCIAL CONDITIONS AND GENERAL PROVISION Of HEALTH SERVICES FOR AREA BIRTHS The live births registered in the Borough in 1942 numbered 1,525, giving a birth rate of 16.49 per 1,000 of the population (England and Wales 15,8). The births were made up as follows:- Males Females Total Legitimate 742 695 1,437 Illegitimate 43 45 88 Total 785 ■ 740 1,525 The number of births represents an increase of 291 compared with the previous year. Illegitimate births formed 5.77% of the total births. Still births. There were 47 still births registered during the year giving a still birth rate of 29.9 per 1,00.0 total (live and still) births. DEATHS The nett deaths registered in the Borough during 1942 were:- Males Females Total 528 547 . 1,075 This represents a decrease of 121 compared with the previous year. The death rate per 1,000 of the population was 11.6, the same as that for England and Wales. An analysis of the death returns shows that the main causes of death were:- (1) Diseases of the heart and circulatory system (2) Cancer (3) Bronchitis, Pneumonia and other respiratory diseases (4) Tuberculosis. 4 CAUSES OF DEATH 1942 Registrar General's Official Returns Causes of Death Males Females Total All Causes 528 547 1,075 1. Typhoid and paratyphoid fevers - 1 1 2. Cerebro-spinal fever - 2 2 3. Scarlet Fever - - - 4. Whooping Cough 2 1 3 5. Diphtheria 1 - 1 6. Tuberculosis of Respiratory System 29 20 49 7. Other forms of Tuberculosis 2 3 5 8. Syphilitic diseases 6 1 7 9. Influenza 2 7 9 10. Measles 1 - 1 11. Acute Polio-myelitis & polio-encephalitis - - - 12. Acute infective encephalitis - - - 13. Cancer of buccal cavity and oesophagus (M) Uterus (F) 7 18 25 14. Cancer of stomach & Duodenum 16 8 24 15. Cancer of breast — 23 23 16. Cancer of all other sites 74 57 131 17. Diabetes 1 5 6 18. Intra-cranial vascular lesions 32 62 94 19. Heart disease 141 154 295 20. Other diseases of circulatory system 10 13 23 21. Bronchitis 31 16 47 22. Pneumonia 27 30 57 23. Other respiratory diseases 8 5 13 24. Ulcer of stomach or duodenum 10 4 14 25. Diarrhoea under 2 years 9 7 16 26. Appendicitis 3 3 6 27. Other digestive diseases 13 14 27 28. Nephritis 18 8 26 29. Puerperal & Post-abortive sepsis - - - 30. Other maternal causes - 2 2 31. Premature birth 8 11 19 32. Congenital malformations, birth injury, infantile diseases 15 6 21 33. Suicide 5 3 8 34. Road traffic accidents 2 - 2 35. Other violent causes 15 13 28 36. All other causes 40 50 90 MATERNAL MORTALITY During the year two deaths were registered as being due to diseases or accidents of child-birth. The maternal mortality rate per 1,000 total (live and still) births, was 1.27 compared with 2.01 for England and Wales, INFANTILE MORTALITY There were. 81 deaths of infants under one year during the year, giving an infantile mortality rate of 53.1 per 1,000 live births. This shows a very favourable reduction compared with the figure of 70.95 for 1941. The rate for England and Wales in 1942 was 49. Congenital malformations, premature birth, etc. caused 40 (or 49.38%) of the total infant deaths. 5 6 BIRTH RATE, DEATH RATE AND ANALYSIS or MORTALITY" DURING 1942 Provisional figures Rate per 1,000 total population Annual Death Rate 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 . . . Diarrhoea & Entertis (under 2 years). Total deaths under 1 year England & Wales 15.8 0.54 11.6 0.00 - 0.01 0.00 0.02 0.05 0.09 5.2 49 126 County Boroughs and great towns, including London 17.3 0.66 13.3 0.00 - 0.02 0.00 0.03 0.06 0.09 7.5 59 11+8 smaller towns (resident populations 25,000 to50,000 at 1931 census). 18.4 0.62 12.1 0.00 - 0.01 0.00 0.02 0.04 0.10 4.8 46 London Adm. County 14.0 0.48 13.9 0.00 - 0.01 0.00 0.04 0.02 0.07 8.6 60 TWICKENHAM 16.49 0.51 11.6 0.01 - 0.01 0.00 0.03 0.01 0.09 10.49 53.1 LABORATORY WORK The usual arrangements were continued during the year and worked satisfactorily. The following table gives the number of specimens examined during the year:- Nature of Specimens No. Result Throat and nasal swabs for diphtheria 245 3 Positive Sputum, etc. for tubercle bacilli 115 10 Positive Miscellaneous 9 Total specimens examined 369 AMBULANCE FACILITIES (1) Infectious diseases (2) Non-infectious and accident cases The ambulance facilities were as described in my last report. The following table shows the work done under (2) by the borough ambulance service during the year 1942:- Year 1942 Total Calls Patients Carried Mileage 1st quarter 315 317 2306.00 2nd quarter 306 298 2155.05 3rd quarter 349 346 2728.80 4th quarter 320 321 3028.70 1290 1282 10218.55 NURSING IN THE HOME The five home-nursing associations in the Borough continued their good work and during the year the Council contributed £300 to the funds of the associations. CLINICS AND WELFARE CENTRES Details of the clinics held within the Borough were set out in my last report. HOSPITALS Smallpox Hospital accommodation, as necessary, is provided by the Middlesex County Council. Tuberculosis Facilities for diagnosis, treatment and institutional care are provided by the Middlesex County Council. There is no clinic in the Borough, but an excellent Dispensary with modern equipment is available at 28, Bell Road, Hounslow. Puerperal Pyrexia During the year the arrangements for the provision 7 of hospital accommodation were reviewed. As a result of negotiations with the appropriate authorities, the following order of priority is used where hospital treatment is desired:- (1) West Middlesex County Hospital (2) North Western Hospital, Hampstead (3) South Middlesex Fever Hospital, Mogden (at discretion of Medical Superintendent) Infectious Diseases. Other cases of infectious diseases were admitted, as necessary, to the South Middlesex Fever Hospital (Mogden) OTHER HOSPITALS There are Three voluntary hospitals in the borough, viz., St, John's Hospital,' Twikenham, St. Mary's Hospital, Hampton, and the Teddington, Hampton Wick and District Memorial Hospital, Teddington. The Council contributed the. total sum of £190 to these hospitals during the year. MATERNITY AND CHILD WELFARE MIDWIFERY AND MATERNITY SERVICES The total number of births notified as occurring in the Borough was 1390. This does not include births which occurred elsewhere, but which were subsequently transferred to Twickenham. Of the births occurring in the Borough, 1038 (74.25%) were attended by midwives in their capacity as midwives, and 360 (25.75/ ) by doctors. Municipal, midwives attended 54.8 births (59.2%)- 401 in their capacity as midwives and 147 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 wore:- York House Centre One weekly session, plus additional session on second and fourth week each month. 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 1942 1038 4842 8 A largo part of this increase is duo to the work of the Council's Municipal Midwives. 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 CARE OP MOTHERS DURING CONFINEMENT The arrangements were as described in my last report. SUBSEQUENT TO CONFINEMENT Eighteen cases of puerperal pyrexia occurred during' the year. Eight patients were admitted to the West Middlesex County Hospital; nine were treated in nursing homes; and one was treated at home. All the patients recovered. No application was received during the year for the services of a consultant in any case of puerperal pyrexia. Post-natal care is carried out at the ante-natal clinics, and mothers are urged to attend. The numbers of mothers who attended were:- 1959 - 98 1941 - 297 1940 - 71 1942 - 255 This York is progressing well, and Health. Visitors and Midwives are of great help in persuading mothers to attend for examination. ..... No maternal death occcurred in the Borough, but two Twickenham residents whose confinements took place in institutions outside the Borough died in consequence of childbirth during the year. DENTAL TREATMENT. Arrangements for dental treatment for expectant and nursing mothers were continued during the year. The following received treatment:- 1942 1941 1940 Expectant mothers 69 52 17 Nursing mothers 32 55 19 patients supplied with dentures 55 37 39 Dentures supplied 100 65 73 HEALTH VISITORS No change took place in the number (8) of the Council Health Visitors, who also carry out the duties of school nurses on behalf of the Middlesex County Council. Their visits included the following:- 1942 1941 1940 To expectant mothers 354 452 358 To children under 1 year of age 3921 4016 3961 To children between the ages of 1 and 5 years 7157 7834 6360 9 Visits were also paid to children of school age for suspected infectious disease,and to follow up those recommended for medical treatment or observation. The Health Visitors also attended as required at minor ailment, ophthalmic and dental clinics. SUMMER SCHOOL Two members of the health visiting staff attended a Summer School for Health Visitors and School Nurses. INFANT WELFARE CLINICS There are five Infant Welfare Clinics; ten sessions for infant consultation held weekly. The total attendances of children and mothers at the various sessions during the year numbered 25,555. In 1941 the number was 21,258. The figures for each' clinic are as follows:- 1942 York House Whitton Teddington Hampton Hampton Wick Total First attendance under 1 year 306 420 243 147 70 1,186 1-5 years 97 91 71 28 52 339 Mothers 1 1 ' - . 5 - 7 Total attendances Under lyyear 3,583 . - 5,795 3,116 2,032 1,092 15,418 1-5 years 1,619 3,831 2,097 1,552 1,031 10,130 Mothers 1 1 — 5 — 7 5,003 9,627 5,213 3,589 2,123 25,555 DENTAL TREATMENT OF CHILDREN UNDER 5 YEARS During the year, 109 children under 5 years of ago received complete dental treatment. MILK AND OTHER FOODS, ETC. During the year, 267 applications for assisted supplies of dried milk and other foods were granted in necessitous cases and supplied free of charge, The total cost of goods supplied was £112. 11. 7d. CHILD LIFE PROTECTION The duties of Child Life Protection Visitors are carried out by the Health Visitors. Regular visits of supervision wore carried out by them during the year. Details of registration during 1942 were:- Number of persons receiving children for reward at end of the year 55 Number of children on register at end of year 96 Number of children who died during year 1 Proceedings taken during the year Nil 10 WAR-TIME NURSERIES In 1942 three War-time Day Nurseries were opened in the Borough. These nurseries are at 51, Hampton Road, Teddington; 40, Cambridge Park, Twickenham; ' and in the grounds of Heathfield School, Powdermill Lane, Whitton. They accommodate a total of 135 children varying in age from 1 month to, 5 years, whose mothers are engaged in various typos of war work. These 'Nurseries have proved very popular and each has a waiting list. The Nurseries are affiliated to the National Society of Children's Nurseries. Student probationers are trained for the Nursery Nurses' Diploma of the Socioty. ORTHOPAEDIC TREATMENT The arrangements under this heading were described in my last report. HOSPITAL TREATMENT During the year assistance was granted towards the cost of maintenance of three children (one for convalescence after severe burns and two for orthopaedic treatment). NURSING HOMES There are eleven 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. OPHTHALMIC TREATMENT OF CHILDREN UNDER 5 The ophthalmic service for school children has been extended so that children under 5 may be seen by the Ophthalmic Surgeon, and nineteen children were referred to him during the year. 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 There have been no major alterations or modifications of the soil sewer system in the Borough during the past year. A length of a main outfall surface water sewer in Strafford Road has been relaid. The disposal of soil sewage into the Mogden sewers 11 and works of the Middlesex County Council has continued without modification of any kind. RIVERS AND STREAMS No complaints of pollution of the river Thames or streams were received by the Department during the year. PUBLIC CLEANSING The three refuse destructors at Twickenham, Teddington and Hampton, remain in use, pending approval of a centralising scheme after the war. The more intensive salvage operations, together with a number of alterations made at the Twickenham destructor site to assist these operations, have considerably diminished the wear and 1 tear on the destructor furnaces, and are enabling those plants to cope with a situation which would otherwise be causing grave difficulties. It is of interest to note that the Corporation's receipts for salvage sold are now well over £12,000 per annum. SANITARY INSPECTION OF DISTRICT. The visits paid in each branch of the work are set out under the appropriate headings. Notices served Informal notices served - 453 Informal notices complied - 389 Housing Act 1936; Sections 9 & 10:- Statutory notices served Statutory notices complied:- (a) By owners - (b) By local authority in default of owners Public Health Acts:- Statutory notices served - 37 Statutory notices complied:- (a) By owners 24 (b) By local authority in default of owners 1 Summary of visits and inspections Visits to premises after complaint - 1,419 Visits to properties under notice and Work in progress - 4,343 Total visits and inspections - 14,898 Summary of works executed in consequence of visits Drains unstopped and repaired - 60 Complete drainage reconstructions - 5 Water supply cisterns repaired - 3 Draw taps from main provided - 7 Gutters repaired - 76 Roofs repaired - 170 W.C. apartments repaired or rebuilt - 10 W.C's repaired - 34 Dustbins provided - 52 Damp walls remedied - 78 Ventilation provided - 4 Rooms stripped and Cleansed. - 83 Offensive accumulations removed - 5 Other works carried out — 538 12 Overcrowding. Housing Act, 1936 (a) (i) Number of dwellings overcrowded at the end of the year - 59 (ii) Number of families dwelling therein 59 (iii) Number of persons dwelling therein 440½ (b) Number of new cases of overcrowding reported during the year - 9 (c) (i) Number of cases of overcrowding relieved during the year - 6 (ii) Number of persons concerned in such cases - - 34½ SMOKE ABATEMENT No formal action regarding excessive emission of smoke was necessary during the year. SWIMMING BATHS AND POOLS Two of the Council's open-air swimming baths were in use during the summer. Regular inspections were made by the Sanitary Inspectors. Samples of water were taken for bacteriological examination and, as usual, these proved to be highly satisfactory. DISINFESTATION During the year 72 promises were found to be verminouse Disinfestation was carried out by the Department, the insecticide used being Zaldecide. No requests were received from the Housing Department for the disinfestation of the belongings of persons before removal to Council Houses Scabies As in the case of other non-notifiable infectious diseases, it is not possible to arrive at accurate information as to the incidence of scabies in the Borough. Some indication is however obtained from the number of cases treated at the First Aid Posts. During the year over 900 (children and adults) were dealt with. The work has progressed very smoothly and reflects great credit on the nurses in charge of the posts. The technique of treatment was continually under review and in January a preparation based on the following formula was tried:- Benzyl Benzoate 20%, Lanette Wax S.X. 1.5%, Water 78.5%. This was found to be an improvement on the earlier preparations. At the same time the arrangements for the disinfestation of bedding were reviewed in the light of experience. Generally speaking disinfestation was carried out only in the case of communal bedding, e.g. firewatchers. The Sanitary Inspectors follow up all cases coming to the knowledge of the Department. COMMON LODGING HOUSE There is one Common Lodging-house in the Borough, and the registration was renewed . The premises were kept in a satisfactory condition, SCHOOLS The sanitary arrangements at the elementary and secondary schools were regularly inspected by the Sanitary Inspectors during the year. 13 PETROLEUM (REGULATION) ACTS, 1928 & 1936 All promises licensed for the storage of petroleum spirit and carbide of calcium wore kept under supervision by the Sanitary Inspectors, 223 visits being paid during the year. Licences were issued in respect of 122 promises. SHOPS ACT 1934 No formal action under the relevant provisions of this Act was necessary. The certificate granted in previous years for one shop under Section 10(2) was renewed. RATS AND MICE ( DESTRUCTION) ACT, 1919 This Act is administered throughout the County by the Middlesex County Council, a number of complaints of rat infestation were received during the year. These were forwarded to the County Superintendent of Rat Destruction. FACTORIES ACT 1937 Inspections for purposes of provisions as to health Inspections Written Notices Factories with mechanical power 307 14 Factories without mechanical power 181 2 Other premises under the Act 159 - Total 647 16 Summary of defects found Found Remedied Wane of cleanliness 3 4 Sanitary conveniences - Insufficient 3 2 Unsuitable or defective 11 6 Not separate for sexes 1 Total 18 12 ESTABLISHMENTS FOR MASSAGE OR SPECIAL TREATMENT All establishments for massage or special treatment licensed by the Council were kept under supervision by the Department. Eight licenses were granted during the year. HAIRDRESSERS' AND BARBERS' PREMISES A register has been compiled of all hairdressers' and barbers' premises in the Borough. Regular inspection of these promises was carried out. 14 RENT AND MORTGAGE INTEREST RESTRICTIONS ACTS 1920 to 1938 Five certificates were granted under the above Acts in respect of premises which wore not in a reasonable state of repair, as compared with 21 for the previous year. INSPECTION AND SUPERVISION OF FOOD Milk Supply Almost the whole of the milk supply of the Borough comes from outside the area and has been pasteurised before delivery. This heat treatment is mostly carried out for commercial convenience and is not compulsory unless the milk is sold as pasteurised under the Regulations mentioned below. There is no doubt that from the public health point of view pasteurisation on a large scale and carried out by modern methods is a very efficient safeguard against the milk-borne infections. Until it is possible and practicable to produce pure milk, pasteurisation should bo our watchword. Milk in Schools Scheme All milk used in the schools under this scheme is pasteurised and is obtained only from dairymen licensed to sell it as such. Milk (Special Designations) Orders During the year the following licences were granted for the sale of designated milk:- "Tuberculin tested" milk - 19 "Accredited." - 1 "pasteurised" - 27 Slaughter-houses Four licences were renewed during the year. Consideration of the condition of three slaughter-houses was further deferred pending the execution of essential repairs. Slaughter of Animals Act. 1933 21 slaughter-men were on the register of the Department at the end of the year. Meat and Other Foods Except for the occasional slaughter of a pig under licence by the Ministry of Food, there was again no general slaughtering in the Borough. No. of pigs killed - 39 No. of pigs inspected - 39 The following meat and other foods were found unfit for human consumption:- 15 1 pig' heart unsound 379 eggs 1 pig affected with Tuberculosis 1 pig affected with septicaemia 238 lbs. cheese 1 pig's carcase and liver unsound 14 lbs. butter 230 lbs. beef 81 lbs. pork 3½ lbs margarine 1 forend of bacon 3 lbs. lard 20 lbs. 10 oz. bacon 8 lb3. 6 oz. mutton 156 lbs. cereals 79 lbs. lamb 1 pkt. Kellogs 8¼lbs. trimmings 1 tin spaghetti ¾lb. tongue 138¼ lbs. tea 679 lbs, 6 oz. fish 111 tins coffee 105 tins pilchards 1 tin cocoa 1 tin crawfish 37 tins herrings 315 lbs. sugar 11 tins sardines 2 tins syrup 1 tin prawns 56 tins salmon 35 jars jam 2 jars lemon cheese 81 rabbits 6 jars paste 11 tins of rabbits 16 bottles sauce 30 chickens 14 jars pickles 1 duck 1 tin rice pudding 156 lbs. potatoes 113 lbs. onions 22 pkts, biscuits 524 tins of vegetables 3 lbs, sweets 411 tins fruit 41 tins soup 1 box 50-60 prunes 1,878 tins milk 487 tins meat During the year, the following visits were made to promises upon which food is prepared or sold:- Bakehouses 135 Batchers' shops 460 Restaurants and eating-house kitchens; Grocers' shops 1,032 Greengrocers' shops 412 Fish shops 168. Ice Cream, etc. Premises 78 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 7 persons and 7 premises had been registered. FOOD AND DRUGS ACT 1938 The Middlesex County Council are the Food and Drugs Authority for the Borough. 16 INFECTI0US DISEASES (a) NOTIFIABLE INFECTIOUS DISEASES Diphtheria Notifications of diphtheria during the year dropped to the remarkably low level of 7, as compared with 25, 18, 25, 70 and 118 respectively for the five previous years. All seven cases were admitted to hospital. The effect of the immunization campaign is now being felt. One death only was recorded, giving a death rate of 0.01 per 1,000 of the population. The figure for England and Wales was 0.05. 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. Although there was some reduction in the number of cases dealt with, excellent progress was made during the year. Immunization facilities are provided for children under five years, school children, and adults at four separate morning sessions each week, and for children under five years, at any Infant Welfare Centre. As necessary, immunization is also carried out by the Medical Officers in the schools. The following is a brief summary of the work carried out during the year:- Total number of new cases - 3,802 Schick Testing:- 1st Schick Test (before Inoculation) No, tested - 94 No, susceptible - 24 No, immune - 64 No. failed to attend 6 2nd Schick Test (after completion of 1st course of injections) No. tested - 2,220 No. protected - 1,865 No. susceptible - 114 No. failed to attend 341 All those found to be incompletely protected after the second Post Schick were re-inoculated. Total No. of attendances for year - 12,214 The diphtheria prophylactic used was A.P.T. Scarlet Fever Daring the year 125 cases of scarlet fever were notified as compared With 78, 38, 93, 274 and 148 for the five previous years. 41 cases 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. Seven contacts were kept under observation. Pneumonia, Malaria and Dysentery Pneumonia. There wore 50 cases of pneumonia notified as 17 compared with 81 for the previous year. The number of deaths recorded from this disease was 57. Malaria . One case of malaria was notified during the year. Dysentery. One case of dysentery was notified during the year. Acute Poliomyelitis, Acute Polio-encephalitis. No cases of acute poliomylitis or acute polioencephalitis were notified, during the year, Ophthalmia Neontorum. 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. 1942 4 4 - 4 - - - Puerperal Pyrexia Eighteen cases of puerperal pyrexia were notified during the year. Eight were treated in the West Middlesex Hospital. Enteric Fever No cases of enteric fever (which includes the paratyphoid fevers) were notified during the year. One death was, however, recorded from this disease. Typhoid immunlzation. . Facilities were again available at the school clinics for typhoid immunization. During the year 974 people were immunized as. compared with 956 in 1941. The total attendances at the clinics numbered 2,004 (1,968 in 1941). Cerebro-spinal fever Three cases of Cerebro-spinal fever were notified as compared with 16 for the previous year. There were two deaths. Measles and Whooping Cough. There Was a prevalence of measles in the Borough during the year, the number of notifications received rising to 1,144 as compared with 292 for the previous year. The increase was to bo expected, since epidemics of measles usually occur every two years. There was one death. Ninety-one cases of whooping cough were notified, as compared with 326 for the previous year. There were three deaths. (b) NON-NOTIFIABLE INFECTIOUS DISEASES The chief source of information concerning the occurrence of non-notifiable infectious diseases comes from the Head Teachers, who send in a certificate whenever a child is absent on account of suspected infectious disease, or as a contact. During the year the following cases wore brought to the notice of the Department:- Mumps 49 Chicken-pox 12. 18 TUBERCULOSIS The number of new cases of tuberculosis notified during 1942 was 130 as compared with 141 for the previous year. The number of deaths recorded from this disease was 59, which showed a' slight decrease (61 in 1941). The following- tables prepared from the records in the Department summarise the position. NEW CASES AND MORTALITY 1942 Age Periods New Cases Deaths Pulmonary' NonPulmonary Pulmonary NonPulmonary '* M F M F M F M F Under 1 - - - - - - - - 1 - 5 1 - 2 - - - - - 5 -10 - - - 1 - - - 10 -15 3 1 1 - - - - — 15 -20 7 6 2 2 1 2 - 20 -25 9 8 - 2 3 2 1 — 25 -35 17 15 - 3 6 9 - - 35 -4-5 14 9 1 1 4 3 1 2 45 -55 13 3 2 7 6 3 - - 55 -65 4 2 - - 7 1 - - 65 & upwards — — — - 2 — - — Total 68 44 8 10 29 20 2 2 PRIMARY NOTIFICATIONS OF TUBERCULOSIS 1937-1942 INCLUSIVE 1937 1938 1939 1940 1941 1942 Pulmonary 85 100 106 114 127 112 Other forms 25 30 19 12 14 18 Total 110 130 125 126 141 130 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 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. 19 20 CASES OF INFECTIOUS DISEASES NOTIFIED DURING THE YEAR 1942 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 Cerebro Spinal Fever 1 - - 1 - - - - - - - 1 - 3 3 2 Diphtheria - - - 1 1 1 2 - 1 1 - - - 7 7 1 Dysentery - - - - - - - - - - - - 1 1 - Erysipelas — — - - — 1 - - - - 1 10 6 18 1 1 Malaria — - — - - - - — - 1 - - - 1 Nil - Measles 40 67 109 99 142 605 5b 15 3 8 1 1 - 1144 12 1 Ophthalmia Neonatorum 4 — - - - - - - - - - - - 4 Nil - Pneumonia 1 - 2 - 1 4 2 3 2 6 10 12 7 50 8 57 Puerperal pyrexia - - - - - - - - 5 10 3 - - 18 8 - Scarlet Fever - 2 2 11 16 68 13 1 5 2 5 - - 125 41 - Whooping Cough 5 9 13 7 18 39 - - - - - - - 91 9 3 21 MONTHLY INCIDENCE OF INFECTIOUS DISEASES DURING THE YEAR 1942 DISEASE NUMBER OF CASES TOTAL Jan. Feb. Mar. Apr. May June July Aug. Sept. Oct. Nov. Dec. Cerebro-spinal Fever - 2 - 1 - - - - - - - - 3 Diphtheria - - - 1 1 - - 1 2 1 - 1 7 Dysentery - - - - - - - - 1 - - - 1 Erysipelas 1 - 2 - 2 2 2 1 1 1 3 3 18 Malaria — - - - - - - - - - 1 - 1 Measles 6 70 141 49 73 179 120 106 19 58 125 198 1144 Ophthalmia Neonatorum - - - 1 — - 2 - - - - 1 4 Pneumonia 9 13 5 8 3 1 1 1 3 1 2 3 50 Puerperal Pyrexia - 1 3 - 1 - 4 1 2 2 1 3 18 Scarlet Fever 4 9 8 16 14 10 10 2 10 8 17 15 125 Whooping Cough 8 5 2 4 1 7 10 2 4 20 10 18 91 INDEX Page Ambulance Facilities 7 Ante-Natal Clinics 8 Anti-toxin, Supply of 17 Births 4,8 Birth Control 9 Blindness, prevention of 19 Care of Mothers during Confinement 9 Care of Mothers subsequent to Confinement 9 Child Life protection 10 Common Lodging House 13 Cerebro-spinal Fever 18 Deaths 4,5 Dental Treatment 9,10 Diphtheria 17 Diphtheria, Immunization 17 Disinfestation 13 Drainage and Sewerage 11 Dysentery 18 Enteric Fever 18 Factories Act, 1937 14 Food, Inspection and supervision of 15 Food and Drugs Act, 1938 16 Hairdressers' and Barbers' Premises 14 Health Visiting 9 Hospitals 7,8 Hospital Treatment 11 Housing 13 Infantile Mortality 5 Infant Welfare Clinics 7,10 Infectious Diseases 8,17,18,20,21 Laboratory Work 7 Malaria 18 Massage or Special Treatment, Establishments for 14 Maternal Mortality 5 Measles 18 Middlesex County Council (general Powers). Act, 1938 16 Midwifery and Maternity Service's 8 Midwives-Acts 8 Milk and Other Foods, etc., Provision of 10 Milk Supply 15 Nursing Associations 7 Nursing Homes 11 Ophthalmic Treatment of Children Under 5. 11 Ophthalmia Neonatorum 18 Orthopaedic Treatment 11 Petroleum (Regulation)Acts. 14 Pneumonia 17 Poliomyelitis 18 Polio-encephalitis 18 Public Cleansing 12 INDEX - continued Page Puerperal Pyrexia 7,18 Rats and. Mice (Destruction) Act 14 Rent and Mortgage Interest Restrictions Acts 15 Rivers and Streams 12 Sanitary Inspection of District 12 Scabies 13 Scarlet Fever 17 Schools 13 Shops Acts 14 Slaughtering of Animals 15 Smallpox 7,17 Smoke Abatement 13 Statistics, General and Vital 3,6 Summer School for Health Visitors 10 Swimming Baths and Pools 13 Tuberculosis 7,19 Typhoid Immunization 18 Unsound Food 15 Wartime Nurseries 11 Water Supply 11 Whooping Cough 18