Twl 11 borough of Twickenham Annual Report Of the MEDICAL OFFICER OF HEALTH ' 1943 JOHN MADDISON, M.D., b.S., D.P.ii. Medical Officer of Health Public Health Department Elmfield Hotise, High Street, Tedding ton. To the MAYOR, ALDERMEN AND COUNCILLORS OF THE BOROUGH OP TWICKENHAM Ladles 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, 1943, The report is again condensed for economy of paper, and again certain tables and figures have been omitted, The strain of war, overwork, fatigue and inconvenience continued throughout 1943; although the health of the people remained remarkably good it will occasion no surprise to note evidence of mental and physical fatigue. The death rate gives some index of vitality; It was a little higher than in 194212,3 as compared with 11.6. The lowest death rate for the Borough was 9.81 in 1938. The rates since 1938 have all been higher, with 1940 a peak year owing to enemy action. The birth rate in 1943 reached 17.7 per thousand of the estimated resident population, which is a record. There were 121 more births than in 1942; the number of Illegitimate births rose still higher to a total of 108 - also a record. The infantile mortality (deaths of infants per thousand live births) showed a reduction, but the still-birth rate was slightly higher, The deaths of illegitimate Infants showed a substantial fall from 102.3 in 1942 to 64.8 in 1943, but there is room for much improvement in the still-birth and Infant mortality rates. There was a distressing increase in the maternal mortality rate. Towards the end of the year the influenza epidemic accounted for a number of deaths, especially In old people, which otherwise might not have occurred; the effect of the epidemic Is reflected In the general death rate. Diphtheria was a new low record for the Borough, It has been shown that the age dist-ribution of the mortality from diphtheria indicates that the reduction is due to immunization. Heart disease continued to claim the greatest number of victims; cancer showed an unwelcome Increase,- with a number of deaths from breast cancer which ought to be capable of reduction. There were 15 deaths of infants under two years of age from diarrhoea - a figure -which also ought to be capable of reduction. Deaths from tuberculosis were slightly down, but the number of notifications of new cases was slightly increased. A special report on tuberculosis was presented to the Council during the year and was favourably received. It resulted in the introduction of some useful measures for helping in the fight against tuberculosis. We are promised, important changes in the medical arrangements for Improving the health.of the people. I trust these arrangements will providb- for a closer liaison and understanding between the practitioners, voluntary hospitals and local authority medical services. It is likely that good would come from regular consultations between these three groups. The healthiness or otherwise of any person depends on so many factors; there is great need for pooling all knowledge for research and Investigation, to determine'how the healthiness of the people can be improved. There is as yet no simple yard-stick for determining whether eaoh of us enjoys the highest state of health ' attainable. To achieve optimum healthiness for everyone requires -2- . close team work among all who are engaged in the work of medicine in all its implications; I would like to see this liaison closer, The public are always ready to listen to advice and information on health matters - the doctor in the literal role of teacher; but the information must be sound, based on accurate observation and experiment, and capable of proof. During the year the Department increased its educational activities and issued leaflets, posters and cinema slides on a number of subjects. The effort appears to bo well justified and worth increasing, 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 and Child Welfare. Committees for their helpfulness and support, which were of the greatest encouragement through this difficult period. I desire also to acknowledge with thanks the friendly co-operation and help which I received from by 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. -3- STATISTICAL SUMMARY for the year 1943 Area In acres 7,007 Number of Inhabited houses 28,808 Rateable value £1,033,694 Sum represented by a penny rate 1943/44 £4,178:4:3 Total M F Live births Legitimate 1538 845 693 Illegitimate 108 46 62 Birth rate per 1000 of estimated resident population 17.7 Total M . F Still births: Legitimate 51 28 23 Illegitimate 3 2 1 Still birth rate per 1,000 total (live and still) births 31.7 Total M F Deaths: 1144 545 599 Death rate per 1,000 of estimated resident population 12.3 Maternal deaths: Puerperal & Post-Abortive Sepsis 3 Other Maternal Causes 3 Rate per 1,000 total (live and still) births 3.5 Death rate of infants under one year of age All infants per 1,000 live births 47.99 Legitimate infants per 1,000 leg. live births 46.8 Illegitimate infants per 1,000 illeg. live births 64.8 Deaths from: Cancer (all ages) 220 Measles (all ages) 2 Whooping cough (all ages) - Diarrhoea (under 2 years of age) 15 STATISTICS, SOCIAL CONDITIONS AND GENERAL PROVISION OF HEALTH SERVICES FOR AREA BIRTHS The live births registered in the Borough In 1943 numbered 1,646, giving a birth rate of 17.7 per 1,000 of the population (England and Wales 16.5) The births were made up as follows:- Males Females Total Legitimate 845 693 1,538 Illegitimate 46 62 108 Total 891 755 1, 646 The number of births represents an increase of 121 compared with the previous year. Illegitimate births formed 6.56% of the total births, an increase of .79% on the previous year. Still births There were 54 still births registered during the year giving a still birth rate of 51.7 per 1,000 total (live and still) births. DEATHS The nett deaths registered in the Borough during 1943 were Males Females Total 545 599 1,144 This represents an Increase of 69 compared with the previous year. The death rate per 1,000 of the population was 12.3 as compared with 12.1 for England and Wales. Main causes of death. An analysis of the death returns reveals the following main causes of death:- Disease Percentage of total deaths Death rate per 1,000 population Diseases of heart and circulatory system 30.8 3.8 Infra-cranial vascular lesions 8.0 .99 Cancer 19.2 2.37 Bronchitis, Pneumonia and other respiratory diseases 11.4 1.4 Tuberculosis 4.1 .5 -5- CAUSES OP DEATH 1943 Registrar General's Official Returns Causes of Death Males Females Total All Causes 545 599 1,144 1. Typhoid and paratyphoid fevers - - - 2. Cerebro-spinal fever - - - 3. Scarlet Fever - - - 4. Whooping Cough - - - 5. Diphtheria 1 - 1 6. Tuberculosis of Respiratory System 31 11 42 7. Other forms of Tuberculosis 1 4 5 8. Syphilitic diseases 4 - 4 9. Influenza 11 15 26 10. Measles 1 1 2 11. Acute Polio-myelitis & polio-encephalitis 1 - 1 12. Acute infective encephalitis 1 - 1 13. Cancer of buccal cavity and oesophagus (M) uterus (F) 7 11 18 14. Cancer of stomach and duodenum- 13 20 33 15. Cancer of breast 1 29 30 16. Cancer of all other sites 82 57 139 17. Diabetes 1 7 8 18. Infra-cranial vascular, lesions 30 62 92 19. Heart disease 160 163 323 20. Other diseases of circulatory system 13 17 30 21. Bronchitis 18 27 45 22. Pneumonia 26 39 65 23. Other respiratory diseases 9 11 20 24. Ulcer of stomach or duodenum 8 2 10 25. Diarrhoea under 2 years 11 4 15 26. Appendicitis - 2 2 27. Other digestive diseases 13 13 26 28. Nephritis 9 11 20 29. Puerperal & Post-abortive Sepsis - 3 3 30. Other maternal causes - 3 3 31. Premature birth 12 9 21 32. Congenital malformations, birth Injury infantile diseases 14 8 22 33. Suicide 2 5 7 34. Road traffic accidents 7 1 8 35. Other violent causes 10 15 25 36. All other causes 48 49 97 MATERNAL MORTALITY During the year six deaths were registered as being due to diseases or accidents of child-birth, all of which occurred in institutions outside the Borough. The maternal mortality rate per 1,000 total (live and still) births, was 3.5 compared with 1,45 for England and Wales. INFANTILE MORTALITY There were 79 deaths of infants under one year during the year, giving an infantile mortality rate of 47.99 per 1,000 live births. This shows a further reduction compared with the figure °f 53.1 for 1942, The rate for England and Wales in 1943 was 49. Congenital malformations, premature birth, etc. caused 43 (or 54.4%) of the total infant deaths. -6- . 7 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 Smallpox Measles Scarlet Fever Whooping Cough Diphtheria Influenza Diarrhoea & Enteritis (under 2 years) Total deaths under year England & Wales 16.5 0.51 12.1 0.00 - 0.02 0.00 0.03 0.03 0.37 5.3 49 126 County Boroughs and great towns, including London 18.6 0.63 14.2 0.00 - 0.02 0.00 / 0.03 0.04 t 0.36 . 7.9 58 148 smaller towns (resident populations 25,000 to 50,000 at 1931 census). 19.4 0. 61 12.7 0.00 - 0.02 0.00 - 0.03 0.04 0.37 4.4 46 London Adm. County 15.8 0.45 15.0 0.00 - 0.02 0.00 0.03 0.02 0.27 10.4 58 TWICKENHAM 17.7 0.58 12.3 0.00 - 0.02 0.00 0.00 0.01 0.28 9.1 47.99 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 ahd,nasal swabs for diphtheria 23,6 ; 1 Positive Sputum, etc. for tubercle bacilli 82 5 Positive Miscellaneous 74 Total specimens examined 392, AMBULANCE FACILITIES Infectious diseases A motor ambulance Is provided by the South Middlesex and Richmond Joint Hospital Board Non-infectious and accident cases Four motor ambulances are provided by the Council). They are stationed at the Hollies Depot and, during the year, garage accommodation was erected. The service provided is adequate for the needs of the Borough. The conditions governing the use of the ambulances were revised during the year. The following table shows the work done by the Borough ambulance service during the year 1943:- Year 1943 Total Calls Patients Carried Mileage 1st quarter 356 356 2938.0 2nd quarter 359 359 2911.1 3rd quarter 303 304 2541.8 4th quarter 440 438 3154.0 1458 1457 11544.9 NURSING IN THE HOME During the year the Council again contributed the sum of £300 to the funds of the five home-nursing associations In the Borough. -8- CLINICS AND WELFARE CENTRES The following clinics were being held within the Borough at the end of the year CLINICS ADDRESS BY WHOM PROVIDED Infant Welfare Centres York House,Twickenham. Hospital Bridge Road, Twickenham. Art School,Teddington. Station Road, Hampton. Baptist Hall, Hampton Wick. Twickenham Council Ante-Natal Clinics York House,Twickenham. Hospital Bridge Road, Twickenham. Art School,Teddington. Station Road, Hampton. Twickenham Council School Clinics York House,Twickenham. Hospital Bridge Road, Twickenham. Stanley Road,Teddington. Percy Road F.A.P., Hampton. Middlesex County Council Dental Clinics York House,Twickenham. Stanley Road, Toddington. Twickenham Council & Middlesex County Council Ophthalmic' Clinics York House,Twickenham. Stanley Road, Tedding ton. 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 were described in my previous report. OTHER HOSPITALS There are three voluntary hospitals in the Borough, viz., St. John's Hospital, Twickenham, St, Mary's Hospital, Hampt on, and the Teddington, Hampton Wick and District Memorial Hospital, Teddington. For the duration of the war the Bearsted Memorial Hospital have taken over premises within the Borough. The Council contributed the total sum of £194 to these hospitals during the year. -9- PROVISION OF INBODIN During the year the Minister of Health gave general approval (for the duration of the war) to enable,the appropriate authorities under the Public Health Acts to provide supplies of Insulin for certain classes of persons suffering from diabetes. Three cases were on the register of the Department at the end of the year. HEALTH EDUCATION Despite war-time difficulties every effort was made to develop this important work during the year, which included the display of posters on public hoardings, offices, etc., exhibition of slides at cinemas, advertisements in the local press, and the distribution of hundreds of leaflets on diphtheria immunization, venereal diseases, droplet infection, hygiene in schools, etc. * MATERNITY AND CHILD WELFARE MIDWIFERY AND MATERNITY SERVICES The total number of births notified as occurring' in the Borough was 1420. This does not include births which occurred elsewhere, but which were subsequently transferred to Twickenham. Of the births occurring in the Borough, 1005 (70.77%) were attended by midwives in their capacity as midwives, and 415 (29.23$) by doctors. Municipal midwives attended 525 births (36.9%) - 385 in their capacity as midwives and 140 as maternity nurses with doctors in charge. Notified Births. Confinement dealt with by / Acting as Midwives / Acting as Maternity Nurses with doctor in attendance Municipal Midlives 385 140 Non-municipal Midwives 37 9 Bearsted Hospital 570 26 Nursing Homes (6) \ _ 13 317 1005 492 MIDWIVES ACTS The number of municipal midwives employed by the Council remains 7 CARE OF EXPECTANT MOTHERS. The number of sessions devoted to this work were 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. -10- 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 1943 1056 5094 The credit for a large part of this increase is due to the 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. Fruit juices, cod liver oil or vitamin tablets were issued by the Ministry of Pood to expectant mothers - the scheme coming into operation in January. These commodities wore distributed from each antenatal clinic. No request for the- services of a consultant was made during the years Towards the end of the year arrangements were made whereby every expectant mother who attended an ante-natal clinic could have an X-ray examination of the chest carried out at one of the two local hospitals. The films are sent to the Tuberculosis Officer at the Chest Clinic at Hounslow, who examines them and makes reports. The fee payable by the Council for each mother, to the hospital is 10/6d. This scheme is I considered to be an important practical step in the control of tuberculosis. An expectant mother who develops tuberculosis will have to face a serious illness, but along with that the disaster to the family is indeed a tragedy. There is likely to be risk of infection to the new-born infant, and also especially to any other adolescent or adult members of the household; and there is the difficulty of household management when the mother is 1ll. There has been no difficulty in persuading mothers to attend for X-ray; the scheme has been welcomed by them and is running smoothly, BIRTH CONTROL No birth control clinic is held 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, 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 difficult or complicated cased. These are referred to the West Middlesex County Hospital. In addition to the employment of part-time Home Helps, the Corporation engaged throe full-time Home Helps during the year under review. The charges for Home Helps varied in accordance with the financial position of the applicant from no charge to full cost. -11- GAS AND AIR ANALGESIA One of the Corporation Municipal Midwives became qualified to administer gas and air analgesics and the necessary apparatus was provided so that she could administer analgesia in suitable cases. Arrangements were made for the other Municipal Midwives to receive training in analgesics but the courses of training were not completed during the year, SUBSEQUENT TO CONFINEMENT Eighteen cases of puerperal pyrexia occurred during the year, and of these, six patients wore admitted to the West Middlesex County Hospital, one to Teddington Hospital, ten were in a nursing home, and fine was treated at homo. All 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 are as follows:- 1939 98 1942 255 1940 71 1943 263 19,41 297 The increase is largely due to the work of the midwives and health visitors. One maternal death occurred in the Borough relating to a non-resident. but six maternal deaths of Twickenham residents took place in institutions outside the district, The causes of death in the latter cases were 3 from sepsis 3 from other causes. DENTAL TREATMENT The following received dental treatment during the year:- 1943 1942 1941 1940 Expectant mothers 72 62 52 17 Nursing mothers 46 32 33 19 Patients supplied with dentures 71 55 37 39 Dentures supplied 129 100 65 73 HEALTH VISITORS One additional Health Visitor was engaged during the year so making a total of nine. They also carry out the duties of school nurses on behalf of the Middlesex County Council, Their visits include the following:— 1943 1942 1941 1940 To expectant mothers 402 354 432 338 To children under 1 year of age 5544 3921 4016 3961 To children between the ages of 1 and. 5 years 7589 7137 7834 6360 Visits were also paid to children of school age in cases of 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 Health Visitors attended the Summer School for Health Visitors and School Nurses, held at Newnham College, Cambridge, -12- INFANT WELFARE CLINICS There are five Infant welfare clinics; ton sessions for infant consultation are hold weekly. The total attendances of children at the various 3ossions during the year numbered 28,586. In 1942 the number was 25,55b. The figures for each clinic are set out below. 1943 York House Whitton Tadding ton Hampton Hampton Wick Total First attendance under 1 year 295 339 232 177 80 1123 1-5 years 77 44 80 31 34 266 Total attendances under 1 year 3773 6409 3327 2963 1200 17672 1-5 years 1630 4086 2481 1693 1024 10914 5403 10495 5808 4656 2224 28586 DENTAL TREATMENT OF CHILDREN UNDER 5 YEARS During the year, 143 children under 5 years of age received complete dental treatment. MILK AMD OTHER FOODS. ETC. During the year, 86 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 £38. 19. 8. 'CHILD LIFE PROTECTION There have been a few instances where foster parents failed to send proper notice of reception or removal of a foster child. 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 1943 were Number of persons receiving children for reward at end of the year 44 Number of children on register at end of year 99 Number of children who died during the year 1 Proceedings taken during the year Nil ADOPTION OF CHILDREN (REGULATION) ACT.1939 This Act came into operation on 1st June, 1943 and general supervision in cases of adoption was carried out In accordance with the requirements of the Act. No. of persons who gave notice under Section 7 (3) during the year 15 (1 applicant adopting 2 children) No. of children "adopted" under the Section during the year 6 No, of children under supervision on at and of year 10. -13- There are five war-time day nurseries in the Borough. The nursery at Station Road Hampton Wick - a pre-fabricated hut accommodating 50 children was opened in July, 1943, and subsequently affiliated to the National Society of Children's Nurseries. The nursery at Old field Road, Hampton, a twostoried building, also accommodating 50 children, was opened in October, 1943. The average daily attendance of children at each nursery is set out below:- 1943 51, Hampton Road 40,Cambridge Park Powder mill Lane Station Rd. Hampton Wick Old field Road, Hampton Average daily attendances 38,05 50.98 30.93 28.32 18 Routine medical inspections showed that the standard of nutrition of the nursery children was high. Although there were outbreaks of the common infectious diseases prevalent in the Borough during Spring and Autumn, (chicken-pox, mumps, whooping cough, measles and rubella), the cases, were mild and.no after-effects were noted. During the year an educationalist was lent by the Central Committee of the National Provisional Council for Mental Health to udvi30 on play material for the nursery children. As a result many useful suggestions were put into operation regarding routine and much help was received in obtaining suitable apparatus and toys, especially for the smaller children. The nurseries received gifts of toys and educational equipment from the National Fire Service, Civil Defence personnel and the Women's Voluntary Services, which were gratefully appreciated. Twelve student-probationers were accepted for training during the year. Three students were entered for the National Society of Children's Nurseries examination in November. One obtained the Diploma and the other two passed the written part of the examination. The senior students attend the Battersea Polytechnic and the junior students the Hammersmith Technical College for the theoretical parts of their training. A parents' group was started at the Hampton Road Day Nursery and was well attended. The parents and staff appreciate this opportunity of discussing child management, particularly in relation to the nursery children. Successful Christmas parties were hold in all the nurseries, to which parents and friends were invited. ORTHOPAEDIC TREATMENT No formal arrangement has been 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. 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. -14- SANITARY ADMINISTRAON WATER SUPPLY The water supply for the Borough is provided by the Metropolitan Water Board. No complaints regarding tho Quality of the water wore received during the year. DRAINAGE AND SEWERAGE The only major alteration of the soil sewer system was effected at Hampton Wick, whore, by laying 712 yards of 8 diameter C.I. rising main from Ejector Station No. 2, Sandy Lane, to a now outfall in Wick Road, Toddington, about one third of the sewage from this area has boon diverted into a wore direct route towards Mogden. The disposal of sewage into the County Council's trunk sewers for treatment at Moddern continued without modification of any kind. RIVERS AND STREAMS Pollution. No action was necessary during the year concerning the pollution of the river Thames or streams within the Borough, PUBLIC CLEANSING Refuse destructors at Twickenham and Toddington continued in use, but controlled tipping at Hatherop Road Recreation Ground resulted in reduced destruction at Toddington, and a cessation of destruction at Hampton, Salvage operations continued during the year, and the treatment of kitchen waste for pig food increased very considerably, The Corporation's receipts for salvage sold are now well over £15,000 per annum, SANITARY INSPECTION OF DISTRICT There was one change in the Inspectorate during the year, Mr, Pickup leaving to take up another, appointment. He was not replaced. The visits paid in each branch of the work are sot out under the appropriate headings. Notices Served Informal notices served - 558 Informal notices complied - 480 Housing Act, 1936; Sections 9 & 10:- Statutory notices served - - Statutory notices (a) By owners (b) By local authority in default of owners - -15- Public Health Acts Statutory notices served - 48 Statutory notices complied (a) By owners 52 (b) By local-authority in default of owners - Prosecutions During the year a summons was applied for in three instances in respect of non-compliance with abatement notices issued under Section 93 of the Public Health Act, 1936. The result was as follows Case 1. Fine of £5 (or 1 month's imprisonment in default") imposed, Order made for abatement of nuisance within one month - Cases 2. Fine of £1 imposed. Order made for abatement of nuisance within one month. Case 5. Case adjourned and subsequently withdrawn - work Having been carried out. Summary of visits and inspections Visits to premises after complaint - 1376 Visits to properties under notice and work in progress - 4184 Total visits and inspections - 15476 Summary of works executed in consequence' of visits Drains unstopped and repaired - 55 Complete drainage reconstructions - 1 Water supply cisterns repaired 8 Gutters repaired - 82 Roofs repaired - 235 W.C. apartments repaired or rebuilt- 6 W.Cs. repaired - 39 Dustbins provided - 35 Damp walls remedied - 49 Ventilation provided 3 Rooms stripped and cleansed - 48 Offensive accumulations removed - 10 Other works carried out - 600 Overcrowding. Housing Act, 1936. During the year the known cases of overcrowding on the Register of the Department were again reviewed ,with the following result (a) (i) Number of dwellings overcrowded at the end of the year - 29 (ii) Number of families dwelling. therein - 31 (iii) Number of persons dwelling there in 202½ (b) Number of new cases of overcrowding reported during the year - 14 (c) (i) Number of cases of overcrowding relieved during the year - 44 (ii) Number of persons concerned In such cases - 299 SMOKE ABATEMENT It was not necessary to take any formal action during the year regarding excessive omission of smoke. -16- SWIMMING BATHS AND POOLS During the summer season samples of water wore taken from the Council's three open-air swimming baths. These were found to bo very satisfactory. DISINFESTATION During the year 77 premises were found to be verminous. 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 During the year 1,288 children and adults were treated at the First Aid Posts for scabies as compared with 900 for the previous year. Credit is duo to the nurses in charge of the posts for the excellent work done in dealing with these cases. COMMON LODGING HOUSES Number on Register 1 This Common Lodging-house was kept in a satisfactory condition during the year and the registration was renewed. SCHOOLS Regular inspection of the sanitary arrangements at the elementary and secondary schools was carried out by the Sanitary Inspectors during the year. It was not necessary to close any of the schools on account of infectious disease among the children. PETROLEUM (REGULATION) ACTS. 1928 & 1956 The Sanitary Inspectors paid 130 visits to promises licensed for the storage of petroleum spirit and carbide of calcium. Licences were issued in respect of 117 premises. SHOPS ACT. 1954 No formal action under the provisions dealt with by the Department was necessary. The certificate granted in previous years for one shop under Section 10(2) of the Act was continued. RODENT CONTROL Since the passing of the Rats and Mice (Destruction) Act, 1919, the County Council have boon responsible for its administration to the exclusion of the Corporation. Under the Infestation Order, 1943, made by the Ministry of Food, certain powers were conferred on the Corporation, although they possessed no powers under the 1919 Act. At the close of the year the County Council suggested that their powers and. duties under the Act should bo delegated to the Corporation. This was approved, but formal transfer had not boon completed. At the request of the Minister of Food a survey to determine the extent of rat infestation in the Borough was undertaken and completed before the end of July. The survey revealed six major and twenty-three minor infestations. -17- Inspections for purposes of provisions as to health Inspections Written Notices Factories with mechanical power 413 10 Factories without mechanical power 100 5 Other premises under the Act 189 - Total 1702 15 Summary of defects found Found Remedied Want of cleanliness 6 5 Sanitary conveniencesInsufficient - - Unsuitable or defective 10 10 Not separate for sexes 1 1 Other offences 1 1 Total 18 16 ESTABLISHMENTS FOR MASSAGE OR SPECIAL TREATMENT Seven licences in respect of establishments for massage or special treatment were issued, during the year. The premises were kept in a satisfactory condition. HAIRDRESSERS' AND BARBERS' PREMISES The inspection of hairdressers' and barbers' promises is carried out by the Sanitary Inspectors and Health Visitors, to ensure that the Council's Bye-laws are being complied with. RENT AND MORTGAGE INTEREST RESTRICTIONS ACTS. 1920 To 1938 Twenty-three certificates were granted under the above Acts in respect of premises which wore not in a reasonable state of repair, as compared with five for the previous year, INSPECTION AND SUPERVISION OF FOOD Milk Supply The bulk of the milk supply of the Borough comes from outside the area and has been pasteurised before delivery, 162 visits were paid to dairies and milk shops, Milk Sampling 23 informal samples of milk were taken during the year for bacteriological examination, or for the purpose of ascertaining whether pasteurisation had been efficiently carried out. All were found to be satisfactory, Milk in Schools Scheme All milk used In the schools under this scheme is pasteurised. Milk (Special Designations) Orders During the year the following licences were grantod for the sale of designated milk:- "Tuberculin tested" milk - 17 "Accredited" - 1 "Pasteurised" - 25. —18— r Slaughter-houses Four licences were renewed during the year. Consider action of the condition of three slaughter-houses was further deferred ponding the execution of essential 'repairs. Public Abattoir. A comprehensive report on the provision of, and necessity for, a public abattoir in the Borough was presented to the Public Health Committee during the year. In the existing circumstances, however, consideration of the matter was deferred, Slaughter of Animals Act, 1955. Seven slaughter-men were on the register of the Department at the end of the year. Meat and Other Foods No general slaughtering took place in the Borough during the year. The number of pigs slaughtered under licences granted by the Ministry of Pood was 37. All were inspected. The following moat and other foods were found unfit for human consumption L 1 hind quarter of beef . 6 lbs. beef 40 lbs. ox livers 3¾ lbs, brisket 8½ lbs• trimmings 25 lbs, tripe 1 pig's head 1 pig's leg 3 lbs. loin of pork 2 pig's lungs 169 lbs. bacon 14flbs. pork pies 30 lbs. pork sausages 10 stone skate 3 stone pilchards 7 stone herrings 8 3tone haddocks 5 stone soles 15 stone cod 2½ stone dog fish 3 stone monk fish 19 stone fish fillets 05 tins pilchards 1 tin crawfish 8 tins crayfish 40 tins herrings 170 tins sardines 224 tins salmon 24 tins mackerel 95 tins miscellaneous fish 5 lbs. tomatoes 7 lbs. split peas 7 lbs. peas 4 lbs. beans 107 lbs. dried peas 76 lbs. haricot beans 420 tins vegetables 464 tins fruit 33 lbs. fruit 20 lbs. sultanas 20 lb3. currants 533 tins meat 83 tins soup 2,109 tins milk 14 tins milk powder 470 eggs 5 tins dried eggs 28 lbs. egg powder 190¾ lbs. cheese 22 lbs. butter 47 lbs. margarine 3 lbs. lard 7 lbs. suet 36 lbs. barloy 14 lbs. oatmeal 92 lbs. breakfast oats 13 pkts. semolina 30 lbs. semolina 3 lbs. cornflour 48lbs. pudding mixture 1 tin Bemax 96 lbs. sago 78 lbs. rice 18 lbs. tea 8 bottles coffee 6 lbs. cocoa 78 lbs. sugar 7 lbs. ginger 983 lbs. flour -19- 27 jars marmalade 95 jars and tins jam 11 jars lemon curd 3 jars fish paste 54 jars chicken & tongue paste 2 jars Betox 1 jar Marmite 14 lbs. Bisto 12 tins pepper 7 lbs. mustard 36 lbs. salt 54 lb3, cake 2 tins biscuits 8 tins & jars of miscellaneous food. 26 rabbits 1 tin of rabbit 238 lbs, rabbits 3 chickens 41 jars of sauce 40 jars of horse radish cream 6 jars mayonaise 79 jars pickle 6 bottles vinegar 43 bottles concentrated orange juice 1 bottle lemon squash 3 bottles lemon & barley During the year the following visits were made to promises upon which food is prepared or sold:- Bakehouses 184 Butchers shops 398 Restaurants and eating- house kitchens; grocers shops 1,406 Greengrocers' shops 350 Pish shops 266 MIDDLESEX COUNTY COUNCIL (GENERAL POWERS) ACT. 1938 The vehicles and/or storage accommodation of hawkers of meat, fish and vegetables-were kept under observation by the FOOD AND DURGS ACT, 1938 The middlesex country council are the food and druge authority for the borough INFECTIOUS DISEASES ' (a) NOTIFIABLE INFECTIOUS DISEASES Diphtheria During the year 4 cases of diphtheria were notified as compared with 7, 25, 18, 25 and 70 respectively for the five previous years. All four cases were admitted to hospital, The exceptionally low number of notifications Is particularly gratifying. 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 0,03, Supply of anti-toxin. The arrangements whereby 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 Toddington, free of charge,were continued during the year. Diphtheria immunization. This work continued steadily a rough out the year. A further publicity campaign was undertaken . which Included advertisements in the local press, showing of slides at the cinemas and exhibition of posters throughout the Borough. -20- The following is a brief summary of the work carried out during the year:- Total number of now cases 2,221 Schick Testing:- 1st Schick test (before inoculation) No. tested 37 No. susceptible 6 No. immune 21 No. failed to attend 10 2nd Schick test (after completion of 1st course of injections) No. tested 2,550 No. protected 2,178(94.4%) No, susceptibl9 128 No. failed to attend 244 All those found to be incompletely protected after the second Post Schick were re-inoculated. Total No, of attendances for year 9,765 The diphtheria prophylactic used was A.P ,T,and T.A,F. Scarlet Fever During the year 238 cases of scarlet fever wore notified as compared with 125, 78, 38, 93 and 274 for the five previous years, 43 cases were admitted to hospital. Generally speaking the type of disease was mild. There were no deaths, The death rate for England and Wales was 0.00 per 1,000 of the population. Smallpox. There wore no cases of smallpox notified during tho year. No contacts were kept under observation by the Department. Pneumonia, Malaria and Dysentery. Pneumonia. There were 60 cases of pneumonia notified, an increase of 10 compared with the previous year, The number of deaths attributed to this disease was 65. Malaria. No case of malaria was notified during the year. Dysentery. One case of dysentery was notified during th year. Acute Poliomyelitis. Acute Polio-encephalitis. Three cases of acute poliomyelitis were notified during the year. All wore treated in hospital. There was' one death. Acute Encephalitis Lethargica. One case of encephalitis lethargica was notified and one death recorded from this disease during the year. Ophthalmia Neonatorum. The following table shows the number of cases notified and result of treatment 4 - 21 - 1 Yoar Cases notfd, Cases treated Vision unimpaired Vision impaired Total blindness Deaths at home in hosp, 1943 6 6 - 6 - - - Puerperal Pyrexia Eighteen cases of puerperal pyrexia wore notified during the year six were admitted to the West Middlesex Hospital and one to Teddington Hospital. Enteric Fever No cases of enteric fever (which include the paratyphoid fevers) were notified during the year. There were no deaths, Typhoid Immunization. Facilities wore again available at the clinics for typhoid immunization, but no oases were dealt with during the year, Cerebro-spihal fever. One case of cerebro-spinal fever was notified as compared with three for the previous year. There were no deaths. Measles and Whooping Cough During the year 450 cases of measles were notified as compared with 1,144 for the previous year. There were two deaths. Whooping cough again became prevalent during the year, 317 cases being notified as compared with 91 for the previous year. There were no deaths. (b) NON-NOTIFIABLE INFECTIOUS DISEASES Influenza Influenza became prevalent towards the latter part of the year and by December had assumed epidemic proportions. The type was of the ordinary nature with a short feverish illness and, generally, a speedy recovery. In order to meet the problems created by the general use of women in the various forms of national service every effort was made to ensure that emergency help was available for persons in difficulty owing to sickness or other domestic crisis as a result of the epidemic. ... The British Red Cross Society, St. John's Ambulance Brigade and Women's Voluntary Services generously offered to help within the resources of their members, while once again full use was made of the nursing staff of the first aid posts who performed excellent work. Other. During the year the following cases of non-notifiable infectious diseases were brought to the notice of the Department . Mumps 11 Chicken-pox 86 - 22 - 1 TUBERCULOSIS Tho number of now cases of tuberculosis notified during the year was 137, as compared with 130 for 1942. The Registrar General credits us with 47 deaths, a reduction of 12 on the previous year. ' Special consideration was given this subject by the public Health Committee during the year who felt that the situation created by the increased prevalence of Tuberculosis needed approach from three points of view (1) what could bo done only by the Ministry of Health (2) what could be done by the Middlesex County Council and (3) what could be done by the Borough. Detailed reports dealing with the matter were presented to the Committee and the following action was decided upon under the above headings. (l) That the Ministry of Health should be urged to take action on the lines suggested in the Medical Research Council's report, (2) That support should be given to the Middlesex County Council as the Tuberculosis Authority in any,action taken up with the Ministry to implement the above report. In addition it was suggested that the Middlesex County Council should consider (a) the provision of an open-air school in the Borough (b) greater attention being given in schools to breathing exercises and singing as protective measures from chest conditions in general and (c) the provision of an advanced cases homo. (3) That locally there should bo an intensification of our efforts directed towards (a) increased propaganda on tubercle in the clinics, etc. (b) closer' co-operation with the Chest Clinic (c) tuberculin patch-testing of children (where desirable) in our own clinics (d) X-ray examination of staff (e.g. Health Visitors) who come in regular and close contact with infants and children (e) X-ray-of all expectant mothers attending our ante-natal clinics (f) adequate housing for tuberculous families (g) provision of panel of women - similar to Maternity and Child Welfare Home Helps scheme - so that when a mother of a family enters an institution for treatment, some one is available to look after her homo and (h) boarding out of contacts. Now Cases and Mortality 1943 The following table prepared from the records in the Department summarises the position. Ago Periods Now Cases Doath3 Pulmonary NonPulmonary Pulmonary NonPulmonary M F M P M P M P Under 1 1 1 - - - - - - 1-5 3 1 1 - 1 - _ 1 5-10 2 3 1 1 _ - - — 10 - 15 2 1 - 1 — - - - 15 - 20 10 15 1 - 1 1 - - 20 - 25 4 10 1 - 1 5 - - 25 - 35 5 10 2 2 4 4 - - 35 - 45 17 9 1 5 10 1 - - 45 - 55 12 1 1 - 3 _ - - 55 - 65 4 1 1 - 7 1 1 - 65 & upwards 5 2 - — 3 1 - 1 Total 65 54 9 9 30 13 1 2 - 23 - 1 primary Notifications of Tuberculosis 1937-1943 Inclusive 1937 1938 1939 1940 1941 1942 1943 Pulmonary 85 100 106 114 127 112 119 Other forms 25 30 19 12 14 18 18 Total 110 130 125 126 141 130 137 Public Health (Prevention of Tuberculosis) Regulations. 1925 Public Health Act, 1936 (section 172) No action was taken under the above 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. - 24 - 1 DISEASE GASES NOTIFIED AT VARIOUS AGES (YEARS) Total Cases Notfd. Cases Admtd. to Hosp. Total Deaths Under 1 yr. 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 Anterior Poliomyelitis — — — — — - 2 1 - - - - - 3 3 - Cerebro-Spinal Fever - 1 - - - - _ - - - - - - 1 1 - Diphtheria - - - - - 3 - - - 1 - - - 4 4 1 Dysentery - - - - - - - - 1 - - - - 1 1 - Encephalitis Lethargica - - - - - - - - - - 1 - - 1 - 1 Erysipelas - - — — — — - 1 — 2 1 9 6 19 4 - Measles 18 39 27 67 62 200 13 11 - 5 2 2 — 450 10 2 Ophthalmia Neonatorum 6 - - - - - - - - - - - - 6 - - Pneumonia 1 1 - 1 1 6 1 2 1 3 11 18 14 60 8 65 Paerperal Pyrexia - - - - — — — - 6 9 « 3 — — 18 7 - Scarlet Fever - 3 12 21 18 138 23 11 5 2 5 - - 238 b3 - Whooping Cough 31 34 32 44 46 122 5 - 1 1 - 1 - 317 16 _J - 1 MONTHLY INCIDENCE OP INFECTIOUS DISEASES DURING THE YEAR 1943 DISEASE NUMBER OF CASES Total J an.. Feh. Mar. Apr. May June ^ ' July Aug, Sept. Oct. Nov. Dec. Acute Anterior Poliormyelitis — - - - - - - - - - 2 1 3 Cerebro-Spinal Fever 1 - - - - - - - - - - - 1 Diphtheria 1 / - - 1 - - - / 1 - - — 1 4 Dysentery - - - - - - - — - - - 1 1 Encephalitis Lethargica - - - - - - 1 1 - - - - 1 Erysipelas 1 - 1 2 2 2 2 2 3 1 2 - 19 Measles 65 72 78 52 55 70 36 16 1 1 — 1 450 Ophthalmia Neonatorum - 1 - - - - 1 - 2 - - - 2 6 Pneumonia 4 12 4 2 1 3 5 - 1 1 5 22 60 Puerperal Pyrexia 3 1 3 1 - 1 3 - 2 1 ~ 3 18 Scarlet Fever 18 17 14 12 8 21 22 8 28 \ 35 35 20 238 Whooping Cough 29 48 46 35 26 31 26 19 Ik 1U 12 17 317 1 INDEX Page Adoption of Children(Regulation) Act, 1939, 13 Ambulance Facilities 8 Ante-natal Clinics9,10 Anti-toxin, Supply of 20 Births 5,10 Birth Control 11 Blindness, prevention of 24 Care of Mothers during Confinement 11 Care of Mothers subsequent to Confinement 12 Child Life Protection 13 Common Lodging Houses 17 Cerebro-splnal Fever 22 Deaths 5,6 Dental Clinics 9 Dental Treatment 12,13 Diphtheria 20 Diphtheria, Immunization 20 Diphtheria Immunization Clinics 9 Disinfestation 17 Drainage and Sewerage 15 Dysentery 21 Encephalitis Lethargica 21 Enteric Fever 22 Factories Act, 1937 18 Food, Inspection and Supervision of 18 Food and Drugs Act, 1938 20 Gas and Air Analgesia 12 Hairdressers' and Barbers' Premises 18 Health Education 10 Health Visiting 12 Hospitals 9 Housing 16 Infantile Mortality 6 Infant Welfare Clinics 9,13 Infectious Diseases 9,20,22,25,26 Influenza 22 Insulin, Provision of 10 Laboratory Work 8 Malaria 21 Massage or Special Treatment, Establishments for 18 Maternal Mortality 6 Measles 22 Middlesex County Council (General Powers) Act, 1938 20 Midwifery and Maternity Services 10 Midwives Acts 10 Milk and Other Foods, etc., Provision of13 Milk Supply 18 \ •Nursing Associations 8 Nursing Homes 14 Ophthalmic Clinics 9 Ophthalmic Treatment Of Children Under 5 15 Ophthalmia Neonatorum 21 Orthopaedic Treatment 14 / - 27 - 1 INDEX - Continued Page Petroleum (Regulation) Acts 17 pneumonia Poliomyelitis 21 Polio-encephalitis 21 Public Cleansing 15 Puerperal Pyrexia 9,22 , Rent and Mortgage Interest Restrictions Acta 18 Rivers and Streams 15 Rodent Control 17 , Sanitary Inspection of District 15 Scabies 17 Scarlet Fever' 21 School Clinics 9 Schools 17 Shops Acts 17 Slaughtering of Animals 19 Smallpox 9,21 Smoke Abatement 16 Statistics, General and Vital 4,7 Summer School for Health Visitors, 12 Swimming Baths and Pools 17 Tuberculosis 9,23 Typhoid Immunization 22 Unsound Pood 19 Wartime Nurseries 14 Water Supply 15 Whooping Cough 22 — 28 1