TW112 borough op twickenham MEDICAL OFFICER OF HEALTH 1944 JOHN MADDISON, M.D., B.S., D.P.H. Medical Officer of Health 1 Public Health Department, Elmfield House, High Street, Teddington. To the MAYOR, ALDERMEN AND COUNCILLORS of 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 3lst December, 1944. The report is again condensed for economy of paper, and again certain tables and figures have been omitted. The year will always be remembered on account of the dislocation of living conditions from the flying bombs. The Borough suffered heavily during the second half of the year. A great many houses were destroyed and hardly a street in the Borough remained undamaged. Large movements of the population took place through official and unofficial evacuation and.,rehousing. The strain on the Department was very heavy, many members of the staff doing their ordinary duty during the day and duty at the Control Centre and First Aid Posts at night. In spite of the dislocation, the ordinary Health and Maternity and Child Welfare Services were maintained at. a high standard. The death rate of infants under one year of age is a good indication of the conditions of life in the town. In 1944 it was 37.1 deaths per 1,000 live births, which is the lowest figure since 1939. The rate for England and Wales was 46 If we can reduce this infantile mortality rate still more we will be approaching the figure achieved by some American towns which we have envied for a number of years. In this Borough congenital malformations arid premature births accounted for a rate of 29.2 deaths per l,000 live births. Premature birth is to a great extent dependent upon the health of the mother during pregnaney and reduction in the rate of premature births will depend on further efforts to improve the health of expectant mothers. Improved moans of saving the lives of premature infants have been introduced by the provision of specially designed electrically heated cots and ancillary apparatus. The cots are loaned out to homes or institutions requiring them for the use of premature infants and already o number of infants have been saved who might otherwise have died. The general death rate per thousand of the population was 12,8 coipared with 11.6 for England and Wales for that year, but this figure is still above the best figure for the Borough of 9.81 in 1938. Deaths from enemy action contributed to the increase. Deaths from influenza were increased, but deaths from cancer fell from 220 in 1943 to 169 in 1944. ' ' The birth rate in 1944 rose to 18.5½ of the estimated resident population which is a record for the enlarged Borough. The illegitimate births rose still higher from 103 in 1943 to 138 in 1944. For unmarried mothers the maternity and child welfare services have done magnificent work in arranging for pre-natal care and hostel accommodation arranging for confinements and post-natal accommodation, finding suitable employment, arranging for the care of the infants, assisting with affiliation orders, adoptions, foster homes and in many other ways. The mortality of illegitimate infants, generally very high, fell to 45.48 which represents a remarkable improvement. There was not a single maternity death during the whole year giving a nil rate which is a rocord. There was again a very low incidence in the Borough of coses of diphtheria (5) as compared with 70 in 1938, 34 in 1939, and 18 in 1940. The immunisation scheme suffered during the flying bomb period so that only 1153 children were dealt with compared with 2,221 in the previous year. - 2 - 1 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 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. - 3 - 1 STATISTICAL SUMMARY for the year 1944 - Area in acres 7,007 Number of inhabited houses 28,615 Rateable value £1,025,969 Sum represented, "by a penny rate 1944/45 £4, 128:12:7 Total M. F. LivB births: Legitimate 1505 738 767 Illegitimate 138 68 70 \ Birth rate per 1,000 of estimated resident population 18.5 Total M. F. at ill births: Legitimate 37 20 17 Illegitimate 2 2 Still birth rate per 1,000 total (live and still) births 24.3 Total M. F. Deaths: 1136 594 542 Death rate per 1,000 of estimated resident population 12.8 Maternal deaths: Puerperal & Post-abortive Sepsis' NIL Other Maternal Causes. NIL Rate per 1,000 total (live and still) births NIL Death rate of infants under one year of age:- All infants per 1,000 live births 37.1 Legitimate infants per 1,000 leg. live births 36.5 Illegitimate infants per 1,000 illeg. live births 43.8 Deaths from: Cancer (all ages) 169 Measles ( all ages) NIL Whooping cough (all ages) 1 Diarrhoea (under 2 years of age) 5 - 4 - 1 STATISTICS, SOCIAL CONDITIONS AND GENERAL PROVISION OF HEALTH SERVICES FOR AREA BIRTHS The live "births registered in the Borough in 1944 numbered I64.3 giving a, birth rate of 18.5 per 1,000 of the population (England and Wales 17.6) The births wore made up as follows:- Male's Females Total Legitimate 738 767 1505 Illegitimate 68 70 13.8 Total 806 837 1643 Main causes of death'. An analysis of the death returns reveals tho following main causes of death:- Disease Percentage of total deaths Death rate per 1,000 population Diseases of heart and circulatory system 31.4 . 4.0' Intra-cranial vascular lesions ' 9.2 1.17 Bronchitis, Pneumonia and other respiratory diseases^ 10.6 1.35 Cancer 14.9 1.9 Violence 7.9 1.0 Tuberculosis 4.2 •5 I - 5 - The number of births represents a slight decrease of 3 compared With the previous year. Illegitimate births formed 8.4% of the total births, an increase of 1.84% on the previous' year. Still Births ' ' ... There were 41 still births registered during the year, giving a still birth rate of 24.3 pre 1,000 total (live and still) births. • • • DEATHS The net deaths registered in the Borough during 1944 were:- Males Females Total. 594 542 1136 This represents a decrease of 8 compared With the previous year. The death rate per 1,000 of the' population was 12.8 as compared with 11.6 for England and Wales 1 CAUSES OF DEATH 1944. Registrar General's Official Returns Causes of Death. Males Females Total All Causes 594 542 1,136 | 1. Typhoid and paratyphoid fevers - - - 2. Cerebro-spinal fever - 1 1 3. Scarlet Fever - — — 4. Whooping Cough - 1 1 5. Diphtheria 1 2 3 6. Tuberculosis of Respiratory System 26 14 40 7. Other forms of Tuberculosis 2 6 8 8. Syphilitic diseases 5 5 10 9. Influenza 1 3 4 10. Measles - - - 11. Acute Polio-myelitis & polio-encephalitis - 1 1 12. Aeute infective encephalitis - 1 1 13. Cancer of "buccal cavity and oesphagus (M) uterus (F) 3 10 13 14. Cancer of stomach and duodenum 6 11 17 15. Cancer of breast - 19 19 l6. Cancer of all other sites 66 54 120 17. Diabetes 3 1 4 18. Intra-cranial vascular lesions 45 59 104 l9. Heart disease 169 148 317 20. Other diseases of circulatory system 20 20 40 21. Bronchitis 25 24 49 22. Pneumonia 30 23 53 23. Other respiratory diseases 11 7 18 24. Ulcer of stomach or duodenum 12 1 13 25. Diarrhoea under 2 years 4 1 5 26. Appendicitis 3 2 5 27. Other digestive diseases 11 19 30 28. Nephritis 16 10 2b 29.Puerperal & Post-abortive Sepsis - - — 30. Other maternal causes - — — 31. Premature birth 7 9 16 32. Congenital malformations, birth injury infantile diseases 18 14 32 33. Suioide 3 4 7 34. Road traffic accidents 7 2 9 35. Other violent causes 31. 37 74 36. All other causes 63 33 96 maternal mortality I have much pleasure in recording that no deaths were registered as being due to diseases or accidents of child-birth as compared with 6 deaths for the year 1943. The maternal mortality rate per 1,000 total (live and still) births, for England and Wales was 1.93. infantile mortality There were 6l deaths of infants under one year during the year, giving an infantile mortality rate of 37.1 per 1,000 live births This shows a further reduction compared with the figure, of 47.99 for %3. The rate for England and Wales in 1944 was 46. Congenital malformations, premature birth, etc. caused 48 or 78.69%) of the total infant deaths. - 6 - 1 BIRTH RATE, DEATH RATE AND ANALYSIS OP MORTALITY DURING 1944 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 & Enteritis (under two years) Total deaths under 1 year England & Wales 17.6 0.50 11.6 0.00 0.00 0.01 0.00 0.03 0.02 0.12 4.8 46 126 County Boroughs and great towns, including London 20.3 0.64 13.7 0.00 - 0.01 0.00 0.03 0.03 0.10 7.3 52 l48 smaller towns (resident populations 25.000 to 50,000 at 1931 census). 20.9 0.61 12.4 0.00 - 0.01 0.00 0.02 0.03 .0.11 4.4 44 London Adm. County 15.0 0.42 15.7 0.00 - 0.00 0.00 0.04 0.01 0.08 10.1 61 TWICKENHAM 18.5 O.46 12.8 0.00 - 0.00 0.00 0.01 0.03 0.05 3.0 37 - 7 - 1 laboratory 'york The usual arrangements were continued during tht). year and worked satisfactorily. 'J The following table gives the number of specimens examined during the year:- Nature of Specimens No. Result. Throat and nasal sw'a'bs for diphtheria Sputum otc. for tubercle baciili Miscellaneous 191 53 98 2 Positive 3 Total specimens examined : 3k2 ■ AMBULANCE FACILITIES Infectious diseases A motor ambulance is provided by the South Middlesex and Richmond Joint Hospital Board. Non-infectious and accident casea. * * * ♦ f , Four motor ambulances are provided by the Council. The service- is adequate for the needs of the Borough. The following table shows the worlc^done "by the Bonough ambulance service during the year 19M+:~ ! Year 19M+. "Total ■> calls , Patients carried. Mil6-:i.r:;e, 1st. quarter hio U70 3572.3 2nd. quarter 453 1x58 3758.1± 3rd. quarter 358 ' 358 3055.2 J+th. quarter 418 8 3571.3 O 170 k 1701+ ■■ ' ^ 13957.2 nursing in the home JiUKo-I-L'Kt IN i'n.a HOMh During the year the Council contributed the sum of £300 to the funds of the five homo-nursing associations in the Borough. • - 8 - 1 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 St. Mark's School., Teddington 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. Station Road, Hampton. Middlesex County Council. Dental Clinics. York House, Twickenham Stanloy Road, Teddington. HospitalBridge Road, Twickenham, 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. Station Road, Hampton. Twickenham Council. Child Guidance Clinic 5.3, Hampton Road, Twickenham. • Middlesex County Council. HOSPITALS Small-pox Tuberculosis Puerperal Pyrexia Infectious diseases The arrangements for the provision of hospital accommodation or residential institutional treatment remained unchanged. OTHER HOSPITALS. In addition to the three voluntary hospitals - St.John's Hospital, Twickenham, St. Mary's Hospital, Hampton, and the Teddington, Hampton Wide and District Memorial Hospital, Teddington the Bearsted Memorial Hospital have' temporarily taken over premises within the Borough. The Council contributed the total sum of £250 to these hospitals during the financial year 1944 45. - 9 - 1 PROVISION OP INSULIN. The provision of insulin for certain classes of persons suffering from diabetes was continued. . Five cases were on the register of the Department at the end of the year. HEALTH EDUCATION The development of Health Education showed good progress during the year and included the continued use of displays of posters on public hoardings, etc. , the distribution of leaflets and a limited number of copies of "Better Health". In conjunction with the Twickenham Local Youth Committee, two series of lectures on Sex Education were held for (a) parents, youth leaders, welfare officers, teachers and clergy and (b) young people (l4 to 20 years). The courses were an unqualified success an average of 400 persons attending the acquit course - and proved helpful to parents and young people. PROMOTION OF CLEANLINESS, ETC. The scheme for head and cleanliness inspections in the schools which included the use of First Aid Post Nurses and specially authorised auxiliary nurses worked satisfactorily during the year. In addition the health visitors continued the methods of persuasion, advice and counsel in the promotion of cleanliness and good habits and the elimination of verminous conditions. Complete co-operation existed between the First Aid Post nurses and authorised auxiliary nurses and the health visitors so that when school children were being cleansed for verminous conditions at the cleansing station children under five living in the same house and if need be their mothers were dealt with at the same time. Suitable pamphlets were also distributed at the Infant Welfare Centres. MATERNITY AND CHILD WE L F A R E MIDWIFERY AND MATERNITY SERVICES The total number of births notified as occurring in the Borough was 1,200. This does not include births which occurred elsewhere but which were subsequently transferred to Twickenham. Of the births occurring in the Borough, 802 were attended by midwives in their capacity as midwives, and 398 by doctors. Municipal midwives.-attended 427 births - 318 in their capacity as midwives and-" 109 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 Midwives 318 109 Non-municipal Midwives 26 Nil Bearsted Memorial Hospital 442 23 Nursing Homes (6) 16 266 ■ 802 398 MIDLIVES ACTS Two additional municipal midwives have been appointed ^ring the year, so making a total of nine.: 10 1 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, third and fourth week of each month. Year Attendances Total for first time attendances 1939 720 2191 1940 750 2998 1941770 3375 1942 1038 4842 1943 5094 1944 944 4393 The number of expectant mothers who were evacuated through the Government Scheme was eleven. Certain foods were supplied to expectant mothers for whom special treatment was ordered. Those foods were supplied free in necessitous cases. Vitamin preparations as supplied by Ministry of Food to expectant mothers continued to be distributed for each ante-natal clinic. No request for the services of a consultant was made during the year. The scheme introduced in the latter part of 1943. whereby expectant mothers could be X-rayed has proved satisfactory. The scheme has been extended to allow Doctors in private practice to send their patients also. Total number of expectant mothers who ware X-rayed was 392 and of these 14. were found to be in need of further observation and/or treatment. The fee payable by the Council for each mother to the hospitals is 10/6d. BIRTH CONTROL No birth control clinic is held in the Borough, but women for whom further pregnancy is considered inadvisable for medical reasons are referred to the Birth Control Clinic at Hounslow or Richmond. In necessitous cases the Corporation undertakes responsibility for payment for consultations and appliances. 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 cases. These are referred to the West Middlesex County Hospital. The full establishment of home helps for the Borough is five but there is great difficulty in recruiting suitable women for this work. There were three full-time home helps on the staff but this number was complemented by the employment of part-time home helps. The charges for the services of the home helps varied in accordance with the financial position of the' applicant from no charge to full cost. The number of home helps supplied during the year was 86. 11 GAS AND AIR ANALGESIA All the Corporation Municipal Midwives arc qualified to administer gas and air analgesics, seven of the midwives having completed the course of training during the year. One additional apparatus was provided bringing the total to three. SUBSEQUENT TO CONFINEMENT Eleven cases of Puerperal Pyrexia occurred during the year, and of these six were admitted to the West Middlesex County Hospital, one to the North Western Hospital, the remaining cases being treated in the institutions where they occurred. All 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 are as follows 1939 98 1942 255 1940 71 1943 263 1941 297 1944 180 One maternal death occurred in the Borough relating to a non-resident. There were no maternal deaths of Twickenham residents. During the year, arrangements were made in conjunction with the Middlesex County Council for the admission of unmarried mothers and their babies into the British Red Cross Home at Hendon. The cost to the Borough for each patient is 35/-d. per week - the contribution payable by the patient towards this amount being assessed according to the Council's Scheme of Assistance. DENTAL TREATMENT The following received dental treatment during the year:- 1944 1943 1942 1941 1940 Expectant mothers 42 73 69 52 17 Nursing mothers 27 46 32 35 19 Patients supplied with dentures 53 71 55 37 39 Dentures- supplied 90 129 100 65 73 HEALTH VISITORS A superintendent Health Visitor was appointed during the year, thus bringing the total of Health Visitors to ten. The Health Visitors carried out the duties of school nurses on behalf of the Middlesex County Council. There is also one full-time School Nurse employed by the Middlesex County Council. The total number of visits paid during the year was 16,761, and included the following visits to:- 1944 1943 1942 1914 1940 Expectant mothers 437 402 351 432 335 Children under 1 year of age 5675 5544 3921 4016 3961 „ between the ages of 1 and 5 years. 7699 7589 7137 7831 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 required at minor ailment, ophthalmic and dental clinics. 12 POST-GRADUATE EDUCATION The Summer Schools Tooth for Health Visitors and Midwives were cancelled owing to the prevailing conditions. Five Health Visitors attended a course on psychology, organised by the Provisional National Council for Mental Health, and the midwives attended a post-graduate course at the County Hall. INFANT WELFARE CLINICS There are five infant welfare clinics; ten sessions for infant consultation are held weekly, and one breast feeding clinic. 1944 Twickenham. Whitton, Teddington Hampton Hamp. Wick. TOTAL First attendance under 1 year 340 299 241 167 98 1145 First attendance 1-5 years 40 59 67 25 26 217 Total attendances under 1 year 2979 4527 2581 2159 1189 13435 Total attendances 1-5 years. 1316 2471 1671 1513 600 7571 DENTAL TREATMENT OF CHILDREN UNDER 5 YEARS During the year, the number of children under 5 years of ago who received dental treatment were New cases 76 Total attendances 113 OPHTHALMIC TREATMENT OF CHILDREN UNDER 5 YEARS During the year, the number of children under 5 years of age examined by the Ophthalmic Surgeon was:- First attendance 49 Total attendances 92 MILK AND OTHER FOODS. ETC. During the year, 42 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 £25. 9. 5d. CHILD LIFE PROTECTION There were a few instances where foster mothers failed to send proper notice of reception or removal of a foster child. All the Health Visitors are appointed Child Life Protection Visitors, and each visitor is responsible for carrying out the supervision of the foster homes in her own district. The number of visits paid to foster children during the year was 792. 13 Details of authorisation during 1944 were:- Individual foster mothers. Persons in charge of residential Nurseries etc. run for profit. TOTAL No. of persons who were receiving children under nine for reward apart from their parents at the end of the year. 29 3 32 No. of children on register at the end of the year 40 30 70 No. of children who died during the year Nil Nil Nil Proceedings taken during the year Nil Nil Nil During the year, with the consent of the Ministry of Health, a scheme was adopted by the Corporation whereby children of mothers who are unable to support them could be placed in approved foster homes and maintained by the Corporation. This scheme is confined to bona-fide residents of Twickenham and applies only to children up to the age of five years. The cost to the Corporation is 3/9d. a day. ADOPTION OF CHILDREN (REGULATION) ACT, 1959 General supervision in cases of adoption was carried out in accordance with the Act. The number of visits paid by Health Visitors for the purposes of supervision was 63. Number of prospective adopters brought to notice of Medical Officer of Health: (a) Compulsorily under Section 7 (3) by participating persons 15 (b) Voluntarily by Adoption Societies or otherwise 26 41 Number of prospective adopters supervised 41 Number of prospective adopters in respect of whom reports were furnished for use of Courts, Adoption Societies, local authorities, etc. 30 Adoption Orders granted in 1944To persons who were notified. to Medical Officers of Health under Section 7 (3) 1943-4; 1944-5 To persons who were notified to Medical Officer of Health voluntarily 1943-3; 1944-7 7 12 Number of prospective, adopters supervised and who abandoned intent-ion to adopt 8 Number of prospective adopters still under supervision; (a) Under Section 7(3) 10 (b) Voluntarily 11 21 41 ORTHOPAEDIC- TREATMENT OF CHILDREN 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. 14 NURSING HOLIES 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 arc 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. WAR-TIMES DAY NURSERIES There are now six war-time day nurseries in the Borough with accommodation for 290 children. A prefabricated hutted nursery, accommodating 50 children was opened in January 1944 at Gifford Lodge, Twickenham, and the extension to the nursery at Powder Mill Lane, comprising a wing to accommodate 10 babies was completed in the Spring. The average daily, attendance of children at each nursery is sot out:- 51 Hampton Road 40 Cambridge Park Powder Mill Lane Hampton Wick Hampton. Gifford Lodge 36.88 53.17 38.17 40.88 34.48 45.14 During the flying bomb period the work was carried out under great difficulty the average total daily attendance of children dropped to 104 in August. The Ministry of Health invited volunteers from the staff for duties in the hard pressed nurseries of the evacuation areas, as a result Miss Keane Matron of Gifford Lodge was seconded to organise a nursery in Somerset. She returned to the Borough in November 1944. Routine medical inspections wore carried out at regular intervals. The high standard of nutrition among the children is being well maintained. There were no serious epidemics in any of the nurseries during the year. An Educational Supervisor, Miss Jenny Miles, was appointed and commenced her duties in March. Her time has been spent entirely with the Toddler groups - their management, their equipment and the training of the young student in the work. Four student-probationers were accepted for training during the year. Seven students were entered for the examination of National Societies of Children's Nurseries, and all were successful in obtaining the Diploma - two with Distinction. The. help of the' Health Visitors has been enlisted to ensure adequate training of the students in the care of young infants. This has resulted in a close relationship between the Health Visitors and Nursery Staff which is most advantageous to the work. A course in nursery work has been arranged for the prenursing students from the County School, and three students are attending the nurseries each week. Pour helpers were appointed during the year and were given the privilege of attending classes at the Thames Valley Secondary School. The Parents Groups unfortunately have not been able to function during the latter half of the year but the parents co-operate in the organisation of the Christmas parties and many were able to attend with the children. 15 SANITARY ADMINISTRATION WATER SUPPLY The water supply for the Borough is provided by the Metropolitan water Board from their works at Hampton. I am indebted to Lt. Col. E.F.W. Mackenzie, the Board's Director of Water examination, for the following report upon the supply:- "The water is derived from the River Thames and after Storage in reservoirs at Walton and Littleton is prechlorinated and passed through primary and secondary sand filters. Finally it is chlorinated before being pumped into supply. Samples of the water in all stages of purification are analysed daily at the Laboratories of the Water Board. The principal average results for 1944 for the finally purified water are as follows:- p.p.m. Albuminoid Nitrogen 0.097 Oxygen absorbed from permanganate, 3hrs at 80ºF. 1.l8 Hardness Total 222 Temporary 159 Percentage number of samples containing no Bact. coli in 100 ml. 99.7 The water is not plumbo-solvent. All new and repaired mains are chlorinated before being returned to service and are subjected to bacteriological tests." DRAINAGE AND SEWERAGE There-have been no major alterations in the Sewerage. System of the District during 1944. With the expected resumption of building activities, including probable extensive housing by the Corporation both of a temporary and permanent nature, there will be extensions of the soil sewer system. There will also he necessary a modification of the sewer and ejector system in the Hampton area, involving new and enlarged plant at Bell Hill. It is probable that a number of the main Surface Water Sowers in the Twickenham area will require re-laying and enlarging if flooding during. heavy storms is to be avoided, A number of Soil and Surface Water Swers were damaged by bombing during the War, which caused difficulties temporarily, but all of these were dealt with immediately they occurred. RIVERS AND STREAMS No action was necessary during the year concerning the pollution of the river Thames or streams within the Borough. PUBLIC CLEANSING Streets The cleansing' of streets, as with other services, has suffered by reason of shortage of labour; it is hoped the normal service will be again available as soon as labour is released. Refuse Collected. A reduced but regular collection has been maintained despite portages of labour and the inevitable deterioration of the Collection Vehicles, The collection of salvage has been maintained at a high level. Refuse Destruction. The Destructors at Twickenham and Teddington have continued in use. Some tipping of refuse at Hatherop Road Recreation Ground 16 has assisted in making available a larger area of ground for recreation. Other refuse has been tipped at the Hampton Destruction Site as part of a scheme for laying out at this site a now Pleasure Ground. The treatment of the vegetable and other food waste has been extended, and the pig food plant now receives this waste from Kingston in addition to that collected in the Borough. SANITARY INSPECTION OF DISTRICT At the close of the year Mr. L. Marsden, Senior Sanitary Inspector, retired under the Superannuation Scheme. Despite the difficult conditions prevailing during the year every effort was made to keep up routine inspections and the enforcement of essential repairs. The visits paid in each branch of the work arc set out under the appropriate headings. Notices Served Informal not ices served 399 Informal notices complied 342 Housing Act, 1936; Sections 9&10 Statutory notices served Statutory notices' complied - (a) by owners (b) By local authority in default owners - Public Health Acts:- Statutory notices served 25 Statutory notices complied - (a) By owners 34 (b) By local authority in default of owners - Prosecutions During the year a summons was applied for in one instance in respect of non-compliance with an abatement notice issued under Section 93 of the Publics Health Act, 1936. Summary of visits and inspections Visits to premises after complaint 1,011 Visits to properties under notice and work in progress 2,553 Total visits and inspections 11,644 Summary of works executed in consequence of visits Drains unstopped and repaired 40 Complete drainage reconstructions 3 Waste pipes disconnected or repaired 22 Water supply cisterns repaired 5 Gutters repaired 50 Roofs repaired 126 W.C.s repaired etc. 40 Dustbins provided 26 Damp walls remedied 53 Ventilation provided 8 Rooms stripped and cleansed 44 Offensive accumulations removed 10 Other works carried out 543 17 Overcrowding. Housing Act, 1956. The known cases of overcrowding on the Register of the Department at the end of the year were as follows:- (a) (i) Number of dwellings overcrowded at the end of the year 34 (ii) Number of families dwelling therein 36 (iii) Number of persons dwelling therein 238 (b) Number of new cases of overcrowding reported during the year 3 (c) (i) Number of oases of overcrowding relieved during the year 3 (ii) Number of persons concerned in such cases 11 SMOKE ABATEMENT No formal action was taken during the year regarding excessive emission of smoke. SWIMMING BATHS AND POOLS The Corporation own three open-air swimming baths in the Borough. These were kept in a satisfactory Condition and no complaint regarding the condition of the water during the summer season was received. DISINFESTATION During the year 78 premises were found to be verminous. Disinfestation was carried out by the Department, the insecticide used being Zaldecide. In 6 cases belengings were disinfested before removal of the families to Council houses. Scabies. During the year 958 children and adults were treated at. the First Aid Posts for scabies as compared with 1288 for, the previous year. 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 maintained 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 & 1936 Luring the year 124 visits were paid by the Sanitary Inspectors to premises upon which petroleum spirit of carbide of calcium was stored. 93 licences were issued in respect of these premises. 18 SHOPS ACT, 1934 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 The Middlesex County Council's powers and duties under the Rats and Mice (Destruction) Act, 1919, were formally delegated to the Corporation with effect from the 1st April, 1944.. Pending the formal delegation however, the Corporation were asked to act as from the 1st February, 1944, on behalf of the County Council as the Statutory Local Authority. A formal direction by the Ministry of Pood under the Defence (General) Regulations, 1939, and the Infestation Order, 1945, requiring the Corporation to take such action as was necessary to remedy the infestation of land within the Borough came into force on the 18th May, 1944. Contracts were taken over from the County Council and a further contract was. entered into during the year. A comprehensive scheme of administration was drawn up and included the nomination of Mr. M.V. Sutcliffc, Sanitary Inspector, as Rodent Officer and the appointment of a Senior Rodent Operative and Assistant. The charge for carrying out rodent control work was fixed on the basis of time and materials, plus 33 1/3% for overhead expenses, with a reduction of the charge according to means. Difficulties in obtaining a suitable assistant operative (three different appointments wore necessary within a few months) prevented the smooth running of the work, but by the end of the. year, definite progress was being made. FACTORIES, ACT, 1937 Inspections for purposes of provisions as to health Inspections Written notices Factories with mechanical power 479 2 Factories without mechanical power 115 5 Other promises under the Act 85 - 679 7 Summary of defects found Found Remedied Want of cleanliness 3 4 Inadequate ventilation 2 2 Sanitary conveniences Insufficient. 2 1 Unsuitable or defective 4 2 9 7 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. 19 HAIRDRESSERS' AND BARBERS' PREMISES Hairdressers' and. barbers' premises in the Borough were inspected by the Sanitary Inspectors and Health Visitors during the year. RENT AND MORTGAGE INTEREST RESTRICTIONS ACTS 1920 to 1938 Pour certificates were granted under the above Acts in respect of premises which were not in a reasonable state of repair, as compared with twenty-three for the previous year. INSPECTION AND SUPERVISION OF FOOD. Milk Supply The bulk of the milk supply of the Borough continues to come from outside the area and has been pasteurised before delivery. 116 visits were paid to dairies and milkshops. Milk Sampling 32 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 granted for the sale of designated milk:- "Tuberculin tested" milk 17 "Accredited" 1 "Pasteurised" 23 Slaughter-houses Pour 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. Seven slaughter-men were on the register of the Department the end of the year. Meat and Other Foods. There was no general slaughtering in the Borough during the year. The number of pigs slaughtered under 1icences granted by the Ministry of Pood was 65. All were inspected. The following is a summary of meat and other foods found to be unfit for human consumption and condemned. The list is exceptionally heavy and includes a large amount of foodstuffs damaged by enemy action. 20 Meat Pork - 1,432 lbs. Bacon, ham - 736 lbs. etc. Lamb & Mutton - 1,507 lbs. Beef - 351 lbs. Sausages- - 680 lbs. Pastes -931 tins and jars. Fish - 799 lbs. - Soup - 519 tins Tinned Meat - 753 tins Tinned Fish - 1,322 tins. Vegetables Dried G-oods - 13 items. Tinned - 465 tins Fresh - 20 items Milk - 1,565 tins Dried - 7. items 3 other items Fats - 9 items Cheese - 56 3 lbs. Pi our - ,5,000 lbs. Eggs 18 bags. Dried - 460 pkts. Fresh - 1,88b Sauces - 13 items Substitute - 224 lbs. Condiments - 6 items Herbs, spices - 19 items Pake & pudding Sugar, Tea, coffee mixtures - 11 items & cocoa - 10 items Bread, cake Jam & Marmalade biscuits etc. - 23 items Tins & Jars - 9,753 3 other items. Fruit Squash & cordials - 6 items Tinned - 489 tins Fresh - 6 items0 Confectionery - 3 items Dried - 7 items Miscellaneous - 9 items Medicine - 9 items During the year the following visits were made to premises upon which food is prepared or sold:- Bakehouses 122 Butchers' shops 314 Restaurants 350 Grocers shops 129 Greengrocers' shops 173 Fish shops 143 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 Sanitary Inspectors during the year. FOOD AND DRUGS ACT, 1938 The Middlesex County Council are the Food and Drugs Authority for the Borough. - 21 - INFECTIOUS DISEASES (a) NOTIFIABLE INFECTIOUS DISEASES Diphtheria The number of cases of diphtheria notified during the year was 5 as compared with 4 in 1943, 7 in 1942, 25 in 1941, 18 in 1940 and 25 in 1939. All five. cases were admitted to hospital. There were three deaths, two being adults in the same family. The death rate was 0.03 per 1,000 of the population as compared with 0.02 for England and Wales. Supply of anti-toxin 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 immunisation At the end of the year it was estimated that the percentage of the child population immunized against diphtheria was as follows:- Under 5 years 52% 5 to 15 years 76.4% The following is a brief summary of the work carried out during the year:- Total number of new cases 1153 Schick Testing 1st Schick test (before inoculation) No. tested 9 No. susceptible 4 No. immune 5 No. failed to attend - 2nd Schick test (after completion of 1st course of injections) No. tested 933 No. protected 766 (82.1%) No. susceptible 39 No. failed to attend 128 All those found to be incompletely protected after the second Post Schick were re-inoculated. Total No. of attendances for year - 4, 164 The diphtheria prophylactic used was A.P.T. and T.A..F. Scarlet Fever There was a sharp drop in the number of cases occurring in the Borough during the year, 121 being notified as compared with 238 for the previous year. 35 cases were admitted to hospital. There were again no deaths. 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. Ten contacts were kept under observation by the Department. -22- Pneumonia, Malaria and Dysentery. Pneumonia. There was a decrease both in the number of cases notified and the deaths recorded from this disease viz. 49 and 53 respectively, as compared with 60 and 65 for the previous year. Malaria. No case of malaria was notified during the year. Dysentery. One case of dysentery was notified during the year. This was treated in hospital. Acute Poliomyelitis. Acuta Polio-encephalitis Two cases of acute poliomyelitis were notified during the year. Both wore treated in hospital. There was one death. Ophthalmia 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 Deaths 1944 8 8 - 8 - - _ Puerperal Pyrexia Eleven cases of puerperal pyrexia were notified - a decrease of seven compared with the previous year. Six-were admitted to the West Middlesex Hospital and one to the North Western Hospital. Enteric Fever No cases of enteric fever.(which includes the paratyphoid fevers) were notified during the year. There were no deaths. Typhoid immunization Facilities were again available at the clinics for typhoid immunization, but no cases were dealt with during the year. Cerebro-spinal fever One case of cerebro-spinal fever was notified, the same as the previous year. There was one death. Measles and Whooping Cough During the year 66 cases of measles were notified as compared with 450 for the previous year, There were no deaths. Whooping cough also declined, during the year, 202 cases being notified as compared with 317 for the previous year. There was one death. (b) NON-NOTIFIABLE INFECTIOUS DISEASES Influenza The influenza epidemic which had assumed serious proportions at the close of 1943 had practically subsided by the end of January. As hitherto 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. Other During the year the following cases of non-notifiable infectious diseases were brought to the notice of the Department. Mumps 104 Chicken-pox 251 - 23 - TUBERCULOSIS The number of new cases of tuberculosis notified during the year was 15.1 as compared with 137 for 1943. The Registrar General credits us with 48 deaths, an increase of one on the previous year. New Cases and Mortality, 1944 The following table prepared from the records in the Department summarises the position. Age Periods New Cases Deaths Pulmonary NonPulmonary Pulmonary NonPulmonary M. F. M. F. M. F. M. F. Under 1 l - - - - - - - 1-5 3 2 - - - - - - 5-10 2 - - 1 - - - 1 10-15 2 3 2 1 - 1 2 1 15 - 20 7 2 - 2 2 1 — - 20-25 15 14 1 3 2 - - - 25-35 12 15 - 4 3 6 - - 35-45 11 9 1 2 3 4 - 1 45-55 13 9 - - 3 1 - - 55-65 10 - 1 - 10 1 - 1 65 and over 2 1 - - 3 - - 1 73 55 5 13 26 14 2 5 primary Notifications of Tuberculosis, 1937 - l944 inclusive 1937 1938 1939 1940 1941 1942 1943 1944 Pulmonary 85 100 106 114 127 112 119 133 NonPulmonary 25 30 19 12 14 13 18 18 Total 110 130 125 126 141 130 137 151 Public Health (Prevention of Tuberculosis) Regulations, 1925 Public Health Act. 1956 (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 CASES OF INFECTIOUS DISEASES NOTIFIED DURING- THE YEAR, 1944 DISEASE CASES NOTIFIED AT VARIOUS AGES (YEARS) Total Cases Notfd Cases Admtd Hosp. Total Deaths Under 1 1-2 2-3 3-4 4-5 5-10 10-15 15-20 20-25 25-35 35-45 45-65 Over 65 Acute Anterior Poliomyelitis - - - - - - 2 - - - - - - 2 2 1 Cerebro-Spinal Fever - - - 1 - - - - - - - - 1 1 1 Diphtheria - 1 - 1 - 1 1 - - - 1 - - 5 5 3 Dysentery - - - - - - - - - 1 - - - 1 1 1 Erysipelas - - 1 - - 1 1 - - 2 4 13 5 27 6 - Measles - 2 4 5 7 41 3 3 - 1 — - - 66 2 - Ophthalmia Neonatorum 8 - - - - - - - - - - - - - - - Pneumonia 1 - - - 1 2 3 1 - 7 7 20 - 49 13 53 Puerperal Pyrexia - - - - - - - 1 2 5 3 - - 11 7 Scarlet Fever 1 2 6 5 9 65 20 5 4 3 1 — - 121 35 — Typhoid Fever - - - - - - 1 - - - - - - 1 1 - whooping Cough 23 27 27 19 31 70 2 1 - 2 - - - 202 10 1 25 MONTHLY INCIDENCE OP INFECTIOUS DISEASES DURING THE YEAR, 1944 DISEASE NUMBER OF CASES TOTAL Jan. Feb. Mar. Apr. May June July Aug. Sept. Oct. Nov. Dec. Acute Anterior Poliomyelitis - - - - 1 1 - - - - - - 2 Carebro-Spinal Fever - - 1 - - - - - - - - - 1 Diphtheria - - - 1 - 1 - - 1 1 - 1 5 Dysentery - - - - - - - - - - 1 - 1 Erysipelas 3 5 5 4 3 2 1 - - 1 2 1 27 Measles - - 3 13 9 7 1 2 - 5 4 22 66 Ophthalmie Neonatorum. 2 1 - - 2 1 - 1 - - - 1 8 Pneumonia 11 3 7 7 3 2 3 1 1 5 2 4 49 Puerperal Pyrexia - - 1 - 5 2 - 1 - - 2 - 11 Scarlet Fever 16 16 27 8 9 4 7 1 4 14 10 5 121 Typhoid - - - - 1 - - - - - - - l Whooping Cough 15 28 25 29 27 25 13 4 l 7 3 25 202 26 I N D E X. Page Adoption of Children(Regulation) Act, 1939 14. Ambulance Facilities, 8 Ante-Natal Clinics 9, 11 Anti-toxin, Supply, of 22 Births 5, 10 Birth Control 11 Blindness, prevention of 24 Care of Mothers daring Confinement 11 Care of Mothers subsequent to Confinement 12 Child Guidance Clinics 9 Child Life protection 13 Cerebro-Spinal Fever 23 Common Lodging Houses 18 Cleanliness, Promotion of 10 Deaths 5,6 Dental Clinics 9 Dental Treatment 12, 13 Diphtheria 22 Diphtheria, Immunization 22 Diphtheria Immunization Clinics 9 Disinfestation 18 Drainage and Sewerage 16 Dysentery' 23 Enteric Fever 23 Factories Act, 1937 19 Food, Inspection and Supervision of 20 Food and Drugs Act, 1938 21 Gas and Air Analgesia 12 Hairdressers' and Barbers' Premises 20 Health Education 10 Health Visiting 12 Hospitals 9 Housing 17 Infantile Mortality 6 Infant Welfare Clinics 9, 13 Infectious Diseases 9, 22, 23, 25, 26 Influenza 23 Insulin, Provision of 10 Laboratory Work 8 Malaria 23 Massage or Special Treatment, Establishment for 19 Maternal Mortality 6 Measles 23 Middlesex County Council (General Powers) Act, 1938 21 Midwifery and Maternity Services 10 Midwives Acts 10 Milk and Other Foods, etc., Provision of 13 Milk Supply 20 Nursing Associations 88 Nursing Homes 15 Ophthalmic Clinics 9 Ophthalmic Treatment of Children under 5 13 Ophthalmia Neonatorum 23 Orthopaedic, Treatment 14 27 INDEX (CONTINUED) Page i petroleum-(Regulation) Acts 18 Pneumonia 23 Poliomyelitis 23 polio-encephalitis 23 Public Cleansing 16 puerperal Pyrexia 9, 23 Rent & Mortgage Interest Restrictions Acts 20 Rivers and Streams 16 Rodent Control 19 Sanitary Inspection of District 17 Scabies 18 Scarlet Fever 22 School Clinics 9 Schools 18 Shops Acts 19 Slaughtering of Animals 20 Smallpox 9, 22 Smoke Abatement 18 Statistics, General and Vital 7 Summer School for Health Visitors 13 Swimming Baths and Pools 18 Tuberculosis 9, 24 Typhoid Immunization 23 Unsound Pood 20 Wartime Nurseries 15 Water Supply 16 Whooping Cough 23 28