AC 439 (1) TWICKEN HAM Twi 13 borough of twickenham Annual Report of the medical officer of health 1945 JOHN MADDISON, M.D., B.S., D.P.H. Medical Officer of Health Public Health Department, Elmfield House, High Street, Teddington. To the MAYOR,ALDERMEN AND COUNCILLORS of the BOROUGH OP TWICKENHAM. Ladies and Gentlemen, I have the honour to submit my Annual Report on the health and sanitary condition of the Borough during the year ending 31st December,1945. Following the practice of the war years, the report has been condensed and certain tables omitted. The year 1945 saw the termination of hostilities both in Europe and in Japan, There was general happiness that the end of the war had come, that conditions would quickly return to their normal peace-time level and a happy anticipation that the near future would bring improvements in our health and maternity services. During the war years the population of the Borough fell from 99,000 in 1939 to below 88,000 during the worst of the flying bomb period of 1944. In 1945 the return of evacuees and new people coming into the Borough caused the population to rise at an enormous rate. This rise, together with the loss of property during the war began to show itself as an acute problem of overcrowding with its attendant discomforts and dangers to health. The number of births and the birth rate for the whole year were a little less than for 1944, but towards the end of the year it was observed that the rate was beginning to increase remarkably. Men were beginning to return home from the Forces and to settle down with their wives to peace-time occupations and were starting their families. The increase in the birth rate would aggravate the already overcrowded conditions in many houses. Time, only too unhappily has proved this to be the case. I think the conditions of overcrowding had an adverse effect on our infant mortality rate for 1945; It was not as good as I would have wished for. The death rate of all infants per 1,000 live births rose to 48.02 as compared with 37.1 in 1944; and the Illegitimate infant death rate rose to 62.5 as compared with 43.5 in 1944. These figures are much worse than those for 1939 when we had reduced the rate to 26.4. In 1945 two-thirds of the infant deaths occurred in babies under four weeks old. We must ensure that our ante-natal services continue at maximum efficiency to ensure that every baby is born in optimum health and in circumstances ensuring as far as possible the best chance of survival. Apart from the statistical information reaching the health department on births, deaths and infectious diseases, very little information is received about the incidence of morbidity the amount of illness, trivial or serious, which is not of an infectious nature, but which may have an adverse influence on the health of the population. I should like to know for example, how many people suffer from rheumatism, at what periods of life it is worst, what factors influence its severity, and much more information of a similar nature. There are many other illnesses causing suffering and disability about which such information would be useful. With a more adequate knowledge of the extent of these problems we might perhaps be able to suggest measures for their prevention. A useful beginning has been made by the Ministry of Health Social Survey, but much more is needed. More and more people are making use of public health services. The attendances at centres are high; over 90% of the mothers of new-born babies attend the clinics for help and advice, whilst at the health department we are receiving requests - 2 - for help on social problems more than ever before. It may be that our services are more highly appreciated than in the past, it may be that the public have a greater awareness of the services at their disposal and are turning to the local authority for the solution of many problems; they are encouraged to do so. A vigorous policy of health education was pursued throughout the year; the booklet "Use your Health Services" was well received and greatly appreciated. We continued our lectures, film shows and the distribution of leaflets on numerous aspects of the work of the department, 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 throughout 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- STATISTICAL SUMMARY for the year 1945 Area in acres 7,007 Population (as extended - census 1931) 79,376 Resident population - estimated to mid-year 1945 (as supplied by the Registrar-General) 91,920 Number of inhabited houses 28,672 Rateable value £1,029,018 Sum represented by a penny rate 1945/46 £4,148: 6: Id. Live Births: Total M. F. Legitimate 1397 740 657 Illegitimate 144 71 73 Total 1541 811 730 Birth rate per1, 000 of estimated resident. population. 16.76 Still Births: Total M, F. Legitimate 35 13 17 Illegitimate 4 3 1 Total 33 21 18 Still Birth rate per 1,000 total (live and still) births 24.68 Deaths: Total M. F. 1,117 543 574 Death rate per 1,000 of estimated resident population 12.15 Maternal deaths: Puerperal and Post-abortive Sepsis 1 Other Maternal Causes Nil. Rate per 1,000 total (live and still) births. 0.63 Death rate of infants under one year of age:- All infants per 1,000 live births 48.02 Legitimate infants per 1,000 leg. live births 46.5 Illegitimate infants per 1,000 illeg. live births 62.5 Deaths from:- Cancer (all ages) 182 Measles (all ages) 2 Whooping cough (all ages) 1 Diarrhoea (under 2 years of age) 6 -4- STATISTICS, SOCIAL CONDITIONS AND GENERAL PROVISION OF HEALTH SERVICES FOR AREA POPULATION The Registrar General's estimate of population for the mid-year 1945 was 91,920 and this has been adopted for the calculation of the statistics in this report. It should be noted however that with the cessation of bombing in the early summer there was a gradual return of the families evacuated during the war years, and it is estimated that at the end of the year 1945 the population was approximately at the 100,000 level. BIRTHS The live births registered in the Borough in 1945 numbered 1541 giving a birth rate of 16.76 per 1,000 of the population (England and Wales 16.1). The births were made up as follows Males Females Total Legitimate 740 657 1397 Illegitimate 71 73 144 Total 811 730 1541 The number of births represents a decrease of 102 compared with the previous year. Illegitimate births formed 9.3% of the total live births, an increase of 0.9% on the previous year. Still Births. There were 39 still births registered during the year, giving a still birth rate of 24,68 per 1,000 total (live and still) births. DEATHS The net deaths registered in the Borough during 1945 were Males 543, Females 574, Total 1,117. This represents a decrease of 19 compared with the previous year. The death rate per 1,000 of the population was 12.13 as compared with 11.4 for England and Wales. The natural increase of population (that is, excess of births over deaths) was 424 as oompared with 507 for 1944. Sex Mortality. The sex mortality rate was as follows;- Males 5.90 per 1,000; females 6.24 per 1,000. Zymotic Diseases Mortality. 1 The mortality rates for this group of diseases which includes Enteric Fever, Smallpox, Scarlct Fever, Diphtheria, Measles, Whooping Cough, and Diarrhoea under two years of age, were:- Dis ease No. of Deaths Death rate per 1,000 of the population Male Female Total Enteric Fever - - - - Smallpox - — - -- Scarlet Fever — - — - Diphtheria 1 — 1 0.01 Measles 2 - 2 0.02 Whooping Cough - 1 1 0.01 Diarrhoea 4 2 6 . . 0.06 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 31.6 3.8 Intra-cranial vascular lesions 11.2 1.36 Bronchitis, Pneumonia and other respiratory diseases 11.2 1.36 Cancer 16.3 1,9 Violence 4,8 0.59 Tuberculosis 4.2 0.52 -6- CAUSES OP DEATH 1945 Registrar General's Official Returns Causes of Death. Males Females Total All Causes 543 574 1117 1. Typhoid and paratyphoid fevers - - - 2. Cerebro-spinal fever - 1 1 3. Scarlet Fever - - - 4. Whooping Cough - 1 1 5. Diphtheria 1 - 1 6. Tuberculosis of Respiratory System 26 17 43 7. Other forms of Tuberculosis 2 3 5 8. Syphilitic diseases 8 2 10 9. Influenza 3 6 9 10. Measles 2 - 2 11. Acute Polio-myelitis & polio-enccphalitis 1 - 1 12. Acute infective encephalitis 1 - 1 13. Cancer of buccal cavity and oesophagus (M) uterus (F) 6 7 13 14. Cancer of stomach and duodenum 9 15 24 15. Cancer of breast 1 21 22 16. Cancer of all other sites 76 47 123 17. Diabetes 6 6 12 18. Intra-cranial vascular lesions 44 81 125 19. Heart disease 138 177 315 20. Other diseases of circulatory system 21 17 38 21. Bronchitis 34 16 50 22. Pneumonia 25 30 55 23. Other respiratory diseases 10 10 20 24. Ulcer of stomach or duodenm 11 2 13 25. Diarrhoea under 2 years 4 2 6 26. Appendicitis 3 2 5 27. Other digestive diseases 6 13 19 28. Nephritis 12 9 21 29. Puerperal & Post-abortive Sepsis - 1 1 30. Other maternal causes - - - 31. Premature birth 13 15 28 32. Congenital malformations, birth injury, infantile diseases 13 6 19 33. Suicide 3 3 6 34. Road traffic accidents 6 6 12 35. Other violent causes 19 17 36 36. All other causes 39 41 80 MATERNAL MORTALITY One death was registered as being duo to diseases or accidents of child-birth as compared with no deaths for the previous year. The cause of death was:- Ia. Post partum eclampsia, II Toxaomia of pregnancy. A full enquiry is made into the cause of every maternal death. The maternal mortality rate per 1,000 total (live and still) births was .63. That for England and Wales was 1.79. -7- INFANTILE MORTALITY There were 74 deaths of infants under one year during the year giving an infantile mortality rate of 48.02 per 1,000 live births. Although this shows an increase on the figure of 37.1 for 1944, it compares favourably with the rate for England and Wales In 1945, which was 46. An analysis of the mortality reveals that neo-natal deaths were responsible for 66.2 per cent of the total deaths, viz:- Under 24 hours 1 to 7 days 1 to 4 weeks Total under 4 weeks Percentage total infant deaths 11 25 13 49 66.2 Congenital malformations, premature birth, etc. caused 47 (or 60.35%) of the total infant deaths. Deaths of illegitimate infants. The death rate of illegitimate infants during 1945 was 62,5 per 1,000, compared with 43.48 for the previous year. The corresponding death-rate of legitimate children was 46.5 (36.5 for 1944) REVIEW OP THE COMPARATIVE VITAL AND MORTALITY STATISTICS FOR THE BOROUGH OF TWICKENHAM, TOGETHER WITH THOSE FOR ENGLAND AND WALES FOR YEARS 1937 - 1945 INCLUSIVE YEAR Birth Rate Death Rate Infantile Mortality Rat Twick. Eng. & Wales, Twick. Eng. & Wales. Twick. Eng. & Wales 1937 14.9 14.9 (a) 11.08 (b) 10.96 12.4 35.4 58 1938 14.4 15.1 (a) 9.91 (b) 9.81 11.6 45.8 53 1939 14.2 15.0 (a) 10.46 (b) 10.35 12.1 26.4 50 1940 14.67 14.6 (a) 14.8 (b) 14.9 14,3 45.8 55 1941 13.4 14.2 13.0 12.9 70.95 59 1942 16.49 15.8 11.6 11.6 53.1 49 1943 17.7 16.5 12.3 12.1 47.99 49 1944 18.5 17.6 12.8 11.6 37.1 46 1945 16.76 16.1 12.15 (a) Crude (b) Adjust 11.4 48.02 46 -8- BIRTH RATE, DEATH RATE AND ANALYSIS OP MORTALITY DURING 1945. Provisional figures J 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 & para typhoid fevers Small pox Measles Scarlet Fever Whoop- ing Cough Diphtheria Influenza Diarrhoea & Enteritis (under two Years) Total deaths under 1 year England and Wales 16.1 0.46 11.4 0. 00 - 0.02 0.00 0.02 0. 02 0.08 5.6 46 126 County Boroughs and great towns, including London 19.1 0. 58 13.5 0. 00 - 0.02 0.00 0. 02 0.02 0. 07 7.8 54 148 smaller towns (resident populations 25,000 to 5C,000 at 1931 census). 19.2 0. 53 12.3 0.00 - 0. 02 0.00 0. 01 0.02 0.07 4.5 43 London Adm. County 15.7 0.40 13.8 0. 00 - 0. 01 0.00 0. 02 0.01 0.07 7.6 53 TWICKENHAM 16.76 0.42 12.15 0.00 - 0. 02 0. 00 0. 01 0.01 0. 09 3.9 48 9 LABORATORY WORK The usual arrangements were continued during the year and worked satisfactorily. The following table gives the number of specimens examined during the year:- Nature of Specimens No. Result Throat and nasal swabs for diphtheria 190 5 positive Sputum etc. for tubercle bacilli 56 8 ” Miscellaneous 65 4 ” Total specimens examined 311 AMBULANCE FACILITIES Infectious diseases. A motor ambulance is provided by the South Middlesex and Richmond Joint Hospital Board. Non-infectious and accident cases. The normal establishment of ambulance vehicles is four. The service is maintained continuously. It deals with street accidents removals to hospitals inside and outside the Borough, a few long distance removals and other emergencies. During the war the service was staffed by Civil Defence personnel. At the meeting of the Public Health Committee in January 1945, I reported on the desirability of an amount being included in the Estimates for the financial year 1945-46, for the employment of a paid ambulance staff on a peacetime basis. This was approved. In April 1945, the Ministry of Health circulated all local authorities on the need for reviewing the peace-time ambulance services as a result of reductions being made in Civil Defence Ambulance Services. The Corporation decided to put into operation, as from 4th. June, 1945, the scheme already provisionally approved for the staffing of the Ambulance Service on a peacetime basis. This provided, for an establishment of 14|. driver attendants on a shift system at the appropriate J.I.C. rate of pay. Fourteen men from the Civil Defence Service were retained for the work. An officer-in-charge of the service was also appointed and the principle of obtaining a sittingcase car approved. The Corporation staff-car was housed at the Hollies Ambulance Station and the services of the driver utilised, when available, as Station Telephonist. Two other developments based on the Ambulance Service an made possible through the assistance obtained from the Civil Defence nurses, were the Continuous Oxygen Administration and Gas and Air Analgesia. Since the disbanding of the Civil Defence personnel, volunteers from the St. John Ambulance Brigade have rendered excellent service on these additional facilities and are deserving of the highest praise. During the year, a full-time auxiliary nurse was appointed to assist, among other things, with the foregoing services when possible. At the close of the year three ambulances were in commission, and a new vehicle was shortly to be delivered. -10- As a result of a conference between certain of the Local Authorities concerned, a mutual assistance scheme was agreed with the Boroughs of Heston and Isleworth, Richmond, Southall and the Urban District of Feltham. The future of the Ambulance Service is bound up with the National Health Service Bill and the service will no doubt be administered in due course by the County Council as the Local Health an t.h nr>i -far. The following table shows the work done by the Borough ambulance service during the year 1945:- 1st Qtr. 2nd Qtr. 3rd. Qtr. 14th Qtr. Total Accidents 91 150 120 131 1492 Removals after accidents 4 16 13 18 51 Ordinary removals 351 275 293 406 1325 School emergency calls 2 3 3 9 17 Total No. of call 448 444 429 464 1885 Mileage 4152.2 3985.6 4034 5424 17595.8 Continuous Oxygen Service Patients attended 13 7 2 16 38 Gas & Air Analgesia Patients attended 4 16 10 3 33 NURSING IN THE HOME There are five home-nursing associations in the Borough and during the year the Council contributed the sum of £300 to their funds. NURSES' ACT, 1943 Agencies for the Supply of Nurses During the year the Corporation made application to the Middlesex County Council for the delegation to them of the latter's functions under Part II of the above Act, as provided by Section 11. The County Council intimated however that as they were the authority throughout the county for the licensing of employment agencies and that there were at present a number of nursing agencies licensed by them as employment agencies, they had decided for the time being not to delegate any of their functions under Part II of the Act to the Council of any County District. -11- CLINICS AND WELFARE CENTRES The following clinics were being held within the Borough at the end of the year. CLINIC ADDRESS BY WHOM PROVIDED Infant Welfare Centres York House, Twickenham. Hospital Bridge Road, Twickenham. Art School, Teddington. Station Road, Hampton. 20 Seymour Road, Hampton Wick. Twickenham Council. Ante-Natal Clinics. York House, Twickenham,, Hospital Bridge Road, Twickenham Art School, Teddington. Station Road, Hampton. 20 Seymour Road, Hampton Wick. Twickenham Council. School Clinics York House, Twickenham, Hospital Bridge Road, Twicketham. Stanley Road, Teddington. Station Road, Hampton. 20 Seymour Road, Hampton Wick, Middlesex County Council. Dental Clinics York House, Twickenham. Stanley Rd, Teddington.. Hospital Bridge Road, Twickenham. Art School, Teddington, (Orthodonyic) Twickenham Council & Middlesex County Council. Middlesex County Council. Ophthalmic Clinics York House, Twickenham. Stanley Road, Teddington. Middlesex County Council. Diphtheria & Typhoid Immunisation York House, Twickenham. Hospital Bridge Road, Twickenham. Stanley Road, Teddington. Station Road, Hampton. 20 Seymour Road, Hampton Wick. Twickenham Council. Child Guidance Clinic, 58, Hampton Road, Twickenham. Middlesex County Council. HOSPITALS Smallpox Tuberculosis Puerperal Pyrexia Infectious Diseases The arrangements for the provision of hospital accommodation or residential institutional treatment remained unchanged. -12- OTHER HOSPITALS In addition to the three voluntary hospitals - St. John's Hospital, Twickenham, St. Mary's Hospital, Hampton, and the Teddington, Hampton Wick 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 1945/6. Mortuary During the year 110 "bodies were admitted to the Mortuary. In all cases post-mortem examinations were held. PROVISION OF 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. REMOVAL OF INFIRM PERSONS It was necessary to take action under section 272 of the Middlesex County Council Act 1944, in respect of two elderly people who were suffering from a grave chronic disease and were unable to devote to themselves, or to receive from each other, proper care and attention. Court Orders were obtained for their removal to an Institution. HEALTH EDUCATION A useful step in furthering public relations was taken during the year in the production of a fourteen page printed booklet entitled "Use your Health Services". Nearly 1,000 copies were distributed to clinics, medical practitioners, libraries, schools, local organisations, etc. The many messages of appreciation received clearly showed its value. A progressive policy in Sex Education was continued during the year and in co-operation with the Head Teachers, seven evening lectures to parents were held in different schools. The theme taken was "Answering children's questions on sex". The lecturers and films were obtained through the Central Council for Health Education. All arrangements were made by the Public Health Department. During the year special publicity was undertaken concerning Venereal Diseases, Droplet Infection (Coughs and Sneezes), Diphtheria Immunization, etc. Leaflets were distributed, as appropriate, on a wide variety of health education subjects in addition to a restricted issue of copies of Better Health. PREVENTION OF BLINDNESS No action was taken during the year under Section 176 of the Public Health Act, 1936. -13- MATERNITY AND CHILD WELFARE MIDWIFERY AND MATERNITY SERVICES The total number of births notified as occurring in the Borough was 1,146. This does not include births which occurred elsew here but which were subsequently transferred to Twickenham. Of the births occurring in the Borough, 749 were attended by Midwives in their capacity as Midwives, and 397 by Doctors. Municipal Midwives attended 380-279 in their capacity as Midwives and 101 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 279 101 Non-municipal Midwives — - Bears ted Memorial Hospital 463 21 Nursing Homes 7 275 749 397 Hampton Wick Clinic. A new Welfare Centre was opened during the year at 20, Seymour Road, Hampton Wick. The Infant Welfare Centre had been held for some years in the Baptist Hall, Upper Teddington Road and subsequently at St, Mark's First Aid Post. When the First Aid Post was closed at the cessation of hostilities, accommodation was found at the above address. An ante-natal consultation clinic and a school medical clinic, have been started in addition to the Infant Welfare consultation clinics, and it is hoped to commence a dental clinic there shortly. MIDWIFERY ACTS The total number of Midwives employed is NINE. CARE OF EXPECTANT MOTHERS, The number of sessions devoted to this work was:- York House Centre One weekly session, plus additional session on second and fourth week of each month. Whitton Centre Two weekly sessions. Teddington Centre Two weekly sessions. Hampton Centre One session first, third and fourth week of each month. Hampton Wick Centre One weekly session. Year Attendance Total first time Attendances 1940 750 2998 1941 770 3375 1942 1038 4842 1943 1056 5094 1944 944 4393 1945 1054 4801 -14- Certain foods were supplied to expectant mothers for whom special treatment was ordered. These foods were supplied free in necessitous cases. Vitamin preparations as supplied by the Ministry cf Pood to expectant mothers continued to be distributed for eaoh ante-natal clinic. No request for the services of a consultant was made during the year. The scheme whereby expectant mothers could be X-rayed continued to prove satisfactory. The total number who were X-rayed was 492 and of these 11 were found to be in need of further observation and/or treatment. The fee payable by the Council to the hospital is 10/6d for each mother. 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 CF 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. HOME HELP SERVICE During the year the Home Help Service was extended to all homes in which urgent domestic help was needed. Previously this service was available only to the Expectant and Nursing Mother and in homes where there were children under the age of five. There are at present four full-time and five part-time Home Helps on the staff, but it is hoped to increase this number at an early date. Maternity Domestic No. of applications received 159 56 No, of homes in which Home Helps attended:- Paying Full Fee 57 49 Paying Part Fee 64 11 Paying No Fee 2 3 Total. 123 63 GAS AND AIR ANALGESIA All the Corporation Municipal Midwives are qualified to administer Gas and Air Analgesia, Analgesia was administered to 45 patients during the year. The two midwives who have cars carry the apparatus with them. Two other machines are kept at the Hollies Ambulance Depot for use by the remaining midwives. -15- SUBSEQUENT TO CONFINEMENT Seven eases of Puerperal Pyrexia occurred during the year and of these two were admitted to the West Middlesex County Hospital and one to Mogden Isolation 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 1940 - 71 1943 - 263 1941 - 297 1944 - 180 1942 - 255 1945 - 172 One maternal death of a Twickenham resident occurred during the year. HOSTEL ACCOMMODATION The Corporation, in conjunction with the Middlesex County Council, arranged for the admission of unmarried mothers and their babies into the British Red Cross home at Hendon. This arrangement has been extended to the patient prior to confinement and a home was opened at 16, The Park, Golders Green, The same arrangements are made as for the post-natal home at Hendon, the cost to the Borough being 35/- per week for each patient, the contribution payable by the patient towards this amount being assessed according to the Council's Scale of Assistance. During 1945 14 were admitted to 16, The Park. 14 " " " Hendon, DENTAL TREATMENT The following received dental treatment during the year:- 1945 1944 1943 1942 1941 Expectant Mothers 40 42 73 69 52 Nursing Mothers 20 27 46 32 33 Patients supplied with dentures 38 53 71 55 37 Dentures supplied 63 90 129 100 65 HEALTH VISITORS An a dditional Health Visitor was appointed during the year thus bringing the total number of Health Visitors to eleven. The Health Visitors carried out the duties of school nurses on behalf of the Middlesex County Council. There is also one fulltime School Nurse employed by the Middlesex County Council. The total number of visits paid during the year was 15,705 and included the following visits to:- 1945 1944 1943 1942 1941 Expectant Mothers 334 437 402 354 432 Children under 1 year of age 5487 5675 5544 3921 4016 Children between the ages of 1 and 5 years 6543 7699 7589 7137 7834 Visits were also paid to children of school age in cases of suspected infectious diseases 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. -16- POST GRADUATE EDUCTION Two Health Visitors attended the Winter School held at Bedford College which was organised by the Women Public Health Officers* Association and one Health Visitor attended the Preliminary Teaching Course under the auspices of the Women Public Health Officers' Association. The Midwives attended a post-graduate course at the County Hall. PROMOTION OF CLEANLINESS, ETC The scheme for head rnd cleanliness inspections in the schools 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. Suitable pamphlets were also distributed at the Infant Welfare Centres. INFANT WELFARE CLINICS There are five Infant Welfare Clinics; ten sessions for infant consultation are held weekly and one breast feeding clinic. 1945 Twickenham. Whitton Teddington Hampton Hampton Wick. TOTAL First attendance Under 1 year 341 395 258 158 101 1253 First attendance 1-5 years 69 88 52 40 35 284 Total attendances under 1 year 3494 5758 3161 2878 1230 16521 Total attendances 1-5 years 1555 3944 2228 1930 851 10508 CONVALESCENT TREATMENT Children under five were recommended for convalescant treatment at a cost to the Corporation of £113:12:3d. The parents' contribution being assessed in accordance with the Council's Scale of Assistance. DENTAL TREATMENT OF CHILDREN UNDER 5 YEARS During the year, the numbers of children under 5 years of age who received dental treatment were:- New cases 153 Total attendances 493 OPHTHALMIC TREATMENT OF CHILDREN UNDER 5 YEARS During the year, the numbers of children under 5 years of ago examined by the Ophthalmic Surgeon were:- First attendance 49 Total attendances 102 Dental and Ophthalmic treatment are free to children under five. -17- MILK AND OTHER FOODS, ETC. During the year, 41 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 £24:16:4½d. 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 551. Details of authorisation during 1945 were:- Individual Fester Mothers, Persons in charge of Residential Nurseries &c.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. 50 3 33 No. of children on register at the end of the year 41 28 69 No. of children who died during the year. 1 - 1 Proceedings taken during the year - - - CARE OF ER EMATURB BABIES Two special cots for care of the premature anr. feeble baby were purchased during the year. The apparatus consist of two sets (for twins if necessary) of:- Asbestos stand heated by two electric lamps and/or three hot water bottles. Draught-proof cot with mattress. Gamgee cloak for baby. Special feeding bottle. Thermometer for recording temperature of cot. Blankets. Masks for attendants. The cots are kept ready at the Hollies Ambulance Depot so that they may be called on in an emergency day or night. The draughtproof cots can be taken from the stands if it is found necessary for the baby to be removed to hospital. The service is proving very satisfactory. MINISTRY OF HEALTH CIRCULAR 2866. In accordance with this Circular, the Corporation will, in certain cases, undertake the maintenance of children living apart from their parents. The payment is 3/9 per day - the parents' contribution being assessed in accordance with the Corporation's Scale of Assistance This scheme is restricted to bona-fide residents of Twickenham. -18- ADOPTION OF CHILDREN (REGULATION) ACT, 1939. 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 126. No. of persons who gave notice under Section VII (3) during the year 29 Total No. of children in respect of whom notice was given under Section VII (3) during the year 29 No. of children notified under Section VII (3) (1) under supervision at the end of the year 14 (2) who died during the year nil (3) on whom inquests were held during the year nil 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. NURSING HOMES There are twelve 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 Bears ted 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. DAY NURSERY SERVICE The six War-time Day Nurseries in the Borough, accommodating 245 children, are now well established and are being used to capacity. The average daily attendance at each Nursery is set out belows:- 51, Hampton 40, Cambridge Powder Mill Station Rd. Oldfield Gifford Road. Park. Lane. H. Wick. Read. Lodge 34.53 43.26 38.07 36.63 37.93 47.04 The routine medical inspections carried out at regular intervals confirm that the high standard of nutrition is being maintained. It is, indeed, satisfactory to report that with the exception of the outbreak of measles, which was general throughout the Borough, and a small epidemic of chickenpox in the 51 Hampton Road Nursery, there have been no serious outbreaks of infection in the Nurseries. Following the cessation of hostilities, the staff have become much more stabilised and it has been possible to carry out an intensive training in the Nurseries. Special attention has been given to those in charge of 2 - 3 year old groups and it has been most encouraging to see the improvement which has been achieved through a deeper understanding of the child's development at this stage. Four Student Probationers obtained the Diploma of the National Society of Children's Nurseries during the year, and another passed the written part of the Examination but failed the practical. At the end of the year, ten Student Probationers were in training for the next Examination for the Diploma. -19- Three pre-nursing students from the Twickenham County School trained in Mothercraft and obtained the Certificate of the Royal Sanitary Institute, two students passing with distinction. Courses in Mothercraft training were arranged for about thirty senior students from Kneller School; the girls spent one morning each week in the Nurseries, where practical demonstrations in the care of children were given by the nursery staff. This course is very popular and other schools have asked if this training can be extended for their use. The Parents' Group has not yet been re-commenced but parents have been most appreciative and have co-operated with the staff in arranging many special parties and outings for their children. -2 0- SANITARY ADMINISTRATION WATER SUPPLY I am indebted to Lt, Col. E.F.W. Mackenzie, Director of Water Examination, Metropolitan Water Board, for the following report upon the supply for the Borough:- "The water supply to the Borough of Twickenham is provided by the Metropolitan Water Board from their works at Hampton. The water is derived from the River Thames and after storage in reservoirs at Walton and Littleton is pre-chlorinated and passed through primary and secondary sand filters. Finally it is chlorinatod before being pumped into supply, Samples of the water in all stages of purification are analysed daily at the Laboratories of the Water Board. All new and repaired mains are chlorinated before being restored to use and samples of water from them are tested bacteriologically. The water is not plumbo-solvent. We have no Information with regard to the proportion of the total number of dwelling houses in Twickenham which are supplied by the Board but of these all are supplied direct and not by means of standpipes." DRAINAGE AND SEWERAGE No major alterations or works on soil or surface water sewerage have taken place during the year. Plans, however, have been prepared for a new and enlarged ejector station at Bell Hill, Hampton, and work here was completed in 1946. A further major improvement concerning the soil system in this area has been proposed, and, it is hoped, will soon be put in hand, whereby the remaining major ejectors and, probably, the main compressor and pumping station at Hampton will be eliminated. As soon as conditions permit, it is hoped to relay certain important main outfall soil and surface water sewers in the East and Central Twickenham areas and to provide a surface water sewer in the Lower Teddington Road, PUBLIC CLEANSING STREETS The various street cleansing services have been carried on as in the earlier war years. It is hoped that the improved labour position will permit of pre-war standards being resumed in 1946, but plant will need renewal °t considerable expense after six years of use without replacement. REFUSE COLLECTION, Similar remarks apply to the refuse collection system# This service, and the collection of salvage has only been maintained during the past year under continual and aggravated difficulties. REFUSE DESTRUCTION The destructors at Twickenham and Teddington have continued in use but labour and plant difficulties have been so acute that day to day problems in dealing with refuse beyond their capacitis have arisen. The position has been relieved by the tipping of refuse, and further useful work in levelling off the Hatherop Road Recreation Ground by this means has been accomplished and will continue during 1946. The vital provision of a modern, hygienic and ample disposal plant has now, however, become one of the Corporation's most pressing needs and the disposal of refuse in a satisfactory manner will not be possible until this plant, now so long overdue, has been provided. -21- PIG FOOD œ LLECTION AND TREATMENT This valuable service has been continued and extended, despi labour shortage and defective collection vehicles. The food shortage has made its continuation throughout 1945 imperative, although the collection bins in certain streets in the Borough have not net with universal approbation from the residents. SALVAGE COLLECTION AND DISPOSAL. These services have continued at a slightly lower level, as regards amounts of materials collected, than in 1944, particularly of waste papor, but the aggregate amounts recovered and sold still give very substantial figures. RIVERS AND STREAMS No action was necessary during the year concerning the pollution of the River Thames or streams within the Borough. SANITARY INSECTION OF DISTRICT The following summary shows the good results achieved by the Sanitary Inspectors who were working under the handicap of being three short for a long period. Mr. Creasey resigned in June. In October, however, Mr. T. Williams was appointed Chief Sanitary Inspector, and Mr. C. Chesterman and Mr. F. A. Sadler District Sanitary Inspectors. The two otter commenced duty in December. The visits paid in each branch of the work are set out under the appropriate headings:- Notices Served Informal notices served 860 Informal notices complied 819 Housing Act, 1936; Sections 9 &, lc:- Statutory notices served - Statutory notices complied - (a) by owners - (b) by local authority in default of owners - Public Health Acts:- Statutory notices served 106 Statutory notices complied - (a) by owners 75 (b) by local authority in default of owners - Prosecutions During the year a summons was applied for in two instances in respect of non-compliance with abatement notices issued under section 93 of the Public Health Act, 1936. Summary of visits and inspections Visits to premises after complaint 1,750 Visits to properties under notice and work in progress 4,592 Total visits and inspections 12,732 -22- Summary of works executed in consequence of visits Drains unstopped and repaired 125 Complete drainage reconstructions 2 Waste pipes disconnected or repaired 58 Water supply cisterns provided or repaired 28 Gutters repaired 95 Roofs repaired 256 W.C.s repaired etc. 128 Dustbins provided 75 Damp walls remedied 67 Ventilation provided 7 Rooms stripped and cleansed 53 Offensive accumulations removed 26 Draw taps from main provided 7 Other works carried out 804 Overcrowding. Housing Act, 1936. The known cases of overcrowding on the Register of theDepartment at the end of the year were as follows:- (a) (i) Number of dwellings overcrowded at the end of the year 48 (ii) Number of families dwelling therein 53 (iii) Number of persons dwelling therein 304½ (b) Number of new cases of overcrowding reported during the year 18 (c) (i) Number of cases of overcrowding relieved during the year 4 (ii) Number of persons concerned in such cases 26 SMOKE ABATEMENT It was not necessary to take any formal action during the year regarding excessive emission of smoke. SWIMMING BATHS AND POOLS Excellent facilities for swimming are provided at the Corporation's three open-air Baths. Water is supplied by the Metropolitan Water Board's main, and samples for bacteriological examination are taken throughout the season. DISINFESTATION During the year 76 premises were found to be verminous. Disinfestation was carried out by the Department, the insecticide used being Zaldecide. In one case belongings were disinfested before removal of the family to a Council house. Scabies. With the closing of the First Aid Post Cleansing Stations use was made of the Cleansing Station attached to the Teddington Hospital. There was an inherent difficulty in this arrangement however in that appointments had to be given to patients and these appointments made to synchronize with the services of the Civil Defence nurse (later the whole-time auxiliary nurse) at times convenient both to the patients and staff. In November the Cleansing Station at Teddington Hospital was discontinued and accommodation at the Hollies Ambulance Station adapted for this purpose. Certain alterations will however be necessary in order to make the accommodation really us itable for the purpose. During the year 874 children and adults were treated. -23- COMMON LODGING HOUSES There is one Common Lodging-house in the Borough. This was kept in a satisfactory condition during the year and the registration was renewed. SCHOOLS 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 19S8 & 1936 During the year 175 visits were paid by the Sanitary Inspectors to premises upon which petroleum spirit or carbide of calcium was stored. 99 licences were issued in respect of these premises. SHOPS ACT, 1954 No formal action under the provisions dealt with by the Department was necessary. The certificate granted in previous years for ono shop under Section 10 (2) of the Act was continued. RODENT CONTROL It became evident during the year that the staff of two rodent operatives, who were attempting to deal with a number of block schemes and at the same time satisfy occupiers who made individual complaints, could not cope with the work. The difficulty was that an operative engaged on a block scheme might have the work interrupted and the progress of a scheme delayed or spoiled when odd complaints had to be dealt with. The Ministry of Food suggested that it would be desirable to appoint a Rodent Officer to take charge of the work, and an additional operative. The Corporation agreed to these suggestions and a Rodent Officer was appointed and commenced duty in December 1945. A scheme for the re-organisation of this work was under consideration at the end of the year and will be dealt with fully in my next report. Summary of work carried out, 1945. Visits by operatives after complaints 287 " " " for survey 3,185 " " " for treatment 1,336 Other visits 1,203 FACTORIES' ACT, 1937 Inspections for purposes of provisions as to health Inspections Written notices Factories with mechanical power 233 3 Factories without mechanical power 39 2 Other premises under the Act. 69 — 341 5 -24- ESTABLISHMENTS FOR MASSAGE OR SPECIAL TREATMENT Eleven 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 Hairdressers' and Barbers' premises in the Borough were kept under supervision by the Sanitary Inspectors and Health Visitors during the year, to ensure the required standard of cleanliness being maintain ed in conformity with the Bye-laws. RENT AND MORTGAGE INTEREST RESTRICTIONS ACTS 1920 to 1938 Eleven certificates were granted under the above Acts in respect of premises which wore not in a reasonable state of repair, as compared with four 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. 65 visits were paid to dairies, milkshops and cowsheds. Milk Sampling. 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 milks- "Tuberculin tested" milk 18 "Accredited" - "Pasteurised" 24 Slaughter-houses. Four licences wore renewed during the year. Consideration of the condition of three slaughter-houses was again deferred pending the execution of essential repairs. Slaughter of Animals Act, 1955. Six slaughter-men were on the register of the Department at 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 licences granted by the Ministry of Food was 38. All were inspected. The following is a summary of meat and other foods found to bo unfit for human consumption and condemned. It includes a large amount of foodstuffs damaged by enemy action: -25- Summary of defects found Found Remedied Overcrowding 1 - Want of cleanliness 2 1 Inadequate ventilation 1 - Sanitary conveniences Insufficient 1 2 Unsuitable or defective 1 1 Other offences 3 3 MEAT: Pork lbs. 52½ Mutton lbs. 2 Beef lbs. 37¾ Rabbits rabbits. 40 Rabbit lbs. 39 FISH: Fresh lbs. 1915 Kippers boxes 5 Winkles bushels 1 EGGS: Fresh eggs 1506 Dried pkte. 1 EGG SUBSTITUTE lbs. 742 BACON AND HAM lbs. 22¼ LARD, MARGARINE & COOKING FATS lbs. 2 BUTTER & CHEESE lbs. 53½ TINNED GOODS tins 4477 DRIED FRUIT lbs. 164½ SUGAR lbs, 112 JAMS & MARMALADE lbs. 170½ SAUSAGES & COOKED MEATS lbs. 106 PICKLES, SAUCES &c. bots. 303 ““ “ galls, ½ OTHER FOODS: Oranges cases 4 “ lbs. 104 Dates lbs. 883 Potatoes tons. 16 Flour lbs. 147 Macaroni, Semolina Spaghetti &c. lbs. 170½ Oats lbs. 109 All Bran, Shredded Wheat, Puffed Wheat pkts. 22 Pearl Barley, Split- Peas lbs. 83 Cake & Pudding Mix. pkts. 163 Buiscuits lbs. 19¾ Sweets lbs. 64½ Preserved Apples pkts. 117 MISC: pkts. 7 Meat Inspected. Pigs 38 Lambs 6 During the year the following visits were made to premises upon which food is prepared or sold:- Bakehouses 81 Butchers' shops 235 Restaurants 203 Grocers' shops 134 Greengrocers' shops. 1ll Fish shops 112 MIDDLESEX COUNTY COUNCIL ACT, 1944 Seventeen visits were made by the Sanitary Inspectors concerning the vehicles and/or storage accommodation of hawkers of meat, fish and vegetables. —26— FOOD AMD DRUGS ACT, 1938 The Middlesex County Council are the Pood and Drugs Authority for the Borough. Mr. S. J, Pugh, Chief Officer, Public Control Department, has kindly supplied the following information relating to samples taken in the Borough during the year. Article. Samples. Taken. Adulterated. Milk 82 - Milk, new 105 7 Almond Type Flavouring 1 - Drinking Chocolate 1 — Gin 1 — Lemon Cheese 1 - Lemon Flavouring 1 - Nutmeg (ground) 1 - Sausages 2 - Sausage meat 1 - Soup 1 - Whisky 1 - Total 198 7 -27- INFECTIOUS DISEASES (a) NOTIFIABLE INFECTIOUS DISEASES Diphtheria There were 4 cases of Diphtheria notified during 1945 as compared with 5 for the previous All cases were admitted to hospital. There was one death - a child aged 2 years who had not been immunized. The death rate was 0.01 per 1,000 of the population as compared with 0.02 for England and Wales. Supply of anti-toxin Medical practitioners practicing in the Borough may at any time obtain a supply of diphthewis. anti-toxin from the fire stations at Twickenham or Teddington, free of charge. Diphtheria Immunization At the end of the year it was estimated that the percentage of child population immunized against diphtheria was as follows:- Under 5 years 5 to 15 years The following is a summary of the work carried out:- Total number of new cases immunised 1603 Schick Testing Schick test (before inoculation) No. tested 11 No. susceptible 5 No. imune 4 No. failed to attend 2 Schick tests (after • completion of 1st course of injections) 1st Test 2nd Test 3rd Test No. tested 1202 171 22 No. protected 954(79%) 124(72%) 16(73%) No. susceptible 75 22 5 No. failed to attend 173 25 1 In nearly all cases those found to be incompletely protected after the second Post Schick were re-inoculated. Total number of attendances for year - 5,842 The diphtheria prophylactic used was A.P.T. and T.A.F. Scarlet Fever. The number of cases of Scarlet Fever notified during the year was 97 compared with 121 in 1944. There were 33 cases admitted to hospital. No deaths were recorded from this disease. Enteric Fever. No cases of enteric fever were notified during the year. There were no deaths. -28- Typhoid. Immunization Facilities wero available at the clinics for typhoid immunization, but no cases were dealt with during the year. INCIDENCE AND MORTALITY DIPHTHERIA, SCARLET FEVER AND ENTERIC FEVER 1937 - 1945 YEAR DIPHTHERIA SCARLET. FEVER ENTERIC FEVER No. of Cases. Case Rate per 1,000 pop. No. of deaths Death Rate per 1,000 pop. No. of Cases. Case Rate per 1,000 pop. No. of deaths Death Rate per 1,000 pop. No. of Cases. Case Rate per 1, 000 pop. No. of deaths Death Rate per 1,000 pop. 1937 116 1.23 2 0.02 148 1.57 - - 2 0.02 1 0.01 1958 70 0.72 5 0.05 274 2.83 1 0.01 - - - - 1939 25 0.25 3 0.03 93 0.95 - - 2 0.02 - - 1940 18 0.19 3 0. 03 38 0.41 - - 2 0.02 - - 1941 25 0.27 3 0.03 78 0.85 - - 7 0.07 - - 1942 7 0.08 1 0.01 125 1.35 - - - - 1 0.01 1943 4 0.04 1 0.01 238 2.56 - - - - - - 1944 5 0.06 3 0.03 121 1.37 - - - - - - 1945 4 0.04 1 0.01 97 1.06 - - - - - - Smallpox No case of smallpox was notified during the year. Twenty contact's were kept under observation by the Department. Pneumonia, Malaria and Dysentery Pneumonia. There were 51 cases of pneumonia notified during 1945 an increase of two on the previous year. Deaths numbered 55, Malaria. Two cases of malaria were notified during the year, one of which was treated in hospital. Both cases were contracted abroad. Dysentery. Pour cases of dysentery were notified and treated in hospital during the year. There were no deaths. Acute Poliomyelitis, Acute Polio-encephalitis Two cases or acute anterior poliomyelitis were notified during the year. Both were treated in hospital. There was one death. Ophthalmia Neonatorum 1937-45 The following table shows the number of cases notified and result of treatment: -29- Year. Cases Notfd. Cases treated Vision unimpaired Vis ion impaired Total blindness Deaths At home In hosp. 1937 6 6 - 6 - - - 1938 12 11 1 12 - - - 1939 7 7 - 7 - - - 1940 4 3 1 4 - - - 1941 5 2 3 5 - - - 1942 4 4 - 4 - - - 1943 6 6 - 6 - - - 1944 8 8 - 8 - - - 1945 2 2 - 2 - - - Puerperal Pyrexia Seven cases of puerperal pyrexia were notified as compared with eleven for the previous year. Three cases were treated in hospital. Cerebro-spinal Fever There were five cases of cerebro-spinal fever notified during 1945 an increase of four on the previous year. Three cases were treated in hospital. One death was recorded from this disease. Measles and Whooping Cough. These diseases have remained notifiable since October, 1939. There was an epidemic of measles during the year 1418 cases being notified as compared with 66 for the previous year. The peak period was the months of February and March when 620 and 416 cases were notified. Eighteen cases were admitted to hospital. Deaths numbered 9 giving a death rate of 0.02 per 1000 of the population, the same as that for England and Wales. The number of cases of whooping cough notified - 163 was below the average and showed a decrease of 39 on the previous year. Seven cases were admitted to hospital. There was one death giving a death rate of 0.01 per 1000 of the population. The rate England and Wales was 0.02. (b) MOM-NOTIFIABLE INFECTIOUS DISEASES Diseases coming under this category include influenza, chicken pox and mumps. As these diseases are not notifiable it is not possible to ascertain the exact incidence. During the year, however, the following cases were brought to the notice of the Department - Chickenpox 31, Mumps 100. TUBERCULOSIS During the year 1945 there were 136 new cases of tuberculosis notified, a decrease of 15 on the previous year. Forty-eight deaths were recorded from this disease giving a death rate of 0.53 per 1,000 of the population. Non-notified tuberculosis deaths - cases not notified as tuberculosis and not recorded in the registers of the Department during life - were responsible for 18.75 per cent of the total tuberculosis deaths. -30- NEW CASES AND MORTALITY 1945 Age Periods New Cases Deaths Pulmonary NonPulmonary Pulmonary NonPulmonary Male Female Male Female Male Female Male Female Under .. 1 - - - - - - 1 - 4 1 2 - 2 - - - 1 5-9 - 1 2 - — - - - 10 - 14 1 - 1 - - - - - 15 - 19 3 3 3 2 - 1 1 - 20 - 24 6 11 1 - 1 3 1 - 25 - 34 14 18 1 1 7 2 - 1 35 - 44 7 7 1 2 rr 3 2 - - 45 - 54 11 2 1 1 9 3 - - 55 - 64 9 2 - - 3 3 - - 65 and over. 3 4 - - 3 4 - — Total 62 56 10 8 26 18 2 2 Primary Notifications of Tuberculosis 1957 - 1.945 inclusive. 1937 1938 1939 1940 1941 1942 1943 1944 1945 Pulmonary 85 100 106 114 127 112 119 133 118 Non-Pulmonary 25 30 19 12 14 18 18 18 18 Total 110 130 125 126 141 130 137 151 136 Public health (Prevention of Tuberculosis) Regulations, 1925. It was not necessary to take any action under the above Regulations concerning persons suffering from tuberculosis and. employed in the milk trade. Public Health Act 1956 (Section 172). No action was taken under this section for the compulsory removal to hospital of persons suffering from tuberculosis. I -31- CASES OF INFECTIOUS DISEASES NOTIFIED DURING THE YEAR 1945 DISEASE CASES NOTIFIED AT VARIOUS AGES (YEARS) 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 Total Cases Notfd. Cases Admtd Hosp. Deaths Acute Anterior Poliomyelitis - - - 1 - - - - - 1 - - — 2 2 - Cerebro Spinal Fever - 1 - - - - - 3 - - 1 - - 5 3 1 Diphtheria - - - 1 - 2 1 - - - - - 4 4 1 Dysentery - - - - - 3 - - - - - 1 — 4 4 - Erysipelas - - -- - - - - 1 - 1 - 18 5 29 4 - Malaria - -. - - - - - - - 1 1 — - 2 1 - Measles 25 127 155 156 174 700 38 21 7 8 6 1 - 1418 18 2 Ophthalmia Neonatorum 2 — - - - - - — - - - - - 2 - - Pneumonia 1 1 1 1 - 2 1 5 1 1 6 14 17 51 8 55 Puerperal Pyrexia - . - - - " - - 1 4 2 - - 7 3 - Scarlet Fever ~ 2 4 4 2 47 19 10 4 2 2 1 - 97 33 - Whooping Cough 7 20 24 15 25 65 1 - - 4 1 1 - 163 7 1 TOTAL 35 151 184 178 201 819 60 40 13 22 23 36 22 1784 86 60 WARD DISTRIBUTION OF INFECTIOUS DISEASES NOTIFIED DURING THE YEAR 1945. { DISEASE EAST twice. CEN. TWICK. SOUTH TWICK. WEST TWICK. WHITTON HAMPTON HAMPTON HILL UPPER TEDD. LOWER TEDD. HAMPTON WICK TOTAL Acute Anterior Policinyelitis — - - - - 1 - 1 - - 2 Cerebro Spinal Fever — 2 - - - - 1 1 - 1 3 Diphthenia - 1 - - 1 - 1 1 - - 4 Dysentery - 1 - 2 1 - - - - - 4 Erysipelas - 3 3 1 2 1 5 7 2 5 29 Malaria l - - - - - 1 - - - 2 Measles 30 114 125 192 268 197 110 106 102 114 1418 Ophthalmia Neonatorum — - - - - - - - - 2 2 Pneumonia 2 9 3 - 3 4 2 9 9 6 51 Puerperal Pyrexia -- 2 1 - - 2 - - 1 1 7 Scarlet Fever 11 5 14 7 14 21 5 3 7 10 97 Whooping Cough 5 28 13 27 29 18 18 16 4 5 163 Total TOTAL 109 165 159 233 318 244 143 144 125 144 1784 CASES OF INFECTIOUS DISEASES NOTIFIED DURING THE YEAR 1945 -34- MONTHLY INCIDENCE OF INFECTIOUS DISEASES YEAR. 1945 DISEASE NUMBER OF CASES TOTAL Jan. Feb. Mar. Apr. May. June. July. • Aug. Sept. Oct. Nov. Dec. Acute anterior Poliomyelitis - 1 - - - - - 1 - - - - 2 Cerebro Spinal Fever - - 1 1 1 - - 2 - - - - 5 Diphihoria - 1 - - - - - 1 - - - 2 4 Dysentery - - - - - - - 1 1 - 1 1 4 Ery sipelas 1 3 2 2 1 3 1 3 3 1 8 1 29 Malaria - - - - - - - - - - - 2 2 Measles 132 620 1+16 150 53 29 12 3 1 - 2 - 1418 Ophthalmia Neonatorum - - 1 - - - - - - 1 - - 2 Pneumonia 12 10 2 2 2 4 - - 3 5 4 7 51 Puerperal Pyrexia - - - 1 - 1 - 2 - 2 - 1 7 Scarlet Fever 3 11 16 5 5 9 4 10 9 11 5 9 97 Whooping Cough 22 10 18 15 6 8 14 16 13 11 15 15 163 TOTAL 170 656 456 176 68 5k 31 39 30 31 35 38 1784 INDEX Page. Adoption of Children (Regulation) Act, 1939 19 Ambulance Facilities 10,11 Ante-Natal Clinics 12,14 Anti-Toxin, Supply of 28 Births 5,14 Birth Control 15 Blindness, prevention of 13 Care of Expectant Mothers 14 Care of Mothers during Confinement 15 Care of Mothers Subsequent go Confinement 16 Cerebro-Spinal Fever 30 Child Guidance Clinics 12 Child Life Protection 18 Cleanliness, Promotion of 17 Common Lodging Houses 24 Convalescent Treatment 17 Day Nursery Service 19 Deaths 5,6,7,8 Dental Clinics 12 Dental Treatment 16,17 Diphtheria 28 Diphtheria, Immunization 28 Diphtheria Immunization Clinics 12 Disinfestation 23 Drainage and Sewerage 21 Dysentery 29 Enteric Fever 28 Factories Act, 1937 24 Food, Inspection and Supervision of 25,26 Food and Drugs Act, 1938 27 Foster Children 18 Gas and Air Analgesia 15 Hairdressers' and Barbers' Premises 25 Health Education 13 Health Visiting 16 Home Help Service 15 Hospitals 12,13 Hostel Accommodation 16 Housing 23 Infantile Mortality 8 Infant Welfare Clinics 12,17 Infectious Diseases 12,28-34 Infirm Persons, Removal of 13 Insulin, Provision of 13 Laboratory Work 10 Malaria 29 Massage or Special Treatment, Establishments for 25 Maternal Mortality 7 Measles 30 Middlesex County Council Act, 1944 26 Midwifery and Maternity Services 14 Midwives Acts 14 Milk and Other Foods, Provision of 18 Milk Supply 25 Mortuary 13 Nurses' Act, 1943 11 Nursing Associations 11 Nursing Homes 19 -35- INDEX (CONTINUED) Page Ophthalmic clinics 12 Ophthalmic Treatment of Children under 5 17 Ophthalmia Neonatorum 29 Orthopaedic Treatment 19 Petroleum (Regulation) Acts 24 Pneumonia 29 Poliomyelitis 29 Poll -encephalitis 29 Population 4,5 Post Graduate Education 17 Premature Babies, Care of 18 Public Cleansing 21 Puerperal Pyrexia 30 Rent & Mortgage Interest Restrictions Acts 25 Rivers and Streams 22 Rodent Control 24 Sanitary Inspection of District 22,23 Scabies 23 Scarlet Fever 28 School Clinics 12 Schools 24 Shops Acts 24 Slaughtering of Animals 25 Smallpox 12,29 Smoke Aba cement 23 Statistics, General and Vital 4,8,9 Swimming Baths and Pools 23 Tuberculosis 12,30,31 Typhoid Immunization 29 Unsound Pood 25,26 Water Supply 21 Whooping Cough 30 -36-