LIBRARY Ac.439 (1) TWINCKENHAM TWI 14 BOROUGH OF TWICKENHAM Annual Report OF THE MEDICAL OFFICER OF HEALTH 1946 JOHN MADDISON, M.D., B.S., D.P.H. Medical Officer of Health. Public Health Department, Elrnfield House, High Street, Teddington. To the MAYOR, ALDERMEN AND COUNCILLORS of the BOROUGH OP TWICKENHAM. Ladies and Gentlemen, I have the honour to submit the annual statistical summary and report on the health and sanitary conditions of the Borough during the year ending 31st December,1946. The figures in the various tables reflect the enormous increase in the popularity and use the public is making of the health services. More and more people are seeking advice; in every section of the department the work dontinues to expand,, A rough estimate of the annual total of visits, consultations and inspections may be put at 60,000. The mortality and infectious disease rates indicate that the health of the people of the Borough is good; the most recent figures shew continuous improvement. The birth rate rose to 19.01 births per 1,000 of the population as compared with 16.7; nearly 2,000 babies were born - an increase of over 400 on the previous year. In addition to this natural increase, the population increased by over 10,000 - due mostly to people coming into the Borough from other places. The Registrar General estimates the population at the middle of the year at almost 103,000 - a figure higher than it had ever been before. The health services were extended without interruption to deal with this extra work. The ante-natal, midwifery and infant welfare services in the Borough can claim great credit for the most commendable fall in the infant mortality rate which placed Twickenham the fourth best Borough in the London and South Eastern Group of great towns. The rate worked out at 26.09 deaths per 1,000 live births compared with 48.02 the previous year; the new rate creates a record, even over the very low figure (26.4) achieved in 1939. Premature births 10 (1945 - 28). Congenital malformations still the same. Unfortunately the illegitimate infant death rate remained high at 80 infant deaths per 1,000 illegitimate infants born. There were 99 infants born to unmarried mothers - 45 less than in the previous year; in almost every case arrangements were made for ante and post-natal care, for midwifery or hospital services at the confinement, for the rehabilitation of the mother after convalescence by finding suitable work for her, by arranging for the baby to bo looked after at home, or by the grandparents, or by being boarded out, or by adoption. The mothers receive advice about ation orders; in a small number of cases they wore accommodated in the ante and post-natal hostels. The general death rate fell from 12.15 the previous year to 10.89. This rate, well below the overage for the country, is the rote we enjoyed beforo the war and indicates that Twickenham is a healthy town to live in. The incidence of the various causes of death is substantially unaltered; there were fewer deaths from tuberculosis, but road traffic accidents caused 18 deaths as compared with 12 the previous - 1 - year, The use mode by practitioners of the continuous oxygon service for patients with pneumonia, heart failure etc., increased from 38 cases in 1945 to 73 in 1946. The gas and air analgesia service also increased from 33 cases in 1945 to 84 in 1946. It is of interest to note the services now available to the public in the various sections of the department; The personal health services provide antenatal clinics; infant management teaching clinics for expectant mothers; midwifery service and obstetric specialists; maternity outfits; gas and air analgesia; premature baby cots; home helps; special arrangements for unmarried mothers; infant welfare clinics; breast feeding clinics; health education, lectures, film shows; marriage guidance; care of foster children; adoptions; day nurseries; diphtheria and whooping cough immunisation clinics; medical and nursing inspection of children in schools; school medical inspection clinics, minor ailment treatment clinics, ophthalmic clinics, orthopaedic, physiotherapy and remedial exercises clinics; dental inspection of children in schools, dental clinics, orthodontic clinics, specialist dental clinics, dental X-rays, appliances laboratory; child guidance clinic, speech therapy clinic, continuous oxygen apparatus; cleansing station; ambulance service. The sanitary and environmental services deal with housing defects, overcrowding, the medical aspects of housing priorities, nuisances, food milk and water control, cow-sheds and dairies, ice cream premises, insect and pest control, shops, restaurants, bakehouses, common lodging houses, factories, hawkers' vehicles, petrol stations, massage establishments, drains and sowers, smoke abatement, chemical and bacteriological analyses, infectious diseases and disinfection. Preventive medicine has achieved remarkable successes in times gone by, although it receives little of the spectacular applause accorded to clinical medicine. Nevertheless there remains much to be done. We have not yet solved the problems of prevention of tuberculosis, rheumatism, cancer, poliomyelitis, the common cold and many other afflictions. Medical officers and their staffs have little time to spare for special investigations into the causes of disease. The smaller local authorities have not the resources to establish special research teams, but such teams should bo within the resources of the larger authorities and arc needed. Just as today the Medical Officer of Health refers his eye cases to the ophthalmologist,or his orthopaedic surgeon, so might he refer to a team of experts for solution the many problems still confronting him, Once again I have to acknowledge the groat loyalty of the staff and their unfailing willingness, - 2 - I desire also to record ray gratitude to the Chairman and Members of the Public Health and Maternity and Child Welfare Committees for their helpfulness and support, which wore of the greatest encouragement. 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 Gentleman, Your obedient servant, JOHN MADDISON. Medical Officer of Health, - 3 - STATISTICAL SUMMARY, for the year 1946. Area in acres 7,007 Population (extended Borough - census 1931) 79,376 Resident population - estimated to mid-year 1946 (as supplied by the Registrar-General) 102,850 Number of inhabited houses 28,911 Rateable value £1,044,096. Sum represented by a penny rate 1946/1947 £4220;7:5 Live Births: Total M. F. Legitimate 1836 954 902 Illegitimate 99 50 49 Total 1955 1004 951 Birth rate per 1,000 of estimated resident population 19.01 Still Births: Total M. F. Legitimate 48 28 20 Illegitimate 1 1 - Total 49 29 20 Still Birth rate per 1,000 total (live and still) births 24.45 Deaths: Total M. F. 1120 553 567 Death rate per 1,000 of estimated resident population 10.89 Maternal deaths: Puerperal and Post-abortive Sepsis Nil Other Maternal Causes 2 Rate per 1,000 total (live and still) births 0.998 Death rate of infants under one year of age:- All infants per 1,000 live births, 26.09 Legitimate infants per 1,000 leg. live births 23.17 Illegitimate infants per 1,000 illeg. live births 80.81 Deaths from:- Cancer (all ages) 205 Measles (all ages ) 1 Whooping Cough (all ages) 2 Diarrhoea ( under 2 years of age ) 4 - 4 - STATISTICS, SOCIAL CONDITIONS AND GENERAL PROVISION OF HEALTH AREA POPULATION The Registrar General's estimate of population for the mid-year 1946 was 102,850 and this has "been adopted for the calculation of the statistics in this report. BIRTHS. The live "births registered in the Borough in 1946 numbered 1955, giving a birth rate of 19.01 per 1,000 of the population. (England and Wales 19.1). The "births were made up as follows Males Females Total Legitimate 954 902 1856 Illegitimate 50 49 99 Total 1004 951 1955 The number of births represents an increase of 414 compared with the previous year. Illegitimate births formed 5.06% of the total live births, a decrease of 4.24% on the previous year. Still Births. There were 49 still births registered during the year, giving a still birth rate of 24.45 per 1,000 total (live and still) births, DEATHS. The net deaths registered in the Borough during 1946 were Males 553, Females, 567, Total 1,120. This represents an increase of 3 compared with the previous year. The death rate per 1,000 of the population was 10.89 as compared with 11.5 for England and Wales. (Twickenham 1945 12.15). The natural increase of population (that is, excess of births over deaths) was 835 as compared with 424 for 1945. Sox Mortality. The sex mortality rate was as follows:- Males 5.38 per 1,000 Females 5.51 per 1,000. - 5 - Zymotic Diseases Mortality. The mortality rotes for this group of diseases which includes Enteric Fever, Smallpox, Scarlet Fever, Diphtheria, Measles, Whooping Cough, and Diarrhoea under two years of age, were:- Disease. No.of Deaths. Death rate per 1,000 of the population. Male. Female. Total. Enteric Fever - - - - Smallpox - - - - Scarlet Fever - - - - Diphtheria - - - - Measles - 1 1 .01 Whooping Cough 1 1 2 .02 Diarrhoea 3 1 4 .04 Main Causes of Death. An analysis of the death returns reveals the following main causes of death:- Disease Percentage of total deaths. Death rote per 1,000 population. Diseases of heart and circulatory system 32.05 3.49 Intro-cranial vascular lesions 8.75 0.95 Bronchitis, Pneumonia and other respiratory diseases 11.88 1.29 Cancer 18.30 1.99 Violence 4.91 0.53 Tuberculosis 3.48 0.38 - 6 - CAUSES OF DEATH 1946. Registrar General's Official Returns. Causes of Death. Males Females Total All Causes 553 567 1120 1. Typhoid and paratyphoid fevers - - - 2. Cerebro-spinal fever 1 1 2 3. Scarlet Fever - - - 4. Whooping Cough 1 1 2 5. Diphtheria - - - 6. Tuberculosis of Respiratory System 22 11 33 7. Other forms of Tuberculosis 3 3 6 8. Syphilitic diseases 3 3 6 9. Influenza 7 12 19 10. Measles - 1 1 11. Acute Polio-myelitis and encephalitis - - - 12. Acute infective encephalitis 1 - 1 13. Cancer of buccal cavity and oesophagus (M) uterus (F) 11 12 23 14. Cancer of stomach and duodenum 21 15 36 15. Cancer of breast - 28 28 16. Cancer of all other sites 75 43 118 17. Diabetes 3 3 6 18. Intro-cranial vascular lesions 30 68 98 19. Heart disease 143 159 302 20, Other diseases of circulatory system 29 28 57 21. Bronchitis 32 23 55 22. Pneumonia 29 29 58 23. Other respiratory diseases 9 11 20 24. Ulcer of stomach or duodenum 7 4 11 25. Diarrhoea under 2 years 3 1 4 26. Appendicitis 1 4 5 27. Other digestive diseases 9 11 20 28. Nephritis 12 10 22 29. Puerperal and Post-abortive Sepsis - - - 30. Other maternal causes - 2 2 31. Premature birth 5 5 10 32. Congenital malformations, birth injury, infantile diseases 9 10 19 33. Suicide 6 6 12 34. Road traffic accidents 11 7 18 35. Other violent causes 13 12 25 36. All other causes 57 44 101 MATERNAL MORTALITY. Two deaths were registered as being due to diseases or accidents of child-birth as compared with one death. for the previous year. Tho causes of death were:- 1. la.Internal haemorrhage. b. Ruptured Ectopic Gestation. 2. la.Paralytic Ileus. b. Infective Endocarditis following caesarean section. A full enquiry is mode into tho cause of every maternal death. The maternal mortality rate per 1,000 total (live and still) births was 0.998. That for England and Wales was 1.43 - 7 - INFANTILE MORTALITY. There were 51 deaths of infants under one year during the year giving an infantile mortality rate of 26.09 per 1,000 live births, This shows a considerable decrease on the figure of 48.02 for 1945, and compares favourably with the rote for England and Wales in 1946, which was 43. The following table, compiled from the official registrations, details the causes of deaths at various ages under one year of age: Under one week 1 - 2 weeks 2-3 weeks 3 - 4 weeks Total under 4 weeks 4 weeks and under 3 months 3 months and under 6 months 6 months and under 9 months 9 months and under 12 months Total deaths umder 1 year ALL CAUSES:- Certified 27 2 1 2 32 4 8 7 - 51 Uncertified. - - - - - - -- - - - Smallpox - - - - - - - - - Chicken-pox - - - - - - - - - - Measles - - - - - - - - - - Scarlet Fever - - - - - - - - - - Diphtheria and Croup - - - - - - - - - - Whooping Cough - - - - - - 1 1 - 2 Diarrhoea - - - - - - - - - - Enteritis - - - 1 1 2 1 - - 4 Tuberculous Meningitis - - - - - - - - - Abdominal Tuberculosis - - - - - - - - - - Other Tuberculous Diseases - - - - - - - - - - Congenital Malformations 8 - - - 8 1 - - - 9 Premature Birth 9 1 - - 10 - - - - 10 Atrophy,Debility & Marasmus - - - - - - - - - - Atelectasis 4 1 - - 5 - - - - 5 Injury at Birth 2 - - - 2 - - - - 2 Erysipelas - - - - - - - - - - Syphilis - - - - - - - - - - Rickets - - - - - - - - - Meningitis (not Tuberculous) - - - - - - - 1 - 1 Convulsions. - - - - - - - - - - Gastritis - - - - - - - - - - Bronchitis - - - - - - - - - - Pneumonia (all forms) 2 - 1 - 3 — 3 4 - 10 Suffocation (overlying) - - - - - - 2 - - 2 Other Causes 2 — — 1 3 1 1 1 - 6 TOTALS 27 2 1 2 32 4 8 7 - 51 An analysis of the mortality reveals that neo-natal deaths were responsible for 62.7 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. 13 14 5 32 62.7 Congenital malformations, premature birth, etc, caused 26 (or 50.98%) of the total infant deaths, Deaths of illegitimate infants. The death rate of illegitimate infants daring 1946 was 80.81 per 1,000, compared with 62.5 for the previous year. The corresponding death-rate of legitimate children was 23.17 (46.5 for 1945). REVIEW OF THE COMPARATIVE VITAL AND MORTALITY STATISTICS FOR THE BOROUGH OF TWICKENHAM, TOGETHER WITH THOSE FOR ENGLAND AND WALES FOR YEARS 1937 - 1946 INCLUSIVE Birth Rate Death Rate Infantile Mortality Rate YEAR Twick. | Eng. and Wales. Twick. Eng. and Wales. Twick. Eng. and Wales. 1937. 14.9 14.9 (a)ll.08 12.4 35.4 58 (b)10.96 1938. 14.4 15.1 (a) 9.91 11.6 45.8 53 (b) 9.81 1939. 14.2 15.0 (a)10,46 12.1 26.4 50 (b)10.35 1940. 14.67 14.6 (a)14.8 14.3 45.8 55 (b)14.9. 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 11.4 48.02 46 1946. 19.01 19.1 10.89 11.5 26.09 43 (a) Crude (b) Adjusted - 9 - - 10 - BIRTH RATE, DEATH RATE AND ANALYSIS OF MORTALITY DURING 1946. 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 and para typhoid fevers Small pox Measles Scarlet Fever Whooping Cough Diphtheria Influenza Diarrhoea & Enteritis (under 2 years) Total deaths under 1 year England and Wales 19.1 0.53 11.5 0.00 0.00 0.00 0.00 0.02 0.01 0.15 4.4 43 126 County Boroughs and great towns, including London 22.2 0.67 12.7 0.00 0.00 0.01 0.00 0.02 0.01 0.13 6.1 46 148 smaller towns (resident populations 25,000 to 50,000 at 1931 census). 21.3 0.59 11.7 0.00 0.00 0.00 0.00 0.02 0.01 0.14 2.8 37 London Adm. County. 21.5 0.54 12.7 0.00 - 0.01 0.00 0.02 0.01 0.12 4.2 41 TWICKENHAM. 19.01 0.48 10.89 0.00 0.00 0.01 0.00 0.02 0.00 0.18 2.05 26.09 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 196 5 positive. Sputum etc., for tubercle bacilli 72 5 positive. Miscellaneous 34 1 positive. | Total specimens examined. 302 AMBULANCE FACILITIES. Infectious diseases. A motor ambulance is provided by the South Middlesex and Richmond Joint Hospital Board. Non-infectious and accident cases. At the close of the year three ambulances were in commission. The following table shows the work done by the Borough Ambulance Service during the year 1946:- 1st.Qtr. 2nd.Qtr. 3rd.Qtr. 4th.Qtr. Total Accidents 106 137 118 147 508 Removals after accidents 21 13 19 9 62 Ordinary removals 464 383 301 393 1541 School emergency calls 5 4 4 9 22 Total no. of calls 596 537 442 558 2133 Mileage. 5153 4493 4089 5364 19099 Continuous Oxygen Service Patients attended 24 30 7 12 73 Gas & Air Analgesia Patients attended 10 16 25 33 84 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. - 11 - CLINICS AND WELFARE CENTRES. The following clinics were, being held within the Borough of 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 Rood, Twickenham. Art School, Teddington. Station Road, Hampton. 20, Seymour Road, Hampton Wick. Twickenham Council School Clinics. York House, Twickenham Hospital Bridge Rood, Twickenham. Stanley Rood,Teddington. Station Rood, Hampton. 20, Seymour Rood, Hampton Wick. Middlesex County Council. Dental Clincis. York House, Twickenham. Stanley Road,Teddington. Hospital Bridge Road, Twickenham. Twinckenham Council & Middlesex County Council. Station Road, Hampton. Art School, Teddington (Orthodontic). Middlesex County Council Diphtheria & Typhoid Immunisation York House, Twickenham Hospital Bridge Rood, Twickenham. Stanley Road, Teddington. Station Rood, 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 hove temporarily taken over premises within the Borough. The Council contributed the total sum of £2.50 to these hospitals during the financial year 1946/7. MORTUARY. During the year 107 bodies were admitted to the Mortuary. In all cases post-mortem examinations were held. PROVISION OP INSULIN. The provision of insulin for certain classes of persons suffering from diabetes was continued. Eight cases wore on the register of the Department of the end of the year. HEALTH EDUCATION. During the year further lectures to parents on Sex Education were arranged in the schools and, in addition, a series of three talks for young people over 16 years and adults on "Preparation for Marriage" was held of York House. First-class lecturers from the Marriage Guidance Council were engaged for the talks. A limited number of copies of "Better Health" and the Health Education Journal of the Central Council for Health Education were distributed and general publicity - including the issue of pamphlets - was also undertaken on Droplet Infection, Diphtheria Immunization etc. 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 l,601. This does not include births which occurred elsewhere but which were subsequently transferred to Twickenham. Of the births occurring in the Borough, 976 were attended by Midwives in their capacity as Midwives and 625 by Doctors. Municipal Midwives attended 510 - 361 in their capacity as Midwives and 149 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 Midwivcs 361 149 Non-municipal Midwives - - Bearsted Memorial Hospital 399 43 Nursing Homes 16 433 976 625 MIDWIFERY ACTS. The total number of Midwives employed of the end of the year was nine. From January to October there was one vacancy. CARE OF EXPECTANT MOTHERS. The number of sessions devoted to this work was:- York House Centre. Two weekly sessions. Whitton Centre. Three 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 for first time Total Attendances. 1940 750 2993 1941 770 3375 1942 1038 4842 1943 1056 5094 1944 944 4393 1945 1054 4801 1946 1337 6661 - 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 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 whereby expectant mothers were given facilities for chest X-ray continued to prove satisfactory. The total number who were X-rayed was 733 and of these 29 were found to be in need of further observation and/or treatment. The fee payable by the Council to the hospital was 10s.6d. for each mother. 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. 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. At the end of the year there were five full-time and six part-time Home Helps on the staff. In addition there were five temporary Home Helps. The number of Home Helps is steadily increasing as the service expands. Maternity Domestic. No, of applications received. 206 155 No, of homes in which Home Helps attended:- Paying Full fee. 77 71 Paying part fee 49 14 Paying No fee. 2 4 Total. 138 89 GAS AND AIR ANALGESTA. All the Corporation Municipal Midwives are qualified to administer Gas and Air Analgesia. Analgesia was administered to 87 patients (as compared with 45 in 1945) 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 - PUERPERAL PYREXIA Fourteen cases of Puerperal Pyrexia occurred during the year and of these two only were domiciliary confinements one of which was admitted to West Middlesex County Hospital, and the other treated at home. The remaining twelve cases were treated in the Institutions where they occurred. All patients recovered. POST NATAL CARE Post-natal core 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 1946 - 206 Two maternal deaths occurred during the year 1946. BIRTH CONTROL AND GYANECOLOGICAL CASES No birth control clinic is hold in the Borough, but arrangements have been made with the Birth Control Clinics at Hounslow for mothers to receive advice on "family spacing" and gynaecological complaints. In necessitous cases the Corporation undertakes responsibility for payment for consultations and appliances. HOSTEL ACCOMMODATION During 1946, six patients wore admitted to 16, The Park, Golders Green, for their confinements, and eleven to the post-natal home at Hendon. The cost of these arrangements is borne by the Corporation, the contribution payable by the patient being assessed according to the Council's Scale of Assistance DENTAL TREATMENT The following received dental treatment during the year:- 1946 1945 1944 1943 1942 1941 Expectant Mothers 204 40 42 73 69 52 Nursing Mothers 55 20 27 46 32 33 Patients supplied with dentures 85 38 53 71 55 37 Dentures supplied 144 63 90 129 100 65 HEALTH VISITORS During the year the approved establishment of Health Visitors was increased to fifteen - including the Superintendent Health Visitor - although due to changes in the personnel this number was not maintained. They also carried out the duties of school nurses on behalf of the Middlesex County Council. The following visits were made to:- 1946 1945 1944 1943 1942 1941 Expectant Mothers 331 334 437 402 354 432 Children under 1 year of age 6891 5487 5675 5544 3921 4016 Children between the ages of 1 and 5 years 9600 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 EDUCATION Pour Health Visitors attended the Preliminary Part-time Teaching Course arranged by the Women Public Health Officers' Association during the year, and the Superintendent Health Visitor attended the Advanced Course. The Midwives attended a postgraduate course arranged by the London, Middlesex and Surrey County Councils. In addition three midwives attended ante-natal and post-natal demonstrations organised by the County Councils and two attended the Post-Graduate School of the Royal College of Midwives. PROMOTION OF CLEANLINESS, ETC. The scheme for head and cleanliness inspections in the schools worked satisfactorily during the year. Literature on this subject has Been distributed at the Infant Welfare Centres and the Health Visitors have also continued to give advice to parents on the subject of cleanliness and good habits INFANT WELFARE CLINICS There are five Infant Welfare Clinics; thirteen sessions for infant consultations are held weekly and three breast feeding clinics. 1946 Twickenham Whitton Teddington Hampton Hampton Wick TOTAL First attendance under 1 year 413 349 316 186 117 1381 First attendance 1-5 years 76 59 55 49 38 277 Total attendances under 1 year 4370 6258 3715 2201 1710 18524 Total attendances 1-5 years 1711 3650 2333 1760 1078 10532 CONVALESCENT TREATMENT as in previous years where necessary convalescent treatment for children under five has been provided by the Corporation. DENTAL TREATMENT OP CHILDREN UNDER 5 YEARS During the year, the numbers of children under 5 years of age who received dental treatment were:- New Cases 175 Total attendances 520 OPHTHALMIC TREATMENT OF CHILDREN UNDER 5 YEARS During the year, the numbers of children under 5 years of age examined by the Ophthalmic Surgeon were:- First attendance 35 Total attendances 94 Dental and Ophthalmic treatment are free to children under five. - 17 - MILK AND OTHER FOODS, ETC During the year, 47 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 £29.13s.1d. 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 490. Details of authorisation during 1946 were:- Individual Foster 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. 30 2 32 No.of children on register at the end of the year 25 18 43 No. of children who died during the year - - - Proceedings taken during the year - - - CARE OF PREMATURE BABIES Special cots for the care of premature babies are kept at the Hollies Ambulance Depot and are available in an emergency day or night. During 1946, twelve calls were received for these cots. 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 164. No. of persons who gave notice under Section VII (3) during the year 20 Total no. of children in respect of whom notice was given under Section VII (3) during the year 33 No. of children notified under Section VII (3) (l) under supervision at the end of the year 21 (2) who died during the year Nil (3) on whom inquests were held during the year Nil - 18 - ORTHOPAEDIC TREATMENT OF CHILDREN Children requiring massage, orthopaedic treatment or remedial exercises were referred to the Middlesex County Council Clinic at Brentford, and to the Jest Middlesex County Hospital. NURSING HOMES There are thirteen registered private nursing homes in the Borough. All the homes were kept under periodic supervision during the year. The three voluntary hospitals which received private patients are exempted from registration and also the Bearsted Memorial Hospital which was removed from the East End of London to the Hampton Court Hotel for the duration of the war. DAY NURSERY SERVICE The five Day Nurseries in the Borough, accommodating 245 children, were used to capacity during the year. The routine medical examination of children was carried out at regular intervals and confirms that the high standard of nutrition is still being maintained. Apart from minor outbreaks of measles, chicken pox and whooping cough, there has been no serious outbreak of infection in the nurseries. The training of staff at the Day Nurseries has been continued and eight students obtained the Diploma of the National Society of Children's Nurseries during the year, one passing with distinction. Four of the staff successfully completed the Senior Child Care Reserve Course and were awarded the appropriate certificate. As in previous years courses in Mothercraft Training have been arranged for senior girls from the schools, practical demonstrations in the care of children being given by the nursery staffs. One student from the Twickenham County School was successful in obtaining the certificate of the Royal Sanitary Institute in mothercraft. - 19 - SANITARY ADMINISTRATION. WATER SUPPLY I am once again indebted to Lt.Col.E.P.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 chlorinated before being pumped into supply. A contact tank is in the course of construction and should be in use in 1948. Means will then be available to complete the disinfection of the water before it is pumped to the consumers. Samples of the water in all stages of purification are analysed daily at the Laboratories of the water Board. The results for 1946 are given below. 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." RESULTS OF THE CHEMICAL AND BACTERIOLOGICAL EXAMINATION OF THE WATER SUPPLIED TO THE BOROUGH OF TWICKENHAM, JANUARY - DECEMBER, 1946. Chemical. Ammoniacal Nitrogen Albuminoid Nitrogen Oxidised Nitrogen Chlorides as C1. Oxygen abs. from Permanganate 5 mins. @ 80°F Oxygen abs. from Permanganate 3 hrs.@ 80°F. Turbidity in terms of silica Colour m.m. brown,2ft.tube Burgess's Tintometer Hardncess (Total) j Hardness ! (Permanent) pH Value Conductivity. .131 . 080 2.9 26.4 1.33 0.7 21 257 80 7.8 475 Bacteriological. No. of samples Colony Count on agar at 37°C. Bact. coli test. percentage of samples negative per 100 ml. Bact.coli per 100 ml. 662 16.9 97.4 .060 - 20 - DRAINAGE AND SERVICES Owing to the continuing restrictions on labour and materials, no major improvements or works have been possible beyond the new pumping station at Bell Hill, Hampton, which is now in operation. The surcharging of existing sewers at East Twickenham in storm times has at times been acute, and the Corporation have decided to carry out a comprehensive scheme of relief to both the soil and surface water systems as soon as it is practicable, PUBLIC CLEANSING. (a) STREETS. The improved labour position has permitted a somewhat higher standard of scavenging during the year and it is hoped to improve still further until at least the pre-war conditions arc attained. A new mechanical sweeper-collector will be delivered, it is hoped, in 1947 and this will help towards this objective and also secure economy in labour. The present mechanical gully emptier which has been in use for 17 years, is also to be replaced by a new vehicle in 1947. (b ) REFUSE COLLECTION. The vehicles on this service are urgently in need of replacement but the type best suited for the area as a whole, nd for transportation to the suggested new Destructor at Sunbury, has still to be settled - when agreed, there is likely to be some appreciable time elapse before delivery is obtained. The labour position has improved and assisted in maintaining the existing services. Salvage has fallen off in quantity, owing mainly to decreasing efforts of the public, although the national need for all salvage, and waste paper particularly, is as great as during the critical war years. (c)REFUSE DESTRUCTION. The three destructors have been in use during the year, but their condition and capacity, together with the shortage of suitable labour, has necessitated, tipping from time to time. The need for a modern plant has become urgent. Fortunately, negotiations with Sunbury Urban District Council for a site in that district have proceeded favourably and it is hoped a new upto-date salvage and incinerating plant for which preliminary plans have already been prepared, will be approved within the next eighteen months. The selection of a,site some six miles from the centre of the Borough has been governed by the shortage of possible sites within the district, and the need for disposing at the site of those materials of a non-salvagable nature. If the scheme matures, it will be a joint works, dealing with refuse and salvage from both areas and controlled jointly by the Corporation and the Sunbury Council. The cost of the scheme is estimated at between £90,000 and. £10C ,000, RIVERS AND . STREAMS. No action was necessary during the year concerning the pollution of the River Thames or streams within the Borough. - 21 - SANITARY INSPECTION OF DISTRICT Mr.T. Williams, Chief Sanitary Inspector, commenced duties on the 1st. January, 1946, and is deserving of high praise for the excellent work achieved by his section during the year. The following pages show the tremendous progress made despite the difficulties experienced by reason of the shortage of builders' supplies etc., The visits paid in each branch of the work are set out under the appropriate headings:- Analysis of Complaints Received Nature of Complaint Total Housing Defects 822 • Choked and Defective drains. 121 Accumulations of Offensive matter 24 Relative to Unsound Pood 102 Verminous Premises: (a) Bugs 13 (b) Rats and Mice infestations 293 (c) Beetles and Crickets 2 - Keeping of Animals and Poultry 18 Unsatisfactory-Milk supplies 5 Miscellaneous 817 2,217 Summary of Visits, Inspections ate., Visits to:- Prcmiscs after complaint 2547 Premises after notified infectious disease. 2 Premises for enquiries after notified infectious disease 356 Promises for Sanitary Inspection after notified infectious disease. 1 Home cases of notified infectious disease 63 Premises for disinfection after notified infectious disease 15 Number of articles removed for disinfection after infectious disease 117 Articles destroyed after infectious disease 4 Disinfections other than after infection disease 49 Articles removed for disinfection other than after infectious disease Visits regarding Scabies:- (a)First visits 178 (b) Subsequent visits 7 Visits to:- Dwolling houses for Housing defects,Public Health .Act. (a) after -complaint 1087 (b) New 16 Dwelling. houses for Housing defects, Housing act. (a) after complaint 135 (b) New 1 Underground Sleeping rooms 2 Tenement houses Common Lodging houses 2 Factories with mechanical power. 380 Factories without me chanical power I83 Other Premises (Factory Act) 16 Outworkers 76 Bake houses 149 Butchers' shops 381 Cowsheds 1 Dairies and Milkshops 109 Drains tested or exposed: (a) Old drains found defective 57 (b) Old drains found sound 9 (c) New drains tested 5 Visits to:- Fish shops 172 Food inspection visits 547 Visits 10:- Greengrocers' shops 119 Grocers' provision shops 345 Hairdressers' premises 100 Hawkers' vehicles (Middle sex County Council Act. 18 Hawkers' premises (Middlesex County Council Act. 16 Ice Cream premises 100 Offensive trades 3 Visits under Petroleum acts 162 Visits tot- Piggeries 83 Properties under notice and work in progress: (a) Public Health Act 7781 (b) Housing Act 18 (c) General 69 Restaurants 285 Sanitary conveniences, Public houses and places of entertainment. 168 Schools 125 Slaughter houses 38 Stables 37 Other Visits 4520 Visits under Rats and Mice (Destruction) Act, 1919. (Other than by operatives). I863 Total number of visits and inspections 21,124. - 23 - Summary of Works executed in consequence of visits. Drains unstopped and repaired 174 Complete drainage reconstructions 3 Waste pipes disconnected or repaired 93 Water supply cisterns provided or repaired 51 Gutters repaired 194 Roofs repaired 443 W.C's repaired etc. 192 Dustbins provided 91 Damp walls remedied 217 Ventilation provided 8 Rooms stripped and cleansed 31 Offensive accumulations removed 23 Other works carried out 1574 Notices Issued Preliminary notices served 1352 Preliminary notices complied 974 Statutory notices served 263 Statutory notices complied 195 Verbal notices served 29 Verbal notices complied 50 Overcrowding. Housing Act, 1936. 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 99 (ii) Number of families dwelling therein l04 (iii) Number of persons dwelling therein 621 (b) Number of new cases of overcrowding reported during the year 53 (c) (i) Number of cases of overcrowding relieved during the year 2 (ii) Number of persons concerned in such cases 13½ 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. AND DISINFECTION Scabies During the year the arrangements for the use of the accommodation adapted as a cleansing station at the Hollies Ambulance Depot were continued. The number of children and adults treated was 763. - 24- Summary. Disinfections after infectious disease 59 Disinfections after other disease 11 D. D. T. treatment (No. of Premises as detailed on following page). 347 TOTAL. 417 Number of articles disinfected after infectious disease 122 Number of articles disinfected after other disease 66 TOTAL. 188 Total Income for D.D.T. Treatment: £168. 12s. 9d. - 25 - - 26 - D. D. T. TREATMENT - 1946 Number of Infestations Treated TYPE OF PREMISES FLIES BUGS FLEAS iMOTHS COCKROACHES CRICKETS ANTS SILVERFISH MOSQUITOES WOOD BEETIE WASPS BEETLES Dwelling Houses 151 57 15 110 2 - 15 2 98 8 6 - General Shops 4 - — — - — . — — - — — Food. Shops 65 — — - 1 1 — — - — - 1 Offices — — — — - — - — - - - — Day Nurseries 3 - — — — — _ — — — - — Clinics 6 - — — — — — — —. — - — Hospitals - — — — — — — — — — — — Miscellaneous 5 - — — — — — — - - — — Food preparation Factories — — — — — — . — — - — — — Factories 1 — — 1 1 — — - — — — — Totals 235 57 15 113 4 1 15 2 98 8 6 2 Number of Premises infested Corporation Rehousing 1946 Dwelling Houses 257 Number of cases approved for rehousing 316 Non-Dwelling Houses 90 Number of cases in the Borough found to be verminous 6 Total 347 Percentage of verminous cases 2 % RATS AND MICE (DESTRUCTION) ACT.1919. INFESTATION ORDER.1943. There are four Rodent Operatives and one Rodent Officer employed under the general direction of the Chief Sanitary Inspector on the work of Rodent Destruction. During 1946, 14,48l visits were made to premises within the Borough and of this total, initial visits following upon complaint or resulting from surveys numbered 6,339, the remaining 8,142 visits comprising re-inspections in connection with laying of baits, poisoning and trapping. The success of the now scheme enabling occupiers to enter into contract with the Corporation for rodent destruction may be judged by the following' summary, there being 370 contracts made and income received amounting to £912.19s.lOd. It was found necessary to serve 148 Preliminary Notices, 39, Statutory Notice's and 1 Final Statutory Notice. NUMBER OF INFESTATIONS. ]FOOD PREMISES, NON FOOD PREMISES, PRIVATE DWELLINGS. FACTORIES. RATS ONLY. MICE ONLY. BOTH RATS AND MICE. 71 40 335 18 419 30 15 . .. DEGREE OF INFESTATION RATS MICE RESERVOIR. MAJOR PRIMARY 50-100. MINOR SECONDARY 1-50 RESERVOIR. MAJOR PRIMARY. MINOR SECONDARY 3 Nil 431 Nil Nil 45 RATS AND MICE (DESTRUCTION) ACT,1919. NOTICES SERVED NOT ICES OUT STANDING Preliminary Noticcs Statutory Not ices. 24 hour (Default) Notice. Preliminary Notices. Statutory Notices. 24 hour (Default) Notice. 148 39 1 8 18 1 RAT DESTRUCTION WORK UNDERTAKEN BY ' ' CORPORATION OCCUPIERS. RATS MICE RATS MICE 336 45 ; 93 Nil. NUMBER OF PREMISES UNDER CONTRACTS WITH CORPORATION.TOTAL 370 12 Months 6 Months 3 Months. 1 Month. Others Total Receipts. 52 : 8 145 145 20 ' £912.19s.l0d. - 27 - 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 schools coming under the jurisdiction of the Divisional Executive was maintained "by the Sanitary Inspectors during the year. It was not necessary to close any of the schools on account of infectious- discase among the children. PETROLEUM (REGULATION) ACTS 1928 and 1956 During the year 162 visits were paid by the Sanitary Inspectors to premises upon which petroleum spirit or carbide of calcium was stored. 106 licences were issued in respect of these promises. SHOPS ACT„ 1954 No formal action under the provisions dealt with by the Department was taken during the year. Three exemption certificates were granted under Section 10 (2) of the Act in relation to sanitary conveniences. FACTORIES' ACT 1957 Inspection for purposes of provisions as to health inspections Written Not ices Factories with mechanical power 380 47 Factories without mechanical power 183 10 Other premises under the Act 16 - Summary of defects found. Found Remedied Overcrowding 1 2 Want of cleanliness 15 16 Inadequate ventilation 18 19 Unreasonable temperature 1 1 Sanitary conveniences: Insufficient 9 9 Unsuitable or defective 20 20 Not separate for sexes 2 2 Other offences 8 8 ESTABLISHMENTS FOR MASSAGE OR SPECIAL TREATMENT Thirteen 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 maintained in conformity with the Bye-laws. RENT AND MORTGAGE INTEREST RESTRICTIONS ACTS 1920-1958 » Five certificates were granted under the above Acts in respect of premises which were not in a reasonable state of repair, as compared with eleven for the previous year. - 28 - INSPECTION AND SUPERVISION OF FOOD Milk Supply At the closc of the year there were registered under the Milk and Dairies (Amendment) Act, 1922, and the Milk and Dairies Order, 1936:- PERSONS Cowkeepers registered as wholesale and retail purveyors of milk Nil Cowkeepers registered as wholesale purveyors of milk Nil Cowkeepers registered as retail purveyors of milk Nil Total number of persons registered for carrying on trade of cowkeeper « Nil Retail purveyors of milk 13 Retail purveyors of milk in sealed bottles only 13 Total number of persons registered as retail purveyors of milk 13 Total number of cowkeepers,wholesale and retail purveyors of milk 13 PREMISES i Number of cowsheds Nil Farms used as dairies Nil Other premises used as dairies 22 The bulk of the, milk supply of the Borough continues to come from outside the area and has been pasteurised before the delivery. 110 visits were paid to dairies, milkshops and cowshcds Milk Sampling Seventy 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. 63 were found to be satisfactory, and 7 unsatisfactory. Further samples were taken from the 7 unsatisfactory sources, and this proved 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" "Pasteurised" 21 - 29 - Slaughter-houses Three licences were renewed during the year. Consideration of the condition of two slaughter-houses was again deferred pending the execution of essential repairs. Slaughter of Animals Act, 1933 Nine slaughter-men were on the register of the Department at the end of the year. FOOD INSPECTION Diseased and unsound conditions found in the animals dealt with caused the detention and surrender for destruction of a total weight in carcases and offal of 607 lbs. details of which are given in the following table:- Beef 498 lbs. Mutton & Lamb 29 lbs. Pork 80 lbs. The following foodstuffs other than meat, being unfit for human consumption were voluntarily surrendered for destruction: - Bacon 57 lbs Butter 40½ lbs Cheese 62½ lbs Cooked Meat 20 lbs Dried Fruit 454 lbs 3 pkts. Dried Peas and Beans 139 lbs Eggs 187 doz. Fish 143 stone 13 boxes Fowls 103 lbs Flour and Cereals 371 lbs 17 pkts. Hares 23 Jam 65 lbs Margarine 76 lbs Oranges 110 lbs Rabbits 1 box Shell Pish Crabs 103 lbs 1 barrel Lobsters 53 lbs Prawns 55 lbs Whelks 1 bushe1 Tinned Foodstuffs Pish 608 tins Fruit 199 tins Meat 212 tins Milk 1226 tins Other 1023 tins Other Foodstuffs Breakfast Cereals, Sausages 3 and Miscellaneous Foods 255 lbs. MIDDLESEX COUNTY COUNCIL ,\CT 19UU 3U- visits were made by the Sanitary Inspectors concerning the vehicles and/or storage accommodation of hawkers of moat, fish and vegetables. _ 3 0 - POOD AND DRUGS ACT, 1956 Precautions against Contamination of Food Section 13. The majority of the. Bakehouses, Restaurant Kitchens and Hotel Kitchens within the Borough have "been inspected, and the work necessary in order that the premises shall reasonably comply with the above legislation has either "been completed or was in progress at the end of the year 1946. In addition, three public houses and hotel "bars and cellars have been similarly inspected under this legislation, and also under Section 89 of the Public Health Act, 1936. Where necessary, special inspections are made with a view to minimising the risk of contamination of beer during refilling of used glasses,"and where the contaminated overflow is collected and liable to be used for re-sale. - 31 - Statistics ]Conditions shop and Restaurant Kitchens Hotel Bars and Cellars Found Remedied Found Remedied Premises Defects Premises Defects Premises Defects Premises Defects Dirty floors 28 31 18 20 — — — — Dirty walls 57 77 40 57 3 6 2 4 Dirty ceilings 47 60 33 50 3 7 2 4 Insufficient or absenco of hot water for cleansing utensils 6 11 5 6 — — — — Insufficient or absence of cold water for cleansing utensils 2 6 — — — — — — Absence of sink or adequate waste pipe 6 9 3 5 1 2 — — Defective drainage boards 1 1 1 1 1 2 — — Inadequate lighting 2 2 2 2 - — — —' Insufficient ventilation 17 17 11 11 1 3 — — Unsatisfactory personal cleanliness — — — — — — — — Insufficient or unsuitable W.C. 15 15 11 11 1 1 >— — Absence of hot water for ablution purposes & inadequate staff room 28 28 19 19 l 1 — — Accumulation of refuse or spittoons requiring removal 12 12 9 9 1 1 — — Verminous conditions steam flies rats & mice 71 71 70 70 — — — — Dirty fittings 1 8 18 13 13 — — — — Unsatisfactory storage facilities 20 20 14 14 1 1 — — Defective wall plaster 23 29 13 15 l 4 - — Defective floor's 13 13 4 4 2 2 — — Defective ceiling plaster 10 29 5 11 — — — — Dampness 14 15 9 9 1 1 - — Total number of Defects Number of Premises 89 464 57 327 3 31 2 8 Number of Notices Served 103 3 Number of Notices Complied 69 2 - 32 - Sampling 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 167 1 Milk, new 18 1 Aspirin 1 — Banana plavouring 1 — Boracic Ointment 2 — Cooked Meats 2 Cream of Tartar 1 — Curry Powder 1 — Dessert Sauce Powder 1 — Drinking Chocolate 2 — Gelatine 1 - Gin 9 - Ginger, ground 1 - Ice Cream Powder 1 - Lemon Cheese 1 - Lemon Curd 1 - Malt Cocoa Spread 1 — Meat Extract 1 - Meat Pies 1 - Meat Savouries 1 - Mustard 4 3 Mustard, continental 1 — Nutmeg, ground 1 - Paprika 1 - Piccalilli 1 - Rennet Essence 1 - Sausages 17 2 Sausages cooked 2 - Sausage Meat 14 1 Self-raising Flour 1 - Smoked Haddock 1 1 Sugar 1 — Vinegar, non-brewed 1 — Whiskey 8 — TOTAL 268 9 - 33 - INFECTIOUS DISEASES. (a) NOTIFIABLE INFECTIOUS DISEASES Diphtheria. There were Ij. cases of Diphtheria notified during 1946, the same number as for the previous year. All cases were admitted to hospital. There were no deaths. The death rate for England and Wales was 0.01 per l,000 of the population. 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 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 67.3% 5 to 15 years 74.6% The following is a summary of the work carried out:- Total number of new cases immunized l,344. Schick Testing Schick Test .(before innoculation) No. tested 4 No.susceptihle 3 No. immune — No. failed to attend 1 Schick tests (after completion of 1st course of injections) 1st.Test. 2nd.Test. 3rd.Test. No,tested 1292 188 15 No.protected 1081 144 10 (83.6%)(76.6%)(66.6%) No. susceptible 54 19 3 No.failed to attend 157 25 2 In nearly all cases those found to be incompletely protected after the second Post Schick were re-inoculated. Total number of attendances for year - 6,223. The diphtheria lorophylact ic used was A.P.T., T.A.F., and Diphtheria and Whooping Cough combined vaccine. Scarlet Fever. The number of cases of Scarlet Fever notified during the year was 60 compared with 97 in 1945. There were 33 cases admitted to hospital. Hodeaths were recorded from this disease. Enteric Fever, No cases of enteric fever were notified during the year. There were no deaths. Typhoid Immunization. " Facilities were available at the clinics for typhoid immunization, hut no cases were dealt with during the year. - 34 - Incidence and mortality diphtheria, scarlet fever and enteric fever 1937 - 1946. diphtheria' scarlet fever /> 1 jIITERIC fever ' year No of Cases Case Rate per 1,000 pop. No. of deaths. Death Rate per 1,000 pop. No. of Cases Case Rete 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 Kate per 1,000 pop. ! i 1937 116 1.23 2 0.02 148 1.57 —] — 2 0.02 1 0.01' 1938 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 - - - - 1 1945 4 0.04 1 0.01 97 1.06 - - - - - i 1946 4 0.04 — — 60 0.58 — — — — — — Smallpox. No ease of smallpox was notified during the year. 117 contacts were kept' under observation "by the Department. Pneumonia, Malaria and Dysentery. Pneumonia. There were 64 eases of pneumonia notified during 1946, an increase of thirteen on the previous year. Deaths numbered 58. Malaria. Thirteen cases of malaria were notified during the year, ten of which were treated in hospital. All cases were contracted abroad. Dysentery. One case of dysentery was notified and treated in hospital during the year, There were no deaths. Acute Poliomyelitis, Acute Polio-encephalitis. Three cases of acute anterior poliomyelitis were notified, during the year. All were treated in hospital. There were no deaths. Ophthalmia Neonatorum 1937 - 19U6. The following table shows the number of cases notified and result of treatment. - 35 - Year, Cases Notfd. Cases Treated ■ Vision unimpaired Vision impa ired 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 — — — 1946 3 2 1 3 — — - Puerperal Pyrexia Fourteen cases of puerperal pyrexia were notified as compared with seven for the previous year. Twelve cases were treated in hospital. Cerebro-spinal Fever. There were two cases .of cerebro-spinal fever notified during 1946, a decrease of three on the previous year. Both cases were treated in hospital. Two deaths were recorded from this disease. Me a s le s and Whoop inp; G ough. During the year, 343 cases of measles were notified as compared with 1,418 for the previous year. Eleven cases were admitted to hospital. There"was one death giving a death rate of 0.01 per 1,000 of population. The death rate for England and Wales was 0.00 per 1,000 of population. The number of cases of,whooping cough notified - 89 was "below the average and showed a decrease of 74 on the previous year. Twelve cases were admitted to hospital, There were two deaths giving a death rate of 0.02 per 1,000 of the population. The rate for England and Wales was 0.02 (b ) NON-HOT IF IaBLE 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 143 Mumps 162 Influenza 1 TUBERCULOSIS. During the year 1946 there were I39 new cases of tuberculosis notified, an increase of three on the previous year, 39 deaths were recorded from this disease giving a death rate of 0.37 per 1,000 of the population. Non-notified tuberculosis deaths - cases not notified as tuberculosis and not recorded in the registers of the deportment during life - were responsible for 25.64 per cent of the total tuberculosis deaths, - 36 - NEW CASES AND MORTALITY 1946 Age Periods. New Gases Deaths Pulmonary Non— Pulmonary Pulmonary Non— Pulmonary Male Female Male Female Male Female Ma le Female Under 1 — — — — — — — — 1—4 3 — 2 — — — 3 — 5—9 2 2 2 1 — — 1 — 10 —14 — 1 3 — — — — — 15 —19 7 13 — 1 — 2 — — 20 —24 11 5 — 1 1 — — 1 25 —34 18 15 1 2 2 3 — — 35 —44 11 5 2 2 2 1 — — 45 —54 5 9 — 1 3 2 — 1 55 —64 5 1 — 1 5 1 — — 65 and over 5 2 — — — 2 — — Total 67 53 10 9 22 11 4 2 Primary Notifications of Tuberculosis 1937 — 1946 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 1936 (section 172) No action was taken under this section for the compulsory removal to hospital of persons suffering from tuberculosis j — 37 — -38- MONTHLY INOHMTCE OF INFECTIOUS DISEASES DURING THE YEAR 1946 DISEASE NUMBER OF CASES TOTAL Jan. Feb. Mar. Apr. May. June. July. Aug. Sept. Oct. Nov . Dec. Cerehro-spinal Fever 2 - - — — — - — - — — — 2 Diphtheria 1 — — — — — 1 1 — 1 — — 4 Dysentery - — 1 — — — — — — — — — 1 Erysipelas 1 5 2 2 3 l — 2 2 3 1 • 22 Malaria 1 - 3 3 2 1 1 — 2 — — 13 Measles 1 - 2 . 10 58 131 59 18 12 26 13 14 344 Ophthalmia Neonatorum — - - 1 - — - — — — 2 3 Acute Poliomyelitis — - - — - 1 - — 1 1 — — 3 Pneumonia 10 17 11 3 2 5 1 — 2 2 3 8 64 Puerperal Pyrexia 1 - 1 3 1 1 1 — 2 1 2 1 14 Scarlet Fever 9 5 6 4 3 5 4 8 — 9 4 3 60 Whooping Cough 9 17 25 18 23 16 15 14 12 10 11 19 189 TOTAlS 35 44 48 44 93 162 82 44 31 55 34 47 719 —39— CASES OF INFECTIOUS DISEASES NOTIFIED DURING THE YEAR 1946 DISEASE Under 1 yr. 1—2 CASES NOTIFIED AT VARIOUS AGES (YEARS) Over 65 Total cases Notfd. Cases Adrntd Hosp. Deaths 2—3 3—4 4—5 5—10 10—15 15—20 20—25 25—35 35—45 45—65 Cerehro—spinal Fever 1 — I — — 1 — — — — — — —' — 2 2 2 Diphtheria — 1 — 1 — 1 — — 1 2 — — — — 4 4 — Dysentery — — — — — — — — — 1 — — — 1 1 — Erysipelas — — — — — 1 — — — 1 2 13 5 22 3 — Malaria — — — — — — — — 1 9 2 1 — 13 10 — Measle s 7 30 46 34 42 164 14 3 3 — 1 — — 344 11 1 Ophthalmia Neonatorum 3 — — — — — — — — — — — — 3 1 — Acute poliomyelitis — — 1 — — — — 1 1 — — — — 3 3 — Pneumonia 2 — — l 1 9 3 1 3 4 11 16 13 64 7 58 Puerperal Pyrexia — — — — — — — — 1 10 3 — — 14 12 — Searlet Fever — 1 — 4 4 30 8 2 2 8 1 — — 60 34 — Whooping Cough 22 20 20 31 22 66 3 — 1 1 . 1 2 — 189 12 2 TOTALS 35 51 67 71 70 271 . 28 7 14 34 21 32 18 719 100 63 —40— WARD DISTRIBUTION OF INFECTIOUS DISEASES NOTIFIED DURING THE YEAR 1946. DISEASE EAST TWICK. CEN TWICK. SOUTH TWICK WEST TWICK. WHITTON : HAMPTON HAMPTON HILL UPPER TEDD. LOWER TEDD. HAMPTON WICK TOTAL \ Cerebro—spinal Fever — ' — — — . — — 1 1 — — 2 Diphtheria .1 — — — — 1 1 — 1 — 4 Dysentery I — — — — 1 — — — — 1 Erysipelas 1 " 1 3 1 1 — 3 7 5 1 22 Malaria 2 1 — 1 5 3 — — 1 — 13 Measles 8 67 48 40 84 21 11 13 11 41 344 Ophthalmia Neonatorum — — — — _ — 1 1 1 — 3 Acuto Poliomyelitis — — — 1 1 — — — — l 3 Ineumonia 1 4 9 7 4 3 5 12 10 9 64 Fuerperal Pyrexia _ 1 — — 2 9 1 1 — — 14 Scarlet Fever 2 1 5 3 13 16 6 10 2 2 60 Whooping Cough 9 30 14 9 21 23 31 23 4 20 189 TOTALS 23 105 79 62 131 82 ' 60 68 35 74 719 INDEX Page Adoption of Children (Regulation) Act, 1939 18 Ambulance Facilities 11 Ante-Natal Clinics 12, 14 Anti-Toxin, Supply of 34 Births 5, 14 Birth Control and Gynaecological Cases 16 Blindness, prevention of 13 Care of Expectant Mothers 14, 15 Care of Mothers during Confinement 15 Care of Mothers Subsequent to Confinement 16 Cerebro-Spinal Fever 36 Child Guidance Clinics 12 Child Life Protection 18 Cleanliness, Promotion of 17 Common Lodging Houses 28 Convalescent Treatment 17 Day Nursery Service 19 D.D.T,Treatment 25, 26 Deaths 5, 6, 7, 8, 9 Dental Clinics 12 Dental Treatment 16, 17 Diphtheria . 34 Diphtheria, Immunization 34 Diphtheria Immunization Clinics 12 Disinfestation and Disinfection 24, 25, 26, 27 Drainage and Sewerage 21 Dysentery 35 Enteric Fever 34 FactoriesvAct, 1937 28 Food, Inspection and Supervision of 29, 30 Food and Drugs Adt, 1938 31, 32, 33 Foster Children 18 Gas and Air Analgesia 15 Hairdressers' and Barbers' Premises 28 Health Education 13 Health Visiting 16 Honjo Help Service 15 Hospitals 12, 13 Hostel Accommodation 16 Housing 24 Infantile Mortality 8, 9 Infant Welfare Clinics 12, 17 Infectious Diseases 12, 34- 40 Insulin, Provision of 13 Laboratory Work 11 Malaria 35 Massage or Special Treatment,Establishment for 28 Materna" Mortality 7 Measles 36 Middlesex County Council Act, 1944 30 Midwifery and Maternity Services 14 Midwives Acts 14 Milk and Other Foods, provision of 18 Milk Supply 29 Mortuary 13 - in - INDEX (CONTINUED) Page Nurses' Act, 1943 11 Nursing Associations 11 Nursing Homes 19 Ophthalmic Clinics 12 Ophthalmic Treatment of Children under 5 17 Ophthalmia Neonatorum 35 Orthopaedic Treatment 19 Petroleum (Regulation) Acts 28 Pneumonia 35 Poliomyelitis 35 Polio-encephalitis 35 Population 4, 5 Post Graduate Education 17 Post Natal Care 16 Premature Babies, Care of 18 Public Cleansing 21 Puerperal Pyrexia 16,34 Rent and Mortgage Irterest Restrictions Acts 28 Rivers and Streams 21 Rodent Control 27 Sanitary Inspection of District 22,23,24 Scabies 24 Scarlet Fever 34 School Clinics 12 Schools 28 Shops Acts (1934) 28 Slaughtering of Animals 30 Slqughter-houses 30 Smallpox 12,35 SmoKe Abatement 24 Statistics, General and Vital, 4,8,9,10 Swimming Baths and Pools 24 Tuberculosis 12,36,37 Typhoid Immunization 34 Unsound Pood 29,30 Water Supply 20 Y/hooping Cough 36 - 42 -