HEALT A1 8Jul49 C.R.54 Twi 15 AC439(1) TWICKENHAM BOROUGH OF TWTCKENHAM ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH 1947 Public Health Department, Elmfield House, High Street, Teddington, To the MAYOR, ALDERMEN AND COUNCILLORS of the BOROUGH OF 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, 1947. The figures in the various tables reflect the enormous increaso in the popularity-and use tho public is making of the health sorvices. More and more people are seeking advice; in every section of tho .department the work continues to expand. The mortality and infoctious 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 19.72 births per thousand, of the population which is the highest it has ever been; there were 2,089 new babies born - an increase of over 500 on the usual average for the Borough. In addition to this natural increase, the population increased by another three thousand, due to people coming into the Borough from other places. The pressure on the housing accommodation became more acute than ever, cases of overcrowding becoming more and more. frequent. The health services were extended without interruption to deal with this extra work. The ante-natal, midwifery and infant welfare services worked smoothly and efficiently, notwithstanding the enhanced volume of work which they were called upon to deal with. The death rate was 11,05 deat hs per thousand of the population, which is lowor than tho death rate for England and Wales. 'Heart disease claims by far the greatest number of victims, followed closely by cancer and stroke. There wore again 143 primary notifications of tuberculosis, which is higher than than pre-war average. In the summer and autumn of this year we had the epidemic of poliomyelitis In which 21 cases occurred. On tho whole tho health of the people in tho Borough remains remarkably good. The children in the schools are well fed, well looked after and have few defects. Nevertheless there are many problems still outstanding including the prevention of tuberculosis, food poisoning, rheumatism, cancer, heart.disease and many other afflictions. The staff of the department have worked exceedingly hard. I beg to acknowledge my indebtedness to the Chairman and Members of the Public Health and Maternity and Child Welfare Committees for their helpfulness and support which are always of the greatest encouragement. I, desire also to acknowledge with thanks tho friendly co-operation and help which I have always received from my colleagues in the 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. - 1 - STATISTICAL SUMMARY for the year 1947 Area in acros 7,007 Population fas extended - oensus 1931) 79,376 Resident population - estimated to mid-year (as supplied by the RegistrarGeneral) 105,930 Number of inhabited houses 29,319 Rateable value £1,056, 682 Sun represented by a penny rate . £4,328:17:10d. Live Births: Total M. P. Legitimate 1,973 998 975 Illogitimate 116 64 52 Total 1,0 62 1,027 Birth rate per 1,000 of estimated resident population 19.72 Still Births: Total M. F. Legitimate 33 19 T4 Illegitimate 2 1 1 Total 35 20 15 Still Birth rate per 1,000 total live and still births 16.48 Deaths: Total M. F. 1,171 568 603 Death rate per 1,000 of estimated resident population.- 11.05 Maternal deaths: Puerperal and Post - abortive Sepsis 2 Other Mat ernal Causes 3 Rate per 1,000 total (live and still) births 2.35 Death rate of infants under one year of age:- All infants per .1,000 live births 40.21 Legitimate infants per 1,000 leg.live births 38.52 Illegitimate infants per 1,000 illeg.live births 68.97 Deaths from: Cancer (all ages) 182 Measles (all ages) 2 Whooping Cough (all ages) 1 Diarrhoea (under 2 years of age) 10 - 2 - statistics. social conditions and general provision of health services for area population The Registrar-General1 s estimate of population for the mid-year 1947 was 105,930 and this has been adopted for the calculation of tho statistics in this report. BIRTHS The -live births registered in the Borough in 1947 numbered 2,089 giving a birth rate of 19.72 per 1,000 of the population (England and Wales 20,5). The births were made up as follows:- Males Femles Total  ? Legitimte 998 975 1,973 Illegitimte 64 52 116 Total 1,062 1,027 2,089 The nunber of births represents an increase of 134 compared with the previous year. Illegitimate births formed 5.55% of the total live births, an increase of .49% on the previous year. Still Births . There were 35 still births registered during the year, giving a still birth rate" of 16.48 per. 1,000 total (live and still) births, DEATHS The net deaths registered in the Borough during 1947 were Males 568 Females 603 Total 1,171, This represents an increase of 51 compared with the previous year. The death rate per 1,000 of the population was 11.05 as compared with 12.0 for England and Wales, The natural increase of population (that is, excess of births over deaths) was 918 as compared with 835 .for 1946. Sex Mortality The sex mortality rate was:- Males 5,36 per 1,000; Femles 5.690 per 1,000. - 3 - Zygotic 'Diseases Mortality The mortality rates 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 i Enteric Fever - - - - Smallpox - - - - Scarlet Fever - - - - Diphtheria - 1 1 .01 Measles - 2 2 .02 Whooping Cough 1 \ 1 .01 Diarrhoea 5 5 10 .1 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 33.48 3.7 Intra-cranial vascular lesions 9.22 1.02 Bronchitis, Pnour.onia and other respiratory diseases . .. 13.75 1.52 Cancer 15.54 1.72 • Violence 3.67 0.41 Tuberculoses 3.42 . 0.38 - 4 - CAUSES OF DEATH 1947 Registrar General' s Official Returns Causes of Death Males Females Total All Causes 568 603 1171 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 Syst 22 17 39 7. Other forms of Tuberculosis - 1 1 8. Syphilitic diseases 6 - 6 9. Influenza 6 8 14 10. Measles - 2 2 11. Acute Polio-myelitis and polioencephalitis . 3 1 4 12. Acute infective encephalitis - - - 13. Cancer of buccal cavity and oesophagus (M) uterus (F) 6 11 17 14. Cancer of stomach and duodenum 11 13 24 15. Cancer of breast - 20 20 16. Cancer of all other sites 63 58 121 17. Diabetes 1 3 4 18. Intra-cranial vascular lesions 46 62 108 19. Heart disease 159 194 353 20. Other diseases of circulatory system 21 18 39 21. Bronchitis 46 28 74 22. Pneumonia 34 32 66 23. Other respiratory diseases 14 7 21 24. Ulcer of stomach or duodenum 11 3 14 25. Diarrhoea under 2 years 5 5 10 26. Appendicitis 3 2 5 27. Other digestive diseases 10 10 20 28. Nephritis 13 14 27 29. Puerperal and Post-abortive sepsis - 2 2 30. Other maternal causes - 3 3 31. Premature birth 6 3 9 32. Congenital mlformations, birth injury, infantile diseases 21 17 38 33. Suicide 3 5 8 34. Road traffic accidents 2 3 5 35. Other violent causes 16 14 30 36. All other causes 39 45 84 MATERNAL MORTALITY Five deaths were registered as being due to diseases or accidents of child-birth as compared with two for the previous year. The causes of death were as follows: Case 1. Post part m haemorrhage. "2. la. Eclampsia. b. Pregnancy 38 weeks (undelivered). 2. Primipara. - 5 - Case 3. la. Ac. yellow atrophy of liver in pregnancy, b. Bilateral Broncho Pneumonia. Infant stillborn not macerated. ,, 4. Pulmonary Embolism-due to child birth. ,, 5. Therapeutic Abortion. 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 2.35. That for England and.Wales was 1.17. INFANTILE MORTALITY. There were 84 deaths of infants under one year during the year giving an infantile mortality rate of 40.21 per. 1,000 live births. This shows a considerable increase on the figure of 26.09 for 1946, but compares favourably with the rate for England and Wales in 1947 which was 4.1.OO. The following table compiled from the official registrations, gives details of the causes of death at various ages under one year of age; Under one week 1-2 weeks 2-3 weeks 3 -4 kweeks 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 under 1 year.  ALL CAUSES:- Certified 33 1 8 8 50 12 11 5 6 84 Uncertified. - - - - - - - - - - Smallpox - - - - - - - - - - Chicken-pox - - - - - - - - - - Measles - - - - - - - - - - Scarlet Fever - - - - - - - - - - Diphtheria and Croup - - - - - - - - - - Whooping Cough - - - - - - - - - - Influenza - - 1 - 1 - - - 1 2 Enteritis - - 1 2 3 1 3 2 - 9 Tuberculous Meningitis - - - - - - - - - - Abdominal Tuberculosi - - - - - - - - - - Other Tuberculous Diseases - - - - - - - - - - Congenital Malformations 7 - - 1 8 2 1 l - 12 Premature Birth 7 - 1 1 9 - - - - 9 Atrophy, Debility & Marasmus - - - - - - - - - - Atelectasis 7 _ 1 - 8 - - - - 8 Injury at Birth 5 1 1 - 7 - - - - 7 Erysipelas - - - - - - - - - - Syphilis - - — _ - - - - - - Rickets - - - - - - - - - - Meningitis (not Tuberculous) - - - - - - - 1 1 Convulsion - - - - - - - - - - Gastritis I- - - - - - - - - - Laryngitis - - — — - - - - - - Bronchitis - - - - - 1 - - - 1 Pneumonia (all forms) 2 - 3 1 6 2 4 1 3 16 Suffocation (overlying) 1 - - _ - 1 1 1 - 4 Other Causes 4 - - 3 7 5 2 - 1 15 TOTALS 33 1 8 8 50 12 11 5 6 84 -6- An analysis of the mortality reveals that neo-natal deaths were responsible for 59.52 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. 14 17 19 50 59.52 Cougenita malformsations, premature births, etc, caused 45 (or 53.57%) of the total infant deaths. Deaths of illegitimate infants. The death rate of illegitimate infants during 1947 was 68.97 per 1,000, compared with 80.81 for the previous year. The corresponding death rate of legitimate children was 38.52 (23.17 for 1946) REVIEW OF THE COMPARATIVE VITAL AND MORTALITY STATISTICS FOR THE BOROUGH OF TWICKENHAM, TOGETHER WITH THOSE FOR ENGLAND AND WALES FOR YEARS 1937 - 1947 INCLUSIVE YEAR BIRTH RATE Death Rate Infantile Mortality Rate Twick Eng.and Wales. Twick. . Eng., and Wales , Twick. Eng. and Wales, 1937. 14.9 14.9 ' (a) 11,08 12.4 35.4 58 (b) 10.9 6 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 L946. 19.01 19.1 i 10.89 11.5 26.09 43 l947. 19 .7 2 20.5 (a) 11.05 Crude 12.0 40.21 41 (b) Adjusted - 7 - "8~ BIRTH RATE, DEATH RATE AND ANALYSIS OP MORTALITY DURING 1914.7. Provisional Figures. * . Rate per 1,000 total population Annual Death Rate per 1,000 population Rate per 1,000 live births Live Births Still Births All Causes Typhoid and para typhoid fevers Small Meas pox les Scarlet Fever Whooping Cough Diph- theria Influenza Diarrhoea & Entcrit is (under 2 years) Total deaths under 1 year England and Wales 20.5 0.50 12.0 : 0.00 0.00 0.01 0.00 0.02 0.01 0. 09 5.8 41 126 County Boroughs and great towns including London 23.3. 0.62 13.0 0.00 0.00 0.02 0.00 0.03 0.01 0.09 8.0 47 148 smaller towns resident populations 25,000 to 50,000 at 1931 census). i 22.2 0.54 11.9 0.00 0.00 0.02 0.00 0.02 0.10 0.08 3.7 36 London Adm. County 22.7 0.49 12.8 0.00 - 0.01 0.00 0.02 0.01 0.08 4.8 37 TWICKENHAM 19.72 0.33 11.05 - — 0.02 - 0.01 0.01 0.13 4.8 40. 21 A dash signifies that there were no deaths. 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 213 nil positive Sputum etc., for tubercle bacilli 40 6 positive Miscellaneous 22 nil positive Total specimens examined 275 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. A sitting case car was also available, The following table shows the work done by the Borough Ambulance Service during the year 1947:– 1st Qtr. 2nd.Qtr. 3rd.Qtr. 4th.Qtr. Total Accidents 119 160 183 146 608 Removals after accidents 10 13 20 24 67 Ordinary removals. 562 359 305 315 1577 School emergency calls . 5 8 3 19 35 Other – – 7 12 19 Total no. of calls 696 540 518 552 2306 Mileage 6385 4906 4787 4688 20,766 Continuous Oxygen Service Patients attended 19 22 15 15 71 Gas & Air Analgesia Patients attended 22 47 66 53 88 NURSING IN THE HOME There are five home-nursing associations in the Borough and during the year the Council contributed the sun of £300 to their funds. 9 CLINICS AND WELFARE CENTRES. The following olinics wero 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 Seymur 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, Twickenham, Stanley Road, Teddington Station Road, Hampton. 20 Seymour Road, Hampton Wick, Kiddlesox County Council. Dental Clinics. York House, Twickenham Stanley Road, Teddington Hospital Bridge Road, Twickenham. Station Road, Hampton, 20 Seymour Road, Hampton Wick. Art School, Teddington. (Orthodontic). 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, Teddi ngton. Station Road, Hampton. 20 Seymour Road, Hampton Wick, Twickenham Council. Child Guidance Clinic. 58 Hampton Road, Twickenham. Middlesex County Council. Orthopaedic Clinic, Art School, Teddi ngton. Middlesex County Council, - 10 - HOSPITALS Smallpox. Tuberculosis. Puerperal Pyrexia. Infectious Diseases. The arrangements for the provision of hospital accomodation or residential institutional treatment remained unchanged. OTHER HOSPITALS. In'addition to'the three voluntary hospitals' - St. John's Hospital, Twickenham, St, Mary's Hospital, Hampton, and the Teddington, Hanpton 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 1947/48. 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. Thirteen cases were on the register of the Department at the end of the year. HEALTH -EDUCATION. During the year some useful progress was made in this work, A series of photographs were taken and, slides made showing the whole of the work of the Public Health Services, This was done by the staff of the Department. A projector was also constructed making it possible to give lantern lectures. These have been very much in demand. In addition the 16 m.m. sound projector which had been on order for some time was delivered. 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 17 6 of the Public Health Act, 1936. - 11 - MATERNITY AND CHILD WELFARE MIDWIFERY AND MATERNITY SERVICES. The total number of births notified as occurring in the Borough was 1,727. This does not include births which occurred elsewhere but which were subsequently transferred to Twickenham, Of the births occurring in the Borough, 1014 were attended by Midwives in their capacity as Midwives and 713 by Doctors, Municipal Midwives attended 522 - 375 in their capacity as Midwives and 147 as maternity nurses with doctors in charge. NOTIFIED BIRTHS. Confinement dealt with by Acting as Kidwives. Acting as Maternity Nurses with Doctor in attendance. Municipal Midwives 375 147 Non-ttunicipal Midwives - 1 Bearsted Memorial Hospital 612 40 Nursing Homes 27 525 1014 713 MIDWIFERY ACTS. The total number of Midwives employed at the end of the year was nine. From February to October inclusive there was one vacancy, CARE OF EXPECTANT MOTHERS. The number of sessions devoted to this work was:- York House Centre. Two sessions weekly. Whitton Centre. Three sessions weekly. Teddington Centre. Two sessions weekly. Hampton Centre. One session, first, third and fourth week of each month. Hampton Wick Centre. One session weekly. Year Attendance Total for first time Attendances. 1940 750 2998 1941 770 3375 1942 1038 4048 1943 1056 5094 1944 944 4393 1945 1054 4801 1946 1337 6661 1947 1108 5981 - 12 - 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 607 and of these 25 were found to be in need of further observation and/or treatment. Until April 1947 the fee payable by the Council to the local hospitals was 10s. 6d. for each mother. The charge was then raised to £1.1.0. With effect from 14th July 1947, the arrangements with the local hospitals were discontinued and expectant mothers were sent to the Hounslow Chest Clinic. The charge remained £1.1.0 per patient. PARE 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. At the end of the year there were eight full-time and nine part-time Home Helps on the staff. In addition there were twelve temporary Homo Helps. The number of Home Helps is steadily increasing as the service expands. Maternity Domestic Total No, of applications 266 138 404 received. GAS AND AIR ANALGESIA All the Corporation Municipal Midwives are qualified to administer Gas and Air Analgesia. Analgesia was administered to 238 patients (as compared with 87 in 1946) during the year. The three 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, PUERPERAL PYREXIA. Thirteen cases of Puerperal Pyrexia occurred during the year and of these four only were domiciliary confinements one of which was admitted to West Middlesex County Hospital, the others being treated at home. The remaining nine cases were treated in the Institutions where they occurred. All patients recovered. POST NATAL CARE. Post-natal care is carried out at the ante-natal clinics and mothers are urged to attend. The numbers are as follows:- 1947 - 374 1943 - 263 1946 - 206 1942 - 255 1945 - 172 1941 - 297 1944 - 180 1940 - 71 - 13 - Five maternal deaths occurred during the year 1947, BIRTH CONTROL AND GYNAECOLOGICAL CASES. No birth control clinic is held in the Borough, but arrangements have been made with the Birth Control Clinios at Richmond and Hounslow for mothers on medical recommendation to receive advice on "family spacing1' and gynaecological complaints. In necessitous cases the Corporation undertakes responsibility for payment for consultations and appliances. HOSTEL ACCOMMODATION. During 1947 four patients were admitted to 16, The Park, Golders Green, for their confinements, and eight to the postnatal 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: - 1947 1946 1945 1944 1943 1942 1941 Expectant Mothers 320 204 40 42 73 69 52 Nursing Mothers 129 55 20 27 46 32 33 Patients supplied with dentures 91 85 38 53 71 55 37 Dentures supplied 159 144 63 90 129 100 65 HEALTH VISITORS. The approved establishment of Health Visitors is 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 follow ng visits were made to:- 1947 1946 1945 1944 j945 1942 1941 Expectant Mothers 69*5 351 334 437 402 354 432 Children under 1 year of age 10,605 6891,5487 5675 5544 3921 4016 Children between the ages of 1 and 5 years 13,957 9 600 6543 7 699 7589 7137 7834 Visits wore also paid to children of school age in cases of suspected infectious diseases and to follow up those reoomnended for medical treatment or observation. The Health Visitors also attended as required at minor ailment, ophthalmic and dental clinics. POST-GRADUATE E?UCATION. Two Health Visitors attended the Preliminary Part-time Teaching Course arranged bythe Women Public Health Officers' Association during the year, and two the Advanced Course. The Midwiv&s attended a post-graduate course arranged by the London, Middlesex o.nd Surrey County Councils. -14- 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 advioe to parents on the subject of cleanliness and good hygiene. INFANT WELFARE CLINICS. There are five Infant Welfare Clinics; 14 sessions for infant consultations are held weekly and 5 breast feeding clinics. 1947 Twickenham Whitton Toddington Hampton Hampton Wick TOTAL First attendance under 1 year 407 504 380 213 136 1640 First attendance 1 - 5 years 71 112 72 50 37 342 Total attendances under 1 year 4851 7090 4291 3167 2278 21677 Total attendances 1 - 5 years 218 6 3625 2185 1911 822 10729 CONVALESCENT TREATMENT. As in previous years whore necessary convalescent treatment for children under five has been provided by the Corporation. DENTAL TREATMENT OF CHILDREN UNDER FIVE YEARS. During the year, the numbers of children under 5 years of age who received dental treatment were:- New Cases 163 Total attendances 693 OPHTHALMIC TREATMENT OF CHILDREN UNDER FIVE YEARS, During the year, the numbers of children under 5 years of age examined by the Ophthalmic Surgeon were:- First attendance 50 Total attendances 122 Dental and Ophthalmic treatment are free to children under five. — 15 — MILK AMD OTHER FOODS, ETC. During the year, 22 applications for assisted supplies of dried nilk and other foods were granted in necessitous cases and supplied free of charge. The total cost of goods supplied was £15.8.5. CHILD LIFE PROTECTION. All the Health Visitors are appointed Child Life Protection Visitors and each visitor is responsible for carrying out the supervision of the foster hones in her own district. The nuriber of visits paid to foster children during the year was 589 Details of authorisation during 1947 wore:- Individual Foster Mothers 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, 25 4 29 No. of children on register at the end of the year. 19 21 40 No. of children who died during the year. - - - Proceedings taken during the year. - - - CARE OF PREMATURE BABIES. Two 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 1947, nine 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 purpose of supervision was 131. No. of persons who gave notice of their participation in the placing of children for adoption under Section VII (3) during the year 19 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 24 (2) who died during the year Nil (3) on whom inquests were held during the year Nil -16- ORTHOPAEDIC TREATMENT OF CHILDREN Children requiring massage, orthopaedic treatment or remedial exercises were referred to the Art School, Church Road, Teddington, and to the West Middlesex County Hospital. NURSING HOMES. There are fifteen registered private nursing homes'in the Borough, two having been registered during the year. All the homes were kept under periodic supervision during the year. The three voluntary hospitals which received.private patients are exempted from registration as is also the Bearsted Memorial Hospital, MY 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 a high standard of well-being is being maintained. Apart from two oases of poliomyelitis and minor outbreaks of measles, chicken pox and whooping cough, there was no serious outbreak of infection in the nurseries. The training of staff at the Day Nurseries was continued but no students were entered for the Examination of the National Nursery Examination Board. Three of the staff successfully completed the Child Care Reserve Supplementary Course and were awarded the appropriate certificate. As in previous years, courses in Mothercraft Training were arranged for senior girls from the schools, practical demonstrations in the care of children being given by the nursery staffs. Five pre-nursing students from the Twickenham County School wore successful in obtaining tho certificate of the Roya". Sanitary Institute in mothercraft, four of the students passing the examination with distinction. During the year a few changes were made. In view of the low attendances of children at the nurseries on Saturdays it was decided to close the nurseries on this morning without undue hardship to the parents. The admission charge to parents of children attending 'the day nurseries was raised to a maximum charge qf G/- per day. Parents who requested reduction were assessed according to the family financial circumstances, and every parent had the right to appeal to the Maternity and Child Welfare Committee, The majority of parents received reductions, the average charge throughout being about two shillings per day. Considerable thought was given to the policy of admission; to ensure that the most deserving cases recoived the available places, every applicant was given a category of priority, admission being based upon the domestic circumstances as ascertained by the health visitor. The categories into which they have been divided for this purpose were:- Category (1) Widows, unmarried mothers, separated and divorced wives, wives with husbands sick or incapacitated, and other cases where the womah is the sole support of tho family, -17- (2) On medical, psychological, sociological and housing grounds. (2a) Hospital cases, confinements; or where a short stay of a few days only is required. (3) Women in full-tine productive employment. (4) Economic or any other circumstances at the discretion of the Medical Officcr, -18- RESULTS OF THE CHEMICAL AND BACTERIOLOGICAL EXAMINATION OF THE WATER SUPPLIED TO THE BOROUGH OF TWICKENHAM, JANUARY - DECEMBER. 1947. Chemical. Ammoniacal Nitrogen Albuminoid Nitrogen Oxidised Nitrogen Chlorides as CI. Oxygen abs. from Permanganate 3 hrs. @ 80°F. Turbidity in terms of Silica Colour m.m. brown, 2ft. tube Burgess's Tintometer Hardness (Total) Hardness (Perrmanet) pH Value Conductivity. Nitrite Nitrate 0.173 0.076 - 3.1 24.3 1.08 0.7 19 245 70 7.7 450 SANITARY ADMINISTRATION. WATER SUPPLY. I an indebted to Lt.Col.E.F. Mackenzie, Director of Water Examination, Metropolitan Water Board, for the folic report upon the supply for the Borough:- "The water supply to the Twickenham, area is derived from the River Thanes, purified in the storage reservoirs at Littleton and Walton and at the filtration works at Hampton. All the water is chlorinated before it leaves the works. Samples of the water are collected at all stages of purification and analysed five tines each week at the Laboratories of the Metropolitan Water Board. All new and repaired nains are chlorinated before bieng restored to use and samples of water fron then are tested bacteriologically. None of the supplies is plur.bo-solvent. We have no information with regard to the proportion of the total number of dwelling houses in Twickenhan which are supplied by the Board, but of these all are supplied direct and not by means of standpipes. Appended are the average results of the chemical and bacteriological analyses of the various supplies." Bacteriological. No. of samples. Colony Count Bact. coli test. on agar at 37 C . Percentage of samples nega- tive per loo ml. Bact. coli per 100 ml. 1080 18.5 99.1 0.013 -19- DRAINAGE AND SEWERAGE There have been no major works or improvements in connection with the Corporation's sewers during the past year owing to the continued restrictions on labour and materials. Work has been confined to general maintenance, flushing and cleansing. The Corporation during the year made application to the Ministry of Health for sanction to proposed extensive improvements to both the soil and surface water sewers in the East Twickenham area, but owing to tho prevailing conditions the Ministry felt itsolf -unable to allow these works to proceed. It remains a source Of apprehension, particularly during times of heavy rainfall, that these improvements have not been sanctioned, and surcharging of these systems with their attendant consequences to a number of properties in this district will continue until the necessary alleviation is practicable. PUBLIC CLEANSING. (a) STREETS. Despite an enforced reduction of labour towards the end of the year a standard of scavenging and street cleansing approximating to that prevailing before the war has been resumed and it is hoped will be maintained. The new mechanical sweeper collector vehicle has befen in use during the year, has served to economise in man-power, and has proved a decided acquisition. The Corporation have also operated a new Gully Emptier and this similarly has been of appre6iable assistance in supplementing the efforts of the manual labour. fb) REFUSE COLLECTION & SALVAGE. Tho Borough Engineer's Department continues to make the best possible use of the existing refuse collection vehicles, but many of these are now in such a state that their replacement is urgently necessary. Tenders have been invited and received for various types of mechanical collectors and it is hoped that a report will be presented to the appropriate Committee very shortly with a view to a decision being arrived at as to the most suitable vehicles tendered for and orders placed for their delivery. Unfortunately, however, even when such an order is placed there will probably be a delay in the actual delivery of the chosen vehicles of between 18 months and 3 years. It will, therefore, be neoessary for repairs to the existing plant to be continued and improvised as has now been the case for 7 or 8 years. Certain changes and reorganisation in tho salvage arrangements at the Destructors have been made during.the year and the result of this has been that an appreciably greater quantity of salvageable materials has been recovered and sold with a corresponding increase in the revenue whioh has aocrued therefrom. In view of the national position this is ah eminently satisfactory result and it is hoped that even better results may be shown in 1948. Fluctuations in the demand for particular classes, however, of salvageable materials occur from time to time and it is difficult to forecast in advance what the position may be from month to month, although the position as regards waste paper, which is the principal source of income, still shows very satisfactory figures, -20. (c) REFUSE DESTRUCTION. All three Destructors, despite their age and unavoidable deterioration, have been in use during the year and such maintenance repairs as have been possible have been carried out from time to time by the Corporation's staff so as to reduce tho amount of refuse which inevitably has to be tipped. The Destructors, however, are still capable only of dealing with about 65% of the refuse collected and tipping at the Broom Road land and elsewhere has been, of necessity, continued. No complaints during the year have been received from these tipping operations and the difficulty in future will rather lie in the procuring of sites to allow this, tipping to continue than in "possible objections which may be received from the public against this method of disposal. Negotiations with the adjoining Urban District of Sunbury for the provision of a new Destructor and Salvage Recovery Plant in the area of the. latter Authority have proceeded satisfactorily, and the Staines Urban District Council.have duri.hg' the past few months agreed to participate in this scheme. The expenditure involved will probably approximate to a figure of not less than £120,000 according to present day'costs, but the three Authorities have agreed the main-principles underlying the scheme and it is hoped that this -much desited provision will come to fruition as soon as the Ministry of Health have indicated that the building and provision of the plant can proceed. SANITARY INSPECTION OF DISTRICT. The following pages show the excellent work achieved by Mr. T. Williams, Chief Sanitary Inspector, and his section during the year. 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 1284 Choked and Defective Drains 180 Accumulations of Offensive matter 134 Relative to Unsound Food 253 Verminous premises (a) Bugs 65 (b) Rats and Mice infestations 264 (c) Beetles and Crickets 36 keeping of Animals and Poultry 30 Unsatisfactory Milk Supplies 13 Miscellaneous 1150 3409 -21- Summary of Visits. Inspections, etc. Visits to:- Dwelling Houses for Housing defects under Public Health Act: (a) after complaint 2302 (b) subsequent visits 3504 Dwelling Houses for Housing defects under Housing Act: (a) after complaint 101 Infected Dwelling Houses: (a) after notified infectious disease 198 (b) contacts 75 (c) fumigations after infectious disease 23 (d) Tuberculosis enquiries and fumigations 3 Schools and Church Halls 37 Swimming Baths 10 Water Sampling: (a) Swimming Baths 1 (b) Dwelling Houses 41 Business Premises 23 Cinemas, Dance Halls, Billiard Halls 26 Offensive Trade Premises 2 Stables, Piggeries, Keeping of Animals 30 Factories with mechanical power 74 Faotories without mechanical power 5 Outworkers1 Premises 2 Common Lodging Houses 2 Underground Rooms 22 Hairdressing Premises 14 Tents, Vans and Sheds 5 Smoke Nuisances 25 Drains tested: (a) by smoke 59 (b) by coloured water 42 (c) by water 17 (d) by breaking down 37 Public Sewers 87 Means of escape in case of fire 16 Watercourses and ditches 3 Land and tips 5 Septic tanks, cesspools 8 Sanitary conveniences - Public houses 53 Miscellaneous visits 687 Visits not inspections 1334 (a) Rats and mice (i) after complaint 563 (ii) Subsequent visits 670 (b) Bug infestations 166 (c) Beetles 53 (d) Other vermin 101 (e) Scabies 4 Unfit foodstuffs other than meat 460 18 Butchers' Shops 214 Bakehouses 32 Pish shops, Grocers and"Greengrocers 161 Factory canteens 7 Restaurant kitchens etc Hotel & Beerhouse Bars and Cellars: 136 (a) Day inspections 29 (b) Night inspections 0 Ice Cream'premises 189 Sausage manufacturers 24 Preserved' meat' prep aration premises 6 Preserved fish preparation premises 0 Hawkers1 vehicles 9 Noise nuisances 27 Petroleum Acts 41 Hawkers' premises 4 -22- Summary of Visits, Inspections, etc. (Contd). Milk sampling for bacteriological examination 40 Cowsheds 4 Dairies at Farms 3 Pasteurisation plants 13 Milkshops and Dairies 33 Shops Act, 1934 54 Housing enquiries 17 6 Environmental reports, Child adoption etc. 27 Total number of visits and inspections 12147 Sanitary Improvements effected. Ditches cleansed 2 Drains repaired 1 Public sewers repaired 2 Drains unstopped 37 Closet accommodation provided 2 Sinks provided 5 W.C's repaired 58 Gullies repaired 10 Sink waste pipes repaired 20 W.C. cisterns and fittings provided 25 Soil pipes repaired 5 Yards and passages paved 1 Roofs repaired 27 2 Eavesgutters repaired 99 Downspouts repaired 25 Pointing repaired 5 Yard paving repaired 6 • Chimney flues repaired 22 Dustbins provided 29 Sashframes and sashcords repaired 78 Floors repaired 51 Stairs repaired 9 Plaster to walls and ceilings repaired 377 Fireplaces repaired 63 Washboilers repaired 9 Chimney stacks repaired 13 External walls repaired 10 Filthy condition of premises remedied 4 Offensive accumulations removed 18 Nuisance from keeping of animals remedied 1 Other works carried out 158 Notices Issued: Preliminary notices served 8 66 Preliminary notices complied 454 Statutory notices served 136 Statutory notices complied 18 6 HOUSING STATISTICS Inspection of Dwelling Houses during the vear. 1. (a) Total number of dwelling houses inspected for housing defects (under Public Health or "Housing Acts 2403 (b) Number of inspections made for the purpose 5907 2. fa) Number of dwelling houses (included under sub head (1) above) which were inspected under the Housing Consolidated Regulations 1925 Nil (b) Number of inspections made for the purpose Nil -33- 3. Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil 4. Number of dwelling houses (exclusive of those referred to under the preceding sub-head) found not to bo in all respects reasonably fit for human habitation 866 2. Remedy of defects during tho year without Service of formal Notices:- Number of defective dwelling houses rendered fit in consequence of informal action by the Local Authority or their officers 454 3. Action under Statutory Powers during the year:- A. Proceedings under sections 9,10,16 of the Housing Act 1936: - (1) Number of dwelling houses in respect of which notices were served requiring repairs Nil (2) Number of dwelling houses which were rendered fit after service of formal notices:- (a) By owners Nil (b) By local authority in default of owners Nil B. Proceedings under Public Health Acts: (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 136 (2) Number of dwelling houses in which defects were remedied after service of formal notices:- (a) By owners 186 (b) By local authority in default of owners Nil C. Proceedings under Sections 11 and 13 of the Housing Act, 1936: (1) Number of dwelling houses in respect of which Demolition Orders were made Nil (2) Number of houses in respect of which an undertaking was accepted under sub section (3) of Section 11 of Housing Act, 1936. Nil (3) Number of dwelling houses demolished in pursuance of Demolition Orders Nil D. Proceedings under Section 12 of the Housing Act 1936: (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made Nil (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil -24- Overcrowding. The known oases 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 145 (ii) Number of families dwelling therein 154 (iii) Number of persons dwelling therein 865 (b) Number of new cases of overcrowding reported during the year 48 (c) (i) Number of cases of overcrowding relieved during the year 2 (ii) Number of persons concerned in such cases 9 LEGAL PROCEEDINGS. During the year legal proceedings were taken in three instances with the following results:- (a) For contravention of the Food & Drugs Act, 1938, sections 13 & 14, a penalty of £12,10s. 0d., with £2.2s, 0d. costs (b) For non-compliance with the requirements of the Food & Drugs Act, 1938, section 13, relative to dirty conditions of a bake-house, cautionary letters were sent, (c) An application under section 57(5) of the Food & Drugs Act, 1938, for a slaughter-house to be licensed was refused. SMOKE ABATEMENT. It was not necessary to take any formal action during the year regarding excessive emissions 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 426, Summary Disinfections after infectious disease 88 Disinfections after other disease - . D.D.T. treatment (No, of promises as detailed on page 27) 271 TOTAL 359 -25- Number of articles disinfected after infections disease 170 Number of articles disinfected after other disease - TOTAL 170 Total Income for D.D.T. treatment: £172.12s. 0d. — 26— -27- D.D.T. TREATMENT - 19u7. Number of Infestations Treated. TYPE OP PREMISES FLIES BUSS FLEAS MOTHS ROACHES . CRICKETS ANTS SILVERFISH MOSQUITOES WOOD BEETLE WASPS BEETLES Dwelling Houses 111 'i 64 20 • 7 - — 6 - 1 2 14 6 General Shops - - - - - - - - - - - Food Shops 37 - - - 2 1 - - - - - 1 Offices 1 - - - - - • - — ! — - - Day Nurseries 3 - - - - - - - — . - Clinics 6 - """ - - - - - - - - - Hospitals - - - - - - - - - - - . Miscellaneous 4 - - - - - - - - - - • Pood preparation Factories - : J - - - - —— - - - - - - - - T0TAL. 162 64 20 7 2 1 6 - 1 2 14 1 Number of Premises Infested. Dwelling Houses 220 Non-Dwelling Houses 51 Total 233 RATS AND MICE (DESTRUCTION) AST. 1919. INFESTATION ORDER, 1945. There arc four Rodent Operatives and one Rodent Officer employed under the general direction of the Chief Sanitary Inspector on the work of rodent destruction. During 1947, 12,432 visits were made to promises within the Borough and of this total, initial visits following upon complaint or resulting from surveys numbered 4,468, the remaining 7,964 visits comprising re-inspections in connection with laying baits, poisoning and trapping. The success of the scheme enabling occupiers to enter into contract with the Corporation for rodent destruction may be judged by the following summary, there being 337 contracts made and income received amounting to £734.2s.6d. It was found necessary to serve 107 Preliminary Notices, 32 Statutory Notices and 10 Final Notices. NUMBER OF INFESTATIONS. FOOD PREMISES. NON-FOOD PREMISES. PRIVATE DWELLINGS. FACTORIES. RATS ONLY MICE ONLY BOTH RATS AND MICE, 47 ! 18 270 17 356 13 8 DEGREE OF INFESTATION. RATS MICE RESERVOIR. MAJOR PRIMARY 50-100. MINOR SECONDARY 1-50. RESERVOIR. MAJOR PRIMARY. MINOR SECONDARY. . 3 2 347 Nil 1 . 20 RATS AND MICE (DESTRUCTION) ACT. 1919. NOTICES SERVED NOTICES OUTSTANDING Preliminary Notices Statutory Notices 24 hour (Default) Notices Preliminary Notices Statutory Notices i 24 hour (Default) Notices 107 32 • 10 Nil Nil 6 RAT DESTRUCTION WORK UNDERTAKEN BY CORPORATION OCCUPIERS RATS MICE RATS MICE 341 21 71 Nil NUMBER OF PREMISES UNDER CONTRACTS WITH CORPORATION, TOTAL 338 12 months. 6 months. 3 months. 1 month. Others. Total Receipts 41 3 110 172 11 £734 2s 6d -28- 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 was carried out by the Sanitary Inspectors during the year. It was not necessary to close any of the schools on account' of' infectious disease among the children. PETROLEUM (CONSOLIDATION) ACT, 1928 and PETROLEUM SPIRIT REGULATIONS 1929/1947. During the year 41 visits wore paid by the Sanitary Inspectors to premises upon Which petroleum spirit or carbide of calcium was stored. 108 licences were issued in respect of these promises. shops act, 1954. Formal action under the provisions dealt with by the Department was taken in respect of two premises during the year. Eleven exemption certificates wore granted under section 10(2) of the Act in relation to sanitary conveniences. ESTABLISHMENTS FOR MASSAGE OR SPECIAL TREATMENT. Twelve 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 wore 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. 1920-58. Eleven certificates were granted under the above Acts in respect of promises which wore not in a reasonable state of repair, -29- FACTORIES' ACT. 1937. Inspection for purposes of provisions as to health. Inspections. Written Notices Factories with mechanical power 378 21 Factories without mechanical power 247 11 Other premises under the Act - — Summary of defects found: Found Remedied Want of cleanliness 2 2 Overcrowding - — Unreasonable temperature - — Inadequate ventilation 1 1 Ineffective drainage of floors - - Sanitary conveniences: (a) insufficient 7 7 (b) unsuitable or defective 3 3 (c) not separate for sexes - - INSPECTION AND SUPERVISION OF FOOD. Milk Supply. At the close of the year there were registered under the Milk and Dairies (Amendment) Act, 1922, and the Milk and Dairies Order, 1936:- PERSONS. 1 Cowkeepers registered as wholesale and retail purveyors of milk Nil Cowkeepers registered as wholesale p purveyors of milk Nil Cowkeepers registered as retail purveyors of milk Nil Total number or persons registered for carrying on trade of oowkeeper 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 1 13 Total number of cowkeepers, wholesale and retail purveyors of milk 13 PRIMISE3. Number of cowsheds Nil Farms used as dairies Nil Other promises used as dairies 22 The bulk of the milk supply of tho Borough continues to cone from outside the area and has boon pasteurised before the delivery. 40 visits wore paid to dairies, milkshops and cowsheds. Milk Sampling. Fifty-three 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. 47 were found to be satisfactory and 6 unsatisfactory. Further samples were taken from the 6 unsatisfactory sources, and 5 of these proved to be satisfactory, A further sample was taken from the remaining source and this was found to be satisfactory. Milk in Schools Scheme. All milk used in tho schools under this scheme is pasteurised. -30-- Milk (Special Designations) Orders, During the year the following licences were granted for the sale of designated milk: - "Tuberculin tested" milk 17 "Accrodited" milk _ "Pasteurised" milk 20 Slaughter-houses. Four licences were renewed during the year, Consideration of the condition of two slaughter-houses was again deferred ponding the execution of essential repairs. Slaughter of Animals Act. 1933. Ten slaughter-men were on the register of the Department at the end of the year, FOOD INSPECTION. Diseases and unsound conditions found in the animals dealt with caused the detention and surrender for destruction of a total weight in carcases of 2442 lbs,, details of which are given in the following table:- Beef 2301 lbs. Mutton and Lamb 102 lbs. Pork 13 lbs. Other meats 26 lbs. The following foodstuffs other than neat, being unfit for human consumption, were voluntarily surrendered for destruction:- Bacon 21 lbs. Butter 39 lbs. Cheese 16 lbs. Dried Fruit 300 lbs. Dried pons and beans 358 lbs. Eggs 483 Fish 1381 lbs. Fowls 31 lbs. Flour and cereals 82 lbs. Jam 330 lbs. Margarine 5 lbs. Rabbits 60 lbs. Chocolate 7 lbs. Onions 230 lbs. Biscuits 251 lbs. Tinned Foodstuffs Fish 855 tins. Fruit 221tins. Meat 348 tins. Corned Beef etc. 450 lbs." Milk 1695 tins. Other 388 tins. Other foodstuffs Confectionery, Pancake mixture and Ice cream mixture 44 lbs, MIDDLESEX COUNTY COUNCIL ACT. 1944. 13 visits were made by the Sanitary Inspectors concerning the vehicles and/or storage accomodation of hawkers of moat, fish and vegetables. -31- FOOD AND DRUGS APT. 1958. 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 cf the year. In addition, 4 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 glasses, and where the contaminated overflow is collected and liable to bo used for re-sale. -32- Statistics. . Conditions Shop and Restaurant kitchens Hotel . Bars ana Cellars Found Remedied Found Remedied No. of premises 28 16 4 2 Dirty floors 21 5 1 - Dirty premises 15 6 1 - Dirty ceilings 28 9 - - Dirty walls 40 11 - - Insufficient or absence j of hot water for cleansing utensils 4 2 1 - Insufficient or absence of cold water for cleansing utensils 1 - - - Absence of sink or adequate waste pipe 3 5 - - Defective drainage boards - - - - Inadequate lighting l - - - Insufficient ventilation 8 6 1 - Unsatisfactory personal cleanliness 12 12 1 1 Insufficient or -unsuitable W.C. 7 2 2 1 Absence of hot water for ablution purposes and inadequate staff room 24 10 - - Accumulation of refuse or spittoons requiring removal 6 3 - - Verminous conditions (rats &mice) 47 47 - - Dirty fittings 2 . 1 — - Unsatisfactory storage facilities 4 - - - Defective wall plaster 10 6 - - Defective floors 3 3 — 1 Defective ceiling plaster 7 5 1 - Dampness 2 3 3 - Total number of defects 245 13 6 11 3 Number of notices served 32 Number of notices complied with 18 -33- Sampling. The Middlesex County Council are the Food 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 261 7 Milk, Channel Island 5 - Coffee & Chicory Essence 2 - Cooked Meats 1 - Gin 7 1 Glycerine 1 - Jam 2 - Lemon Curd 1 — Malt Vinegar 1 - Meat Pies 6 2 Meat Savouries 5 — Mineral Oil 1 1 Run 1 - Sausages 4 - Sausages, cooked 10 — Sausage Meat 4 - Sulphur Lozenges 1 - Whale Meat Sausages 1 - Whisky 8 - White Precipitate Ointmont 1 - Zinc Ointmont 1 - TOTAL 324 11 -34- INFECTIOUS D I 3 E A 3 E S. ( a) NOTIFIABLE INFECTIOUS DISEASES. Diphtheria. There were four cases of diphtheria notified during 1947, the same number as for the previous year. All oases were admitted to hospital. There was one death. The death rate was .01 per 1,000 of the population as compared with 0.01 for England and Wales. On the 5th February, 1947, I received a notification that a student at a training college was suffering from diphtheria and had been admitted to hospital. On the 9th February another student took ill with diphtheria; by that time it had boon ascertained that the first student was suffering from a mixed infection of haemolytic streptococci and diphtheria. On the 10th February the college was visited, and Schick tests wore done on about 300 of the staff and students. On the 12th February, 45 positive reactors to the Schick test had been found. As it was impossible to give an unqualified undertaking that no untoward effect might arise as to the result of the administration of serum, it was decided to give each of the positive reactors 1 c.c. of T.A.F. immunising agent, followed by other two injections at the correct intervals of time. Reactions to this were negligible. On the 1st March another student took ill with diphtheria. It was decided to ascertain if there were any diphtheria carriers among the staff or students. Two days later at my request, a doctor and three technicians from the Central Public Health Laboratory, visited the college and carried out the swabbing of tho nose and throat of all the staff and students available. From these tests it was ascertained that three students were carrying in their throats the same virulent strain which had caused the illness in the three patients admitted to hospital. The three carriers were admitted to hospital, although not themselves ill, and were treated until they were non-infectious All throe patients made a good recovery and no further cases occurred. Free Supply of Anti-toxin. During the year Medical Practitioners practising in the Borough could at any tine obtain a supply of diphtheria antitoxin from the fire stations. 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 54.6% 5 to 15 years 7 6.9% The following is a summary of the work carried out:- Total number of new cases immunized 1677 -35- | Number of Children who completed Full Course of Primary Immunization in Twickenham (including temporary residents) in 1947. Age at date of Final Injection TOTAL Under 5 5 to 14 1516 161 • 1677 Total Number of Children who were given a Secondary or reinforcing Injection (i.e. subsequent to complete full course) 1173 Scarlet Fever. The number of cases of Scarlet Fever notified during the year was 60, the same number as in 1946. There were 26 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, Typhoid Immunization. Facilities wore available at the clinics for typhoid immunization but no cases were dealt with during the year. -36- INCIDENCE AND MORTALITY DIPHTHERIA, SCARLET FEVER AND ENTERIC FEVER 1937 - 19U7 YEAR DIPHTHERIA SCARLET FEVER ENTERIC PEVER 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 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 - - - — ~ - 1945 4 0.04 1 0.01 97 1.06 - - - — - - 1946 4 0.04 - - 60 0.58 - - - - - - 1947 4 0.04 1 0.01 60 0.58 - - - - - - Smallpox No case of smallpox was notified during the year. Eight contacts were kept under observation by the Department. Pneumonia, Malaria and Dysentery. Pneumonia. There were 60 cases of pneumonia notified during the year, a decrease of four on 1946. Deaths numbered 66. Malaria. Two cases of malaria were notified during the year, one of which was treated in hospital. Both cases were contracted abroad. —37— Dysentery. No case of dysentery was notified during the year. There were no deaths. Acute Poliomyelitis, Acute Polio-encephalitis. Poliomyelitis is always endemic - an odd case occurs here and there throughout the country. Occasionally wo have a case in Twickenham. During 1947, the national incidence of cases was of the usual low sporadic nature - about ten cases per week, Towards the end of May, it was noticed that the national incidence had begun to rise. By the end of July, the national incidence was over 300 cases per week, and by the end of August had risen to the proportions of a bad opidemic with over 650 cases a week. The opidemic then began to decline; by the beginning of October the incidence rate had dropped again to about 300 per week, and from then,onwards to the end of the year the decline continued until by the end of December, the national incidence had again dropped, although there were still about 40 cases per week occurring. During this period, Twickenham received its share of this distressing malady. The first case occurred on the 15th May, 1947, in a boy aged 3 years, who was attending one of the day nurseries. On the 27th June, another case occurred in a baby boy aged 14 months, who was also attending a day nursery. In July, five cases occurred - one boy aged 5½ years, three girls aged 11 months, 4 years and 14 years, and one woman; in August two cases - a boy aged 15 and a girl aged 7 years; in September, five cases - two boys aged 12 and 16 years, two girls aged 2 and 17 years and one woman; and in October, six cases, three boys aged 11, 15 and 18 years, two girls aged 11 and 18 years and one woman. There were twenty-one cases in all; they ranged in severity from a mild abortive type of infection with no residual paralysis, through various grades of mild paralysis affecting one small group of muscles to severe degrees of paralysis affecting head, nock, back, abdomen and limb muscles. Four very mild cases were treated at homo, and the remaining seventeen were admitted to hospital, Some of these were treated in the mechanical respirator, I regret that three of the patients died from the severity of the paralysis. In other instances, patients made excellent receveries. Immediately a case was confirmed in a child attending a nursery or a school, a letter of advice was sent to all parents with children in the nursery or school. It was pointed out that Poliomyelitis is an infectious disease caused by a minute virus. It is believed that most people have become immunised by being exposed to the virus without developing any symptoms of the disease, A few who catch the infection suffer from a slight feverish attack only; fewer still suffer, in addition, from symptoms resembling meningitis, but do not develop paralysis; fewest of all become paralysed and develop varying degrees of disability of movement. Persons who develop the illness are most infectious to others a few days both before and after the attack. Healthy carriers are known to exist who may harbour the infection, although they themselves are well. They are able to spread the infection to other people by talking, sneezing, coughing or from the bowels. Experience shows that as a rule in schools or nurseries, relatively few children are attacked, and excessive outbreaks are not common. The risk of spread to other children is small, though it cannot be completely excluded. The incubation period (the time from exposure to infection to the onset of the illness) is up to three weeks. As there is no means of detecting carriers, some parents may wish to keep their children away from the school. The children should be prevented from mixing with other groups -38- with whom they do not habitually come in contact, as for example at children's parties, etc. Simple hygienic precautions any be taken to prevent the soroad. of infection; for a cold, paper handkerchiefs may be used and afterwards burnt, or linen handkerchiefs may be soaked in a solution of izal, lysol or dettol and then boiled; after using the lavatory a child's hands should be thoroughly was ed, Every effort should be made to keep down flies by the use of powder or spraying fluid containing pyrethrum or D.D.T. If a child develops a rise of temperature or complains of headache or stiffness or pains in the neck or back, he should at once be put to bed and a doctor consulted. It was believed there might he some connection between the effects of operation for .the removal of tonsils and adenoids and the extraction of teeth, so during the period of the epidemic and for sane time after wards, these activities were suspended. Intensive efforts were made to try to trace the source of infection as each case occurred. Here and there information received seemed to point to a likely source, but no definite conclusions could be drawn. Ophthalmia Neonatorum, 1937 - 1947. The following table shows the number of cases notified and result of treatment. YEAR. Cases Notfd. Cases Treated Vision Unimpaired Vision impaired Total Blindness Deaths At Home. In hosp. 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 - - - 1943 2 2 - 2 — • — 1946 3 2 1 3 — — - 1947 5 5 - 5 — — — Puerperal Pyrexia. Thirteen cases of puerperal pyrexia were notified, as compared with fourteen for the previous year, flight cases were treated in hospital. Cerebro-spinal Fever. There wore two cases of cerebro-spinal fever notified during 1947, the same number as in the previous year. Both cases were treated in hospital. One death was recorded from this disease. Measles and Whooping Cough. During the year, 607 cases of measles were notified, as compared with 343 for the previous year. The peak period was the months of February and March, when 212 and 139 cases were notified. Thirty-three cases wore admitted to hospital. There wore two deaths, giving a death rate of 0.022 per 1,000 of population. The death rate for England and Wales was 0.01 per 1,000 of population. The number of cases of Whooping cough notified - 226 showed an increase of' 139 on the previous year, Thirty cases -39- wore admitted to hospital. There was one death, giving a death rate of 0.01 per 1,000 of population. The rate for England and Wales was 0.02, (b) NON-NOTIFIABLE INFECTIOUS DISK.SES. 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 223 Mumps 195 TUBERCULOSIS. During the year 1947 there were 143 new cases of tuberculosis notified, an increase of four on the previous year. ,42 deaths were recorded from the disease, giving a death rate of 0.38 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 11.9 per cent. of the total tuberculosis deaths. NEW CASES ANT MORTALITY 1947. Age Periods Now Cases Deaths Pulmonary Non- Pulmonary Pulmonary Non- Pulmonary Male Female Male Female Male Female Male ' Female Under 1 1 - - - - - - - 1-4 5 1 1 1 - 1 - - 5-9 2 3 3 — - - - — 10 - 14 — 1 — 1 - - - 1 15 - 19 8 11 - — - 2 - - 20 - 24 13 12 — - 3 1 — — 25 - 34 15 18 - 1 7 7 - - 35 - 44 13 4 1 - 5 4 - - 45 - 54 6 3 — 2 2 2 - - 55 - 64 8 2 - — 4 1 - - 65 and over 5 1 1 - 2 - - - Total 76 56 6 5 23 18 - 1 Primary Notifications of Tuberculosis 1937 - 1947 inclusive. 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 Pulmonary 85 100 106 114 127 112 119 133 118 120 132 Non-Pulmonary 25 30 19 12 14 18 18 18 18 19 11 Total 110 130 125 126 141 130 137 151 136 139 143 -40- " ^ 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 sccti6n for the compulsory removal to hospital of persons suffering from tuberculosis. FOOD POISONING. On the 15th May, 1947, a message was received from Teddington Police Station that a mother and her small daughter had collapsed with vomitting, diarrhoea, faintness and severe abdominal pains. The local practitioner was called in. A visit was at once made by an Inspector, who ascertained that the illness appeared to have followed the consumption-of some prepared pork sausage neat, obtained from a local retailer. The retailer readily gave the address of the source of his consignment, and the names and addressee of the customers he had supplied. A message to the wholesale firm elicited the information that ten retailers in the Borough had been supplied with the meat and that districts in various parts of London were affected. The Ministry of Health require information at once when a suspected outbreak of food poisoning occurs. The situation was reported to the Ministry who stated that the outbreak was widespread over the London area. i In the meantime every available Inspector and Health Visitor was at once sent out to call on as many customers who had purchased the neat as could be traced from all the shops in the list supplied by the wholesalers. By this prompt action, almost the whole of the neat purchased that day was retrieved. Unfortunately it was impossible to prevent some of it from being consumed, and although sane hundreds of people were saved from being ill, there were twenty cases of severe food poisoning, of whom six required to be admitted to hospital. -41 -ij.2— WARD DISTRIBUTION OF INFECTIOUS DISEASES NOTIFED DURING THE YEAR. DISEASE EAST TWICK CEN. TWICK. SOUTH TWICK. WEST TWICK. WHITTON HAMPTON HAMPTON HILL. UPPER TED. LOWER TED. HAMPTON WICK. TOTAL. Cerebro Spinal Fever i - 1 - - - 1 - - - 1 2 Diphtheria 1 — 2 - - - - - - 1 4 Erysipelas - - 1 - 4 1 - 4 1 3 14 Malaria - - 1 - - - - - 1 - 2 Measles 48 42 59 52 69 37 75 115 72 38 607 Ophthalmia Neonatorum - - - - 2 - 1 2 ~ - 5 Pneumonia 5 6 2 1 8 i 3 9 12 13 60 Polioencephalites - 1 — - - - - 2 2 - 5 Poliomyelitis 1 - 2 - 1 — 1 1 3 4 13 Purperal Pyrexia — - 2 - 1 7 1 1 - 1 13 Scarlet Fever 6 6 4 3 14 7 4 8 3 5 60 Whooping Cough. 17 31 . 18 26 25 15 • 2k 30 23 19 228 TOTALS 78 87 91 82 124 69 109 172 117 84 1013 -43- MONTHLY INCIDENCE OP INFECTIOUS DISEASES DURING THE YEAR 1947 DISEASE NUMBER OF CASES TOTAL Jan. Feb. Mar. Apl. May. June. July. Aug. Sept. Oct. Nov. Dec. Cerebro-spinal Fever - 1 - — 1 - - - - - - - 2 Diphtheria 1 1 1 - - - 1 - - - - - 4 Erysipelas 2 1 1 2 1 1 1 1 2 1 - 1 14 Malaria - - - - - - 1 - - - 1 - 2 Measles 34 212 139 85 60 41 21 9 3 2 - 1 607 Ophthalmia Neonatorum - 1 - 2 1 - 1 - - - - - 5 Pneumonia 11 4 11 6 3 3 1 1 1 2 6 11 60 Polioencephalitis - - - - - - - - 2 3 - - 5 . Poliomyelitis - - - - - - 5 - 4 4 - - 13 Puerperal Pyrexia - 3 2 2 - 1 1 - - 1 - 3 13 Scarlet Fever 18 6 6 9 - 5 1 1 - 5 5 4 60 Whooping Cough . 31 41 45 29 16 11 21 6 5 5 11 7 228 TOTAL 97 270 205 135 82 62 54 18 17 23 23 27 1013 -44- CASES OF INFECTIOUS DISEASES NOTIFIED DURING THE YEAR 1947. DISEASE CASES NOTIFIED AT VARIOUS AGES (YEARS) Total Cases Notfd. Cases Admtd Hosp. Deaths Age | Unkn. 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 CerebroSpinal Fever - — — — — — 1 - - — — — — - 2 2 1 Diphtheria - - - - - - - - 3 1 - - - - 4 4 1 Erysipelas - - - - - - - 1 - - 1 2 9 1 14 4 - Malaria - - - - - - - - - - 1 1 - - 2 1 - Measles 3 15 51 77 78 72 255 20 17 7 6 4 2 - 607 33 2 Ophthalmia Neonatorum - 5 — — — — — — - - - - - - 5 1 - Pneumonia - 2 1 1 3 - 4 2 3 1 8 6 19 10 60 3 66 Polioencephalitis - - - 1 - - - - 3 1 - - - - 5 5 - Poliomyelitis - 1 - - - 1 2 4 3 2 - — — — 13 9 4 Puerperal Pyrexia - - - - - - - - - 2 9 2 - - 13 8 — Scarlet Fever - - - 4 3 3 27 12 6 - 3 2 - - 60 26 - Whooping Cough 3 22 22 23 34 36 78 4 1 1 1 2 1 - 228 30 1 TOTAL 6 45 74 106 118 112 367 44 36 15 29 19 31 11 1013 126 75 INDEX Page. Adoption of Children (Regulation') Act, 1939 16 Ambulance Facilities 9 Ante-Natal Clinics 10,12 Anti-toxin, Supply of 35 Births 3,12 Birth Control and Gynaecological Cases 14 Blindness, Prevention of 11 Care of Expectant Mothers 12 Care of Mothers during Confinement 13 Care of Mothers Subsequent to Confinement 14 Cerebro-Spinal Fever 39 Child Guidance Clinic 10 Child Life Protection 16 Cleanliness, promotion of 15 Common Lodging Houses 29 Convalescent Treatment 15 Day Nursery Service 17,18 D.D.T. Treatment 25,26,27 Deaths 3,4,5 Dental Clinics 10 Dental Treatment 14,15 Diphtheria 35,37 Diphtheria Immunization 35,36 Diphtheria Immunization Clinics 10 Disinfestation and Disinfection 25,26,27,28 Drainage and Sewerage 20 Dysentery 37,38 Enteric Fever 36,37 Factories Act, 1937 29 Food, Inspection and Supervision of 30,31 Food Poisoning 41 Food and Drugs Act, 1938 32,33,34 Foster Children 16 Gas and Air Analgesia 13 Hairdressers' and Barbers' Premises 29 Health Education 11 Health Visiting 14 Home Help Service 13 Hospitals 11 Hostel Accommodation 14 Housing Statistics 23,24,25 Infantile Mortality 6 Infant Welfare Clinics 10,15 Infectious Diseases 35-44 Insulin, Provision of 11 - 45 - INDEX (CONTINUED) Page, Laboratory Work 9 Legal Proceedings 25 Malaria 37 Massage or Special Treatment, Establishments for 29 Maternal Mortality 5 Measles 39 Middlesex County Council .Act, 1944 31 Midwifery and Maternity Services 12 Midwives Acts 12 Milk and Other Foods, Provision of 16 Milk Supply 30 Mortuary 11 Nursing Associations 9 Nursing Homes 17 Ophthalmic Clinics 10 Ophthalmic Treatment of Children Under 5 15 Ophthalmia Neonatorum 39 Orthopaedic Clinic 10 Orthopaedic Treatment 17 Petroleum Acts 29 Pneumonia 37 Poliomyelitis 38,39 Polio-encephalitis 38,39 Population 3 Post Graduate Education 14 Post Natal Care 13 premature Babies, Care of 16 Public Cleansing 20 Puerperal Pyrexia 13,39 Rent and Mortgage Interest Restrictions Acts 29 Rodent Control 28 Sanitary Inspection of District 21,22,23 Scabies 25 Scarlet Fever 36,37 School Clinics 10 Schools 29 Sex Mortality 3 Shops Acts (1934) 29 Slaughtering Animals 31 Slaughter-houses 31 Smallpox 37 Smoke Abatement 25 Statistics, General and Vital 2-8 Still Births 3 Swimming Baths and Pools 25 Tuberculosis 40,41 Typhoid Immunization 36 Unsound Food 31 Water Supply 19 Whooping Cough 39 Zymotic Diseases Mortality 4