AC 439(1) TWlCKNHAm The HEALTH of TWICKENHAM The Annual Report of the Medical Officer of Health with statistical tables for 1948. JOHN MADDISON, M.D., B.S., D.P.H. INDEX Page Adoption of Children (Regulation) Act, 1939 21 Ambulance Facilities 13 Ante.Natal Clinics 14, 17 Anti.toxin, Supply of 39 Births 7, 17 Birth Control and Gynaecological Cases 18 Care of Expectant Mothers 17 Care of Mothers during Confinement 18 Care of Mothers subsequent to Confinement 19 Cerebro.Spinal Fever 41 Child Guidance Clinic 14, 22 Child Life Protection 21 Cleanliness, Promotion of 20 Common Lodging Houses 30 Complaints received during the Year 25 Convalescent Treatment 20 Day Nursery Service 22 D.D.T. Treatment 32 Deaths 8,9,10,11,12 Dental Clinics 14 Dental Treatment 19 Diphtheria 39, 40 Diphtheria Immunisation 39 Diphtheria Immunisation Clinics 14 Disinfestation and Disinfection 30,31,32,33 Drainage and Sewerage 24 Dysentery 40, 41 Enteric Fever 40 Factories Act, 1937 38 Food, Inspection and Supervision of 33, 34, 35, 36, 37 Food Poisoning 43 Food and Drugs Act, 1938 34, 35, 37 Foster Children 21 Gas and Air Analgesia 18 Hairdressers' and Barbers' Premises 39 Health Education 15, 16 Health Visiting 19 Home Help Service 18 Hospitals 15 Hostel Accommodation 18 Houses Let in Lodgings 30 Housing Statistics 28, 29, 33 Infantile Mortality 10, 11 Infant Welfare Clinics 14, 20 Infectious Diseases 39.46 Insulin, Provision of 15 Laboratory Work 13 Legal Proceedings 30 2 INDEX . continued Page Malaria 41 Massage or Special Treatment, Establishments for 38 Maternal Mortality 9 Measles 41 Middlesex County Council Act, 1944 39 Midwifery and Maternity Services 16 Mid wives Acts 17 Milk and Other Foods, Provision of 20 Milk Supply 33 Mortuary 15 Nursing Associations 13 Nursing Homes 21 Ophthalmia Neonatorum 41 Ophthalmic Clinics 14 Ophthalmic Treatment of Children under Five 20 Orthopedic Clinic 14 Orthopedic Treatment 21 Petroleum Acts 38 Pneumonia 40 Poliomyelitis 41 Polio.encephalitis 41 Population 7 Post.Natal Care 18 Premature Babies, Care of 21 Public Cleansing 24 Puerperal Pyrexia 41 Rent and Mortgage Interest Restrictions Acts 38 Rodent Control 30, 31 Sanitary Improvements Effected 27, 28 Scabies 33 Scarlet Fever 40 School Clinics 14 Schools 38 Sex Mortality 8 Shops Acts (1934) 38 Slaughtering of Animals 35, 36 Slaughter.houses 35, 36 Smallpox 40 Smoke Abatement 38 Statistics, General and Vital 6.12 Still Births 7 Summary of Visits, Inspections, etc 25, 26, 27 Swimming Baths and Pools 38 Tuberculosis 42, 43 Unsound Food 36 Water Supply 23 Whooping Cough 41, 42 Zymotic Diseases Mortality 8 3 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 my Annual Report and statistical tables on the health and sanitary conditions of the borough for the year ending December 31st, 1948. The vital statistics for 1948 were by far the best ever recorded. The general death rate was 10.04 per thousand of the estimated resident population, which is a lower rate than in any of the war years. The infant death rate, which is a sensitive index of the state of the public health, was 20.69 infant deaths per thousand live births ; the previous best in Twickenham was 26.09 in 1946 ; for England and Wales the best was 34.00 in 1948. The still.birth rate per thousand total births was 11.68, which indicates a high standard in the health of expectant mothers, compared with the previous lowest, 16.48 in 1947. The inspections of children in schools revealed comparatively few defects amongst the children, who are well fed and in good health. There was no serious outbreak of infectious disease. Considering the difficulties of rationing and catering, the health of the people of the borough is, generally speaking, remarkably good. Nevertheless, it has been found that amongst the women population there are signs of fatigue. In the middle of a year which furnished such abundant evidence of the Borough Council's success as a health authority, it ceased to be a health authority. The personal health services.midwifery, maternity and child welfare, health visiting, supervision of foster children, home helps, immunisation and day nurseries.were severed from the environmental and sanitary services; the buildings which housed the personal health services, the equipment and staff, were all transferred to the County Council. As a health authority, the Borough Council is now back where it was in the nineteenth century.a sanitary authority responsible for house repairs, nuisances, food inspection, destruction of rats and mice, and control of infectious diseases. The Council's share in the administration of the South Middlesex Isolation Hospital passed to the North.West Metropolitan Regional Hospital Board. These changes were not sought by the Borough Council, which can take pride in the outstanding quality of its personal health services prior to the transfer. The changes came about by reason of the National Health Service Act, which transferred the personal health services of municipal boroughs to county councils. The County of Middlesex was divided into ten areas for public health purposes. Twickenham was combined with Feltham, Staines and Sunbury in Area 10, and is administered by an Area Health Committee, which is a sub.committee of the Health Committee of the County Council. It was hoped that the delegated functions given to area committees would be 4 real and effective ones ; in practice almost every decision is subject to the over.riding decisions of other County Council committees, which causes great delay in the settlement of outstanding items. Thus the local interest and initiative have not had the same stimulus as in the past. 1 have felt the sense of frustration inevitable through being absorbed into a vast administrative machine, and I have missed the flexibility of action which hitherto I always enjoyed under an understanding and sympathetic Borough Council. The population of Area 10 is 211,450, far larger than many a provincial county borough. It is probable that greater progress could be made and more efficient administration carried out in the health services if the area were to become a county borough. Under the new arrangement it is sometimes a problem to remember which things belong to the Borough Council and which to the County Council. As Medical Officer of Health of Twickenham I deal with the same families, the same personal and environmental influences as I used to deal with before the transfer, the responsibility being shared between the Area Committee and the Borough Council ; in Sunbury, Staines and Feltham districts I deal with the personal health services through the Area Committee, but not the environmental, which are dealt with by the medical officers of health of three separate district councils; for the school health service I serve two different divisional executives; and for some services, such as the supervision of nursing homes, I am assistant county medical officer. The remainder of this report deals with the separate services in more detail. For over twelve months following the transfer to the County Council, the staff of the Twickenham Public Health Department carried most of the burden for the work of the enlarged area and worked very hard indeed. I would specially like to mention Mr. H. J. Pugh, on whom the administrative load fell with extreme severity. I beg to acknowledge my indebtedness to the Chairman and members of the Public Health Committee and the former Maternity and Child Welfare Committee for their helpfulness and support, which were always of the greatest encouragement. I desire also to acknowledge with thanks the 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 oj Health. STATISTICAL SUMMARY for the Year 1948 Area in acres 7,007 Population (as extended.census 1931) 79,376 Resident population.estimated to mid'year (as supplied by the Registrar'General) 106,700 Number of inhabited houses 29,576 Rateable value £1,048,274 Sum represented by a penny rate £4,190 5s. 4d. Total M. F. Live Births: Legitimate 1,598 790 808 Illegitimate 94 45 49 Total 1,692 835 857 Birth rate per 1,000 of estimated resident population 15.86 Total M. F. Still Births: Legitimate 19 10 9 Illegitimate 1 1 . Total 20 11 9 Still birth rate per 1,000 total (live and still) births 11.68 M. F. Deaths : 538 533 1,071 Death rate per 1,000 of estimated resident population 10.04 Maternal deaths : Puerperal and postabortive sepsis, 1 1 Other maternal causes, nil Rate per 1,000 total (live and still) births 0.58 Death rate of infants under one year of age. All infants per 1,000 live births 20.69 Legitimate infants per 1,000 legitimate live births 18.77 Illegitimate infants per 1,000 illegitimate live births 53.19 Deaths from: Cancer (all ages) 219 Measles (all ages) 1 Whooping cough (all ages) Diarrhoea (under 2 years of age) 4 6 STATISTICS, SOCIAL CONDITIONS AND GENERAL PROVISION OF HEALTH SERVICES FOR AREA Population. The Registrar.General's estimate of population for the mid.year 1948 was 106,700, and this has been adopted for the calculation of the statistics in this report. The following table shows the changes that have taken place in the numbers of the population since 1937:. Year Population Population trend Migration excess Total increase or decrease Percentage proportion Natural increase or decrease Inward Outward 1937 94,230 + 4,090 + 4.34% + 376 3,714 - 1938 96,550 + 2,320 + 2.46% + 363 1,957 - 1939 97,440 + 890 + 0.92% + 383 507 - 1940 94,070 - 3,370 . 3.46% . 15 - 3,355 1941 91,820 -2,250 . 2.39% + 38 - 2,288 1942 92,460 + 640 + 0.70% +450 190 - 1943 92,780 + 320 + 0.35% + 502 - 182 1944 88,660 -4,120 . 4.44% + 507 - 4,627 1945 91,920 + 3,260 + 3.68% + 424 2,836 - 1946 102,850 + 10,930 + 11.89% + 835 10,095 - 1947 105,930 + 3,080 + 2.99% + 918 2,162 - 1948 106,700 + 770 + 0.73% +621 149 - Births. The live births registered in the borough in 1948 numbered 1,692, giving a birth rate of 15.86 per 1,000 of the population (England and Wales 17.9). The births were made up as follows :- Males Females Total Legitimate 790 808 1,598 Illegitimate 45 49 94 Total 835 857 1,692 The number of births represents a decrease of 397 compared with the previous year. Illegitimate births formed 5.55 per cent. of the total live births, the same as in 1947. Still Births. There were 20 still births registered during the year, giving a still birth rate of 11.68 per 1,000 total (live and still) births. 7 Deaths. The net deaths registered in the borough during 1948 were: Males, 538; females, 533; total, 1,071. This represents a decrease of 100 compared with the previous year. The death rate per 1,000 of the population was 10.04, as compared with 10.8 for England and Wales. The natural increase of population (that is, excess of birth over deaths) was 621, as compared with 918 for 1947. Sex Mortality. The sex mortality rate was : Males, 5.04 per 1,000 ; females, 5.00 per 1,000. Zymotic 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 Enteric Fever - - - - Smallpox .- - - - Scarlet Fever - - - Diphtheria - - - - Measles 1 - 1 •009 Whooping Cough . - - - Diarrhoea 1 3 4 •037 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 of the population Diseases of heart and circulatory system 33.8 3.39 Intra.cranial vascular lesions 10.36 1.04 Bronchitis, Pneumonia, and other respiratory diseases 11.2 1.12 Cancel 20.45 2.05 Violence 2.24 0.22 Tuberculosis 4.3 0.43 8 Causes of Death, 1948- Registrar-General's Official Returns- Causes of Death Males Females Total All causes 538 533 1,071 1. Typhoid and paratyphoid fevers - - - 2. Cerebro spinal fever - - - 3. Scarlet fever - - - 4. Whooping cough - - - 5. Diphtheria - - - 6. Tuberculosis of respiratory system 25 16 41 7. Other forms of tuberculosis 2 3 5 8. Syphilitic diseases 6 3 9 9. Influenza 4 2 6 10. Measles 1 1 11. Acute polio-myelitis and polio-encephalitis 2 1 3 12. Acute infective encephalitis - 1 1 13. Cancer of buccal cavity and oesophagus (M),uterus(F) 7 13 20 14. Cancer of stomach and duodenum 18 17 35 15. Cancer of breast 1 20 21 16. Cancer of all other sites 89 54 143 17. Diabetes 2 4 6 18. Intra-cranial vascular lesions 50 61 111 19. Heart disease 159 159 318 20. Other diseases of circulatory system 22 22 44 21. Bronchitis 37 17 54 22. Pneumonia 21 27 48 23. Other respiratory diseases 7 11 18 24. Ulcer of stomach or duodenum 3 4 7 25. Diarrhoea under 2 years 1 3 4 26. Appendicitis - - - 27. Other digestive diseases 10 11 21 28. Nephritis 7 15 22 29. Puerperal and post-abortive sepsis - 1 1 30. Other maternal causes - - - 31. Premature birth 2 5 7 32. Congenital malformations, birth injury, infantile disease 11 6 17 33- Suicide 2 4 6 34. Road traffic accidents 5 2 7 35. Other violent causes 6 5 11 36. All other causes 38 46 84 Maternal Mortality- One' death was registered as being due to diseases or accidents of child birth as compared with five for the previous year- The cause of death was as follows :- Septicaemia due to incomplete abortion- Natural causes- P-M- 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 0-58- That for England and Wales was 1-02- 9 Infantile Mortality- There were 35 deaths of infants under one year during the year, giving an infantile mortality rate of 20-69 per 1,000 live births- This shows a considerable decrease on the figure of 40-21 for 1947- The rate for England and Wales in 1948 was 34-00- The following table, compiled from official registrations, gives details of the causes of death at various ages under one year of age:- Under 1 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 under 1 year All Causes :-Certified 18 3 2 - 23 5 2 2 3 35 Uncertified - - - - - - - - - - Smallpox - - - - - - - - - - Chicken-pox - - - - - - - - - - Measles - - - - - - - - - - Scarlet Fever - - - - - - - - - - Diphtheria and Croup - - - - - - - - - - Whooping Cough - - - - - - - - - - Influenza - - - - - - - - - - Enteritis - - - - - 1 - 1 - 2 Tuberculous Meningitis - - - - - - 1 - - 1 Abdominal Tuberculosis - - - - - - - - - - Other Tuberculous Diseases - - - - - - - - 1 1 Congenital Malformations 1 1 1 - 3 1 1 - - 5 Premature Birth 6 1 - - 7 - - - - 7 Atrophy, Debility and Marasmus - - - - - - - - - - Atelectasis 3 - - - 3 - - - - 3 Injury at Birth - - - - - - - - - - Erysipelas - - - - - - - - - - Syphilis - - - - - - - - - - Rickets - - - - - - - - - - Meningitis (not Tuberculous) - - 1 - 1 - - - - 1 Convulsions - - - - - - - - - - Gastritis - - - - - - - - - - Laryngitis - - - - - - - - - - Bronchitis - 1 - - 1 - - - - 1 Pneumonia (all forms) - - - - - 2 - - - 2 Suffocation (overlying) - - - - - - - - - - Other causes 8 - - - 8 1 - 1 2 12 Totals 18 3 2 - 23 5 2 2 3 35 An analysis of the mortality reveals that neo'natal deaths were responsible for 65-71 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 7 10 6 23 65.71 10 Congenital malformations, premature births, etc., caused 18 (or 51.43 per cent.) of the total infant deaths. Deaths of Illegitimate Infants. The death rate of illegitimate infants during 1948 was 53.19 per 1,000, compared with 68.97 for the previous year. The corresponding death rate of legitimate children was 18.77 (38.52 for 1947). Review of the Comparative Vital and Mortality Statistics for the Borough of Twickenham, together with those for England and Wales for years 1937.1948 inclusive. Year Birth Rate Death Rate Infantile Mortality Rate Twickenham England and Wales Twickenham England and Wales Twickenham England and Wales 1937 14.9 14.9 (а) 11.08 (б) 10.96 12.4 35.4 58 1938 14.4 151 (a) 9.91 (b) 9.81 11.6 45.8 53 1939 14.2 15.0 (а) 10.46 (б) 10.35 12.1 26.4 50 1940 14.67 14.6 (a) 14.8 (ib) 14.9 14.3 45.8 55 1941 13.4 14.2 13.0 12.9 70.95 59 1942 16.49 15.8 11.6 11.6 53.1 49 1943 17.7 16.5 12.3 12.1 47.99 49 1944 18.5 17.6 12.8 11.6 37.1 46 1945 16.76 16.1 12.15 11.4 48.02 46 1946 19.01 19.1 10.89 11.5 26.09 43 1947 19.72 20.5 11.05 12.0 40.21 41 1948 15.86 17.9 10.04 10.8 20.69 34 (a) Crude (b) Adjusted 11 12 Birth Rate, Death Rate and Analysis of Mortality during 1948. 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 Paratyphoid fevers Whooping Cough Diphtheria Tuber culosis Influenza Smallpox Acute Poliomyelitis and Polioencephalitis Pneumonia Diarrhoea and Enteritis {under two years) Total Deaths under 1 year England and Wales 17.9 0.42 10.8 0.00 0.02 0.00 0.51 0.03 - 0.01 0.41 3.3 34 126 County Boroughs and great towns, including London 20.0 0.52 11.6 0.00 0.02 0.00 0.59 0.03 - 0.01 0.38 4.5 39 148 smaller towns, resident populations 25,000 to 50,000 at 1931 census 19.2 0.43 10 '7 0.00 0.02 0.00 0.46 0.04 - 0.01 0.36 2.1 32 London Admin. County 20.1 0.39 11.6 0.00 0.01 0.01 0.63 0.02 - 0.00 0.54 2.4 31 Twickenham 15.86 0.19 10.04 - - - 0.43 0.06 - 0.03 0.45 2.4 20.69 A dash (. ) signifies that there were no deaths GENERAL. 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 209 Nil positive Sputum, etc., for tubercle bacilli 57 17 „ Miscellaneous 157 12 „ Total specimens examined 423 - Ambulance Facilities. On the 5th July, 1948, the County Council became the responsible authority for the provision of the Ambulance Service under the National Health Service Act, 1946. Non.infectious and Accident Cases. The following table shows the work done by the Corporation's Ambulance Service prior to the transfer, i.e., 1/1/48 to 4/7/48:- Total number of calls 1,405 Accidents 334 Removal after accident 62 Ordinary removals 959 School emergency 22 Clinic emergency 13 False calls 1 Other calls 14 Total mileage 12,856 Continuous Oxygen Service. Total number of calls 93 Number of patients treated 41 Mileage 351 Nursing in the Home. The work done by the five nursing associations in the borough was taken over by the County Council on the 5th July, 1948, under the National Health Service Act. 13 14 Clinics and Welfare Centres. The following clinics were being held within the borough at the end of the year:- Clinic Address By whom provided Infant Welfare Centres York House, Twickenham; Hospital Bridge Road, Twickenham; Art School, Teddington; Station Road, Hampton; 20, Seymour Road, Hampton Wick. Twickenham Council up to and including 4th July, 1948. Middlesex County Council since 5th July, 1948. Ante.Natal Clinics York House, Twickenham; Hospital Bridge Road, Twickenham; Art School, Teddington; Station Road, Hampton; 20, Seymour Road, Hampton Wick. Twickenham Council up to and including 4th July, 1948. Middlesex County Council since 5th July, 1948. School Clinics York House, Twickenham; Hospital Bridge Road, Twickenham; Stanley Road, Teddington; Station Road, Hampton; 20, Seymour Road, Hampton Wick. Middlesex 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 and Middlesex County Council up to and including 4th July, 1948. Middlesex County Council since 5th July, 1948. Middlesex County Council. Ophthalmic Clinics York House, Twickenham; Stanley Road, Teddington. Middlesex County Council. Diphtheria Immunisation York House, Twickenham; Hospital Bridge Road, Twickenham; Stanley Road, Teddington; Station Road, Hampton; 20, Seymour Road, Hampton Wick. Twickenham Council up to and including 4th July, 1948. Middlesex County Council since 5th July, 1948. Child Guidance Clinic 58 Hampton Road, Twickenham. Middlesex County Council. Orthopaedic Clinic Art School, Teddington. Middlesex County Council. Hospitals. On the 5th July, 1948, the hospitals in the borough passed to the control of the North.West Metropolitan Regional Hospital Board. Mortuary. During the year 74 bodies were admitted to the mortuary. In all cases post.mortem examinations were held. Provision of Insulin. The Corporation provided insulin for certain classes of persons suffering from diabetes, twelve cases being on the register of the department on the 4th July, 1948. Thereafter the patients were able to obtain a prescription from their own doctors for a free supply under the National Health Service. Health Education. Up to the 5th July, 1948, every use was made of various health education methods, including propaganda by posters and leaflets, lectures illustrated by films or lantern slides and demonstrations. Copies of "Better Health" and the " Health Education Journal " were also circulated. The Corporation still have power under Section 179 of the Public Health Act, 1936, to continue health education work-and there is tremendous scope for this in food hygiene campaigns and other fields-but the major share will be carried out by the County Council. Film Shows in Clinics. Considerable thought was given as to the best method of introducing health education films to the mothers attending the clinics. An experiment was carried out on the following lines. The films "Your Children and You," and "Round Figures," were sorrowed from the Central Council for Health Education for a period of five weeks. Arrangements were made for the showing of the films for a complete week at each centre, at 3 p.m. or 3.30 p.m. on clinic afternoons. 15 The programme was as follows:- No. of showings. Approximate attendance. 1. Art School 3 46 2. Hampton 3 62 3. York House 3 + 1 51 + 30 students. 4. Whitton 4 60 5, Hampton Wick 2 31 An extra session was also given at York House to day nursery students, at the request of the head of the women's department of the Acton Technical College. The experiment has been very useful. It has enabled us to study the reactions of the audiences under varying clinic conditions, to appreciate how long a film should run without tiring the mothers, and to develop our cinematograph technique. "Your Children and You" and "Round Figures" were equally good films, but together the running time was about 35 minutes. After showings at the Art School and Hampton it was decided that, although the films were well received, "Round Figures" should be cut from the programme in order to reduce the show to 25 minutes. This is about right. Otherwise the infants and toddlers present with their mothers become fidgety and attention is lost. Not all the centres lend themselves to film shows. The Art School and Hampton centres are the most suitable and a full.size 52in. by 40in. picture can be projected on the screen. The best "atmosphere" was at Hampton, where the room is a convenient size and a small cinema effect is obtained. A certain amount of traffic while the show is on is unavoidable at York House and Whitton. At Hampton Wick it is not possible to show the full' size picture, but the smaller one proved quite satisfactory. The projector, resistance, screen, stand and apparatus required is bulky and heavy equipment, and influenced the decision to show the film for a whole week at each centre. It is, of course, difficult accurately to assess the measure of our achievement in this experiment. In its initial stages the attenance figures are no reliable guide, but there is no doubt some of the lessons to be learned from the film have been taken home by the mothers and will prove of benefit. MATERNITY AND CHILD WELFARE. The whole of the work in this section covers the period 1st January to 4th July, 1948, only when the Maternity and Child Welfare services were transferred to the County Council under the National Health Service Act. Midwifery and Maternity Services. The total number of births notified as occurring in the borough during the period under review was 703. This does not include births which occurred elsewhere but which were subsequently transferred to Twickenham. Of the births occurring in the borough during the above period, 477 were attended by midwives in their capacity as midwives and 226 by doctors. Municipal midwives attended 195.149 in their capacity as midwives and 46 as maternity nurses with doctors in charge. 16 Notified Births. Confinement dealt with by Acting as Midwives Acting as Maternity Nurses with Doctor in attendance Municipal Midwives 149 46 Non.Municipal Midwives - 3 Bearsted Memorial Hospital 312 29 Nursing Homes 16 148 Totals ... 477 226 Midwifery Acts. The total number of midwives employed at the 4th July, 1948, was nine. 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. Attendance Total Year. for first time. attendances. 1948 (to 4/7/48) 532 2,770 1947 1,108 5,981 1946 1,337 6,661 1945 1,054 4,801 1944 944 4,393 1943 1,056 5,094 1942 1,038 4,842 1941 770 3,375 1940 750 2,998 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 at Hounslow Chest Clinic continued to prove satisfactory. The total number who were X.rayed during the period 1st January, 1948, to 4th July, 1948, was 158, and of these 8 were found to be in need of further observation and/or treatment. The fee payable by the Council is £1 1s. Od. per patient. 17 Care of Mothers during Confinement. The Corporation had no maternity home and had 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. On the 4th July, 1948, there were 10 full.time and 20 part.time home helps on the staff. Gas and Air Analgesia. All the Corporation municipal midwives were qualified to administer gas and air analgesia. Analgesia was administered to 98 patients during the period. The three midwives who had cars carried the apparatus with them. Two other machines were kept at the Hollies Ambulance Depot for use by the remaining midwives. Post.natal Care. Post.natal care was carried out at the ante.natal clinics and mothers urged to attend. The numbers were as follows:- 1/1/48.4/7/48 240 1947 374 1943 263 1946 206 1942 255 1945 172 1941 297 1944 180 1940 71 One maternal death occurred during the period 1st January, 1948, to 4th July, 1948. Birth Control and Gynaecological Cases. No birth control clinic was held in the borough, but arrangements existed with the birth control clinics at Richmond and Hounslow for mothers on medical recommendation to receive advice on "family spacing" and gynaecological complaints. In neccessitous cases the Corporation undertook responsibility for payment for consultations and applicances. Hostel Accommodation. During the period under review 3 patients were admitted to 16, The Park, Golders Green, for their confinements, and 5 to the post.natal home at Hendon. The cost of these arrangements was borne by the Corporation, the contribution payable by the patient being assessed according to the Council's scale of assistance. 18 Dental Service- The following table shows the excellent work carried out:- Period January to 4th July, 1948 Expectant Mothers Nursing Mothers Young children referred from Infant Welfare Centres Examined by Dental Officer 203 48 100 Referred for treatment 198 45 54 TREATMENT No- of New cases commenced treatment 153 40 48 Teeth extracted 381 355 207 Teeth filled 304 158 182 Teeth treated with silver nitrate --- - 147 Teeth-other operations 179 82 65 Scalings 72 14 - Local anaesthetics 113 109 7 General anaesthetics --- 340 238 200 Patients X-rayed (a) at County Council Clinics --- 5 2 - (b) at Hospital - - - DENTURES *Dressing 138 192 - Supplied 35 70 - Number of attendances 816 622 377 Number of appointments not kept 139 90 41 Number of patients X-rayed (a) at County Council Clinics - - - (b) at Hospital - - - * includes " impressions," " bites," " try-in " and " easing-" Health Visitors. The approved establishment of Health Visitors was 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. 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- 19 Promotion of Cleanliness, etc. The scheme for head and cleanliness inspections in the schools worked satisfactorily. Literature on this subject was distributed at the infant welfare centres and the Health Visitors continued to give advice to parents on the subject of cleanliness and good hygiene. Infant Welfare Clinics. Attendances. 1.1.48 to 4.7.48 Twickenham Whitton Tedding. ton Hampton Hampton Wick Totals First attendance, under 1 year 201 225 145 121 87 779 First attendance, 1 to 5 years 47 81 38 29 12 207 Total attendances, under 1 year 2,880 3,155 2,123 1,785 1,400 11,343 Total attendances, 1 to 5 years 1,265 2,159 1,104 913 518 5,959 Totals 4,393 5,620 3,410 2,848 2,017 18,288 Convalescent Treatment. Where necessary, convalescent treatment for children under five was provided by the Corporation. Ophthalmic Treatment of Children under Five Years. The numbers of children under five years of age examined by the ophthalmic surgeon were:- First attendance 51 Total attendance 94 No charge was made for dental and ophthalmic treatment for children under five. Milk and other Foods, etc. During the period 17 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 £11 l1s. 10d. 20 Child Life Protection. All the Health Visitors were appointed Child Life Protection Visitors, and each visitor was responsible for carrying out the supervision of the foster homes in her own district. Details of authorisation during the period under review were:- Individual Foster-mothers Residential Nurseries, etc., run for profit Total Number of persons who were receiving children under nine for reward, apart from their parents, at the 4th July, 1948 24 2 26 Number of children on register at the 4th July, 1948 29 13 39 Number of children who died during the period - - - Proceedings taken during the period - - - Care of Premature Babies. Two special cots for the care of premature babies were kept at the Hollies Ambulance Depot and were available in an emergency day or night. Five 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. 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. On the 5th July, 1948, the powers of the Corporation under the Public Health Act, 1936, for the registration of nursing homes reverted to the County Council. There were fifteen registered private nursing homes in the borough. All the homes were kept under periodic supervision during the period under review. 21 Day Nursery Service. The five day nurseries in the borough, accommodating 245 children, were used to capacity. The following table shows the attendances during the period:- Nursery Number of Places Actual Attendances Average Daily A ttendances 0-2 2-5 Total 0-2 2-5 Total 0-2 2-5 51, Hampton Road, Teddington 16 24 40 1,684 3,217 4,901 13.05 24.94 40, Cambridge Pk., Twickenham 25 30 55 1,431 4,822 6,253 11.09 37.38 Station Road, Hampton Wick 25 25 50 2,162 3,619 5,781 16.76 28.05 Oldfield Road, Hampton 25 25 50 765 3,586 4,351 5.93 27.80 Gifford Lodge, Twickenham 25 25 50 1,779 3,404 5,183 13.79 26.39 Totals 116 129 245 7,821 18,648 26,469 60.63 144.56 Attendance of Psychiatric Social Worker at the Infant Welfare Clinic. For an experimental period arrangements were made for a psychiatric social worker from the Child Guidance Clinic to attend the Infant Welfare Clinic at York House, on Monday afternoons, commencing on the 26th April, 1948. The object of this arrangement was to try the effect of close co.operation between a psychiatric social worker and the Health Visitors at the Infant Welfare Centre. It was believed that it would be possible to prevent many psychological problems in young children from arising at all if psychiatric guidance were available in the earliest stages of the difficulty. It was felt that mothers would respond more readily if the approach were made in the homely atmosphere of a welfare clinic in the first instance, rather than that the first approach should take place at the Child Guidance Clinic. This is not to say that the atmosphere is different in the two clinics, but that, as the Child Guidance Clinic is still comparatively young compared with the welfare centre, mothers have not yet quite got used to the idea of using the Child Guidance Clinic to the same extent as the welfare centre. The arrangements proved most satisfactory, 22 SANITARY ADMINISTRATION. Water Supply. I am indebted to Lt..Col. E. F. W. Mackenzie; Director of Water Examination, Metropolitan Water Board, for the following report upon the supply for the borough :. The water supply to the Twickenham area is abstracted from the River Thames at Laleham and Walton, 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, and adequate contact to ensure complete action by the chlorine has been provided at Hampton by the building of a contact tank, which first came into operation in July, 1948. Since the 19th October, 1948, the filtered water has been treated by the methods of superchlorination in place of the ammonia.chlorine process. Free chlorine is a much more powerful disinfectant than chloramine, and there is, in addition, a considerable saving in cost of chemicals, such as ammonia. Treatment is controlled by hourly testing of the final water on the works and samples of the water are collected at all stages of purification at least five times each week and analysed at the laboratories of the Metropolitan Water Board. All new and repaired mains are disinfected with chlorine before being restored to supply, and samples of water from them are tested bacteriologically. None of the supplies is plumbo.solvent. Number of houses supplied by the Board:- (a) Direct 29,563 (106,671 persons) (b) By means of standpipes 13 (29 persons) Reports of the Chemical and Bacteriological Examination of the Water supplied to the Borough of Twickenham, January.December, 1948. Chemical A mmoniacal Nitrogen A Ibuminoid Nitrogen Oxidised Nitrogen Chlorides as CI. Oxygen abs. from permanganate 3 hours at 80°F. Turbidity in terms of silica Colour m.m. brown 2ft. tube Burgess's Tintometer Hardness (total) Hardness (permanent) p.H. Value Conductivity Nitrite Nitrate 0.097 0.080 - 3.8 27.5 0.96 0.5 16 248 71 7.7 475 23 Bacteriological No. of samples Colony Count on Agar at 37°C. Bad. coll. test Percentage of samples negative per 100 ml. Bact. coli. per 100 ml. 1,065 4.7 100.0 Nil Drainage and Sewerage. The embargo placed by the various Ministries against the execution of any major improvements to sewers has, for another year, prevented the carry ing out of the much.needed improvements in the East and Central Twickenham areas. Surcharging of both soil and surface water systems is, therefore, likely to recur under unfavourable conditions at any time. Ordinary repairs of a routine nature, flushing, and the necessary regular inspections have again comprised the only work possible under these circumstances. Towards the end of the year the Kingston Corporation were allowed, under arrangements made with the Middlesex County Council, to lay a sewer pumping main across the River at Hampton and along the Lower Teddington Road, to discharge the whole of their sewage into the County Council's Mogden sewer near the Teddington Destructor site. This was rendered necessary by the erection of the new electricity generating station on the site of the Kingston Sewage Works. This pumping main delivers approximately an average extra daily flow of some three million gallons of sewage through the Mogden sewer running through Twickenham, and will operate until the suggested new joint sewage disposal scheme for Kingston, Surbiton, Maiden, and probably Epsom, becomes an accomplished fact. Special measures have been necessary to avoid smell along the route of this main. Public Cleansing. (a) Streets. It has been possible to maintain the improved standard of scavenging during the past year, although this standard has not yet reached that of the pre.war years. (b) Refuse Collection and Salvage. A tender has been accepted for eight new modern refuse collection vehicles, and its acceptance has been approved by the Ministry of Health, after considerable investigation and comparative tests with other types of vehicles. Seven of the new petrol.driven lorries, all with aluminium bodies and a refuse compression device, known as the "PAXIT" vehicle and manufactured by Dennis Bros., of Guildford, will be, it is hoped, in service by the middle of 1949, and four further lorries of the same type within an additional year. The twelfth vehicle is specially constructed to collect from back and narrow streets. The Committee, in their choice of vehicle, have been influenced by the progress made on the scheme for the new destructor and salvage plant proposed at Sunbury, referred to below. The weekly collection of refuse has continued, but it cannot be contended that the present system of collection by skips in the immediate vicinity of kitchens and larders is in accord with modern ideas of hygiene, or consistent with the standing and prestige of a progressive borough. The weekly collection of salvage has also been maintained, with generally satisfactory results. 24 Refuse Disposal. The three old destructors have all been kept fully in service during 1948, but, owing to their limitations, recourse has been had to a still greater degree to tipping. It has been gratifying to receive approval in principle to the new destructor scheme proposed at Sunbury and this has now so far progressed in preparation that it is hoped to have it erected, for the joint use of Twickenham, Sunbury and Staines, by the end of 1950. The estimated costs of £120,000 may, however, by the time the buildings and plant are put into use, be considerably exceeded. The design and working arrangements for salvage recovery and refuse disposal have been extended and improved, and, when erected, the project should be one of the most modern, hygienic and advanced plants in the country. A reorganisation in salvage arrangements during the past year has resulted in a reduction of costs and an increase in revenue, which latter figure now is at an approximate rate per annum of £14,000. Complaints Received during the Year. There were 2,772 complaints received, and these were investigated in accordance with the following analysis:- Number Nature of complaint. received. Housing defects 987 Choked and defective drains 147 Accumulations of offensive matter 51 Unsound food 371 Verminous premises:- (a) Bugs 57 (b) Rats and mice 369 (c) Other 102 Keeping of animals 26 Unsatisfactory milk supplies 4 Miscellaneous 658 Total 2,772 Summary of Visits, Inspections, etc. Dwelling.houses for housing defects under Public Health Act:- (a) After complaint 2,125 (b) Subsequent visits 5,135 Dwelling houses under Housing Act:- (a) After complaint 726 (b) Subsequent visits 169 Dwelling.houses:- Housing applications, specially investigated 482 25 Infected dwelling houses:- (a) After notified infectious disease (other than tuberculosis) 154 (b) Special investigations re gastro enteritis and flybome diseases 401 (c) Contacts 39 (d) Fumigations after infectious disease 25 (e) Phthisis enquiries and fumigations 22 School and church halls 326 Swimming baths 2 Water sampling:- (a) Swimming baths 4 (b) Dwelling houses 4 Business premises 13 Cinemas, dance halls, billiards halls 34 Offensive trade premises 15 Stables, piggeries, keeping of animals 87 Houses let in lodgings 9 Factory Act, 1937:- Factories with mechanical power 99 Factories without mechanical power Outworkers' premises Common lodging houses 1 Underground rooms Hairdressing premises Tents, vans and sheds 16 Smoke nuisances 67 Fairgrounds 23 Drainage : Testing by:- (a) Smoke 90 (b) Coloured water 53 (c) Water 27 (d) Breaking down 127 re Public sewers Watercourses and Ditches Land and tips 45 Septic tanks and cesspools 7 Sanitary conveniences-public.houses 15 Miscellaneous visits 574 Visits not inspections 1,898 Verminous premises:- (a) Rats and mice-(i) After complaint or from survey 906 (ii) Subsequent visits 956 (b) Bug infestations: Number of premises 53 (c) Cockroaches 8 (d) Special visits re flyborne infections 622 26 Inspections re supervision of food:— Unfit foodstuffs other than meat 332 Slaughterhouses 11 Butchers' shops (Public Health (Meat) Regulations, 1924) 293 Food and Drugs Act, 1938, Section 13:— Bakehouses 105 Fish shops, grocers and greengrocers 363 Factory canteens 11 Restaurant kitchens, etc. 206 Hotel and beerhouse bars and cellars:— (a) Day inspections 63 (b) Night inspections — Food and Drugs Act, 1938, Section 14:— Ice cream premises (Heat Treatment Regulations, 1947 and 1948) 340 Sausage manufacturers 3 Preserved meat preparation premises 4 Preserved fish preparation premises 18 Milk and Dairies Regulations, 1926-1943:— Milk sampling for bacteriological examination 20 Contraventions of Milk and Dairies Regulations 6 Cowsheds 8 Dairies at farms 6 Pasteurisation plants 2 Milkshops and dairies 29 Shops Act, 1934, Section 10 41 Middlesex County Council Act, 1944:— Hawkers' vehicles 14 Hawkers' premises 7 Noise nuisances 48 Petroleum (Consolidation) Act, 1928, and Regulations, 1929-48 236 Total number of visits and inspections 17,950 Sanitary Improvements Effected. Offensive accumulations removed 41 Nuisance from keeping of animals remedied 5 Chimney flues repaired 33 Chimney stacks repaired 25 Roofs repaired 576 Eavesgutters repaired 219 Downspouts repaired 88 Pointing renewed 185 Drains repaired 42 Drains unstopped 52 27 Dustbins provided 77 Fireplaces repaired 141 Filthy condition of premises remedied 9 Floors repaired 231 Gullies repaired 27 Plaster to walls and ceilings repaired 857 Sashframes and sashcords repaired 205 Public sewers repaired 7 Sinks provided 9 Sink waste pipes repaired 65 Soil pipes repaired 22 Stairs repaired 26 External walls repaired 26 W.C.s repaired 119 W.C. cisterns and fittings provided 162 W.C. accommodation provided 8 Yard paving repaired 40 Other works carried out 593 Housing Statistics. I. Inspection of dwelling-houses during the year. 1. (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 2,851 (b) Number of inspections made for the purpose 8,155 2. (a) 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 3. Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 4 4. Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 1,331 II. Remedy of defects during the 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 1,278 III. Action under statutory powers during the year. A.—Proceedings under sections 9, 10 and 16 of the Housing Acts, 1936:— (1) Number of dwelling-houses in respect of which notices were served requiring repairs Nil 28 (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 113 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 125 (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 3 (2) Number of dwelling-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 1 D.—Proceedings under section 12 of Housing Act, 1936:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made 1 (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 Notices Served. Administrative action was taken during the year to secure abatement of nuisances and to enforce the appropriate statutory enactments, as follows:— Subject of Notice Public Health Act Food & Drugs Act, Sections 13 & 14 Number of Informal Notices served 1,331 133 Number of Informal Notices complied with 1,278 57 Number of Statutory Notices served 113 — Number of Statutory Notices complied with 125 — Number of cautionary letters sent by Town Clerk — 1 29 Legal Proceedings. During the year legal proceedings were taken in five instances with the following results:— (a) 38, Sandycvmbe Road, Twickenham. For non-compliance with the requirements of the Public Health Act, 1936, sections 39 and 94, the summonses were withdrawn, following prior completion of the works, on payment of costs amounting to one guinea. (b) 24, Queens Road, Twickenham. For non-compliance with the requirements of the Public Health Act, 1936, sections 92/4, the summons was withdrawn after adjournment of one month, during which time the works were completed. (c) 56, York Road, Teddmgton. For non-compliance with the requirements of the Public Health Act, 1936, sections 45 and 94, an order for the work to be completed with 28 days was made, a fine of £5 was imposed, and costs awarded to the extent of 5 guineas. (d) 136, Broom Road, Teddington. For non-compliance with the requirements of the Public Health Act, 1936, sections 92/4, proceedings were adjourned for one month, during which time the works were completed and further action withdrawn. (e) 62, Kings Road, Teddington. For non-compliance with the requirements of the Public Health Act, 1936, sections 92/4, the summons was withdrawn, costs being paid by defendant, as the works of repair had previously been completed satisfactorily. Houses Let in Lodgings. There is one common lodging house in the borough. This was kept in a satisfactory condition during the year and the registration was renewed. Destruction of Rats and Mice. Rats and Mice (Destruction) Act, 1919. The 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 1948, 14,605 visits were made to premises within the borough, and, of this total, initial visits following upon complaint or resulting from surveys numbered 7,073, the remaining 7,521 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 467 contracts made and income received amounting to £594 17s. 3d. It was found necessary to serve 243 preliminary notices, 105 statutory notices, and 22 notices of the Corporation's intention to carry out work in default. 30 NUMBER OF INFESTATIONS Food Premises Non-food Premises Private Dwellings Factories Rats only Mice only Rats and mice 36 31 388 12 428 31 8 DEGREE OF INFESTATION RATS MICE Reservoir Major Primary 50-100 Minor Secondary 1-50 Reservoir Major Primary Minor Secondary Nil 4 432 Nil 1 30 RATS AND MICE (DESTRUCTION) ACT, 1919 NOTICES SERVED NOTICES OUTSTANDING Preliminary Notices Statutory Notices Final (Default) Notices Preliminary Notices Statutory Notices Final (Default) Notices 243 105 22 15 13 1 RAT DESTRUCTION WORK UNDERTAKEN BY CORPORATION OCCUPIERS Rats Mice Rats Mice 436 31 139 Nil NUMBER OF PREMISES UNDER CONTRACT WITH CORPORATION TOTAL 467 12 months 6 months 3 months 1 month Others Total Receipts 25 105 195 119 23 £594 17s. 3d. 31 32 D.D.T. TREATMENT, 1948. Number of Infestations Treated Type of Premises Ants Beetles Bugs Cockroaches Fleas Flies Lice Mosquitoes Moths Silver Fish Wasps Wood Beetles Totals Dwelling-Houses 3 1 50 — 4 156 2 — 7 3 48 6 280 Workplaces — — 1 — — — — — — — — — 1 Food Shops — — — — 16 — — — 1 1 — 18 Offices — — — — 1 — — — — — — 1 Day Nurseries — — 1 — — 4 — — — — 3 — 8 Clinics — — — — — 3 — — — — 1 — 4 Miscellaneous — — 1 4 — 11 — — — — — — 16 Totals 3 1 53 4 4 191 2 — 7 4 53 6 328 Total income for D.D.T. treatment, £192 0s. 6d. Corporation premises treated (re-housed families), 3 per cent. 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 268. Disinfection after Disease. Disinfections after infectious diseases 37 Disinfections after other diseases Nil Number of articles disinfected after infectious disease 80 Housing Act, 1936. Overcrowding. The known cases of overcrowding on the register of the department at the end of the year were as follows:— (a) (1) Number of dwellings overcrowded at the end of the year 91 (2) Number of families dwelling therein 125 (3) Number of persons dwelling therein 369 (b) Number of new cases of overcrowding reported during the year 79 (c) (1) Number of cases of overcrowding relieved during the year 133 (2) Number of persons concerned in such cases 912 Inspection and Supervision of Food. Milk Supply. At the close of the year there were registered under the Milk and Dairies Order, 1936:— Persons. Cowkeepers registered as wholesale and retail purveyors of milk Nil Cowkeepers registered as wholesale purveyors of milk 2 Cowkeepers registered as retail purveyors of milk Nil Total number of persons registered for carrying on trade of cowkeeper 2 Retail purveyors of milk in sealed bottles only 12 Total number of persons registered as retail purveyors of milk 12 Total number of cowkeepers, wholesale and retail purveyors of milk 14 33 Premises. Number of cowsheds 2 Farms used as dairies 2 Other premises used as dairies 4 Other premises used as milkshops 19 The bulk of the milk supply of the borough continues to come from outside the area and has been pasteurised or heat-treated before delivery. Seventy'one visits were paid to dairies, milkshops and cowsheds. Milk Sampling. Sixteen informal samples of milk were taken during the year for bacteriological examination or for the purpose of ascertaining whether pasteurisation had been efficiently carried out. All were found to be satisfactory. Milk in Schools Scheme. All milk used in the schools under this scheme is pasteurised. Milk (Special Designations) Regulations, 1936-1946. During the year the following licences were granted for the sale of designated milk:— Dealers' licences. Supplementary licences. "Tuberculin tested" milk 16 4 "Accredited" milk Nil Nil "Pasteurised" milk 22 4 Food and Drugs Act, 1938. All of the bakehouses, restaurant kitchens and hotel kitchens, and a large number of food preparation premises within the borough have been inspected and the work necessary in order that the premises shall comply with the above legislation has either been complied or was in progress at the end of the year. In addition, 63 inspections of public-houses and hotel bars and cellars were carried out under this legislation, as well as under section 89 of the Public Health Act, 1936. In one instance of a complaint of a loaf of bread found to contain a metal button, the matter was reported to the Public Health Committee and a cautionary letter sent to the firm of suppliers. 34 Food and Drugs Act, 1938. Statistics. Conditions Food Shops, Restaurants and Kitchens Hotel Bars and Cellars Found Remedied Found ied Number of premises 127 56 6 1 Accumulation of refuse 8 3 — — Ceilings—defective 18 2 1 — Ceilings—dirty 43 19 4 — Cleanliness (personal) unsatisfactory 2 — — — Dampness 3 1 — — Floors—defective 17 8 2 — Floors—dirty 8 4 — — Lighting inadequate 3 — — — Sink—absence of 7 2 — — Sink-waste pipe inadequate 3 1 — — Storage facilities unsatisfactory 2 5 — — Ventilation insufficient 10 4 — — Walls—dirty 50 18 4 — Wall-plaster—defective 20 6 4 — Insufficient or absence of hot and cold water for cleansing utensils 8 1 3 — Absence of hot water for ablution purposes 42 23 1 1 W.C. accommodation—insufficient or unsuitable 5 2 3 1 Other defects 76 30 2 — Totals 325 129 24 2 Private Slaughterhouses. Meat—Carcases Inspected and Condemned. Cattle, excl. Cows Cows Calves Sheep and Lambs Pigs Number killed (if known) — — — — 16 Number inspected — — — — 16 All diseases except tuberculosis: Whole carcases condemned — — — — — Carcases of which some part of organ was condemned — — — — — Percentage of the number inspected affected with disease other than tuberculosis — — — — — Tuberculosis only: Whole carcases condemned — — — — — Carcases of which some part or organ was condemned — — — — — Percentage of the number inspected affected with tuberculosis — — — — — 35 Slaughterhouses. Three licences were renewed during the year. The licensing of two slaughterhouses was again deferred pending the execution of essential repairs. There is no horse-slaughtering establishment within the borough. Slaughter of Animals Act, 1933. Ten slaughter-men were on the register of the department at the end of the year. Food Inspection. Diseased and unsound conditions found in meat caused the detention and surrender for destruction of a total weight in carcases (or portions of carcases) of l,769lbs., details of which are given in the following table:— lbs. Beef 901 Mutton and lamb 450 Pork Nil Other meats 418 The following foodstuffs, other than meat, being unfit for human consumption, were voluntarily surrendered for destruction:— Eggs 256 Fowls 6 lbs. Bacon 29 Butter 60 Cheese 24 Cooked meat 83 Fish 3,679 Flour and cereals 425 Jam 178 Chocolate 4 Cake mixture 66 Biscuits 121 Sugar 142 Swedes 7,728 Potatoes 3,136 Tea 71 Fruit 343 Canned Foodstuffs. Tins. Fish 648 Fruit 505 Meat 261 Milk 1,575 Vegetables 1,092 Other 719 36 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 Taken A dulterated Milk 205 7 Milk, Channel Islands 8 — Apple wine cocktail 1 — Aluminium hydroxide medicine 1 — Boracic Powder 2 1 Brandy 2 — Cooked meat 3 — Coffee and chicory essence 2 — Essence of rennet 1 — Fishcake 2 1 Fish paste 1 — Gin 33 — Ground almond substitute 1 — Haddock, smoked 6 — Haggis 1 — Hake 1 — Honey, synthetic 1 — Fruit preserve 1 1 Lemonade crystals 1 — Malted milk tablets 1 — Meat savoury 1 — Minced beef, pressed 1 1 Nut cream 1 — Rum 2 Salad dressing 1 1 Salad cream 3 2 Sausages 12 — Sausages, cooked 6 — Sausage meat 4 — Sherbet 1 1 Whiskey 36 1 White pepper 1 — Totals 343 16 Rent and Mortgage (Interest) Restrictions Act, 1920-38. Three certificates were granted under the above Acts in respect of premises which were in a state of disrepair. Schools. Inspection of the sanitary arrangements and canteens 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 disease among children. 37 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. Smoke Abatement. It was not necessary to take any formal action during the year regarding excessive emissions of smoke. Petroleum (Consolidation) Act, 1928, and Petroleum Spirit Regulations, 1929-47. During the year 236 visits were paid by the Sanitary Inspectors to premises upon which petroleum or carbide of calcium was stored. One hundred and nine licences were issued in respect of these premises. Shops Act, 1934. One statutory notice was served under section 10 of this Enactment in respect of one premises with insufficient W.C. accommodation. Two exemption certificates were granted under section 10 (2) of the Act in relation to sanitary conveniences, making a total of 13 premises within the borough for which such certificates are now extant. Factories Act, 1937. Inspection for the Purposes of Provisions as to Health. Inspections. Written notices. Factories with mechanical power 99 19 Factories without mechanical power 27 9 Outworkers' premises 22 — Summary of Defects Found. Found. Remedied. Want of cleanliness 2 — Overcrowding — — Unreasonable temperature — — Inadequate ventilation 4 2 Ineffective drainage of floors — — Sanitary conveniences:— (a) Insufficient 8 2 (b) Unsuitable or defective 22 9 (c) Not separate for sexes — — Other offences against the Act 17 6 Establishments for Massage or Special Treatment. Eleven licences in respect of establishments for massage or special treatment were issued during the year. The premises were kept in a satisfactory condition. 38 Hairdressers' and Barbers' Premises. Twenty-eight visits were made to hairdressers' and barbers' premises in the borough, which were kept under supervision by the Sanitary Inspectors and Health Visitors during the year, to ensure the required standard of clean' liness being maintained in conformity with the bye-laws. Middlesex County Council Act, 1944. Twentyone visits were made by the Sanitary Inspectors concerning the vehicles and/or storage accommodation of hawkers of meat, fish and vegetables. Five persons and two premises were registered under section 279, Middlesex County Council Act, 1944, during the year. Tents, Vans and Sheds. Middlesex County Council Act, 1944, section 345. Public Health Act, 1936, section 269. During the year licences were renewed authorising persons to station and use three caravans for human habitation at Longford Close, Hampton Hill, and a new licence was similarly issued in respect of a caravan situate at Cardinal Vaughan School Playing Fields, Twickenham. INFECTIOUS DISEASES (a) Notifiable Infectious Diseases Diphtheria. There was one case of diphtheria notified during 1948, a decrease of three on the previous year. The case was admitted to hospital. There were no deaths. The death rate for England and Wales was 0.00 per 1,000 of the population. Free supply of anti-toxin. During the year medical practitioners practising in the borough could at any time obtain a supply of diphtheria anti'toxin from the fire stations. Diphtheria immunisation. At the end of the year it was estimated that the percentage of child population immunised against diphtheria was as follows:— Under 5 years 59.6 Five to 15 years 75.9 The following is a summary of the work carried out:— Total number of cases immunised 1,574 Number of Children who Completed a Full Course of Primary Immunisation in Twickenham (including Temporary Residents) in 1947. Age at date of Final Injection Total Under 5 5 to 14 1,441 133* 1,574 *Includes two children over 14 years of age 39 Scarlet Fever. The number of cases of scarlet fever notified during the year was 99, an increase of 39 on 1947. There were 49 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. Incidence and Mortality. Diphtheria, Scarlet Fever and Enteric Fever. 1937-1948. Year Diphtheria Scarlet Fever Enteric Fever No. of Cases Case Rate per 1,000 pop. No. of Deaths Death Rate per 1,000 pop. o. 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 1 001 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 — — — — — — 1948 1 0.01 — — 99 0.93 — — — — — — Smallpox. No case of smallpox was notified during the year. Three contacts were kept under observation by the department. Pneumonia, Malaria, Dysentery. Pneumonia. There were 33 cases of pneumonia notified during the year, a decrease of 27 on 1947. Deaths numbered 48. 40 Malaria. Three cases of malaria were notified during the year, one of which was treated in hospital. All cases were contracted abroad. Dysentery. Three cases of dysentery were notified during the year. All cases were treated in hospital. There were no deaths. Acute Poliomyelitis, Acute Polio-encephalitis. Seven cases of poliomyelitis and one case of polio-encephalitis were notified during the year, compared with 21 cases during 1947. Six of these cases were treated in hospital and there were three deaths. Ophthalmia Neonatorum, 1937-1948. The following table shows the number of cases notified and result of treatment:— Year Cases notified Cases Treated Vision unimpaired Vision impaired T otal 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 — — — 1947 5 5 — 5 — — — 1948 4 4 — 4 — — — Puerperal Pyrexia. Twelve cases of puerperal pyrexia were notified, as compared with thirteen for the previous year. All cases were treated in hospital. Cerebro-spinal Fever. There was one case of cerebro-spinal fever notified during 1948, a decrease of one on the previous year. The case was treated in hospital. No deaths were recorded from this disease. Measles and Whooping Cough. During the year 542 cases of measles were notified, as compared with 607 for the previous year. The peak period was the months of May and June, when 126 and 113 cases were notified. Twenty-eight cases were admitted to hospital. There was one death, giving a death rate of 0.01 per 1,000 of population. 41 The number of cases of whooping cough notified—142—showed a decrease of 86 on the previous year. Eleven cases were admitted to hospital. There were no deaths. The rate for England and Wales was 0.02. (b) Non-notifiable Infectious Diseases Diseases coming under this category include influenza, chicken-pox and mumps. As these diseases are not notifiable it is not possible to ascertain the exact incidence. During the year, however, the following cases were brought to the notice of the department. Chicken-pox 246 Mumps 247 Tuberculosis During the year 1948 there were 134 new cases of tuberculosis notified, a decrease of nine on the previous year. Forty-five deaths were recorded from the disease, giving a death rate of 0.42 per 1,000 of the population. Nonnotified tuberculosis deaths—cases not notified as tuberculosis and not recorded in the registers of the department during life—were responsible for 17.78 per cent, of the total tuberculosis deaths. New Cases and Mortality, 1947. Age Periods New Cases Deaths Pulmonary Non-pulmonary Pulmonary Non-pulmonary Male Female Male Female Male Female Male Female Under 1 1 — — — — — — — 1-4 2 1 — — 1 — — — 5-9 1 1 2 — — — — 10-14 4 — 1 2 — — — — 15-19 10 4 — 1 1 4 — — 20-24 12 9 2 3 — — — — 25-34 17 14 — — 5 2 — — 35-4 8 4 — 2 1 1 — — 45-54 11 4 1 1 7 2 — 1 55-64 7 2 1 1 8 2 — 65 and over 4 2 — — 3 5 2 — Totals 77 41 5 12 26 16 2 1 42 Primary Notifications of Tuberculosis, 1937-1948 inclusive 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 Pulmonary 85 100 106 114 127 112 119 133 118 120 132 117 Non- Pulmonary 25 30 19 12 14 18 18 18 18 19 11 17 Totals 110 130 125 126 141 130 137 151 136 139 143 134 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. Food Poisoning. There is an increase in the number of cases of food poisoning, due to food infected by organisms. The chief offenders are the staphylococcus and the salmonella group. A large amount of work has been done in attempting to raise the standards of hygiene in food shops, hotels and restaurants. We hope in the near future to interest the traders in the formation of a Clean Food Guild. 43 44 Ward Distribution of Infectious Diseases Notified during the Year 1948. Disease Twickenham Whitton Hampton Hampton Hill T eddington Hampton Wick Total East Central South West Upper Lower Cerebro-spinal Fever — — — 1 — — — — — — 1 Diphtheria 1 — — — — — — — — — 1 Dysentery — 1 — — 1 1 — — — — 3 Erysipelas — — — 3 4 1 3 4 4 2 21 Malaria 1 — — 1 — 1 — — — — 3 Measles 29 29 31 59 98 111 48 25 31 81 542 Ophthalmia Neonatorum — 1 — 1 1 — — — 1 — 4 Acute Polio-encephalitis — — — — — — — 1 — — 1 Acute Poliomyelitis 1 1 4 — 1 — — — — — 7 Pneumonia 5 1 — 2 4 2 2 8 2 7 33 Puerperal Pyrexia — — — — — 12 — — — — 12 Scarlet Fever 9 9 6 6 13 29 7 8 4 8 99 Whooping Cough 5 10 10 8 8 20 12 29 22 18 142 Totals 51 52 51 81 130 177 72 75 64 116 869 45 Monthly Incidence of Infectious Diseases during the Year 1948. DISEASE NUMBER OF CASES TOTAL January February March April May June July August Sept. October Nov. Dec. Cerebrospinal Fever — — 1 — — — — — — — — — 1 Diphtheria 1 — — — — — — — — — — — 1 Dysentery — 1 — — — 1 — — — 1 — — 3 Erysipelas 1 3 5 3 3 2 1 — — — 2 1 21 Malaria — — — — — 1 — 1 — — — 1 3 Measles 49 11 60 11 126 113 40 16 3 2 2 7 542 Ophthalmia Neonatorum — — — — 1 1 1 — 1 — — — 4 Acute Polio-encephalitis — — — — — — — 1 — — — — 1 Acute Poliomyelitis — 1 — — — 1 1 2 1 1 — — 7 Pneumonia 5 2 3 6 2 4 1 — 2 1 2 5 33 Puerperal Pyrexia 3 1 2 —- — 1 2 — 1 2 — — 12 Scarlet Fever 11 11 21 5 6 7 14 4 6 6 7 1 99 Whooping Cough 7 16 22 18 17 13 8 11 8 — 13 9 142 Totals — 46 114 145 155 144 68 35 22 13 26 24 869 46 Cases of Infectious Diseases Notified during the Year 1948. DISEASE CASES NOTIFIED AT VARIOUS AGES (YEARS) Total cases notified Cases admitted Hospital Deaths Under 1 year 1-2 2-3 3-4 4-5 5-10 10-15 15-20 20-25 25-35 35-45 45-65 Over 65 Age not known Cerebro-spinal Fever — — — — — 1 — — — — — — — — 1 1 — Diphtheria — — — — — — 1 — — — — — — — 1 1 — Dysentery — 1 — — — — 1 — — — 1 — — — 3 3 — Erysipelas — — — — — — — — — 2 — 13 6 — 21 4 — Malaria — — — — — — — — 2 — — 1 — — 3 1 — Measles 26 43 52 52 84 229 18 5 9 3 4 — — 17 542 28 1 Ophthalmia Neonatorum 4 — — — — — — — — — — — — — 4 — — Acute Polio-encephalitis — — — 1 — — — — — — — — — — 1 1 — Acute Poliomyelitis 1 — — — — 2 — 1 1 2 — — — — 7 5 3 Pneumonia 1 2 3 — — — — 2 3 1 5 9 6 1 33 5 48 Puerperal Pyrexia — — — — — — — — 2 6 4 — — — 12 12 — Scarlet Fever — — 2 7 9 43 22 9 — 3 3 — — 1 99 49 — Whooping Cough 1 14 18 16 30 46 1 1 — 2 1 1 1 — 142 11 — Totals 43 60 75 76 123 321 43 18 17 19 18 24 13 19 869 121 52