AC.439(1) TWICKEN 4AM TWI 18 DECEMBER, 1951 GOOD HEALTH IN TWICKENHAM The Annual Report of the Medical Officer of Health. JOHN MADDISON, M.D., B.S., D.P.H. CONTENTS Page Introduction 2 Health Committee and Staff 4 Foot Health 5 Economics of House Repairs 7 What we have done for the Old Folks 8 Safety in Food 11 Keeping the Borough Clean 14 Water Supply 15 Industrial Health 16 General Matters 16 Statistical Summary 19 1 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 current Annual Report on the health and sanitary conditions of the Borough. The report contains as a supplement the statistical tables for the year 1950 as required by the Ministry of Health. I apologise that owing to the pressure of day-to-day affairs the publication has been delayed. The medical officer of health is required by law "to inform himself as far as practicable respecting all matters affecting or likely to affect the public health in the district and be prepared to advise the local authority on any such matter." Under special statutes such as the Public Health Act, the National Health Service Act, the Education Act, the Food and Drugs Act, the Shops Act, the Factories Act, and the Middlesex County Council Act, he is required to be responsible for the efficient performance of a great many public health functions, all of which have to do with the safeguarding of the public health of the people in his district. By virtue of my dual role of Medical Officer of Health for the Borough and Area Medical Officer for the County it has been possible, after some initial difficulties, to weld together the staff on the Borough side with those on the County side into one unified team working smoothly and efficiently. It has for long been an accepted practice for local authorities to appoint to the staff of the medical officer of health, assistants with varying degrees of skill in the many techniques which form the work in a health department. Such assistants may be doctors, nurses, inspectors, administrators, clerical workers, psychologists, social workers, domestic workers, physiotherapists, speech therapists, and others. All these can be regarded in some capacity as medical auxiliaries helping the medical officer of health to discharge his many responsibilities. Each person is required to possess a certain standard of education and competence for the proper performance of his allotted duty; and although these duties vary very much in importance, each in his own way contributes his quota to the promotion of good health, the social welfare and the alleviation of suffering among the population. The staff are a team of workers with a high ideal. The efficiency of this team depends on careful selection of the members, suitable education and training for each post, a sense in each one of performing a useful public service, a loyalty to the team as a whole, and happiness in the work. One of their main functions is to provide the auxiliary eyes and ears to assist the medical officer to keep himself informed of the state of the public health in his district, and to inform him when conditions need attention or modification. The medical officer must keep them united to form an efficient, co-operative group of workers; indeed, much of the success of his department depends on his ability to do this well. 2 A glance at the tables in the appendix will show the vast and important field covered in environmental health. It includes the control of outbreaks of communicable diseases, food hygiene, infestations by pests and insects and the repair of private houses, the inspection of shops and factories, and many other matters. I have selected two or three subjects of topical interest for comment which are dealt with in the remainder of this report. I beg to acknowledge my indebtedness to the Chairman and members of the Public Health Committee for their helpfulness and support, which is 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 of Health. 3 MEMBERS OF THE HEALTH COMMITTEE Ex officio members: His Worship The Mayor, Councillor J. W. Nicholls, J.P. The Deputy Mayor, Councillor C. E. Hastings Chairman: Alderman J. Allinson Vice-Chairman: Councillor A. T. Kremers Alderman V. G. Heptinstall Councillor Mrs. J. L. Gill Alderman J. M. Johnson Councillor J. W. M. Hurles Alderman J. H. Knaggs, J.P. Councillor J. H. W. Mears Alderman Mrs. N. K. Taylor, B.A. Councillor N. Sheldon Councillor L. Clements Councillor Mrs. M. E. G. Welch STAFF OF THE PUBLIC HEALTH DEPARTMENT Medical Officer of Health Dr. J. Maddison, M.D., B.S., D.P.H. (Also Area Medical Officer, Twickenham, Feltham, Staines and Sunbury.) Deputy Medical Officer of Health Dr. W. Cormack, M.B., Ch.B., D.P.H. (Also Deputy Area Medical Officer, Twickenham, Feltham, Staines and Sunbury.) Chief Sanitary Inspector Mr. T. Williams, M.R.S.I., M.S.I.A. Deputy Chief Sanitary Inspector Mr. H. G. Easter Sanitary Inspectors Messrs. L. Burrows, K. E. Evans, J. A. K. Garratt, J. W. Paine, C. W. Wood All the Inspectors hold the Certificate of the Royal Sanitary Institute and Sanitary Inspectors' Examination Joint Board, and the Meat Inspectors' Certificate. Chief Clerk Mr. H. J. Pugh (Also Area Chief Clerk, Twickenham, Feltham, Staines and Sunbury.) Senior Clerk Mr. W. J. Larwood Clerical Staff Miss G. Payne, Mrs. W. E. George, Miss P. V. Herbemont Senior Rodent Operative Mr. H. T. Jackman Rodent Operatives Messrs. C. H. Deacon, M. P. Robinson Disinfector/Drain Tester Mr. E. G. Cooper 4 FOOT HEALTH Have You Bad Feet? Mrs. Smith is a capable mother who comes to one of our clinics; she is in her middle thirties and is one of a family of ten. Her father was a farm labourer who never earned much; her mother was a simple woman, shiftless and incapable. They lived in a farm cottage in an isolated country village. The children rarely had enough to eat; once a week, on Sundays, they had a small piece of meat. They wore each other's cast-off clothes and shoes. There was no welfare clinic in that neighbourhood; the doctor attended only at times of crisis. They depended much on the charity of the farmer employer. The older children dragged up the younger; it is a miracle how they all survived to adult life. Mrs. Smith has dreadful feet, the result of ignorance and neglect in childhood. She is bow-legged—her knees are about two inches apart when her feet are together. Her ankles tilt over so that she walks on the inner edges of her feet and she looks flat-footed. On both feet the big toe is bent under the second toe; the big toe joints bulge inwards towards each other. Each joint is stiff and the skin over it is red and inflamed. Her other toes are out of line, the little toe sticks up and has a corn on it. She is not badly off now, but she spends a fortune on shoes. About every three weeks she buys a new pair of shoes, generally the wrong fit. For about a fortnight they look good, then go completely out of shape and look dreadful. Until she left home and earned her own living, Mrs. Smith was never taken to a shop to be fitted with shoes. She always wore the cast-off shoes of her older brothers and sisters. They never had fitted shoes either. Shoes or boots were bought for them by the farmer when he went to the market town. Mrs. Smith now finds it painful to walk anything over a mile. In her old age, she will join the horde of elderly women confined to the house through crippled feet. Why are her feet like this ? Every child's foot is soft and pliable; it can be moulded to an unnatural shape by pressure. It takes 20 years for the bones of the foot to become properly hardened and at any time during this period the foot may be permanently deformed through ill-fitting footwear. In Mrs. Smith's case, she began badly by suffering in health through inadequate and wrong feeding; she must have had rickets in early infancy, which gave her permanently deformed bow-legs. The bones round her ankle, already soft, but softened still more by rickets, allowed her foot to tilt over inwards, giving her the flat-footed appearance. No doubt the shoes and stockings she wore were always ill fitting. They must frequently have been too short. Her toes were pushed backwards; the pressure on her big toe pushed the joint out of line, causing the V-type deformity which we call halux valgus. She says she can remember when she was about 8 or 9 years old having awful pains in her legs and feet, and how in the mornings, she could hardly stand on the floor, the pains were so bad. Nobody, of course, took any notice. How it Happens. Now this is by no means an extreme or rare case. There are thousands of people, especially women, like this today. These deformities are very difficult if not impossible to cure. It is far better to prevent them ever happening. Parents should realise how soft is the structure of a child's foot. In badly fitting shoes, especially those too short and too narrow, the foot takes the shape 5 of the shoe. The toes get cramped, assume a deformed position and the deformity becomes permanent. The tightness restricts the blood supply to the joints and tendons; there is no pain at first, but later the child shows unwillingness to walk, run or play. There may be aching in the knees and legs due to fatigue of the leg and foot muscles. The joints become stiff and cause pain in later years, especially after age 40. The strain leads to bad health, bad position of the body generally, poor movement and slowness. Choosing Footwear. It is very important to choose a child's shoes with great care. The child does not know whether his shoes fit properly or not. Measure the length and width of the foot and heel in the standing position. The length of the fitted shoe from the back of the heel to the front of the toe cap should be three-quarters of an inch longer than the length of the foot standing. The width of the shoe should properly fit the width of the forefoot and heel, the widest part of the shoe should coincide with the widest part of the foot. The heel should fit snugly. The curve of the shoe should fit the curve of the foot. Try on both shoes as the fit may not be alike in both feet. A good tip is to fit the child's heel into the shoe with the remainder of the foot resting lightly on top of the shoe. You can then see if there is sufficient clearing in the length and width and that the curve is correct. Check the length and width of the child's shoes frequently. Don't bother about sizes; they vary enormously in different makes. Have the shoes repaired early. Check measurements when they come back from the repairers. Buy shoes of good quality. Find a shop which stocks the correct fit and stick to that shop. Never buy shoes without a fitting. Have good strong laces that don't snap. Don't walk about in shoes without stockings. The leather becomes sodden, infected and unhealthy. Changing shoes frequently brings relief to overworked muscles and preserves the shape of shoes. If possible have two pairs available for wear on alternate days. Don't forget about the house slippers at school. These are often never checked. When your daughter is between 14 and 17 years old, do not let her have her own way about choosing shoes. The fit is the important thing. She will ruin her feet if she buys them too tight. She will look far smarter in a well-fitting shoe, and it will keep its shape and smartness longer. Big feet look smartest in shoes which fit them. If they are too tight, she will get bulging ankles, halux valgus, bunions, corns and callosities. These points about well-fitting shoes apply with equal importance to socks and stockings; if these are too tight they will cause the same damage. There are some dreadful baby shoes in which you cannot distinguish right from left; they will ruin your baby's feet in no time. Periodic Check. You can examine a child's foot yourself. Every now and again, stand him erect with feet together. Look at both back and front of his feet and legs. See that there are no knock-knees or bow-legs; that the ankles are straight and not tilted over, and that the big toe is straight in line with the inner edge of the foot. Then sit the child down in a chair and test each foot for movement. You should be able to bend the foot upwards and downwards in line with the leg quite freely and from side to side; there should be free movement of all the toes, especially the big toe. If there is any deformity or stiffness, or unequal wear on either shoe, do not hesitate to consult your own doctor or the doctor at your local welfare centre, or school clinic, or at the time of the child's medical inspection in school. 6 ECONOMICS OF HOUSE REPAIRS The Rising Cost. Every year in this Borough over 2,000 houses are inspected for defects and well over a 1,000 are found to have dilapidations of varying degrees of severity. A most important problem facing health departments of local authorities is how to hold a just balance between the amount of repairs absolutely necessary and the amount otherwise desirable, having regard to the enormous rise in the cost of building and repair work. Let us consider an ordinary small two-storey terrace house having three bedrooms, two living rooms and a kitchen, and occupied by a man, his wife and say four children. The house is over 40 years old and has a controlled rent of 10s. 6d. per week inclusive of rates. Over the years the fabric has deteriorated so that now the house needs extensive repairs. It has had a succession of tenants some of whom have treated it badly. A typical list of defects would include a defective roof, perished pointing to the walls and chimney stack, defective eaves-gutters and rainwater pipes; a defective damp-proof course causing rising dampness inside the house; patches of perished wall plaster and defective ceiling plaster; defective window sashes and beading, broken floor boards and rotting floor joists; a broken sink and a broken firegrate; the whole house would need to be painted and decorated; outside there would be a defective W.C. cistern, the branch drain would need to be renewed and the yard paved. The detailed specification of works required to make such a house fit might well show the cost to be about £270. The income from the property might be set out in a table as follows:— £ s. d. Gross annual rent at 10s. 6d. per week 27 6 0 Deductions or outgoings paid by owner:— £ s. d. Rates inclusive 7 16 0 Collection of rent and management —5% of gross rental 1 7 4 Contingencies, insurance, voids, etc., —5% of gross rental 1 7 4 Repairs and maintenance —25% of net rent 4 3 10 14 14 6 Net annual income £12 11 6 £12 l1s. 6d. is the interest at 5% from the investment of a capital sum of £252. £12 l1s. 6d. is the interest at 6% from the investment of a capital sum of £210. £12 l1s. 6d. is the interest at 7% from the investment of a capital sum of £180. If this house were properly repaired it might be expected to last another 15 or 20 years before any further major repairs were needed. As the house is over 40 years old, the present owner is not likely to be the same person who originally built or acquired the property. He may have inherited it, or bought it many years ago. Whatever benefit the original owner had during the years when the house was new has now long since gone, and so is of no comfort to the present owner because his capital asset is worn out and he is saddled with a 7 heavy liability. Three courses are open to him; he might try to give away or sell the house, the most likely purchaser being the tenant; or he may ask the local authority to declare the house unfit for human habitation and incapable of being repaired at a reasonable cost, in which case the house is demolished and he cuts his loss; or he may sink more capital in having the house repaired and hope to repay himself over the years, but he cannot charge more rent. If you were an owner in his place what would you do ? The tenant, on the other hand, living in the house is dissatisfied with the bad conditions, but would not welcome the prospect of being turned out to allow the house to be demolished unless he had somewhere else to go. He might find happiness in the thought that the Council would rehouse him in a nice new Council house, but he will get a shock when he learns that the Council are not obliged to provide him with a house, and might not be able to do so even if they wished. In any case he would have to pay a far higher rent. If you were the tenant would you be prepared to buy the old house at a nominal figure and pay for the repairs yourself ? As a ratepayer and taxpayer you have interest in this problem of rehousing because on every new house built—now costing anything up to £1,750—you contribute in your rates and taxes about 8s. 6d. a week towards the rent. If you think the Council should buy up derelict property and put it in order, then that policy will push up your rates. From a national point of view is it wise to scrap an old house which might be put in good order for £270 and replace it with a new house—admittedly superior—for £1,750 ? If you were Minister of Local Government and Planning what would you advise ? These questions have been posed to illustrate the difficulty and complexity of getting house repairs done. There is no simple solution. In the Health Department we are obliged to exercise a constant vigilance to see that the cost of repairs ordered or enforced are reasonable within the very difficult interpretation of that term. WHAT WE HAVE DONE FOR THE OLD FOLKS Living Alone. Occasionally it is necessary for the Council to apply to the Court for an Order to remove an old person compulsorily to a place of care and safety when the stage of degeneration of mental and physical powers has become so severe as to produce serious threat to health and indeed life. In 1950 we had to deal in this way with an elderly widow aged about 80. I visited her, but found it extremely difficult to gain entry to the house. Eventually after several attempts she answered the door and allowed me in. She was extremely dirty, had not been washed for probably months or years; her clothes were filthy. She kept the blinds drawn constantly so that the front room was dark. By the light of the open door, I could see that the room was thick with dirt and dust. The back room also was in total darkness until she drew up the blind and let in some light. In this room, which she used as a living room, the conditions were far worse. On the floor and the furniture there was the dirt of years. The walls were almost completely black with smoke and dirt. There was no fire; I learned from her and some neighbours that she never had a fire, and on the rare occasion when she formerly used to have one, the 8 chimney smoked so badly as to make it impossible to have the fire on. The table had on it a filthy cover, and on that two or three milk bottles, only one partly consumed. A neighbour told me that a few days previously she had put 24 unopened milk bottles outside. All the milk was sour. Some bread in the cupboard was mouldy and unfit to eat. The smell in this room was sickening; mice were running over the floor. This poor creature, although able to get about was severely deteriorated. She had lost the ability to keep herself clean or provide herself with the ordinary necessities of life, so that she was starving from neglect. Her memory was almost completely gone; she could not remember whether she had ever been married or had any children. She spent most of the day wandering aimlessly round the block, at other times she just stayed in bed and it was difficult to get her roused. She refused any voluntary assistance, so we had to get a Court Order to remove her to a hostel. Failing Strength. This example is, of course, an extreme case, but it illustrates the dangers which old people may often be subject to when they live alone. If for any reason the old person comes to lose the care of the family or wife or other associates, then for even relatively trivial causes, the deterioration in mental and physical powers rapidly becomes extreme. Every year the proportion of old people in the country is getting higher. It would be a fair estimate to say that in the Borough at present there is at least one old person to every six younger adults; a proportion may well be nearer one to five. Two-thirds of those over 65 do not need any help; one-tenth are confined to the house and are, for the most part, beyond help; about a quarter have limited powers of movement outside. They manage to look after themselves at home, and some even manage to continue at work. They do their best to preserve their independence on a diminishing reserve of physical strength; both husband and wife often have to combine to get through the ordinary domestic duties. These people are already on the downward path. They suffer mostly from rheumatism, failing hearts, senile weakness, painful feet, dizziness, incontinence (in women), and the effects of strokes. About half the women suffer from painful feet, which limits their usefulness. The prevention of this item alone, would avoid much needless waste of potential effort. Preventing the Weakness of Old Age. Although a great many of these people can look after themselves quite well, there is nevertheless a growing strain amongst the others who are concerned in looking after them. A great deal can be done to lessen this strain. The first thing is to keep the old men and women active as long as possible. Relatives should not readily adopt the attitude of mind which encourages grandmama to sit by the fire all day long in the belief that she is not able to do anything. Grandmama loves sitting by the fire all day long, but it is not good for her. She would be much better employed doing some dusting and cooking and shopping and taking her share in all the activities of the household. Grandpapa should go on working long after he has drawn his pension. Employers might be encouraged to continue the employment of these men on tasks suited to their physical strength and at rates of wages adjusted accordingly. When because of some infirmity the ability of the old person to pursue a life of normal 9 activity has become restricted, a little thought by the relatives can do a great deal to ease their burden. The worst thing is to allow the old man or woman to go to bed and stay there. This immobility causes stiffness of the joints, loss of power in the muscles so that further weakness quickly supervenes. It is important for the old people to be got up, dressed and kept active. If the old person cannot get up or down stairs a rearrangement of the rooms may be possible so as to give her a downstairs bedroom. If the toilet is upstairs, a bedroom Commode, properly adjusted for height, will be a great convenience. In the geriatric departments of hospitals, elderly people recovering from disabilities are taught simple methods of rehabilitation such as bending and stretching exercises, and getting about with the aid of appliances. In the home it may be possible to continue this good work by the provision, say, of a strong hook securely fastened at a convenient height to a wall and to which a rope can be attached for continuing the exercises. An old person is usually afraid of falling—a serious matter, as limbs are so easily broken. Some thought can be given to the arrangement of the furniture so as to make a table, a sideboard, a dressing table or a strong chair available for support to the old person in getting around. Hostels, Hospitals and Home Helps. On a national scale it is far too expensive to provide hospitals or hostels to accommodate old people. It is much better to keep them active at home. The County Council, through their home help service, are assisting 45 old people to keep going by providing them with domestic assistance for the heavier household tasks for a few hours a day on two or three days a week. If these same cases have to be accommodated in hostels the cost would be far higher. Twickenham Consultative Committee for Old People's Welfare. In 1950 the Ministry of Health asked local authorities to promote a scheme in each district for the closer co-operation of the many statutory and voluntary bodies interested in the welfare of old people. Twickenham has tackled this problem magnificently. The Mayor last year, Councillor C. E. Hastings, called a public meeting and invited all the public and voluntary organisations who were interested in old people to send representatives. The meeting was well attended. We heard an address by Dr. Marjory Warren, the Consulting Physician in the geriatric department at the West Middlesex Hospital, who told us how old men and women in the hospital were having their disabilities treated and confidence in themselves restored; how they learned to move about again, take an interest in their surroundings, and look forward to going back home to their own people. A short stay in hospital can do much to improve an old person to a sufficient extent to enable him afterwards to carry on outside with assistance. Malnutrition can be corrected; physical disabilities ameliorated; some of those incontinent can have their functions restored. But it must not be supposed they can stay in hospital after whatever curative work which is possible has been done. As the cost in hospital is about £15 a week, it is much more economical to provide amenities for the preservation of health and to prevent deterioration. We heard also from Miss Stainton, from the London Council of Social Service, how the welfare problem was being tackled in other districts. The Mayor then asked for nominations, and a committee was set up with representatives from the Borough Council, the County Council, the voluntary 10 ciations for old people's welfare, the churches, and other voluntary bodies. This committee is assisted by officers of the Borough Council, the County Council, the National Assistance Board and the Women's Voluntary Services. The Consultative Committee, as its name implies, acts only in a consultative, co-ordinating and advisory capacity. It has held regular meetings and has examined a wide variety of problems. Chiropody Service. One of the first things the committee did was to consider how to provide a chiropody service for old people. A considerable proportion of the aged suffer from crippling defects of the feet, aggravated by neglect. Such defects cause pain, prevent walking and occasion much misery and disability. They arise from deformities of the toes such as when the big toe is severely bent and presses on the other toes, often causing the second or third toe to override on its neighbour; this condition is often accompanied by a bunion and corns; the toe nails are tough and difficult to cut; they press into the flesh, making the toes tender and painful. Often the old people cannot bend sufficiently to give themselves the necessary attention; in course of time they cannot get about. There are twelve establishments for chiropody in the Borough, but many old people cannot afford the fees. The local authority has no power under any Act of Parliament to set up a clinic. The committee were fortunate and delighted to receive an offer from a qualified chiropodist to give her services free. The County Council also allowed free of charge the use of their clinic in Church Road, Teddington. Already the clinic is running to capacity with new appointments and reappointments. The chiropodist is assisted by two members of the St. John Ambulance Brigade and the almoner from Teddington Hospital. The Teddington Old People's Welfare Association is responsible for the cost of dressings, although this item can be kept to a minimum if patients take care to obtain prescriptions from their doctors. The clinic is providing a most useful service in alleviating and curing foot defects and is performing excellent work in preventive medicine. The committee have recently received another offer of service from a chiropodist through the British Red Cross Society and it may be possible to commence another clinic in the near future. Keeping in Touch. Our knowledge of the numbers and needs of the old people in the Borough is far from complete; it is certain there are lots of old people who do not know of the various voluntary organisations able and willing to assist them. It is hoped in time to arrange for representatives from the organisations to get in touch with all old people, with a view to offering friendly assistance should it be required. SAFETY IN FOOD Poison. During 1950 we dealt with 75 cases of food poisoning. There must have been many more which we did not hear about. There were three outbreaks in which the cause was identified. In the first outbreak eight people refreshed themselves with coffee and cream cakes in a cafe in Twickenham. Soon 11 wards they became sharply ill with abdominal pain and diarrhoea, which lasted from three to five days, causing considerable worry and inconvenience. On receiving a report from the doctor, we commenced investigations immediately. We soon found out that this outbreak in Twickenham was associated with a similar outbreak in Richmond, where 15 cases had been reported. All the patients had eaten cream cakes; we soon discovered the infective organism— the salmonella—in the cream filling of the cakes. The people in the bakery where the cream came from were all tested for organisms and one of them was found to be the carrier of a salmonella which exactly matched that in the cream. This organism can live and be carried in the bowel, often by a person who exhibits no symptoms. It is conveyed to food on the fingers after using the toilet, especially when the hands have not been washed afterwards. In this outbreak the cause was discovered quickly so that further spread to other people was promptly stopped. Had it not been so the effect could have been much more serious. In the second outbreak four people ate a cream layer cake which was infected by another organism—the staphylococcus—which causes food poisoning through the toxin it is able to form in the food as it multiplies. The symptoms are usually more rapid in their onset than in the case of salmonella and resemble a violent attack of seasickness lasting one or two days. Prompt measures were taken to deal with the source of infection. In the third outbreak 39 children from an infant school became ill one day with symptoms resembling food poisoning. We were able to prove that the meat eaten by 30 of them was infected with the staphylococcus and its toxin, but it remained a curious fact that the other nine children who had similar symptoms had not eaten the infected meat. We were not able to demonstrate with certainty what the cause was in their case. In two other outbreaks we were not able to prove with certainty what the causative organism was. This was also so in 17 individual cases which we investigated. Thus in spite of much investigation, assisted by excellent laboratory techniques, there still remains a high proportion of patients who exhibit the symptoms resembling food poisoning but in whom the cause is undetermined. There has recently been an outbreak of an illness affecting people all over the town, lasting two or three days and resembling food poisoning, but no food poisoning organisms have been isolated. It is clearly infective, spreads from person to person, and appears to have an incubation period of about five days. It may possibly be that this illness is caused by a virus like the one which causes influenza, but there could be other agents. Chemicals in Food. Sir Edward Mellanby, in an article in the British Medical Journal, has called attention to the great expansion in recent years of the practice by the food industries of adding substances to food which are foreign to the body and sometimes harmful. These substances improve the appearance of food and so please customers, but they often at the same time lower the nutritional value and may sometimes produce a toxic effect. These unnatural chemicals are added to food in order to save fat, to facilitate emulsification, as preservatives, as sweetening, as flavouring and colouring agents, and as improvers and bleachers of flour; also to washing-up water and as sterilisers for utensils; and to kill insects and control pest and fungus diseases in the food industries and agriculture. 12 Substitutes for sugar are used extensively in the baking trade and soft drinks industry. One substance, dulcin, was used as a sweetening agent for 50 years before it was discovered only two years ago that in animals it caused tumours of the liver, retarded growth, caused anaemia and a higher mortality rate. Another substance, P4,000, so called because it was 4,000 times stronger in sweetening power than cane sugar, also extensively used, has recently been shown to produce disease of the thyroid and kidneys. Certain colouring substances of the azo-dye group have been shown to produce liver cancer in rats. Although the incidence of primary liver cancer in this country is exceedingly rare, it is surely common sense to exclude these substances from food. In my report last year I spoke of the poor quality of much of the food which we were obliged to eat. I said we seemed less able in this country to withstand the strain of prolonged physical and mental labour than our friends in Canada and the U.S.A. One reason is our preference for pure white bread. This encourages millers to remove the coloured portion of the wheat grain, the germ, the aleuron layer (semolina) and the bran, and to add to the flour chemicals known as bleachers and improvers. The effect of the addition of bleachers is said to reduce the amount of the natural product which makes vitamin A. An improver makes the loaf lighter by allowing more air and gas to be incorporated in it. Recently it was discovered that agenised flour—that is flour treated with nitrogen trichloride—causes hysteria and running fits in dogs. The process has been abandoned in the U.S.A., but not yet in this country, although no doubt in time it will disappear. It has been stated that there is no evidence that agene treated flour has any deleterious effect on man, but, as every animal tested with the pure substance shows severe toxic symptoms of the nervous system, it would be remarkable if man were an exception. We certainly have enough chronic degenerative changes in the nervous system and other organs of unknown cause. The safest plan for housewives is to insist on buying a whole wheat loaf made from a whole wheat flour without the addition of any "improver." Safeguarding Food Supplies. Thus by unsafe handling, infection by organisms of disease, by the removal of the protective substances, and by the addition of deleterious chemicals, our food has many opportunities of doing harm. The Health Department is always on the watch to prevent as much of this harm as possible. The Corporation have made byelaws which deal with the handling, wrapping and delivery of food; we have made vigorous efforts to secure the full compliance of the traders with these byelaws, especially the vendors trading from barrows and stalls in the streets. The fair held on Bank Holidays at Hampton Court has had special supervision; there has been a great improvement in the standard of food hygiene on the various food stalls. The Clean Food Guild has made steady progress under the able chairmanship of Alderman J. Allinson, the Chairman of the Public Health Committee. In December 1950 the Guild held its first annual meeting, followed by a public meeting, at which the President, His Worship The Mayor, Councillor C. E. Hastings, J.P., took the chair. The large hall at York House was well filled to hear a lecture by Professor R. Cruickshank, Professor of Bacteriology, University of London. The Guild has made every endeavour to keep alive interest in the 13 importance of safe food by newspaper advertisements, personal letters from the Chairman to food traders, by advertisements on cinema screens, and by lectures given by the Chief Sanitary Inspector, and myself, to various organisations. The support given by the local press, whose staff regularly attend and report the meetings of the Guild, has really been invaluable. There are now 68 registered members in the Guild; steady progress has continued, new applications coming in from traders every month. Those whose standards comply reasonably well with the codes of practice of the Guild are registered on the recommendation of the chief inspector. In several cases, applicants for membership have incurred little or no expense other than the small membership enrolment fee. In others, the determination of the traders to carry out the maximum work needed to reflect the Guild standard in their premises has involved voluntary expenditure up to as much as £500. The standard of hygiene in many of these is far above that enforceable by law. In only one case was it necessary to suspend temporarily a registered member; this step was taken without loss of goodwill. Subsequently a marked improvement in the premises concerned enabled the membership to be renewed. Safe food depends on having a clear understanding of a few principles and the carrying out of simple procedures based on those principles. The two most important, and which have been constantly emphasised in our experience with food poisoning cases, are (1) to keep clean hands, especially after using the toilet, and (2) to cool rapidly and keep in the refrigerator all meat preparations intended for consumption some time after cooking. The Health Department has organised several courses of instruction for food traders and their employees which have been well attended; we are now arranging courses in the premises where food handlers work during the daytime, in factory and school canteens, and for the children in schools. KEEPING THE BOROUGH CLEAN I am obliged to Mr. A. S. Knolles, the Borough Surveyor, for the following report about drainage, sewerage and public cleansing:— Drainage and Sewerage. The continued restrictions on capital expenditure imposed by the Government have prevented the execution of the several main drainage improvements outstanding in the Borough. The only works which have been possible are the sewer constructions involved in the new Housing Schemes, mainly at Butts Farm, Feltham. No serious flooding by storms on the surface-water system has occurred, but complaints of polluted matter entering the River Thames via these sewers have been received from the Port of London Authority, and have been investigated. Public Cleansing. Streets. Difficulties have again been experienced in obtaining and retaining adequate labour for street orderly work. These manual duties are supplemented now by a mechanical sweeper but, taken as a whole, this service is still falling short of pre-war standards. 14 Refuse Collection. During 1950, deliveries of five new Dennis "Paxit" refuse collection vehicles were made, together with another motor-vehicle specially designed to serve narrow streets and back roads and these are now all in service. The remaining "Paxit" vans were delivered during 1951. The old and obsolete horse-drawn vans have now completely disappeared and the "Pagefield" lorry with its containers, which has given such good service for some 20 years has now become redundant. The collection remains a weekly service. Salvage, also collected weekly apart from special requirements, has been continued throughout the year and yields a profitable return to the ratepayers as well as assisting in the production of goods for export and home. The method of collecting pig-food for processing and sale to pig farmers and breeders by means of lorries and communal bins in the streets has continued, but has not been completely satisfactory as the contents often become objectionable to residents and passers-by, particularly in the summer. This method is now in course of being superseded by the provision of four electric collecting vehicles and a system of supplying pails with covers, free of charge, to all individual householders who are willing to co-operate; this system is now operating in a substantial part of the Borough. These pails will be kept and used by the householder at or near the kitchen or rear of the house and there is evidence already that the average housewife much prefers this system to that of the street bin. Refuse Disposal. The experiments referred to in my last report have been completed satisfactorily and have provided valuable information for the proposed Charlton plant at Sunbury. The proposals for this plant have been steadily advanced. A tender for the engineering plant involved has been provisionally accepted and tenders for the remaining works, the buildings to house this plant, have been received recently. If existing restrictions on building and capital expenditure should permit of a commencement of actual construction in 1952, the Corporation and the districts of Sunbury and Staines may, in a period of a further two years or so, then be in possession of a really modern and fully equipped works, capable of dealing with this pressing problem. The present situation is being met by retaining in part use the old destructors at Teddington and Hampton and by an increased use of controlled tipping on various low-lying sites. The Twickenham destructor has not been in use. WATER SUPPLY I am indebted to Lt.-Col. E. F. W. Mackenzie, Director of Water Examination, Metropolitan Water Board, for the following report:— "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. After filtration all the water receives a small dose of chlorine before it leaves the works and adequate contact is provided to ensure complete action of the chlorine before the water is pumped into supply. The contact tank first came into operation at Hampton in July 1948, and the dose of chlorine required to achieve satisfactory sterilisation is governed by the maintenance of a predetermined residual of free chlorine after a prescribed period of contact. This 15 residue of free chlorine is recorded continuously by specially designed apparatus and any variations are readjusted by alteration of the dose of chlorine by chlorination attendants who are continuously on duty. All new and repaired mains are disinfected with chlorine before being restored to supply and samples of water from them are tested bacteriologically. Jute yarn used in the packing of joints in water mains is specially sterilised beforehand. Samples of the water are collected at all stages of purification at least five times each week and are analysed at the laboratories of the Metropolitan Water Board. The results are shown in table No. 9." Number of houses supplied by the Board:— (a) Direct 29,907 (107,589 persons) (b) By means of standpipes 5 (11 persons) INDUSTRIAL HEALTH Factories. It is surprising that in a Borough like Twickenham there are as many as 372 factories. Most of them are engaged in light industries such as the manufacture of electrical components, piston rings, aircraft parts, nameplates, and bakery furniture. The number of persons employed in these factories ranges from 500 in the largest to one or two in the smallest. All factories are visited to see that proper sanitary accommodation is provided; those factories which do not use mechanical power are inspected for cleanliness, avoidance of overcrowding, for adequate warmth and ventilation, and proper drainage of floors. During 1950 the inspectors paid 201 visits to factories; in 36 factories the attention of the management had to be drawn to contraventions of the regulations. The inspectors also paid 33 visits to out-workers' premises. GENERAL MATTERS Shops. The Shops Act, 1934, was repealed and replaced by the Shops Act, 1950, as from the 1st October, 1950. Section 38 of the new Act which deals with the provisions for the health and comfort of the staff, is substantially the same as the section of the old Act which it replaces. Shops are required to be properly ventilated, adequately warmed, and sufficiently lighted; they have to have toilet and washing facilities; if the staff take meals on the premises there must be suitable arrangements. These requirements are enforced by the Local Authority. Occasionally it happens, as in the case of a small lock-up shop, it is impossible to provide a separate toilet on the premises. In these cases the occupier may make an alternative arrangement to share a nearby toilet and a certificate of exemption is granted from the requirement in the Act. During 1950 three exemption certificates were granted which makes a total of 18 in the Borough. Mortuary. The mortuary at Hampton, though small, is a good building. It provides an important public service. During any year there occurs a series of cases in which owing to either accident, sudden death, drowning in the river or other 16 untoward happening, a post-mortem examination is required by the coroner to ascertain the cause of death. The number of bodies admitted to the mortuary for this purpose during 1950 was 139. The mortuary has been supplied with a new refrigerator and has been redecorated throughout. We hope shortly to effect further improvements in the arrangements for viewing bodies. 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. Health Education. Continued use is made of various health education methods, including propaganda by posters, leaflets and lectures illustrated by films or lantern slides. Laboratory Work. The usual arrangements were continued during the year and worked satisfactorily. Establishments for Massage, Chiropody, Electrical and Special Treatment. Thirteen licences in respect of establishments for these purposes were issued during the year 1950. The premises are all inspected regularly and are well run. Registration of Hawkers of Food and their Premises. A strict watch is kept on street food traders. Both the persons and the premises where they store their food have to be registered. Registration can be refused if the conditions are unsatisfactory. During the year 1950, five persons and three premises were registered. The inspectors paid 109 visits. Petrol Filling Stations. During the year 1950, 92 visits were paid by the sanitary inspectors to premises where petroleum or carbide of calcium is stored, and 106 licences were issued. Rent Restriction Certificates. Two certificates were granted for premises which were in bad repair. Two cancellation certificates were issued. Tents, Vans and Sheds. During 1950, five new consents were issued for temporary sites for caravans. 17 Smoke Abatement. It was not necessary to take any formal action during 1950 regarding excessive emissions of smoke. Schools. Inspections of the sanitary arrangements and canteens at the schools within the jurisdiction of the Divisional Executive were carried out by the sanitary inspectors during the year 1950. It was not necessary to close any schools on account of infectious disease among children. Ambulance Facilities. The Middlesex County Council is the responsible authority for the provision of the ambulance service under the National Health Service Act, 1946. 18 TABLES FOR STATISTICAL YEAR 1950 19 STATISTICAL SUMMARY for the Year 1950 Area in acres 7,007 Population (as extended—census 1931) 79,376 Civilian population—estimated to mid-year (as supplied by the Registrar-General) 107,600 Number of inhabited houses 29,912 Rateable value £1,069,273 Sum represented by a penny rate £4,464 1s. 3d. Total M. F. Live Births: Legitimate 1,366 714 652 Illegitimate 69 32 37 Total 1,435 746 689 Birth rate per 1,000 of estimated civilian population 13.34 Total M. F. Still Births: Legitimate 27 17 10 Illegitimate 4 4 — Total 31 21 10 Still birth rate per 1,000 total (live and still) births 21.14 M. F. Deaths 582 607 1,189 Crude death rate per 1,000 of estimated civilian population 11.05 Adjusted death rate 10.72 Maternal deaths 1 Rate per 1,000 total (live and still) births 0.68 Death rate of infants under one year of age:— All infants per 1,000 live births 20.10 Legitimate infants per 1,000 legitimate live births 19.76 Illegitimate infants per 1,000 illegitimate live births 43.48 Deaths from: Cancer (all ages) 207 Measles (all ages) 1 Whooping cough (all ages) — Diarrhoea (under 2 years of age) — 20 Table 1. Population 1938-1950. Year Population Population trend Migration excess Total increase or decrease Percentage proportion Natural increase or decrease Inward Outward 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 — 1949 106,900 +200 +0.19% +399 — 199 1950 107,600 +700 +0.65% +246 454 — Table 2. Causes of Death. Registrar-General's Official Returns. Causes of Death Males Females Total All causes 582 607 1,189 1. Tuberculosis, respiratory 25 9 34 2. Tuberculosis, other 1 2 3 3. Syphilitic disease 4 1 5 4. Diphtheria — — — 5. Whooping cough — — — 6. Meningo-coccal infections — — — 7. Acute poliomyelitis — 1 1 8. Measles — 1 1 9. Other infective and parasitic diseases 2 4 6 10. Malignant neoplasm, stomach 17 9 26 11. Malignant neoplasm, lung, bronchus 30 7 37 12. Malignant neoplasm, breast — 23 23 13. Malignant neoplasm, uterus — 8 8 14. Other malignant and lymphatic neoplasms 44 66 110 15. Leukaemia, aleukaemia 2 3 5 16. Diabetes 3 10 13 17. Vascular lesions of nervous system 55 97 152 18. Coronary disease, angina 101 63 164 19. Hypertension with heart disease 20 20 40 20. Other heart disease 83 115 198 21. Other circulatory disease 15 23 38 22. Influenza 10 12 22 23. Pneumonia 34 22 56 24. Bronchitis 35 23 58 25. Other diseases of respiratory system 3 4 7 26. Ulcer of stomach and duodenum 12 2 14 27. Gastritis, enteritis and diarrhoea — 4 4 28. Nephritis and nephrosis 8 9 17 29. Hyperplasia of prostate 7 — 7 30. Pregnancy, Childbirth, abortion — 1 1 31. Congenital malformations 5 4 9 32. Other defined and ill-defined diseases 43 49 92 33. Motor vehicle accidents 6 2 8 34. All other accidents 12 9 21 35. Suicide 5 3 8 36. Homicide and operations of war - 1 1 21 Table 3. 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 — - — — Table 4. 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 37.01 4.09 Intra-cranial vascular lesions 12.78 1.41 Bronchitis, Pneumonia, and other respiratory diseases 12.03 1.33 Cancer 17.58 1.94 Violence 3.19 0.35 Tuberculosis 3.11 0.34 22 Table 5. Infantile Mortality. (a) 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 17 3 - - 20 6 4 - - 30 Uncertified — -— — — — — — — — — Smallpox - - - - - - - - - - Chicken-pox - - - - - - - - - - Measles - - - - - - - - - - Scarlet Fever - - - - - - - - - - Diphtheria and Croup - - - - - - - - - - Whooping Cough - - - - - - - - - - Influenza - - - - - - - - - - Enteritis — - - - - - - - - - Tuberculous Meningitis - - - - - - - - - - Abdominal Tuberculosis - - - - - - - - - - Other Tuberculous Diseases - - - - - - - - - - Congenital Malformations — 1 — — 1 1 — — — 2 Premature Birth 7 1 — — 8 — — — — 8 Atrophy, Debility and Marasmus - - - - - 1 - - - 1 Atelectasis 3 — — — 3 — — — — 3 Injury at Birth - - - - - - - - - - Erysipelas - - - - - - - - - - Syphilis - - - - - - - - - - Rickets - - - - - - - - - - Meningitis (not Tuberculous) - - - - - - - - - - Convulsions - - - - - - - - - - Gastritis - - - - - - - - - - Laryngitis - - - - - - - - - - Bronchitis - - - - - - - - - - Pneumonia (all forms) 1 1 — — 2 3 2 — — 7 Suffocation (overlying) — — — — — — — — — — Other causes 6 — — — 6 1 2 — — 9 Totals 17 3 - - 20 6 4 - — 30 (b) An analysis of the mortality reveals that neo-natal deaths were responsible for 66.66 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 3 20 66.66 23 Table 6. Maternal Mortality. Case No. Cause of Death Post Mortem held 1 Eclampsia following normal non-instrumental delivery—live birth Yes 24 TABLE 7. Birth Rate, Death Rate and Analysis of Mortality. 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 Tuberculosis Influenza Smallpox Acute Poliomyelitis and Polioencephalitis Pneumonia Diarrhoea and Enteritis (under two years) Total Deaths under 1 year England and Wales 15.8 0.37 11.6 0.00 0.01 0.00 0.36 0.10 0.00 0.02 0.46 1.9 29.8 126 County Boroughs and great towns, including London 17.6 0.45 12.3 0.00 0.01 0.00 0.42 0.09 0.02 0.49 2.2 33.8 148 smaller towns, resident populations 25,000 to 50,000 at 1931 census 16.7 0.38 11.6 0.00 0.01 0.00 0.33 0.10 0.02 0.45 1.6 29.4 London Admin. County 17.8 0.36 11.8 0.00 0.01 0.00 0.39 0.07 — 0.01 0.48 1.0 26.3 Twickenham 13.34 0.29 (a) 11.05 (b) 10.72 — — — 0.34 0.20 — — 0.52 0.04 20.10 A dash ( — ) signifies that there were no deaths (a) crude (b) adjusted 25 Table 8. Review of the Comparative Vital and Mortality Statistics for the Borough of Twickenham, together with those for England and Wales for years 1938-1950 inclusive. Year Birth Rate Death Rate Infantile Mortality Rate Twickenham England and Wales Twickenham England and Wales Twickenham England and Wales 1938 14.4 15.1 (a) 9.91 11.6 45.8 53 (b) 9.81 1939 14.2 15.0 (a) 10.46 12.1 26.4 50 (b) 10.35 1940 14.67 14.6 (a) 14.8 14.3 45.8 55 (b) 14.9 1941 13.4 14.2 13.0 12.9 70.95 59 1942 16.49 15.8 11.6 11.6 53.1 49 1943 17.7 16.5 12.3 12.1 47.99 49 1944 18.5 17.6 12.8 11.6 37.1 46 1945 16.76 16.1 12.15 11.4 48.02 46 1946 19.01 19.1 10.89 11.5 26.09 43 1947 19.72 20.5 11.05 12.0 40.21 41 1948 15.86 17.9 10.04 10.8 20.69 34 1949 14.99 17.09 (a) 11.26 11.7 21.21 32 (b) 11.03 1950 13.63 16.17 (a) 11.05 11.6 20.10 29.8 (b) 10.72 (а) Crude (б) Adjusted 26 TABLE 9. Results of the chemical and bacteriological examination of the water supply to the borough of twickenham for 1950. Parts per million (unless otherwise stated). (a) Chemical. Description of the Sample Number of Samples Ammoniacal Nitrogen AIbuminoid Nitrogen Oxidised Nitrogen (Nitrate) Chlorides as cl Oxygen abs. from Permanganate 3 hrs. at 80° F. Turbidity, in terms of Silica Colour, m.m. brown, 2 ft. tube, Burgess's Tintometer Hardness (total) Hardness (permanent) pH. Value Phosphate as P.O. Silica as SiO2 Conductivity River Thames water filtered at Hampton Works 244 0.016 0.091 4.1 25.8 1.18 0.4 16 274 83 7.9 0.41 11.0 475 (b) Bacteriological. Description of the Sample Number of Samples Plate count (average per millilitre) Colonies counted on agar after 20-24 hrs. at 37°c. Bact. coli test Percentage of samples negative in 100 ml. Average number of Bact. coli per 100 ml. River Thames water filtered at Hampton Works 817 6.9 99.9 0.002 27 Table 10. Analysis of Complaints Received. Nature of Complaint Number Received Housing defects 695 Choked and defective drains 145 Accumulations of offensive matter 24 Unsound food 224 Verminous premises:— (a) Bugs 77 (b) Rats and mice 358 (c) Other 81 Keeping of animals 29 Unsatisfactory milk supplies 1 Miscellaneous 197 Total 1,831 28 Table 11. Summary of Visits, Inspections, etc. Number Dwelling-houses for housing defects under Public Health Act:— (a) After complaint. 1,854 (b) Subsequent visits 4,604 Dwelling-houses under Housing Act:— (a) After complaint... 267 (b) Subsequent visits 39 Dwelling-houses:— Housing applications, specially investigated 104 Infected dwelling-houses:— (a) After notified infectious disease (other than tuberculosis) 388 (b) Contacts ... 249 (c) Fumigations after infectious disease 14 (d) Phthisis enquiries and fumigations 27 School and church halls 23 Swimming baths 3 Water sampling:— (a) Swimming baths 1 (b) Dwelling-houses 9 Business premises 5 Cinemas, dance halls, billiard halls 47 Offensive trade premises 2 Stables, piggeries, keeping of animals 97 Houses let in lodgings Nil Factories Acts, 1937 and 1948:— Factories with mechanical power 192 Factories without mechanical power 15 Outworkers' premises 28 Common lodging houses Nil Underground rooms 36 Hairdressing premises 17 Tents, vans and sheds 74 Smoke nuisances 90 Fairgrounds 5 Drainage: Testing by:— (a) Smoke 58 (b) Coloured water 30 (c) Water 63 (d) Breaking down 213 Re public sewers 770 Watercourses and ditches 6 Land and tips 107 Septic tanks and cesspools Nil Sanitary conveniences—public-houses 17 Miscellaneous visits 1,043 Visits not inspections 1,833 Verminous premises:— (a) Rats and mice: (i) After complaint or from survey 201 (ii) Subsequent visits 511 (b) Bug infestations: Number of premises visited 247 Number of premises where definite infestation existed 78 (c) Cockroaches 10 (d) Other vermin 172 29 Table 11—continued. Inspections for supervision of food:— Unfit foodstuffs other than meat 303 Slaughterhouses 4 Butchers' shops (Public Health (Meat) Regulations, 1924) 343 Food and Drugs Act, 1938, Section 13:— Bakehouses 287 Fish shops, grocers and greengrocers 1,052 Factory canteens 12 Restaurant kitchens, etc. 456 Hotel and beerhouse bars and cellars: (a) Day inspections 85 (b) Night inspections 9 Food and Drugs Act, 1938, Section 14:— Ice-cream premises (Heat Treatment Regulations, 1947 and 1948) 220 Sausage manufacturers 6 Preserved meat preparation premises 1 Preserved lish preparation premises 71 Milk and Dairies Regulations, 1949:— Milk sampling for bacteriological examination 3 Contraventions of Milk and Dairies Regulations 4 Dairies 26 Shops Act, 1934, Section 10 and Shops Act, 1950, Section 38 27 Middlesex County Council Act, 1950:— Hawkers' vehicles 62 Hawkers' premises 47 Noise nuisances 10 Massage and/or special treatment establishments ... 25 Petroleum (Regulation) Acts, 1928 and 1936; Petroleum Spirit Regulations, 1929-1950 92 National Assistance Act, 1948, Section 47 9 Total number of visits and inspections 16,703 30 Table 12. Sanitary Improvements Effected. Number Offensive accumulations removed 11 Nuisance from keeping of animals remedied 5 Chimney flues repaired 2 Chimney stacks repaired 1 Roofs repaired 397 Eavesgutters repaired 160 Downspouts repaired 21 Pointing renewed 50 Drains repaired 25 Drains unstopped 27 Dustbins provided 179 Fireplaces repaired 60 Filthy condition of premises remedied 10 Floors repaired 139 Gullies repaired 18 Plaster to walls and ceilings repaired 426 Window frames and sashcords repaired 88 Public sewers repaired 16 Sinks provided 5 Sink waste pipes repaired 32 Soil pipes repaired 5 Stairs repaired 8 External walls repaired 13 W.C.s repaired 35 W.C. cisterns and fittings provided 65 W.C. accommodation provided 7 Yard paving repaired 20 Other works carried out 495 31 Table 13. Housing Statistics. I. Inspection of dwelling-houses during the year Number 1. (a) Dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 2,121 (b) Inspections made for the purpose 6,764 2. (a) Dwelling-houses (included under sub-head (1) above) which were inspected under the Housing Consolidated Regulations, 1925 Nil (b) Inspections made for the purpose Nil 3. Dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil 4. Dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 1,125 II. Remedy of defects during the year without service of formal notices Defective dwelling-houses rendered fit in consequence of informal action by the local authority or their officers 994 III. Action under statutory powers during the year A.—Proceedings under sections 9, 10 and 16 of the Housing Acts, 1936:— (1) Dwelling-houses in respect of which notices were served requiring repairs Nil (2) 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) Dwelling-houses in respect of which notices were served requiring defects to be remedied 88 (2) Dwelling-houses in which defects were remedied after service of formal notices: (a) By owners 79 (b) By local authority in default of owners Nil C.-—Proceedings under sections 11 and 13 of the Housing Act, 1936:— (1) Dwelling-houses in respect of which Demolition Orders were made Nil (2) Dwelling-houses in respect of which an undertaking was accepted under sub-section (3) of section 11 of Housing Act, 1936 Nil (3) Dwelling-houses demolished in pursuance of Demolition Orders 3 D.—Proceedings under section 12 of Housing Act, 1936:— (1) Separate tenements or underground rooms in respect of which Closing Orders were made Nil (2) Separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit 3 32 Table 14. 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 1,125 392 Number of Informal Notices complied with 994 337 Number of Statutory Notices served 88 — Number of Statutory Notices complied with 79 — Number of cautionary letters sent by Town Clerk — 5 Table 15. Offences under Food and Drugs Act, 1938. Case No. Section contravened Offence Action taken 1 Section 10 Nail in eccles cake Cautionary letter sent by the Corporation. 2 Section 10 Piece of metal in a stick of mint twist. Ditto 3 Section 13 Dirty condition of premises. Legal proceedings instituted. Fine of £12 imposed. 4 Section 10 Hairclip in slice of bread. Cautionary letter sent by the Corporation. 5 Section 13 Bottling of soft drinks in unsatisfactory premises. Ditto 6 Section 15 Sale of food in the open air not protected against contamination. Ditto 33 Table 16. Prevention of Damage by Pests Act, 1949 VISITS Initial Visits following upon Complaints or Resulting from Surveys Re-inspections for Laying Baits, Poisoning and Trapping Total Visits 8,723 8,865 17,588 NUMBER OF INFESTATIONS Food Premises Non-food Premises Private Dwellings Factories Rats only Mice only Rats and mice 53 103 607 15 719 54 5 DEGREE OF INFESTATION rats mice Reservoir Major Primary 50-100 Minor Secondary 1-50 Reservoir Major Primary 50-100 Minor Secondary 1-50 Nil Nil 724 Nil Nil 54 Prevention of Damage by Pests Act, 1949 notices served notices outstanding Preliminary Notices Statutory Notices Final (Default) Notices Preliminary Notices Statutory Notices Final (Default) Notices 202 28 5 9 3 Nil RAT DESTRUCTION WORK UNDERTAKEN BY:— corporation occupiers Rats Mice Rats Mice 590 54 134 Nil NUMBER OF PREMISES UNDER CONTRACT WITH CORPORATION TOTAL 644 12 months 6 months 3 months 1 month Others Total Receipts 16 300 286 23 19 £699 8s. 6d. 34 Eradication of Insect Pests. D.D.T. and Other Special Treatments. Number of Infestations Treated Type of Premises Ants Beetles Bugs Cockroaches Fleas Flies Lice Moths Silver Fish Wasps Weevils Wood Beetles Totals Dwelling-Houses — 3 78 1 13 59 — — 1 18 — 1 174 Food Shops — — — 1 — 11 — — — — — — 12 Totals — 3 78 2 13 70 — — 1 18 — 1 186 Total income for D.D.T. and other special treatments, £86 12s. 6d. Corporation premises treated (re-housed families only), 1.9 per cent. 35 Table 18. Disinfections, etc. Number Premises disinfected after infectious diseases 51 Premises disinfected after other diseases 4 Articles disinfected after infectious disease ... 128 Persons (children and adults) treated for scabies at cleansing station 28 Table 19. Housing Act, 1936. Overcrowding. The known cases of overcrowding on the register of the department at the end of the year were as follows:— Number (a) (1) Dwellings overcrowded at the end of the year 122 (2) Families dwelling therein 144 (3) Persons dwelling therein 561 (b) New cases of overcrowding reported during the year 33 (c) (1) Cases of overcrowding relieved during the year 44 (2) Persons concerned in such cases 98 Table 20. Milk and Dairies Regulations, 1949. Milk (Special Designation) (Raw Milk) Regulations, 1949. Milk (Special Designation) (Pasteurised and Sterilised Milk) Regulations, 1949. The necessary registration of persons and premises, and the issue of appropriate licences, has been effected in accordance with the following table:— Milk and Dairies Regulations, 1949. Persons registered as distributors14 Premises registered as dairies (not being dairy farms) 15 Special Designation Dealers' Licences Supplementary Licences Milk (Special Designation) (Raw Milk) Regulations, 1949. Tuberculin tested 20 9 Accredited Nil Nil Milk (Special Designation) (Pasteurised and Sterilised Milk) Regulations. 1949. Pasteurised 22 11 Sterilised 18 10 36 Table 21. Food and Drugs Act, 1938. Unhealthy Conditions in Food Premises. Number of premises found with unhealthy conditions 392 Number of premises remedied 337 Unhealthy conditions found in premises above Number of defects Number of defects remedied Accumulation of refuse 29 27 Ceilings—defective 58 35 Ceilings—dirty 149 144 Cleanliness (personal) unsatisfactory 14 10 Dampness 4 1 Floors—defective 77 46 Floors—dirty 38 46 Lighting inadequate 2 1 Sink—absence of 2 5 Sink-waste pipe inadequate 1 2 Storage facilities unsatisfactory 22 11 Ventilation insufficient 40 37 Walls—dirty 197 174 Wall-plaster—defective 62 63 Insufficient or absence of hot and cold water for cleansing utensils 43 40 Absence of hot water for ablution purposes 23 44 W.C. accommodation—insufficient or unsuitable 15 15 Other defects 398 354 Totals 1,174 1,055 Public Abattoirs. There is no public abattoir within the Borough. 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. Seven slaughter-men were on the register of the department at the end of the year. Table 22. Meat—Carcases Inspected and Findings at Private Slaughterhouses in the Borough. Cattle, excl. Cows Cows Calves Sheep and Lambs Pigs Number known killed — — — — 4 Number inspected — — — — 4 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 — — — — — Table 23. (a) Meat. Diseased and unsound conditions found in meat caused the detention and surrender for destruction of:— lbs. Beef 946 Mutton and lamb 313 Pork 28 Other meats 584 Total 1,871 (b) Other Foodstuffs. The following foodstuffs, other than meat, being unfit for human consumption, were voluntarily surrendered for destruction:— Eggs 673 Fowls — lbs. Bacon 283 Butter —. Cheese 11 Cooked meat — Fish. 427 Flour and cereals 1,062 Jam 207 Chocolate — Cake mixture — Biscuits — Sugar — Swedes — Potatoes — Tea — Fruit — Bottles Pickles 589 Canned foodstuffs:— Tins Fish 1,914 Fruit 839 Meat 515 Milk 1,362 Vegetables 3,004 Other 307 38 Table 24. Sampling. The Middlesex County Council is the food and drugs authority for the Borough. The Chief Officer, Public Control Department, has kindly supplied the following information relating to samples taken in the Borough during the year ended 31st December, 1950:— Article Taken Incorrect Milk (various) 171 2 Almonds, ground 1 — Beans (in tomato sauce) 1 — Beef Suet, shredded 1 — Brandy 1 — Brawn 2 — Cakes (various) 23 1 Cherries (in syrup) 1 — Coconut square 1 — Coffee 1 — Coffee and chicory essence 1 — Crab, dressed 1 1 Curry powder 2 — Drugs 5 1 Faggots 1 — Fish cakes 1 — Gelatine compound 1 — Gin 6 — Haddock, smoked 4 — Hake 1 1 Ice-cream 4 — Lemon butter 2 2 Lemon curd 2 1 Lemon sole 1 — Marmalade 1 — Marshmallow 1 — Meat, cooked 3 — Mincemeat 1 — Mustard 1 — Rum 3 — Sausages (various) 45 — Sausage meat 7 — Sausage roll 1 — Sherbert 1 — Tomato ketchup 1 — Vinegar, malt 1 — Whisky 25 — Total 326 9 39 Table 25. Factories Acts, 1937 and 1948. Part I of the Act. 1. INSPECTIONS for Purposes of Provisions as to Health : Premises Number on Register Number of Inspections Written Notices Occupiers prosecuted (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 56 14 11 - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 316 187 11 - (iii) Other premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) — - - - Total 372 201 22 — 2. Cases in which DEFECTS were Found : Particulars Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied Referred To H.M. Inspector By H.M. Inspector Want of cleanliness (S.1) — — — — — Overcrowding (S.2) — — - — — Unreasonable temperature (S.3) — — — — — Inadequate ventilation (S.4) .. 2 4 — — — Ineffective drainage of floors (S.6) - - - - - Sanitary Conveniences (S.7):— (a) Insufficient 3 1 1 1 — (b) Unsuitable or defective 7 3 - 2 — (c) Not separate for sexes 1 - - — Other offences against the Act (not including offences relating to outwork) 22 8 - - - Total 36 16 1 3 — Part VIII of the Act. Outwork. Nature of the work Lampshades Section 110 : Number of outworkers in August list required by Section 110 (1) (c) 5 Number of cases of default in sending lists to Council — Number of prosecutions for failure to supply lists — Section 111: Number of instances of work in unwholesome premises — Notices served — Prosecutions — 40 Table 26. Infectious Diseases. Incidence and Mortality. Diphtheria, Scarlet Fever and Enteric Fever. 1938-1950. Year Diphtheria Scarlet Fever Enteric Fever No. of Cases Case Rate per 1,000 pop. No. of Deaths Death Rate per 1,000 pop. No. of Cases Case Rate per 1,000 pop. No. of Deaths Death Rate per 1,000 pop. No. of Cases Case Rate per 1,000 pop. No. of Deaths Death Rate per 1,000 pop. 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 — — — — 1949 — — - — 128 1.20 — — — — — 1950 — — 115 1.07 — — — 41 Table 27. Ophthalmia Neonatorum, years 1938-1950. The following table shows the number of cases notified and result of treatment:— Year Cases notified Cases Treated Vision unimpaired Vision impaired Total blindness Deaths At home In hosp. 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 — — — 1949 — — — — - — — 1950 2 2 — - - — — 42 TABLE 28. Cases of Infectious Diseases Notified during the Year 1950. 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 Dysentery - - - - - - - - - - - - - - 1 — — Erysipelas - - - - -- - - - 1 3 6 8 1 1 20 - — Food Poisoning — 1 1 2 — 3 2 1 3 2 4 6 — 2 27 —• — Measles 7 12 24 32 28 113 6 2 — 5 2 2 — 2 235 — — Para-typhoid — — — — — — — — — — — — — — — Acute Poliomyelitis 1 1 1 — — 1 2 2 1 — 1 — — — 10 —' — Pneumonia — — — 5 1 7 3 3 — 4 4 12 5 2 46 —> — Puerperal Pyrexia - - - - - - - - 4 1 2 — — — 7 7 — Scarlet Fever 1 — 15 13 12 58 3 3 3 4 — 1 — 2 115 — — Typhoid Fever — — — — — — — — — — — — — — — — — Whooping Cough 7 7 19 20 17 45 1 2 1 1 - — — 1 121 - - Totals 16 21 60 72 58 228 17 13 13 20 19 29 6 10 582 7 — 43 TABLE 29. Monthly Incidence of Infectious Diseases during the Year 1950. DISEASE NUMBER OF CASES TOTAL January February March April May June July August Sept. October Nov. Dec. Dysentery — — — — — — — — — — — 1 1 Erysipelas 1 2 5 1 4 1 — 2 — 2 1 1 20 Food Poisoning — 2 — - — 1 3 5 7 5 3 — 1 27 Measles — 2 4 9 22 46 12 20 5 5 29 81 235 Para-typhoid — — — — — — — — — — — — — Acute Poliomyelitis 1 1 — — — — 1 3 4 — — — 10 Pneumonia 5 4 12 1 10 1 2 1 — 6 — 4 46 Puerperal Pyrexia 2 — — — 1 — — 2 — — — 2 7 Scarlet Fever 10 22 16 9 11 10 8 3 5 5 9 7 115 Typhoid Fever — — — — — — — — — — — — — Whooping Cough 8 10 — 5 5 13 25 13 3 12 13 14 121 Totals 27 43 37 25 54 74 53 51 22 33 52 111 582 44 TABLE 30 Ward Distribution of Infectious Diseases Notified during the Year 1950. Disease Twickenham Whitton Hampton Hampton Hill Teddington Hampton Wick Heathfield Total East Central South West Upper Lower Dysentery — — — — — 1 — — — — 1 Erysipelas 2 1 — 3 — 2 2 3 2 5 — 20 Food Poisoning 3 — 2 8 3 3 8 — — — — 27 Measles 71 18 14 28 42 22 14 9 9 4 4 235 Para-typhoid — — — — — — - — — — — — Acute Poliomyelitis 2 — 2 — 2 1 1 — 2 — — 10 Pneumonia 5 2 2 2 2 3 6 9 6 9 — 46 Puerperal Pyrexia — — — — — 7 — — — — — 7 Scarlet Fever 13 3 6 1 8 16 13 15 19 15 6 115 Typhoid Fever — — — — — — — — — — — — Whooping Cough 5 2 2 4 32 11 12 18 15 3 17 121 Totals 101 26 28 46 89 66 56 54 53 36 27 582 45 Table 31. Tuberculosis. The following tables have been compiled from the notifications received:— New Cases and Mortality. Age Periods New Cases Deaths Pulmonary Non-pulmonary Pulmonary N on-pulmonary Male Female Male Female Male Female Male Female Under 1 1 — — - - - - 1-4 3 — — 1 — - — — 5-9 1 3 1 1 — - — — 10-14 — — — — — - — — 15-19 2 6 — — — 1 — — 20-24 2 9 1 — 4 - — — 25-34 9 9 — 1 — 2 — — 35-44 17 5 - 1 4 2 — — 45-54 10 2 1 4 7 2 — — 55-64 9 2 1 2 10 — 1 — 65 and over 4 2 1 — 6 — 1 — Totals 57 39 5 10 31 7 2 — 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. Table 32. Primary Notifications of Tuberculosis, 1938-1950 inclusive. 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 Pulmonary 100 106 114 127 112 119 133 118 120 132 117 115 96 Non-Pulmonary 30 19 12 14 18 18 18 18 19 11 17 5 15 Totals 130 125 126 141 130 137 151 136 139 143 134 120 111 46 Table 33. Food Poisoning. Food Poisoning Notifications : 1st Quarter 2 2nd Quarter 5 3rd Quarter 15 4th Quarter 3 TOTAL 25 Outbreaks Due to Identified Agents : Number of outbreaks 3 Number of cases 45 Outbreaks due to : Salmonella organisms 1 Staphylococci (including toxin) 2 Outbreaks due to Undiscovered Cause: Number of outbreaks 2 Number of cases 8 Single Cases : Cases due to identified agents : Staphylococci 3 Salmonella 2 Number of cases 5 Cases due to undiscovered cause : Number of cases 17 Total all cases 75 47 00 TABLE 34. Clinics and Welfare Centres. The following clinics are being held within the Borough:— Clinic Address By whom provided Infant Welfare Centres York House, Twickenham; Hospital Bridge Road, Twickenham; Church Road, Teddington; 24, Station Road, Hampton; 20, Seymour Road, Hampton Wick. Middlesex County Council. Ante-Natal Clinics York House, Twickenham; Hospital Bridge Road, Twickenham; Church Road, Teddington; 24, Station Road, Hampton; 20, Seymour Road, Hampton Wick. Middlesex County Council. School Clinics York House, Twickenham; Hospital Bridge Road, Twickenham; Stanley Road, Teddington; 24, Station Road, Hampton; 20, Seymour Road, Hampton Wick. Middlesex County Council. Dental Clinics York House, Twickenham; Hospital Bridge Road, Twickenham; Church Road, Teddington (Orthodontic). Middlesex County Council. Ophthalmic Clinics York House, Twickenham; Stanley Road, Teddington. Middlesex County Council. Diphtheria Immunisation York House, Twickenham; Hospital Bridge Road, Twickenham; Church Road, Teddington; Stanley Road, Teddington; 24, Station Road, Hampton; 20, Seymour Road, Hampton Wick. Middlesex County Council. Child Guidance Clinic 58, Hampton Road, Twickenham. Middlesex County Council. Orthopaedic Clinic Church Road, Teddington. Middlesex County Council.