The Annual Report of the Medical Officer of Health. JOHN MADDISON, M.D., B.S., D.P.H. TWI20 NOVEMBER. 1953 GOOD HEALTH IN TWICKENHAM Ac439(1)TWICKENHAM k4/1/54 Cm CONTENTS Page Introduction 2 Health Committee and Staff 3 Smoke Plus Fog Equals Smog 4 Are You Fat or Thin ? 7 Blood Pressure 11 The War of the Virusts 12 Poliomyelitis 14 Cancer and Smoking 16 Dental Service 17 Pest Destruction 17 Keeping the Borough Clean 18 Water Supply 18 Industrial Health 19 General Matters 19 Statistical Summary 24 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 the statistical tables for the year 1952 as required by the Ministry of Health. The health of the population of the Borough is good and the sanitary circumstances, with few exceptions, are satisfactory. Medical officers of health are now directing their attention more and more to the prevention and control of illnesses which are not infectious; such as, for instance, the heaviest killing diseases, cancer and heart disease. These and many others are claiming much thought, investigation and research. In the field of infectious illnesses there has been progress in the control of tuberculosis, influenza, whooping cough, and poliomyelitis. In the body of the report I have given some account of diseases and conditions which are of current interest. Since my last report I have been working out a variety of statistical techniques suitable for application to the research in the school health service which is still in progress, and I hope to report the results of this research in the near future. 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. 2 MEMBERS OF THE HEALTH COMMITTEE Ex-officio members: His Worship The Mayor, Councillor F. J. Edwards, J.P. The Deputy Mayor, Councillor H. F. Inkpen. Chairman: Alderman J. Allinson Vice-Chairman: Councillor Mrs. J. L. Gill Alderman J. H. Knaggs, J.P. Councillor S. A. Gee Councillor R. C. E. Brown Councillor J. W. M. Hurles Councillor G. D. Burnett Councillor A. T. Kremers Councillor J. Clapson Councillor Mrs. O. M. Renier Councillor Mrs. M. B. Davies Councillor N. Sheldon 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.) Senior Sanitary Inspector Mr. H. G. Easter Deputy Senior Sanitary Inspector Mr. H. D. Smith c T , f Messrs. L. Burrows, K. E. Evans, Sanitary Inspectors J. A. K. Garratt, J. W. Paine, J. Hacker 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 K. Dopson Senior Rodent Operative ... Mr. H. T. Jackman Rodent Operatives Messrs. C. H. Deacon, J. Jago Disinfector/Drain Tester Mr. E. G. Cooper 3 SMOKE PLUS FOG EQUALS SMOG A Major Disaster. On 5th December, 1952, a great fog descended on London and over 4,000 people lost their lives. Its effect was greatest on those over middle age, especially the elderly, and very young infants. Fog is caused when warm moist air is cooled quickly. Under ordinary conditions the air near the earth's surface is comparatively warm as compared with that of the upper air; the lower layers of air are constantly rising and they are being replaced with air coming in from other places, causing a breeze or wind. We usually have a certain amount of cloud in the upper air which prevents excessive radiation of the warmth of the earth's surface; but occasionally, as on a clear starry night, the warmth in the earth's surface can radiate rapidly and the ground can cool quite quickly. When this happens no air rises and there is no wind; if the air is moist fine drops of moisture condense on particles of dust, forming a mist. If at the same time the air is laden with particles of soot or grit from chimneys, the mist soon turns to a dense yellow fog. Sulphur dioxide, sulphur trioxide and other products of combustion of fuel are added to the fog and give it the objectionable taste and smell and other harmful effects. On 4th December we had a large anti-cyclone with severe cold weather which stayed with us until 9th December. During those days the amount of smoke, sulphur dioxide and sulphur trioxide in the atmosphere was five times greater than usual. The Danger of Sulphur Dioxide. Recent research reports tell us that when sulphur dioxide is carried to the lungs in the presence of moisture it forms sulphurous and sulphuric acid; in this form it becomes exceedingly poisonous and can kill an animal in four seconds. We read last December of the distressing symptoms in the cattle at the fat stock show at Olympia; five of the animals died. The research reports also tell us that when people breathe air containing sulphur dioxide their pulse and respiration rates rise, they breathe more rapidly and may have symptoms of distress. After breathing moderate quantities of sulphur dioxide continuously we can acquire a certain amount of immunity to the poisonous effects of the gas, but this may only happen at the cost of a chronic inflammation of the upper air passages and we cannot say how much permanent damage may be taking place. Twickenham had its share in the fog disaster. In an ordinary winter the number of deaths each week in the Borough gradually begins to rise during November and December and attains a maximum about February. The number of deaths which occurred each week in the few weeks before and after the great fog are show diagrammatically in the following figure. 4 The deaths took a sharp rise just immediately following the fog; there is no doubt the fog hastened the deaths of quite a number of people in Twickenham. Prevention of Smog. There is only one way of preventing the evil effects of smoke-laden fog and that is by preventing the emission of smoke from chimneys. The Health Committee have often discussed this question and at their suggestion the Council recently rejoined the National Smoke Abatement Society. The chairman, Alderman J. Allinson, and the Senior Sanitary Inspector, Mr. Easter, attended the annual conference of the Smoke Abatement Society at which a discussion took place on the evil effects of the London fog and on measures for preventing the emission of smoke. About half the smoke poured into the atmosphere comes from domestic hearths and amounts to some 900,000 tons per annum. 5 Any scheme for eliminating the domestic portion of the atmospheric pollution must therefore obtain the co-operation of householders. Many people have urged that householders should fit the modern improved types of grate which bum fuel more completely than the older types; and also should burn in them nothing but smokeless fuel. If they cannot do this they should use gas or electric fires. Of course, the essential point is to burn nothing but smokeless fuel, but it is well known that the supply is far too small to supply all domestic users throughout the country, to say nothing of the higher cost which most householders would be unwilling to pay. Even the old-fashioned type of grate can burn smokeless fuel with comparatively little smoke, but that is not what the householder wants. With the continuous burning types of grate the housewife wants the fire to stay on all night so that she does not have to light it again in the morning. Mr. Easter has pointed out that housewives soon discover that the best way to keep the fire in all night is to bank it up with slack and then cut off the draught. The fire goes on smouldering all night, sending out soot and sulphur dioxide from the chimney, which on a cold and foggy night will mingle in the atmosphere, contributing its quota of smog. To bank up with nutty slack, coal dust or even ashes is cheaper than burning smokeless fuel; it ensures that the fire is still burning in the morning; and serves the purpose of getting rid of an otherwise unusable accumulation of coal dust, These are important points to the housewife, as not only can the house be kept warm at a very low cost, but save much labour in laying fires and chopping sticks. There can be no doubt that the continuous burning fire has proved of great domestic value, as the tremendous sales over the past few years—said to be over two and a quarter million for the country—have shown. In London it is probable that half a million continuous burning fires poured their contribution into the fog-laden air all through those critical four days and nights last December; and at night these stoves would nearly all be burning coal dust or slack. During the night the combustion rate would be slow and thick tarry smoke caused by low temperature combustion would be emitted. Smoke of this type must have made a substantial contribution to the conditions which obtained during this vital period. The closed boilers for heating domestic water do not cause much pollution because they will only burn continuously on smokeless fuels, and any attempt to bank them up with coal dust or nutty slack puts the fire out. A Possible Remedy. Mr. Easter has suggested that whenever the meteorological experts consider that a fog is imminent, the B.B.C. should be asked to broadcast an appeal to all housewives to let all domestic fires go out during the night. If possible, it would be better still if all domestic fires were actually put out when such a warning was broadcast. It is very likely that the main trouble from continuous burning fires occurs during the night when the air consumption is reduced to a minimum to ensure that the fuel burns slowly. In the daytime most people prefer a bright fire, using more air for combustion and consequently emitting less fuel. I am sure that many housewives would answer such an appeal, and even if this is only a partial remedy it would surely result in a reduction of smoke and no doubt a saving of life. 6 Smokeless Fuel. On the production of smokeless fuel, it has been said that we should concentrate on the areas of heaviest pollution as in Greater London and that the main supply of smokeless fuel should go to these areas. With the assistance of the Government and local authorities it is claimed that it would be possible to achieve this aim in four years. Some local authorities have sought powers in local Acts to establish smokeless zones, but even given that the furnaces in buildings are all capable of being operated continuously without emitting smoke, and that the best appliances are available in households, the solution still turns upon the supply of smokeless fuel available, and there is just not enough. In the meantime we can do something towards directing public attention to the dangers of adding more smoke to the atmosphere in times of fog, and the peril to elderly people in such circumstances. There has recently been a committee set up under the chairmanship of Sir Hugh Beaver to examine the nature, causes and effects of air pollution and to consider preventive measures, and the Ministry of Health is also conducting a medical enquiry. The knowledge that every fog tends to shorten the lives of people over middle age will probably do most to engender a healthy respect for the prevention of atmospheric pollution by smoke. ARE YOU FAT OR THIN? In previous reports I have written about safe food and the effects on the nutrition of children living in various types of home. Now that we see the end of rationing in sight, my thoughts have turned to the effects of food on the body, and to the question of how much or how little food is good for us. With famine in various parts of the world and constant threats of wars, the subject is always of outstanding interest to us as a community. The subject of undernutrition had always engaged the attention of school medical officers who have tried to find methods of measuring the amount of undernutrition in children. At the same time research has been going on on the subject of overnutrition. For instance it has been observed that fat people tend to develop high blood pressure and to die earlier of heart disease and stroke. Our death returns for Twickenham show that heart disease and stroke is becoming commoner as the cause of death after middle age. Only one thing determines whether a person shall be fat or thin, and that is the amount of food he eats. If he eats more food than he needs for his energy requirements he will grow fat; if he eats the correct amount he will remain stationary; if there is too little food available he will grow thin; and if the restriction is severe he will ultimately die of starvation. Growth. During the growing stage the cells of the body multiply and the organs enlarge as growth proceeds. If the constituents of the diet are in the correct amounts to supply the protein necessary for the multiplication of the cells and the fat and carbohydrate necessary for energy, then growth will take place 7 at an optimum rate. If there is an excess growth rate, maybe in advance of the optimum, then a child will tend to store carbohydrates and fats and be overweight. If the supply of constituents is insufficient, the amount of growth is slowed down; growth rate is then less than the optimum, so that a child has no fat for storage and will be quite thin. In the body, the mechanism for controlling the accuracy of the energy balance with the amount of food eaten must be astonishingly accurate, for as Professor McCance1 of Cambridge points out, if the mechanism is out of adjustment by as little as one-thirtieth of an ounce per day, this would amount to a gain in weight of about fifteen pounds in twenty years. This is about the normal amount of middle-age spread in the forties. Regulating Requirements. We use up energy when we are asleep, sitting, dressing, walking, playing, doing our work or merely idling about. The average man needs about 3,000 calories per day in food requirements to balance his energy expenditure. But individuals vary widely from this average, one person requiring more and another person less, and each individual himself varies in his requirements from day to day, depending on the circumstances in which he is required to expend energy; yet in the long run the balance over a number of years is very exact, The balance cannot be kept good by any conscious effort, because a child of eight months can regulate his own rate of growth automatically, and all animals do the same. In primitive times food must have been scarce, and cooking, if any at all, exceedingly simple. The survival of the fittest will have been in those who had hearty appetites, could eat simple uncooked food without indigestion, and who developed into shapes tending to swiftness rather than fatness. Those people who are overweight are so because they live in a civilised world with plenty to eat, and their regulation mechanism has broken down, The exact mechanism which regulates appetite is not known; it may be regulated by the amount of glucose circulating in the blood which affects certain sensitive cells in the brain; but other things, such as smell, sight, hearing and memory, are all associated. The regulating mechanism of a person may break down in a number of ways; the result of course is an increase or decrease in weight. Decrease from shortage of food in time of war or famine is obvious; also from illnesses and afflictions such as obstructions of the stomach or bowel which interfere with the proper intake of food. Expectant and nursing mothers often consume enormous quantities of food in preparation for the developing baby and its feeding. Some people overeat because it gives them a sense of wellbeing and freedom from care. Food acts as a sedative; after a hearty meal we feel less anxious, less inclined to restless activity, and more content with the world in general. It may be that food supplies some substance soothing to the nerves. Other people take a sort of perverted pride in being excessively fat. Under the stress of emotion people tend to undereat, as when worries and troubles overtake them. Indeed, any kind of emotion can allay appetite, such as unsatisfied love, or a desire to attract attention by fasting or refusing food. A change of habit can lead to increased weight, such as when a man gives up walking or cycling and goes by bus or car instead. As age advances, the regulating mechanism seems to weaken with a consequent tendency to put on weight. In extreme old age the desire to exert oneself, to acquire the necessary amount of food may fail completely. Some people, however, following a 1 McCance, R. A. (1953). Lancet II. 739. 8 change in habit may increase in weight to some extent and then stabilise themselves at a new and heavier level. Most healthy people in this country can consciously control the amount of food they take or do not take. Hence if you are sufficiently interested and determined, your weight, so to speak, is in your own hands. Body Constituents. The body is made up of four main groups of tissues: (1) the cell mass— muscles, liver, kidneys, pancreas, brain, etc.; (2) the extracellular fluid—blood, lymph; (3) the bone or skeleton; (4) the fat—under skin, in the abdomen, round the kidneys and heart. In true undernutrition there is a decrease in the cell mass and an increase in the extracellular fluid. In overnutrition the main change is a large increase in fat. Of course, the proportions of the four constituents vary in different people and there is no exact proportion which is ideal for everybody. In severe malnutrition, the muscles will waste away to provide the necessary ingredients to maintain the composition of the internal organs such as the heart, brain and kidney. As tissues are used up fluid takes their place, so the extracellular fluid increases. In undernutrition the compensatory mechanism is remarkable, so that a person can be severely malnourished without appearing to be so. In children, if the malnutrition is not too severe, the mechanism is changed so as to preserve as much as possible the cell mass at the expense of growth, so that growth may be delayed for months or years and the child remains at a standstill. This effect is probably due to the presence in children of a growth hormone, one of whose effects is to spare the consumption of proteins as much as possible. Development. Overweight and obese women tend to have large babies, and conversely undernourished women tend to have small babies. Both very large babies and very small babies have less chance of survival than an average-size baby of 6½ to 1½ lbs. The baby of an undernourished mother is generally premature, even if born at full term, because the development of the baby has been delayed. In conditions of undernutrition in young animals and children, growth is delayed so that a child aged, say, seven may be only the stature of a child aged five. However, if such a child is provided with abundance of the right food, in time he will catch up and come level with the other children who are average in his own age. On the other hand, in growing animals, the slow growth rate prolongs the life of the animal so that it takes longer for the animal to become mature, and its whole life processes are spread over a longer period. If the growth rate of children is slower than normal and prolonged beyond the age of about eighteen or nineteen, then the growing ends of the bones become united to the shafts and the adolescents remain permanently at a stature less than they could have done. We have often noticed the differences in stature between children of the same age in different schools, one from a rich area and another from a poor area, and the same applies to their parents. I know cause may be effect and vice versa. Maturity. It seems that nature likes to have her plants animals and human beings as near perfection as possible by the time they reach the early adult stage of life when they are ready for the propagation of their species. Nature has 9 plenty of time, and if the individual is slow in developing to the adult propagating stage, nature does not mind—she is content to wait. If on the other hand the individuals mature early and become fit for propagation early, then, when that stage is over and the young have been born, nature is satisfied and the adult may die. Well-fed children are taller, heavier, and suffer less from defects and diseases, than those less well fed. It is possible that growth is stimulated by an increase in the amount of insulin in the blood and by increased saliva in the swallowed food. These children thus come to biological maturity earlier by good feeding. If overnutrition and obesity continues it will tend to shorten their lives. Fat men and women are more prone to accidents and are bad insurance risks. Heavy consumption of fat leads to an increase in the blood of serum cholesterol, which leads to arteriosclerosis and high blood pressure. Fat people get diabetes more readily, possibly because more demand is made on the cells in the pancreas which supply insulin. Changes also take place in the kidneys and other organs of fat people. Taken together these signs are the signs of early degeneration and completion of the life cycle. So if you wish to delay your departure from the miseries of this wicked world, you must keep down your diet, especially your intake of fat. When I am asked for advice on slimming, I sometimes say "take minced meat and cabbage three times a day", meaning that the person should take a moderate diet of protein and green vegetable, with a minimum of starchy foods and fat. Living Standards. However, a contented mind needs a well-filled body. In conditions of undernutrition, people become restless and their standard of behaviour falls. They become less scrupulously honest in their dealings, or even amoral; ordinary good living people take to lying and stealing, and they inevitably impart these principles to their children. I wonder if this wave of crime which we have seen this few years, especially among juveniles, is not the result of lowered moral standards from food scarcity which we went through during the war years. It is a sobering thought if a period of starvation leads to a generation of criminals. I reported last year on the special investigation we are conducting about the health of school children. It is conceivable that there might be an optimum rate of growth and development for children which would ensure that they are neither over or undernourished, with the consequent dangers from both. I hope our investigation will help us to reach some conclusion about this. If we could say that the best birth weight was so much and that a child fed in such a way would attain the ideal growth rate and hence have the minimum of disabilities and illnesses, we should have effected a great step forward in public health. This much we can say, that now as in the past, a great many diseases can be avoided if we take the trouble to live healthily, even although we do not know the exact causes of the diseases we are avoiding. Years ago it was known that a clean water supply would avoid the danger of typhoid fever; that was before the cause of typhoid fever was known. To-day if we avoid over-indulgence, obesity, alcoholism, heavy smoking, dusty and foggy air, unwholesome food and such like, we can avoid a great many dangers, even although we do not know the exact mechanisms by which these evils cause diseases; and in the meantime we may be confident that future research will provide us with the knowledge. 10 BLOOD PRESSURE Hypertension. In normal healthy persons the blood is held at a pressure of about 70 millimetres of mercury; every beat of the heart forces a quantity of blood into the arterial system and the pressure is raised to about 120 millimetres of mercury for a fraction of a second, and then it drops again to 70 until the next heart beat starts the cycle again. When a patient suffers as we say from "blood pressure" we mean that the ordinary normal blood pressure is habitually higher than it should be, and that there is a threat to the health or life of the patient. The blood pressure rises in times of stress or excitement and will subside naturally to normal limits when the stress or excitement ceases. In acute infection of the kidney, or in the affection of the kidney due to abnormal poisons in pregnancy, the blood pressure can be raised, sometimes quite dangerously, but the pressure returns to normal when the infection is healed or the pregnancy ended. Other forms of disease of the kidney or the adrenal gland near the kidney can produce high blood pressure; if the affection is confined to one site, and if it is possible to remove the cause, there is sometimes resumption of the normal blood pressure. The Dangerous Level. However, there are some cases of high blood pressure whose cause is not exactly known; the blood pressure in these persons continues to rise and to remain at a high level in what appears to be the absence of any obvious disease. Indeed, the blood pressure can go on rising until it gets to such a level that the nerves in the retina at the back of the eye become affected and both sight and life are in danger. Raised blood pressure which is not excessive is known as benign hypertension, but the type which approaches dangerous level is known as malignant hypertension. In the absence of known cause the two together are designated essential hypertension. The threat to life is from stroke—a vessel bursting in the brain. Most doctors distinguish two types of raised blood pressure, that due to diseases of the kidneys known as renal hypertension, and that due to other but unknown causes known as essential hypertension. However, whether the causes of the raised blood pressure is due to kidney disease or to some unknown cause, the very presence of the high blood pressure itself has an effect on the kidneys, which degenerate and become diseased and make the blood pressure rise higher still. If it is possible to lower the blood pressure in some way, it is possible to avert the dangerous phase of malignant hypertension and to save life and eyesight. The reduction of blood pressure can be effected by operation, or by drugs. There are very marked differences in individuals; women can sustain a level of high blood pressure which in men would in a few years turn to the malignant type with dire consequences. 11 Exaggerated Responses. The level of blood pressure may rise and fall in response to physiological stresses, strains and necessities. It may also rise and fall if there is any disease within the body which requires a temporary rise in blood pressure to supply blood to an affected part. It would seem when this occurs in some individuals there is a secondary response by the tiny arteries of the body which contract to keep the blood pressure high; but when the time comes for the pressure to be reduced again, the mechanism for the relaxation of the arteries seems to fail; so that the blood pressure remains permanently at a higher level than before and at a level higher than it need be. The small arteries seem to exaggerate the requirements of nature. Thus the mechanism which sends up the blood pressure to counteract or cure some disease itself results in damage to the tissue of the kidneys. When this occurs a vicious circle is set up, the kidney lesions themselves producing a higher blood pressure, the kidney disease getting worse, the blood pressure going higher still and so on. This is the dangerous and distressing fact about high blood pressure, namely, that a physiological response becomes over-exaggerated. Prevention. Year by year our death returns show that fatalities due to high blood pressure, especially stroke, are, together with cancer, becoming a commonest form of terminating this life. There is some evidence to show that excessive intake of fat produces some chemical which causes the blood pressure to rise, and that once the rise has started it is very difficult to reverse it. This may be only one of many causes, but in the meantime a preventive measure would be for people to avoid getting excessively fat. THE WAR OF THE VIRUSES Atypical Infections. It is possible that we acquire immunity to many more virus infections than was once thought to be the case. I recently saw some children with spots on the skin very like those seen in chickenpox. Most of the children had been diagnosed as cases of chickenpox, and yet on close examination of the lesions I thought they were not just exactly typical of classical chickenpox as described in the books. There was something different about the shape and the grouping of the spots and the amount of crusting. The condition was very infectious and had spread through a community of children, in which practically all had been infected. Young children often have little spells of fever with vague symptoms, the whole illness passing off within, say, 12 to 24 hours; a doctor is never called in and the illness is never diagnosed. Epidemic Nausea. In January, 1952, there was an outbreak of epidemic nausea, or winter vomiting. Although this condition is not new, I have not seen it in this borough in such proportions as it appeared to be that winter. The practitioners were good enough to notify it voluntarily and we investigated about 60 cases. 12 The illness occurred mostly in adults who were off colour for one or two days with nausea, vomiting, headache, slight rise of temperature and malaise. The laboratories were exceedingly busy at that period, and were not able to devote the necessary staff to the investigation of the organism, but I have no doubt the illness was due to a virus spreading from one person to another. Colds. Most people have noticed how frequently they get a cold in the head on returning from a holiday, especially from one where they have been away from crowds of people. It is possible that the virus of the common cold gains access to the lining of the nose and throat because the ordinary bacterial inhabitants are less in number than usual. It is possible that the bacteria have developed some defensive mechanism against attacks against themselves by the much smaller viruses. Still higher in the evolutionary scale are the moulds, which are tiny plant-like structures, and which can manufacture substances like penicillin which have a deleterious influence on the growth and multiplication of certain bacteria. Unicellular organisms like the amoeba can ingest and absorb the chemicals which make up the bodies of the bacteria. A similar mechanism exists in the human body in which the white cells of the blood perform a similar function when we are infected with bacteria. It is tempting to think that in the battle of the species, the organisms higher in the series develop defensive mechanisms against the inroads of the organisms lower down, and that possibly over the millions of years the biological battle has resulted in an equilibrium so that it may be that the survival of the higher organisms depends on a balance of activity between the viruses and the bacteria. Structure of Viruses. There is some evidence for thinking that the viruses consist of chains of amino acids assembled in a spiral form, like the coil of a spring with bulges on the wire every so often throughout its length. Variations can take place in the amino acids occupying the various positions in the spiral. It may be that the closely similar or mutant forms of the viruses are merely variants of amino acids in closely similar positions. It may be that a living cell on the human body can absorb a certain amount of the virus and in doing so the cell constituents are modified in some way. The effect of the presence of the virus lasts throughout a lifetime, thus preventing further inroads of the same virus, and indeed also of closely similar or related viruses. Hence we get the phenomenon of vaccination whereby the virus of vaccinia or cow pox whilst occupying the cells of the body prevents the inroad of the closely related smallpox virus. Even more curious still are viruses quite different in their construction and effects which can exclude each other from the human living cell. Thus the virus in the vaccine of yellow fever will prevent an attack by the virus of influenza A. This action might explain some curious things, such as why one child in a family does not get chickenpox or measles at the same time as the others; why some people get the paralytic form of poliomyelitis, whereas others do not. Do these exceptions depend on a previous immunising effect by other viruses, which although they occur in the majority of people miss a certain small proportion ? A virus can sometimes become active when it attacks a tissue which ordinarily it would not attack, as when a child gets respiratory paralysis in poliomyelitis following operation for tonsillectomy, or where an anti-diphtheria inoculation has possibly been contaminated and a 13 virus injected into the muscle. This event does not now happen in our clinics since we adopted the subcutaneous method of immunisation. And finally, certain forms of warts on children have been found to be caused by a virus infection; which leads to the thought, could it be that cancer in older people is caused by virus infections which we have not yet detected ? POLIOMYELITIS During the past few years there has been remarkable progress in out knowledge of poliomyelitis. We know the disease is caused by a virus, one of the smallest organisms known. For many years the only known method of cultivating the virus was by injecting it into the brain of a living monkey; but recently the bacteriologists have learned how to cultivate it on tissue-cultures and in developing chicks in eggs. It has been found there are at least three different species of virus, each one quite distinct in the illness it produces; they are known as Brunhilde (type 1), Lansing (type 2), and Leon (type 3), Each type produces a specific immunity in a person attacked, but the immunity does not protect against either of the other types. Epidemics. Before 1947, poliomyelitis in this country was endemic; that is, odd cases occurred here and there throughout the year. It is believed that the organism mainly responsible was the Lansing (type 2) species; also that most people received an infection from this organism in early childhood and acquired immunity, but that a few were stricken with the paralysis in varying forms of severity. However, in 1947 there was a tremendous epidemic outbreak of a much more severe type, with frequent paralysis both of the skeletal muscles and of the respiratory and swallowing mechanism, and many deaths. The epidemic wave has been high in the autumn of every successive odd year from 1947, that is, in 1949, 1951 and 1953, and moderately high in the even years. By far the commonest species now found is the Brunhilde (type 1). This species seems mainly to have been responsible for the widespread epidemics in the United States and in Copenhagen. In order of importance the main killing infectious diseases are now tuberculosis, influenza, whooping cough, and poliomyelitis. But poliomyelitis inflicts by far the greatest amount of residual damage in the resulting paralysis and crippling. Clinical Cases. For convenience we divide the population who have been infected with any of the types of poliomyelitis as follows:— Group 1. Non-paralytic, where no residual paralysis has occurred. (a) Silent immunising infection. (b) Abortive type with fever. (c) Severer type with neck stiffness. Group 2. Paralytic, where paralysis has followed infection. (a) Spinal type. (b) Bulbar type. 14 It is supposed that most infants and young children get exposed to infection, and without showing much sign of illness acquire an immunity which is probably life-long. This type of immunising reaction is thought to be probable in the case of Lansing (type 2), in which the reaction has only rarely been severe, and also possible in the two other types. It is not known what proportion of the population become thus immunised; it may possibly be perhaps 80 per cent. In group 1 (b) infection, the patient—usually a child—has a rise of temperature for a day or two with a feeling of malaise, sore throat, and a flushed appearance, and possibly headache and abdominal pain. The condition is almost indistinguishable from any type of feverish infection, and might suggest an early sore throat, or a bowel infection. The patient recovers and has acquired life-long immunity. In group 1 (c) the symptoms are similar, but more severe, and there is neck stiffness; the patient cannot kiss his knees. The condition suggests meningitis, or meningismus from any toxic illness; food poisoning; or acute infection of the kidney or rheumatic fever. The neck rigidity disappears if the patient is laid face downwards with the head over the edge of the bed, a sign which distinguishes poliomyelitis from true meningitis. Again, even with this more severe illness, the patient recovers and acquires a life-long immunity. In group 2 (a) the illness can cause paralysis of any muscle of the body, including the urinary bladder and the diaphragm. In group 2 (b), in additon to paralysis of skeletal muscles, there occurs paralysis of the muscles of the throat, voice, and respiration; it is very serious and frequently fatal. For groups 1 (c), 2 (a) and 2 (b) admission to hospital is necessary and the disease must be notified. In group 1 (b) the patient should be isolated in bed and if the doctor suspects a poliomyelitis infection he should notify it. Preventing Poliomyelitis. It is reasonably certain that poliomyelitis is acquired by contact with a case, or with a carrier. Arguments have been advanced for requiring quarantine of all individuals who have been in contact with the patient up to four days before the onset of the illness; this would include all persons living in the same house, contacts outside the family and contacts at the place of work or school. The period of quarantine for an individual should be 15 days, and for a group even longer. The difficulty with such a policy is that many people do have contact with patients and carriers without subsequent harm; and it is not possible to predict who will be victims. In America, a trial has taken place with various vaccines prepared from cultures of poliomyelitis virus. Children have been inoculated and the vaccines appear to be safe and capable of stimulating the production of protective substances in the blood. The vaccines, however, are not yet ready for universal use. In another experiment in America, the protective effect of gammaglobulin has been demonstrated. This substance is a fraction of the globulin part of human blood. We know that this substance will abort or modify an attack of measles if injected in the early stages. On the same analogy it was tried in various towns in the United States where poliomyelitis epidemics were present during 1951 and 1952. It was shown that less children suffered from an attack of poliomyelitis when injected with gamma-globulin than in those injected with an inert substance. However, such a method of prevention is not at present a practicable method, because gamma-globulin is scarce and difficult to prepare, and the effect is only temporary. 15 We have had a country-wide epidemic this summer, not so great asi 1947, but still fairly widespread. Twickenham has been fortunate in havin only 9 cases, of which 7 had paralysis and 2 no paralysis. Two of the paralyti patients died. The public, justifiably, have a widespread fear of this illness although it receives far more publicity than tuberculosis, which is much moi frequent and serious. CANCER AND SMOKING Since about 1920, the national death statistics have shown more and mor cases of people dying from cancer of the lung. When allowance is made fo the more ready use of X-rays and increased accuracy in diagnosis, there is m doubt that the increase in deaths from lung cancer is real. This last year o two there have been a number of reports which show that cancer of the lung has in part something to do with smoking. An investigation carried out in 1950 by Dr. Doll and Professor Bradfori Hill,1 showed that more people died of cancer of the lung who were heavt smokers than those who were not; and that the probability of dying of cancel of the lung was roughly related to the number of cigarettes or amount of pipe tobacco smoked. A person who smoked 20 or 30 cigarettes a day was mori likely to get cancer of the lung than a person who smoked two or three only The method of carrying out the enquiry was to question those people in hospitals with known cancer of the lung about their smoking habits, and then to question other people of equal age and sex, but without cancer of the lung, and then to compare the answers of the groups. It is not of course claimed that smoking is the sole cause of cancer of the lung, but it may be a contributory factor, That there are other factors is shown by Dr. Stocks,2 who has reported that the risk of dying from cancer of the lung in any area is closely related to the amount of smoke which is poured into the atmosphere and which may contain sulphur dioxide, arsenic and benzpyrene. The greatest risk occurs in the large densely populated towns like London, Manchester and Liverpool. The effect of the prevailing wind is to increase the risk of lung cancer in those districts which receive the smoke blown towards them, as in Finsbury, Shoreditch, Bethnal Green, Stepney, and Bermondsey in the London area. In the present state of our knowledge all we can say is that when certain products of combustion are inhaled over long periods, they do something to the lung tissue which makes it more susceptible to an attack of cancer. We do not know which products of combustion do it, but they are the things which come from burning coal, and presumably burning tobacco. It may be that these products have to be associated with something else; it could possibly be a virus, but that we do not know. At any rate it would seem a useful preventive measure to limit the amount of smoke inhaled, whether it comes from tobacco or from our chimneys. 1 Doll, R., Hill, A. B. (1950), Brit. Med. J., 2, 739, and (1952), ibid2, 1271. 2 Stocks, P. (1953), Brit. Med. J., 2, 847. 16 DENTAL SERVICES The position in the priority dental services is slowly improving. In 1951 in Area 10 we had five dentists, and now we have equal to eight with the early prospect of more. Three years ago we engaged an oral hygienist to assist the dentist with minor dental procedures like scaling and polishing in certain clinics. Her services have proved invaluable and the experiment fully justified. These auxiliary dental workers can relieve dental surgeons of a great deal of the less exacting work and so save valuable time; thus the operations of scaling and polishing are done with staff at a salary less than half that of the dentists, which is common-sense economy. There are many more minor procedures done by qualified dentists which could quite well be done by less qualified auxiliary helpers; but as the law stands at present it is illegal for anyone other than a dentist to do any kind of surgical work in the mouth. This prohibition has prevented the expansion of auxiliary dental workers, such as has taken place in the medical profession. Medical auxiliary workers perform numerous functions; there are nurses, physiotherapists, speech therapists, chiropodists, social workers, psychologists, audiometricians, laboratory workers, and a host of others, but the dentist may not delegate anything to an ancillary worker, not even the most trivial procedure. Dental Nurses. In New Zealand, the government have allowed dental ancillary workers known as dental nurses to carry out extractions or fillings in children. The scheme appears to have worked well. The nurses are under the supervision of fully qualified dentists. I believe the British Parliament will soon be considering a Dentists Bill which will provide for controlled experiments to be carried out here by the dental profession on the use of auxiliary staff for carrying out minor procedures. We have anticipated this measure in all our new clinics by providing an additional surgery in which an ancillary worker can work under the supervision of the dentist, and we hope by this means to save valuable time and to provide a much more comprehensive service for the children and the expectant and nursing mothers. PEST DESTRUCTION The service provided by the Health Department enables residents in the Borough to obtain advice as to the identification and method of eradication of a wide variety of insect pests, as well as the normal work of the department connected with rodent destruction. During the year an unusually severe infestation of a type of ant known as Pharaoh's ant was observed in flats where solid-fuel central-heating systems existed. Modern methods of eradication have been employed using 2 per cent chlordane. 17 The persistent nuisance in bakehouses caused by the common cockroach (Blatta orientalis) has been successfully combated using viscous insecticides with benzine hexa-chloride fortified by a high pyrethrum additive. The income from pest destruction has reached the surprising total of £113 13s. 3d. KEEPING THE BOROUGH CLEAN 18 I am obliged to Mr. A. S. Knolles, the Borough Surveyor, for the following report about drainage, sewerage and public cleansing:— Drainage and Sewerage. No works of major improvement have been possible because of the continued restriction on capital expenditure, but following certain flooding as the result of a rather exceptional storm last August, the Committee have agreed to construct short lengths of relief sewers during 1953. There is continued evidence of the pollution of the surface water system from material which should be connected to the foul water system, and although certain factories have been disconnected from the surface water system further investigation is being carried out to try and improve the position. Public Cleansing (a) Streets. Due to the continued difficulties regarding the engagement of adequate labour and the high cost of the street orderly system, experiments have been carried out with a view to reducing labour by the introduction of pedestrian-operated electric vehicles, to augment the street sweeping arrangements. This experiment having proved satisfactory, it is proposed to bring the new system into operation during the coming year. (b) Refuse Collection. The Dennis Paxit vehicles are still proving satisfactory. The public are very appreciative of the individual household collecting bin system we are operating in the Borough and an extension will be contemplated in the near future. (c) Refuse Disposal. Work on the new Charlton Plant has commenced and the works should be completed in 1954. 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 Wraysbury, Laleham and Walton, purified in the storage reservoirs at Staines, Littleton and Walton and at the filtration works at Hampton. After filtration the water receives a small dose of chlorine and adequate contact is provided to ensure complete action of the chlorine before the water is pumped into supply. It is therefore possible to provide a water of consistently GENERAL MATTERS 19 high bacterial quality and yet having none or so little chlorine remaining in the water in the distribution system that there is no likelihood of chlorine tastes being detected by consumers. Samples of water are collected at all stages of purification at least five times each week and are analysed by experts at the laboratories of the Metropolitan Water Board. Any falling off in the quality of the water is immediately reported to the Chief Engineer's department and remedial measures are put into operation forthwith. The average results of chemical and bacteriological analyses of the water are shown in Table No. 8. Number of houses supplied by the Board :— (a) Direct 30,070 (106,490 persons) (b) By means of standpipes 5 (10 persons) INDUSTRIAL HEALTH Factories. Most of the 353 factories in the Borough 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, j avoidance of overcrowding, for adequate warmth and ventilation, and proper drainage of floors. During 1952 the inspectors paid 517 visits to factories; in 34 factories the attention of the management had to be drawn to contraventions of the regulations. The inspectors also paid 58 visits to out-workers' premises. Shops. Section 38 of the Shops Act, 1950, deals with the provisions for the health and comfort of the staff. 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. 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 1952 exemption certificates were granted, which makes a total of 19 in the Borough. Mortuary. The mortuary at Hampton, though small, is a good building. It provide! an important public service. During any year there occurs a series of cases iil which owing to either accident, sudden death, drowning in the river or othejl untoward happening, a post-mortem examination is required by the coronei to ascertain the cause of death. The number of bodies admitted to the mortuanl for this purpose during 1952 was 372. Considerable improvements have been made during 1952 to the furniture and fittings of the viewing room. Arrange! ments are in hand for the provision of new watercloset accommodation, and al new seat in the visitors room. 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 six samples for bacteriological examination were taken throughout the season, all of whicl were satisfactory. 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. 102 samples of ice cream were obtained, and all but 26 were satisfactory. In addition, 148 miscellaneous specimens, mainly faeces, were submitted to the laboratory in connection with food poisoning and dysentery enquiries. Establishments for Massage, Chiropody, Electrical and Special Treatment. Fourteen licences in respect of establishments for these purposes were issued during the year 1952. 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 1952, eight persons and three premises were registered. The inspectors paid 63 visits. Petrol Filling Stations. During the year 1952, 402 visits were paid by the sanitary inspectors to premises where petroleum or carbide of calcium is stored, and 109 licences were issued. 20 It was considered desirable to carry out an exhaustive survey of establishments where petroleum/petroleum mixtures are stored. Comprehensive details are now available of conditions existing at all establishments subject to licence. Where practicable, such as in the case of renewal of petrol pumps, an opportunity has been taken to apply an air test to existing underground storage tanks; the pumps are required to comply with recommendations as to flameproofing of motors and electrical equipment and in each case the manufacturers of the equipment have been kind enough to give the necessary certificate to say that the equipment complies with the conditions laid down by the Corporation. Rent Restriction Certificates. One certificate was granted for premises which were in bad repair. Two cancellation certificates were issued in respect of premises which were put in reasonable state of repair. Tents, Vans and Sheds. During 1952, one renewal of consent was issued for temporary sites for caravans. Smoke Abatement. It was not necessary to take any formal action during 1952 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 1952. 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. Rag Flock and Other Filling Materials Act, 1951. Four premises have so far been registered under the Rag Flock and Other Filling Materials Act, 1951, and one sample of rag flock was obtained and was satisfactory. There are no premises requiring to be licensed as there is no manufacture or storage of rag flock in the Borough. National Assistance Act, 1948, Section 47. It was not necessary, during 1952, to remove to suitable premises any persons in need of care and attention. 21 22 Complaints. During 1952 the number of complaints received by the department was 1,936. One complaint from Hampton caused considerable excitement. Within an hour, several telephone calls were received that the carcase of a cow had been found on a grass verge in a quiet residential road. Immediate investigation was made, and the carcase of an ox was found; there was considerable putrefaction and smell; the flesh was infested with flies and maggots. The police and the Ministry of Agriculture and Fisheries were contacted and it was confirmed that there was no evidence of foot and mouth disease or other dangerous infection. In view of the serious nuisance, the consent of the Chairman of the Public Health Committee was obtained for the immediate removal and incineration of the carcase. Within a few hours of receiving the first complaint, all that remained of this unusual "deposit" was an area ol flattened grass soaked with disinfectant. I am indebted to the Borough Surveyor and his staff for their splendid co-operation. I believe the police suspected black-market activities, but so far as I am aware the culprits were never found. TABLES FOR STATISTICAL YEAR 1952 23 24 STATISTICAL SUMMARY for the Year 1952 Area in acres 7,078 Population (preliminary census return figure, 1951) 105,645 Civilian population—estimated to mid-year (as supplied by the Registrar-General) 106,500 Number of inhabited houses 30,075 Rateable value £1,096,811 Sum represented by a penny rate £4,440 14s. 2d. Total M. F. Live Births: Legitimate 1,260 635 625 Illegitimate 75 46 29 Total 1,335 681 654 Birth rate per 1,000 of estimated civilian population 12.54 Total M. F. Still Births: Legitimate 16 9 7 Illegitimate 2 2 — Total 18 11 7 Still birth rate per 1,000 total (live and still) births 13.48 M. F. Deaths 577 614 1,191 Crude death rate per 1,000 of estimated civilian population 11.18 Adjusted death rate 10.84 Maternal deaths Nil Rate per 1,000 total (live and still) births Nil Death rate of infants under one year of age:— All infants per 1,000 live births 20.22 Legitimate infants per 1,000 legitimate live births 21.43 Illegitimate infants per 1,000 illegitimate live births. Nil Deaths from: Cancer (all ages) 238 Measles (all ages) — Whooping cough (all ages) — Diarrhoea (under 2 years of age) — Table 1. Population 1938-1952. 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 — 1951 106,300 — 1,300 — 1.28% + 91 — 1,391 1952 106,500 + 200 + 0.19% + 144 56 — Table 2. Causes of Death. Registrar-General's Official Returns. Causes of Death Males Females Total All causes 577 614 1,191 1. Tuberculosis, respiratory 19 9 28 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 — — — 9. Other infective and parasitic diseases 2 1 3 10. Malignant neoplasm, stomach 18 8 26 11. Malignant neoplasm, lung, bronchus 43 9 52 12. Malignant neoplasm, breast — 22 22 13. Malignant neoplasm, uterus — 10 10 14. Other malignant and lymphatic neoplasms 73 55 128 15. Leukaemia, aleukaemia 1 5 6 16. Diabetes 3 5 8 17. Vascular lesions of nervous system 64 111 175 18. Coronary disease, angina 94 55 149 19. Hypertension with heart disease 10 17 27 20. Other heart disease 78 122 200 21. Other circulatory disease 20 31 51 22. Influenza 1 7 8 23. Pneumonia 22 28 50 24. Bronchitis 45 27 72 25. Other diseases of respiratory system 7 3 10 26. Ulcer of stomach and duodenum 3 6 9 27. Gastritis, enteritis and diarrhoea 1 4 5 28. Nephritis and nephrosis 6 8 14 29. Hyperplasia of prostate 8 — 8 30. Px-egnancy, Childbirth, abortion — —- — 31. Congenital malformations 3 7 10 32. Other defined and ill-defined diseases 35 45 80 33. Motor vehicle accidents 4 2 6 34. All other accidents 9 11 20 35. Suicide 1 3 4 36. Homicide and operations of war 1 - 1 25 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 35.81 4.01 Intra-cranial vascular lesions 14.69 1.64 Bronchitis, Pneumonia, and other respiratory diseases 11.08 1.24 Cancer 19.98 2.23 Violence 2.60 0.29 Tuberculosis 2.60 0.29 26 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 — - - - Whooping Cough — — - - Diarrhoea — — - — 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 15 2 2 19 4 2 1 1 27 Uncertified ... — — — — — — — — — — Smallpox — — — — — — — — — — Chicken-pox ... — — — — — — — — — — Measles — — — — — — — — — — Scarlet Fever — — — — — — — — — — Diphtheria and Croup Whooping Cough — — — — — — — — — — Influenza — — — — — — — — — — Enteritis — — — — — — — — — — Tuberculous Meningitis Abdominal Tuberculosis Other Tuberculous Diseases Congenital Malformations ... — — — — — — — — — Premature Birth 8 1 — 1 10 — — — — 10 Atrophy, Debility and Marasmus Atelectasis 2 1 — — 3 — — — — i Injury at Birth — — — — — — — — — — Erysipelas — — — — — — — — — — Syphilis — — — — — — — — — — Rickets — — — — — — — — — — Meningitis (not Tuberculous) Convulsions ... — — — — — — — — — — Gastritis — — — 1 1 — — — — 1 Laryngitis — — — — — — — — — — Bronchitis Pneumonia (all forms) 2 1 — 1 4 Suffocation (overlying) — — — — — 1 — — — 1 Other causes 5 — — — 5 1 1 1 — 8 Totals ... 15 2 2 19 4 2 1 1 27 (b) An analysis of the mortality reveals that neo-natal deaths were responsible for 70.33 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 8 7 4 19 70-33 27 28 Birth Rate, Death Rate and Analysis of Mortality. Provisional Figures. Table 6. 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 A cute Poliomyelitis and Polioencephalitis Pneumonia Diarrhoea and Enteritis (under two years) Total Deaths under 1 year England and Wales 15.3 0.35 11.3 0.00 0.00 0.00 0.24 0.04 0.00 0.01 0.47 1.1 27.6 160 County Boroughs and great towns, including London 16.9 0.43 12.1 0.00 0.00 0.00 0.28 0.04 - 0.01 0.52 1.3 31.2 160 smaller towns, resident populations 25,000 to 50,000 at 1951 census 15.5 0.36 11.2 0.00 0.00 0.00 0.22 0.04 - 0.00 0.43 0.5 25.8 London Admin. County 17.6 0.34 12.6 — 0.00 0.00 0.31 0.05 — 0.01 0.58 0.7 23.8 Twickenham 12.54 0.17 (a) 1118 (b) 10.84 — — — 0.29 0.08 — 0.00 0.47 — 20.22 A dash (— ) signifies that there were no deaths (a) crude (b) adjusted Table 7. Review of the Comparative Vital and Mortality Statistics for the Borough of Twickenham, together with those for England and Wales for years 1938-1952 inclusive. Year Birth Rate Death Rate Infantile Mortality Rate Twickenham England and Wales T wickenham 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 1951 13.18 15.86 (a) 11.97 12.5 24.98 29.6 (b) 11.61 1952 12.71 15.65 (a) 11.18 11.3 20.22 27.6 (b) 10.84 (a) Crude (6) Adjusted 29 30 Results of the Chemical and Bacteriological Examination of the Water Supply to the Borough of Twickenham for 1952. Parts per million (unless otherwise stated). (a) Chemical. Description of the Sample Number of Samples Ammottiacal Nitrogen Albuminoid Nitrogen Oxidised Nitrogen (Nitrate) Chlorides as CI Oxygen abs. from Permanganate 3 hrs. at 27°c. Turbidity, in terms of Silica Colour, m.m. brown, 2 ft. tube, Burgess's Tintometer Hardness (total) Hardness (Non-carb.) pH. Value Phosphate as P.O. Silica as SiOa Conductivity Table 8. River Thames water filtered at Hampton Works 246 0.022 0.088 4.0 24.0 1.09 0.2 13 259 62 7.9 0.28 10.0 475 (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. Bad. coli test Percentage of samples negative in 100 ml. Average number of Bad. coli per 100 ml. River Thames water filtered at Hampton Works 786 7.0 99.9 0.004 Table 9. Analysis of Complaints Received. Nature of Complaint Number Received Housing defects 455 Choked and defective drains 188 Accumulations of offensive matter 40 Unsound food 287 Verminous premises:— (a) Bugs 27 (b) Rats and mice 418 (c) Other 162 Keeping of animals 8 Unsatisfactory milk supplies 2 Miscellaneous 349 Total 1,936 31 Table 10. Summary of Visits, Inspections, etc. Number Dwelling-houses for housing defects under Public Health Act:— (a) After complaint 1,177 (b) Subsequent visits 4,211 Dwelling-houses under Housing Act:— (a) After complaint 275 (b) Subsequent visits 21 Dwelling-houses:— Housing applications, specially investigated 136 Infected dwelling-houses:— (a) After notified infectious disease (other than tuberculosis) 434 (b) Contacts 204 (c) Fumigations after infectious disease 16 (d) Phthisis enquiries and fumigations 8 School and church halls 27 Swimming baths 4 Water sampling:— (a) Swimming baths 2 (b) Dwelling-houses 1 Business premises 31 Cinemas, dance halls, billiard halls 37 Offensive trade premises 72 Stables, piggeries, keeping of animals 114 Houses let in lodgings Nil Factories Acts, 1937 and 1948:— Factories with mechanical power 455 Factories without mechanical power 62 Outworkers' premises 58 Common lodging houses 4 Underground rooms 35 Hairdressing premises 67 Tents, vans and sheds 38 Smoke nuisances 107 Fairgrounds 28 Drainage: Testing by:— (a) Smoke 160 (b) Coloured water 48 (c) Water 29 (d) Breaking down 194 Re public sewers 961 Watercourses and ditches 8 Land and tips 106 Septic tanks and cesspools 6 Sanitary conveniences—-including public-houses 67 Miscellaneous visits 863 Visits not inspections 1,772 Verminous premises:— (a) Rats and mice: (i) After complaint or from survey 14 (ii) Subsequent visits 366 (b) Bug infestations: Number of premises visited 93 Number of premises where define infestation existed 48 (c) Cockroaches 9 (d) Other vermin 344 32 Table 10—continued. Inspections for supervision of food:— Unfit foodstuffs other than meat 513 Slaughterhouses 28 Butchers' shops (Public Health (Meat) Regulations, 1924) 539 Food and Drugs Act, 1938, Section 13:— Bakehouses 284 Fish shops, grocers and greengrocers 1,424 Factory canteens 102 Restaurant kitchens, etc. 646 Hotel and beerhouse bars and cellars: (a) Day inspections 110 (b) Night inspections Nil Food and Drugs Act, 1938, Section 14:— Ice-cream premises (Heat Treatment) Regulations, 1947 to 1951 375 Sausage manufacturers 38 Preserved meat preparation premises 66 Preserved fish preparation premises 86 Milk and Dairies Regulations, 1949:— Milk sampling for bacteriological examination 2 Contraventions of Milk and Dairies Regulations — Dairies 36 Shops Act, 1950, Section 38 197 Middlesex County Council Act, 1950:— Hawkers' vehicles 25 Hawkers' premises 38 Noise nuisances 126 Massage and/or special treatment establishments 6 Petroleum (Regulation) Acts, 1928 and 1936; Petroleum Spirit Regulations, 1929-1950 402 National Assistance Act, 1948, Section 47 19 Rag Flock and other Filling Materials Act, 1951 13 Dealers in Old Metal and Marine Stores 10 Pet Animals Act, 1951 26 Total number of visits and inspections 17,823 33 Table 11. Sanitary Improvements Effected. Number Offensive accumulations removed 4 Nuisance from keeping of animals remedied 3 Chimney flues repaired 5 Chimney stacks repaired Nil Roofs repaired 268 Eavesgutters repaired 115 Downspouts repaired 46 Pointing renewed 46 Drains repaired 20 Drains unstopped 24 Dustbins provided 21 Fireplaces repaired 29 Filthy condition of premises remedied 1 Floors repaired 70 Gullies repaired 9 Plaster to walls and ceilings repaired 203 Window frames and sashcords repaired 21 Public sewers repaired 14 Sinks provided 4 Sink waste pipes repaired 14 Soil pipes repaired 5 Stairs repaired 9 External walls repaired 4 W.C.s repaired 19 W.C. cisterns and fittings provided 68 W.C. accommodation provided 10 Yard paving repaired 9 Other works carried out 416 34 Table 12. 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) 1,452 (b) Inspections made for the purpose 5,684 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 1 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 742 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 607 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 121 (2) Dwelling-houses in which defects were remedied after service of formal notices: (a) By owners 107 (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 1 (2) Dwelling-houses in respect of which an undertaking was accepted under sub-section (3) of section 11 of Housing Act, 1936 1 (3) Dwelling-houses demolished in pursuance of Demolition Orders 2 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 1 35 Table 13. 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 A ct. Sections 13&14 Number of Informal Notices served 742 150 Number of Informal Notices complied with 607 187 Number of Statutory Notices served 121 — Number of Statutory Notices complied with 107 — Number of cautionary letters sent by Town Clerk — — Table 14. Offences under Food and Drugs Act, 1938. Case No. Section contravened Offence Action taken 1 9 Part of small bird in loaf Legal proceedings instituted. Fine of £25 and £5 5s. costs imposed. 2 9 Mould in meat and vegetable pie Legal proceedings instituted. Fine of £10 and £2 2s. costs imposed. 36 Table 15. 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 4,867 6,662 11,529 NUMBER OF INFESTATIONS Food Premises Non-food Premises Private Dwellings Factories Rats only Mice only Rats and mice 44 33 404 47 408 112 8 DEGREE OF INFESTATION RATS MICE Reservoir Major Primary 50-100 Minor Secondary 1-50 Reservoir Major Primary 50-100 Minor Secondary 1-50 Nil 8 404 Nil 3 113 RAT DESTRUCTION WORK UNDERTAKEN BY:— CORPORATION OCCUPIERS Rats Mice Rats Mice 376 114 36 2 NUMBER OF PREMISES UNDER CONTRACT WITH CORPORATION TOTAL 490 12 months 6 months 3 months 1 month Others Total Receipts 18 58 315 80 19 £545 0s. 6d. 37 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 72 6 1 2 1 Nil OD 00 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 Miscellaneous Wood Beetles Totals Table 16. Dwelling-Houses - - 48 - 9 14 - 2 - 51 7 - 131 Workplaces — — — — — 3 — — — 1 — — 4 Food Shops — — — 3 - 27 — - - — 1 - 31 Miscellaneous 1 - — 1 - 1 — — — 8 1 — 12 Totals 1 — 48 4 9 45 — 2 — 60 9 — 178 Total income for D.D.T. and other special treatments, £113 13s. 3d. Corporation premises treated (re-housed families only): Nil. Table 17. Disinfections, etc. Number Premises disinfected after infectious diseases 24 Premises disinfected after other diseases 5 Articles disinfected after infectious disease 243 Persons (children and adults) treated for scabies at cleansing station — Table 18. 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 147 (2) Families dwelling therein 189 (3) Persons dwelling therein 687 (b) New cases of overcrowding reported during the year 36 (c) (1) Cases of overcrowding relieved during the year 9 (2) Persons concerned in such cases 39 Table 19. 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 distributors 26 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 10 Accredited Nil Nil Milk (Special Designation) (Pasteuri sed and Sterilised Milk) Regulations, 1949. Pasteurised 21 10 Sterilised 34 10 39 Table 20. Food and Drugs Act, 1938. Public Health Act, 1936, Section 89. Insanitary Conditions in Food Premises. Number of premises found with insanitary conditions 150 Number of premises remedied 187 Insanitary conditions found in premises above Number of defects Number of defects remedied Accumulation of refuse 17 26 Ceilings—defective or dirty 39 73 Cleanliness (personal) unsatisfactory 1 4 Dampness — — Floors—defective or dirty 19 37 Lighting inadequate 1 1 Sink—absence of 1 2 Sink-waste pipe inadequate — — Storage facilities unsatisfactory 5 10 Ventilation insufficient — 3 Walls—dirty or plaster defective 59 98 Insufficient or absence of hot and cold water for cleansing utensils 4 10 Absence of hot water for ablution purposes 1 6 W.C. accommodation—insufficient or unsuitable 2 2 Other defects 82 147 Totals 231 419 Byelaws under Section 15 of the Food and Drugs Act, 1938. Byelaws with respect to Handling, Wrapping and Delivery of Food and Sale of Food in the open air have been enforced, particularly on Fairgrounds on holiday occasions. No formal action has been necessary. Public Abattoirs. There is no public abattoir within the Borough. Slaughterhouses. Three licences were renewed during the year. The licencing 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. Nine slaughter-men were on the register of the department at the end of the vear. Table 21. Meat—Carcases Inspected and Findings at Private Slaughterhouses in the Borough. Cattle, excl. Cows Cows Calves Sheep and Lambs Pigs Number known killed — — — — 9 Number inspected — — — — 9 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 — — — — — 40 Table 22. (a) Meat. Diseased and unsound conditions found in meat caused the detention and surrender for destruction of:— lbs. Beef 2,290 Mutton and lamb 25 Pork 128 Other meats 264 Total 2,707 (b) Other Foodstuffs. The following foodstuffs, other than meat, being unfit for human consumption, were voluntarily surrendered for destruction:— Eggs 82 Fowls — lbs. Bacon — Butter — Cheese 57 Cooked meat 147 Fish 421 Flour and cereals 78 Preserves 192 Chocolate — Cake mixture 92 Biscuits 3 Sugar — Swedes — Potatoes — Tea — Fruit 132 Bottles Pickles 22 Canned foodstuffs:— Tins Fish 298 Fruit 2,146 Meat 1,250 Milk 479 Vegetables 1,345 Other 384 41 Table 23. 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, 1952:— Article Taken Unsatisfactory Milk (various) 92 — Arrowroot 4 — Baking powder 1 — Bread 4 3 Cakes (various) 33 3 Cider i — Coffee and chicory essence 2 — Cooked meats (various) 11 — Cornflour 3 — Curry powder 1 — Dried egg 1 — Drugs (various) 10 — Evaporated milk 1 — Fish (various) 43 4 Fish paste 3 1 Flour 1 — Fruit salts 1 — Gin 1 — Honey 1 — Ice cream 4 — Jam 1 — Jelly 1 — Lemon curd 3 — Meat pie 2 — Meringue powder 1 — Mustard 1 — Non-brewed condiment 1 — Orange squash 1 — Pepper 3 — Pork 2 — Sausages 32 — Sausage meat 4 — Sherry 2 — Soup 2 — Suet 1 — Sweets (various) 3 — Tinned peaches 1 — Tinned peas 1 — Tomato sauce 1 — Victoria plums 7 1 Vinegar 27 2 Welsh rarebit 1 — Whisky 25 — Total 341 14 Bread. In one case a loaf of bread contained a cigarette stub. The baker responsible was prosecuted and fined £5 and £1 costs. In another case a loaf contained a maggot but it being possible that the loaf was contaminated at the purchaser's home, no action was taken. In the third case a loaf of bread contained a piece of metal. The baker was prosecuted and in view of his previous good record was absolutely discharged on payment of two guineas costs. Cakes. In one case a Dundee cake contained pieces of slate. The manufacturers were prosecuted and fined with five guineas costs. In the two other instances cake was mouldy and contained small particles of cloth respectively. Official cautions were issued. Fish. Unsatisfactory samples were all of passing off smoked cod for smoked haddock and resulted in two official cautions being sent to fishmongers. Fish Paste. A sample of pre-packed dressed crab was deficient in crab meat and an official caution was despatched to the importers. Victoria Plums. Ponds Seedlings were sold in one instance for Victoria plums. An official caution was addressed to the seller. Vinegar. Two sales of vinegar were deficient in acetic acid. A caution was despatched. 42 Table 24. 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 43 62 25 — (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 310 455 8 — (iii) Other premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) — — — — Total 353 517 33 — 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) 7 1 — — — Overcrowding (S.2) — — — — — Unreasonable temperature (S.3) — — — — — Inadequate ventilation (S.4) 1 1 — — — Ineffective drainage of floors (S.6) — — — — — Sanitary Conveniences (S.7):— (a) Insufficient 4 4 — — — (b) Unsuitable or defective 4 3 — — — (c) Not separate for sexes — — — — — Other offences against the Act (not including offences relating to outwork) 18 15 — — — Total 34 24 — — — Part VIII of the Act. Outwork. Nature of the work Lampshades Wearing apparel Electric Fuse Makers Section 110: Number of outworkers in August list required by Section 110 (1) (c) 5 1 37 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 — — — 43 Table 25. Infectious Diseases. Incidence and Mortality. Diphtheria, Scarlet Fever and Enteric Fever. 1938-1952. 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 — — — — — — 1951 — — — — 64 0.60 — — — — — — 1952 — — — — 135 1.28 — — — — — — 44 Table 26. Ophthalmia Neonatorum, years 1938-1952. 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 — — — — — 1951 8 6 2 8 — — — 1952 4 3 1 4 — — — 45 46 Table 27 Cases of Infectious Diseases Notified during the Year 1952. 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 — 3 4 2 3 6 — — 2 8 7 5 4 — 44 1 — Erysipelas — — 1 — — — — — — 2 2 6 2 — 13 1 — Food Poisoning 4 4 4 4 1 2 2 2 3 14 17 14 4 — 75 8 — Measles 9 49 61 89 86 374 25 6 1 2 1 — — — 703 20 — Meningococcal Infections 1 — — — — 3 2 1 — 1 — — — — 8 8 — Ophthalmia Neonatorum 4 — — — — — — — — — — — — — 4 1 — Acute Poliomyelitis — — — 2 1 6 2 — 1 3 2 — — — 17 16 1 Pneumonia 1 1 3 1 — 9 2 1 3 4 9 44 21 2 101 8 50 Puerperal Pyrexia — — — — — — — 1 4 9 2 — — — 16 16 — Scarlet Fever — 1 5 9 15 85 11 5 2 — — 2 — — 135 42 — Whooping Cough 5 4 8 14 14 54 2 — — — — 1 — — 102 4 — Totals 24 62 86 121 120 539 46 16 16 43 40 72 31 2 1,218 125 51 47 Table 28, Monthly Incidence of Infectious Diseases during the Year 1952. DISEASE NUMBER OF CASES TOTAL January February March April May June July August Sept. October Nov. Dec. Dysentery 11 7 — 1 5 1 — 3 5 4 3 4 44 Erysipelas 1 2 1 — 1 1 2 — 1 1 3 — 13 Food Poisoning 20 8 12 4 — 5 2 14 1 1 2 6 75 Measles 59 166 177 178 48 17 8 13 4 3 4 26 703 Meningococcal Infections 1 — 1 3 — — 2 — 1 — — — 8 Opthalmia Neonatorum 2 — — 1 1 — — — — — — — 4 Acute Poliomyelitis 1 — — — — 1 2 4 2 3 3 1 17 Pneumonia 14 20 7 4 7 3 5 2 7 5 8 19 101 Puerperal Pyrexia 1 2 2 1 5 — 2 — 1 — 2 — 16 Scarlet Fever 9 13 16 16 8 13 15 8 6 6 15 10 135 Whooping Cough 5 4 8 8 8 10 11 28 8 5 1 6 102 Totals 124 222 224 216 83 51 49 72 36 28 41 72 1,218 48 Table 29 Ward Distribution of Infectious Diseases Notified during the Year 1952. Disease Twickenham Whitton Hampton Hampton Hill Teddington Hampton Wick Heathfield Total East Central South West Upper Lower Dysentery 1 1 6 18 1 — 7 — 2 — 8 44 Erysipelas — — 1 1 1 3 1 2 1 2 1 13 Food Poisoning 4 8 3 2 3 19 19 2 8 5 2 75 Measles 64 46 27 43 43 160 38 64 58 88 72 703 Meningococcal Infections 1 — — 1 1 — — 1 2 2 — 8 Ophthalmia Neonatorum — — — — — — 1 2 1 — — 4 Acute Poliomyelitis — 2 4 2 — 3 1 — 2 — 3 17 Pneumonia 2 5 2 4 6 17 32 9 11 8 5 101 Puerperal Pyrexia — — — — — 16 — — — — — 16 Scarlet Fever 13 1 3 8 31 12 8 5 4 21 29 135 Whooping Cough 8 10 8 10 1 10 30 9 10 2 4 102 Totals 93 73 54 89 87 240 137 94 99 128 124 1,218 Table 30. Tuberculosis. The following tables have been compiled from the notifications received:— New Cases and Mortality. Age Periods New Cases Deaths Pulmonary N on-pulmonary Pulmonary Non-pulmonary Male Female Male Female Male Female Male Female Under 1 — 1 — — — — — — 1-4 1 — — 1 — — — — 5-9 2 4 1 1 — — — — 10-14 1 1 — — — — — — 15-19 3 6 — 1 1 — — — 20-24 10 3 1 2 1 2 — — 25-34 6 10 1 4 3 3 1 — 35-44 5 5 2 2 1 4 — — 45-54 5 4 — 1 5 — — — 55-64 4 4 — 1 6 — — — 65 and over 3 1 — 2 1 — — 1 Totals 40 39 5 15 18 9 1 1 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 31. Primary Notifications of Tuberculosis, 1938-1952 inclusive. 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 Pulmonary 100 106 114 127 112 119 133 118 120 132 117 115 96 107 79 Non-Pulmonary 30 19 12 14 18 18 18 18 19 11 17 5 15 14 20 Totals 130 125 126 141 130 137 151 136 139 143 134 120 111 121 99 49 Table 32. Food Poisoning. Food Poisoning Notifications : 1 st Quarter 2nd Quarter 3rd Quarter 4th Quarter TOTAL 40 8 16 11 75 Outbreaks Due to Identified Agents: Number of outbreaks 3 Number of cases 9 Outbreaks due to: Salmonella organisms Nil Staphylococci (including toxin) 3 Outbreaks due to Undiscovered Cause: Number of outbreaks 10 Number of cases 25 Single Cases: Cases due to identified agents: Shigella Sonnei 1 Proteus Vulgaris 1 Staphylococcus Aureus 2 Salmonella organisms 1 Number of cases 5 Cases due to undiscovered cause:— Number of cases 36 Total all cases 41 50 51 Table 33. 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 24, Station Road, Hampton; 20, Seymour Road, Hampton Wick; York House, Twickenham; Hospital Bridge Road, Twickenham; Stanley Road, Teddington; 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.