Twizi DECEMBER. 1954 GOOD HEALTH IN TWICKENHAM The Annual Report of the Medical Officer of Health. JOHN MADDISON, M.D., B.S., D.P.H. AC439(1) TWUCJEBGAM 1 Div 5B 2 LIBRAY CONTENTS Page Introduction 2 Health Committee and Staff 3 Can You Control Your Emotions? 4 The Diseases and Disabilities of Old Age 14 Pest Destruction 17 Keeping the Borough Clean 17 Water Supply 18 Industrial Health 18 General Matters 19 Statistical Summary 23 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 Annual Report for 1954 on the health and sanitary conditions of the Borough together with the supplement containing the statistical tables for 1953 as required by the Ministry of Health. The health of the people in the Borough is reasonably good and the sanitary circumstances fairly satisfactory. This does not mean that we can be complacent; there is always a mighty amount to be done in improving health, alleviating sickness and in improving environmental standards. All this goes on continuously and calls for no special comment. This year the report consists mainly of two contributions to preventive medicine. The first is an attempt to set down in simple form a working hypothesis on the principles governing human conduct. The second is a summary of a research into the ailments of old age. The Minister of Health has asked how co-operation between the various branches of the health service is proceeding. Co-operation limps along; each branch casts wary side-long glances at the others to see who is getting the biggest share of the health services financial pie. Reform of local government is in the air. At least, for health administration purposes, if for nothing else, I would like to see the whole country divided into about 200 units, the average population in each being about 250,000. Each could be an all-purpose health authority; it could have the functions now carried out by district sanitary authorities and by county health authorities, it could be a hospital authority and it could have the local executive council functions for general practitioners and pharmacists. In this way we would get real integration and co-operation within the health service. We would certainly save a lot of friction and irritation and possibly a lot of money as well. 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 H. F. Inkpen, J.P. The Deputy Mayor, Councillor Mrs. M. E. Owen. Chairman : Alderman J. Allinson Vice-Chairman: Councillor A. T. Kremers Alderman J. H. Knaggs, J.P. Councillor J. W. M. Hurles Councillor G. D. Burnett Councillor P. D. Keep Councillor Mrs. M. B. Davies Councillor N. T. Poulter Councillor F. J. Edwards Councillor Mrs. O. M. Renier Councillor Mrs. J. L. Gill 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.) Chief Sanitary Inspector Mr. H. G. Easter Deputy Chief Sanitary Inspector Mr. H. D. Smith Messrs. K. E. Evans, J. W. Paine, Sanitary Inspectors B. E. W. Gabb 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 Miss G. Payne, Mrs. W. E. George, Clerical Staff 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 CAN YOU CONTROL YOUR EMOTIONS ? Family Quarrels. Have you ever quarrelled with someone you love? Have you ever felt so irritated with your child that you felt like throwing him out? Have you ever felt so hurt by an injustice done to you at work that you felt like resigning and yet you couldn't? After any of these situations have you felt a bitterness and misery inside you, almost unbearable and indescribable which made you sick of life, unable to face your friends, made you angry and yet frustrated, and unable to effect a solution? Have you experienced the terrible longing for comfort and sympathy in such a situation, the wonderful joy to find someone who seems able to understand you, who can calm you down and sooth your nerves; and have you experienced the dreadful sensation bordering on panic when that comfort is denied you and you are at your wits end to know which way to turn? Mental Illness. If you have been through this you have been mentally ill. It might only have lasted one or two days or it might have gone on for weeks or months. A cold in the head will last a few days; tuberculosis will last months or years. If we could prevent colds in the head or tuberculosis it would be a wonderful achievement in preventive medicine. But if we could prevent mental illness it would be a still mightier achievement, for there is more mental illness in the population, more hospital beds occupied by persons mentally ill than for all other diseases put together. It is not only inside the mental hospitals that there is need for medical science to be applied to the prevention and care of mental illness. For mental illness is to a large extent either a mal-development or arresting of emotional development, or a reversion to a more immature level after satisfactory development. I believe that we can do a great deal to prevent a large amount of mental illness, some of which afflicts all of us sometime in our lives, if we all learn a bit about it and try to understand why we act in certain ways—-sometimes steadily, sometimes emotionally, sometimes childishly, sometimes foolishly. The Angry Letter. A woman acquaintance came to see me recently. Her opening remark was "I must tell somebody about this trouble." She showed me a letter from the wife of her husband's brother Tom. I have rarely read a more scurrilous, virulent, malignant attack; in language bordering on the obscene, Tom's wife called my friend mean, ungrateful, spiteful and scheming. The letter read 4 "You should be ashamed to do a trick like this to Tom and me after all we have done for you all these years." I asked my friend what she had done to bring down this torrent of wrath. She told me "What I have done is not to invite Tom and his wife to stay with us for Christmas which we have always done for the last 26 years. We have good reasons for wishing to be a little quieter this Christmas and I cannot do with visitors. For years Tom and his wife have come at Christmas time; the length of their stay has increased each year until it is now always between three weeks and a month. They close their house and come to stay with us; they accept our hospitality and never contribute a thing in return; they even criticise the food we provide and the quality of the occasional bottle of sherry in the sideboard. Now because we do not invite them this year I get this torrent of abuse." I thought for a minute about this situation. Here was a couple who for 26 years had accepted hospitality every Christmas; they must have saved many pounds each year in housekeeping expenses. I knew my friend provided generous fare. Why was it then that, instead of gratitude for all that had been done, Tom's wife felt the very reverse and sent a stinging letter deliberately intended to hurt. The real truth, which I explained to my friend, was that Tom's wife felt the bitter pangs caused by rejection from the social group which she and Tom always found pleasant and stimulating—the people coming to the brother's house—and whose company they valued and enjoyed. We all feel deeply hurt when, either in reality or in imagination, we feel rejected by any social group, be it only one or two persons, and more especially and deeply when the rejection comes from loved ones. Neurotic Behaviour. Yet Tom's wife was behaving unrealistically. She had really no right to expect to be invited every Christmas. The adult attitude would be one of gratitude and pleasure and even surprise at having had the invitation continued so long; she could not expect it to go on for ever. Yet she was behaving as a toddler behaves when it is thwarted of its desires—by rage, temper, screaming and sadistic injury to a loved one. The anxiety engendered by the fancied rejection made her act with neurotic conduct. Why this was so I could not say; but it was no doubt due to experiences in her earlier life. All of us are what we are today mainly by reason of what we were and what our experiences were in the past. The explanation of our conduct may even be traced to babyhood. The Rejected Child. I have before me the file of a child who has come to the notice of the health department because of special conduct difficulties—one of many such; she is Marjory Stoll (this is not her real name), aged seven. At the time of her birth her mother was an unmarried girl of 17 and her father a middle-aged married man. The man left his wife and family, proceeded to set up a second home as best he could and took in the girl and her baby to live with him. This arrangement proved to be hopeless; they were wholly unsuited to each other, of widely separated ages, of quite different tastes and interests; from a situation of mutual 5 tolerance in the beginning they rapidly drifted to unveiled hatred of each other and at the end of two years separated for ever. It was into this atmosphere that Marjory was brought up through babyhood. After the separation the mother was destitute; her parents refused to have her back unless she got rid of the baby, so she arranged for her to go to a foster home to substitute.parents. The mother went out to work; most of her earnings went to pay for the baby. The season of the year was autumn. In the foster home Marjory lived the life of an unwanted child. Although she was cared for in the material sense, being fed, clothed and looked after, she received no shred of affection whatever—let alone love. The foster mother had a boy of school age whom she indulged and spoiled and who in consequence was an unbearable little prig. The foster father was inclined to welcome Marjory and make a fuss of her. The foster mother soon sensed that her husband's fatherly affections were turned towards the child; she felt this as a threat to herself and the boy, so unconsciously she turned against Marjory, treating her with coldness and indifference. After two years of this regime Marjory had the appearance of a typical 'institution child' —pale, slightly undernourished, slightly undersized, deathly quiet, hardly daring to breathe, taking no interest in a toy doll and making no attempt to play. The welfare worker whose duty it was to keep an eye on her became worried about her appearance and thought it would be best to try to get the child moved to a different home. She knew of a Mr. and Mrs. Boscobel (these are also made-up names) who some years before had adopted a baby and wished to adopt another one. The welfare worker discussed with this couple a proposal to take in Marjory with a possible view to adoption later and as an alternative to the second baby. It was not quite what Mr. and Mrs. Boscobel wanted but they agreed to give Marjory a trial, especially as she was not very different in age from the adopted boy. They thought the two children would play and grow up together. Marjory was moved to her new parents; the season of the year was autumn. The Boscobels had no children of their own because of a strong fear in the husband's mind that because a distant relative had been born defective he also might beget a defective child. Although his wife agreed with him superficially, she was secretly deeply hurt at not having a child of her own. For a time the first adopted baby had satisfied her maternal instincts, she had grown to love the boy who at this time was a bright attractive child just starting school. For the next 12 months Marjory was brought up in the home of the Boscobels. After the first few months trial they decided to adopt her legally chiefly on Mr. Boscobel's persuasion, for he had discovered that a four-year-old girl can be quite fascinating and attractive and he had felt flattered with the attention she gave him in her childish way. The court granted an adoption order and Marjory became their own child. A year went by and the autumn came round again and Marjory began to attend the infants school. This was a further strain on her endurance for she had to learn to adjust herself to the new school situation which was not easy at first. By now she had learned to dread the autumn as it nearly always meant change to an unhappy atmosphere and tears. In another way Marjory was glad to go to school for it meant a period of escape each school-day from her adopted mother, who because of her husband's initial affection for Marjory had 6 grown more and more jealous of the child until finally she had come to hate her. Mrs. Boscobel, first by implication and later by open avowal made her feelings more and more plain to her husband so that he in turn, for the sake of peace and because it was easiest, turned from Marjory and treated her as if she did not exist. Poor Marjory was thus back where she had been the autumn before and two autumns before that. She sought comfort from her teacher, who found her a bright, willing child and an apt pupil. About this time Marjory was taken to a psychiatrist. She was alleged by her adopted mother to be having screaming fits; to have uncontrollable behaviour; to be doing things to attract attention to herself; to be having an evil influence on her older brother; she was said to be obstinate, disobedient and always wanting her own way. Mrs. Boscobel stated that her husband considered Marjory to be a certifiable insane child and that she was a nuisance in school. This last statement about the school was known to be untrue. The psychiatrist reported that Marjory was a timid child who appeared to be fearful of arousing displeasure and in constant expectation of reproof and rebuff. Nevertheless the child appeared well able to establish a good relationship when encouraged. The psychiatrist could find no signs in the child of emotional instability to account for the parents' allegations of violent attacks of rage and fury and constant rigid obstinacy always directed to opposing their wishes. It was evident that the parents hated the child and resented her presence in their home. The child's reaction was to rebel and defy them whenever she could. At school she was good and conformed well to the wishes of her teachers. At home she was in danger of developing a warped character which might in later life turn into delinquency. It was recommended that she be sent to a residential school so as to get her out of her adopted parents' home. I trust she will not be sent away in the autumn. Emotional Steadiness. Two years ago I wrote about personality; about how we can classify people into types. We recognise varying amounts of intelligence in different people, of assertiveness and submissiveness, of conscientiousness and unreliability and so on. One of the most important traits is the ability to control the emotions. I am inclined to think that this is the most important of all the aspects of personality. It is like intelligence in that it grows from babyhood onwards through the infant and junior school levels to adolescence and full maturity. The person possessing little emotional control acts as if the stage of development had been arrested at what would be the infant or junior school level for a normal person. This is just like intelligence where the dull adult has had his mental faculties arrested at the infant or junior school level for a normal person. A baby expresses its emotions by smiling or laughing at trifles; by crying to attract attention; by shrieking, 'creating' and temper tantrums when its wants are not satisfied. The toddler or infant school child feels a longing for the mother's love, care, sympathy, comfort and petting. Towards the junior school stage the child feels the need for the security of the father who, to the child is all-wise, all-powerful, wonderful, and dependable. In adolescence we realise the world is not so perfect as we thought it was and we feel the need for 7 perfect ideals; we thus go through the stage of hero worship when we pin up the pictures of the film and athletic stars; when the boys make heroes of the masters and the sixth-formers, and the girls develop crushes on the mistresses and older girls. Then in adult life when we face the realities of life we learn to act with realism, with proper regard for what is and is not possible, with due care and thought to the risks run, to the safeguards necessary, to the feeling; and reactions of other people, to the social code and the customs of the group The characteristic of full emotional maturity is steadiness; the emotionally adult person does not fly off the handle at the slightest word of criticism to implied derogation or when in danger or in a foolish situation. He tries tc think out the best course of action and keeps his feelings under control. Avoiding Neuroses. I have often thought that if everyone could learn a simple explanation of human conduct we might go a long way to preventing the neuroses which afflict us all from time to time and which constitute a mighty volume of illness throughout the country. Human conduct is not unpredictable or irrational. The difficulty is to present a simplified theory. I am encouraged to try to do this when I remember that the ' advanced' theories of 25 or 50 years ago which found their way into the text-books for degree courses are now in the curricula of the schools. The Theory of Anxiety as a Biological Safeguard. All animals, birds and insects are born with natural tendencies or instincts to perform certain acts such as herd together for mutual protection, flee from danger, fight an enemy, disguise themselves against the correct coloured background; to find water and food, find shelter or build a nest; to find a mate, to suckle and rear the young. They are the biological urges to protect the individual, to sustain life and to carry on the species. Applied to human beings these urges drive us to adopt certain lines of conduct in order to satisfy our own needs. In rough order of importance we may list them as:— 1. Needed for protection from danger— The need to hide or flee from danger or fight an enemy either alone or with the group. The need to be in good standing, on good terms and accepted by others; to feel you belong to someone or a group; to be held in esteem and given prestige; to be given help and protection when necessary. 2. Needed for sustaining life— Water, food, shelter, warmth. 3. Needed for carrying on the race— Sexual satisfaction, love and care for children. 4. Needed for self-satisfaction and pride of achievement— Creative work. 8 Anxiety. The need compelling most urgent attention is the threat of danger. When the danger is real and comprehended we usually feel afraid and take steps either by hiding, fleeing or fighting either alone or with others, to deal with the threat. But when the danger is not understood, and most especially when the support of a person or group of persons is withdrawn and we feel rejected or despised, then instead of fear we experience the dreadful sensation of anxiety. In the acute form it is a feeling of extreme discomfort, tinged perhaps with an element of panic. It is so distressing that we will do almost anything to avoid it; it is all-powerful and compelling. It takes our whole attention and while it lasts all thoughts of other activities are suspended. Anxiety of the worst form is nearly always brought on by the feeling of rejection. It may also be brought on by the threat of the loss of the means for sustaining life, such as food, shelter and warmth, but for practical purposes anxiety results from loss of prestige and esteem, the loss of the love of someone held dear, the loss of a friendship, or the loss of the assistance afforded by friends, relatives, workmates, subordinates, superiors, or family. The reason is that without others we cannot exist adequately; the loss of the support of those important to us is a biological threat to existence, it produces an anxiety so acute as to be almost unbearable. It is a denial of the instinct to herd together for mutual protection. When anxiety of any degree of severity arises any time in our lives we react at once with conduct calculated to lessen it. This conduct is nearly always a reversion to one of the forms of conduct typical of some stage of childhood or adolescence. To see what these stages are let us consider behaviour, emotional development and biological needs from babyhood to adult life. Babyhood. A young baby needs attention, care, warmth and shelter; milk, fondling and love; he makes his wants known by wriggling and crying. There is little emotional development at first, but towards the end of the first year he gradually becomes aware of himself as a separate individual. Toddler Stage. As a toddler the child is concerned only with his own selfish needs especially comfort; he has to learn the control of bladder and bowel, and to conform to the wishes of his parents. In addition to the needs of a baby he seeks help from his parents and wants to feel wanted and loved by them. When his needs are denied he indulges in crying, shrieking, demanding, ' creating,' and temper tantrums; later he becomes resigned to disappointment, is apathetic, feels insecure and develops a clinging attitude; he becomes fearful, disobedient and hateful. If this type of conduct continues to adult life he will react by regression to childish conduct in every trying situation. By incessant demands, tears, and temper outbursts he constantly gains attention; he assumes too 9 readily defeatism and disappointment in his plans and aspirations and has little faith in his own ability. He develops feelings of insecurity about his livelihood, his hope of success, and the esteem of other people; he develops also a clinging helpless attitude to those around and is constantly needing reassurance. If the demands of his parents are too great and their standards too strict the child develops feelings of guilt because of his inability to conform to their wishes. He becomes indifferent, stubborn and rebellious, hostile and disobedient, cruel to other creatures and destructive. If this conduct is continued to adolescence and beyond he turns out to be a rebellious, stubborn and indifferent boy, bad tempered, cruel and destructive. As a man he will be fearful, anxious, and unco-operative; he will be hostile to society, obtaining revenge for rejection by breaking rules, disobedience, and delinquency. If the child, although able to conform, is allowed to disregard his parents' wishes, he will become spoiled—that is untrained in obedience to discipline. He develops habits of gluttony and over-dependency. In later life he tries to get things without effort and indulges excessively in food and drink, and becomes selfish and heartless. If the child is neglected in the basic need of food his growth rate will be slow and his general health poor. If this is continued he will grow to adult life stunted, ill-developed, unhealthy, and possibly apathetic. Infant School Stage. When the child reaches infant school age the personality has to develop over a wider field; he has to learn to conform to the wishes not only of parents but of his teacher and other adults and his playmates. Especially does he need to feel that he is wanted and loved by them; and in order to keep in good standing he will go far to conform and submit to their wishes. He learns to imitate his parents, teacher, older brother or other hero because their conduct must be acceptable. If he develops this habit to excess he may grow up to be too submissive, always conforming to the wishes of someone else or of his group. He will develop the trick of identifying himself with a hero or a national figurehead, or his manager, or the chairman of his group. The child will also take much trouble to learn many things so as to try to be not less competent than the person or group he imitates; he therefore needs much information and answers to many questions, including how he came into the world. The habit of learning is good, but it can sometimes be used to turn the person into a ' smart Alec ' or ' clever guy ' in order always that he can outdo his associates, and this habit may continue. If the child is given false answers to his questions, especially those about sex, he will develop an uneasy mistrust of his parents. He may grow up in the belief that sex activity in married life is inherently wrong; this attitude of mind can cause serious unhappiness in his own marriage. So strong is the desire to keep in good standing that the child, when he falls from grace, is not averse to throwing the blame on someone else for his own misdemeanours or shortcomings; in later life this habit leads to unreliability and lying. 10 If the desired affection is constantly denied, the rejected child becomes sullen, stubborn and resentful. If in spite of all his efforts he cannot get the longed-for love, he compensates by making do with substituted imaginary satisfactions and make-believe, as when the poor boy becomes a king, or Cinderella a princess. In later life he will live his life too much in fantasy and be content with second-best. Sometimes if the demands on him are excessive and he cannot keep up the standard expected, or has failed to achieve a coveted success, he reacts with over-carefulness and precision, and goes through routines and rituals to show how good he is. In later life he cannot bear anything to be wrong and is too exacting with everybody. Owing to the attraction of opposite sexes, a little boy learns he can generally get more attention from his mother than from his father, and so she tends to receive the greater part of his affection; and similarly but vice versa with little girls. If the mother's love is denied, the boy goes on unconsciously searching for a mother substitute and yet bearing a sullen resentment against all women; he never learns to accept anything from them graciously; in his sex relationship he may become frigid and impotent. Junior School Stage. At the junior school stage the sense of altruism is very small, so children tend to be aggressive, bullying and tyrannical. They call each other nasty names and are cruel to each other and animals. If the good example of love and consideration for others is absent at home, a child will grow up completely indifferent to the feelings of others, and may continue his bullying and cruelty into adult life. These children as yet have little idea of conscientiousness and reliability. They are indifferent to the opposite sex. Greater still is their need to feel accepted and liked especially by other children, and to obtain respect and prestige. Thus more than ever they indulge in imitation of people of importance as when the cowboy overpowers the indian, and the detective captures the criminal. Their need for information is growing stronger, especially from father who is, of course, one of the heroes. He has to answer a great many questions; if he does not, the child will develop anxiety through insecurity and seek his remedy in the company of gangs and groups. The habit may continue to adult life when he must always be at the club or at a party. The deep anxiety of insecurity is often ' converted ' to some real situation or episode entirely unrelated to the real cause and which is seized upon as an excuse for fear or anger; thus a wife expresses fear of her husband's car-driving when her real trouble is the anxiety of insecurity. Sometimes the love and acceptance of the child by parents, teachers, and other adults is conditional upon the child conforming to very strict standards of behaviour and achievement. The child may get the competitive habit in which to obtain his feeling of superiority and to avoid anxiety he must always win every contest or argument; otherwise he reproaches himself for his shortcomings or puts the blame on someone else; he also indulges in self-praise or blowing his his own trumpet—often falsely. If he cannot attain the standards expected 11 or otherwise is unable to obtain love and affection and, especially if he i: tormented and rejected, he is spurred to ill-considered defence activity as ir panic; there is a similar reaction in adults. Alternatively he may seek seclusion thereby avoiding anxiety by avoiding people; this habit may also continui throughout life. In seclusion he can indulge in day-dreams and fantasies substituting pleasant dreams for unpleasant realities. However, the menta mechanism is merciful; the incidents which produce anxiety can be repressee and ' forgotten.' Constant anxiety in children, as indeed in persons of all ages, can produci bodily stress symptoms. As the person continues to ' suffer in silence ' thi nerves which control blushing, pallor, bowel movement, and which regulate th amount of adrenalin—the defence hormone—are all constantly stimulated producing bodily disorders such as headache, sickness, diarrhoea, gastric ulce and asthma. Adolescent Stage. In early adolescence children display a rigid self-sufficiency and almos insufferable priggishness and superiority; they think they know everything They have to go through a phase of adjustment in order to achieve good socia relationships; they are still rather thoughtless about the feelings of others There is thus great need for them to be taught tolerance and how to join ii life's activities cheerfully and not be too critical or aloof; to be willing to shar community life. The finest incentive towards achieving this good conduct i for them to see good examples of it at home, in school, and at work; they neei also to be taught the right principles. At this age there is development of the secondary sex characteristics and feelings; they have to go through a phase of adjustment to achieve acceptance of the opposite sex and to get over the awkwardness due to rapid growth. They need information about sex feelings and functions much of which should have been given already in answers to questions in earlier years. Girls need knowledge about menstruation and the development of the figure. In the absenc of proper knowledge boys and girls tend to be shy and awkward in mixed groups; these feelings may be continued into adult life and may possibly result in unhappiness in marriage. In adolescence there is still the need for love and security. If these are denied the continuous frustration felt by the rejection, especially rejection or indifference by the parent, eventually leads to hatred of the person responsible. As this cannot be expressed outwardly as such because it is socially wrong to express hatred for a relative, the feelings are bottled up. The situation is resolved by the unconscious substitution of the hated person by perilous objects, ghosts, weird animals and frightening situations, such as falling fror a height, or being kicked by a horse. The substitutions appear in nightmares Adolescence, too, is the period for effecting emancipation from dependency and for preparing for adult responsibility. If the upbringing has been bad the child will be slow to accept aelult responsibility and will probably become an: anxious, shy, retiring, isolated adult avoiding responsibility altogether. The same thing may occur if opportunities for responsibility are withheld, as when the parent anticipates every difficulty, shields the child too much and will not let him grow up. The child learns to keep his anxiety under control by childish 12 and illogical behaviour; with increasing intelligence he is more able to defend it by plausible and logical explanations. Typical examples of the adult who has grown up in these circumstances is the one with the rigid viewpoint, as in the father who cannot tolerate the minor excesses or extravagances in his son because of his own stubborn rigidity of mind and the anxiety which would follow his admitting he had behaved the same way himself; or the other overactive adult who avoids anxiety by having no time for it. Many people get relief from anxiety by the temporary substitution of the excitement of gambling; others take to drink and drugs. Finally there are those who give up the struggle altogether and become insane, imagining themselves to be kings and queens or superior persons—the victims of international plots. The Anxiety Reaction. Throughout all these stages you will have noted time and time again that where the herd instinct is denied—that is, where there is a threat to safety or security or acceptance the person reacts with anxiety—vague feelings of helplessness and panic. The reaction is always one which restores social acceptance in the mind of the person himself; that is it restores self-respect, self-regard, and self-esteem, and prestige. Whether the person is or is not held in esteem in reality does not matter; if the person himself believes he is in good standing all will be well; but even the threat of a weakening of that belief will provoke a reaction to restore the belief because of the painful feeling of anxiety. Thus anxiety will come on in circumstances where we fear we might make fools of ourselves and so lose prestige, such as in stage-fright, or fear of losing a game before it is played, or going to meet an important person, or going in for an examination, or when the house is untidy when someone calls. In all these situations the person is unconsciously thinking ' I will lose prestige, and my good standing with this person or group will suffer and I might become an outcast.' Prestige. This state of prestige is a biological safeguard. The man held in high esteem often becomes the leader of a group. Without a leader the group is more vulnerable to its enemies. Therefore the leader gets special protection from the group which would rather protect a bad leader than have no leader at all. And there is considerable inertia in a group over a change of leader—that is, the group will take a very great amount of persuasion to change from a bad leader to one supposedly better. Thus, if any person can get to be a leader of any group such as the president, chairman, manager, or foreman of a society or public body or business then that person not only gets the prestige of the leader but he also gets the not inconsiderable security of tenure of his office by reason of the natural support given to him by the group he leads. Reducing Anxiety. So all our lives from babyhood onwards we constantly make adjustments in our conduct calculated as we think best to minimise all feelings of anxiety. We thus create habits and patterns of behaviour which tend as we grow older to become a fixed part of us. We use the same old tricks which we used 13 when we were children and growing up; thus we tend to behave to persons in authority as we did to our parents and teachers; to our fellow workers as we did to our brothers and sisters at home or our school-fellows at school. In married life the patterns of childhood are similarly evident; the submissive secluded schoolgirl who was denied her mother's love becomes in later life the dependent wife who regards her husband as a substitute father; the bullying domineering tyrannical boy rebelling in childhood against over-harsh standards becomes the cruel, brutal husband. Do you recognise yourself in any of these patterns? We become so habituated to the patterns of conduct which minimise the anxiety of threatened rejection that we become ' conditioned ' as in ' brainwashing ' or insensitive to the niceties of the good influences in other people, to the subtleties of expression and innuendo in their voices, and to the quirks and twists in their actions—usually to our own detriment; this insensitiveness comes on because we are not sufficiently emotionally mature or generousminded enough to realise that we would suffer no hurt by accepting a different viewpoint or line of action. We develop a selective inattention whereby unconsciously we ' miss ' all sorts of things which would cause us embarrassment. Summary. When you feel cross or hurt or angry or just plain stubborn pause a moment and ask yourself ' What is the cause of my anxiety and what episode in my upbringing has given rise to this reaction? ' If you can bring yourself to do this in the middle of your bad temper I feel sure you will cool off pretty quickly and you will be sorry that you allowed your emotions to overcome your good sense. By understanding the reasons for your behaviour you can avoid embarrassing situations and save yourself the anxiety from having to retract or climb down. So you will learn to prevent mental illness. Acknowledgements. I am indebted to a number of authors and publications for material for this part of the report and especially to two books available in the Twickenham Library, ' How to Understand Yourself and Other People,' by H. C. Lindgren, and ' Emotional Problems of Living,' by O. S. English and G. H. J. Pearson. THE DISEASES AND DISABILITIES OF OLD AGE A Survey of the Over 60's. During 1954 I assisted a colleague with a research on the medical problems of old age. In 1952 my friend Dr. R. C. F. Smith, Medical Officer of Health of Sunderland Rural and Boldon Urban District, conceived the idea of undertaking, in a circumscribed district, a thorough physical examination of the men and women over 60 years of age to see how healthy they were or what diseases and disabilities they suffered from. He asked me if I would do the statistical work and I agreed. 14 There have been a number of surveys of old people, but none that we knew of had attempted full medical examinations; so that accurate information about the health of people over 60 was lacking. Dr. Smith chose the villages of Tunstall and Silksworth in his area in County Durham as typical of a middleand working-class urban district. The population was 7,500, the density of houses and persons per acre slightly better than average, and in other respects such as the infectious disease rates and death rates the area was about average. The workers are employed mostly in the coal-mining and shipping industries and small shops. Arranging the Medical Examinations. The names and addresses of all people over 60 were obtained by using every source of information possible such as the voting lists, all organisations and clubs, the churches, welfare officers and the medical practitioners. The complete list contained 550 names or 7.3 per cent, of the population, which is slightly less than in comparable areas of England and Wales. By courtesy of the consulting physician Dr. o. Olbrich, the facilities for medical examination in the department of geriatrics at Sunderland General Hospital were placed at Dr. Smith's disposal. He arranged for about 60 people from the list to be invited each week to attend the hospital. About half of them accepted; but some, perhaps feeling quite well and not in need of medical attention, some perhaps fearing something being found out, some saying they did not wish to tempt providence, some recently attended by their own doctors or already attending hospital, and some ill in bed—and for other reasons were reluctant or refused to attend. Dr. Smith visited most of them and persuaded a number to come. Some private car owners including the Red Cross volunteered to provide transport. The number finally persuaded to attend was 238 out of the original 550. The medical examinations were very thorough indeed, covering every system of the body and including X-rays and laboratory tests. The findings were entered on the hospital clinical records. Factor Analysis. We decided to do a factor analysis of the findings to see if they revealed any factors. This procedure is used to test if there are any common influences which can account for the differences amongst the people examined; it also serves as a means of classifying them. We selected certain information from the clinical records such as sex, age, haemoglobin level, blood pressure, and the diseases found. Some persons had two diseases, some three, and a few four. We divided these details into 42 sub-classes. We then made up a table showing how many people fell into each sub-class. This table constitutes the first step in the analysis of the factors. The whole analysis is a complicated mathematical procedure. It took many many hours of work at odd times. One part required the use of Hollerith punch-card and sorting machinery and the use of the electronic calculator. 15 By reason of the friendship existing between the Twickenham Borough Council and the National Physical Laboratory, I was afforded the very great courtesy of having the assistance of the staff of the Mathematics Division, who helped with the punching, sorting and the electronic calculations. Without this assistance the procedure could not have been tackled at all and we should have had to be content with a much less accurate method. I think the results proved the effort to be well worth while. The factor analysis revealed four factors or common influences:— Factor 1. Healthiness. The influence operating on this group kept them healthy. They were mostly men aged 60 to 64 and were completely free from disease. Their haemoglobin levels were high and their blood pressures low. Factor 2. Infection and Anaemia. In this group there were both men and women aged 70 to 74. Their haemoglobin was low, their blood pressures rising. They suffered from bronchitis and other diseases of the chest, and anaemia—sometimes quite severe. It is quite likely that these people had a deficiency of iron in their diet and possibly of other trace elements like boron, manganese, molybdenum, copper, etc., and possibly also some deficiency of protein; because there is reason to believe that deficiencies such as these render living animals and plants susceptible not only to deficiency diseases but also to infection. Factor 3. Obesity, Hypertension and Multiple Disabilities. This group was made up mainly of women aged 65 to 79. Their haemoglobin was slightly below normal and their blood pressure moderately high. The most important finding was obesity; this is the group of fat old women with rising blood pressure. They also have multiple illnesses and disabilities, the most frequent being uterine prolapse, diabetes, asthma, myxoedema, bronchitis, anaemia and osteo-arthritis. These women may well have the same deficiencies of diet as in Factor 2, but they have also the rising blood pressure. A possible cause for this is deficiency of choline, a substance found in egg yolk. In working-class households it is common for the women to deny themselves the expensive protein and protective foods, which usually go to the men; the women instead live mostly on starchy foods, especially bread and margarine and jam, or bread and dripping. They tend to put on weight in the 30's getting fatter and fatter as they get older; some even reach 18 stones in weight. Factor 4. Malignant Hypertension. This group have severe high blood pressure; with this go enlargement and failure of the heart, and angina. It is associated with obesity but not always, for there are people with high blood pressures who are not obese. The Nature of the Factors. It is curious and interesting that the four factors are closely related to blood pressure, the outlook becoming worse as the blood pressure rises. In round figures about one-fifth of the over 60's are healthy and have low blood pressure; two-fifths have infections and anaemia and rising blood pressure; onefifth have obesity, multiple disabilities and moderately high blood pressure; and one-fifth have severe high blood pressure. About half the people who are ill 16 have got raised blood pressure of more or less severity. They die mostly from heart failure and stroke; this corresponds to the expected 50 per cent. mortality rate (mostly old people) found in the table of causes of death. Blood pressure tends to rise with age especially in women, and as it rises the victims are afflicted with two, three or four illnesses or disabilities concurrently. Prevention. We need to investigate further the diets and habits of these people to see if we can determine more accurately the probable associations. In the meantime two useful preventive measures would be to encourage by health education the consumption of a diet sufficient in proteins and minerals, and to warn people of the dangers of obesity, and to show them how to slim and to control their weights. Acknowledgements. Dr. Smith and I acknowledge with grateful thanks the assistance we have received from many people during the course of this research. We would specially like to mention Dr. O. Olbrich and his staff of doctors, nurses and laboratory technicians in the Geriatric Department of the Sunderland General Hospital. Also Sir Edward Bullard the Director of the National Physical Laboratory for permission, and Dr. E. T. Goodwin, Mr. T. Vickers, Miss Rigg and the staff of the Mathematics Division for assistance, in punching cards and sorting and the extraction of the latent roots and vectors of the matrix of correlations in the factor analysis. 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. In one large restaurant kitchen there had been recurring infestations by the common cockroach. On the advice of this department one of the new insecticides Urea Formaldehyde containing Dieldrin and Aldrin was applied and a hundred per cent, clearance was effected. The income from pest destruction for the year was £85 4s. 2d. 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. No works of major improvement have been possible because of the continued restriction of capital expenditure. 17 There have been no heavy storms during the year and the relief sewers constructed in the Fulwell Park Estate and near Woodlawn Crescent have not, therefore, been fully tested. Due to the disconnection of certain premises discharging foul water into the surface water system, pollution of this system has been reduced, but there is still evidence that persons are either wittingly or unwittingly discharging polluted matter into the surface water system and investigations are proceeding. Public Cleansing. (a) Streets. New pedestrian electrically operated vehicles have been installed in some areas, with a result of economy in cost. (b) Refuse Disposal. The new works at Charlton were in operation in November, 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 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 30,141 (105,290 persons) (b) By means of standpipes 5 (10 persons) INDUSTRIAL HEALTH Factories. Most of the 351 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; 18 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 1953 the inspectors paid 381 visits to factories; in 17 factories the attention of the management had to be drawn to contraventions of the regulations. The inspectors also paid 143 visits to out-workers' premises. GENERAL MATTERS 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 1953 one exemption certificate was granted, which makes a total of 20 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 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 1953 was 425. 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 12 samples for bacteriological examination were taken throughout the season, all of which 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. 114 samples of ice cream were obtained, and all but 8 were satisfactory. In addition, 183 miscellaneous specimens, mainly faeces, were submitted to the laboratory in connection with food poisoning and dysentery enquiries. 19 Establishments for Massage, Chiropody, Electrical and Special Treatment. Thirteen licences in respect of establishments for these purposes were issued during the year 1953. 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 1953, six persons and seven premises were registered. The inspectors paid 56 visits. Petrol Filling Stations. During the year 1953, 305 visits were paid by the sanitary inspectors to premises where petroleum or carbide of calcium is stored, and 104 licences were issued. Rent Restriction Certificates. No certificates were granted for premises which were in bad repair. No cancellation certificates were issued in respect of premises which were put in reasonable state of repair, but one certificate was cancelled because the premises had been demolished. Tents, Vans and Sheds. During 1953, one renewal of consent was issued for temporary sites for caravans. Smoke Abatement. It was not necessary to take any formal action during 1953 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 1953. 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. 20 Rag Flock and Other Filling Materials Act, 1951. Five premises have so far been registered under the Rag Flock and Other Filling Materials Act, 1951, and three samples of rag flock were obtained and were 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 1953, to remove to suitable premises any persons in need of care and attention. Complaints. During 1953 the number of complaints received by the department was 1,736. 21 TABLES FOR STATISTICAL YEAR 1953 23 STATISTICAL TABLES for the Year 1953 Table 1. Summary. 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) 105,300 Number of inhabited houses 30,146 Rateable value £1,104,624 Sum represented by a penny rate £4,455 4s. 2d. Total M. F. Live Births: Legitimate 1,344 663 676 Illegitimate 52 30 22 Total 1,396 698 698 Birth rate per 1,000 of estimated civilian population 13.26 Total M. F. Still Births: Legitimate 20 10 10 Illegitimate — — — Total 20 10 10 Still birth rate per 1,000 total (live and still) births 14.12 M. F. Deaths 596 550 1,146 Crude death rate per 1,000 of estimated civilian population 10.88 Adjusted death rate 10.01 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 20.06 Legitimate infants per 1,000 legitimate live births 20.83 Illegitimate infants per 1,000 illegitimate live births Nil 24 Table 2. Population 1938-1953. 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 103,900 + 200 + 0.19% + 399 — 199 1950 107,600 + 700 + 0.65% 4.246 454 — 1951 106,300 — 1,300 — 1.28% + 91 — 1,391 1952 106,500 + 200 + 0.19% + 144 56 — 1953 105,300 — 1,200 — 1.13% + 250 — 1,450 Table 3. Causes of Death. Registrar-General's Official Returns. Causes of Death Males Females Total All causes 596 550 1,146 1. Tuberculosis, respiratory 17 8 25 2. Tuberculosis, other 1 — 1 3. Syphilitic disease 2 1 3 4. Diphtheria — — — 5. Whooping cough — 1 1 6. Meningo-coccal infections — — - 7. Acute poliomyelitis 2 — 2 8. Measles — — — 9. Other infective and parasitic diseases 1 1 2 10. Malignant neoplasm, stomach 14 13 27 11. Malignant neoplasm, lung, bronchus 43 4 47 12. Malignant neoplasm, breast — 16 16 13. Malignant neoplasm, uterus - 8 8 14. Other malignant and lymphatic neoplasms 54 46 100 15. Leukaemia, aleukaemia 4 1 5 16. Diabetes 1 3 4 17. Vascular lesions of nervous system 52 78 130 18. Coronary disease, angina 119 58 177 19. Hypertension with heart disease 12 14 26 20. Other heart disease 65 112 177 21. Other circulatory disease 29 33 62 22. Influenza 14 16 30 23. Pneumonia 27 24 51 24. Bronchitis 45 26 71 25. Other diseases of respiratory system 1 3 4 26. Ulcer of stomach and duodenum 7 5 12 27. Gastritis, enteritis and diarrhoea 2 — 2 28. Nephritis and nephrosis 1 5 6 29. Hyperplasia of prostate 6 — 6 30. Pregnancy, Childbirth, abortion — - — 31. Congenital malformations 5 4 9 32. Other defined and ill-defined diseases 34 45 79 33. Motor vehicle accidents 15 4 19 34. All other accidents 16 16 32 35. Suicide 5 3 8 36. Homicide and operations of war 2 2 4 25 Table 4. 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 — 1 1 0.009 Diarrhoea — — — — Table 5. 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 38.56 4.19 Intra-cranial vascular lesions 11.34 1.23 Bronchitis, Pneumonia, and other respiratory diseases 10.99 1.20 Cancer 16.57 1 .88 Violence 5.49 0.60 Tuberculosis 2.26 0.25 26 Table 6. 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 1 1 1 20 3 1 2 2 28 Uncertified — — — — — — — — — — Smallpox — — — — — — — — — — Chicken-pox — — — — — — — — — — Measles — — — — — — — — — — Scarlet Fever — — — — — — — — — — Diphtheria and Croup — — — — — — — — — — Whooping Cough — — — — — — — — — — Influenza — — — — — — — — — — Enteritis — — — — — — — — — — Tuberculous Meningitis — — — — — — — — — — Abdominal Tuberculosis — — — — — — — — — — Other Tuberculous Diseases — — — — — — — — — — Congenital Malformations 3 1 — — 4 — — 2 — 6 Premature Birth 7 — — — 7 — — — — 7 Atrophy, Debility and Marasmus — — — — — — — — — — Atelectasis 6 — — — 6 — — — — 6 Injury at Birth — — — — — — — — — — Erysipelas — — — — — — — — — — Syphilis — — — — — — — — — — Rickets — — — — — — — — — — Meningitis (not Tuberculous) — — — — — — — — — — Convulsions — — — — — — — — — — Gastritis — — — — — 1 — — — 1 Laryngitis — — — — — — — — — — Bronchitis — — — — — — — — — — Pneumonia (all forms) — — — — — 2 1 — 1 4 Suffocation (overlying) — — — — — — — — — — Other causes 1 — 1 1 3 — — — 1 4 Totals 17 1 1 1 20 3 1 2 2 28 (b) An analysis of the mortality reveals that neo-natal deaths were responsible for 71.43 per cent. of the total deaths, viz.:— Under 24 hours 1 to 7 days 1 to 4 weeks Total under 4 weeks Percentage total infant deaths 14 3 3 20 71.43 27 28 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 T uberculosis Influenza Smallpox A cute Poliomyelitis and Polioencephalitis Pneumonia Diarrhoea and Enteritis (under two years) Total Deaths under 1 year England and Wales 15.5 0.35 11.4 0.00 0.01 0.00 0.20 0.16 0.00 0.01 0.55 1.1 26.8 160 County Boroughs and great towns, including London 17.0 0.43 12.2 0.00 0.01 0.00 0.24 0.15 0.00 0.01 0.59 1.3 30.8 160 smaller towns, resident populations 25,000 to 50,000 at 1951 census 15.7 0.34 11.3 - 0.00 0.00 0.19 0.17 0.00 0.01 0.52 0.9 24.3 London Admin. County 17.5 0.38 12.5 — 0.00 — 0.24 0.15 — 0.01 0.64 1.1 24.8 Twickenham 13.26 0.19 (a) 10.88 — 0.00 — 0.25 0.28 — 0.02 0.48 — 20.06 (b) 10.01 A dash ( — ) signifies that there were no deaths (a) crude (b) adjusted Table 8. Review of the Comparative Vital and Mortality Statistics for the Borough of Twickenham, together with those for England and Wales for years 1938.1953 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 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 1953 13.45 15.85 (a) 10.88 11.4 20.06 26.8 (b) 10.01 (a) Crude (b) Adjusted 29 30 Results of the Chemical and Bacteriological Examination of the Water Supply to the Borough of Twickenham for 1953. Parts per million (unless otherwise stated). (a) Chemical. Description of the Sample Number of Samples Ammoniacal Nitrogen Albuminoid Nitrogen Oxidised Nitrogen (Nitrate) Chlorides as c1 Oxygen abs. from Permanganate 4 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.111/4 Silica as SiO2 Conductivity River Thames water filtered at Hampton Works 234 0.008 0.077 3.5 26.6 1.04 0.3 13 263 64 7.9 0.62 11.0 500 Table 9. (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 Bact. coli per 100 ml. River Thames water filtered at Hampton Works 873 6.0 99.8 0.004 Table 10. Analysis of Complaints Received. Nature of Complaint Number Received Housing defects 371 Choked and defective drains 211 Accumulations of offensive matter 15 Unsound food 280 Verminous premises:— (a) Bugs 31 (b) Rats and mice 401 (c) Other 108 Keeping of animals 4 Unsatisfactory milk supplies 2 Miscellaneous 315 Total 1,736 31 Table 11. Summary of Visits, Inspections, etc. Number Dwelling-houses for housing defects under Public Health Act:— (a) After complaint 1,198 (b) Subsequent visits 4,431 Dwelling-houses under Housing Act:— (a) After complaint 409 (b) Subsequent visits 43 Dwelling-houses:— Housing applications, specially investigated 48 Infected dwelling-houses:— (a) After notified infectious disease (other than tuberculosis) 379 (b) Contacts 134 (c) Fumigations after infectious disease 4 (d) Phthisis enquiries and fumigations 9 School and church halls 10 Swimming baths 1 Water sampling:— (a) Swimming baths 6 (b) Dwelling-houses 15 Business premises 20 Cinemas, dance halls, billiard halls 40 Offensive trade premises 1 Stables, piggeries, keeping of animals 93 Houses let in lodgings 4 Factories Acts, 1937 and 1948:— Factories with mechanical power 330 Factories without mechanical power 51 Outworkers' premises 143 Common lodging houses 1 Underground rooms 71 Hairdressing premises 75 Tents, vans and sheds 50 Smoke nuisances 169 Fairgrounds 5 Drainage: Testing by:— (a) Smoke 215 (b) Coloured water 31 (c) Water 33 (d) Breaking down 286 Re public sewers 1,235 Watercourses and ditches 6 Land and tips 110 Septic tanks and cesspools 8 Sanitary conveniences—including public-houses 121 Miscellaneous visits 781 Visits not inspections 1,431 Verminous premises:— (a) Rats and mice: (i) After complaint or from survey 38 (ii) Subsequent visits 264 (b) Bug infestations Number of premises visited 130 Number of premises where definite infestation existed 42 (c) Cockroaches 6 (d) Other vermin 207 32 Table 11—continued. Inspections for supervision of food:— Unfit foodstuffs other than meat 384 Slaughterhouses 12 Butchers' shops (Public Health (Meat) Regulations, 1924) 484 Food and Drugs Act, 1938, Section 13:— Bakehouses 201 Fish shops, grocers and greengrocers 1,162 Factory and school canteens 59 Restaurant kitchens, etc. 514 Hotel and beerhouse bars and cellars: (a) Day inspections 61 (b) Night inspections Nil Food and Drugs Act, 1938, Section 14:— Ice-cream premises (Heat Treatment) Regulations, 1947 to 1951 344 Sausage manufacturers 24 Preserved meat preparation premises 39 Preserved fish preparation premises 57 Milk and Dairies Regulations, 1949:— Milk sampling for bacteriological examination — Contraventions of Milk and Dairies Regulations 3 Dairies 24 Shops Act, 1950, Section 38 557 Middlesex County Council Act, 1950:— Hawkers' vehicles 25 Hawkers' premises 31 Noise nuisances 29 Massage and/or special treatment establishments 7 Petroleum (Regulation) Acts, 1928 and 1936; Petroleum Spirit Regulations, 1929-1950 305 National Assistance Act, 1948, Section 47 11 Rag Flock and other Filling Materials Act, 1951 9 Dealers in Old Metal and Marine Stores 4 Pet Animals Act, 1951 15 Total number of visits and inspections 17,045 33 Table 12. Sanitary Improvements Effected. Number Offensive accumulations removed 6 Nuisance from keeping of animals remedied 1 Chimney flues repaired 7 Chimney stacks repaired 6 Roofs repaired 174 Eavesgutters repaired 94 Downspouts repaired 38 Pointing renewed 23 Drains repaired 16 Drains unstopped 29 Dustbins provided 39 Fireplaces repaired 20 Filthy condition of premises remedied 4 Floors repaired 52 Gullies repaired 10 Plaster to walls and ceilings repaired 142 Window frames and sashcords repaired 29 Public sewers repaired 15 Sinks provided 3 Sink waste pipes repaired 14 Soil pipes repaired 4 Stairs repaired 1 External walls repaired — W.C.s repaired 10 W.C. cisterns and fittings provided 63 W.C. accommodation provided 6 Yard paving repaired 15 Other works carried out 437 34 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) 1,607 (b) Inspections made for the purpose 6,081 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 594 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 546 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 87 (2) Dwelling-houses in which defects were remedied after service of formal notices: (a) By owners 105 (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 respcct 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 1 (3) Dwelling-houses demolished in pursuance of Demolition Orders Nil D.—Proceedings under section 12 of Housing Act, 1936:— (1) Separate tenements or underground rooms in respect of which Closing Orders were made ... 1 (2) Separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil 35 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 594 84 Number of Informal Notices complied with 546 93 Number of Statutory Notices served 87 1 Number of Statutory Notices complied with 105 1 Number of cautionary letters sent by Town Clerk — — Table 15. Offences under Food and Drugs Act, 1938. Case No. Section contravened Offence Action taken Nil Nil Nil Nil 36 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 5,359 6,047 11,403 NUMBER OF INFESTATIONS Food Premises Non-food Premises Private Dwellings Factories Rats only Mice only Rats and mice 35 21 402 54 377 123 12 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 383 Nil Nil 129 NOTICES NOTICES SERVED NOTICES OUTSTANDING Preliminary Notices Statutory Notices Final (Default) Notices Preliminary Notices Statutory Notices Final (Default) Notices 47 2 Nil Nil Nil Nil RAT DESTRUCTION WORK UNDERTAKEN BY CORPORATION OCCUPIERS Rats Mice Rats Mice 358 129 25 Nil NUMBER OF PREMISES UNDER CONTRACT WITH CORPORATION TOTAL 487 12 months 3 months 6 weeeks 1 month Others Total Receipts 28 372 70 17 £560 17s. 1d. 37 38 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 Dwelling-Houses 2 - 42 3 3 4 - 2 - 20 4 - 80 Workplaces 1 — — 1 — 2 — — — — 1 — 5 Food Shops — — — 11 — 13 — - — 1 — — 25 Miscellaneous — - — — — — — - — 3 - - 3 Totals 3 — 42 15 3 19 — 2 — 24 5 - 113 Total income for D.D.T. and other special treatments, £85 4s. 2d. Corporation premises treated (re-housed families only): Nil. Table 17. Table 18. Disinfections, etc. Number Premises disinfected after infectious diseases 19 Premises disinfected after other diseases 1 Articles disinfected after infectious disease 116 Persons (children and adults) treated for scabies at cleansing station — 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) (l) Dwellings overcrowded at the end of the year 178 (2) Families dwelling therein 231 (3) Persons dwelling therein 819 (b) New cases of overcrowding reported during the year 43 (c) (1) Cases of overcrowding relieved during the year 12 (2) Persons concerned in such cases 51 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 distributors 27 Premises registered as dairies (not being dairy farms) 16 Special Designation Dealers' Licences Supplementary Licences Milk (Special Designation) (Raw Mil k) Regulations, 1949. Tuberculin tested 20 11 Accredited Nil Nil Milk (Special Designation) (Pasteurised and Sterilised Milk) Regulations, 1949. Pasteurised 21 11 Sterilised 34 10 39 Table 21. Food and Drugs Act, 1938. Public Health Act, 1936, Section 89. Insanitary Conditions in Food Premises. Number of premises found with insanitary condition 84 Number of premises remedied 93 Insanitary conditions found in premises above Number of defects Number of defects remedied Accumulation of refuse 12 10 Ceilings—defective or dirty 32 29 Cleanliness (personal) unsatisfactory 3 — Dampness — — Floors—defective or dirty 9 9 Lighting inadequate — — Sink—absence of — — Sink-waste pipe inadequate 1 — Storage facilities unsatisfactory — — Ventilation insufficient — — Walls—dirty or plaster defective Insufficient or absence of hot and cold 50 46 water for cleansing utensils 3 1 Absence of hot water for ablution purposes 3 — W.C. accommodation—insufficient or unsuitable 1 6 Other defects 32 44 Totals 146 145 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. Fight slaughter-men were on the register of the department at the end of the vear. 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 — — — — 5 Number inspected — — — — 5 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 23. (a) Meat. Diseased and unsound conditions found in meat caused the detention and surrender for destruction of:— lbs. Beef 3.203 Mutton and lamb 61 Pork 638 Other meats 733 Total 4,635 (b) Other Foodstuffs. The following foodstuffs, other than meat, being unfit for human consumption, were voluntarily surrendered for destruction:— Eggs 190 Fowls — Bacon lbs. 22 Butter — Cheese 41 Egg powder 56 Fish 1,062 Flour and cereals 207 Preserves 75 Chocolate — Cake mixture — Biscuits — Sugar — Swedes — Potatoes 840 Tea — Fruit 205 Pickles Bottles 8 Canned foodstuffs:— Tins Fish 151 Fruit 2,574 Meat 716 Milk 569 Vegetables 831 Other 67 41 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, 1953 :— A rticle Total Samples procured Unsatisfactory Milk (various) 95 — Arrowroot 1 — Batter flour mixture 1 1 Biscuits 1 1 Bread 4 4 Cakes (various) 29 — Cheese 1 — Coffee 1 — Condensed milk 4 — Cooked meat 2 — Cream 8 — Drugs 6 — Evaporated milk 5 — Fish (fresh) 41 — Fish (tinned) 2 — Fish and meat pastes 2 — Flour 2 — Fruit squash 1 — Gelatine 1 — Jelly 3 — Minced meat 1 — Mint in vinegar 1 — Non-brewed condiment 3 — Nuts (brazil) 1 1 Peppermint wine (non-alcoholic) 1 — Preserves and mincemeat 4 — Sausages and sausage meat 36 6 Self-raising flour 1 — Soups 2 — Sponge mixture 1 ;— Suet 3 — Sweets (various) 4 — Tomato vitamin 1 1 Victoria plums 8 1 Vinegar 23 — White pepper 1 — Wines and spirits 47 — Totals 348 15 The following brief notes relate to other activities by my Council by virtue cf their duties as Food and Drugs Authority. Merchandise Marks Acts, 1887-1926. Attention has been paid in particular to compliance with the Imported Food Orders made under the Merchandise Marks Act, 1926, and which require in respect of specified foods that when, inter alia, they are exposed for retail sale they must bear a clear indication cf the country of origin, that is to say either the words " Empire " or " foreign " as the case may be or the specific country of production. 304 premises were visited and 4,093 head of poultry, displays of meat, stacks of apples or tomatoes or dried fruit were examined. One 42 butcher was prosecuted for removing from imported poultry the indication of origin, but the proceedings were dismissed. An official caution was addressed to another firm of butchers in respect of imported geese which were marked " English." Labelling of Food Order, 1953. Twenty-three premises were visited and 100 different articles of food were examined to ensure compliance with this Order. No infringement of substance was discovered. Defence (Sale of Food) Regulations. A firm of greengrocers was prosecuted for exposing for sale Ponds Seedlings which were marked " Victoria's," and was fined £\ and one guinea costs. Samples Containing Foreign Bodies. Nine samples were unsatisfactory in that each contained foreign bodies. Three samples of sausages were found to contain glass. The manufacturer was prosecuted and fined £6 and 10 guineas costs. A loaf of bread was found to contain a piece of metal and the bakers were prosecuted and fined £5 and 5 guineas costs. Three loaves of bread were each found to contain insects, a sample of biscuits was found to contain a button, and a sample of batter flour mixture was found to contain bristles. In all these cases an official caution was addressed to the manufacturers. Pork Sausage Meat. Three samples were found to contain undeclared preservative and official cautions were issued to the manufacturers concerned. Brazil Nuts. The Analyst reported that this sample was contaminated with Phenol. As extensive enquiries could not establish where, when, how or by whom the nuts became so contaminated, no further action was possible. Tomato Vitamin. This imported food was packed in tubes which were not labelled in accordance with the provision of the Labelling of Food Order. An official caution was addressed to the Importers. Victoria Plums. The retailer concerned was prosecuted for applying a label " Victoria's " to a pile of fruit which was a mixture of Victoria plums and Giant Prunes and was fined £1 and two guineas costs. He was also prosecuted in respect of a sale made from this display and a conviction was recorded but no separate penalty imposed. 43 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 47 51 1 — (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 304 330 16 — (iii) Other premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) — — — — Total 351 381 17 — 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) 1 — — — — Ineffective drainage of floors (S.6) — — — — — Sanitary Conveniences (S.7) :— (a) Insufficient 3 4 — — — (b) Unsuitable or defective 6 7 — — — (c) Not separate for sexes 2 2 — — — Other offences against the Act (not including offences relating to outwork) 20 17 — — — Total 32 30 — — — 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) 6 1 53 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 — — — 44 Table 26. Infectious Diseases. Incidence and Mortality. Diphtheria, Scarlet Fever and Enteric Fever. 1938-1953. 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 18 019 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 — — — — — — — 1946 4 0.04 — — 60 0.58 — — — — — — 1947 4 0.04 1 0.01 60 — — — — — — — 1948 1 0.01 — — 99 0.93 — — — — — — 1949 — — — — 128 1.20 — — — — — — 1950 — — — — 115 1.07 — — — — — — 1951 — — — — 64 0.60 — — — — — — 1952 — — — — 135 1.28 — — — — — — 1953 — — — — 100 0.95 — — — — — — 45 Table 27. Ophthalmia Neonatorum, years 1938-1953. The following table shows the number of cases notified and result o] treatment:— Year Cases notified Cases Treated Vision unimpaired vision impaired Total blindness Deaths At home In haosp. 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 — — — 1953 4 4 — 4 — — — 46 47 Table 28. Gases of Infectious Diseases Notified during the Year 1953. DISEASE Under 1 year CASES NOTIFIED AT VARIOUS AGES {YEARS) Total cases notified Cases admitted Hospital Deaths 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 — 3 — 4 9 3 1 1 — 3 2 2 — 31 8 — Erysipelas — — — — 1 — 1 — — — 2 5 2 — 11 — — Food Poisoning 1 1 — 3 1 7 — 2 1 15 10 13 6 — 60 5 — Measles 13 46 60 96 101 374 18 10 4 3 3 — 1 — 729 25 — Meningococcal Infections — — — — — — — — 1 — — — — — 1 1 — Ophthalmia Neonatorum 4 — — — — — — — — — — — — — 4 — — Acute Poliomyelitis — — 1 — 2 2 2 1 — 2 — — — — 10 9 2 Pneumonia 4 2 3 2 — 12 2 2 1 6 8 30 33 — 105 11 51 Puerperal Pyrexia — — — — — — — 2 3 5 1 — — 1 12 12 — Scarlet Fever — — 3 3 14 67 10 1 1 — — — 1 — 100 28 — Whooping Cough 32 14 21 30 36 103 5 — — 4 2 3 — 2 252 14 1 Totals 57 63 91 134 159 574 41 19 12 35 29 53 45 3 1,315 113 54 48 Table 29. Monthly Incidence of Infectious Diseases during the Year 1953. DISEASE NUMBER OF CASES TOTAL January February March April May June July A ugust Sept. October Nov. Dec. Dysentery — 2 4 1 7 1 3 3 3 4 1 2 31 Erysipelas — 2 2 — — 1 — 1 3 — 1 1 11 Food Poisoning 6 3 7 5 9 9 9 2 1 5 — 4 60 Measles 51 131 267 180 64 22 4 4 1 3 2 — 729 Meningococcal Infections — — — — — — — 1 — — — — 1 Ophthalmia Neonatorum — 1 — — — 1 1 — — 1 — — 4 Acute Poliomyelitis — — — 1 — — 1 3 2 2 — 1 10 Pneumonia 40 26 9 5 1 3 2 — — 6 4 9 105 Puerperal Pyrexia 1 2 1 — 1 2 — 2 1 — 2 — 12 Scarlet Fever 15 2 12 8 9 10 11 4 5 7 2 15 100 Whooping Cough 29 24 21 30 31 35 22 27 16 5 — 12 252 Totals 142 193 323 230 122 84 53 47 32 33 12 44 1,315 49 Table 30. Ward Distribution of Infectious Diseases Notified during the Year 1953. Disease Twickenham Whitton Hampton Hampton Hill Teddington Hampton Wick Heathfield Total East Central South West Upper Lower Dysentery 3 3 4 5 — — 3 — 6 5 2 31 Erysipelas 2 1 1 1 1 1 — — 2 2 — 11 Food Poisoning 11 1 4 12 — 6 2 1 7 10 6 60 Measles 70 55 65 69 17 93 76 58 128 60 38 729 Meningococcal Infections — — — — — — — — — — 1 1 Ophthalmia Neonatorum — — — — — — 2 — 1 1 — 4 Acute Poliomyelitis 1 1 — — 3 — — 1 — 1 3 10 Pneumonia 1 6 12 5 3 27 19 7 11 11 3 105 Puerperal Pyrexia — — — — 1 11 — — — — — 12 Scarlet Fever 10 12 3 14 8 16 9 7 5 5 11 100 Whooping Cough 1 23 14 45 23 27 29 32 25 22 11 252 Totals 99 102 103 151 56 181 140 106 185 117 75 1,315 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 Non-pulmonary Male Female Male Female Male Female Male Female Under 1 — — — — — — — — 1-4 3 1 1 — — — — — 5-9 3 1 — 1 — — — — 10-14 1 1 — — — — — — 15-19 4 6 1 — — — — — 20-24 6 6 1 1 — — — — 25-34 14 17 1 1 2 3 — — 35-44 3 4 1 1 5 — — — 45-54 13 4 1 2 5 1 — — 55-64 12 2 — 1 5 3 — — 65 and over 3 1 1 — 4 — — — Totals 62 43 7 7 21 7 — — 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, 1938-1953 inclusive. 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 Pulmonary 100 106 114 127 112 119 133 118 120 132 117 115 96 107 79 105 Non- Pulmonary 30 19 12 14 18 18 18 18 19 11 17 5 15 14 20 14 Totals 130 125 126 141 130 137 151 136 139 143 134 120 111 121 99 119 50 Table 33. Food Poisoning. Food Poisoning Notifications : lst Quarter 2nd Quarter 3rd Quarter 4th Quarter TOTAL 16 23 12 9 60 Outbreaks Due to Identified Agents : Number of outbreaks Nil Number of cases Nil Outbreaks due to : Salmonella organisms Nil Nil Staphylococci (including toxin) Nil Nil Outbreaks due to Undiscovered Cause : Number of outbreaks Nil Number of cases Nil Single Cases : Cases due to identified agents : Number of cases 11 Staphylococci 6 Shigella Sonnei 2 Salmonella organisms 2 Proteus Morgani 1 Cases due to undiscovered cause :— Number of cases 49 Total all cases 60 51 52 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. Table 34.