Ac 439 1 Mr. O. hidon D-5B 2 Library TWI 23 NOVEMBER. 1956 GOOD HEALTH IN TWICKENHAM The Annual Report of the Medical Officer of Health JOHN MADDISON, M.D., B.S., D.P.H. CONTENTS Page Introduction 2 Health Committee and Staff 4 High Fat Diets 5 Fatigue in Women 7 Your Symptoms 7 Little Strokes 8 The Dangerous Staphylococci 9 Father 11 Peptic Ulcer 11 Aspirin 12 Runny Noses 12 Tuberculosis 13 Backache 14 Giving Medicines to Babies 14 Pest Destruction 15 Keeping the Borough Clean 15 Water Supply 17 Industrial Health 17 General Matters 18 Statistical Tables 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 1956 on the health and sanitary conditions of the Borough together with the supplement containing the statistical tables for 1955 as required by the Ministry of Health. I am most disappointed with the proposals for the retention of two-tier local government in Middlesex as set out in the Government White Paper on the Areas and Status of Local Authorities in England and Wales. Members of the Area Health Committee know that this Committee meets six times a year to do little more than to approve the actions taken by the staff in the course of their normal duties and to hear what new changes in policy the County committees have formulated. It takes so long to obtain any amendment to a decision that the original reason is frequently forgotten. The dead hand of uniformity exerts its cold pressure on all initiative. I beg you, Madam Mayor, to do all in your power to obtain for Twickenham, and if you can for the other parts of this area, the status of a county borough with real power to control its own health services. Not until then will the old spirit of enterprise which urged us to experiment with and introduce new measures of preventive and social medicine, regain its brightness like a shining star to lead us on with renewed vigour to further endeavour, as it was before 1948. The Society of Medical Officers of Health celebrated its hundredth birthday this year. It afforded an opportunity of looking at the progress made in community health over the past hundred years and to examine the problems of the future. For the fifty odd years up to 1900 the main concern was in cleaning up the filth in the towns and in controlling the infectious diseases. The next fifty years were concerned in providing and developing the personal health services, such as the school health service, maternity and child welfare, midwifery, health visiting, home helps, the handicapped and the aged. The next fifty years will be concerned with the elimination of the degenerative diseasescoronary thrombosis, diseases of the heart and arteries, high blood pressure, and cancer. There is already an important contribution to the possible cause of arterial disease mentioned later in this report. Scientific progress is nowadays so rapid that often problems which appeared insoluble a few years ago are being conquered with great rapidity. Poliomyelitis, like diphtheria, is probably on its way out. Tuberculosis still remains to be conquered. I want very much to try the experiment of a clinic for the discovery and prevention of the diseases of the elderly. There is ample evidence of the amount of disability affecting them and there are already a number of useful preventive measures which can be instituted. I wish, Madam Mayor, you had the power to say " Go ahead and do it." 2 I have nothing serious to report. I could do with a great deal more information as to the illnesses from which our people suffer and which are known only to the general practitioners and the Ministry of National Insurance. However, as far as I can tell the health of our people is pretty good. The services are functioning efficiently; the attendances in the clinics are as high as ever ; I think the public are more than ever conscious of the help they can obtain from their health services and are using them without hesitation. It is gratifying to me that this is so and that our work is appreciated. I hardly ever think of the Borough and County services as being separate, so closely are they integrated and so smoothly do they work in co-operation in the health department. I am indebted to the heads of all sections of the work at Elmfield House, and in particular of course to my deputy, Dr. Cormack, without whose loyal help these results could not have been obtained. There are about 400 other members of the staff in the Area and Borough health services. The excellence of their work is a pleasure; I am grateful for that blessing. 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, Madam Mayor, Ladies and Gentlemen, Your obedient servant, JOHN MADDISON, Medical Officer of Health 3 MEMBERS OF THE HEALTH COMMITTEE Ex-officio members: The Mayor, Councillor Mrs. M. E. Owen, J.P. The Deputy Mayor, Councillor J. W. H. Crane Chairman: Councillor A. T. Kremers Vice-Chairman: Councillor Mrs. M. B. Davies Alderman J. Allinson Councillor A. R. Melvin, F.R.I.C.S. Alderman F. J. Edwards, J.P. Councillor A. E. Pakes Alderman J. H. Knaggs, J.P. Councillor N. Sheldon, Councillor S. J. Hastings A.R.C.S., F.R.I.C. Councillor Mrs. K. E. Staddon Councillor R. F. E. Howard-Hodges, M.B.E. Councillor Miss O. J. Wilkins 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 Public Health Inspector Mr. H. G. Easter Deputy Chief Public Health Inspector Mr. H. D. Smith Specialist Housing Inspector Mr. K. E. Evans Messrs. T. W. Paine, Public Health Inspectors A. E. G. Walker, 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. R. N. Himson Miss K. Dopson, Mrs. J. Hodgson Clerical Staff Miss V. A. White Senior Rodent Operative Mr. H. T. Jackman Rodent Operatives Messrs. C. H. Deacon, S. Jackman Disinfector/Drain Tester Mr. E. G. Cooper 4 HIGH FAT DIETS This last few years we have been hearing a good deal about the danger of diets high in animal fat. Fat meat, fat pork, bacon, and butter are the main items. It is said that a high animal fat diet is the main cause of the increase of a substance called cholesterol in the blood stream, and this in turn causes the arteries to harden and thicken and leads to coronary disease of the heart with restriction of blood supply to the heart muscle itself, giving danger of early death from coronary thrombosis. Racial Differences. In South Africa an experiment was carried out in which three groups of people were compared as regards their diets and rate of death from coronary artery disease. In Capetown there are Europeans, Cape coloured population, and the Bantu. The Europeans have the highest standards of living and have always enough money for plenty of food. The Bantu occupy the lowest social grades ; they are mainly labourers with the poorest wages and they live mainly on cheap starchy foods, such as maize-meal, porridge and bread. The Cape coloured population occupy a position midway between the Bantu and the Europeans. By comparing the diets it was shown that as the standard of living rises so does the amount of animal fat consumed per person. A similar association was noted in the amount of cholesterol in the blood and also in the number of deaths from coronary disease, those in the Europeans being highest, the Cape coloured intermediate, and the Bantu lowest. We must not make the mistake of confusing cause with effect or both with a third factor. Thus if sedentary workers are less active, they also earn more money and so tend to live on a more generous diet ; but they may also be more worried because of the greater load of responsibility they carry. However, the mental stress of administrative responsibility may be no greater than the mental stress of extreme poverty. The Problem. Fat is an important source of energy to all of us. 4 ounces of fat are worth 9 ounces of starchy foods in energy value. If then we gave up eating animal fat we should have to supply our energy in some other way, either by more of the highly expensive protein foods of which we all need some, or by substituting the less expensive but bulky starchy foods, such as bread, or by a different form of fat which is not harmful. Still better would be the discovery of the reason why the animal fats are harmful, and a means of overcoming the difficulty. In another experiment2 it was noted that the increase in blood cholesterol and the high rate of death from coronary thrombosis did not seem to be associated with high intake of vegetable oils derived from peanuts, sunflower seeds, soybeans, cotton seeds, olive oil, arachis oil, and with oils derived from fish, such as pilchard and seal oil. Different types of fats and oils were given to volunteers to see what effect they had on the blood cholesterol level. It was found that the vegetable and fish oils which contain essential or unsaturated fatty acids like linoleic acid lowered the amount of cholesterol in the blood, 5 whereas the animal fats, butter, beef dripping, beef muscle and eggs caused a rise. However, when the vegetable fats obtained from the seeds and beans are subjected to a hardening process to convert them into margarine, the linoleic acid is converted into something else which has not the property of lowering cholesterol. We thus find an explanation for the differing amounts of coronary disease throughout the world. In Norway during the German occupation coronary disease fell because the factories making margarine were bombed, so the population had to live on more natural foods such as fish. Eskimos very rarely suffer from coronary disease ; they live on the seals, fish and other marine animals which contain high amounts of the essential fatty acids necessary for cholesterol control. Fish is also a major factor in the diet of the Japanese who have one of the lowest death rates from coronary heart disease in the world. Coronary heart disease is not so prevalent in the Latin peoples who use a lot of olive oil; nor in primitive peoples such as the natives of Africa and China who eat maize, soya bean and sunflower seed oils. In western countries the consumption of animal fats is increasing year by year, and so also is the consumption of the saturated fatty acids in animal fats which increase the amount of cholesterol. Also the opportunity for eating the essential or unsaturated fatty acids is lessened by reason of the hardening during processing of the natural vegetable oils into margarine. A Dietary Deficiency. It thus appears that atherosclerosis in which deposits are formed on the inner lining of the arteries and which contribute to coronary narrowing and thrombosis is caused by deficiencies in our diet. These deficiencies are the essential fatty acids such as linoleic acid which with vitamin B.6. control the formation of atherosclerosis in the arteries3. Not only are the natural essential fatty acids lost in the process of manufacture of margarine, but also in the manufacture of flour; the more and more the extraction proceeds to make pure white flour the more deprived of the essential fatty acids is the result. The essential fatty acids occur in the wheat germ oil and this is practically all removed in the manufacture of white flour. The addition of "improvers" also tends to destroy the small remaining amounts of unsaturated fatty acids. Similarly the vitamin B.6 is removed in the whitening process. Another vitamin, vitamin E, which helps to prevent the conversion of the essential fatty acids is also removed by the improvers. Men suffer far more commonly than women by the deficiency. The deficiency encourages the deposition of cholesterol in the arteries. Animals which have this deficiency are more sensitive to noxious influences such as ultra-violet light, X-rays and cancer producing substances. It is said that atherosclerosis of the aorta is common in people who die of cancer of the lung. It is also possible that the deficiency in essential fatty acids causes a weakness in the skin which results in eczema. Other diseases of highly civilised communities are disseminated sclerosis, duodenal ulcer and a tendency to rapid clotting of the blood which would aid coronary thrombosis. The lesson we can all learn from this is to be wary of a diet high in animal fats such as fat beef, fat bacon, fat pork, butter, cream and dripping. There should be available for us a margarine without the hardened fats and which contain more of the essential fatty acids. We need a flour composed as near as 6 possible of all the natural ingredients in the wheat. We should refuse to eat the pure white flour. We might try cooking things more in olive oil than in lard or animal fat or dripping. We might experiment too with maize and soya flour diets. 1 Bronte-Stewart, B., et al. (1955a) Lancet, ii. 1103. 2 Bronte-Stewart, B., et al. (1956) Lancet, i. 521. 3 Sinclair, H. M., (1956) Lancet, i. 381. FATIGUE IN WOMEN In the infant welfare clinics we have been noticing that a number of younger mothers seem to complain more of fatigue than their mothers used to do. These younger women are those with one or two young children; they usually come from good homes where the standards are high. I wonder if the struggle for the maintenance of high standards of health and well-being; the possession of a good home and furniture, the keeping up of appearances with the neighbours; the maintenance of a high standard of infant and child welfare; the pressure on all sides from the welfare services, women's magazines, and other sources of information and teaching, whether all these tend to exhaust our mothers too much. Forty years ago I fancy our mothers weren't so well informed; so I wonder if the fatigue is due to the pressure of modern life, or do our present day standards demand too much? We must not let our quest for excellence be so strong and enthusiastic as to be inimical to the welfare of those for whom it is intended. YOUR SYMPTOMS What We Feel. A woman patient recently said to me "I have no need of a psychiatrist, I am physically ill, not mentally ill." For a considerable time she had been explaining in great detail her symptoms. She spoke at great length about a minor physical disability which prevented her from carrying out her work properly. She spent a great deal of time explaining the attitude of a woman she knew and how this woman was a difficult person to get along with, indeed a social failure. She enlarged on the philosophy of friendship in general, explaining how necessary it was to adopt certain attitudes in life in order to keep friends with people. She switched her conversation rapidly from one subject to another until it became difficult to follow her arguments at all clearly or closely. She was in reality exhibiting the reaction of the psychotic who escapes reality by imagining himself the victim of circumstances and plots and then indulges in garrulous explanations about the causes. 7 What We See In Others. We can all of us do something to practise preventive medicine if we understand the reactions of the people around us. In two recent articles1 on functional disease2 we are told to notice how a person describes the symptoms. Now and again there comes the dramatic pause where no pause should be; the exaggerated description such as the violent, excrutiating, agonising, terrible pain, when it is clear there is no pain at all; the woman who says her husband is the most wonderful man in the world is sometimes trying to conceal her disappointment in him; the person who discusses her symptoms by reference to a list in her diary has obviously been preoccupied with herself and is almost always neurotic. During emotional disturbances the pulse rate is raised; blood pressure may rise to quite abnormal heights and fluctuate widely. Continued sighing is a sign significant of anxiety neurosis or great fatigue. Excessive emotionalism is often shown by flushing and blushing or excessive perspiration; often there is loss of hair due to alopecia; the pupils are often dilated, the eyelids flutter, the mouth quivers and twiches and there is a tremor in the voice. The patient suffers frequently from headaches described with great exactness as occurring in many parts of the head in different varieties. She may hear weird noises, or have choking sensations in the throat, or have various ill-defined pains. However, we doctors must make allowances; a clinical interview can be quite frightening to some people. I once saw a strong healthy man faint when waiting for a simple subcutaneous injection. I have seen women in the clinics bring in long lists of written questions, mainly about themselves, when primarily the visit was intended for the baby. Some are genuinely seeking advice and not all are hypochondriacs, but even if they are, they require help to establish their relationship with the environment again, for the hypochondriac is seeking sympathy in order to gain favour and be in good standing with those around her; because this is the essence of all behaviour, namely to so conduct yourself as to live in the love and respect of those around you and so gain security and freedom from fear. 1 Lonshin, L. L. 1956. Postgraduate Medicine, 19, 526. 2 Matthews, H. A. 1956. Postgraduate Medicine, 20, 53. LITTLE STROKES A little while ago I noticed a sudden change in the personality of an elderly woman whom I knew well. From being a kindly likeable person, considerate in her feelings for those around her and generous even to a fault, she suddenly changed to an ungracious old woman. She appeared to have difficulty in distinguishing even the members of her own family and had suddenly completely forgotten their kindness and love for her over all the years of their lives. Looking back on this incident I feel sure she had had a little stroke which had been unrecognised. This is usually the result of clotting of the blood in a 8 small artery of the brain. This causes the part of the brain supplied by the artery to lose its function and become useless. It can affect the patient by loss of speech, loss of feeling or numbness in the arms or legs, or weakness or slight paralysis. Sometimes there is dizziness, confusion or slight nausea. Often, if the occurrence takes place in bed during the night, the patient may be unaware that anything has happened. The change in the personality is noted by the patient's relatives. In a man there may be changes in character, temperament and ability; he may become irritable and useless in his business; he may have lost his cleanliness and neatness. Relatives may suspect something like this has occurred when they notice a sudden change in the personality of someone dear to them. THE DANGEROUS STAPHYLOCOCCI What They Are. The organism staphylococcus has been talked about so much this last few years that I should think most people are now familiar with it. It is the organism which causes boils and carbuncles, septic spots, whitlows, abscesses, running sores, severe infections of wounds, pneumonia, generalised septicaemia, the dreaded puerperal fever, and sometimes worst of all severe food poisoning. A few months ago some of my colleagues in the health service and I had lunch in a public restaurant; towards evening we all of us were feeling dizzy, attacked with severe nausea and vomiting, were up most of the night with indescribable wretchedness, unfit for work the next day, and generally prostrate for about 48 hours. We had all of us stupidly eaten steak pie on a Monday which had stood over the weekend since the previous Friday or Saturday. The weather was warm and I assume that the meat had not been kept in a refrigerator. Where They Are. The staphylococci are with most of us all our lives. About half the population carry the staphylococcus in the front part of the nose. The organisms live there and breed and grow in the secretions of the nose. Babies acquire them in the first week of life and continue to harbour them throughout life. The staphylococcus is peculiar in that it can live in the nose for years without causing distress or disease to its host; it can cause minor forms of disability such as infected scratches or boils; it can produce a poison which we know to be dangerous as food poisoning; it can cause all sorts of diseases from a minor acute form as in the boil to a more severe generalised form as in pneumonia or septicaemia; and it can become resistant to the anti-bacterial drugs. The curious thing is the way these germs manifest one form of disease at one time and another at a different time. About half the population are persistent carriers of staphylococci in the nose, and about half are persistently free from them. We read much of the danger of the development of drug resistant staphylococci becoming more prevalent. It is possible that there are more people alive today who are susceptible to infection by the staphylococcus than there were in former times. The reason 9 is that modern therapeutic methods are able to save the lives of many who would formerly have died. Thus nowadays the expectation of life for diabetics, for various blood diseases, various sites of cancer, tuberculosis, conditions treated by cortisone, X-rays, anti-histomines and so on are saving the lives of many who would formerly have succumbed. These people are sometimes less able to combat infections than others who are fully healthy. For instance some oi them need repeated needle punctures every day. The Transmission of Staphylococcus. It has been shown recently that the way the staphylococcus travels from person to person is not as was formerly thought by droplets sprayed from mouth or nose whilst talking, coughing or sneezing; but by a different method1, In carriers the organisms are present in the secretions in the front part of the nose. The secretions flowing from the nose make the upper lip and surrounding area heavily contaminated. From here the organisms are conveyed on fingers or handkerchief or any other object to the skin of the hands, the clothing of the person by day, and the bedding by night. When the moisture has dried the particles are scattered into the air every time the person moves or the clothes are disturbed or the bedding shaken, and in the act of washing hands and face. The organisms float in the air and settle on other individuals in the neighbourhood. In this way they reach the front part of the nose in other persons and make them carriers in turn. But they also settle on the eyes of newborn infants, on cuts and abrasions, or maybe breathed in to cause pneumonia, or reach the body in some other way to cause septicaemia. Even if the person wears a clean or sterile overall the organisms are still scattered about in the air and settle on the objects around. There is thus potential danger, especially with those strains which cause food poisoning when staphylococcal carriers are about during the preparation of the dangerous foods, such as cooked meats, gravies and creams. If everyone realised this danger, the necessity would become evident for the rapid cooling of these foods, and their storage preferably in refrigerators. Get Rid of Them. It would be a useful public health measure to eliminate the staphylococcus altogether. This really means a direct attack on the places where the organism lurks in the front part of the nose. Recently it has been shown that the organism can be eliminated from the noses of carriers by rubbing inside a preparation such as hibitane cream or neobacrin2. If this should prove a simple and reliable method we would have achieved a notable advance in preventive medicine. 1 Hare, R. and Thomas, C. G. A. (1956) Brit.Med.J. 2. 840. 2 Brit.Med.J. 2. 867. 10 FATHER It is not uncommon nowadays for fathers to bring their babies and children to clinics to have them weighed, to have immunisations, to have consultations with the health visitors and to see the doctor. Years ago this would have seemed quite remarkable. A father even carrying a baby or wheeling a pram in those days might have felt embarrassed. Not so nowadays. I heard of a father who took a half day's annual leave each week to accompany his wife to the clinic when the baby was needing expert attention. The attitude of fathers to family responsibility is changing. It is much commoner nowadays for father to take an active share in the upbringing of his children, as he ought to do, and most parents benefit by discussions on parenthood. PEPTIC ULCER If you have indigestion, heartburn and discomfort in your stomach, even pain, especially combined with a feeling of weariness, consult your doctor. There are several diagnoses for your condition, some of them serious. One diagnosis is gastric or duodenal ulcer. If this is confirmed you should take it seriously, for if you do not you are likely to have the ulcer for the rest of your life and it may lead to serious consequences. One potent cause of ulcer is anxiety. Anxiety is worry caused by constant fear, a fear which may not even be consciously recognised. The fear is due to the consequences which follow imagined loss of love and affection from those who matter to us ; because of this imagined loss of prestige we strive to do things often beyond our capacity, in the hope that we shall get wonderful praise. There comes a stage when nature puts on the brake as a safeguard. One of the safeguards is fatigue caused by gastric ulcer. The lining of the stomach can be rendered pale and bloodless just as the face is in fright or panic ; that is under strong emotion. When this happens constantly the surface of the stomach breaks down and ulceration commences. The treatment of your ulcer then is to so regulate your life as to live within your resources. As each attack of indigestion occurs it will be cured sooner or later by taking alkalies and rest. However, if you go on as you have been doing the ulcer will return and you will be faced with a second and a third and continued attacks for the rest of your life. In between attacks you will be off your guard and tempted to try to do things beyond your capacity ; if you do the ulcer will come back. It is foolish to try to ignore or to fight your symptoms ; you must examine your mode of life and try to make adjustments. The ulcer often appears at the time of a change of work, or a change of house, or a change in some other way such as getting married, or children growing up and requiring various things, a change in the manager, or a change in the policy at the office or works, a loss of a dear friend or relative, or anything that makes life different and harder from what it formerly was. 11 So it is very important to try to aim at a calm unemotional type of life and not to get unduly upset by trivial or even serious events. Of course it is easy to say this but it needs practise and care to be able to do it, but most of us can if we try. We must try to ease whatever excessive burdens in life may be helping to cause the ulcer. It may be possible to adjust your work by careful thought to reducing the unnecessary activities, or by doing things in a different way, so as to eliminate unnecessary fatigue. In the home you can consider how to plan so as not to overtire yourself. A little thought will show that many a job you consider to be essential can be put off for a week or a month or a year. If you look back over the years of your life there must have been innumerable instances of worry, and yet you got over them. Some of the most serious worries of our lives seem trivial in retrospect years afterwards. We may not even remember the name of a person who caused us great unhappiness twenty or thirty years ago ; even the details of the incident will be forgotten. It will help so much if you can make a mental list of the blessings which are yours; and consider how much worse off you would be without them. In this way your outlook can become more philosophic and your worries lessened. ASPIRIN A few years ago when cortisone was discovered to have a beneficial effect on rheumatoid arthritis, it gave hope and encouragement to millions of sufferers all over the world. Yet as time went on it was found that giving cortisone presented dangers which were unknown at the time of its discovery. In common with many drugs which are composed mostly of products manufactured inside the body itself, when taken cortisone tends to suppress the natural manufacture of the drug and to cause the organ doing it to lose its ability. Thus when cortisone is given to a patient and is then withdrawn the patient is in greater debility than ever before. But recently it has also been shown that aspirin in sufficient dose and under proper medical supervision and guidance, is in many cases almost as good as cortisone. What we have discovered is that aspirin was a much better drug than we believed it to be. "RUNNY NOSES" I do not see so many children with runny noses as I used to do years ago. But there are still plenty of them about. One author1 gives the causes of chronic nasal discharge as due to enlargement of the adenoids, or to being allergic to something, or to the presence of an obstruction in the nose. In my student days, I was taught twenty-six causes of nasal obstruction. Very rarely indeed does a child put something up its nose. Most of the children with chronic runny noses that I used to see came from the poor classes and were often underfed and malnourished and in poor condition. They nearly all had retraction of the ear drum showing blockage of the internal ear canal and partial deafness. Many of them had enlarged tonsils and adenoids, but I was never one who advocated wholesale operations for them. I have a great deal of sympathy 12 with the view of a local practitioner who investigated this problem some time ago. He came to the conclusion that nearly all these children lived in families where there was an adult with an infected nose, or an infected nasal cavity, or chronic nasal catarrh of some sort. The children thus live in an atmosphere of heavy infection and unless they are well fed and able to establish good resistance they succumb to the chronic reinfection time and time again. The situation is parallel to the household in which the elderly man with open tuberculosis spreads his infection to the children; similarly in the case of the staphylococcus, the nasal carrier also spreads his infection to other people in the house. We are reminded once again that the family is a unit and in considering what happens to one member we should have regard to the state of affairs of the whole. 1 Williamson, P. (1956) G.P. 13. 85. TUBERCULOSIS Elderly Men. There are more deaths from tuberculosis in men than in women after the age of 50. Notifications in the older age groups have been gradually rising during the last few years. The explanation why men suffer more than women is not easy to find. It may have something to do with their constitutional make-up. Frequently in older men tuberculosis is combined with chronic bronchitis and with restriction of movement of the chest. A great many of these men are infectious and spread tuberculosis germs in coughing, talking, and sneezing. In such households there is an obvious risk to children, especially where they are left in the care of grandfather. In elderly people, cough, shortness of breath, indigestion and lassitude are often regarded as being natural to old age. Miniature X-ray radiographic units should be readily available in all parts of the area to give diagnostic opinions to practitioners who need them. We need an effective campaign to search for these infectious cases which are the reservoir of tuberculosis in our towns. The End of an Epidemic. Some people are now saying that they see the end of the tuberculosis epidemic which began in the fourteenth or fifteenth century, rose to a peak in the nineteenth century, and is now said to be dying out. It is said that tuberculosis has been conquered because whereas in 1938 there were 25,000 deaths in 1955 there were only 6,500 deaths ! Suppose the whole disease were concentrated in Twickenham, then in 16 years the whole town would be wiped out and completely devoid of population. There is no cause for complacency here. There is no diminution at all in the number of notifications year by year. In Twickenham it is always about 100; in the whole country there were 40,000 new cases in 1936 and there were 40,000 cases in 1954 just the same. One reason for the reduced mortality is the success of the new antibiotic drugs. Formerly we used to have tuberculosis officers who were concerned with the epidemiology, 13 the prevention of spread, the isolation of the patient and the welfare of the family to whom he belonged. Now we have only chest physicians who are concerned with one part of the body and the cure of an individual. Vaccination. We shall soon be starting on the scheme for B.C.G. vaccination of school children aged between 13 and 14. This procedure does not prevent them from getting tuberculosis. It raises the immunity of the child so that the probability of contracting uncontrollable tuberculosis is diminished. So far so good, but we ought at the same time to be directing our efforts to the eradication of the disease altogether. This is an epidemiological problem and ought to be tackled on epidemiological lines. We must find the sources of infection and try to prevent them spreading the disease to other people. BACKACHE The commonest cause of backache is injury and strain to the muscle tendons and ligaments of the spine, especially in the lumbar region, and in those connecting the sacral bone to the spine and hip. The cause is usually due to bending down and lifting a heavy weight from the floor in the stooping position. If you have to lift a heavy weight take care and thought; lift it from the squatting position with knees bent rather than from the stooping position from the hips. GIVING MEDICINES TO BABIES In Bolton1 an enquiry was carried out to find out what remedies were given to babies without medical advice; also to see what type of vitamins were given and the frequency with which medical advice was sought. Teething powders were given fairly frequently, aspirins moderately frequently, aperients were given quite regularly to a good number, in some cases the infants had castor oil and liquid paraffin. Boric acid was used as an ointment on some infants; boric acid crystals for the prevention of soreness of the buttocks was used quite commonly. The children who did not receive their full quota of vitamins were in the poorest classes of the population. About three quarters of the babies had attended their family doctor at some stage. Those who regularly attended infant welfare centres, by far the most were in the upper middle classes and the poorest attenders were in the poorest classes. It is obvious there is still need for active education and encouragement to ensure that mothers bring their babies regularly to welfare centres, so as to receive medical advice and teaching in modern methods of mothercraft. 1 Bryant, H. (1955) Medical Officer, 94. 209. 14 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. The British Museum (Natural History Section) are always willing to assist in the identification of unusual specimens, and I am most grateful to them for their assistance. An interesting experiment in the use of Dieldrin, a modern insecticide was carried out near Crane Park at Whitton. Complaints were received from a block of houses about an infestation of crickets. These insects were found on a disused tip adjoining the back gardens, and in the houses themselves. Evidence was found that the crickets were breeding in the tip, and the Borough Surveyor promised his full co-operation and assistance in dealing with the trouble. All the householders were interviewed and advised to lay protective barriers of Gammexane powder near doors and french windows to prevent access to the insects. Shell Chemicals agreed to carry out experimental work on the tip with Dieldrin. This insecticide had been used with success against the desert locust and nearer home against the beach fly, but had not to my knowledge been previously used against the house cricket. A portion of the tip about 120 yards long and 25 yards deep was prepared for treatment. The Borough Surveyor had the weeds on the tip cut down and gave us the use of his Ferguson low volume sprayer, which is normally used for spraying weed killer. The strip of land was then completely covered with the solution of insecticide. This one application proved completely successful and no more crickets have been seen or heard in this area. The normal work of the department connected with rodent destruction continued during the year, and the sewers were again treated during the months of January and September. Twenty-one premises were treated against bugs and in one case person and premises were disinfested for body lice. In all cases complete clearance was effective. KEEPING THE BOROUGH CLEAN I am obliged to A. S. Knolles, Esq., B.Sc., M.Inst.C.E., M.I.Mun.E., Chartered C.E., the Borough Surveyor, for the following report about drainage, sewerage, public cleansing and refuse disposal:— 15 Drainage and Sewerage. No works of major improvement have been carried out during the year, but certain difficulties have been met in connection with size and condition of some of the sewers in the Hampton Area. An investigation is being carried out on the possibility of removing corrosion in the sewer in Thames Street, and in the meantime the important manhole at the junction of Church Street, Thames Street and Hampton Court Road, which was shewing signs of collapse has been entirely rebuilt. Public Cleansing. The shortage of manual labour has persisted until recently when it was possible to augment the staff with the appointment of a certain amount of Jamaican labour. Refuse Disposal. The new Charlton Works have now had over a year in operation and although there is still difficulty in recruiting staff, the position is not nearly so bad as during the first year and the men are getting more and more accustomed to the various processes. During the first twelve months of operation, salvage to the value of £20,566 was recovered and it is expected that this figure will be exceeded during the second year's running because the sales to-date are equivalent to £27,000 per annum. Before the new works were opened pilot experiments were carried out on the disposal of various size screenings in water and the action of sulphate reducing bacteria was studied. In the light of the experience of these pilot experiments it was proposed that large lagoons should be built in the water area into which refuse (screenings from the plant) could be tipped. Since the plant has been in operation lagoons have been built with clinker from the burnt tailings and filling of one of these lagoons has been completed. Throughout this work extensive records of the condition of the water in the lagoon and in the surrounding pit have been kept and valuable data has been obtained. No aerial nuisance was encountered and the method of disposal of the screenings is considered to be highly satisfactory. Additional lagoons have been built with clinker and further filling of these lagoons is being undertaken under varying weather conditions and further data will be collected which should be useful in connection with the general problem of the tipping of refuse into waterlogged pits. In connection with this full scale work the co-operation and help of the— Ministry of Housing and Local Government The Department of Scientific and Industrial Research The Government Chemist are gratefully acknowledged. 16 WATER SUPPLY I am indebted to E. Windle Taylor, Esq., M.A., M.D., D.P.H., M.R.C.S., L.R.C.P., Barrister-at-Law, Director of Water Examination, Metropolitan Water Board for the following report:— The source of the water is the River Thames abstracted at the Wraysbury, Walton and Laleham intakes and stored in the Thames Valley reservoirs at Staines, Littleton and Walton. After storage the water is treated at the filtration works at Hampton. The water is filtered by means of primary or rapid filtration followed by secondary or slow sand filtration. All the water is finally chlorinated before it leaves the works. In order to provide adequate contact to ensure complete action by the chlorine a contact tank is provided at the works. The water is treated by a method of controlled superchlorination by maintaining a fixed residual of free chlorine after a given period of contact. The chlorination process is now entirely automatic both in regard to changes in quality as well as changes in quantity of the filtered water. Samples of water are collected at all stages of the purification process at least five times each week and analysed at the laboratories of the Metropolitan Water Board. All new and repaired mains are disinfected with chlorine before being restored to supply and samples of water from them are tested to establish that its quality is up to that normally supplied. The supply is not plumbo-solvent. INDUSTRIAL HEALTH Factories. Most of the 375 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, avoidance of overcrowding, for adequate warmth and ventilation, and proper drainage of floors. During 1955 the inspectors paid 412 visits to factories ; in 6 factories the attention of the management had to be drawn to contraventions of the regulations. The inspectors also paid 16 visits to out-workers' premises. 17 GENERAL MATTERS Shops. Section 38 of the Shops Act 1950 deals with provisions for the health and comfort of the staff. Shops must be properly ventilated, adequately warmed and sufficiently lighted; they must 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 use a nearby toilet, and a certificate of exemption is granted from the requirement of the Act. There are at present 20 exemption certificates in force. 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 1955 was 471. 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 11 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. Type of Sample or Specimen No. Taken Result Ice Cream 157 112 Grade 1 Satisfactory 25 „ 2 15 „ 31 Unsatisfactory 2 „ 4 3 Not Graded. Water 19 17 Satisfactory. 2 Unsatisfactory. Faeces 337 — 18 Establishments for Massage, Chiropody, Electrical and Special Treatment. Twelve licences in respect of establishments for these purposes were issued during the year 1955. 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 one person was registered. The inspectors paid 79 visits. Petrol Filling Stations. During the year 1955, 426 visits were paid by the sanitary inspectors to premises where petroleum or carbide of calcium is stored, and 105 licences were issued. Certificates of Disrepair. There has been a considerable falling off in the number of applications for certificates of disrepair ; during the year 43 certificates were granted to tenants who had been served with notices of increase of rent by their owners. In 28 cases, the items specified on the certificates were completed and revocation was granted. One of the objects of the Housing Repairs and Rents Act 1954 was to prevent further deterioration of property which was already below a reasonable standard of repair. It was hoped that owners would be encouraged to improve the condition of their houses and at the same time be able to get some increase in rent. It is perhaps early to pass judgment on the success or otherwise of this measure, but the redaction in the number of applications for certificates gives an indication of the position. 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 1955. 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. Five premises have so far been registered under the Rag Flock and Other tilling Materials Act, 1951, and two 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. 19 National Assistance Act, 1948, Section 47. It was not necessary during 1955, to remove to suitable premises any persons in need of care and attention. Complaints. During 1955 the number of complaints received by the department was 1,568. Smoke Abatement. During the year 307 smoke observations were made. The Byelaws prescribe that the emission of black smoke for more than 2 minutes in any period of 30 minutes shall until the contrary is proved be deemed a statutory nuisance and a smoke nuisance. These observations were taken over 30 minute periods, but each district inspector is constantly taking spot observations of factory chimneys in his district. It was found necessary on 3 occasions to report contraventions of the Byelaws to the Health Committee and warning letters were sent to offending firms by the Town Clerk. This action proved effective and no further contraventions were recorded. Housing. A start was made in dealing with the unfit houses listed in the return which had to be made to the Minister of Housing and Local Government by August 1955. In December the Minister confirmed the first clearance order which consisted of a block of seven cottages in Hampton Wick. The photograph on page 22 gives an idea of the condition of the property. In addition, demolition orders were made in respect of 2 houses in Whitton and Closing Orders, which have since been determined, in respect of 2 houses in Twickenham. 169 houses are scheduled to be dealt with in the five-year plan, but the rate of progress must be dependant upon the Corporation's ability to re-house the tenants of the unfit houses. Pet Animals Act, 1951. No person is allowed to keep a pet shop except under the authority of a licence granted in accordance with the provisions of this Act. These conditions have regard to the need for securing : (a) that animals will at all times be kept in accommodation suitable as respects size, temperature, lighting, ventilation and cleanliness ; (b) that animals will be adequately supplied with suitable food and drink and (so far as necessary) visited at suitable intervals ; (c) that animals, being mammals, will not be sold at too early an age; (d) that all reasonable precautions will be taken to prevent the spread among animals of infectious diseases ; (e) that appropriate steps will be taken in case of fire or other emergency. 20 There are 13 licences in force in the Borough and 28 visits were made for the purpose of securing compliance with the conditions of licence. Food Hygiene Regulations, 1955. These regulations made under Section 13 of the Food and Drugs Act, 1955, for securing the observance of sanitary and cleanly conditions and practices in connection with the sale of food for human consumption, came into operation during 1956. The Regulations are more stringent than any previous legislation made about the sale of food, and a tremendous amount of work was thrown upon the inspectors. New records and inspection sheets had to be devised, and a start was immediately made upon the re-inspection of all food premises in the Borough. The task is now well in hand and the next annual report will show the improvements brought about under this important measure. Hairdressing Establishments. The Corporation have made byelaws under the Middlesex County Council Act for " the purpose of securing the cleanliness of any premises used for the purpose of carrying on the business of a hairdresser or barber and of the instruments, towels, equipment and materials used in such premises." During the year 50 inspections were made of these premises. It was not found necessary to take any action for contraventions. 21 TABLES FOR STATISTICAL YEAR 1955 23 STATISTICAL TABLES for the Year 1955 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) 104,300 Number of inhabited houses 30,520 Rateable value £1,113,687 Sum represented by a penny rate £4,488 9s. 3d. Total M. F. Live Births: Legitimate 1,210 617 593 Illegitimate 55 38 17 Total 1,265 655 610 Birth rate per 1,000 of estimated civilian population 12.13 Adjusted birth rate 12.37 Total M. F. Still Births: Legitimate 11 7 4 Illegitimate 1 1 — Total 12 8 4 Still birth rate per 1,000 total (live and still) births 9.40 M. F. Deaths 567 593 1,160 Crude death rate per 1,000 of estimated civilian population 11.12 Adjusted death rate 10,23 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 22 .92 Legitimate infants per 1,000 legitimate live births 21.49 Illegitimate infants per 1,000 illegitimate live births 54.55 24 Population 1938.1955. Table 2. 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% 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 1954 104,700 — 600 — 0.57% + 167 — 767 1955 104,300 — 400 1 — 0.38% + 105 — 505 Table 3. Causes of Death. Registrar-General's Official Returns. Causes of Death M ales Females Total All causes 567 593 1,160 1. Tuberculosis, respiratory 11 4 15 2. Tuberculosis, other — 1 1 3. Syphilitic disease — — — 4. Diphtheria — — — 5. Whooping cough — — — 6. Meningo- coccal infections — — — 7. Acute poliomyelitis — 1 1 8. Measles 1 — 1 9. Other infective and parasitic diseases — 3 3 10. Malignant neoplasm, stomach 27 14 41 11. Malignant neoplasm, lung, bronchus 39 6 45 12. Malignant neoplasm, breast — 19 19 13. Malignant neoplasm, uterus - 10 10 14. Other malignant and lymphatic neoplasms 58 58 116 15. Leukaemia, aleukaemia 3 — 3 16. Diabetes 2 5 7 17. Vascular lesions of nervous system 52 101 153 18. Coronary disease, angina 99 72 171 19. Hypertension with heart disease 16 21 37 20. Other heart disease 70 105 175 21. Other circulatory disease 27 35 62 22. Influenza 3 4 7 23. Pneumonia 23 25 48 24. Bronchitis 35 23 58 25. Other diseases of respiratory system 1 4 5 26. Ulcer of stomach and duodenum 5 3 8 27. Gastritis, enteritis and diarrhoea 1 5 6 28. Nephritis and nephrosis 2 2 4 29. Hyperplasia of prostate 11 — 11 30. Pregnancy, Childbirth, abortion — — — 31. Congenital malformations 4 1 5 32. Other defined and ill-defined diseases 48 50 98 33. Motor vehicle accidents 5 5 10 34. All other accidents 15 11 26 35. Suicide 8 5 13 36. Homicide and operations of war 1 — 1 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 Male No. of Deaths Death rate per 1,000 of the population Female Total Enteric Fever — — — — Smallpox — — — — Scarlet Fever — — — — Diphtheria — — — — Measles 1 — 1 .009 Whooping Cough — — — — 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 38.36 4.27 Intra- cranial vascular lesions 13.19 1.47 Bronchitis, Pneumonia, and other respiratory diseases 9.57 1.06 Cancer 19.91 2.21 Violence 4.31 0.48 Tuberculosis 1.38 0.15 26 Table 6. Infant 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 18 2 1 1 22 5 1 1 29 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 — — — — 4 Premature Birth 7 2 - 1 10 1 — — — 11 Atrophy, Debility and Marasmus - - - - - - - - - - Atelectasis 3 — — — 3 I — — — 4 Injury at Birth - - - - - - - - - - Erysipelas - - - - - - - - - - Syphilis - - - - - - - - - - Rickets - - - - - - - - - - Meningitis (not Tuberculous) - - - - - - - - - - Convulsions - - - - - - - - - - Gastritis - - - - - - - - - - Laryngitis - - - - - - - - - - Bronchitis - - - - - - - - - - Pneumonia (all forms) 3 - — — 3 3 1 — 1 8 Suffocation (overlying) - - - — - - - - - - Other causes 2 - — - 2 — — — — 2 Totals 18 2 1 - 22 5 1 - 1 29 (b) An analysis of the mortality reveals that neo- natal deaths were responsible for 75.86 per cent, of the total deaths, viz.:— a decrease of 13.61 from the previous year. Under 24 hours 1 to 7 days 1 to 4 weeks Total under 4 weeks Percentage total infant deaths 9 9 4 22 75.86 27 Table 7. Review of the Comparative Vital and Mortality Statistics for the Borough of Twickenham, together with those for England and Wales for years 1938.1955 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 16.7 (a) 11.26 11.7 21.21 32 (6) 11.03 1950 (a) 13. 34 15.8 (a) 11.05 11.6 20.10 29.8 (b) 12.54 (b) 10.72 1951 (a) 12.82 15.5 (a) 11.97 12.5 24.98 29.6 (b) 12.05 (b) 11.61 1952 (a) 12.54 15.3 (a) 11.18 11.3 20.22 27.6 (b) 11 • 79 (b) 10.84 1953 (a) 13.26 15.5 (a) 10.88 11.4 20.06 26.8 (6) 13.53 (b) 10.01 1954 (a) 12.73 (b) 12.98 15.2 (a) 11.14 (b) 10.25 11.3 14.25 25.5 1955 (a) 12.13 15.0 (a) 11.12 11.7 22.92 24.9 (b) 12.37 (6) 10.23 (a) Crude (b) Adjusted 28 H > td r M GO Results of the Chemical and Bacteriological Examination of the Water Supply to the Borough of Twickenha for 1955. 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 Sulphates as SO4 River Thames water filtered at Hampton Works 232 0.011 0.083 3.9 26.0 1.05 0.3 13 261 67 7.8 0.50 10 450 49 29 (b) Bacteriological. Description of the Sample Number oj 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 913 4.8 100.0 NIL Table 9. Analysis of Complaints Received. Nature of Complaint Number Received Housing defects 285 Choked and defective drains 255 Accumulations of offensive matter 35 Unsound food 160 Verminous premises:— (a) Bugs 8 (b) Rats and mice 504 (c) Other 97 Keeping of animals 7 Unsatisfactory milk supplies 2 Miscellaneous 215 Total 1,568 30 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 3,219 Dwelling-houses under Housing Act:— After complaint 1,000 Dwelling-houses:— Housing applications, specially investigated 69 Infected dwelling-houses:— (a) After notified infectious disease (other than tuberculosis) 439 (b) Contacts 110 (c) Fumigations after infectious disease 14 (d) Phthisis enquiries and fumigations 5 School and church halls 20 Swimming baths 6 Water sampling:— (a) Swimming baths 6 (b) Dwelling-houses 10 Business premises — Cinemas, dance halls, billiard halls 25 Offensive trade premises — Stables, piggeries, keeping of animals 61 Houses let in lodgings 1 Factories Acts, 1937 and 1948:— Factories with mechanical power 374 Factories without mechanical power 38 Outworkers' premises 16 Common lodging houses — Underground rooms 79 Hairdressing premises 50 Tents, vans and sheds 8 Smoke nuisances 307 Fairgrounds 3 Drainage: Testing by:— (a) Smoke 96 (b) Coloured water 41 (c) Water 56 (d) Breaking down 36 Re public sewers 733 Watercourses and ditches — Means of escape in case of fire — Land and tips 90 Septic tanks and cesspools — Sanitary conveniences— including public-houses 78 Miscellaneous visits 1,675 Visits not inspections 2,216 Verminous premises:— (a) Rats and mice: (i) After complaint or from survey 53 (ii) Subsequent visits 140 (b) Bug infestations: Number of premises visited 33 Number of premises where definite infestation existed 18 (c) Cockroaches 2 (d) Other vermin 232 (e) Scabies ... 1 31 Table 10— continued. Inspections for supervision of food:— Unfit foodstuffs other than meat 240 Slaughterhouses 16 Butchers' shops (Public Health (Meat) Regulations, 1924) 279 Food and Drugs Act, 1938, Section 13:— Bakehouses 110 Fish shops, grocers and greengrocers 930 Factory and school canteens 62 Restaurant kitchens, etc. 394 Hotel and beerhouse bars and cellars: (a) Day inspections 92 (b) Night inspections — Food and Drags Act, 1938, Section 14:— Ice.cream premises (Heat Treatment) Regulations, 1947 to 1951 164 Sausage manufacturers 1 Preserved meat preparation premises 4 Preserved fish preparation premises 27 Milk and Dairies Regulations, 1949:— Milk sampling for bacteriological examination — : Contraventions of Milk and Dairies Regulations 3 Dairies 22 Shops Act, 1950, Section 38 159 Game Licences 1 Middlesex Countv Council Act, 1950:— Hawkers' vehicles 77 Hawkers' premises 2 Noise nuisances 52 Massage and/or special treatment establishments 3 Clean Food 65 Petroleum (Regulation) Acts, 1928 and 1936; Petroleum Spirit Regulations, 1929.1950 426 National Assistance Act, 1948, Section 47 12 Rag Flock and other Filling Materials Act, 1951 4 Dealers in Old Metal and Marine Stores — Pet Animals Act, 1951 28 Total number of visits and inspections 15,710 32 Table 11. Sanitary Improvements Effected. Number Offensive accumulations removed 2 Nuisance from keeping of animals remedied — Chimney flues repaired 7 Chimney stacks repaired 2 Roofs repaired 140 Eavesgutters repaired 33 Downspouts repaired 12 Pointing renewed 45 Ditches requiring cleansing 4 Drains repaired 6 Drains unstopped 26 Dustbins provided 17 Fireplaces repaired 11 Filthy condition of premises remedied 3 Floors repaired 36 Gullies repaired 7 Pail closets renewed 8 Plaster to walls and ceilings repaired 79 Window frames and sashcords repaired 29 Public sewers repaired 6 Sinks provided — Sink waste pipes repaired 9 Soil pipes repaired 2 Stairs repaired 15 External walls repaired 60 Wash boilers defective 13 W.C.s repaired 62 W.C. cisterns and fittings provided 18 W.C. accommodation provided 4 Yard paving repaired 1 Unpaved Yards & Passages 5 Other works carried out 356 33 Table 12. Housing Statistics. Houses Number of Persons displaced Houses demolished or closed during the year:— (1) Housing Act, 1936 (a) Demolished as a result of formal or informal procedure (Section 11) Nil Nil (b) Closed in pursuance of an undertaking given by owners under Section 11 and still in force Nil Nil (c) Parts of buildings closed (Section 12) 2 4 (2) Housing Act, 1949 Closed as a result of closing orders under Sections 3 (1) and 3 (2) Nil Nil (3) Local Government (Miscellaneous Provisions) Act, 1953 Closed as a result of closing orders under Sections 10 (1) and 11 (2) Nil Nil Number of Houses REPAIRS in the period:— (4) Unfit houses rendered fit and houses in which defects were remedied during the period as a result of informal action by the local authority under the Housing or Public Health Acts 424 (5) Public Health Acts-action after service of formal notice:— Houses in which defects were remedied (a) by owners 25 (b) by local authority in default of owners Nil (6) Housing Act, 1936-action after service of formal notice (Sections 9, 10, 11 and 16):— Houses made fit (a) by owners Nil (b) by local authority in default of owners Nil (7) Housing Repairs and Rents Act, 1954:— Houses reconstructed, enlarged or improved and Demolition Orders revoked (Section 5) Nil 34 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 dy 14 Number of Informal Notices served 410 95 Number of Informal Notices complied with 400 87 Number of Statutory Notices served 39 — Number of Statutory Notices complied with 20 — Number of cautionary letters sent by Town Clerk — — 35 Table 14. Prevention of Damage by Pests Act, 1949 TYPE OF PROPERTY Local Authorily Non-Agricultural Total of Cols. 1, 2 & 3 Agricultural Dwelling Houses {inch Council Houses) A11 other (incl. Business Premises) Number of properties inspected as a result of (a) Notification 31 390 88 509 Nil (b) Survey under the Act 25 2,694 448 3,167 1 (c) Otherwise (e.g. when visited primarily for some other purpose) 1 15 9 25 Nil Total inspections carried out including re-inspections 283 8,694 2,568 11,545 1 Number of properties inspected which were found to be infested by (a) Rats 15 376 68 459 Nil (b) Mice 6 107 17 130 Nil Number of infested properties treated by L.A. 21 473 73 567 Nil Total treatments carried out including re-treatments 33 531 30 594 Nil Number of notices served under Section 4 of the Act: (a) Treatment Nil 20 18 38 Nil (b) Structural work Nil Nil Nil Nil Nil Number of cases in which default action was taken following the issue of a notice under Section 4 of the Act Nil Nil Nil Nil Nil Legal proceedings Nil Nil Nil Nil Nil Number of Block control schemes carried out 10 36 Table 15. Eradication of Insect Pests. D.D.T. and Other Special Treatments. Number of Infestations Treated Type of Premises Bugs Cockroaches Fleas Flies Lice Wasps Miscellaneous Totals Dwelling-houses 18 6 4 - 28 3 59 Workplaces — — — — — 2 1 3 Food Shops — — — — — — — — Miscellaneous - 2 - - 1 10 - 13 Totals 18 2 6 4 1 40 4 75 37 Total income for D.D.T. and other special treatments, £47 8s. 3d. Corporation premises treated (re-housed families only): 3. Table 16. Disinfections, etc. Number Premises disinfected after infectious diseases 10 Premises disinfected after other diseases — A rticles disinfected after infectious disease 172 Persons (children and adults) treated for scabies at cleansing station — Table 17. 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 203 (2) Families dwelling therein 275 (3) Persons dwelling therein 912 (b) New cases of overcrowding reported during the year 14 (c) (1) Cases of overcrowding relieved during the year 2 (2) Persons concerned in such cases 10 Table 18. 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 28 Premises registered as dairies (not being dairy farms) 16 Special Designation Dealers' Licences Supplementary Licences Milk (Special Designation) (Raw Milk) Tuberculin tested Regulations, 1949. 18 10 Accredited Nil Nil Milk (Special Designation) (Pasteurised and Sterilised Milk) Regulations, 1949. Pasteurised 20 10 Sterilised 30 9 38 Table 19. Food and Drugs Act, 1938. Public Health Act, 1936, Section 89. Insanitary Conditions in Food Premises. Number of premises found with insanitary conditions 95 Number of premises remedied 87 Insanitary conditions found in premises above : Number of defects Number of defects remedied Accumulation of refuse 2 3 Ceilings— defective or dirty 51 57 Cleanliness (personal) unsatisfactory 2 — Dampness — — Floors— defective or dirty 22 20 Lighting inadequate — — Sink— absence of — — Sink-waste pipe inadequate ... — — Storage facilities unsatisfactory 1 1 Ventilation insufficient — 1 Verminous Conditions 2 — Walls— dirty or plaster defective 86 84 Insufficient or absence of hot and cold water for cleansing utensils 1 - Absence of hot water for ablution purposes - - W.C. accommodation— insufficient or unsuitable 12 6 Other defects 56 40 Totals 235 212 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 iormal action has been necessary. Public Abattoirs. There is no public abattoir within the Borough. Slaughterhouses. There are no slaughterhouses or horse-slaughtering establishments within the Borough. Slaughter of Animals (Amendment) Act, 1954. Eight slaughter-men were on the register of the department at the end of the year. 39 Table 20. Meat— Carcases Inspected and Findings at Private Slaughterhouses in the Borough Cattle excl. Cows Cows Calves Sheep and Lambs Pigs Horses Number killed (if known) - - - - - - Number inspected — — — — — - All diseases except Tuberculosis and Cysticerci: Whole carcases condemned - - - - - - Carcases of which some part or organ was condemned — - - - - - Percentage of the number inspected affected with disease other than tuberculosis and cysticerci - - - - - - Tuberculosis only: Whole carcases condemned - - - - - - Carcases of which some part or organ was condemned - - - - - — Percentage of the number inspected affected with tuberculosis - - - - - - Cysticercosis: Carcases of which some part or organ was condemned - - - - - - Carcases submitted to treatment by refrigeration - - - - - - Generalised and totally condemned - - - - - - 40 Table 21. (a) Meat. Diseased and unsound conditions found in meat caused the detention and surrender for destruction of:— lbs. Beef 2,276 Mutton and lamb 164 Pork 153 Other meats 691 Total 3,284 (b) Other Foodstuffs. The following foodstuffs, other than meat, being unfit for human consumption, were voluntarily surrendered for destruction:— lbs. Bacon 150 Butter 5 Cheese 148 Dried Fruit 60 Eggs (frozen) 14 Fish 373 Fruit Pulp 160 Haricot Beans 16 Margarine 2 Peanuts 112 Preserves 49 Sugar 84 Tomatoes 37 Jars Paste 4 Pickles 11 Tins Canned foodstuffs:— Fish 64 Fruit 700 Meat 284 Milk 276 Soup 41 Vegetables 767 Other 84 41 Table 22. Sampling. The Middlesex County Council is the food and drugs authority for th Borough. The Chief Officer, Public Control Department, has kindly suppliec the following information relating to samples taken in the Borough during th year ended 31st December, 1955:— Article Total Samples procured Unsatisfactory Milk 77 Apple Pectin 1 — Apricot Nectar 1 — Arrowroot 2 — Butter 14 — Bread 4 4 Cakes 11 — Cake Mix 1 — Cheese 8 2 Cheese Spread 1 — Cooked Meats 5 — Condensed Milk 2 — Cream 17 1 Crab Meat 1 — Drugs 13 — Fish 13 2 Fish Cakes 1 — Fish Paste 2 — Fruit Squash 3 — Glace Cherries 1 — Horseradish Sauce 1 - Ice Cream 2 1 Jellies 2 — Liver 4 — Margarine 4 — Mayonnaise 2 — Meat Paste 1 — Meatendra 1 — Minced Meat 13 — Mustard and Mayonnaise 1 1 Non-brewed Condiment 5 2 Oranges 3 — Pears 1 — Sausages 13 3 Sweets 3 — Sardines 1 — Self-raising Flour 1 — Sausage Meat Roll 1 — Soups 1 — Tomato Puree 1 — Tomato Sauce 2 - Victoria Plums 4 - Vinegar 21 1 Wines and Spirits 35 Totals 301 17 42 Regarding the samples noted as unsatisfactory, I add the following comments:— Bread. Of these four samples two loaves of bread were found to contain in one case pieces of wood, and in the other case a cigarette end. The bakers were issued with official cautions. A Vienna loaf contained a piece of wire, and here again an official caution was issued to the bakers. This last firm sold a sliced fruit loaf containing a nail. Proceedings were authorised and they were fined £10 0s. Od. and ordered to pay £I Is. Od. costs. Cheese. These two samples were procured from different retailers and were sold as "cream cheese". In one case it was found to be processed whole milk cheese and an official caution was issued. In the other case the cheese was found to be deficient in fat, but a follow-up sample proved to be genuine and no further action was taken. Cream. This sample, sold as " thick cream was found to be deficient in fat. Further samples proved to be genuine and no further action was taken. Fish. A tin of Smoked Sliced Saithe was found to be unfit for human consumption caused through a "blown tin". The stock was disposed of and no further action was taken. " Filleted witch " was sold as " filleted sole ", the firm was prosecuted and fined £10 0s. Od. Ice Cream. This sample was deficient in fat, but follow-up samples proved genuine and no further action was taken. Mustard and Mayonnaise. The retailer so described and sold this article but no mayonnaise was found in the sample; he was cautioned. Non-Brewed Condiment. Two samples of non-brewed condiment were found to be deficient in acetic acid. Further follow-up samples proved genuine and no further action was taken. Sausages. Three samples of sausages all contained preservative. In one case the follow-up sample proved to be genuine, the presence of preservative being declared, and therefore no further action was taken. In the other two cases official cautions were issued. Vinegar. A sample sold as " Vinegar " was non-brewed condiment. Proceedings were authorised and a fine of £2 0s. Od. imposed on the retailer. Merchandise Marks Acts, 1887-1926. 102 inspections of shops were undertaken to ensure that the Marking Orders relating to certain imported foodstuffs made under the Merchandise Marks Act, 1926 were complied with. 337 separate displays of meat, apples, tomatoes, dried fruit, butter and salmon were examined. Two serious infringements were disclosed; one being of filleted witch falsely described as "filleted sole" and the other case of a false description of weight applied to smoked sliced saithe. Proceedings were authorised in each case, a fine of £10 0s. Od. and £5 0s. Od. being imposed respectively, and costs of £5 5s. Od. and £1 Is. Od. The other cases in which proceedings were authorised concerned greengrocers not marking with the country of origin imported apples and tomatoes; one case being of Channel Island tomatoes not so marked— a fine of £1 0s. Od. was imposed— and three 43 cases of imported apples all unmarked. In these latter three cases the retailers were each fined £1 Os. Od. and ordered to pay £1 Is. Od. costs. There was one case where the retailer falsely described Dutch tomatoes as "English". He was fined £1 Os. Od. on each of two summonses and ordered to pay £1 2s. Od. costs. The Defence (Sale of Food) Regulations, 1943. One greengrocer was prosecuted under these Regulations for falsely describing a display of Keiffer pears as "Williams". He was fined £1 Os. Od. Three other greengrocers falsely described displays of Packham pears as "Williams". They were each prosecuted and fined £1 Os. Od. and ordered to pay £1 Is. Od. costs. The Labelling of Food Order, 1953. This Order requires that in general pre-packed foods shall bear on the label a clear statement of the designation of the food and, in the case of compound foods, the ingredients. It also requires that the name and address of the packer or labeller appears. At 90 premises 625 articles of pre-packed food were examined. No proceedings were taken but in respect of infringements found see paragraph " False or Misleading Descriptions " below. False of Misleading Descriptions. In addition to the foregoing activities which arise specifically from inspections in your area a considerable amount of work has been done for the benefit of all districts of Middlesex equally in scrutinising advertisements and the labels of pre-packed foods and correcting false or misleading descriptions or errors in statement of composition found therein. Corrective action during the year in question included biscuits, confectionery, spirits, sausages in brine, cereals, fruit squashes, margarine, ginger wine, imitation cream, liver puree, iced lollies, cheese spreads, tinned fruit and vegetables. Special Designated Milk. No licences are issued by my Council in respect of Dealer/Pasteurisers or Dealers/ Sterilisers in your area. Six samples of special designated milk were taken from roundsmen in your Borough during the year and submitted to examination. They proved satisfactory. 44 Table 23. 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 40 38 1 - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 318 374 10 - (iii) Other premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) — — - — Total 358 412 11 — 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.l) 3 3 - 1 — Overcrowding (S.2) — — — — — Unreasonable temperature (S.3) — — — — — Inadequate ventilation (S.4) 3 3 — — — Ineflective drainage of floors (s.6) - - - - - Sanitary Conveniences (S.7):— (a) Insufficient 1 2 — 1 — (b) Unsuitable or defective 9 8 — 1 — (c) Not separate for sexes 1 — — — — Other offences against the Act (not including offences relating to outwork) - 3 — — — Total 17 19 — 3 — Part VIII of the Act. Outwork. e of the work Lampshades Wearing apparel Electric Fuse Makers Section 110: Number of outworkers in August list required by Section 110 (1) (c) 10 9 59 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 - — — 45 Table 24. Infectious Diseases. Incidence and Mortality. Diphtheria, Scarlet Fever and Enteric Fever. 1938-1955. 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.c6 - - - - - - 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 - - - - - - 1953 — - — — 100 0.95 — - - — — — 1954 - - - - 64 0.61 - - - - - - 1955 — — — — 97 0.93 — — — - — - 46 Table 25. Ophthalmia Neonatorum, years 1938-1955. The following table shows the number of cases notified and result of treatment:— Year Cases notified Cases Treated Vision unimpaired Fision impaired Total blindness Deaths At home 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 — — 1954 2 2 — 2 — — 1955 5 2 3 5 — — 47 Table 26. Cases of Infectious Diseases Notified during the Year 1955. DISEASE Under 1 year 1-2 CASES NOTIFIED AT VARIOUS AGES (YEARS) Age not known Total cases notified Deaths 2-3 3-4 4-5 5-10 10-15 15-20 20-25 25-35 35-45 45-65 Over 65 Dysentery — 2 2 1 1 7 2 2 1 2 6 5 3 — 34 — Encephalitis - - - - - - - - - - - -- - - - - Erysipelas - - - - - - - - - - - 5 2 1 8 - Food Poisoning — 1 5 2 1 2 3 2 4 8 6 8 15 5 62 Measles 13 67 109 111 136 608 18 8 — 3 2 1 — 31 1107 1 Meningococcal Infections - - - - - - - - - - - - - - - - Ophthalmia Neonatorum 5 - - - - - - - - - - - - - 5 — Acute Poliomyelitis — — 2 - - 8 2 2 3 1 1 — — — 19 1 Pneumonia 3 — 1 2 — 10 1 5 2 8 12 16 21 4 85 48 Puerperal Pyrexia — — — - — 1 — — 2 5 — — — 1 9 — Scarlet Fever — 1 6 6 9 63 7 3 1 1 — — — — 97 — Typhoid & Para-Typhoid Whooping Cough 8 7 7 10 10 48 2 — 1 — 1 — 1 95 — Totals 29 78 132 132 157 747 35 22 13 29 27 36 41 43 1521 50 48 Table 27. Monthly Incidence of Infectious Diseases during the Year 1955. DISEASE NUMBER OF CASES TOTAL January February March April May June July A ugust Sept. October Nov. Dec. Dysentery — 1 — 1 1 7 10 4 2 6 2 — 34 Encephalitis — — — — — — — — — — — Erysipelas — 1 1 — — 1 2 1 1 — — 1 8 Food Poisoning... 2 14 5 7 — 4 16 2 7 5 — — 62 Measles ... 2 10 17 118 363 419 134 32 6 1 1 4 1,107 Meningococcal Infections — — — — — — — — — — — — — Ophthalmia Neonatorum 1 — — 1 1 — 1 — — — 1 — 5 Acute Poliomyelitis — — — — — — — 4 4 7 2 2 19 Para-Typhoid — — — — — — — — — — — — — Pneumonia 13 19 16 6 5 1 — 1 — 5 10 9 85 Puerperal Pyrexia — 1 1 1 — — 1 — 1 2 1 1 9 Scarlet Fever 2 6 18 10 9 13 5 5 3 11 8 7 97 Whooping Cough 2 7 8 17 8 8 2 8 8 7 10 10 95 Totals 22 59 66 161 387 453 171 57 32 44 35 34 1,521 49 Table 28. Ward Distribution of Infectious Diseases Notified during the Year 1955. Disease Twickenham Hampton Hill Heddington Hampton Wick Heathfield Total East Central South West Whitton Hampton Upper Lower Dysentery 8 1 2 14 — — — 1 6 — 2 34 Encephalitis — — — — — — — — — — — — Erysipelas — — — — 1 1 1 2 1 1 1 8 Food Poisoning 4 5 2 2 2 30 — — . 2 14 1 62 Measles 158 185 127 175 85 35 70 35 101 70 66 1,107 Meningococcal Infections — — — — — — — — — — — Ophthalmia Neonatorum — — — — — 2 2 — — — 1 5 Acute Poliomyelitis 2 1 2 2 7 — 3 1 1 — — 19 Para-Typhoid — — — — — — — — — — — — Pneumonia 6 1 9 6 3 12 22 9 4 12 1 85 Puerperal Pyrexia — — — — 5 I 1 1 — 1 9 Scarlet Fever 10 2 4 7 3 10 16 22 15 2 6 97 Whooping Cough 15 11 9 12 5 4 7 8 8 5 11 95 Totals 203 206 155 218 106 99 122 79 139 104 90 1,521 50 Table 29. 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 — — — — — 1-4 — 2 — 1 — — — — 5-9 2 1 — 1 — — — — 10-14 1 1 1 — — — — — 15-19 6 3 — — — — — — 20-24 — 6 — 1 — — — — 25-34 6 6 — 2 — — — — 35-44 3 5 2 — — — — — 45-54 12 3 1 — 3 2 — 1 55-64 7 — 1 — 1 — — — 65 and over 5 1 — — 7 2 — — Totals 42 28 6 5 11 4 — 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 30. Primary Notifications of Tuberculosis, 1938-1955 inclusive. 1938 1939 1940 1941 1942 1943 1944 1945 1946 19471948 1949 1950 1951 1952 1953 1954 1955 Pulmonary 100 106 114 127 112 119 133 118 120 132 117 115 96 107 79 105 88 70 Pulmonary 30 19 12 14 18 18 18 18 19 11 17 5 15 14 20 14 12 11 Totals 130 125 126 141 130 137 151 136 139 143 134 120 111 121 99 119 100 81 51 Table 31. Food Poisoning. Food Poisoning lsi Quarter 21 Notifications : 2nd Quarter 3 3rd Quarter 33 4th Quarter 5 TOTAL 62 Outbreaks Due to Identified Agents: 1 Number of cases 17 Outbreaks due to: Chemical Poisons Nil Salmonella organisms Nil Staphylococci (inc. toxin) Nil CI. Welchii 1 Outbreaks Due to Undiscovered Cause Nil Number of cases Nil Single Cases: Due to identified agents: Chemical Poisons Nil Number of cases 6 Salmonella organisms 2 Staphylococci 3 P. Morgani 1 Due to undiscovered cause:— Number of cases 42 Total all cases 65 52 Premises concerned with Health Services in Area 10. A = Ante-natal and postnatal care D = Dental. H = Headquarters Personal Health. P = Family Planning (provided by Voluntary Organisation). of mothers. B = Baby Welfare. E = Eye testing. I = Vaccination & Immunisation. S = School Health. C = Chiropody (Old People— provided by Voluntary Organisation) . F = Distribution of Welfare Foods. M = Mental Health. T = Talking & Speech Therapy. G = Child Guidance. O = Orthopaedic. V = Environmental Health. Table 33. Enquiries should be made at the appropriate address for particulars as to persons eligible, special conditions as to services and the times the premises are open. Elmfield House, High Street, Teddington. H V Council Offices, Bridge Street, Staines. V Grove Crescent, Hanworth. A B D E F I S T Church Road, Teddington. A B C D F I O Stanwell Road, Ashford. A B C D E F I O S Imperial Road, Bedfont. A B D F I S T Hospital Bridge Road, Whitton. A B C D F I S The Grange, Gresham Road, Staines. A B D E F G I M O P S T A B F I Council Offices, Green Street, Sunbury. V 20 Seymour Road, Hampton Wick. A B D F I P S Village Hall, Stanwell. Duddingston House, Green Street, Sunbury. A B C D F I S Stanley Road, Teddington. C D E I S Village Hall, Laleham. B F I Chertsey Road, Ashford Common. A B C D F I S 24, Station Road, Hampton. A B C D F I S St. Anne's School, Ashford. S Sheep Walk, Shepperton. B C D F I S York House, Richmond Road, Twickenham. A B C D E F I S St. Mary's Church Hall, Bridge Street, Staines. F New Hall, Upper Halliford. A B F I 58 Hampton Road, Twickenham. G T Council Offices, Hanworth Road, Feltham. V Hawke House, Green Street, Sunbury. F Baptist Church Hall, Hounslow Road, Whitton. F Cardinal Road, Feltham. A B D E F I S Bagster House, High Street, Shepperton. F 53