AC 439(1) Library Room Aioh TWI 30 DECEMBER, 1963 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 Public Health Committee and Staff 6 Keeping the Borough Clean 7 Water Supply 7 Food 7 Industrial Health 11 Housing 11 Clean Air Act, 1966 12 Pest Destruction 13 Health Education 14 General Matters 15 Statistical Tables 18 1 Telephone: TEDdington Lock 2223-4. TEDdington Lock 4411-5. PUBLIC HEALTH DEPARTMENT, ELMFIELD HOUSE, HIGH STREET, TEDDINGTON. To His Worship the Mayor, Aldermen and Councillors of the Borough of Twickenham. MR. MAYOR, LADIES AND GENTLEMEN, I have the honour to present the Annual Report on the work of the Health Department; the statistical tables refer to the calendar year 1962, The population of the Borough based on the 1951 census was 105,645 and the 1961 census gave a population of 100,971, a fall of about 5,000 during the ten year period. The estimated figure for mid-year 1962 was 102,500. The average density at the 1961 census was 14.4 persons per acre, but this varied from 28.1 in West Twickenham to 5.0 in Hampton Wick. In Hampton it was 7.4 but these last two figures are unrealistic by reason of the inclusion of the park. The working figure is about 25 persons per acre. The average persons per room was 0.62; it was highest in Heathfield at 0.69 and lowest in Lower Teddington at 0. 59. We know there are about 6,500 children under 5 and about 13,000 school children. This leaves about 83,000 in other age groups and of these there are about 14,000 "older people" -say in the age range 65 upwards. Prom these figures we see that the services dealing with health, social and welfare conditions are responsible for about 33,500 people of whom more than half need periodic attention. The Ten Year Plan 1 emphasises the importance of placing ever more responsibility on the services of local authorities to enable everyone to live a full, happy and healthy life in a comfortable home. To enable this to be done requires extensive supporting services of all kinds. The local authorities will thus find themselves taking the burden ever more heavily on their local rates of expenditure formerly borne by the hospitals as a national charge; and themselves providing more and more supporting and ancillary medical services. This trend is here already; we are providing practitioners with nurses in their surgeries, with midwives in their surgeries and at clinics, with health visitors both in their surgeries and on call, and with mental health and social workers for weekly sessions. All this is new this last few years. A year ago I commented on the wasteful division of the health services into the three categories. I have lately noticed the early beginnings of a new heart and understanding in the relationships between the practitioners' organisation and our own, which is a very welcome change for the better. In the preface to the report on the development of local authority community care the Minister says there can be few people into whose lives 1. Health and Welfare; The Development of Community Care; (1963) Cmnd l973 H.M.S.O. London. 2 the health and welfare services of the local authorities do not at some stage enter. Millions of people use them every year, These services tend to be less in the public eye than the hospital or the general practitioner service, but recent years have seen a rapidly growing appreciation of their importance. Their value and effectiveness cannot be measured in financial terms; but in the last five years alone current expenditure on them has risen by 50 per cent. and capital expenditure has quadrupled. The Minister goes on to say that still further development of these services is essential. They are far from having reached their full potential. Without them neither the general practitioner service nor the hospital service can evolve as it should. The ten year plans envisage an increase of 45 per cent. of the staffs employed. Twickenham Council is soon to be heavily involved in these matters when it joins with Richmond and Barnes to form the new Borough. I have often said it is difficult for a councillor in a County district like Twickenham to appreciate the extent and ramifications of the County personal health services, when he is concerned as a councillor with a health department staff of 15 dealing with a few environmental services as compared with a staff of 430 dealing with all the personal services; and this does not include still more dealing with welfare services. I personally welcome the new set-up wholeheartedly. At long last we shall be rid of this futile, stupid, artificial division between health services and I trust, as I said in my last report, that we shall not split into separate departments such things as mental health, welfare, and environmental health. All these are so closely concerned with the health and well being of every household that they need staff who feel themselves to belong to one health-giving organisation and who regard themselves as colleagues in one department. Such an arrangement leads to greater efficiency, greater interest for the members of the staff, and greater economy of administration. Within our health service the pattern of requirement of the patient has undergone considerable change. The patient with symptoms and signs fitting a textbook disease is no longer a "case". He is a person bound up with the complexities of modern life and with all sorts of relationships in his home with his wife, his children and his house; in his travelling arrangements to work; in his type of employment; in the personalities of his workmates and employers; in his recreations and interests. The prescription of a few tablets is no longer appropriate, because this patient may need adjustments and advice about his mode of life which might help to readjust himself to become again an efficient and responsible citizen. Thus in each of his relationships he may need help not only from a practitioner but also perhaps through his wife and children, the maternity, midwifery, and child welfare clinic; the school health service or child guidance; in an acute illness a home nurse, the home help, a special appliance, or an ambulance; in convalescence a recuperative holiday; in his attitude to life he may need a mental welfare worker; perhaps a marriage guidance counsellor; or in distress an almoner. If he is older he will need preventive medical services for older people; the special welfare provisions; appliances for handicapped people; chiropody; and may be admission to an old people's home. All these ancillary services and many more are provided by or supported by local authorities. You can see how these services can 3 develop a voracious appetite for manpower and money. In 1947, the peak year of the bulge, there were 2,089 births; in 1962, the second bulge has produced 1,623. The arrangements for these confinements are far from satisfactory. We lose 30 babies per year many of whom could be saved; and others are born with a risk to their health which could have been avoided. For many years now there has been an increasing demand for hospital confinements especially for first births, fourth and subsequent births, complicated births, and births in bad social conditions. The demand for hospital accommodation is of the order of 70 per cent. and tends ,to creep higher. There is only accommodation for about 50 per cent. Many mothers who should be accepted fail to obtain hospital bookings. At the last minute and when in labour such a mother is admitted through the emergency bed service to a hospital perhaps far away where she is unknown, perhaps difficult of access for her relatives, and in circumstances which I think are appalling and inhuman. In Salisbury, Southern Rhodesia, every birth takes place in hospital under safe conditions, carried out by the mother's own district midwife, assisted if need be by an obstetrician. We could have the same arrangement here if we had two units one say in Twickenham and one in Teddington, each of about 40 to 50 beds and provided with several labour rooms and all the necessary equipment. Confinements in these units could be carried out by our district midwives, assisted when necessary by practitioner obstetricians, with consultant help on call. In these circumstances the confinements would be safe, the babies less in danger, the journeys short, the mothers could go home early, they would be attended to both at the confinement and later by their own professional attendants. In this country there is no preventive medical service as such for older people. In my report on our work in the experimental clinic for preventive medicine for older people 2. I have pointed out that almost everyone in later life has numerous disabilities, many of which are capable of being prevented, ameliorated or cured. We have described techniques for acheiving this happy state. There is a crying need for preventive services for older people conducted either in the clinics of the local authorities or by practitioners. Our preventive service has grown so much that we are in urgent need of a bigger and better clinic. I am disappointed that work on the new clinic for Teddington cannot be started before April 1965. Over this last 18 months we have always been short of inspectors. For some of the time we have had only two district inspectors. Mr. Easter and his four remaining inspectors have been kept at full stretch to try to keep going as much of the routine work in the health department which requires at least 8 inspectors. They have to cover the inspection and supervision of houses, factories, shops, places of entertainment, schools, canteens, restaurants and cafes;; they have to investigate hundreds of complaints, nuisances, and follow up and trace contacts in certain infectious diseases; they have to inspect and supervise food; they have done their best with the smoke control programme. It has been a difficult and anxious time. Hence it is that I commend with greater emphasis and pleasure than usual the zeal and devotion to duty of your inspectors and 2. Maddison. J, (1963) Horn to Keep the Old Folks Young. Middlesex County Health Department, High Street, Teddington. 4 clerical staff who have sacrificed themselves unstintingly in your service. Dr. Wilkinson and I have been heavily beset with the great pressure constantly upon us in the management not only of your environmental health services but also of the huge volume and case load of personal health services which we carry. We need all the help and support we can get Mr. Mayor from you and your colleagues in the committees of the Council. The Chairman and members of the Public Health Committee have constantly supported me and have granted every request I have made to them; I acknowledge my indebtedness to them for their helpfulness. I desire also to acknowledge with thanks the friendly co-operation and help which I have always received from my colleagues in other departments of the Corporation. I am, Mr. Mayor, Ladies and Gentlemen, Yours sincerely, JOHN MADDISON, Medical Officer of Health. 5 MEMBERS OF THE PUBLIC HEALTH COMMITTEE Ex-Officio members: THE MAYOR, ALDERMAN J. A. DENHAM, J. P. THE DEPUTY MAYOR, COUNCILLOR P. BLACKMORE Chairman; ALDERMAN F.J. EDWARDS, J. P. Vice-chairman: ALDERMAN MRS, M.B. DAVIES Alderman J.H. Knaggs, J. P. Councillor W.P. Letch, LL.B., B.Cora., A. C.I.S. Councillor L. Defries-Porter. LL.B., Councillor R.H. Mitchlson M. B I. M. Councillor F.D. Gilday-Fox Councillor G.J. Samuel, M.A. Councillor D.G. Harris Councillor C.W. Sewell, M.A., F. R. Econ. S. Councillor Mrs. P.J.L, Holroyde, B.A. Councillor B.J. Stops, B.A. 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. Megan E. Wilkinson MB., 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 Public Health Inspectors Messrs. K.W, Clement, A.E.G. Walker, three vacancies. 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 Administrative Officer, Twickenham, Feltham, Staines and Sunbury) Senior Clerk Mr. R.N. Himson Clerical Staff Mrs. J, Hodgson, Miss D, E. Wheeler Mrs. M.G. Bateman (Part-time) Mrs. E.B. Paisley (Part-time) Senior Rodent Operative Mr. H* T. Jackman Rodent Operative Mr. S. W. Jackman Disinfector/Drain Tester Mr. E. G. Cooper Mortuary Attendant Mr. G. Chase 6 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 Engineer and Surveyor for the following report of Drainage and Sewerage and Refuse Disposal. Drainage and Sewerage Increasing difficulty is being experienced with the ejector system in the Hampton Hill area due to increased volume of sewage and the worn out condition of pumping equipment and air mains. A scheme to modernise the ejector stations in this area has been abandoned on the grounds that the existing mains to be retained would not effectively carry the extra strain likely to be imposed on them and a scheme for replacing most of the ejectors with gravity sewers is in an advanced stage of preparation, Improvements to the pumping station at Bell Hill and Hampton Wick will be put in hand on the completion of the gravity sewers. Expenditure for these works has been authorised. Refuse Disposal In spite of a continued increase in the weight and volume of refuse the Charlton Plant continues to operate satisfactorily. Salvage prices generally have continued to fall over the year. Alterations to the reception hoppers have been completed giving additional storage capacity for crude refuse with a consequent reduction in the volume of refuse sent to the tip, Water sprays have been installed in the dustcatcher to one set of cells in order to reduce the emission of grit from the chimney, The erection of a refuse composting plant is in course of construction. WATER SUPPLY All the dwellings in the Borough are supplied from the Metropolitan Water Board's main, and I am indebted to Dr.E.Windle Taylor, M. A., M. D., D.P. H., M.R. C. S., L.R.C.P. Director of Water Examination, Metropolitan Water Board, for the following report: "The source of water is the River Thames and it is stored in the Thames Valley reservoirs at Staines, Littleton and Walton. After storage the water is treated at the filtration works at Hampton, Ashford Common, Hanwcrth Road and Kempton Park. Samples of water are collected at ail stages of the purification process at least five times a week and the summary of the analyses of the finished waters are set out on pages 23. The supply is not plumbo-solvent and there have been no important extensions to trunk mains nor changes in the general scheme of supply to your area during 1962. New mains have been laid in Twickenham to the extent of 833 yaids and all these new as well as 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." FOOD Fbort and Drugs Act, 1955 Sampling The Middlesex County Council is the food and drugs authority 7 for the Borough. J.A.O'Keefe, Esq.. O.B.E., Chief Officer, Public Control Department, has kindly supplied the information in the table on page 38 relating to samples taken in the Borough during the year ended 3ist December, 1962. He reports:-A total of 285 samples was procured and 3 were found to be unsatisfactory. One of these samples was a seedless grapefruit which was procured informally, because it was described on the stack as "seedless". On examination this grapefruit was found to contain 61 seeds. Further samples of grapefruit from the same shop were found to be satisfactory and for this reason no action was taken in respect of the isolated infringement. A resident in your area complained of a jar of marmalade that it contained a foreign body. On investigation it was found that the foreign body was a small sliver of wood which appeared to have come from an orange box. It was not considered that the wood was in any way harmful although, of course, it should not have been present. The manufacturers were a large company with a good record, and in view of all the circumstances they were sent a letter of caution. A sample of cream cheese which was procured in your borough was found to be deficient in milk fat. The sample was labelled "Soft Cream Cheese" and should have contained not less than 50% of fat, in fact it contained 36% of fat. The manufacturers agreed to amend their label so as to make clear to the purchaser precisely what was being offered. In these circumstances a letter of warning was sent to them. In addition to samples purchased in the borough labelled stacks and displays of fish (115), meat (90), apples (307), citrus fruit (97), potatoes (74), offal (49), plums (25), and vegetables (2), were examined in 230 shops. Formal samples are selectively procured based on these examinations of labelled displays of natural foods where there is doubt as to the accuracy of the label or where there is need for further more detailed examination. The inspectors of the department have, over a number of years acquired a considerable expertise in the identification of cuts of meat and varieties of fish and fruit. The infringement relating to seedless grapefruit reported above arose from these inspections. In 1962 new Regulations were introduced dealing with emulsifiers and stabilisers in food, and with preservatives in food. In addition there has been an amended food standard relating to table jellies. The effect of the Regulations dealing with emulsifiers and stabilisers and with preservatives is to define and limit the additives which are permitted, and (in the case of preservatives), to extend the range of foods in which, and the types of, preservatives which are allowed, but nevertheless closely limiting the quantities of such preservatives. No infringement arising from the new Regulations has been reported during the year. THE MERCHANDISE MARKS ACTS, 1887-1953 Inspections are carried out under the above Acts to ensure that the requirements of the various Marking Orders relating to the indication of origin of reported foodstuffs are applied. Inspections were made at 322 premises, and 168 stacks and displays of meat,350 of apples, 163 of tomatoes, 119 of butter, 230 of poultry, 26 of bacon, and 38 of other miscellaneous foods were examined for compliance with the Orders. An official caution was sent to a retailer who displayed apples of Italian origin as "Empire Produce". Other minor infringements have been dealt with by verbal warning. 8 SAFE MILK Fifty samples of pasteurised or sterilised milk were procured from retailers in the district and tested to ascertain whether or not pasteurisation or sterilisation had been correctly performed. No failures have been reported. Sixty-seven inspections of premises at which milk is pasteurised or at which it is sold were carried out during the year to ensure that the premises concerned conformed to the requirements of the Milk (Special Designation) Regulations, 1960. THE LABELLING OF FOOD ORDER, 1953 This Order requires prepacked food to be marked with the name and address of the packer or labeller, or to bear a registered trade mark; to be marked with its common or usual name or its appropriate designation; and to bear a statement of ingredients if the food consists of more than one ingredient. It also controls the manner in which the presence of vitamins and minerals is disclosed. A total of 50 premises have been visited in connection with the Order,, and 67 articles of food have been examined. Two infringements were disclosed. In one of these a canned meat product was described as "Corned Beef" when in fact the product was corned beef loaf, to which a different standard of meat-content applies. The seller was sent a letter of caution A letter of caution was sent to a retailer who sold as cooking chocolate a substance which should properly have been described as couverture, LABELLING AND ADVERTISING OF FOODSTUFFS A considerable amount of work was done in the year which, while it did not arise from samples and inspections in the area of Twickenham, nevertheless has the effect of protecting the residents of your county district. The matters mentioned below were of nationally retailed articles of food, which are widely distributed throughout the County. Several manufacturers and importers were reminded of the obligation to put on the labels of foods the name and address of the packer or labeller. Similar action was taken in respect of pickles., canned peas and mixed vegetables which did not bear a statement of ingredients. One manufacturer of ice cream was found to be putting all the statutory declarations on the base of the carton. He was reminded that these declarations are required to be both conspicuous and prominent. Two advertisements for honey did not disclose that the honeys offered were of foreign origin. The Merchandise Marks Act requires this, and letters were sent to the advertisers reminding them of their obligations to declare the origin in advertisements. Some prepacked lamb chops found to be generally on sale were of imported origin. The declaration in such a case is required to be in half inch letters; the lettering used was so small as to be quite inconspicuous, and the packers were required to comply with the prescribed conditions. Matters dealt with under the Food and Drugs Act by correspondence included a sample of cream cheese containing less milk fat than was considered sufficient to justify the title. Five examples of cake-mixes, which were not complete mixes in that other additions, such as egg or milk were necessary before the mix could be used, were found. The manufacturers were required prominently to show what additions were necessary. The manufacturers of four brands of milk pudding which were described on the label as "creamed rice" were challenged on the ground that the product was in fact a rice milk pudding and not 9 creamed rice. Correction to the labels was secured. The manufacturer of a lemon juice was challenged that a claim on the label for slimming properties for the juice was not justified, and he amended his labels to delete the claim. A sample of cream was procured which was labelled "thick crean". The fat content of this cream was less than the standard prescribed for thick cream and the product was re-labelled "sterilised cream". A manufacturer of a canned meat product claimed on the label that it was "full of lean red meat". In fact, the meat content was no more than is normal for this class of product, and the manufacturer was therefore challenged as to the accuracy of the claim. It was withdrawn. It was claimed for a sample of chopped pork that it pontained "more meat". In fact the percentage of meat was no greater than that of comparable products and the manufacturer was required to delete the claim. The manufacturers of several breakfast cereals were challenged on the ground that the labels claimed the foods to be "vitamin enriched". The vitamins present did not provide one half of the daily requirement which, it is considered, is the minimum to support claim to enrichment. The labels were amended to "vitamin fortified" which, because vitamins were added, was true. A sample of ice lollies for which it was claimed that glucose was present, was found on analysis not to be correct. The lollies originally it was found had been made with added glucose, but glucose had been dropped from the recipe. The label was not amended to conform to the new recipe, and was therefore incorrect. Reference to glucose was deleted from the new labels. A sample of butter mintoes was labelled "made with butter". This was not true; other fats were present as well; the label was amended after representations to the manufacturer to "contains butter". A sample of sodium fluoride tablets was found on analysis to be deficient of the stated amount of the chemical. Because, in spite of the deficiency in the chemical, it was considered that the efficacy of the tablets was not impaired, the manufacturer was not prosecuted but was sent a letter of caution. Two samples of instant coffee were found to contain sulphur dioxide, a preservative not at the time permitted in instant coffee. The manufacturers and importers concerned were sent letters of caution. Similar action was taken in respect of a sample of dried apricots which were found to contain sulphur dioxide. The quantity of preservative would have been satisfactory if its presence had been declared, and the manufacturers were required to amend the label. A firm of confectionery importers was cautioned for selling sweets containing colouring matter not permitted. The firm had withdrawn from retailers sweets imported earlier, and had thought the stock from which the sample was procured was satisfactory. Only permitted colours are now used. During the year a manufacturer put on to the market with a large scale newspaper advertising campaign a new product which consisted of 99% pure sugar with 1% of saccharin. It was claimed for this product that it was "Slimmers Sugar". The manufacturer was challenged on the ground that the product (because it contained saccharin) was not sugar. Exception was taken to advertising matter for the same reasons. 10 Correction of advertising matter and the labels was secured, the manufacturer devising a new description for his product. An advertisment for vitamin capsules made extravagent claims. On being challenged, the advertisement and literature were modified so as to delete the objectionable wording used. Food and Drugs Act, 1955 Food Hygiene (General) Regulations, 1960 The table on page 35 gives details of the work carried out under these regulations. It was found necessary to institute legal proceedings in four cases. A grocer was fined £3. with £5 5s Od. costs for selling a tin of Blackcurrants which had become contaminated by the tin, A baker was given a conditional discharge with £10 10s Od. costs for selling bread containing a cigarette end, a restaurant proprietor was fined £10 0s 0d. with £10 10s 0d. costs for storing meat in a state of decomposition and another grocer was fined £15 0s Od. with £5 5s Od, costs for selling pork pies affected with mould. Twenty one complaints were received about unsound food purchased from retailers in the Borough. INDUSTRIAL HEALTH Factories All factory premises are inspected periodically to see that suitable sanitary accommodation is provided and where mechanical power is used to see that they are kept clean, are not overcrowded, are sufficiently ventilated and that floors are adequately drained. Of the 312 factories in the Borough, most of them are engaged in light industries. The number of persons employed range from 650 in the largest to one or two in the smallest. Outworkers Under Section 110 of the Factories Act, 1937, the occupier of every factory has to submit to the local authority twice a year lists of outworkers directly employed by him in the business, outside the factory. The number of outworkers in the Borough in 1962 was 99. HOUSING Further progress was made on the three-year slum clearance programme which commenced in January 1961. Two houses were deleted from the list to be dealt with under the current programme and the closing order on one house was determined following satisfactory execution of works of repair and improvement. Two Closing Orders involving nine houses were confirmed by the Minister. Notices were served under the Housing Act, 1961, on the owners of two houses which were found to be not reasonable suitable for occupation by the number of persons accommodated. Rent Act, 1957 During the year 4 applications were received for certificates of disrepair, 3 certificates were issued and in 1 case an undertaking was given by the Landlord under paragraph 5 of the First 11 Schedule. There were no applications for cancellation of certificates. CLEAN AIR ACT, 1956 Smoke Control Areas As a result of changes in the administrative requirements of the Ministry of Housing and Local Government it was possible to dispense with a detailed survey of every private dwelling in the area before making a Smoke Control Order, and the Corporation were then able to speed up their programme for converting the whole of the Borough into one smoke controlled area. The first Smoke Control Order came into force on the 1st October, 1962, and the second made on the 8th May, 1962, was confirmed by the Minister on the 20th December, 1962, By the end of 1962, through these orders, positive action had been taken in respect of over 10,000 dwellings. However, by the end of the year, only one order was actually in force and experience gained in dealing with this first order should help considerably in the future. Of the 1,300 houses dealt with in the first Order only approximately 1/3 of the householders made any application for approval of works, and it is now apparent that it will not cost the Corporation nearly as much as the £100,000 originally estimated. It has also been possible to reach the following conclusions - 1. In order to avoid numerous office enquiries and unnecessary calls by the public health inspectors, it is essential that each individual householder should be given as much information as possible, with the aid of pamphlets, exhibitions, etc. 2. As much time as possible should be given to enable householders to arrange with builders, etc., to carry out the necessary works of adaptation' etc. There is sometimes a considerable time lag between the date when the order is given and the date of completion of work. 3. Legislation should be brought in to prohibit the sale of bituminous coal to dwelling houses situated within the area of a smoke control order. 4. All types of authorised solid fuels should be more readily available to householders within the area. Measurement of Atmospheric Pollution In January 1962, in addition to the existing station at Elmfield House, Teddington, new stations were set up in the Clinics at Hampton and Whitton and it was agreed to co-operate in the national scheme for the measurement of air pollution. This scheme takes in over 100 towns situated throughout the country and it is estimated that the survey will take five years to complete. In December 1962 the Warren Spring Laboratory published a leaflet explaining the factors influencing air pollution by sulphur compounds in residential smoke control areas, viz:- "Whenever the introduction of smoke control areas under the Clean Air Act is being considered it is generally said that while the changes will reduce the emission of smoke to negligble proportions, pollution by sulphur compounds would probably be unaffected, but it is often implied that pollution by sulphur might, in fact, 12 be increased. Neither of these statements about sulphur is correct. The introduction of smoke control would be expected to cause a decrease in the emission of sulphur oxides by anything up to about 25 per cent. depending on the proportion of coal used in the area for domestic heating. The reasons are set out below. The major change in the use of fuel brought about by setting up a smoke control area is the replacement of coal for domestic heating by coke, whether ordinary gas-works coke or the more freely-burning low temperature cokes. For the same standard of comfort every ton of coal previously used will be replaced by 15 to 16 cwt. of coke. Average coke contains the same percentage of sulphur as average coal, and the same proportion of this sulphur is retained in the ash of both fuels. The change from coal to coke would, therefore, be expected to produce a decrease of 20 to 25 per cent in the amount of oxides of sulphur emitted. On the domestic side, this decrease is accentuated by a proportion of householders who meet the requirements of a Smoke Control Order by changing from open coal fires to electricity, gas, or oil. Electricity produces no oxides of sulphur where it is being used so that for any coal replaced by electricity the reduction in emission of those compounds is 100 per cent. For gas and oil the corresponding figures are about 97 and 95 per cent respectively, taking into account the organic sulphur content of the gas, and the sulphur in the grades of oil used for domestic heating. From these considerations it is probable that for a purely residential smoke control area, the decrease in sulphur pollution is nearer 25 per cent than 20 per cent. Finally, but not least in importance, it must be emphasized that in addition to the decrease in emission of sulphur dioxide brought about by smoke control, as described above, the removal of smoke from the air lets through more of the sun's heat which sets up convection and so increases the dispersion of other pollutants harmlessly into the upper air. In the absence of smoke there is less danger of high concentrations of sulphur dioxide building up, than when smoke is present," Smoke From Furnaces Section 3 of the Act deals with the installation of new furnaces and the requirement that new furnaces shall be so far as possible smokeless. During the year 1962, 4 applications to instal furnaces were received and approved. PEST DESTRUCTION Rats and Nice During the last 15 years considerable strides have been made in the methods used for the eradication of these vermin. Experiments are constantly being made by the Ministry of Agriculture, Fisheries and Food and two years ago a length of the Borough's sewers was treated by them with a new type of poison. The result of that experiment was so successful that today this poison is being used in sewers throughout the country. The introduction of the use of the poison "Warfarin", which is used when disinfesting residential and business premises has meant a considerable saving of time and labour because it is not necessary when using this poison to carry out pre-baiting. The service provided by the department in respect of residential premises is free but work carried out at business 13 premises is paid for by the firms concerned and is not a charge on the rates. Insect Pests Residents are able to have insect pests identified and advice is given as to the best methods for their eradication. Unusual specimens are sent to the British Museum (Natural History Section) for identification and I am most grateful to them for their willing and valuable assistance. Control of Birds Under Section 74 of the Public Health Act, 1961, the Local Authority is given power to take steps for the purpose of abating or mitigating nuisance or damage caused by the congregation in any built-up area of house doves or pigeons or of starlings or sparrows. The Local Authority using these powers will not be subject to the provisions of the Larceny Act, 1861, but they must take all reasonable precautions to ensure that seizure and destruction of the birds are carried out humanely. Further, the Local Authority must believe that the birds concerned have no owner, and they must not destroy birds which are subject to the Protection of Birds Act, 1954. It follows that care must be taken, before the powers are used, fully to examine the position. HEALTH EDUCATION Smoking and Health Medical opinion, in 1957, condemned the smoking habit as being injurious to health, and early in 1962 a report published by the Royal College of Physicians on "Smoking and Health" stressed this fact more forcibly. The report considers the subject under many headings, such as the history of smoking, present smoking habits, the chemistry and pharmacology of smoking, smoking and lung cancer, and the relationship of smoking with other diseases. It gives much factual and statistical evidence, and after a very full interpretation of all the evidence, concludes as follows:- The benefits of smoking are almost entirely psychological and social. It may help some people to avoid obesity. There is no reason to suppose that smoking prevents neurosis. Cigarette smoking is a cause of lung cancer and bronchitis and probably contributes to the development of coronary heart disease and various other less common diseases. It also delays healing of gastric and duodenal ulcers. The risks of smoking to the individual are calculated from death rates in relation to smoking habits among British doctors. The chance of dying in the next ten years for a man aged 35 who is a heavy cigarette smoker is 1 in 23 whereas the risk for a non-smoker is only 1 in 90. Only 15 per cent (one in six) of men of this age who are non-smokers but 33 per cent (one in three) of heavy smokers will die before the age of 65. Not all this difference in expectation of life is attributable to smoking. The number of deaths caused by diseases associated with smoking is large. Such diseases are Bronchitis, Coronary Heart Disease, Gastric and Duodenal Ulcer. 14 The report goes on to discuss the effect of general air pollution, and states that even if this pollution was abolished completely and immediately, smokers in this country would continue to have a greater risk of lung cancer than smokers who had never been exposed to pollution. The risk could be reduced only by avoiding the smoking of cigarettes The summing up conclusion is that it is necessary for the health of the present population of this country that any measures which are practicable and likely to produce beneficial changes in smoking habits should be taken promptly. Over the past few years, the Middlesex County Council, as local health authority, has conducted much anti-smoking propaganda, mainly aimed at dissuading children from starting the smoking habit. In 1957, a propaganda pamphlet to school children was issued, in which special stress was not laid on the association between smoking and lung cancer but in which it was emphasised that smoking was imcom-patable with perfect physical fitness. In addition, a circular letter from the County Medical Officer was distributed to all youth leaders, seeking their co-operation in dissuading young people from taking up smoking. More recently a leaflet was prepared for the information of all teachers and leaders of youth organisations throughout the county, setting out in "Question and Answer" form the salient facts relating to the association between smoking and chest disease. Finally, after carrying out a comprehensive survey in various schools in the county, the County Health Education Officer designed a special leaflet. This was produced not by guess work but from the opinions gathered from the young people themselves. The draft leaflet was then submitted to a special committee of young people representing all types of schools In Middlesex and the alterations made to fit with their suggestions. Each school child in Middlesex between the ages of 9 and 18 years received this pamphlet in 1961. The danger of smoking and lung cancer has also been a frequent subject at parent-Teacher Association meetings at various schools. Circulars have been received from the Ministries of Health and Education asking that the conclusions of the report about the danger of smoking should be made as widely known as possible. Both Ministries are actively engaged in the preparation of fresh publicity material suitable for use in schools and also for general distribution to the public. General During the year I have given a number of talks on health topics to various associations in the Borough.; and the Chief Public Health Inspector and his staff have also shared in the work. Films and filmstrips are used as appropriate, and propaganda by posters and leaflets has been continued. The Corporation again made a contribution of £14 6s Od. to the Central Council for Health Education. GENERAL MATTERS Shops Act, 1950 Section 38 of this Act deals with provisions for the health and comfort of staff employed in shops. Shop premises 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 made for them. 15 Occasionally it happens, as in the case of a small lock-up shop. that it is impossible for the occupier to provide a separate toilet on the premises. Provided that alternative arrangements are made to use a nearby toilet, a certificate of exemption can be granted from the requirements of the Act. There are 22 exemption certificates in force. Schools Inspections of the sanitary arrangements and canteens at schools within the jurisdiction of the Divisional Executive were carried out by Public Health Inspectors during the year. The general standard of the canteens is good. It was not necessary to close any schools on account of infectious disease amongst the children. Complaints There were 820 complaints received during 1962. 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. There are 11 licences in force in the Borough and 25 visits were made for the purpose of securing compliance with the licensing conditions. Petroleum Installations Regular inspections are made of all premises where petroleum or petroleu mixtures are stored and in the year 351 visits were made to the 106 premises licensed. Registration of Hawkers of Food and Their Premises A strict watch is kept on all street traders selling food. Both the person and the storage premises have to be registered, and if conditions are unsatisfactory registration can be refused. During 1962,1 person was registered and 37 visits were made by Inspectors. Establishments for Massage, Chiropody, Electrical and Special Treatment. 7 licences in respect of establishments were issued during the year 1962. 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 10 inspections were made of these premises. It was not found necessary to take any action for contraventions. Common Lodging Houses There are no common lodging houses in the Borough. Swimming Baths Excellent facilities are provided for swimming at the Corporation's three open air baths. 16 Twickenham Bath is the largest with a capacity of 280,000 gallons; Hampton Bath has a capacity of 206,000 gallons,, and Teddington Bath has a capacity of 180,000 gallons. Water for all three baths is supplied by the Metropolitan Water Board's Main and is purified by continuous sand filters with marginal chlorination. The Teddington and Hampton Baths have venturi-induced aeration and the Twickenham Bath has cascade aeration. The whole of the bath water is completely changed at both Twickenham and Teddington every hours and that at Hampton every 4 hours. During the 1962 season 27 samples were taken for bacteriological examination and all the samples proved satisfactory. Laboratory Work The usual arrangements continued during the year and worked satisfactorily. Type of Sample or Specimen NO. Taken Result Ice Cream (including Ice Lollies) 73 70 -Grade I Satisfactory 3 -Grade III Unsatisfactory Water 32 32 -Satisfactory Faeces 76 Miscellaneous 7 National Assistance Act, 1948, Section 47 National Assistance (Amendment) Act, 1951 It was necessary during 1962 to remove to suitable premises one person who was in need of care and attention. Mortuary The number of bodies admitted to the Mortuary during the year was 303, This figure is lower than in recent years, because of the closing of the Mortuary for two months during the year and to the opening of Feltham Mortuary in January 1962. 17 STATISTICAL TABLES for the Year 1962 Table 1 Summary Area in acres 7,078 Population (census 1961) 100,971 Civilian population -estimated to mid-year (as supplied by the Registrar-General) 102,500 Number of inhabited houses 31,490 Rateable value £1,972,868 Sum represented by a penny rate £8,023 Total M. F. Live Births-Legitimate 1,529 811 718 Illegitimate 94 44 50 Total 1,623 855 768 Live Birth rate per 1,000 of estimated Civilian Population 15.83 Adjusted Live Birth rate per 1,000 of estimated civilian Population 16.46 Illegitimate Live Births per cent. of total Live Births 5.79 Total M. F. Still Births-Legitimate 19 15 4 Illegitimate 2 1 1 Total 21 16 5 Still Birth rate per 1,000 live and still births 12.77 Total Live and Still Births 1,644 Infant Deaths (under 1 year of age) Total M. F. Legitimate 21 14 7 Illegitimate 5 3 2 Total 26 17 9 Infant mortality rate per 1,000 live births 16.02 Legitimate Infant mortality rate per 1,000 legitimate live births 13.73 Illegitimate Infant mortality rate per 1,000 illegitimate live births 53.19 Neo-Natal deaths Under 4 weeks of age Under 1 week of age Total M. F. Total M. F. Legitimate 12 9 3 11 8 3 Illegitimate 4 3 1 3 2 1 Totals 16 12 4 14 10 4 Neo-Natal mortality rate per 1,000 live births 9.86 Early Neo-Natal mortality rate (deaths under 1 week per 1,000 total live births) 8.63 Perinatal mortality rate (stillbirths and deaths under 1 week combined per 1,000 total still and live births) 21.29 Maternal deaths Nil Maternal mortality rate per 1,000 live and still births Nil Total M. F. Deaths 1,206 594 612 Crude death rate per 1,000 of estimated civilian population 11.77 Adjusted death rate 11.18 18 Table 2 Population 1938-1962 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 +11.39% +835 10,095 - 1947 105,930 +3,080 +2.99% 918 2,162 - 1948 106,700 +770 +0.73% 621 149 - 1949 106,900 +200 +0.19% +399 - 199 1950 107,600 +700 +0.65% +246 454 - 1951 106,300 -1,300 -1.28% +91 - 1,391 1952 106,500 +200 +0.19% +144 56 - 1953 105,300 -1,200 -1.13% +250 - 1,450 1954 104,700 -600 -0.57% +167 - 767 1955 104,300 -400 -0.38% +105 - 505 1956 104,000 -300 -0.29% +146 - 446 1957 103,600 -400 -0.39% +217 - 617 1958 103,500 -100 -0.10% +198 - 298 1959 103,600 +100 +0.10% +115 - 15 1960 103,450 -150 -0.14% +212 - 362 1961 101,650 -1,800 -1.77% +293 - 2,093 1962 102,500 +850 +0.84% +417 433 - 19 Table 3 Distribution of Deaths by Age and Cause Registrar General's Official Returns, 1962 Cause of Death Age Group Total Grand Total Under 1 1-4 5-14 15-24 25-44 45-64 65-74 75 and over M F M F M F M F M F M F M F M F M F Tuberculosis, respiratory - - - - - - - - - - 2 - 3 1 - - 5 1 6 Tuberculosis, other - - - - - - - - - - - - - - - - - - - Syphilitic disease - - - - - - - - - - - - - - - 1 - 1 1 Diphtheria - - - - - - - - - - - - - - - - - - - Whooping cough - - - - - - - - - - - - - - - - - - - Meningococcal infections - - - - - - - - - - - - - - - - - - - Acute poliomyelitis - - - - - - - - - - - - - - - - - - - Measles - - - - - - - - - - - - - - - - - - - Other infective and parasitic diseases - - - - - - - - - - - 4 - - - - - 1 1 Malignant neoplasm, stomach - - - - - - - - 2 1 2 3 7 4 2 7 13 15 28 Malignant neoplasm, lung, bronchus - - - - - - - - - - 22 5 15 3 7 4 44 12 56 Malignant neoplasm, breast - - - - - - - - - 2 - 8 - 6 - 7 - 23 23 Malignant neoplasm, uterus - - - - - - - - - - - 3 - 7 - 2 - 12 12 Other malignant & lymphatic neoplasms - - - - 1 - 1 1 3 1 15 21 26 13 26 26 72 62 134 Leukaemia, aleukaemia - - - - - - - - - 2 - - 1 1 - 1 1 4 5 Diabetes - - - - - - - - - 1 - - - 4 1 1 1 6 7 Vascular lesions of nervous system - - - - - - - - - 1 12 5 15 22 23 63 50 91 141 Coronary disease, angina - - - - - - - - 3 - 52 16 38 21 42 50 135 87 222 Hypertension with heart disease - - - - - - - - - - 2 3 2 3 4 6 8 12 20 Other heart disease - - - - - - - - 1 - 5 6 12 17 32 90 50 13 163 Other circulatory disease - - - - - - - - - 1 8 1 4 5 15 15 27 22 49 Influenza - - - - - - - - - - 1 1 2 - - - 3 1 4 Pneumonia 2 2 - 1 - - - - 1 - 3 2 10 6 16 26 32 37 69 Bronchitis - - - - - - - 1 - 1 11 5 20 2 15 14 46 23 69 Other diseases of respiratory system - - - - 1 - - - - - 1 - 1 - 3 3 6 3 9 Ulcer of stomach and duodenum - - - - - - - - - - 5 - 4 - 3 3 12 3 15 Gastritis, enteritis and diarrhoea - - - - - - - - 2 - 1 2 - - 2 1 5 3 8 Nephritis and nephrosis - - - - - - - - - - 1 - 2 1 - 2 3 3 6 Hyperplasia of prostate - - - - - - - - - - - - 1 - 3 - 4 - 4 Pregnancy, childbirth, abortion - - - - - - - - - - - - - - - - - - - Congenital malformations 2 3 - - 1 - - - - - 1 - - - 4 - 5 3 8 Other defined and ill-defined diseases 13 4 3 - 2 - 1 1 1 1 5 9 6 9 15 23 46 47 93 Motor vehicle accidents - - - - 1 - 4 - 1 - 3 - 1 1 - 5 10 6 16 All other accidents - - - - 1 - 1 - - 1 - 1 3 2 3 9 8 13 21 Suicide - - - - - - - - 1 1 2 2 4 3 1 1 8 7 15 Homicide and operations of war - — - - - - — 1 - - - - - - - - — 1 1 17 9 3 1 7 - 7 4 15 13 154 94 177 131 214 360 594 612 1206 20 Table 4 Main Causes of Death An analysis of the death returns reveals the following main causes of death: Disease Percentage of total deaths Death rate pet 1,000 of the population Diseases of heart and circulatory system 37.65 4.43 Vascular lesions of nervous system 11.69 1.38 Bronchitis, Pneumonia, and other respiratory diseases 12.52 1.47 Cancer 21.39 2.52 Accidents, Violence 4.39 0.52 21 Table 5 Review of the Comparative Vital and Mortality Statistics for the Borough of Twickenham, together with those for England and Wales for years 1938-1962 inclusive Year Birth Rate Death Rate Infantile Mortality Rate Twickenham England ana 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 (b) 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)ll.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 (b)l3.53 (b) 10.01 1954 (a) 12.73 15.2 (a)11.14 11.3 14.25 25.5 (b)12.98 (b) 10.25 1955 (a) 12.13 15.0 {a) 11.12 11.7 22.92 24.9 (b)12.37 (b) 10.23 1956 (a)l2.77 15.7 (a) 11.37 11.7 10.54 23.8 (b)13.15 (b)10.92 1957 (a) 12.86 16.1 (a)10.76 11.5 16.52 23.0 (b)13.25 (b)10.33 1958 (a)13.29 16.4 (a)11.38 11.7 17.44 22.5 (b) 13.69 (b)10.81 1959 (a)13.23 16.5 (a)12.12 11.6 16.78 22.0 (b)13.63 (b)11.51 1960 (a) 13.91 17.1 (a)11.86 11.5 13.20 21.9 (b)14.33 (b) 11.39 1961 (a) 14.75 17.4 (a) 11.86 12.0 16.68 21.4 (b)15.34 (b)11.15 1962 (a)15.83 18.0 (a) 11.77 11.9 16.02 21.4 (b)16.46 (b)11.18 (а)Crude (b)Adjusted 22 Table 6 AVERAGE RESULTS OP THE CHEMICAL EXAMINATION OF WATER SUPPLIED TO THE BOROUGH OP TWICKENHAM FOR THE YEAR 1962 Milligrammes per litre (unless otherwise stated) Description of the Sample No. of Samples Ammoniacal Nitrogen Albuminoid Nitrogen Nitrate Nitrogen Chlorides as Cl. Oxygen abs, from KMnO4 4 hrs. at 27·C. Turbidity units Colour (Burgess) scale Hardness (total) Hardness (noncarbonate) pH value Phosphate as PO4 Silicate as SiO2 Sulphate as SO4 Magnesium as Mg. Fluoride as F. Surface active material as Manoxol OT Electrical Conductivity (micromhos) River Thames Ashford Common Group 208 0.040 0.076 3.9 30 1.10 0.2 11 272 58 7.9 1.3 10 61 6 0.25 0.12 560 BACTERIOLOGICAL RESULTS - YEARLY AVERAGES, 1962 Source of Supply Number of Samples After Treatment Agar plate count per ml. Coliform count E.coli count 20-24 hours at 37°C 3 days at 22°C Per cent. samples negative in 100 ml. Per cent. samples negative in 100 ml. River Thames Ashford Common Group 1.883 19.2 100.0 100.0 23 24 Table 7 Analysis of Complaints Received Nature of Complaint Number Received Housing defects 150 Choked and defective drains and sewers 289 Accumulation of offensive matter 35 Unsound Food 97 Verminous and other Infested premises (a) Bugs 12 (b) Rats and Mice 450 (c) Wasps 37 (d) Others 39 Keeping of Animals 2 Unsatisfactory milk supplies 7 Smoke nuisances 26 Noise nuisances 18 Fumigation of rooms following Infectious diseases 5 Miscellaneous 9 Total 1,176 Table 8 Summary of Visits, Inspections, etc. Number Housing Acts: Clearance Areas 186 Individual Unfit Houses 189 Underground Rooms 64 Overcrowding 14 Housing Applications 279 Rent Act Certificates 48 Houses Let in Multiple Occupation 37 Public Health Act: Drain testing 84 Provision and maintenance of drainage systems 735 public Sewers 1,051 Septic Tanks and Cesspools 2 Provision of dustbins 42 Dirty/verminous premises and articles 153 Verminous persons and clothing - Wasps, flies and insects 229 Sanitary accommodation at Licensed Premises 4 Statutory nuisances relating to Premises 2,091 " " " " Animals 49 " " " " Accumulations 261 " " " " Dust and Effluvia 55 " " " " Workplaces - Infectious Disease 479 Tents, Vans, Sheds 32 Outside Interviews 408 Miscellaneous matters 764 Factories Acts: Factories with mechanical power 122 Factories without mechanical power 6 Outworkers - Rodent Control 99 Clean Air Act 839 Clean Air Act Survey 4, 554 Shops Acts 1 Water Act 41 Pet Animals Act 25 Rag Flock Act 2 25 Table 8 continued Petroleum Regulations . 351 Milk and Dairies Regulations 16 Noise Nuisances 512 Supervision of Food Supplies: Inspection of Meat 32 Inspection of Other Foods 248 Manufacturing and wholesale premises 22 Bakehouses 92 Butchers Shops 305 Grocer Shops 394 Fishmongers Shops 59 Fried Fish Shops 29 Sweet Shops 60 Bakers Shops 76 Greengrocers Shops 148 Restaurants 381 Licensed Premises 53 Factory and School Canteens 79 Ice-Cream Premises 36 Preserved meat and fish preparation premises 6 Sampling: Ice-Cream 23 Domestic water supplies 8 Swimming bath water 12 Middlesex County Council Act: Places of public entertainment 50 Hawkers, Vehicles and Premises 37 Hairdressing Establishments 10 Total number of visits and inspections 15,984 26 Table 9 Sanitary Improvements Effected Number Offensive accumulations removed 2 Nuisance from keeping of animals remedied - Chimney flues repaired 2 Chimney stacks repaired 6 Dampness to walls remedied 53 Downspouts repaired 2 Drains repaired 3 Drains unstopped 7 Dustbins provided 4 Eavesgutters repaired 27 Filthy condition of premises remedied - Fireplaces repaired 3 Floors repaired 15 Gullies repaired 4 Plaster to walls and ceilings repaired 66 Roofs repaired 70 Sashframes and sashcords repaired 10 Sinks provided and repaired 1 Sink waste pipes repaired 10 Soil pipes repaired 11 Stairs repaired 1 Walls (external) repaired 5 Water closets repaired 20 Water closet cisterns and fittings repaired 22 Water closet accommodation provided - Yard paving repaired 2 Private sewers repaired - Pail closets renewed - Other works carried out 36 27 Table 10 Housing Statistics HOUSES IN CLEARANCE AREAS AND UNFIT HOUSES ELSEWHERE Return for the Year ended 31st December, 1962. A HOUSES DEMOLISHED In Clearance Areas declared under Section 42 of the Housing Act, 1957 9 No: of Houses Demolished Unfit for human habitation included by reason of bad arrangement. - On land acquired under S 43(2), Housing Act, 1957 - Persons Displaced From houses unfit for human habitation 61 From houses included by reason of bad arrangement From houses on land acquired under S.43(2), Housing Act 1957 - Families Displaced From houses unfit for human habitation ,,, 41 From houses included by reason of bad arrangement - From houses on land acquired under S 43(2), Housing Act 1957 - Not in Clearance Areas 1 No. of Houses Demolished As a result of formal or informal procedure under S.16 or 8.17(1), Housing Act, 1957 Local Authority owned houses certified unfit by the Medical Officer of Health - Houses unfit for human habitation where action has been taken under local Acts - Houses indued in unfitness orders made under para. 2 of the 2nd Schedule to the Town and Country Planning Act, 1959 • Persons DiS" placed From Houses to be demolished as a result of formal or informal procedure under S. 16 or S„ 17(1), Housing Act, 1957 18 From local authority owned houses certified unfit by the Medical Officer of Health ... 7 From houses unfit for human habitation where action has been taken under local Acts . . - From houses included in unfitness orders - Families Displaced From houses to be demolished as a result of formal or informal procedure under S.16 or S.17(1), Housing Act, 1957 4 From local authority owned houses certified unfit by the Medical Officer of Health 2 From houses unfit for human habitation where action has been taken under local Acts - From houses included in unfitness orders ... ... - Number of dwellings included aboye which were previously reported as closed - B UNFIT HOUSES CLOSED No. of Houses Under Sees 16(4), 17(1) & 35(1), Housing Act. 1957 and Sec. 26 Housing Act, 1961 ... .. ... ... Under Sees. 17(3) & 26, Housing Act, 1957 2 Persons Displaced From houses to be closed: Under Sees. 16(4), 17(1) & 35(1), Housing Act, 1957 and Sec.26 Housing Act, 1961 1 Under Sees. 17(3) & 26, Housing Act, 1957 ~ Families Displaced From houses to be closed: Under Sees. 16(4), 17(1) & 35(1), Housing Act, 1957 and Sec. 26, Housing Act, 1961 1 Under Sees. 17(3) & 26, Housing Act, 1957 - PARTS OF BUILDINGS CLOSED under S,18, Housing Act, 1957: Number of houses - Number of persons displaced . Number of families displaced - 28 Table 10 continued C, UNFIT HOUSES MADE FIT AND HOUSES IN WHICH DEFECTS WERE REMEDIED After Informal action by local authority. by owner 125 After formal notice under Public Health (a) by owner 10 Acts: (b) by L. A. - After formal notice under Sees-9 & 16, (a) by owner 2 Housing Act, 1957: (b) by L. A - Under Section 24, Housing Act, 1957: by owner - D, UNFIT HOUSES IN TEMPORARY USE (Housing Act, 1957) Retained for Temporary accommodation Under Section 48 Number of Houses _ Number of Separate dwellings contained therein - Under Section 17(2) Number of Houses - Number of separate dwellings contained therein - Under Section 46 Number of Houses Number of separate dwellings contained therein Licensed for temporary accommodation under Section 34 or 53 - No. of houses - E. PURCHASE OF HOUSES BY AGREEMENT Houses in clearance areas other than those included in confirmed orders or compulsory purchase orders Number of Houses - Number of occupants... - 29 Table 11 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 and Drugs Act Number of Informal Notices served 180 80 Number of Informal Notices complied with 125 69 Number of Statutory Notices served 14 - Number of Statutory Notices complied with 10 - 30 31 Table 12 Prevention of Damage by Pests Act, 1949 Report for 12 months ended 31st December, 1962 Type of Property Non-Agricultural 5 1 2 3 U Local Authority Dwelling Houses (incl, Council Houses) All other (incl. Business Premises) Total of cols 1.2 & 3 Agricultural 1, Number of properties in Local Authority's District 136 31,372 5, 311 36, 819 29 2. Total number of properties inspected as a result of notification 18 369 63 450 - Number of such properties found to be infested by:- Common rat Major - - _ _ - Minor 10 195 34 239 _ Ship rat Major - - - - - Minor - - - - - House mouse Major - - _ - _ Minor 8 72 16 96 - 3. Total number of properties inspected in the course of survey under the Act 16 2,982 550 3,548 - Number of such properties found to be infested by:- Common rat Major - - - - - Minor 4 177 40 221 - Ship rat Major - - - - - Minor - - - - - House mouse Major - - - - - Minor - 13 2 15 - 4. Total number of properties otherwise inspected (e g when visited primarily for some other purpose) - 3 2 5 - Number of such properties found to be infested by; - Common rat Major - . - - - Minor - - 1 1 - Ship rat Major - - - - - Minor - - - - - House mouse Major - - - - - Minor - - 1 1 - 5. Total inspections carried out - including re-inspections 195 5,299 1,393 6,887 - 6. Number of infested properties (in Sections 2, 3. & 4) treated by the L A. 35 440 60 535 - 7. Total treatments carried out - including re-treatments 35 440 58 533 - Table 12 continued Type of Property Non-Agricultural 5 1 2 3 4 Local Authority Dwelling Houses (incl, Council Houses) All other (incl. Business Premises) Total of cols 1,2 & 3 Agricultural 8. Number of notices served under Section 4 of the Act: (a) Treatment - - - - - (b) Structural Work (i.e. Proofing) - - - - - 9. Number of cases in which default action was taken following the issue of a notice under Sect.4 of the Act, - - - - - 10 Legal Proceedings - - _ - - 11. Number of " Block" control schemes carried out. - - - - - 32 Table 13 Eradication of Insect Pests D.D.T. and Other Special Treatments Number of Infestations Treated Type of Premises Ants Bugs Cockroaches Fleas Wasps Miscellaneous Totals Dwelling-houses 17 3 8 20 48 Workplaces • 1 - - 2 1 4 Pood Shops - - - - - - - Miscellaneous 3 2 7 12 Totals 3 18 5 8 29 1 64 Total income for D.D.T. and other special treatments £59 13s l1d. 33 Table 14 Disinfections, etc. Number Premises disinfected after infectious diseases 5 Premises disinfected after other diseases - Persons (children and adults) treated for Scabies at cleansing station - Table 15 Housing Act, 1936, Overcrowding [ Number New cases of overcrowding referred to the Housing Committee during the year 6 (1) Cases of overcrowding relieved during the year 14 (2) Persons concerned in such cases 53 Table 16 Milk and Dairies (General) Regulations, 1959 The necessary registration of persons and premises, has been effected in accordance with the following table; Number Persons registered as distributors 44 Premises registered as dairies (not being dairy farms) 14 34 Table 17 Food and Drugs Act, 1955 Food Hygiene (General) Regulations 1960 Public Health Act, 1936, Section 89 Public Health Act, 1961, Section 80 INSANITARY CONDITIONS IN POOD PREMISES Number of premises found with insanitary conditions 80 Number of premises remedied 69 Insanitary conditions found in premises above Number of defects Number, of defects remedied Equipment not kept in good order 25 20 Food so placed as to involve risk of contamination 3 2 Food placed within eighteen inches of the ground and not adequately protected 1 - Absence of personal cleanliness - 4 Insufficient lighting and ventilation to W.C. 4 6 Absence of "Wash your Hands" notices to W,C,s 4 2 Absence of suitable and sufficient wash-hand-basins 2 4 Absence of hot water at a suitably controlled temperature over wash-hand-basins 4 1 Absence of soap,nail brushes, clean towels, etc. near wash-hand-basins 3 3 Absence of first aid materials 2 2 Absence of accommodation for clothing not worn during working hours 3 3 Absence of suitable and sufficient sinks for the washing of food and equipment - - Absence of hot water at a suitably controlled temperature over sinks - - Absence of soap, clean cloths, etc. at sinks - - Absence of suitable and sufficient lighting in food room - 1 Absence of suitable and sufficient ventilation in food room 3 1 Walls, etc., in food room not kept clean 13 11 Walls, etc., in food room not kept in good order 28 17 Walls, etc., in other rooms not kept in good order 11 14 Accumulation of refuse, etc, 1 3 Defective Floor covering 3 8 Yard not kept in good order 11 12 Miscellaneous 22 11 Returnable containers not protected 1 Totals 150 125 35 Table 18 (a) Meat®Carcases Inspected and Findings at Private Slaughter* houses in the Borough Cattle excls. cows Cows Calves Sheep and Lambs Pigs Horses Number killed (if known) - - - o - - 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 o o m Tuberculosis only: Whole carcases condemned - - - - - - Carcases of which some part of 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 - - - - - - (b) Other Carcases Inspected Nil 36 Table 19 (a) Meat Diseased and unsound conditions found in meat caused the detention and surrender for destruction of: lbs Beef 675 Lamb 39 Pork 53 Other Meats 168 935 '(b) Other Foodstuffs The following other foodstuffs, being unfit for human consumption„were voluntarily surrendered for destruction*. lbs Bacon 330 Cheese 83 Fish 56 Offal 88 Poultry 49 Sausages 16 Flour 10 632 Jars Pickles, Sauces etc. 18 Preserves 77 Other 6 101 Tins Cream 14 Fish 88 Fruit and Fruit Juices 923 Meat 265 Milk 73 Puddings 25 Soup 55 Vegetables 319 Other 20 1782 Pkts. Frozen Foods 617 Crisps 73 Puddings 17 Ice Cream and Ice Lollies 239 946 Drinks Draught Beer - gallons 83 Bottled Beer - bottles 1301 Mineral Water - bottles 1030 37 Table 20 Food and Drugs Act, 1955 Sampling Article Total Samples Taken Unsatisfactory Milk (various) 11 " (evaporated) 1 Butter 28 Cakes and Biscuits 5 Cream 19 Drugs 3 Pish and Fish Products 22 Fruit (fresh and canned) 40 1 " (dried and preserved) 3 Ice Cream 21 Liver 14 Margarine 6 Meat and Meat Products 43 Preserves 5 1 Sausages 7 Salmon 4 Soft Drinks and Fruit Juices 3 Spirits 4 Vegetables 6 Vinegar 17 Miscellaneous 23 1 285 3 38 Table 21 Factories Acts, 1937 to 1959, Part I of the Act. 1. INSPECTIONS, FOR PURPOSES OF PROVISIONS AS TO HEALTH Premises Number on Register Number of lnspections Written Notices Occupiers prosecuted (i) Factories in which Sections 1, 2,3,4, and 6 are to be enforced by Local Authorities 22 6 - - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 290 <22 7 - (iii) Other premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) - - - • Totals 312 128 7 - 39 2. CASES IN WHICH DEFECTS WERE FOUND Particulars Number of cases in which defects were found Number of cases in which prosecutions were institut Found Remedied Referred To Inspector By H.M. Inspector want of cleanliness (a. l) - 1 - - Overcrowding (S, 2) - - - - - Unreasonable temperature (S. 3) 1 - • - - Inadequate ventilation (S.4) - - - - - Ineffective drainage of floors (S. 6) - - - - - Sanitary Conveniences (S,7) (a) Insufficient - - - - - (b) Unsuitable or defective 5 2 • - - (c) Not separate for sexes - - - - - Other offences against the Act (not including offences relating to outwork) 5 1 - - - Totals 11 4 - - - Part VIII of the Act, Outwork Nature of the Work Lamp shades Wearing apparel Electric Fuse Makers Section 110! Number of outworkers in August list required by Section 110 (1) (c) 13 22 62 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 - - — Table 22 Infectious Diseases, Incidence and Mortality DIPHTHERIA, SCARLET FEVER AND ENTERIC FEVER 1938-1962 Year Diphtheria Scarlet Fever Enteric Fever No, of Cases Case Bate per 1,000 pop. No, of Deaths Death Rate per 1,000 pop• No. of Cases Case Bate per 1,000 pop. No. of Deaths Death Bate per 1,000 pop. No. of Cases Case Rate per 1, 000 pop. No. of Deaths Death Bate 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 - - - - - 0.01 1943 4 0. 04 1 0.01 238 2.56 - - - - - - 1944 5 0.06 - 0.03 121 1.37 - - - - - - 1945 4 0.04 1 0.01 97 1.06 - - - - - - 1946 4 0.04 - - 60 0.58 - - - - - - 1947 4 0.04 1 0.01 60 0.58 - - - - - - 1948 1 0.01 - - 99 0.93 - - - - - - 1949 - - - - 128 1.20 - - - - - - 1950 - - - - 115 1.07 - - - - - - 1951 - - - - 64 0.60 - - - - - - 1952 - - - - 135 1. 28 - - - - - - 1953 - - - - 100 0. 95 - - - - - - 1954 - - - - 64 0.61 - - - - - - 1955 - • - - 97 0.93 - - - - - - 1956 - - - - 51 0.49 - - - - - - 1957 - - - - 17 0. 16 - - - - - - 1958 - - - - 38 0.37 - - - - - - 1959 - - - - 116 1.11 - - - - - - 1960 - - - - 49 0.47 - - - - - - 1961 - - - - 32 0.31 - - - - - - 1962 i 1 - - - - 21 0.20 - - - - - - 40 Tatjle 23 Ophthalmia Neonatorum, years 1938"1962 The following table shows the number of cases notified and result of treatment: Year Cases not ified Cases Treated Vision unimpaired Vision impaired Total blindness Deaths At home In hosp. 1938 12 11 1 12 - - - 1939 7 7 - 7 - - - 1940 4 3 1 4 - - - 1941 5 2 3 5 - - - 1942 4 4 - 4 - - - 1943 6 6 - 6 - - - 1944 8 8 - 8 - - - 1945 2 2 - 2 - - - 1946 3 2 1 3 - - - 1947 5 5 - 5 - - - 1948 4 4 - 4 - - - 1949 - - - - - - - 1950 2 2 - 2 - - - 1951 8 6 2 8 - - - 1952 4 3 1 4 - - 1953 4 4 - 4 - - - 1954 2 2 - 2 - - - 1955 5 2 3 5 - - - 1956 4 - 4 4 - - - 1957 5 5 5 - - - 1958 2 1 1 2 - - - 1959 1 1 1 - - - 1960 - - - - - - 1961 - - - - - - 1962 - - - • - - 41 Cases of Infectious Diseases Notified during the Year 1962 Diseases CASES NOTIFIED AT VARIOUS AGES (YEARS) Total cases noti fied Deaths Under 1 Year 1-2 2-3 3-4 4-5 5-10 10-15 15-20 20-25 2 5-35 35-45 45-65 Over 65 Age nOt Known Diphtheria - - - - - - - - - - - - - - Nil - Dysentery 1 - - - - - - - - - - - - - 1 - Erysipelas - - - - - - - - - - 1 - 1 - 2 - Food Poisoning - - - - - - - - - - - - - - Nil - Malaria - - - - - - - - - - ' - - - Nil - Measles 2 6 7 9 3 10 3 2 - 1 - - - - 43 - Meningococcal Infections - - - - - - - - - - - - - - Nil - Ophthalmia Neonatorum - - - - - - - - - - - - - - Nil - Pneumonia - - - - - 3 2 1 1 1 2 8 8 - 26 69 Poliomyelitis - - - - - - - - - - - - - - Nil - Puerperal Pyrexia - - - - - - - - 4 - - - - - 1 - Scarlet Fever - 1 1 - 1 13 2 1 2 - - - - - 21 - Smallpox - - - - - - - - - - - - - - N41 - Typhoid ft ParaTyphoid - - - - - - - - - - - - - - Nil - Whooping Cough - 1 1 - - 1 - - - - - - - - 3 - Totals 3 8 9> 9 4 27 7 4 4 2 3 8 9 - 97 69 Table 24 42 Monthly Incidence of Infectious Diseases during the Year 1962 Diseases NUMBER OF CASES TOTAL Jan. Feb. March April May June July August Sept. Oct. Nov. Dec. Diphtheria - - - - - - - - - - - - Nil Dysentery - - - - - - - - • - - 1 1 Erysipelas 1 - - - - - - 1 - - - - 2 Pood Poisoning - - - - - - - - - - - - Nil Malaria - - - - - - - - - - - - Nil Measles 1 1 6 6 2 - 1 3 2 4 12 5 43 Meningococcal Infections - - - - - - - - - - - - Nil Ophthalmia Neonatorum - - - - - - - - - - - - Nil Pneumonia 8 - 5 2 1 5 1 - 1 1 1 1 26 Poliomyelitis - - - - - - - - - - - - Nil Puerperal Pyrexia - - - - - - - - 1 - - - V i Scarlet Fever 3 2 2 2 - - 3 - - - 6 3 21 Smallpox - - - - - - - - - - - - Nil Typhoid and ParaTyphoid - - - - - - - - - - - - Nil Whooping Cough 2 - - - - - - - - - - 1 3 Totals 15 3 13 10 3 5 5 4 4 5 19 11 97 Table 25 43 Ward Distribution of Infectious Diseases Notified during the Year 1962 Diseases Heathfield Whitton West Twickenham Ventral Twickenham South Twickenham East Twickenham Hampton Hampton Hill Upper ington Lower Teddington Hampton Wick Total Diphtheria - - - - - - - - - - - Nil Dysentery - - • - - - - 1 - - - 1 Erysipelas - - - - 1 - - - 1 - - 2 Food Poisoning - - - - - - - - - - - Nil Malaria - - - - - - - - - - Nil Measles 3 - - 1 - 18 13 3 - 4 1 43 Meningococcal Infections - - - - - - - - - - - Nil Ophthalmia Neonatorum - - - - - - - - - - - Nil Pneumonia 1 - 2 3 1 2 4 7 1 2 3 26 Poliomyelitis - - - - - - - - - - - Nil puerperal pyrexia - - - - - - - - - 1 - 1 Scarlet Fever 4 - - - 1 2 8 1 4 1 - 21 Smallpox - - - - - - - - - - - Nil Typhoid and Para-Typhoid - - - - - - - - - - - Nil Whooping Cough - - 1 - - - 1 - - - 1 3 Totals 8 - 3 4 3 22 26 12 6 8 5 97 Table 26 44 45 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 - - - - - - - - 5-9 1 - - - - - - - 10 - 14 - - 1 - - - • • 15 - 19 2 1 - - - - - 20 - 24 1 - - 1 - • - 25 - 34 3 4 1 1 - - ~ 35 - 44 2 1 - 1 • • - - 45 - 54 4 1 1 2 - - - 55 - 64 5 1 - 2 - - - - 65 and over 2 3 - 1 3 1 - - age unknown - - - - - - - - Totals 20 12 2 7 5 1 - - Table 27 PRIMARY NOTIFICATIONS OF TUBERCULOSIS 1938-1962 INCLUSIVE Pulmonary 1938 100 1939 106 194C 114 1941 127 1942 112 194E 119 1944 133 194! 118 194C 120 1947 132 1948 117 194! 115 1950 96 1951 107 1952 79 195J 105 195"! 88 1955 70 B5( 58 1957 57 1958 54 195S 31 1960 45 1961 35 1962 32 Non- Pulmonary Totals 30 130 19 125 12 126 14 141 18 130 18 137 18 151 18 136 19 139 11 143 17 134 5 120 15 111 14 121 20 99 14 119 12 100 11 81 3 61 7 64 7 61 5 36 3 48 4 39 9 41 Table 28 Table 29 Food Poisoning Food Poisoning Notifications: 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Total Nil Nil Nil Nil Nil OUTBREAKS DUE TO IDENTIFIED AGENTS: Outbreaks due to: Chemical Poisons Salmonella organisms Staphylococci (inc,toxin) CI. Welchii Nil Number of cases Nil OUTBREAKS DUE TO UNDISCOVERED CAUSE Nil Number of cases Nil SINGLE CASES: Due to identified agents: Chemical Poisons Salmonella organisms Staphylococci P.Morgani Nil Number of cases Nil DUE TO UNDISCOVERED CAUSE Nil Number of cases Nil Total all cases Nil 46 Premises concerned with Health Services in Area 10 A - Aote-natal and post-natal D - Dental H - Headquarters Personal P - Family Planning (provided care ot mothers Health by Voluntary Organisations B - Baby Welfare E - Eye testing I - Vaccination and S - School Health C - Chiropody (Middlesex F - Distribution of Welfare tion J - Geriatric T - Talking and Speesh Therapy County Council and/or Foods Voluntary Organisations) G - Child Guidance M - Mental Health V - Environmental Health 0 - Orthopaedic Enquiries should be made at the -appropriate address for particulars as to persons eligible, special conditions as to services and the time the premises are open. Elmfield House, H V Council Offices V Imperial Road, Bedfoni A B C D F High street, Teddington Bridge Street, Staines I S T Church Road, Teddington B D F J I Stanwell Road, Ashford A B C D E Council Offices, V F I 0 S T Green Street, Sunbury Hospital Bridge Road, A B C F The Grange, A B D E F Duddington House, A B C D F Whitton I S Gresham Road, Staines G I M 0 P Green Street, sunbury X S T 20 Seymour Road, B D F I S T Chertsey Road, A B C D F Hampton Wick P S 0 c Ashford Common I S T Stanley Road, Teddington A c E I S 12 Tilley's Lane, F Lalehan Road, B C D F I High street, Staines Shepperton S T 24 Station Road, Hampton A B C D F Council Offices V New Hall, Upper Halliford A B F X I S Hanworth Road, Feltham York House, Richmond Road. A B C D E Cardinal Road, Feltham A B C D E F 1 A Staines Road West, F Twickenham F I s I S P T Sunbury 58 Hampton Road, G T Grove Crescent, A B C D F Hadrian way. B C D F I Twickenham. Hanworth I S T Stanwell S T In addition to the premises listed above there is a mobile clinic in use in the area, Table 30 47