Ac 439 (1) DECEMBER, 1964 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 7 New Legislation 8 Keeping the Borough Clean 8 Water Supply 9 Pood 9 Industrial Health 10 Housing 10 Clean Air Act,1956 11 Pest Destruction 11 Health Education 12 General Matters 12 Statistical Tables 17 1 Telephone: PUBLIC HEALTH DEPARTMENT, TEDdington Lock 2223- 4 ELMFIELD HOUSE, TEDdington Lock 4411-5 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 1963. Development of the Services. I have been your Medical Officer of Health for 26 years and this is my twenty-sixth report; it is the last but one. For the last 16 years I have been the Area Medical Officer for Twickenham, Feltham, Sunbury and Staines with a total population bordering on a quarter of a million. With one or two minor exceptions the County Council have delegated the management of all their personal health services to the Area Committee, so that it has fallen to me with the able co-operation of my medical, professional, and administrative colleagues in the Health Department of both Borough and County to manage these services and a staff of over 400. When I took over in 1948 some of the clinic services in the South-West part of the area were very primitive. During the years we built four new clinics at Hanworth, Bedfont, Stanwell, and Shepperton; purchased and converted two houses for clinics at Sunbury and Staines; added extensions to two clinics at Ashford and Spelthorne; built a new day nursery at Feltham; and purchased a mobile clinic which goes round the area on different days serving 15 rather inaccessible parts of the area. The services and staff were correspondingly increased. Almost every clinic is now working to near full capacity; infant welfare attendances can often reach over 70. We have developed special techniques for preventive medicine for older people at Church Road, Teddington, and these clinics have already been extended to Whitton and Hampton. Training the Doctors. We have trained our medical staff in the advanced techniques for the early detection of disabilities in young babies to a far more accurate degree than ever hitherto was thought possible. The deaths of infants went up to 37 in 1963 whereas in previous years it has generally been round about 16. No parent likes to lose a baby. When I first came to Twickenham there used to be about 70 babies die each year. More than half of them died of infections such as bronchitis, pneumonia, and enteritis. In 1963 we had 5 deaths from these causes, more than usual which is disappointing; but the hard core of congenital malformation remains the same today as it was years ago. The need for a solution to this problem is manifest. This year for the first time the Society of Medical Officers of Health together with the London School of Hygiene and Tropical 2 Medicine will hold a six weeks course in child health designed to give a comprehensive training in developmental paediatrics to experienced doctors in the maternity and child welfare and school health services. This indicates that the doctors are keen to prepare themselves to meet a new challenge the early diagnosis of congenital abnormalities and the co-ordination of medical care and supporting services for children suffering from handicapping conditions of all kinds. These doctors require a deep understanding of the psychiatry of childhood and of preventive psychiatry; of the causes of congenital abnormalities and be highly trained in screening techniques and developmental diagnosis. Keep them Fit. Our attitude towards the handicapped child and the older person has undergone a profound change during this last decade. To place a child or an old person in an institution for long term care should be the final solution offered to relatives rather than the first one. Instead every effort should be made to enable either a child or an older person to remain as long as possible with the family and as independent as possible; by providing day care, or short term care which can relieve relatives of strain; and to take advantage of group technique applicable to both types of patient. We have come to realise that the ante-natal and obstetric services which have largely gone from the local authorities are more than ever important in the prevention of childhood and permanent disability both mental and physical. Research We are following the advice of the Ministry of Health in organising schemes for the notification by maternity hospital and domiciliary midwives of adverse factors occurring in pregnancy, labour, and the puerperium which might place the baby at risk of developing a handicap and we are building up these “at risk” registers. Eventually we should have a comprehensive knowledge of all the handicapped children in our area and still more important be in a position to indicate possible lines of research. Attachments. We are being told even by such an eminent body as the Working Party on General Practice that attachment of health visitors to general practitioners will improve our remedies for medico-social care, protection, and prevention. At a medical conference recently I heard Dr.John Pry tell the audience that practitioners as a group had neither the time, facilities, nor experience to do screening and preventive work in the fields of infant welfare, school health, or older people. If it requires special training for our own medical officers who have already had years of experience, how much more so for those doctors who have never worked in this field. There has been no research as yet to find out the most effective method of using our health visiting and other ancillary services; such a measure is urgently necessary before we accept ex-cathedra pronouncements. The essential difference is this: the practitioner; traditionally waits for a sick person to ask for his attention; 3 these sick persons comprise possibly only one quarter of those needing medical attention. The health visitor is concerned with the promotion and maintenance of health and the prevention of breakdown in everybody - especially the three quarters who rarely if ever visit their practitioner and yet still need medical attention. Initially she makes the contact and offers her professional skill, seeking to create attitudes of mind which take a positive and active interest in maintaining health and developing individual and family potential and resource to the full. She works in the school health service, is a link between home and school, is a contact with the hospital, gives group health education lectures, contacts societies and clubs, is engaged in training others, and takes part in research. We may seriously ask ourselves whether the three-quarters who receive services other than through practitioners would do better or worse by "schemes of attachment." In one experimental attachment in this area we have given a group of doctors the clinic medical officer and all the ancillary services part-time for the needs of their practice. We have thus preserved the expertise of the health team for the use of this practice and the remainder of their time to the needs of the authority services. Progress in the Prevention Clinic for Older People. In the prevention of disability in older people we have made important advances. The techniques at our experimental clinic have been vastly improved this last few years. We have come to understand much better the causes of failing health in later life and how to detect them at an earlier stage. These disabilities are partly due to defective diets and partly to the deterioration of the endocrine glands with diminution of the output of the body hormones. We have devoted intense study to this problem and believe we have made important contributions to the techniques of replacement therapy. This work shows the urgent need for a vast expansion of this service to the whole of the aged population in the same way as the school health service and the infant welfare service were brought in to look after the special needs of children. If we were to do this there need be no retiring age at all; a worthy contribution would be made towards the solution of the problem of mental health and the prevention of mental deterioration which so frequently comes on in later life; and substantial savings would be made on the vast expenditure on supporting services for the elderly both private and public. Unifying the Service Dr.N.Coghill and Dr.J.D.B. Andrews have recently commented on the inadequacy of the provision of beds for older people at the West Middlesex Hospital. At a recent meeting of the British Geriatric Society a speaker put forward the view that the hospital beds and the places in the Part III homes should be under the charge of the hospital consultant geriatrician. I would go further than this and say that the provision of hospital facilities for older people, places in Part III homes, the provision of day treatment centres, the prevention clinics for older people and certain special screening techniques should all be in the hands of a unified medical team. 4 Screenings In 1963 there were 14 deaths from cancer of the uterus. On an estimated population of 40,000 women this gives a rate of 1 case in 2,860. These are mostly women in early and middle life. So that each death is a tragedy, often to a young family. Over the years the numbers are considerable. The demand for routine screening for early detection of cancer is now increasing. The medical and nursing resources will be substantial if we are required to screen 40,000 women per year in this Borough alone; or even one tenth of that number. In screening trials in this country, America, and elsewhere, it has been found that only about five per cent of women avail themselves of the service when it is offered; and these come mainly from the professional social classes. With suitable health education methods, this proportion can be increased. There is a type of cancer which develops very slowly - maybe over 20 years - in the cervix of the uterus which can be detected by screening methods. Although the techniques are by no means certain as yet, they can pick out potential cases. We should be getting on with offering this service and by ensuring that the gynaecological backing for treatment is sufficient and satisfactory. In older people about one-third have got anaemia; great numbers have defective eyesight, the wrong glasses, deformities of the feet, endocrine deficiencies and many other defects. Our clinic has shown that most of these can be screened for; there is urgent need to expand our screening clinics, and similarly to back these up with treatment facilities, In Bedford Dr. C.L.Sharp has shown that the number of diabetics in a population is far greater than is commonly supposed. We are screening our school children for defective eyesight and hearing by completely new methods and with far greater efficiency. There are lots of other diseases capable of being ascertained by screening methods, We have seen how tuberculosis was enormously reduced by mass X-ray screening. I think much of the work of the Health Department will in future consist of carrying out screening methods on large sections of the population in clinics properly equipped with the modern apparatus required to do it. Other Needs The problems facing the public health service are enormous. I had hoped to suggest introducing an entirely different form of school health inspections which would deal with those mostly in need rather than a multitude of healthy ones. We have made some progress in our clean air campaign but we still have more than two-thirds of the Borough still untouched. The consumption of smoke is an important danger to health. In 1963 there were 70 deaths from cancer of the lung; this rate is rising and will continue to do so until we have convinced people that cigarette smoking is an important cause and, like spitting, an evil social habit. We have 10 deaths from motor accidents and 15 from other accidents, and 18 suicides, Accidental death and injury is the most important factor in childhood mortality and morbidity. Diseases of the arteries stroke and coronary thrombosis exact the biggest toll of all 707 deaths. In our 5 experimental clinic we found some slight evidence that animal fats butter, cream, and meat fats - contribute to the cause; and there is some evidence that refined sugar and sugar products are also implicated; but the problem still remains unsolved. Working for the new Borough. Over this last year we have been under intense pressure in this department by reason of the changes inherent in setting up the new London Borough of Richmond upon Thames. We have had to work out schemes for anticipating the movements of staff; for preparing for the Feltham and Bedfont part of the area to be transferred to Hounslow; for the Staines and Sunbury part to be transferred to Surrey; and for a judicious balance of staff and administrative arrangements to be retained for Twickenham in anticipation of the change-over, We have given much consideration and have prepared reports for the Joint Committee of London Borough 24. In particular we gave anxious thought to the position of the health and welfare departments. These activities caused much extra work in all sections of the department. We had to search through 150,000 records to extract those for transfer to the take-over authorities. A great deal of this burden has fallen on the shoulders of Dr.Wilkinson, Mr.Pugh, Mr.Matthews, Mr.Durey, Mr.George and Mr,Mallaband. We here in Elmfield House perhaps do not see as much of you Mr.Mayor and your colleagues, the Aldermen and Councillors of this Borough as we would like. Nevertheless we need your constant help, support and encouragement. I am more than grateful for the constant kindness I receive from our Chairman,, Alderman P.J.Edwards and the Health Committee. I would like also to thank the other members of our staff here and my colleagues in the other departments of the Corporation. I am, Mr.Mayor, Ladies and Gentlemen, Yours sincerely, JOHN MADDISON, Medical Officer of Healths 6 MEMBERS OF THE PUBLIC HEALTH COMMITTEE Ex-Officio members: THE MAYOR, COUNCILLOR J. E. WOODWARD, O. B. E. , J. P. THE DEPUTY MAYOR, COUNCILLOR D. G. HARRIS Chairman: ALDERMAN F.J. EDWARDS, J. P. Vice-chairman: ALDERMAN MRS. M. B. DAVIES Alderman L.Defries-Porter, LL. B. , M.B. I.M. Alderman J. H. Knaggs, J. P. Councillor P. Blackmore Councillor F.D. Gilday-Fox Councillor W. P. Letch, LL. B., B. Com. , A. C. I. S. Councillor R.H. Mitchison Councillor G.J. Samuel, M.A. Councillor G.W. Sewell, M.A., F. R. Econ. S. 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, 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 Public Health inspectors Messrs. K.W.Clement, K.E.Evans, N.J.Rogers, E.L.Taylor, A. E. G. Walker Technical Assistants Messrs.H. E.Carter and J.L. Tunnicliff Pupil Public Health Inspector Mr. S. H.Waller 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 and Sunbury) Senior Clerk Mr. R.N.Himson Clerical Staff Mrs.J.Hodgson, Vacancy Mrs. M. G. Bateman (Part-time) Mrs. E. B. Paisley (Part-time) Senior Rodent Operative Mr.H.T.Jackman Rodent Operative Vacancy Disinfector/Drain Tester Mr.E.G.Cooper Mortuary Attendant Mr. G. Chase 7 NEW LEGISLATION - 1963 Radioactive Substances Act, 1960 - Appointed day 1/12/1963 The Act is concerned with control of the accumulation and disposal of radioactive wastes. As from the appointed day persons who keep or use radioactive material, are, unless exempted, required to be registered with the Minister of Housing and Local Government and obtain authorisation from him for the accumulation or disposal of radioactive wastes. The control of radioactive wastes is a central government and not a Local Authority responsibility but the Minister can under certain circumstances require a Local Authority to accept and deal with this material when sent to their refuse tip, if that is the best method of disposal. Alkali etc. Works Order, 1963 - Operative day 1/4/1963 This Order extends and varies the list of works scheduled under the Alkali etc. Works Regulation Act, 1906 and extends the list of noxious or offensive gases mentioned in it. The Meat Inspection Regulations, 1963 These regulations came into operation on the 1st October, 1963. They make provision that meat must not be removed from the place of slaughter until it has been inspected and passed as fit for human consumption. Public Lavatories (Turnstiles) Act, 1963 This Act which received Royal assent on the 31st July 1963, imposes a duty on Local Authorities to abolish within 6 months turnstiles in public lavatories and sanitary conveniences. 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 The construction of the new gravity sewer in the Hampton area has now commenced. This will replace most of the old pumping equipment. Sewage disposal in the Borough is the responsibility of the Middlesex County Council Main Drainage Department. Refuse Disposal The refuse disposal plant at Charlton continues to operate satisfactorily. The composting plant is now completed and has started operating. 8 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, Director of Water Examination, Metropolitan Water Board, for the following report: "The source of water is the River Thames which is stored in the Thames Valley reservoirs at Staines, Littleton and Walton. After storage the water is filtered and chlorinated at the Board's works at Hampton, Ashford Common, Hanworth Road and Kempton Park. Samples of water are collected at all stages of the purification process at least five times a week and the summary of the analyses showing the quality of the treated waters from the Hampton and Ashford Common group of works are set out on page 22. 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 1963. New mains have been laid in Twickenham to the extent of 1,422 yards 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 Food and Drugs Act, 1955 Food Hygiene (General) Regulations, 1960 The table on page 34 gives details of the work carried out under these regulations. It was found necessary to institute legal proceedings in the following 7 cases. 1. Greengrocer fined £15 with £3.3s.0d. costs for smoking whilst handling food. 2. Greengrocer fined £50 with £7.7s.0d. costs for smoking whilst handling food. 3. Baker fined £50. with £10.10s.0d. costs for selling a loaf of bread with tobacco embedded in it. 4. Delicatessen keeper fined £10 with £7.7s.0d. costs for selling scotch eggs infested with maggots. 5. Butcher fined £20 with £5.5s.0d. costs for selling a mouldy pie. 6.&7. Due to conflicting evidence the cases brought against two bakers for selling mouldy bread were dismissed. Thirty two complaints were received about unsound food purchased from retailers in the Borough. A complaint was received from a local resident about smoking by customers in food shops. There are, of course, no legal powers to prevent smoking under these circumstances, but many of the more 9 enlightened food firms exhibit "no smoking" notices in their shops. It was decided to distribute to food shops suitable notices requesting shoppers to refrain from smoking in the interests of public health. Milk and Dairies (General) Regulations, 1959 A complaint was received from a headmaster of a school regarding a 1/3rd. of a pint milk bottle which was badly stained on its internal surface. The analyst to whom the bottle was submitted reported that "the substance examined was a residue from a water coloured paint such as is used by children in school. The green dye is organic and unlikely to be harmful or to have contaminated the milk in any way". A letter was received from the Dairy expressing their concern at the misuse of milk bottles by sections of the public, and explaining the measures in force to try to prevent occurrences such as this. A warning letter was sent to the firm. INDUSTRIAL HEALTH Factories All factory premises are inspected periodically to ensure that suitable sanitary accommodation is provided. Factory premises where mechanical power is not used are inspected to see that they are kept clean, are not overcrowded, are sufficiently ventilated and that floors are adequately drained. Most of the 322 factories in the Borough are engaged in light industry. The number of persons employed ranges from 679 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 1963 was 109. HOUSING Although the three year slum clearance programme, which was commenced in January 1961, was not completed by the end of the year, further progress was made and only individual unfit houses now remain to be dealt with. Closing Orders involving 5 houses and Demolition Orders involving 9 houses were made; undertakings not to use 4 houses for human habitation were accepted; and a Compulsory Purchase Order was made in respect of 4 houses. Notices were served under Section 15 of the Housing Act, 1961 on the owners of 4 houses which were found to be not reasonably suitable for occupation by the number of persons accommodated. None 10 of the notices were complied with. As distinct from the now repealed section of the Housing Act, 1957, no provision was made in the present Act for penalties for non-compliance with such notice and the only remedy available was for the Corporation to carry out the work and recover the cost. The Corporation decided to ask the Association of Municipal Corporations to approach the Minister of Housing with a view to the re-instatement of the penalty provisions. Rent Act, 1957 During the year 9 applications were received for certificates of disrepair. 4 certificates were issued and in 3 cases an undertaking was given by the landlord under paragraph 5 of the First Schedule. There were no applications for cancellation of certificates. CLEAN AIR ACT, 1956 Smoke Control Areas Owing to shortage of staff it was not possible to adhere to the proposed Smoke Control programme. In October 1963, Smoke Control Order No. 2 came into force. This Order covers an area of 460 acres and contains 3272 private dwellings, 413 Corporation dwellings and 130 industrial commercial and other buildings. The total estimated cost of carrying out conversions in the area was £33,054, (£30,822 private and £2,232 Corporation). Claims for grant are still coming in but following the pattern set by Smoke Control order No.1, it is unlikely that the total cost of conversions will come to more than a third of the estimated cost. In December 1962 the Minister confirmed Smoke Control Order No.3 and in January, 1963, letters and pamphlets were distributed to all householders affected by the Order. In October 1963 the Coal Utilisation Council's mobile exhibition spent a week in the area. 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 1963, 3 applications to instal furnaces were received and approved. PEST DESTRUCTION Rats and Mice The service provided by the department is free in respect of residential premises but work carried out at business premises is paid for by the firm concerned and is not a charge on the rates. Insect Pests Residents of the Borough are able to have insect pests identified and advice is given as to the best methods for their 11 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 The Local Authority are given power under Section 74 of the Public Health Act, 1961, to take steps to abate nuisances caused by the congregation in built up areas of doves, pigeons, starlings or sparrows. One complaint only was received during the year. HEALTH EDUCATION During the year I gave a number of talks on health topics to various associations in the Borough. Many more were given by the Chief Public Health Inspector and his staff, and by the doctors, health Visitors and nurses in all parts of the area. Where appropriate, films and filmstrips are used; propaganda by posters and leaflets has been continued. In March 1962 and again in June 1963, posters stressing the health hazard of smoking, especially cigarette smoking, were sent to all the larger factories in the Borough. A contribution of £14.6s,0d. was made by the Corporation to the Central Council for Health Education. GENERAL MATTERS Typhoid Fever - Imported Cases Cases of typhoid fever were reported in England and Wales among persons who had left Zermatt, Switzerland, during the last week of February, 1963. In view of the threat of a possible typhoid epidemic in the Borough, all establishments handling food were notified and requested to contact the Public Health Department if any of their employees had recently returned from Switzerland so that the necessary arrangements for investigation could be put in hand without delay. All medical practitioners were also alerted to be on the look out for suspicious cases or possible contacts. No cases were notified in the Borough in 1963. Noise Nuisance Complaints were received from many residents about noise from a car-cleaning plant situated on a main road in Twickenham. Through the generosity of the Wimbledon Public Health Department a sound level indicator was borrowed, and the readings which were produced were submitted to the Accoustics Section of the National Physical Laboratory. From the conclusions which they reached and after further consultation with the owners of the plant, additional sound proofing measures were carried out to reduce the noise. Complaints, however, were still being received and it was decided to refer the matter to an accoustics expert for guidance. 12 It should be remembered that Section 1(3) of the Noise Abatement Act, 1960, provides that it shall be a defence in any proceedings for the defendant to prove that the best practicable means have been used for preventing and counteracting the effect of noise or vibration. Following a survey of the premises and after examination of the installation the accoustics expert reached the conclusion that whilst the modifications which had already been carried out might be expected to have provided a worthwhile reduction, they did not constitute "the best practical means for preventing and counteracting the effects of the noise"". On the advice of the accoustics expert further measures were carried out by the firm and no further complaints were received. 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, sufficiently lighted and to have toilet and washing facilities; if the staff take meals on the premises there must be suitable arrangements made for them. 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 the 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 childreh. Complaints There were 899 complaints on general matters of health received during 1963. 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 10 licences in force in the Borough and 24 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 petroleum mixtures are stored and in the year 237 visits were made to the 102 premises licensed. 13 Registration of Hawkers of Pood 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 1963, 2 persons were registered and 35 visits were made by Inspectors. Establishments for Massage, Chiropody, Electrical and Special Treatment 7 licences in respect of establishments were issued during the year 1963. 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 3 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. Twickenham Bath is the largest with a capacity of 280,000 gallons; Hampton Bath has a capacity of 206,000 gallons, and Teddington Bath 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 6% hours and that at Hampton every 4 hours. During the 1963 season 21 samples were taken for bacteriological examination and all the samples proved satisfactory. Laboratory Work The usual arrangements continued during the year and worked satisfactorily. 14 Type of Sample No, Taken Result or Specimen Ice Cream (Including Ice Lollies) 56 54 - Grade I ) 2 - Grade II)Satisfactory Water 35 31 - Satisfactory 4 - Unsatisfactory Faeces 195 Throat Swabs 50 Miscellaneous 8 National Assistance Act, 1948, Section 47 National Assistance (Amendment)Act, 1951 It was not necessary during 1963 to remove to suitable premises any person in need of care and attention. Mortuary The number of bodies admitted to the Mortuary during the year was 429. 15 STATISTICAL TABLES for the year 1963 Table l Summary Area in acres 7,078 Population (census 1961) 100,971 Civilian population - estimated to mid-year (as supplied by the Registrar-General) 102, 110 Number of inhabited houses 31,679 Rateable value £5,029,097 Sum represented by a penny rate £20, 800 Total M. F. Live Births-Legitimate 1512 748 764 Illegitimate 92 43 49 Total 1604 791 813 Live Birth rate per 1,000 of estimated Civilian Population 15.71 Adjusted Live Birth rate per 1,000 of estimated civilian Population 16.02 Illegitimate Live Birth per cent, of total Live Births 5.74 Total M. F. Still Births-Legitimate 15 8 7 Illegitimate 3 2 1 Total 78 10 1 Still Birth rate per 1.000 live and still births 11/10 Total Live and Still Births 1622 Infant Deaths (Under 1 year of age) Total M. F. Legitimate 34 17 17 Illegitimate 3 2 1 Total 37 19 18 Infant mortality rate per 1,000 live births 23. 07 Legitimate Infant mortality rate per 1,000 legitimate live births 22.49 Illegitimate Infant mortality rate per 1,000 illegitimate live births 32.61 Neo-Natal deaths Under 4 weeks of age Under 1 week of age Total M. F. Total M. F. Legitimate 20 9 11 16 8 8 Illegitimate 3 2 1 3 2 1 Totals 23 11 12 19 10 9 Neo-Natal mortality rate (deaths under 4weeks per 1,000 total live births) 14.34 Early Neo-Natal mortality rate(deaths under 1 week per 1,000 total live births) 11.84 Perinatal mortality rate (stillbirths and deaths under 1 week combined per 1.000 total live and still births) 22.81 Maternal mortality (including abortion) deaths 2 Maternal mortality rate per 1,000 live and still births 1.23 Total M. F. Deaths 1324 663 662 Crude death rate per 1,000 of estimated civilian population 12.97 Adjusted death rate 11.80 17 Table 2 Population 1938-1963 Year Population Population trend Migration excess Total increase or decrease Percentage proportion Natural increase or decrease Inward Outward 1938 96,550 + 2,320 + 2.46% + 363 1,957 - 1939 97,440 + 890 + 0.92% + 383 507 - 1940 94/070 - 3,370 - 3.46% - 15 - 3,355 1941 91,820 - 2,250 - 2.39% + 38 - 2, 288 1942 92,460 + 640 + 0.70% + 450 190 - 1943 92,780 + 320 + 0. 35% + 502 - 182 1944 88,660 - 4,120 - 4.44% + 507 - 4,627 1945 91,920 + 3,260 + 3.68% + 424 2,836 - 1946 102,850 + 10,930 + 11.89% + 835 10, 095 1947 105,930 + 3,080 + 2,99% + 918 2, 162 - 1948 106,700 + 770 + 0,73% + 621 149 - 1949 106,900 + 200 + 0. 19% + 399 - 199 1950 107,600 + 700 + 0.65% + 246 454 - 1951 106,300 - 1,300 - 1.28% + 91 - 1,391 1952 106,500 + 200 + 0. 19% + 144 56 - 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 , 4 50 150 - 0.14% + 212 - 362 1961 101, 650 - 1,800 - 1,77% 4 293 - 2, 093 1962 102,500 4 850 4 0.84% + 417 433 - 1963 102,110 - 390 - 0,38% + 280 670 18 Distribution of Deaths by Age and Cause Registrar General’s Official Returns- 1963 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 - - - - - - - - - - - 1 - 1 - - - 2 2 Tuberculosis other - - - - - - - - - - - - - - - - - - - Syphilitic disease - - - - - - - - - - - - - 1 - - - 1 1 Diphtheria - - - - - - - - - - - - - - - - - - - Whooping cough - - - - - - - - - - - - - - - - - - - Meningococcal infections - - - - - - - - - - - - - - - - - - - Acnte poliomyelitis - - - - - - - - - - - - - - - - - - - Measles - - - - - - - - - - - - - - - - - - - Other infective and parasitio diseaseis - - - - - - - - 1 - - - - - - 1 1 1 2 Malignant neoplasm,, stomach - - - - - - - - 1 - 8 5 4 2 1 7 14 14 28 Malignant neoplasm, lung, bronchus - - - - - - - - 3 1 26 4 17 5 11 3 57 13 70 Malignant neoplasm, breast - - - - - - - - - 1 - 12 - 9 1 2 1 24 25 Malignant neoplasm, uterus - - - - - - - - - 1 - 4 - 3 - 6 - 14 14 Other malignant & lymphatic neoplasms - - 1 - - - 1 - 4 4 17 17 21 12 20 19 64 52 116 Leukaemia, aleukaemia - - - - - - - - - - 2 2 - 2 2 4 4 8 Diabetes - - - - - - - - - - - - 1 2 2 1 3 3 6 Vascular lesions of nervous system - - - - - - - - 1 1 7 13 13 15 32 73 53 102 155 Coronary disease, angina - - - - - - - - 3 1 69 24 55 31 51 56 178 112 290 Hypertension with heart disease - - - - - - - - - 2 - 5 2 4 11 11 13 24 Other heart disease - - - - - - 1 - 3 1 4 3 9 12 45 86 62 102 164 Other circulatory disease - - - - - - - - - - 5 5 3 15 17 29 25 49 *74 Influenza - - - - - - - - - - - 1 1 - 1 1 2 3 Pneumonia 2 4 - - - - - - - - 4 3 8 5 24 33 38 45 83 Bronchitis 1 - - - - - - - 1 - 12 3 17 5 27 12 58 20 78 Other diseases of respiratory system - - - - - - - - 3 1 3 1 4 6 10 8 18 Ulcer of stomach and duodenum - - - - - - - - - - 1 - 2 1 1 3 4 4 8 Gastritis, enteritis and diarrhœa 1 1 - - - - - - - - - - - - 1 2 2 3 5 Nephritis and nephrosis - - - - - - - - 1 - - 1 - 1 - 1 1 3 4 Hyperplasia of prostate - - - - - - - - - - - - - 3 - 3 - 3 Pregnancy, childbirth, abortion - - - - - - - 1 - 2 - - - - - - - 3 3 Congenital malformations 8 2 - - - 1 - - - - 1 1 - - - - 9 4 13 Other defined and ill-defined diseases 7 11 1 - - - 2 1 4 - 10 6 7 9 7 19 38 46 84 Motor vehicle accidents - - - - - - 4 - 2 - 2 - - 1 1 - 9 1 10 All other accidents - - 1 - - - 1 - 2 1 1 1 1 2 3 2 9 6 15 Suicide - - - - - - - 1 3 1 2 6 2 1 1 1 8 10 18 Homicide and operations of war - - - - - - - - - - - - - - - - - - - 19 18 3 - - 1 19 3 29 14 174 112 171 137 258 376 663 661 1324 19 Table 4 Main Causes of Death An analysis of the death returns reveals the following main causes of death: Disease Percentage of total deaths Death rate per 1,000 of the population Diseases of heart and circulatory system 41.69 5.41 Vascular lesions of nervous system 11.71 1.52 Bronchitis, Pneumonia, and other respiratory diseases 13,89 1.80 Cancer 19.71 2.55 Accidents, Violence 1.89 0.24 20 Table 5 Review of the Comparative Vital and Mortality Statistics for the Borough of Twickenham, together with those for England and Wales for years 19381963 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)l0.35 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 7 0.95 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 19.3 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)11.18 11.3 20.22 27.6 (b)11.79 (b)l0. 84 1953 (a) 13. 26 15.5 (a)10.88 11.4 20.06 26.8 (b)13.53 (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)12.77 15.7 (a)ll.37 11.7 10.54 23.8 (b) l3.15 (b)10.92 1957 (a)12.86 16.1 (a) 10.76 11.5 16.52 23.0 (b) 13. 25 (6)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 i960 (a) 13.91 17.1 (a)11.86 11.5 13.20 21.9 (b)l4.33 (b)ll.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 1963 (a)15.71 18.2 (a)12.97 12.2 23.07 20.9 (b)16.02 (b)ll.80 (a) Crude (b) Adjusted 21 Table 6 AVERAGE RESULTS OP THE CHEMICAL EXAMINATION OF WATER SUPPLIED TO THE BOROUGH OF TWICKENHAM IN 1963 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 4hrs. 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. Natural Fluoride as F. Surface active material as Manoxol OT Sodium as Na. Potassium as K. Electrical Conductivity ((micromhos) Hampton 52 0.165 0.076 3.9 32 1.22 0.3 11 276 68 7.8 1.3 12 560 River Thames derived. North of River 206 0.180 0.080 3.8 32 1.20 0.3 11 282 68 7.9 1.3 12 60 5 0.30 0.07 25 5.2 570 BACTERIOLOGICAL RESULTS - YEARLY AVERAGES, 1963 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. Percent samples negative in 100 ml. Percent samples negative in 100 ml Hampton 1.091 10.6 - 100.0 100.0 Thames - derived, North of River 1,930 14.4 - 99.43 99.43 22 Table 7 Analysis of Conplaints Received Nature of Coaplaint Number Received Housing defects 211 Choked and defective drains and sewers 377 Accumulation of offensive matter 40 Unsound Pood 99 Verminous and other Infested premises (a) Bugs 14 (b) Rats and Mice 460 (c) Wasps 20 (d) Others 35 Keeping of Animals 3 Unsatisfactory milk supplies 3 Smoke nuisances 33 Noise nuisances 17 Fumigation of rooms following Infectious diseases 5 Miscellaneous 42 Total 1,359 23 Table 8 Summary of Visits, Inspections, etc. Number Housing Acts: Clearance Areas 225 Individual unfit Houses 270 Underground Rooms 2 Overcrowding 27 Housing Applications 236 Rent Act Certificates 28 Houses Let in Multiple Occupation 73 Public Health Act: Drain testing 76 Provision and maintenance of drainage systems 656 Public Sewers 767 Septic Tanks and Cesspools - Provision of dustbins 3 Dirty/verminous premises and articles 177 Verminous persons and clothing 9 Wasps, flies and insects 132 Sanitary accommodation at Licensed Premises 7 Statutory nuisances relating to Premises 1,728 " " " " Animals ,.. 25 " " " " Accumulations 206 " " " " Dust and Effluvia 30 " " " " Workplaces - Infectious Disease 469 Tents, Vans, Sheds 73 Outside interviews 285 Miscellaneous matters 524 Factories Acts: Factories with mechanical power 85 Factories without mechanical power 7 Outworkers - Rodent Control 56 Clean Air 6,269 Clean Air Act Survey - Shops Acts 1 Water Act 28 Pet Animals Act 24 Rag Flock Act 24 Table 8 continued. Petroleum Regulations 237 Milk and Dairies Regulations 29 Noise Nuisances 262 Supervision of Pood Supplies: Inspection of Meat 15 Inspection of Other Poods. 253 Manufacturing and Wholesale premises 22 Bakehouses 45 Butchers Shops 260 Grocers Shops 215 Fishmongers shops 36 Fried Fish Shops 27 Sweet Shops 21 Bakers Shops 43 Greengrocers Shops 110 Restaurants 294 Licensed Premises 30 Factory and School Canteens 30 Ice-Cream Premises 35 Preserved meat and fish preparation premises 3 Sampling: Ice-Cream 21 Domestic water supplies 14 Swimming bath water 8 Middlesex County Council Act: Places of public entertainment 34 Hawkers, Vehicles and Premises 35 Hairdressing Establishments 3 Total number of visits and Inspections 14,580 25 Table 9 Sanitary Improvements Effected Number Offensive accumulations removed 2 Nuisance from keeping of animals remedied - Chimney flues repaired 2 Chimney stacks repaired 2 Dampness to walls remedied 21 Downspouts repaired 5 Drains repaired 10 Drains unstopped 9 Dustbins provided - Eavesgutters repaired 22 Filthy condition of premises remedied 3 Fireplaces repaired 1 Floors repaired 13 Gullies repaired 8 Plaster to walls and ceilings repaired 21 Roofs repaired 55 Sashframes and sashcords repaired 3 Sinks provided and repaired ??? Sink waste pipes repaired 4 Soil pipes repaired 4 Stairs repaired 2 Walls (external) repaired 3 Water closets repaired 23 Water closet cisterns and fittings repaired 16 Water closet accommodation provided ??? Yard paving repaired 1 Private sewers repaired ??? Pail closets renewed ??? Other works carried out 59 26 Table 10 Housing Statistics HOUSES IN CLE ARANCE AREAS AND UNFIT HOUSES ELSEWHERE Return for the Year ended 31st December, 1963. A. HOUSES DEMOLISHED In Clearance Areas declared under Section 42 of the Housing Act. 1957 31 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 22 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 8 From houses Included by reason of bad arrangement - From houses on land acquired under S.43(2), Housing Act 1957 - Not in Clearance Areas No. of Houses Demolished As a result of formal or informal procedure under S. 16 or S.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 included in unfitness orders made under para.2 of the 2nd Schedule to the Town and Country Planning Act, 1959 - Persons Displaced From houses to be demolished as a result of formal or informal procedure under S.16 or S.17(1), Housing Act, 1957 - From local authority owned houses certified unfit by the Medical Officer of Health - 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 - From local authority owned houses certified unfit by the Medical Officer of Health - From houses unfit for human habitation where action has been taken under local Acts - From houses included in unfitness orders - Number of dwellings included above 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 10 Under Sees. 17(3) & 26, Housing Act, 1957 - Persons Displaced From houses to be closed: Under Sees. 16(4), 17(1) & 35(1),Housing Act, 1957 and Sec.26 Housing Act, 1961 4 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, 1351 1 Under Sees. 17(3) & 26, Housing Act, 1957 - PARTS OF BUILDINGS CLOSED under S.18, Housing Act, 1957: Numb&r of houses - Number of persons displaced - Number of Families displaced - 27 Table 10 continued C. UNFIT HOUSES MADE FIT AND HOUSES IN WHICH DEFECTS WERE REMEDIED After informal action by local authority: by owner 137 After formal notice under Public Health Acts: (a) by owner 12 (b) by L.A. - After formal notice under Sees. 9 & 16 Housing Act, 1957: (a) by owner - 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 accomodation 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 - 28 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 252 77 Number of informal Notices complied with 161 65 Number of Statutory Notices served 34 - Number of Statutory Notices complied with 19 - 29 Table 12 Prevention of Damage by Pests Act, 1949 Report for 12 months ended 31st December, 1963 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 1. Number of properties in Local Authority's District 41 31,665 5,548 37, 25 4 14 2. Total number of properties inspected as a result of notification 13 401 48 462 - Number of such propperties found to be infested by:- Common rat Major - - - - - Minor 9 224 25 258 - Ship rat Major - - - - - Minor - - - - - House mouse Major - - - - - Minor 3 62 12 77 - 3. Total number of properties inspected in the course q,f survey under the Act 34 2,949 664 3,647 - Number of such propperties found to be infested by:- Common rat Major - - - - - Minor 11 254 7 272 - Ship rat Major - - - - - Minor - - - - - House mouse Major - - - - - Minor 6 10 1 17 - 4. Total number of properties otherwise ininspected (e.g. when visited primarily for some other purpose) 4 1 2 3 - Number of such properties found to be in fested by:- Common rat Major - - - - - Minor - - - - - Ship rat Major - - - - - Minor - - - - - House mouse Major - - - - - Minor - 1 1 2 - 5. Total inspections carried out including re-inspections 211 5,397 1,337 6,945 - 6. Number of infested properties (in Sections 2, 3 & 4) treated by L.A. 29 551 49 629 - 7. Total treatments carried out - including re-treatments 29 551 31 611 - 30 Table 12 c cntinued Type of Property Non-AgricuItural 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 - - - - - lOrLegal Proceedings - - - - - 11.Number cf "Block" control schemes carried out - - - - - 31 32 Table 13 Eradication of Insect Pests D.D.T. and Other Special Treatments Number of Infestations Treated Type of Premises Ants Bugs Mosquitoes Fleas Wasps Miscellaneous Totals Dwelling-houses _ 12 1 5 7 3 28 Workplaces - 1 - 1 - - 2 Food Shops - - - - - - - Miscellaneous 2 - 2 - 4 - 8 Totals 2 13 3 6 11 3 38 Total income for D.D.T. and other special treatments £42.17s. 11d. Table 14 Disinfections. etc. Number Premises disinfected after infectious diseases 2 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 9 (1) Cases of overcrowding relieved during the year 5 (2) Persons concerned in such cases 17 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 51 premises registered as dairies (not being dairy farms) 14 33 Table 17 Food and Drugs Act, 1955 Pood and Hygiene (General) Regulations 1960 Public Health Act. 1936. Section 89 Public Health Act. 1961. Section 80 INSANITARY CONDITIONS IN FOOD PREMISES Number of premises found with insanitary conditions 77 Number of premises remedied 65 Insanitary conditions found in premises above Number of defects Number of defects remedied Equipment not kept in good order 9 17 Food so placed as to involve risk of contamination 3 5 Food placed within eighteen inches of the ground and not adequately protected 2 2 Absence of personal cleanliness - - Insufficient lighting and ventilation to W. C. 2 4 Absence of "Wash your Hands" notices to w.C.S 11 6 Absence of suitable and sufficient wash-hand-basins 5 5 Absence of hot water at a suitably controlled temperature over wash-hand-basins 14 6 Absence of soap, nail brushes, clean towels, etc. near wash-hand-basins 9 5 Absence of first aid materials 1 - Absence of accommodation for clothing not worn during working hours 3 2 Absence of suitable and sufficient sinks for the washing of food and equipment 1 - Absence of hot water at a suitably controlled temperature over sinks 3 1 Absence of soap, clean cloths, etc. at sinks 2 1 Absence of suitable and sufficient lighting in food room 1 _ Absence of suitable and sufficient ventilation in food room Walls, etc., in food room not kept clean 15 16 Walls, etc., in food room not kept in good order 12 9 Walls, etc., in other rooms not kept in good order 35 31 Accumulation of refuse, etc. - - Defective floor covering 8 11 Yard not kept in good order 1 2 Miscellaneous 56 42 Returnable containers not protected 3 3 Totals 196 168 34 Table 18 (a) Meat-Carcases Inspected and Findings at Private Slaughter^ houses in the Borough Cattle excl. cows Cows Calve 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 - - - - - - (b) Other Carcases Inspected Nil 35 Table 19 (a) Meat Diseased and unsound conditions found in meat caused the detention and surrender for destruction of: lbs Ham 26 Pork 17 Other Meats 37 Total 80 (b) Other Foodstuffs The following other foodstuffs, being unfit for human consumption were voluntarily surrendered for destruction. lbs Bacon 226 Cheese 54 Dough 224 Fish 21 Offal 22 Poultry 7 Sausages 2 Total 556 Jars Paste 39 Pickles, Sauces, etc. 77 Preserves 27 Total 143 Tins Cream 9 Fish 155 Fruit and fruit juices 1475 Meat 452 Meat (cooked) 3 Milk 82 Puddings 70 Soups 117 Vegetables 564 Other 42 Total 2969 Pkts. Frozen foods 1286 Flour 23 Chocolate 38 Other 15 Total 1362 36 Table 20 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 Inspections Written Notices Occupiers prosecuted (i) Factories .in which Sections 1, 2,3,4, and 6 are to be enforced by Local Authorities 22 7 - - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 280 85 9 - (iii)Other premises in which Section 7 is enforced by the Local Authority (excluding out workers' premises) - - - - Totals 302 92 9 - 2. CASES IN WHICH DEFECTS WERE FOUND Particulars Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied Referred To H.M. Inspector By H.M. Inspector Want of cleanliness (S. 1) 1 1 - - - Overcrowding (S.2) - - - - - Unreasonable temperature (S.3) - - - - - Inadequate ventilation (S. 4) 2 2 - - - Ineffective drainage of floors (S. 6) - - - - - Sanitary Conveniences (S.7) - - - - - (a) Insufficient 1 - - - - (b) Unsuitable or defective 12 8 - - - (c) Not separate for sexes - - - - - Other,offences against the Act (not including offences relating to outwork) 5 6 Totals 21 17 - - - Part VIII of the Act, Outwork Nature of Work Lampshades Wearing apparel Electric Fuse Makers Section 110 Number of outworkers in August list required by section 110 (1) (C) 19 47 43 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 - - - 37 Table 21 Infectious Diseases, Incidence and Mortality DIPHTHERIA. SCARLET FEVER AND ENTERIC FEVER 1938-1963 Diphtheria Scarlet Fever Enteric Fever Year No. of Cases Case Rate per 1,000 pop. No. of Deaths Death Rate per 1,000 pop. No. of Cases Case Rate per 1,000 pop. No. of Deaths Death Rate per 1,000 pop. No. of Cases Case Rate per 1,000 pop. No. of Deaths Death Rate per 1,000 pop, 1938 70 0.72 5 0.05 274 2.83 1 0.01 - - - - 1939 25 0.25 3 0.03 93 0.95 - - 2 0.02 - - 1940 18 0.19 3 0.03 38 0.41 - - 2 0.02 - - 1941 25 0.27 3 0.03 78 0.85 - - 7 0.07 - • 1942 7 0.08 1 0.01 125 1.35 - - - - 1 0.01 1943 4 0.04 1 0.01 238 2.56 - - - - - - 1944 5 0.06 3 0.03 121 1.37 - - - - - - 1945 4 0.04 1 0.01 97 1.06 - - - - - - 1946 4 0.04 - - 60 0.58 - - - - - - 1947 4 0.04 1 0.01 60 0.58 - - - - - - 1948 1 0.01 - - 99 0.93 - - - - - - 1949 - - - - 128 1.20 - - - - - - 1950 - - - - 115 1.07 - - - - - - 1951 - - - - 64 0.60 - - - - - - 1952 - - - - 135 1.28 - - - - - - 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 - - - - 21 0.20 - - - - - - 1963 - - - - 34 0.33 - - - - - - 38 Table 22 Ophthalmia Neonatorum, years 1938"1963 The following table shows the number of cases notified and result of treatment: Year Cases notified Cases Treated Vision impaired 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 - - - - - - - 1963 - - - - - - - 39 40 Table 23 Cases of Infectious Diseases Notified during the year 1963 DISEASE CASES NOTIFIED AT VARIOUS AGES (YEARS) Total Cases Notified Deaths Under 1 Year 1-2 2-3 3-4 4-5 5-10 10-15 15-20 20-25 25-35 35- 45 45-65 Over 65 Age not known Diphtheria _ _ _ _ _ _ _ _ _ _ _ _ _ _ Nil _ Dysentery 2 2 _ _ _ 2 1 _ 1 1 1 5 1 _ 16 _ Erysipelas _ _ 1 _ _ _ _ _ _ _ _ 2 2 _ 5 _ Pood Poisoning _ _ _ _ _ _ _ _ _ _ _ _ _ _ Nil _ Malaria _ _ _ _ _ _ _ 1 _ _ _ _ _ _ 1 _ Measles 28 103 109 130 137 487 19 4 1 7 2 _ _ _ 1027 _ Meningococcal Infection _ _ _ _ _ _ _ _ _ _ _ _ _ Nil _ Ophthalmia Neonatorum _ _ _ _ _ _ _ _ _ _ _ _ _ _ Nil _ Pneumonia 1 _ _ _ 1 2 _ _ 2 2 1 12 8 _ 29 83 Poliomyelitis _ _ _ _ _ _ _ _ _ _ = _ _ _ Nil _ Puerperal pyrexia _ _ _ _ _ _ _ 1 2 9 _ _ _ _ 12 _ Scarlet Fever _ 4 _ 6 3 17 2 _ _ 1 _ 1 _ _ 34 _ Smallpox _ _ _ _ _ _ _ _ _ _ _ _ _ _ Nil _ Typhoid & Para_ Typhoid _ _ _ _ _ _ _ _ _ _ _ _ _ _ Nil _ Whooping cough _ 8 8 4 5 10 6 _ _ _ _ _ _ _ 41 _ Totals 31 117 118 140 146 518 28 6 6 20 4 20 11 _ 1165 83 41 Table 24 Monthly Incidence of Infectious Diseases during the Year 1963 Diseases NUMBER OF CASES TOTAL Jan. Feb. March April May June July August Sept. Oct. Nov. Dec. Diphtheria - - - - - - - - - - - - Nil Dysentery - - - 1 8 6 - - - 1 - - 16 Erysipelas - - 1 1 - 1 - - 1 1 - - 5 Food Poisoning - - - - - - - - - - - - Nil Malaria - - - - - - - - 1 - - - 1 Measles 94 170 232 282 119 71 42 14 1 1 1 - 1027 Meningococcal Infections - - - - - - - - - - - - Nil Ophthalmia Neonatorum - - - - - - - - - - - - Nil pneumonia 6 8 3 - 2 1 3 3 - - 2 1 29 Poliomyelitis - - - - - - - - - - - - Nil Puerperal Pyrexia 1 2 - - - 2 - 5 1 - 1 - 12 Scarlet Fever 1 3 5 5 2 3 8 3 1 1 2 - 34 Smallpox - - - - - - - - - - - - Nil Typhoid and Para Typhoid - - - - - - - - - - - - Nil Whooping cough 2 1 - 2 1 12 3 6 13 1 41 Totals 104 184 241 289 133 84 54 37 8 10 19 2 1165 42 Table 25 Ward Distribution of Infectious Diseases Notified during the Year 1963 Diseases Heathfield Whitton West Twickenham Centra Twickenham South Twickenham East Twickenham Hampton Hampton Hill Upper Teddington Lower Teddington Hampton Wick Total Diphtheria - - - - _ _ _ _ _ _ - Nil Dysentery 1 2 4 3 - 4 1 - 1 - - 16 Erysipelas - - - - 1 - - 3 1 - - 5 Food Poisoning - - - - - - - - - - - Nil Malaria - - - - - - - - - - 1 1 Measles 51 32 41 68 31 85 200 183 137 107 92 1027 Meningococcal Infections - - - - - - - - - - - Nil Ophthalmia Neonatorum - - - - - - - - - - - Nil Pneumonia 1 1 3 - 2 2 8 6 4 1 1 29 Poliomyelitis - - - - - - - - - - - Nil puerperal Pyrexia 1 1 - - 1 2 6 - - - 1 12 Scarlet Fever 2 1 - 1 - 1 16 6 3 3 1 34 Smallpox - - - - - - - • - - Nil Typhoid and Para-Typhoid - - - - - - - - - - - Nil Whooping cough 1 3 5 2 2 2 6 3 6 5 6 41 Totals 57 40 53 74 37 96 237 201 152 116 102 1165 43 Table 26 Tuberculosis The following tables have been compiled from the notifications received NEW CASES AND MORTALITY 1963 Age Periods New Cases Deaths Pulmonary Non-Pulmonary Pulmonary Non Pulmonary Male Female Male Female Male Female Male Female Under 1 - - - - - - - - 1 - 4 - - - 1 - - - - 5-9 - 1 - - - - - - 10 - 14 - - - - - - - 15 - 19 1 - - - - • - - 20 - 24 4 - - - - - - - 25 - 34 5 2 1 2 - - - - 35 - 44 6 1 1 - - - - - 45 - 54 3 6 1 - - 1 - - 55 64 2 - - - - - - - 65 and over 2 3 - 1 - 1 - - age unknown - - - - - - - - Totals 23 13 3 4 - 2 - - Table 27 PRIMARY NOTIFICATIONS OF TUBERCULOSIS 1938 1963 INCLUSIVE 1938 1939 1940 1941 1942 1943 1914 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 pulmonary 100 106 114 127 112 119 133 118 120 132 117 115 96 107 79 105 88 70 58 57 54 31 45 35 32 36 Non- Pulmonary 30 19 12 14 18 18 18 18 19 11 17 5 15 14 20 14 12 11 3 7 7 5 3 4 9 7 Totals 130 125 126 141 130 137 151 136 139 143 134 120 111 121 99 119 100 81 61 64 61 36 48 39 41 43 Table 28 Food Poisoning Food poisoning Notifications 1963 1st Quarter Nil 2nd Quarter Nil 3rd Quarter Nil bth Quarter Nil Total Nil OUTBREAKS DUE TO IDENTIFIED AGENTS: Outbreaks due to: Chemical Poisons Salmonella organisms Staphylococci (inc.toxin) Cl.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 44 45 Premises concerned with Health Services in Area 10 A - Ante-natal and post-natal care of mothers D - Dental H - Headquarters Personal Health 0 - Orthopaedic B - Baby Welfare E - Eye testing I - Vaccination and Immunisation P - Family Planning (provided by Voluntary Organisation) C - Chiropody (Middlesex County Council and/or Voluntary Organisations) F - Distribution of Welfare Foods J - Geriatric S - School Health G - Child Guidance L - Local Doctors Clinic T - Talking and Speech Therapy M - Mental Health V - Environmental Health 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 Council Offices, V Table 29 High Street, Teddington Bridge Street, Staines Green Street. Sunbury Church Road, Teddington B D F J I Stanwell Road, Ashford B C D E Duddington House, A B C D F F I O S T Green Street, Sunbury IST Hospital Bridge Road, A B C F The Grange, A B D E F G Chertsey Road , A B D F Whitton I J S D Gresham Road, Staines I M O P S T Ashford Common IST 20 Seymout Road, B D F I 12 Tilley's Lane, F Laleham Road, B C D F I Hampton Wick P S O C High Street. Staines Shepperton S T Stanley Road, Teddington A C E I S Council Offices V New Hall, Upper Halliford A B F I Hanworth Road, Feltham 24 Station Road, Hampton B C D F I J S Cardinal Road, Feltham B C D E F 1 A Staines Road West, F I S P T Sunbury York House, Richmond A B C D E Grove Crescent. A B C D F Hadrian Way, B C D F I Road, Twickenham F I S Hanworth IST Stanwell L S T 58 Hampton Road, G T Imperial Road, Bedfont A B C D F Twickenham IST In addition to the premises listed above a mobile clinic visits the following sites:- Twickenham: Feltham: Staines: Dean Road, Hampton Finch Drive, Feltham Wheatsheaf Lane, Penton Hook, Staines, St.James’s Avenue, Hampton Hill Spring Road, Lower Feltham Moor Lane, Staines Rosslyn Road, Twickenham Wigley Road, Hanworth Hithermoor Road, Stanwell Moor, Staines Headway, Twickenham Chattern Hill, Ashford Colonial Avenue, Whitton Edinburgh Drive, Laleham Opposite Village Hall, Laleham -