BARN 52 URBAN DISTRICT OF BARNES THE Annual Report of the Medical Officer of Health for the year 1926 E. A. Fref.ar Wilkes, M.r.c.s.Eng., l.k.c.p.Lond, D.p.H.Camb. Medical Officer of Health. Barnes, S.W.: R W SIMPSQN & CO., LTD., PRINTERS, 15 HIGH STREET. 1927 THE Urban District Council of Barnes. IPublic ibealtb Committee. Mr. Aldis Mr. Harber Mr. Lane ,, Baily „ Harding Mrs. Macnamara „ Barton „ Hibberd Mr. Maynard „ Bates ,, Hill „ Medus ,, Capell „ Hunt „ Pike ,, Davis „ Hutter (Chairman) „ Stanley Sparkes „ Firmston „ Jackson ,, West ,, Green „ King Major Williams Public Dealth Department. STAFF Medical Officer of Health, E. A. Freear Wilkes, M.R.C.S.Eng., L.R.C.P.Lond., D.P.H.Camb. D.P.H., R.C.P.S.Lond. Chief Sanitary Inspector, C. S. Perchard, Cert.R.San.Inst. (Certified Inspector of Meat and Other Foods.) Assistant Sanitary Inspector, W. G. J. Sutton, Cert.San.Insp.Ex.Board. (Certified Inspector of Meat and Other Foods.) Health Visitors, Miss Parnell. Miss McNish. Matron of the Isolation Hospital, Miss Peters. Clerk, R. E. Forrest. SUMMARY OF CONTENTS. page 1. Natural and Social Conditions of the Area 2 II. General Provision of Health Services in the Area 12 III. Sanitary Circumstances of the Area 19 IV. Housing 29 V. Inspection and Supervision of Food 32 VI. Prevalence of, and Control over, Infectious Diseases 35 VII. Maternity and Child Welfare 46 Summary of Statistics for the year 1926. Area of the District in Acres:— Total area 2,650 Area excluding tidal waters and foreshore 2,519 Population (Registrar-General) 36,180 Density of Population per Acre 14.4 Number of Inhabited Houses (1921 Census) 7,939 „ „ Families or Separate Occupiers (1921 Census) 8,654 Persons per Inhabited House 3.6 Birth Rate (Registrar-General) 15.0 Death Rate (Registrar-General) 10.5 Infantile Mortality Rate per 1,000 Births 49.8 „ , (Legitimate Infants 40.4 a e or l Illegitimate Infants 273.0 Zymotic Death Rate 0.28 Phthisis Death Rate 0.69 Rateable Value £367,103 0 0 Sum Rkpresbnted by a Penny Rate £1,350 0 0 Public Health Department, Council House, Mortlake, S.W.14. May, 1927. To the Chairman and Members of the Urban District Council of Barnes. Mr. Chairman, Mrs. Macnamara and Gentlemen, I have the honour to submit my Annual Report for the year 1926 on the sanitary circumstances, the sanitary administration and the vital statistics of the District. This Annual Report, in accordance with the directions of the Minister of Health, has been compiled as an Ordinary Report, that is, a Report of a more simple character than the full Survey Report which was prepared last year. In presenting this Report I take the opportunity of expressing my appreciation of the support and assistance which I have continued to receive from the Chairman aud Members of the Council, and also of thanking the Chief Sanitary Inspector and other members of the staff of the Public Health Department, and the Matron and Nursing Staff of the Isolation Hospital for their efficient service and loyal co-operation during the past year. 2 Section 1. NATURAL AND SOCIAL CONDITIONS OF THE DISTRICT. Area of the District. The total area of the Urban District is 2,650 acres: the total waters of the foreshore cover 131 acres, the area of land and inland water being 2,519 acres. Population. The population of the Barnes Urban District as enumerated at the last three Censuses is given below:— Census. Population. 1901 17,821 1911 30,377 1921 34,281 For the year 1926 the Registrar General has estimated the mid-yearly population for the District to be 36,180. Contrasted with the mid-yearly estimated population of 34,010 for 1921, the estimated population for 1926 represents an increase in the population over a period of five years of 2,170 persons. During those five years the increase in population by reason of the excess of births over deaths amounts to 1,100 persons, and during the same period 1,466 new dwelling houses were erected and occupied by families mostly from outside the district. There does not appear to have been much emigration from the District. A very considerable increase in the population has undoubtedly occurred, and with the continuance of building in the area a large further increase may be expected. The density of population is now 14.4 persons per acre, having doubled since 1901, when the density was 7.1 per acre. Physical Features and General Character of the Area. In my Annual Report for 1925 details were given of the physical features and the general character of the area, and reference may be made to page 3 of that report. 3 Number of Inhabited Houses. At the 1921 Census the number of "structurally separate" dwellings in the District was 7,939. During the period 1921 to 1926 the number of newly-erected dwelling houf.es completed and occupied has been 1,466, 326 of these having been erected during the year 1926. Building, almost entirely of dwelling houses, is still proceeding extensively in the District, and the remaining sites available for development are rapidly becoming built over. Rateable Value. Social Conditions and Occupations of the Inhabitants The area is largely a residential one. There are approximately 16,000 occupied persons resident in the District, and in the case of more than half of these their workplace is situated outside the area. As regards trades and industries carried on in the District, in none of these has there appeared to be any prejudicial effect on health connected with conditions of occupation. Considerable detail with regard to the social conditions of the inhabitants and their occupations was given in my Survey Report for 1925 (Pages 4 to 8), and there has since occurred no material alteration. Vital Statistics. Comparative vital statistics with reference to birth-rate, death-rate and infantile mortality are given in tabular form on pages 4 and 5. The Rateable Value and Assessable Value for District Rate purposes for 1926 were as under:— Rateable Value. £ Agricultural Land 1,055 Other Hereditaments 366,048 Total £367,103 Assessable Value for District Rate purposes £346,247 Sum represented by a Penny Rate £1,350 4 Table 1.—Vital Statistics of Barnes Urban District During- 1926 and previous 5 Years. Year. Population estimated to middle of each year. R.G Births. Total Deaths Registered in the District. Transferable Deaths Next Deaths belonging to the District. Uncorrected Number. Nett. Of nonresidents registered in the District. Of residents not registered in the District. Under 1 year of age. At all ages. Number. Rate. Number. Rate. Number. Rate per 1,000 nett births Number. Rate 1 2 3 4 6 6 7 8 9 10 11 12 I3 1921 34,010 618 651 19.1 316 9.3 34 106 42 64.5 388 11.4 1922 34,130 520 574 16.8 289 8.5 27 115 29 50.5 377 11.0 1923 34,400 497 558 16.2 252 7.3 27 116 26 46.4 341 9.9 1924 34,600 436 482 13.9 262 7.6 21 114 25 51.9 355 10.3 1925 35,120 414 498 14.2 255 7.3 21 130 28 56.2 364 10.3 1926 36,180 435 542 15.0 260 7.2 27 147 27 49.8 380 10.5 5 Table II. Birth-rate, Death-rate, and Analysis of Mortality during the year 1926, with corresponding rates for England and Wales, 105 Great Towns, 157 Smaller Towns, and for the County of London for comparison. The mortality rates reftr to the whole population as n-gards Kngland and Wales but only to civilians as regards London and the groups of towns Birth Rate Per 1,000 Total Population. Annual Death raii£ per 1,000 Population. Rate per 1.000 Births. Percentage ok Total Deaths All Causes Enteric Fever. Small-pox Measles. Scarlet Fever. V\ hooping Cough. Diphtheria. Inlluenza. Violence Diarthcea and Enteritis (under 2 years). Total Deaths under One Year. Certified Causes of Death. Inquest Cases. Uncertfied Causes of Death. England and Wales 17.8 11.6 0.01 0.00 0.09 0.02 0.10 0.07 0.22 0.47 8.7 70 91.8 7.2 1.0 105 Great Towns, including London (1921 Census Populations exceeding 50,000) 18.2 11 .6 0.01 0.00 0.12 0.02 0.10 0.10 0.22 0.43 11.8 73 92.0 7.5 0.5 157 SmallerTowns (1921 Census Populations 20,000—50,000). 17.6 10 6 0.01 0.00 0.07 0.02 0.11 0.06 0.21 0.40 6.6 67 92.6 6.3 11 London 17.1 11.6 0.01 0.00 0.20 0.02 0.05 0.12 0.17 0.48 11.8 64 90.6 9.4 0.0 Barnes Urban District 15.0 10.5 0.00 0.00 0.22 0.00 0.03 0.00 0.25 0.58 1.8 50 91.3 9.7 0.0 6 Birth-rate.—The number of births registered in the District during the year was 435. After correction for inward and outward transfers the "nett" number of births was 542, and the Birth-rate for the District was 15.0 per 1,000 of the population. The Birthrate for the year for England and Wales was 17.8, and for London 17.1. The birth-rate of 15.0 per 1,000 of the population for 1926 is a slightly higher one than1 was recorded in the two previous years, that for 1925 having been 14.2, and for 1924, 13.9. Distributed according to sex and legitimacy, the births were as follows:— Male. Female. Total. Legitimate 279 241 520 Illegitimate 10 12 22 Total 289 253 542 Death-rate.—The number of deaths registered in the Urban District during the year 1926 was 260. Of these 27 were deaths of persons who were not "residents" of the District, and 233 were deaths of "residents." To obtain the correct number of deaths representing the true mortality amongst the population it is necessary to add 147 deaths of "residents" whose deaths occurred outside the Urban District. The corrected number of deaths therefore belonging to this District is 380. This number represents a death rate of 10.5 per 1,000 of the population. The death-rate for the year for England and Wales was 11.6, and that for London also 11.6. The death-rate for 1926 compares favourably with the rate in the District during previous years. Table III —Showing Causes of, and Ages at, Death during the Year 1926. Causes of Death. Nett Deaths of Residents whether dying within or outside the District. Deaths of Residents Dying in the Urban District. Deaths of Residents Dying ouiside the Urban District. Nett Deaths in or belonging to whole Distiict at subjoined ages. Deaths in or belonging to Localities (at all ages). Total Deaths Sex Distribution. Deaths in Institutions. All Ages Under 1 year. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25 25 and under 45. 45 and under 65. 65 and upwards Barnes. Mortlake Male. Female. Enteric Fever - - - - - - - - - - - - - - - - Small-pox - - - - - - - - - - - - - - - - Measles 8 1 2 4 1 - - — - 4 4 3 5 5 3 5 Scarlet Fever - - - - - - - - - - - - - - - - Whooping-Cough 1 — 1 — — — - — - - 1 - 1 - 1 - Diphtheria and Croup - - - - - - - - - - - - - - - - Influenza 9 — — — — 1 1 1 6 4 5 2 7 1 8 1 Encephalitis Lethargica Meningococcal Meningitis - - - - - - - - - - - - - - - - Pulmonary Tuberculosis 25 _ — — — 8 9 8 - 10 15 15 10 11 16 - Other Tuberculous Diseases 2 - - - - - 2 - - 1 1 1 1 1 1 1 Cancer, malignantdisease 58 - - — — — 4 26 28 23 35 24 34 18 37 21 Rheumatic Fever 2 — — — — 1 — — 1 1 1 — 2 - 2 — Diabetes 2 — - — — — — 2 — - 2 — 2 — 1 1 Cerebral Haemorrhage 24 — - — — 1 — 8 15 12 12 4 20 7 15 9 Heart Disease 51 — - 1 — — 6 15 29 27 24 27 24 17 31 20 Arterio-sclerosis 17 — — — — — - 6 11 9 8 10 7 2 13 4 Bronchitis 24 - - - - - 1 4 19 16 8 9 15 8 15 9 Pneumonia (all forms) 3 - 1 1 3 5 6 7 14 15 6 7 14 7 Other diseases of Respiratory organs 6 - - - - - 2 4 — 4 2 3 3 3 3 3 Ulcer of Stomach and Duodenum 4 - - - - - - 3 1 1 3 2 2 1 3 1 Diarrhoea and Enteritis 1 1 — — — - - - 1 — 1 — 1 — 1 Appendicitisand Typhlitis 5 — — — 2 1 2 - - 1 4 5 — 4 — 5 Cirrhosis of Liver 5 - - - - - 1 3 1 2 3 3 2 2 3 2 Nephritis and Bright's Disease 6 - — — - — 1 5 — 5 1 2 4 2 4 2 Puerperal sepsis - - - - - - - - - - - - - - - - Other accidents and diseases of Pregnancy and Parturition - - - - - - - - - - - - - - - - Congenital Debility anc Malformation, including Premature Birth 17 17 - - - - - - - 10 7 7 10 5 10 7 Suicide 3 - - - - - - 3 — 2 1 3 — — 2 1 Violent Deaths,excluding Suicide 18 2 — — 1 — 2 6 7 9 9 10 8 10 6 12 Other defined diseases .. 71 4 2 - 2 - 5 17 41 26 45 32 39 23 45 26 Causes ill-defined or unknown - - - - - - - - - - - - - - - - All causes 380 27 8 5 7 13 39 116 165 175 205 178 202 128 233 147 7 Causes of Death.—As regards causes of death during 1926, an analysis of the total (corrected) deaths for the whole District is shown in Table III. on the opposite page, classified under various causes of death, and distributed for age, sex and locality. Amongst the principal causes of death, cancer, heart disease, tuberculosis, bronchitis and pneumonia are the most frequent causes of death, their frequency being in the order in which they are stated. Comparative figures showing the number of deaths from each of these causes during the past five years are given in Table IV., below. Table IV.—Principal Causes of Death: Annual number of deaths from these causes during five years, 1921 to 1925, and during 1926. Cause of Death. Number of Deaths in previous 5 years. Deaths in Death Rate per 1,000 Population for 1926. 1921 1922 1923 1924 1925 1926 Barnes Urban District. London. Zymotic (Epidemic) Diseases 16 15 10 9 12 10 0.28 0.58 Influenza 8 15 5 18 13 9 0.25 0.17 Bronchitis 27 27 25 27 25 24 0.66 0.78 Pneumonia 27 25 16 19 12 21 0.58 0.93 Tuberculosis 35 30 24 25 23 27 0.74 0.99 Cancer 56 41 46 52 48 58 1.60 1.43 Heart Disease 31 46 36 31 49 51 1.41 1.79 Bright's Disease 6 12 12 5 16 6 0.17 0.34 Puerperal Fever — 1 1 1 — — 0.00 0.03 Diseases and Accidents of Child.birth 2 2 2 1 0.00 0.03 Premature Birth, &c. 19 8 9 8 10 17 0.47 0.37 Violence and Suicide 9 16 12 13 16 21 0.58 0.48 The death.rates for 1926 from each of the seven principal epidemic diseases (zymotic diseases) are given separately in Table V., and in Table VI. the zymotic death.rates for the five years, 1921 to 1925, are contrasted with the rate for 1926. In each of these Tables the death-rates for London and for England and 8 Wales for corresponding periods are also shown for comparison; the death-rates for this District contrast favourably with those. Table V —Epidemic Diseases: Death-rates per 1,000 of the Population, 1926. Disease. Barnes. London. England and Wales. Small-pox 0.00 0.00 0.00 Enteric Fever 0.00 0.01 0.01 Measles 0.22 0.20 0.09 Scarlet Fever 0.00 0.02 0.02 Whooping Cough 0.03 0.05 0.10 Diphtheria 0.00 0.12 0.07 Diarrhoea (under 2 years) 0.03 0.20 0.15 Zymotic Death Rate 0.28 0.58 0.44 Table VI.—Zymotic Death-rate for 1926, contrasted with the Death-rates for the years 1921 to 1925. Year. Barnes. London. England and Wales. 1921 0.47 0.98 0.70 1922 0.44 1.07 0.60 1923 0.29 0.60 0.55 1924 0.46 0.73 0.45 1925 0.34 0.59 0.54 1926 0.28 0.58 0.44 Deaths in Public Institutions. — During 1926 128 Barnes inhabitants died in public institutions; this represents 34.2 per cent, of the 380 total deaths assigned to this District. Of the 233 residents who died in the District, three only died in an institution, viz., in the Isolation Hospital. Of the 147 residents whose death occurred in other areas outside the District, 125 died in institutions, 59 of these deaths occurring in the Poor-law Institution. Richmond, and 66 in various other public institutions outside the District. 9 The proportion of deaths which occurred in public institutions generally, and of deaths which occurred in the poor-law institution, during each of the five years, 1921 to 1925, and for comparison during 1926, are given as percentages of the total deaths for those years. Percentage of Total Deaths for the Year. Deaths occurring in all Public Institutions. Deaths occurring in the Poor-law Institution. 1921 21.1 per cent. 9.8 per cent. 1922 27.1 13.8 1923 27.6 11.1 1924 28.7 11.5 1925 30.7 13.4 1926 34.2 15.8 It is seen that of the total deaths, the proportion of persons who died in public institutions in 1921 was on© in five, and that this proportion has gradually increased until in 1926 one death in every three occurred in an institution. These figures indicate to what a large extent institutional treatment is being resorted to, not only for urgent treatment of acute and serious illness, but also in order to obtain proper nursing attention during the last stages of chronic diseases. Inquests.—Inquests were held in respect of 37, or 9.7 per cent., of the 380 deaths assignable to the District. The causes of deaths in these cases were as follows:— Deaths from suicide 3 Violent deaths, excluding suicide 21 Deaths from natural causes 13 Infantile Mortality. During 1926 the number of deaths of infants under one year of age was 27, representing a rate of Infantile Mortality of 50 per 1,000 registered births, the Infantile Mortality rate for England and Wales being 70, and that for London 64 per 1,000 registered births for the corresponding period. On reference to Table VII., below, in which the average infantile mortality rates for quinquennial periods since 1891 are given, it will be seen that in this District infantile mortality has steadily declined. The lowest rate ever recorded in the District was one of 47 per 1,000 registered births in 1923; the rate for 1926 is only slightly higher than this. 10 Table VI!.—Showing- the Infantile Mortality rate for 1926, and the average rate for quinquennial periods since 1891 for the Barnes Urban District and for England and Wales. PERIOD. Infantile Mortality Rate per 1,000 registered births. Barnes Urban District. England and Wales 1891-1895 113 151 1896-1900 124 156 1901-1905 102 138 1906-1910 92 117 1911-1915 78 110 1916-1920 75 90 1921-1925 54 76 1926 50 70 The causes of death of infants dying under one year of age during 1925 are analysed in Table VIII. (on page 11), which shows the distribution for age groups and for localities. Further reference to this subject will be found in the section of this report dealing with Maternity and Child Welfare. It Table VIII — Infant Mortality during the Year 1926. Nett Deaths from stated Causes, at various Ages, under 1 Year of Age. Cause of Death. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 4 Weeks. 1-3 Months. 3-6 Months. 6-9 Months. 9-12 Months. Total under 1 Year. Barnes. Mortlake. Deaths in the Urban District. Deaths outside the Urban District. Deaths in Institutes Small-pox - - - - - - - - - - - - - - - Chicken-pox - - - - - - - - - - - - - - - Measles - - - - - - - - 1 1 1 - - 1 1 Scarlet Fever - - - - - - - - - - - - - - - Whooping Cough - - - - - - - - - - - - - - - Diptheria - - - - - - - - - - - - - - - Erysipelas - - - - - - - - - - - - - - - Tuberculous Meningitis - - - - - - - - - - - - - - - Abdominal Tuberculosis - - - - - - - - - - - - - - - Other Tuberculous Disease - - - - - - - - - - - - - - - Meningitis (not Tuberculous) - - - - - - - - - - - - - - - Convulsions - - - - - - - - - - - - - - - Laryngitis - - - - - - - - - - - - - - - Bronchitis - - - - - - - - - - - - - - - Pneumonia (all forms) - - - - - 1 - - 1 2 2 - 1 1 1 Diarrhcea and Enteritis - - - - - 1 - - - 1 1 - - 1 1 Gastritis Syphilis — — — — — - - - - - - - - - - Rickets — — — — - — - - - - - - - - - Atrophy, Debility and Marasmus 2 2 - - 4 1 - - - 5 3 2 3 2. 1 Premature Birth 5 — — — 5 1 1 - - 7 3 4 6 1 1 Congenital Malformations 4 - - - 4 - 1 - - 5 2 3 1 4 3 Injury at Birth — 1 — — 1 — — — - 1 - 1 1 - - Atelectasis - - - - - - - - - - - - - - - Suffocation (overlaying) - - - - - 1 - - - 1 - 1 1 - - Violence 2 — — — 2 — — — — <> 1 1 2 - - Other causes 1 — — — 1 — 1 — — 2 1 1 1 1 1 All causes 14 3 - — 17 5 3 — 2 27 14 13 16 11 9 Nett Births in the Year: Total Births, 542; Legitimate, 520; illegitimate, 22. Nett Deaths (under 1 year): Total Deaths, 27; Legitimate Infants, 21; Illegitimate Infants, 6. Infantile Mortality Rate: Total, 50 ; Legitimate, 40 ; Illegitimate, 273. 12 Section II. GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. (1) Hospitals provided or subsidised by the Urban District Council or by the Surrey County Council. (a) Fever Hospital. An Isolation Hospital has been provided by the Barnes District Council for the treatment of cases of infectious disease occurring in the District. The Hospital is situated in South Worple Way, Mortlake. The extent and nature of the accommodation is as follows: — (i) a Scarlet-fever Block (12 beds) consisting of a male ana female ward, each accommodating 6 patients; (ii) a Diphtheria Block (13 beds) consisting of a male and female ward, each accommodating 6 patients, and a side-ward for 1 patient; (iii) an Isolation Block (14 beds) consisting of 4 small wards, two of which accommodate 4 patients each, the other two accommodating 3 patients each. An extension of the Hospital is now being made to provide increased accommodation both for patients and staff. Further reference to the Isolation Hospital will be found on page 43 under the heading of 'Control over Infectious Diseases." (b) Small-pox Hospital. Hospital accommodation for cases of small-pox arising in this District is provided, by arrangement with the Surrey County Council, at the Small-pox Isolation Hospital, Clandon, Surrey. The removal of cases to the Hospital by ambulance is undertaken by the Surrey County Council at the cost of the Barnes District Council. (c) Tuberculosis. Patients suffering from tuberculosis who need institutional treatment are admitted to various Sanatoria and Special Hospitals under the County Tuberculosis Scheme. There is a small Tuberculosis Pavilion situated in the grounds of the District Council's Isolation Hospital, Mortlake, providing accommodation for 12 patients—6 male and G female. 13 (d) Maternity. Provision during 1926 has continued to be made under the Surrey County Council Maternity and Child Welfare Scheme for the admission of women needing special treatment during confinement to certain Maternity Homes in Surrey. Patients from this District so provided for are usually sent to a Maternity Home at Redhill or Kingston. There is no Maternity Home situated in the District which is provided or subsidised by the District Council or by the County Council. On 1st January, 1927, the Barnes Urban District Council became the Local Authority for the purposes of the Maternity and Child Welfare Act, 1918. (e) Children's Hospitals. There being no hospital in the area for the treatment of children, the District Council make a donation annually to the Royal Hospital, Richmond, the Putney Hospital, and the West London Hospital, Hammersmith, these three Hospitals being those mainly used by the inhabitants of this area. In addition, the Surrey County Council, as the local education authority, have made provision for operative treatment of enlarged tonsils and adeuoids to be undertaken at the Royal Hospital, Richmond, in the case of children attending the public elementary schools. (2) Institutional Provision for Unmarried Mothers, Illegitimate Infants and Homeless Children. Provision for cases of the above description belonging to this District is made by the Surrey County Council, under the County Maternity and Child Welfare Scheme, in institutions outside this District in the case of persons not already provided for by the Poor-law Authority. (3) Ambulance Facilities. (a) For Infectious Cases. A motor ambulance is provided by the Council for removal of patients suffering from infectious disease to the Isolation Hospital. This ambulance is so constructed as to enable the infected bedding and clothing to be removed at the same time as the patient. 14 (b) For Non-infectious and Accident Cases. The Council have provided a motor ambulance for use in removing accident cases to Hospital, and in such cases no charge is made. The ambulance may also be hired at a nominal scale of charges, according to distance, by residents of the District for the conveyance of patients suffering from non-infectious diseases to Hospitals, Nursing Homes, etc. In necessitous cases the fees may be remitted. (4) Clinics and Treatment Centres. Name of Clinic, etc. Address. Days of attendance. Provided by. (a) Situated in the District: Maternity and Child Welfare. Ante-natal Clinic Infant Welfare Clinic Technical Institute, North Worple Way, Mortlake Wednesday, 2.30 Tuesday, 2.30 Thursday, 2.30 Urban District Council of Barnes School Clinics— Minor Ailments Clinic „ „ Daily, Monday to Friday, 9.30 Surrey County Eye Clinic „ „ Monday, 2 Council Dental Clinic „ „ Tuesday, 9.30 Friday, 2 Tuberculosis Dispensary South Worple Way, Mortlake Tuesday, 5 „ (b) Situate outside District: Venereal Diseases Clinics Richmond Royal Hospital Males, Tuesday and Friday, 6 Females, Tuesday & Friday, 5 „ West London Hospital, Hammersmith Daily 5.30 „ And at 21 other Hospitals in the County of London Various times as advertised „ (5) Public Health Staff. (a) Medical Officer of Health. The Medical Officer of Health of the Barnes Urban District in addition to undertaking the duties of District Medical Officer of Health acts also as Bacteriologist and as Medical Superintendent of the Council's Isolation Hospital. For the past ten years the 15 District Medical Officer of Health has also carried out the work of School Medical Inspection and School Clinics, and acted as Tuberculosis Officer and Medical Officer for Maternity and Child Welfare, under the Surrey County Council's Schemes, within the Urban District. A scheme for the reorganisation of the medical servioes in the area was completed on January 1st, 1927, under which the Medical Officer of Health of the Barnes Urban District now undertakes the duties of District Medical Officer of Health, Bacteriologist, Medical Superintendent of the Council's Isolation Hospital and Medical Officer for Maternity and Child Welfare only. (b) Sanitary Inspectors. The services of Mr. T. Grylls have been retained by the Council as Consulting Sanitary Inspector. The Chief Sanitary Inspector holds the Sanitary Inspectors' Certificate of the Royal Sanitary Institute, and in addition, a Certificate as an Inspector of Meat and Other Foods. In addition to his duties as Chief Sanitary Inspector, this Officer acts as Inspector under the Petroleum Acts, Inspector under the Shops Acts, and as Executive Office) under the Rats and Mice (Destruction) Act, 1918. The Assistant Sanitary Inspector holds the Certificate of the Sanitary Inspectors' Examination Board, and a Certificate as an Inspector of Meat and Other Foods. (c) Health Visitors. There are two whole-time Health Visitors employed in the District; their duties until 31st December, 1926, included those of School Nurse and Tuberculosis Nurse, work under the Notification of Births Act, and in connection with Maternity and Child Welfare and Infectious Diseases. Under a scheme of reorganisation, commencing 1st January, 1927, the Health "Visitors cease to undertake the duties of School Nurse and Tuberculosis Nurse after that date. Both Health Visitors are trained nurses, and hold the Certificate of the Central Midwives Board, and one of them also holds the Health Visitors' Certificate of the Royal Sanitary Institute. (d) Clerical Staff. One whole time shorthand typist clerk is employed in the Public Health Department. 16 (e) Isolation Hospital Staff. The staff consists of the Matron, one Sister, and eight trained Nurses; there are, in addition, a lodge-porter, a disinfecting officer, a boiler attendant, a gardener, and eleven domestic servants included in the permanent staff. (f) Other Staff. Rat Catcher (who also acts as Disinfecting Officer). Public Mortuary Attendant, Superintendent and Matron of the Cleansing Station (part-time) The Officers to whose salary contribution is made under the Public Health Acts or by Exchequer Grants are the Medical Officer of Health, the Chief Sanitary Inspector, and the two Health Visitors. (6) Professional Nursing in the Home. (a) General Nursing. Neither the County Council nor the District Council employ any nurses to undertake general nursing in the homes of the poorer inhabitants of this District. Such work is entirely arranged for by Voluntary Associations, and the Urban District Council make a contribution of £50 per annum to the Mortlake District Nursing Association towards the cost of such services. (b) For Infectious Diseases. No special nurses have been provided for the actual nursing of cases of infectious diseases in the homes of the poor; it is very desirable that such services should be available for cases of measles of a severe type, or with complications, occurring in poor class homes. Such cases should be admitted to a hospital, but it is extremely rare that accommodation at the Isolation Hospital is available for them. (7) Midwives. There are 8 Midwives practising in the District-5 of these are resident within the District, and 3, although resident outside the Urban District, occasionally practise in Barnes. There are no Midwives working in the District employed by or subsidised by a Public Health Authority, and I do not consider such provision is needed. 17 (8) Chemical Work. The County Council is the authority responsible for the administration of the Sale of Food and Drugs Act in this area (vide page 34, for results of examinations of samples by the Public Analyst). For other chemical work the District Council send samples, when required, to an analyst for examination. (9) Bacteriological Examinations. Pathological specimens are examined at the Council's laboratory at the Isolation Hospital. Details of the examinations carried out are given in the section dealing with "Control over Infectious Diseases.'' (10) Public Mortuary. The Council have provided a Public Mortuary, situated in South Worple Way, Mortlake, adjacent to the Isolation Hospital. During 1926 31 bodies, on which post-mortem examinations were conducted and inquests held, were received; of this number 16 were bodies of persons resident in the District, 9 were bodies of non-residents whose death occurred in the District, and 6 were bodies of persons unknown. (11) Legislation in force in the District. List of Adoptive Acts in force in the District, with dale of adoption Adoptive Acts. Portion Adopted. Date of Adoption. Infectious Diseases (Prevention) Act, 1890 The Whole Act 13th Mar., 1894 Public Health Acts (Amendment) Act, 1890 Part II. 28th Sept., 1897 Part III. 11th July, 1893 Housing of the Working Classes Act, 1890 Part III. 8th Dec., 1896 Private Street Works Act, 1892 The Whole Act 8th Aug., 1893 Small Dwellings' Acquisition Act, 1899 The Whole Act 12th Dec., 1899 Public Health Acts (Amendment) Act, 1907 Parts II., III.,IV. (except Sec. 66) 14th July, 1908 Notifications of Births Act, 1907 The Whole Act 8th July, 1913 Public Health Act, 1925 Parts II to V. 23rd Nov., 1925 18 List of Bye-laws and Regulations relating to Public Health in force in the District, with date of commencement of operation. Byelaws Regulations, etc. Statute. Dale coming into Operation. New Streets and Buildings P.H. Act (Amend.) Act, 1890 15th April, 1914 Prevention of Nuisances Public Health Act, 1875 17th Dec., 1894 Cleansing of Earth Closets, &c. Public Health Act, 1875 21st Feb., 1906 Removal of Filth through Streets P.H. Act (Amend.) Act, 1890 22nd Mar„ 1912 Offensive Trades (Fish-Fryers) P.H. Act (Amend ) Act, 1907 28th May, 1913 Slaughter Houses Public Health Act, 1875 17th Dec., 1894 Public Mortuary Public Health Act, 1875 23rd Dec., 1895 Common Lodging Houses Public Health Act, 1875 19th June. 1912 Houses Let in Lodgings Housing & Town Planning Act, 1919 11th July, 1922 Domestic Servants' Registries P.H Act (Amend.) Act, 1907 10th Aug., 1909 Tents, Vans and Sheds Housing of Working Classes Act, 1885 27th Nov., 1897 Fire-escape in Factories and Workshops Factory & Workshops Act, 1901 24th April, 1908 Dairies, Cowsheds and Milk Shops Dairies, Cowsheds, and Milk Shops Order, 1885 13th Oct., 1903 Notification of Measles, &c. City of Leeds (Measles and German Measles) Regulations, 1920 8th Mar., 1920 Notification of Human Anthrax Infectious Diseases (Notification) Act, 1899 5th Mar., 1921 Particulars of the administration of the above-mentioned Acts, Bye-laws, and Regulations will be found referred to under the various subjects to which they relate. Section III. SANITARY CIRCUMSTANCES OF THE AREA. Water Supply. Throughout the district the water supply is from the waterworks of the Metropolitan Water Board direct to the houses. This supply is constant and is ample and of good quality. No case of water-borne disease has been met with in the District during the past year. Almost entirely throughout the area the supply is through a storage cistern; in an increasing number of houses water for drinking purposes is available from a tap on the service pipe. Periodical inspection of storage cisterns in poorer-class dwelling houses has been carried out. The number of cisterns repaired or renewed has been 11, and in 2 instances taps off the main have been provided. River and Stream Pollution. No case of pollution of streams by effluents, solid refuse or filth has come to my notice during 1926. Drainage, Sewerage and Sewage Disposal. There has been no important extension or change during the year 1926 in the drainage or sewerage of the district or in the method of sewage disposal. The water-carriage system of sewage disposal is in use practically throughout the whole area. Numerous defects in connection with drains of occupied houses have been discovered by the Sanitary Inspectors and the defective conditions remedied. Details of these defective conditions will be found on reference to Table X., on page 23. 20 Closet Accommodation. With the exception of 3 earth-closets all closets in the area are water-closets. All water-closets are connected up to the main drainage and sewerage system except eleven, which, being situated in low-lying positions where connection with a sewer is impossible, drain to a cess-pool. There is no privy in the district. The earth-closets and cess-pools have been found in a satisfactory condition. Public Conveniences.—The public conveniences in the District have been regularly inspected by the Sanitary Inspectors, 73 visits having been made during the year Tn four instances informal notices were served in respect of defective conditions discovered, and remedy of the defects obtained. The public convenience at Mortlake Green has been closed, and will shortly be replaced by the erection of a modern convenience providing accommodation for both sexes. Scavenging and Refuse Disposal. The scavenging and the disposal of refuse from the District is carried out by the Surveyor's Department. Collection of House Refuse.—Occupiers are required to deposit house-refuse in sanitary dustbins, kept covered. The refuse is collected, in motor-driven vehicles, once weekly and removed to the Council's Destructor for incineration. It is important that every opportunity should be taken to educate the public as to the necessity of keeping the contents of the dustbin dry, and to this end occupiers are urged to destroy as far as possible decomposable refuse by burning. During the summer months when opportunities for the destruction of such refuse in the house often do not exist, and when such matter decomposes rapidly, creating a nuisance and endangering health by assisting fly-breeding, the removal of house refuse should be undertaken twice weekly. It is of the utmost importance in the interest of public health that the vehicles removing refuse should be kept covered to avoid as far as possible the dissemination of germ-laden dust from the refuse. Movable sanitary dustbins are in use throughout the area except at 10 houses in one street where fixed receptacles exist. During the past year 1 ashpit has been abolished. 21 During 1926, in compliance with notices served by the Sanitary Inspector, 101 new movable sanitary dustbins have been provided. Cleansing and Scavenging of Streets.—Mechanical sweepers are used for this purpose and the road-sweepings are removed by motor vehicles to a tip at the destructor works, or to a tip on Palewell Fields. Disposal of Refuse.—The house refuse removed is incinerated at the Council's Destructor. In addition to the refuse from the Barnes Urban District the house refuse from the Borough of Richmond is also destroyed at the Council's Destructor. During 1926 the amount of refuse destroyed was 19,730 tons, from the Barnes Urban District 10,176 tons, and from Richmond Borough 9,554 tons. Xo nuisance has been experienced in the district arising from the destructor works except a prevalence of flies and crickets complained of by the occupiers of some of the houses erected by the Council near the destructor for housing their workmen employed on the works. Every endeavour has been made to lessen this nuisance as far as possible. The cleansing of the three earth-closets and eleven cesspools in the area is undertaken by the occupiers of the premises. Cleansing has been carried out in accordance with the bye-laws. Sanitary Inspection of the District. The work undertaken during the year under the various Public Health Acts, Bye-laws and Regulations (including the Adoptive Measures given in the table on pages 17 and 18) is shown below in the tabular statement, furnished by the Chief Sanitary Inspector under Article XIX of the Sanitary Officers Order, 1922, containing particulars as to the number and nature of the inspections made by the Sanitary Inspectors during the year, the number of notices (statutory and informal respectively) served, and the result of the service of such notices. The total number of premises visited by the Sanitary Inspectors under the various Acts, etc., in operation was 1,529, the total number of visits paid being 5,558. These figures do not include visits made by the Sanitary Inspector in connection with his duties as Inspector under the Petroleum Act and Shops Acts, neither do they include the visits made to premises by the Ratcatcher. Legal Proceedings. It was not found necessary to institute legal proceedings in any case during 1926. 22 Table IX.— Showing the number and nature of the inspections made by the Sanitary Inspectors during 1926, the number of Notices served in respect of defects found in the course of inspection, and the number of Notices complied with. Nature of Inspections. Number of Premises Visited. Number of Visits of Inspection and Reinspection. Action taken in respect of defective conditions. Informal Notices. Statutory Notices. Number issued. Complied with. Number issued. Complied with. Milkshops 24 52 4 4 - — Butchers' Shops 32 217 1 1 — — Fishmongers and Poulterers 13 18 3 3 - - Greengrocers 29 45 2 2 — — Cooked-provision shops 6 15 1 1 - - Ice-cream shops 35 35 10 10 — — Restaurants 18 11 5 5 — — Fried-flish Shops 5 48 — — — — Slaughter-houses 1 51 — — — — Bakehouses 15 31 5 5 — — Factories 3 40 2 2 — — Workshops 97 125 1 1 — — Workplaces 33 87 — — — — Home-workers 17 54 — — — — Schools 32 61 — — — — Places of Amusement 5 5 — — — — Van Dwellers 5 5 — — — - Servants' Registries 8 8 1 1 — — Marine Stores 2 2 — — — - Stable Yards 35 306 4 4 1 1 Public Conveniences 35 73 4 4 — — Dwelling - houses (including houses let in lodgings):— (1) House-to-House Inspection 124 4269 648 570 40 15 (2) Inspected on complaint 280 (3) Inspected in course of other work:— (a) Housing work, etc. 473 (b) For infectious Diseases 202 Totals 1529 5558 691 613 41 16 23 Table X.—Defective Conditions Remedied. Drainage. Sewers cleared or repaired 6 Drains inspected on complaint 38 „ water tests applied 106 „ smoke tests applied 64 „ cleansed or repaired 87 „ relaid 34 „ reconstructed 35 „ ventilated 3 Inspection Chambers repaired 34 „ „ new provided 51 Interceptors—caps fixed 4 Soil Pipes renewed 3 „ „ new provided 24 Ventilating Shafts repaired 5 „ „ new provided 5 Fresh air inlets repaired or new provided 22 Rain-water pipes disconnected from drains 8 Water Closets. Pans and traps provided 74 Waste water preventers repaired 28 „ „ „ new provided 8 „ „ „ water supplied 12 Apartments repaired 69 „ lighted and ventilated 2 Sinks and Baths. Repaired or newly fixed 29 Waste pipes repaired 7 „ „ newly fixed 19 „ „ trapped 4 Cesspools. Abolished 0 Urinals. Repaired or cleansed 2 New provided 1 Water Supply. Cisterns repaired or renewed 11 Taps off main provided 2 24 Dustbins. Provided 101 Ashpits abolished 1 Yards. Paving repaired 60 Newly Paved 20 Dampness. Roofs repaired 82 Gutters and rain water pipes repaired 32 Damp proof courses provided 20 External walls repointed 51 Floor spaces ventilated 4 Dangerous structures repaired or rebuilt 6 Sites below floors concreted 2 General. Food larders ventilated or new provision provided 4 Windows repaired 19 „ made to open 1 Stairs repaired or handrails provided 12 Grates repaired or renewed 17 Smoky chimneys remedied 2 Washing coppers repaired 10 Walls and ceilings—plaster repaired 90 „ „ stripped and redecorated 211 Floors repaired 34 Verminous premises fumigated and cleansed 7 „ bedding cleansed or destroyed 2 Offensive accumulations removed 56 Miscellaneous defects remedied 19 Animals improperly kept 2 Stables. Premises cleansed 1 Manure receptacles provided or repaired — Floors and yards properly paved and drained - Injected Rooms and Articles. Rooms disinfected 206 „ stripped and cleaned 34 Schools disinfected 2 Lots of bedding disinfected 155 „ „ destroyed 6 25 Factories, Workshops, and Home-workers.—The work carried out in connection with the inspection of factories, workshops and home-workers is summarised in tabular form below. The numbers of these premises on the Council's Register at the end of year were:—factories 46, workshops and workplaces 130, home-workers 17. The factories, workshops and workplaces have been routinely inspected by the Sanitary Inspectors, and premises occupied by home-workers have been kept under observation in connection with the prevention of spread of infectious disease. The number of factories, workshops, workplaces and homeworkers' premises visited, and the number of visits of inspection made to each are given in Table IX., on page 22. As regards action taken in matters referred by H.M. Inspectors of Factories as remediable under the Public Health Acts, but not under the Factory and Workshops Act, 1901, Sec. 5, notifications were received from H.M. Inspector in regard to two matters, and reports of action taken in each of them were sent to H.M. Inspector. Table XI.—Inspection of Factories, Workshops & Workplaces. PREMISES. Number of Inspections. Written Notices Prosecutions. Factories (Including Factory Laundries) 42 2 — Workshops (Including Workshop Laundries) 125 6 - Workplaces (Other than Outworkers' premises) 87 - - Total 254 8 — 26 Table XII.—Defects found in Factories, Workshops and Workplaces. PARTICULARS. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector Nuisances under Public Health Acts:— * Want of cleanliness 5 5 — — Want of Ventilation — — — — Overcrowding — — — — Want of drainage of floors 1 — — — Other nuisances — — — — Sanitary accommodation insufficient 2 — — — - - - - not separate for sexes 2 1 — — Offences under the Factory and Workshop Acts:— Illegal occupation of underground bakehouse (s. 101) - - - - Other offences (Excluding offences relating to outwork and offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921.) - - - - Total 10 6 — - *Including those specified in sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. Table XIII.—Showing the number of Home-workers on the Register, and the nature of the Work undertaken by them. Nature of Work. Number of Home Workers. Boot Repairers 1 Fancy Needleworkers 8 Furriers 1 Tailors 7 Total 17 27 Smoke Abatement. The area not being an industrial area nuisances from smoke are of rare occurrence. The chimneys of the factories and other buildings have been kept under observation. No proceedings became necessary during the year. Premises and Occupations which are controlled by Bye-laws or Regulations. Houses Let in Lodgings.—On account of the continued shortage of houses the number of houses which are let in lodgings or occupied by members of more than one family is still very •considerable. At the end of the year 1926 there were 196 houses on the Register. There is, therefore, only too frequently, very inadequate provision for personal cleanliness, for cooking, and for the proper storage of food, and insufficient water-closet accommodation; these can only be adequately provided by structurally altering the houses. Action has been taken in respect of some of the houses let under such unsatisfactory conditions. Common Lodging Houses.-There are no common lodging houses in the district. Underground Sleeping Rooms.—There is likely to be an increase in the number of underground rooms used habitually as a sleeping-place as the larger houses with basement rooms become let for occupation by several separate families. In such circumstances it is not uncommon to find one of the families living entirely in the underground rooms of the house, the rooms which are used as sleeping places being unfit for that purpose. A Closing Order was made in respect of one underground room which was habitually used as a sleeping place. This underground room, I regret to say, still continues to be occupied. Tent and Van Dwellers.—Bye-laws are in force in the District. There are no tent or van dwellers permanently located in the area ; caravans occasionally come into the District attached to fairs, and they are kept under general supervision. Servants' Registries.—Registries for female domestic servants are controlled by bye-laws in force in this District; there are eight such premises on the Register Inspection during the year disclosed a breach of the bye-laws in one case, the records not having been properly kept. Offensive Trades.—The only offensive trade carried on in the area is that of fish frying, which has been declared to be an 28 offensive trade "within the Barnes Urban District, and is controlled by bye-laws. There were on the Register during the year five premises on which fish frying was permitted. No breach of the bye-laws was discovered. Rats and Mice (Destruction) Act, 1919. The Council have continued to employ a whole-time ratcatcher acting under the supervision of the Sanitary Inspector to assist in the work of rat destruction and so reduce the amount of damage and risk to health arising from these rodents. Inspections are made periodically of premises likely to harbour rats; during the year, 181 complaints of the presence of rats on premises were received by the Sanitary Inspector. The ratcatcher paid 270 visits to premises, and 331 visits to open spaces, including the Commons, market gardens and orchards, and the banks of the Thames and the Beverley Brook. Poison baits were laid at 25 premises. The number of rat-tails brought to the Public Health Office by the rat-catcher during the year was 933. In 1926, during the first week in December a Rat-week was again held as in the previous year; a film depicting "The Rat Menace,'' lent by the Ministry of Agriculture and Fisheries, was shown at the East Sheen Picturedrome by the courtesy of the management, and leaflets were distributed to the public as they entered and left the building. In addition, two lantern lectures on "The Story of the Rat" were given by the Sanitary Inspector at the Technical Institute. Schools. There are 13 Public Elementary Schools, and 19 Private Schools in the District, and the sanitary accommodation and general sanitary conditions have been found, on inspection, to be very satisfactory on the whole. The defective condition of the slate-slabbing of the urinals at certain of the Schools having been brought to the notice of the School Managers, the slates in question were replaced by glazed fire-clay. The Sanitary Inspector reports that this has been a great improvement. Careful investigations have been made into all outbreaks of infectious diseases amongst scholars attending either public elementary or private schools, and the procedure with regard to exclusion, referred to in detail in my Survey Report for 1925 (pages 38 to 40), has been continued during 1926 as in previous years. 29 Section IV. HOUSING. The housing situation in this District was fully reviewed in my Survey Report for 1925 (pages 41 to 50); there has been little alteration in the general housing conditions in the area during the past year. The number of new houses erected approximated to the average of the number built in the two preceding years. For purposes of comparison, the number of houses erected during 1926 and during each of the preceding ten years is given hereunder. 1915. 1916. 1917. 1918. 1919. 1920. 1921. 1922. 1923. 1924. 1925. 1926. 108 55 33 0 6 69 149 110 188 311 382 326 in spite of the large number of houses erected during the past three years there has not been any marked reduction of the overcrowding which existed in the District. At the end of 1926 there were still 24 cases of serious overcrowding known to exist; instances of overcrowding of a lesser degree were numerous. Every endeavour has been made to keep up the general standard of housing. During the year 877 dwelling houses were inspected for housing defects, and in 648 of these houses defective conditions were discovered; a detailed list cf the defects found and remedied is given in Table X, page 23. In connection with the work. 4,067 visits to premises were made by the Sanitary Inspectors. Closing Orders in respect of 5 dwelling houses represented as unfit for human habitation were made by the Council in 1926. These houses, however, are still occupied. No complaints have been received, nor representations made during the year in respect of any "unhealthy area." 30 Housing Statistics for the Year 1926. Number of new houses erected during the year: — (a) Total (including numbers given separately under (b)) 326 (b) With State assistance under the Housing Acts:- (1) By the Local Authority 27 (2) By other bodies or persons 0 1. Unfit dwelling houses. Inspection—(1) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 877 (2) Number of dwelling houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910, or the Housing Consolidated Regulations, 1925 124 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 5 (4) Number of dwelling houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects "reasonably fit for human habitation" 648 2. Remedy of Defects without Service of formal Notices. Number of defective dwelling houses rendered fit in consequence of informal action by the Local Authority or their Officers 570 3. Action under Statutory Powers. A.—Proceedings under section 3 of the Housing Act, 1925. (1) Number of dwelling houses in respect of which notices were served requiring repairs 1 (2) Number of dwelling houses which were rendered fit after service of formal notices:— (a) by owners 0 (b) by Local Authority in default of owners 0 (3) Number of dwelling houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close 0 31 B.—Proceedings under Public Health Acts. (1) Number of dwelling houses in respect of which notices were served, requiring defects to be remedied 40 (2) Number of dwelling houses in which defects were remedied after service of formal notices:— (a) by owners 15 (b) by Local Authority, in default of owners 2 C.—Proceedings under sections 11, 14 and 15 of the Housing Act, 1925. (1) Number of representations made with a view to making of Closing Orders 5 (2) Number of dwelling houses in respect of which Closing Orders were made 5 (3) Number of dwelling houses in respect of which Closing Orders were determined, the dwelling houses having been rendered fit 0 (4) Number of dwelling houses in respect of which Demolition Orders were made 0 (5) Number of dwelling houses demolished in pursuance of Demolition Orders 0 32 Section v. INSPECTION AND SUPERVISION OF FOOD. Milk Supply. The source of the whole of the milk supplied to the inhabitants is from other areas, no milk being produced in this District. All the milk-shops have been kept under close supervision by the Sanitary Inspectors, and have been generally found to be kept in conformity with the requirements of the Milk and Dairies Order, 1926. In four instances during the year defects were found, but these were remedied on informal notices. There were at the end of the year; 24 milkshops on the Register; in addition there were four firms registered as retailers of milk in the District who retailed milk from premises situated outside the District. There is no cowshed in the area. Tuberculous milk and Tuberculous cattle.—No instance has occurred where there was reason to suspect that tuberculosis was caused or likely to be caused by the consumption of milk sold in the District. The Council is not a Local Authority for the purposes of the Diseases of Animals Act, 1894. Designated milk.- Two purveyors of milk in this District were granted supplementary licences in accordance with rhe Milk (Special Designations) Order, 1922, to retail "Certified" milk within the District in 1923, and both of these firms have continued to supply "Certified" milk since that year. One purveyor of milk was granted a supplementary licence to retail "Grade A"' milk, and another firm was granted a licence to retail pasteurised milk, designated as such, from eight dairies in the District. Refusal or Revocation of Registration.—It has not been found necessary to revoke any registrations during the year. Bacteriological examination of milk.—In the case of both purveyors who are retailing graded milk in this District the primary licences are granted by the Local Authority of a neighbouring district. In accordance with arrangements made by the 33 Ministry of Health, periodical samples for examination bacteriologically are taken by the Local Authority for that District, sampling by the Local Authority by whom the supplementary licences are granted not being required. Adulteration.-Seventy-four samples of milk were taken by the County Inspector under the Sale of Food and Drugs Acts, and two of these samples were found to be adulterated. Proceedings were not taken in respect of any of the adulterated samples. Meat. Inspection of Meat.—There is only one licensed slaughter-house in the District. Inspection of meat at the slaughter-house has been carried out by the Sanitary Inspector, who is a Certified Inspector of Meat, on every occasion of slaughtering. In accordance with the Public Health (Meat) Regulations, 1924. 68 notices of intention to slaughter were received during the year, and in consequence the following carcases were examined: Cattle, 38; Sheep, 42; Calves, 14; Swine, 69. One carcase, that of a heifer, was. found to be diseased with generalised tuberculosis and was destroyed. Inspection of Butchers' Shops.—The butchers' shops in the District number 32; these shops, and, in addition, shops at which bacon and ham are sold, have been frequently visited by the Sanitary Inspector, 217 visits of inspection having been made. Tn no instance was diseased meat found exposed for sale; and it was not found necessary in any instance to institute proceedings under the Public Health (Meat) Regulations, 1924, in respect of proper cleanliness not being observed in the handling of meat. Slaughterhouses.—There is no public slaughter house in the area. There is one private slaughterhouse which has continued to be licensed annually up to the present time ; this slaughterhouse has been kept in a satisfactory condition. Other Foods In addition to the above-mentioned premises where meat and milk are dealt with, other places where food is sold, stored or prepared for sale or consumption, such as greengrocers, fishmongers, poulterers, restaurants and eating houses, cooked provision shops, fried-fish shops and bakehouses, have been periodically inspected by the Sanitary Inspectors. The number of each of these premises in the District, the visits of inspection, and the number of defects found are given in the Table on page 22. 34 The following articles of food in an unsound condition were surrendered voluntarily and destroyed:—Four cases of fish and 101b. of strawberries. Premises where ice cream is prepared or sold have been visited. Thirty-five such premises have been inspected, and it was found necessary to issue informal notices in 10 instances with regard to the unsatisfactory conditions under which the ice cream was either prepared or sold. There are 15 bakehouses in the District, three of which are underground bakehouses. In 5 instances defective conditions called for the issue of informal notices, mainly in connection with whitewashing, otherwise reasonable care has been taken to ensure cleanliness and freedom from contamination of the food. Sale of Food and Drugs Acts: Milk and Cream Regulations. The Council of this District is not a Local Authority under the Sale of Food and Drugs Acts; these Acts are administered by the Surrey County Council, and the County Medical Officer has supplied me with the information contained in the following Table setting out the work undertaken in this District by the County Inspectors. Table XIV.—Return of Samples Analysed during the Year ending 31st December, 1926. Articles. Analysed. Adulterated or deteriorated Prosecutions. Convictions. Formal. Informal. Total. Formal. Informal Total. Milk 74 1 75 2 - 2 - - Cream 3 — 3 2 — 2 — — „ Preserved 4 — 4 - - - - - Butter — 2 2 — — — — — Cheese — 1 1 - — — — — Wine 2 — 2 2 — 2 — — Spirits 5 — 5 1 — 1 — — Other Articles 2 10 12 - 3 3 - - Totals 90 14 104 7 3 10 - — 35 Section VI. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS DISEASES. The incidence of infectious diseases in the area is a comparatively low one for an urban district in close proximity to the County of London . Particulars of the incidence and distribution of the cases of infectious disease notified during the year 1926 are set out in Table XVI in which the number of cases removed to hospital and the number of deaths in the District from these diseases are also shown. In table XV the seasonal prevalence during 1926 is shown. The prevalence of the various notifiable infectious diseases during 1926 is shown in Table XVII, which gives, for comparison, the number notified during each of the previous 10 years. Table XV.—Showing the Notifications of Infectious Diseases received during 1926 arranged in four-weekly periods Four-weekly period ending Diphtheria. Scarlet Fever. Measles. Enteric Fever. Pulmonary Tuberculosis. Non-pi:linonary Tuberculosis. Pneumonia. Erysipelas Ophthalmia Neonatorum. Poliomyelitis. Puerperal Fever. Jan. 30 i 3 106 - 2 2 2 1 - - - Feb. 27 2 14 188 — 3 1 2 2 1 - - Mar. 27 2 8 177 - 6 1 4 2 - - - April 24 1 9 83 - 1 — 3 1 — - - May 22 — 13 39 - 4 — 3 - - - - June 19 2 5 20 — 3 — — - - - - July 17 — 6 2 - 4 — — - — - l Aug. 14 1 6 — — 4 — — - — - - Sept 11 1 1 2 - 4 — 2 1 - — - Oct. 9 2 2 — — 6 — 1 - - l - Nov. 6 — 2 — - 4 1 — - — - - Dec. 4 — 7 — 1 2 1 3 1 — - - „ 31 — 4 1 — 4 — 6 — - — — Totals 12 80 618 1 47 6 26 8 1 l 1 36 Table XVI.—Notifiable Infectious Diseases, 1926. Diseases. Total Cases Notified. Ages, in years. Parish. Removed to Hospital. Total Deaths of Residents.  Under 1 year. 1 to 2. 2 to 3. 3 to 4. 4 to 5. 5 to 10. 10 to 15. 15 to 20 20 to 25. 25 to 35 35 to 45. 45 to 65. 65 and Over. Barnes Mortlake. Diphtheria 12 — — 2 - 1 3 2 2 1 - - 1 — 8 4 10 — Scarlet Fever 80 1 — 1 — 4 46 14 8 1 1 3 1 — 37 43 71 — Enteric Fever 1 - - - - - — - - 1 — — - - 1 - 1 — Pneumonia 26 - 2 1 2 2 2 2 1 1 1 3 9 - 8 18 - 14 Pul. Tuberculosis 47 - - - - - - - 4 9 15 5 10 4 17 30 *47 16 Non-Pul. Tuberculosis 6 — 1 — - — 1 - 1 2 1 - — 3 3 7 1 Erysipelas 8 — - - - — - — - - 2 2 3 1 3 5 - — Ophth. Neonatorum 1 1 - — — - - - — — — - - - 1 — — — Ant. Poliomyelitis 1 - - - - - - 1 - - - - - - — 1 1 — Puerperal Fever 1 - — - - — - — - — - 1 - — 1 — - — Measles 618 17 29 37 51 50 310 70 27 12 9 6 - — 172 446 - 3 Rubella 216 3 3 3 9 9 91 52 21 10 7 7 1 — 47 169 - - All Diseases 1017 22 35 44 62 66 452 142 63 36 37 28 25 5 298 719 127 34 *Three of these 47 tuberculous patients were admitted to the Isolation Hospital, Mortlake; the remaining 44 were admitted to the other institutions outside the District, viz., 28 to Sanatoria, 5 to Poor-law Institutions and 11 to other Hospitals for advanced cases. †The deaths recorded in this column are the total corrected number of deaths assignable to the District, and arc not necessarily deaths of persons recorded as notified during the year. 37 Table XVII.—Notifiable Infectious Diseases, 1916 to 1926. Year. 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1925 Diphtheria 34 28 29 42 103 90 65 20 59 46 12 Scarlet Fever 94 37 32 88 69 108 100 74 60 102 80 Enteric Fever 2 6 — - 3 1 — 1 7 1 1 Puerperal Fever 1 — 3 2 4 — 1 3 1 — 1 Erysipelas 8 8 2 13 13 6 6 9 7 12 8 Continued Fever — — — — — — — — — — — Relapsing Fever - - - - - - - - - - - Typhus Fever - - - - - - - - - - - Small-pox — - - - - - - - - - - Cholera - - - - - - - - - - - Plague — — — — — — — - — — — Tuberculosis, P. 55 54 58 44 35 52 52 34 36 36 47 „ Non-P. — 14 17 12 6 4 10 11 12 8 6 Cerebro-spinal Fever 3 4 2 2 - - - - - 1 - Poliomyelitis 3 — 1 - — — — 3 2 1 1 Ophthalmia Neonatorum 1 3 2 3 3 1 3 3 2 2 1 Measles 229 451 742 83 472 44 590 76 784 218 618 Rubella 200 292 25 76 98 4 — 6 16 153 216 Encephalitis Lethargica * * * 2 1 5 - 2 1 3 - Polioencephalitis * * * - - - - - 2 - - Malaria * * * 18 12 - - - - - - Dysentery * * * 1 1 — — — — — — Trench Fever * * * 3 1 - — - - - - Pneumonia * * * 67 35 34 29 26 22 17 26 Anthrax * * * — — — — — — — — *Not Notifiable. Notifiable Infectious Diseases (excluding Tuberculosis). Small-pox. During the past year no case of small-pox occurred in this District. The number of cases of small-pox notified in England and Wales during 1926 was 10,205. A number of intimations have been received from Port Sanitary Authorities of persons who have been exposed to the infection of small-pox on board ship and who have given an address in this District as their place of destination; all such contacts have been visited, advised as the desirability of being vaccinated if not already protected, and instructed to report at once if ill. 38 Vaccination.—I have not in my capacity of Medical Officer of Health had occasion to perform any vaccinations under the Public Health (Small.pox Prevention) Regulations, 1917. The following particulars with reference to the state as regards, vaccination on the 31st December, 1926, in respect of the 435 infants whose births were registered between 1st January and the 31st December, 1926, have been supplied to me by the Vaccination Officer for the District: — Births registered 435 Certificates of successful Vaccination 341 Certificates of exemption (statutory declarations) 90 Diphtheria. —Remarkably few cases of this disease occurred in the District during 1926; only twelve cases were notified, being the smallest number notified in any year since 1894, when there were eleven cases. No case occurred during the last three months of the year. The relative freedom of the District from diphtheria is all the more remarkable as the incidence of the disease in the County of London was high. The incidence (cases per 1,000 of the population) for Barnes was 0.33, that for London being 2.97, and for England and Wales 1.36. No death from diphtheria occurred in this District. The Mortality Rate (deaths per 100 cases) for London was 3.95. The incidence.rate (cases per 1,000 of the population), the percentage of notified cases removed to Hospital, and the mortality. rate per 100 cases during the year 1926 and during the previous 10 years are given in the subjoined Table. Table XVIII.—Diphtheria. Year. Number of Cases Notified. Number of cases removed to hospital Number of Deaths. Incidence Rate. Cases per 1,000 of Population. Percentage Removed to Hospital. Mortality Rate per 100 cases. 1916 34 25 1 1.06 74 2.94 1917 28 27 1 0.86 96 3.57 1918 29 28 3 0.89 97 10.34 1919 42 38 4 1.27 90 9.52 1920 103 56 7 3.07 54 6.80 1921 90 77 1 2.88 84 1.10 1922 65 61 3 1.90 94 4.61 1923 20 17 1 0.59 85 5.00 1924 59 57 6 1.71 97 10.17 1925 46 45 3 1.31 98 6.52 1926 12 10 0 0.33 83 0.00 39 The preventive measures taken during 1926 have been similar to those followed in the past five years; full details of these have been given in previous annual reports. Use has not so far been made of the Schick test nor of the recently developed artificial methods of immunisation against diphtheria. Diphtheria antitoxin is supplied to Medical Practitioners applying for it for their patients resident in this District; a supply is immediately available on application at the Isolation Hospital. Antitoxin supplied in this way is charged for at cost price unless the patient to whom it. was administered is subsequently admitted to the Isolation Hospital, in which case no charge is made. Scarlet Fever.—The incidence of scarlet fever during 1926 was about the average for the District; the disease was most prevalent during the first three months of the year. Eighty cases were notified and seventy-one of these were removed to the Isolation Hospital. The prevalence of scarlet fever and the mortality from this disease during the year 1926, and for the previous 10 years will be seen from details given in the Table below. Table XIX.—Scarlet Fever Year. Number of Cases Notified. No. of Cases removed to Hospital. Number of Deaths. Incidence Rate: Cases per 1,000 of Population. Percentage removed to Hospital Mortality Rate per 100 Cases. 1916 94 81 2 2.94 86 2.13 1917 37 35 0 1.12 95 0.00 1918 32 25 1 0.99 78 3.13 1919 88 63 0 2.65 72 0.00 1920 69 57 1 2.02 83 1.45 1921 108 83 1 3.18 77 0.92 1922 100 85 4 2.93 85 4.00 1923 74 69 0 2.15 93 0.00 1924 60 60 1 1.73 100 1.66 1925 102 91 0 2.90 89 0.00 1926 30 71 0 2.21 89 0.00 The incidence rate (cases per 1,000 of the population) in Barnes was 2.21, the rate for London being 2.69, and that for England and Wales. 2.09. 40 No death occurred during the year in this District, the Mortality Rate (death per 100 cases) for London was 0 66. The preventive measures detailed in my Annual Report for 1925 (page 64) have been continued during the past year. Use has not so far been made of the Dick test. Enteric Fever..—During 1926 only one case of enteric fever was notified, the infection being with Bacillus Paratyphosus B." Infection occurred in Ireland; the patient, who had been staying there with friends, returned to this District only a few hours before the onset of his illness. The patient was removed to the Isolation Hospital, and recovered. No further case occurred. The incidence rate of enteric fever in this District was 0.03 per 1,000 of the population, compared with an incidence rate of 0 07 for London, and 0.08 for England and Wales. Measles.- This disease was epidemic during 1926 and 816 cases were notified; in addition, 216 cases of German measles were notified. This epidemic occurred in the winter months, being at its height during February and March, and there were a large proportion of cases with pulmonary complications. . Eight deaths occurred corresponding to a death.rate of 0'22 per 1,000 of the population; the death.rate for London was 0.20, and for England and Wales 0 09. Non-Notifiable Infectious Diseases. Whooping Cough.—During 1926 whooping cough was not unduly prevalent. One death occurred, corresponding to a death. rate of 0 03 per 1,000 of the population contrasted with a death. rate of 0 • 05 for London, and 0.10 for England and Wales. Influenza.—This disease was of a less serious type than in recent years. The death.rate in Barnes was 0.25 for 1926, contrasted with a death-rate of 0.37 and 0 52 for 1925 and 1924 respectively. Tuberculosis. During 1926 47 cases of pulmonary tuberculosis and 6 cases of non-pulmonary tuberculosis were notified, representing an incidence-rate of 1.28 cases per 1.000 of the population for pulmonary tuberculosis, and 1 .44 for all forms of the disease. 41 The death-rate in this District during 1926 was 0.69 per 1,000 of the population for pulmonary tuberculosis, and 0.74 for all forms of the disease. Particulars of the new cases of tuberculosis coming to the knowledge of the Medical Officer of Health during the year 1926 and of the deaths which occurred during that year are given in Table XX below. Of the 52 new cases of pulmonary tuberculosis 47 were primary notifications, the other four being transfers from other areas. Table XX.—Tuberculosis: New Cases and Mortality during 1926. AGE-PERIODS. NEW CASES.* DEATHS. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. Male Female Male Female Male Female Male Female 0-1 years - - - - - - - - 1-5 „ — — 1 — — - — — 5-10 „ - - - - - - - - 10 15 „ - - 2 - - - - - 15-20 „ 1 3 - - 1 - - - 20-25 „ 1 9 1 l 3 4 - - 25-35 „ 10 5 1 1 2 1 1 — 35-45 „ 3 4 — l 3 3 — l 45 55 „ .5 1 - - 3 1 - - 55-65 „ 4 2 - - 3 1 - - 65 „ and over 3 1 - - - - - - All ages 27 25 5 3 15 10 1 1 * In addition to primary notifications, all other new cases coming to the knowledge of the M.O.H. are included in these figures. Notification of Tuberculosis.—There were 27 deaths from tuberculosis assignable to this District during 1926, 17 were deaths of residents who died within the District, and 10 were transferable deaths of persons who had formerly been residents but who died at addresses elsewhere. There was one instance only amongst the twenty-seven deaths in which a notification under the Tuberculosis Regulations had not been received in this District during the life-time of the patient. 42 There has been a very decided improvement in notification during the past six years; in every case of failure to notify the medical practitioner has been communicated with and reminded of his obligations under the Regulations. No instance has occurred in which it was necessary to institute proceedings. The Register of Notifications has been kept revised in accordance with the requirements of the Public Health (Tuberculosis) Regulations, 1924, and the number of cases added to or removed from the Register during the year and the number remaining on the Register on December 31st, 1926, are as under:— Table XXI. Form of Disease. On Register 1st Jan., 1926. New Cases Added. Removed from Register. Remaining on Register, 31st Dec. 1926. Primary Notif ns Otherwise. Total Cured. Left District. Died. Total. Pulmonary 203 47 5 52 13 13 21 47 208 Non-Pulmonary 68 6 2 8 8 2 5 15 61 All Forms 271 53 7 60 21 15 26 62 269 Preventive work carried nut by the Council. The same measures of prevention have been followed during 1926 as detailed in my Report for 1925 (page 71). A total of 270 home-visits were made by the Health Visitors in connection with patients suffering from tuberculosis. It has not been found necessary to take action during the year under the Public Health (Prevention of Tuberculosis) Regulations, 1925, in respect of any tuberculous persons employed in the milk trade, nor has there been any occasion for compulsory removal to hospital under Section 62 of the Public Health Act, 1925 to be resorted to. Treatment—Dispensary and Institutional —The Surrey County Council is the Local Authority responsible for the treatment of all tuberculosis cases within the Urban District. The District Medical Officer of Health, however, acts as Tuberculosis Officer, and the two Health Visitors carry out the work of Tuberculosis Nurses under the County Council's Scheme. Statistical returns as to the work carried out have been furnished to the County Medical Officer, and will be included in his Annual Report. 43 Isolation Hospital. Diseases under treatment at the Isolation Hospital have been mainly Diphtheria, Scarlet Fever and Pulmonary Tuberculosis. The cases admitted during 1926, together with the deaths that occurred, are given in Table XXII. Table XXII.—Isolation Hospital: Admissions and Deaths, 1926. DISEASE. ADMISSIONS. DEATHS. Diphtheria 10 - Tonsilitis Notified as Diphtheria 3 - Influenza 1 - Scarlet Fever 71 — Rubella, Notified as Scarlet Fever 2 — Enteric Fever 1 - Pulmonary Tuberculosis 42 11 Hystero-epilepsy* 1 — All Diseases 131 11 *This case was admitted as a suspected case of Encephalitis Lethargica. Diphtheria cases admitted.—Very few cases of diphtheria were under treatment during 1926. Of the twelve cases notified, ten were admitted to the Isolation Hospital. Five of the cases admitted were mild in degree, three were moderately severe, and two were severe, one of them being dangerously ill at the time of admission. No death occurred. Scarlet Fever cases admitted.—Seventy-one of the eighty cases notified were admitted to Hospital. No death occurred. Complications were as follows:—Adenitis, 8 cases; Rhinorrhœa, 6; Otorrhœa, 9; Mastoid abscess, 1 (double mastoid); Albuminuria, 9; and Arthritis, 1 case. 44 During the greater part of the year the cases were mostly mild in type, but cases admitted during the last two months were very acute, and early otorrhœa occurred in a large proportion of these cases. There was no "return case" during the vear. Tuberculosis cases admitted.—Forty-two patients suffering from Pulmonary Tuberculosis were admitted during the year, two of the patients being from the Barnes Urban District, and forty from other areas in the County of Surrey. Eleven of these patients died in the Hospital; 21 were discharged (twelve of these, having shown considerable improvement, were transferred to sanatoriums, the remaining 9 returned to their homes). Ten of the patients remained under treatment at the end of the year. Administration-Cross-Infection. -Cases of cross-infection during the year were very few. especially considering the limited provision which exists for isolation purposes. Particulars as to the cases of imported infection, and the number of cases of cross-infection that have arisen from them, during the past five years are given below. SCARLET FEVER WARD. Diseases concurrent on admission:— Scarlet Fever and Chicken-pox, I case: resulting cross-infection, 2 cases. Scarlet Fever and Whooping Cough, I case: „ „ I case. A dmitted in the incubation stage of a second infection: — {incubating Measles, I case: Admitted with Scarlet Fever { resulting cross infection, none. DIPHTHERIA WARD. No case of cross infection. Incidence of infectious disease amongst the staff.—A nurse, engaged temporarily from a Nursing Home, and on duty in the Scarlet Fever Ward, contracted scarlet fever. Accommodation for Patients and Staff.— Extensions are now being made at the Hospital to provide increased accommodation for the patients and for the necessary staff. The new buildings will be completed and put into use during the coming year. Details of the nature of the extensions were given in my Survey Report for 1925 (page 80). 45 Laboratory. A laboratory is provided by the Council at the Isolation Hospital. Pathological outfits are supplied to medical practitioners and specimens from their patients residing in the District are examined free of charge. The bacteriological examination of specimens from patients in the Hospital is also undertaken in the laboratory. Examinations undertaken during the year were as follows: — For the detection of tubercle bacilli 159 For the detection of diphtheria bacilli 293 Total 452 Disinfection. Disinfection is carried out by the staff of the Health Department. For the disinfection of rooms vacated by persons suffering from infectious disease formaldehyde vapour is used. Infected bedding and clothing is removed for steam disinfection at the Disinfecting Station attached to the Isolation Hospital. The number of rooms disinfected after infectious disease during 1926 was 206, and 202 lots of bedding and clothing were steam-disinfected. Cleansing and Disinfestation of Verminous Persons. The Council have provided a Cleansing Station situated at the Council's Depot for the disinfestation of verminous persons and their belongings. In 1921 arrangements were completed whereby the Council's Cleansing Station was made available for the purpose of cleansing children attending the Public Elementary Schools who, on account of their persistently verminous condition, were removed there from the Schools under powers conferred by Section 122 of the Children Act, 1908. In addition the Cleansing Station has been made use of for the treatment of children and adults affected with scabies. The use of the cleansing station for dealing with persistently verminous children has had very satisfactory results, and1 the improvement in the cleanliness of children in the schools has been pronounced1. During 1926 4 children only were treated at the Cleaning Station for verminous condition of the head; attendances for the treatment of scabies numbered 14. 46 Section VII. MATERNITY AND CHILD WELFARE. Hitherto, whilst the Urban District of Barnes has been the Local Authority for the purpose of carrying out the Notifications of Births Act, 1907, in this area, the work under the Maternity and Child Welfare Act, 1918, has been undertaken by the Surrey County Council as part of the County Scheme for Maternity and Child Welfare. From the 1st January, 1927 the Urban District Council will carry out directly the whole of the Maternity and Child Welfare work. Infantile Mortality.—Measures carried out under the Maternity and Child Welfare Act has had a very pronounced effect in reducing the rate of mortality amongst infants under 1 year of age in this District. The infantile mortality for 1926 was 50 per 1,000 registered births. In 17 of the 27 deaths assignable to the District, death occurred before the infant was 2 weeks old, a fact indicating the need for preventive measures to be begun as early as possible, indeed, the importance of ante-natal measures is clearly shown by the very large proportion of the deaths which had occurred at this very early age. In 14, or half the total deaths, the infants died within the first week of life, in fact, 9 deaths, one-third of the total, occurred within 24 hours of birth. Maternal Mortality.—There was no death during 1926 either from puerperal fever or other diseases or accidents of pregnacy and childbirth. The deaths from these causes during the previous 5 years were respectively 2, 1, 3, 1 and 1. Puerperal Fever.—One case of puerperal fever was notified in 1926. The case was a serious one, sepsis following a still-birth in which there had been severe ante-partum haemorrhage from placenta prsevia ; the patient recovered. This case was not removed to Hospital. 47 Notification of Births Act, 1907. Of the 435 births registered during the year 420, or 96.6 per cent., were duly notified in accordance with the provisions of the above-mentioned Act. Of the 420 births notified 174 were notified by medical practitioners, 230 by midwives, and 16 by other persons. In every instance in which there was at failure to notify a birth the person, or persons, responsible have been communicated with and reminded of their obligations under the Act. Still-births.—There were 10 still-births notified during 1926, representing 2.3 percent. of the total births occurring in the year. Enquiries were made into each of these cases. Home-Visiting. The Health Visitors have made visits to the homes of all newly-born infants amongst the working-classes. During 1926 the total notifications of birth received numbered 420; 372, or 89 percent., of these were home-visited, the visits being made as soon as possible after the birth. In a large number of the cases visited the infants were subsequently brought to the Infant Welfare Clinics, the number thus persuaded to attend, 121, being very satisfactory considering the character of the District. Infants and young children who were not brought to the Centre, and in whose case the particular circumstances indicated any need for following-up, were re-visited periodically by the Health Visitors with the object of keeping them under observation until they became of school age. The Health Visitors made 1,023 revisits in connection with this work of following-up. Special visits have also been made by the Health Visitors in connection with infectious diseases occurring amongst infants and children under 5 years, in cases of ophthalmia neonatorum, and for purposes of investigation into still-births and infant deaths, and into cases of puerperal fever. A number of visits have also been made to expectant mothers. Maternity and Child Welfare Centre. The Maternity and Child Welfare Centre is held at the Technical Institute, North Worple Way, Mortlake. The building unfortunately does not entirely meet the requirements of the Clinics; the accommodation available does not allow of the routine undressing of babies for weighing. 48 Infant Consultations.—The Child Welfare Clinic has continued to be held during 1926 on one Session per week, namely Thursday afternoon at 2.30. It has been arranged that, during 1927, two Sessions per week will be held for this purpose, and an additional clinic, on Tuesday afternoons, will shortly be held. There will then be greater opportunity for more routine medical examinations of the infants attending than can be attempted at the present time in addition to the examination of ailing infants. The attendances during the past year have been very satisfactory. The average attendance at the Clinic has been in the case of infants under one year 34 per session, and in the case of young children, aged 1 to 5 years, 22 per session, a total of 56 infants and young children per session. The number of new cases, the total number of infants and young children attending at the Centre, and the total attendances made by then during 1926 are given below. New Cases:— Infants under 1 year 121 Children 1 to 5 years 38 Total 159 Number of Children attending during the year:— Infants under 1 year 162 Children 1 to 5 years 114 Total 276 Number of attendances made by: — Infants under 1 year 1,757 Children 1 to 5 years 1,115 Total 2,872 Mothers 2,871 Assistance is given at the Centre by Voluntary Workersthanks are due to these ladies for devoting so much time to, and showing such enthusiasm in the work. Ante-Natal Clinic.—Up to the end of the year 1926 no separate Clinic was held for this purpose, expectant mothers being seen at the Maternity and Child Welfare Clinic on the same afternoon as the Infant Welfare Clinic was held. Since the beginning of 49 1927, however, a separate session for ante-natal work has been held on Wednesday afternoon at 2.30. It will now be possible to carry out much more efficient work, and a larger attendance of expectant mothers is hoped for. Ophthalmia Neonatorum. This disease being of a serious nature every effort should be made to prevent its occurrence; ante-natal inquiries to detect and treat conditions in the mother that might give rise to the disease, and instructions to the mother as to methods of avoiding infection of infant's eyes are of importance. Care of the eyes during labour and after the birth is equally necessary. On notification each case is promptly and rigidly followed-up in order to ensure that appropriate treatment for the condition is obtained at once and persisted in until a cure has been effected. During 1926 only one case was notified in this District. Notifications of this disease in each of the five previous years numbered 1, 3, 3, 2 and 2 respectively. Table XXIII.—Ophthalmia Neonatorum: Cases notified during 1926. Serial Number in Register. CASES. Vision Unimpaired. Vision Impaired. Total Blindness Deaths. Notified. Treated. At home. Hospital. (1) 21 Feb. l — l — — — I have the honour to be, Mr. Chairman, Mrs. Macnamara and Gentlemen, Your obedient Servant, E. A. FREEAR WILKES, Medical Officer of Health. 51 INDEX PAGE Acute Anterior Poliomyelitis 37 Acute Polioencephalitis 37 Adoptive Acts 17 Ambulance Provision 13 Bacteriological Work 45 Bakehouses 22 Birth Rate 6 Bye-laws and Regulations 18 Cancer 7 Cerebro-spinal Fever 37 Cleansing Station 45 Common Lodging Houses 27 Dairies, Cowsheds and Milkshops Regulations 32 Death Rate 6 Death, Causes of 7 Death, Causes of, at age periods, Table Facing 7 Deaths in Public Institutions 8 Density of Population 2 Diphtheria 38, 43 Disinfection 45 Drainage Work 23 Encephalitis Lethargica 37 Enteric Fever 40 Factories and Workshops 25 Fishmongers 22 Fried Fish Shops 27 Health Visitors, Duties and Work of 15 Homes for Unmarried Mothers and their Children 13 Hospitals, Children's 13 „ Isolation (Fever) 12 „ Maternity 13 „ Small-pox 12 PAGE Hospitals, Tuberculosis 12 Houses Let in Lodgings 27 Housing 29 „ Statistics, 1926 30 Infantile Mortality 9 „ „ Rate of 10 „ „ Causes of 11 „ „ Table, 1926 11 Infectious Diseases, Notifiable 35 „ „ Non-notifiable 40 Influenza 40 Inquests 9 Isolation Hospital 43 Laboratory Work 45 Legal Proceedings 21 Maternity and Child Welfare 46.49 do. Home Visiting 47 do. Centre 47 Maternity Hospitals „ 13 Measles 40 Meat 33 Midwives 16 Milk Supply 32 Mortuary 17 Notification of Births Act 47 Nursing Arrangements, Home Nursing, &c. 16 Offensive Trades 27 Ophthalmia Neonatorum 49 Overcrowding 29 Pneumonia 37 Population, Census 2 52 INDEX (continued). PAGE Public Conveniences 20 Puerperal Fever 46 Rats and Mice Destruction Act 28 Refuse, Collection of House Refuse 20 Refuse Disposal 20 Registries for Female Domestic Servants 27 River and Stream Pollution 19 Sale of Food and Drugs Act 34 Sanitary Administration 19-28 Sanitary Inspectors, Summary of Work of 21 Scarlet Fever 39, 43 Scavenging of Streets 21 Schools and School Clinics 14, 28 Sewage Disposal 19 Slaughter Houses 33 Small-pox 37 Smoke Abatement. 27 PAGE Staff of Public Health Department 14 Statistics, Summary of Facing 1 Tuberculosis Deaths 41 „ Incidence 40 „ Notification of 41 „ Preventive Measures 42 „ Treatment, Dispensary and Institutional 42 Unsound Food 34 Vaccination 38 Venereal Diseases Clinics 14 Verminous Persons and Premises 45 Vital Statistics 3-11 „ „ Tables 4-5 Water Supply 19 Whooping Cough 40 Zymotic Diseases 8