BARN 5 library BOROUGH OF BARNES Annual Report of the Medical Officer of Health For the Year 1937 1 1 1 BOROUGH OF BARNES the Annual Report ok the Medical Officer of Health for the year 1937 E. A. Freear Wilkes, M.R.C.S.Eng., L.R.C.p.Lond., D.p.H.camb. Medical Officer of Health. BOROUGH OF BARNES. Public Health Committee. Chairman. Alderman Stanley Sparkes, J.P. Members. The Mayor (Councillor G. S. Marler, J.P). Alderman A. W. Aldis Councillor T. E. Dixon ,, E. P. Barry ,, J. A. Dorey ,, J. D. Firmston, J.P. ,, G. H. Freyberg, O.B.E. ,, P. Hamilton Hughes, J.P. ,, L. Gassman ,, S. E. Jackson, J.P. ,, H. Hedderly, J.P. „ W. J. Lane, J.P. ,, J. G. Hensman „ E. Middleton ,, L. J. Nicholls Councillor E. S. Bolton ,, J. W. J. Samels ,, R. H. Cale „ E. S. Stevens ,, B. J. Capell ,, T. E. V. Sturgis ,, J. N. P. Conlan, J.P. ,, F. G. Sutton-Mattocks ,, H. G. Curran ,, H. Thomas ,, E. T. Dailley ,, D. Urquhart-Nicol ,, F. Davis ,, W. Young Hospital Sub-Committee. Chairman. Alderman W. J. Lane, J.P. Members. Alderman A. W. Aldis Councillor E. S. Bolton ,, J. D. Firmston, J.P. ,, F. Davis ,, Stanley Sparkes, M.B.E., J.P. ,, L. J. Nicholls Councillor E. S. Stevens Maternity and Child Welfare Committee. Chairman. Co-opted Member: Mrs. Ludlow, J.P. Council Members. Adlerman P. Hamilton Hughes, J.P. Councillor T. E. Dixon ,, W. J. Lane, J.P. ,, J. A. Dorey Councillor J. N. P. Conlan, J.P. ,, G. H. Freyberg, O.B.E. ,, E. T. Dailley ,, L. J. Nicholls ,, F. Davis ,, H. Thomas Co-opted Members. Mrs. Boorman Mrs. Burgess Mrs. Colbourne Housing Committee. Chairman. Alderman A. W. Aldis. Members. The Housing Committee consists of the members of the Public Health Committee given above with the exception of Alderman E. Middleton and Councillors H. G. Curran, and J. G. Hensman, and with the addition of Councillor C. T. Wright-Warren. STAFF OF THE PUBLIC HEALTH DEPARTMENT. 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. Assistant Medical Officer for Maternity and Child Welfare (part-time). Margaret J. M. Cuthbert, M.A., M.B., B.Ch., St. Andrews. Medical Officer for Diphtheria Immunisation (part-time). D. S. Murray, B.Sc., M.B., Ch.B., Glasgow. Chief Sanitary Inspector. C. S. Perchard, Cert.R.San.Inst., Cert. Meat and Food Insp. Assistant Sanitary Inspectors. G. G. Gardiner}! A. A. Brown}Cert.San.Insp., Cert. Meat and Food Insp. R. H. Street} Health Visitors. Miss M. Parnell, S.R.N., S.c.m., H.V.Cert. Miss J. McNish, S.c.m. Miss O. L. Wilson, S.R.N., S.c.m., H.V.Cert. Chief Clerk. R. E. Forrest. Assistant Clerks. R. A. Billen. Miss D. E. Gouldby. G. K. Shilleto. Matron of the Isolation Hospital. Miss E. E. Peters, S.R.N. SUMMARY OF CONTENTS. PAGE I. Statistics and Social Conditions of the District 2 II. General Provision of Health Services in the Area 12 III. Sanitary Circumstances of the Area 17 IV. Housing 28 V. Inspection and Supervision of Food 34 VI. Prevalence of, and Control over, Infectious Diseases 37 VII. Maternity and Child Welfare 55 Public Health Department, High Street, Mortlake, S.W.I4. To the Mayor, Aldermen and Councillors of the Borough of Barnes. Mr. Mayor and Gentlemen, I have the honour to present my Annual Report for the year 1937, on the sanitary circumstances, the sanitary administration, and the vital statistics of the Borough. In accordance with the requirements of the Minister of Health the Annual Report for 1937 has been compiled as an Ordinary Report. The Report contains detailed information specifically directed by the Minister of Health and a record of alterations, improvements or developments which have taken place during the year. The vital statistics of the Borough show the various mortality rates for the year under review to be satisfactory, and they compare favourably with the statistics of similar areas, and of England and Wales as a whole. The extremely low mortality from infectious diseases, from diseases and accidents of childbirth, and amongst children under one year of age during 1937 is especially worthy of mention. Not a single death occurred from the acute infectious diseases—diphtheria, enteric fever, scarlet fever, measles, whooping cough or epidemic diarrhoea. The rate of maternal mortality was nil; 1937 was the third year in succession in which there has been no death from maternal causes, and, further, during the first eight months of the present year no death from this cause has occurred. The infantile mortality rate for 1937 is the lowest ever recorded for the district, being only 35.6 compared with a rate of 58 per 1,000 registered births for England and Wales. I regret the preparation of this Report has been delayed ; the delay has been occasioned by additional work in connection with the organisation of new services, and extension of existing ones, in accordance with recent legislation. In presenting this report I take the opportunity of expressing my appreciation of the support which I have received from the Council, and of thanking the staff of the Public Health Department for their assistance. I have the honour to be, Mr. Mayor and Gentlemen, Your obedient Servant, E. A. FREEAR WILKES, August, 1938. Medical Officer of Health. 2 BOROUGH OF BARNES. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1937. Section i. STATISTICS AND SOCIAL CONDITIONS OF THE DISTRICT. PHYSICAL FEATURES AND GENERAL CHARACTER OF THE AREA. A detailed review of the physical features and general character of the area was given in my previous Survey Reports. There has been no alteration in the extent or boundaries of the area since that date. The area is now very largely built-up and the existence of the numerous and extensive permanent open spaces in such a district is of incalculable value from a public health aspect. Area of Borough in acres 2,650 Population—Census, 1921 34,281 ,, Census, 1931 42,440 Estimated, 1937, R.G 41,100 Number of inhabited houses—Census, 1921 7,939 „ „ „ Census, 1931 10,575 ,, „ ,, Rate-books, 1937 11,007 Number of Families, or Separate Occupiers—Census, 1921 8,654 „ „ „ „ Census, 1931 11,746 Rateable Value £509,169 Sum represented by a Penny Rate £2,021 3 SOCIAL CONDITIONS AND OCCUPATION OF THE INHABITANTS. The district is mainly a residential one; more than fifty percent. of the employed persons living in Barnes have their place of work outside the Borough. There are relatively few industries in the Borough. In none of the trades and industries carried on in the district has evidence been forthcoming of any detrimental effect on health connected with conditions of occupation. VITAL STATISTICS. Statistical Summary, 1937. Births:— Birth-rate (per 1,000 of population) 89 Live Births:— Total. M. F. Legitimate 337 178 159 Illegitimate 28 12 16 Total 365 190 175 Still Birth-rate (per 1,000 total births) 26.7 Total . M. F. Still Births 10 4 6 Deaths:— Death-rate (per 1,000 of population) 11.4 Total. M. F. Deaths (all causes) 469 224 245 Percentage of all deaths occurring in Public Institutions 40% Death-rate from Maternal Causes (per 1,000 total births) 0.0 Deaths from Sepsis Nil ,, ,, Other causes Nil Death-rate from Zymotic Diseases 0.0 Deaths from Cancer (all ages) 80 ,, ,, Measles (all ages) Nil ,, „ Whooping Cough (all ages) Nil ,, ,, Diarrhoea (under two years of age) Nil Death-rate of infants under one year of age 35.6 Legitimate infants 32.6 Death-rate for {Illegitimate 35.7 Natural increment or decrease in the population for 1937 (excess of births over deaths or vice versa):— Decrease 104. Comparative vital statistics with reference to birth-rate, deathrate and infantile mortality are given in tabular form on pages 4 and 5. Table I. \ital Statistics of the Borough of Barnes during 1937 and previous 5 Years. Year. Population estimated to middle of each year. R.G. Registered Births. Total Deaths Registered in the District Transferable Deaths Nett Deaths belonging to the District. Uncorrected Number. Nett. Number. Rate. Of nonresidents registered in the District. Of residents not registered in the District. Under 1 year of age. At all ages. Number. Rate. Number. Kate per 1,000 nett births Number Rate 1 2 3 4 5 6 7 8 9 id 11 12 13 1932 42,790 322 421 9.8 294 6.9 27 184 21 49.9 451 10.5 1933 42,590 292 386 9.1 243 5.7 12 205 16 41.5 436 10.2 1934 42,050 281 356 8.5 252 6.0 17 218 25 702 453 10.8 1935 42,030 288 393 94 205 4.9 18 204 19 48.3 391 9.3 1936 41,560 259 351 8.4 271 6.5 12 227 19 54.1 486 11.7 1937 41,100 278 365 8.9 252 6.1 25 242 13 35.6 469 11.4 4 Table II.—Birth-rate, Death-rate, and Analysis of Mortality during the Year 1937, with corresponding rates for england and wales, 125 great towns, 148 smaller towns, and for the County of London for comparison. The mortality rates refer to the whole population as regards England and Wales, but only to civilians as regards London and the groups of towns. Birthrate per l.000 Total tion. Annual Death rate per 1,000 Population Death rate per 1.000 Births. Matfrnal Mortality Rate per 1,000 Total Births All Causes Enteric Fever. Small-pox Measles. Scarlet Fever. Whooping Cough. Diphtheria. Influenza. Violence Disrrha and Enteritis (under 2 years). Total Deaths under One Year. All Causes. Puerperal Sepsis Other Causes. England and Wales 14.9 12.4 o.oo — 0.02 o.o1 0.04 0.07 0.45 0.54 5.8 58 3.23 0.97 226 125 County Boroughs and Great Towns, including London 14.9 12.5 001 - 0.03 o.o1 0.04 0.08 0.39 0.45 7.9 62 Not available 148 Smaller Towns (Estimated Resident Populations 25,000 to 50,000 at Census, 1931) 15.3 11.9 o.oo 0.02 o.o1 0.03 0.05 0.42 0.42 3.2 55 London 13.3 12.3 o.oo — o.o1 o.o1 0.06 0.05 0.38 0.51 12.0 60 Barnes Borough 8.9 11.4 0.00 — 0.00 0.00 0.00 0.00 0.29 0.51 o.oo 36 0.00 o.oo 0.00 5 6 Population. The Registrar General's estimate of the population of Barnes for mid-year 1937 is 41,100. This is a decrease of 460 persons on his estimate of the population for the previous year, and represents a decrease of 1,340 persons since the date of the last Census six years ago, when the population of the Borough was found to be 42,440 persons. Although there has been during the six years since the 1931 Census a natural decrease from excess of deaths over births amounting to 414 persons, there have been during that same period 804 newly erected dwellings completed, and occupied, whilst less than 100 dwellings have been demolished. The density of population is now 16.3 persons per acre, considerably more than double the density in 1901 which was only 7.1 persons per acre. Birth-rate. The number of live births registered in the district during the year was 278. After correction for inward and outward transfers the "nett" number of births assignable to the district was 365, corresponding to a birth-rate of 8.9 per 1,000 of the population. The birth-rate for the year for England and Wales was 14.9 and for London 13.3. The birth-rate for the area has been declining since 1921; from that year until 1930 there was a steady decline, but from 1930 to the present time the fall has been much more marked. The lowest ever recorded for the area was in 1936 when the rate was a low as 8"4 per 1,000 of the population. Death-rate. The number of deaths registered in the district during the year 1937 was 252. Of these 25 were deaths of presons who were not "residents" of the Borough, and 227 were deaths of "residents." To obtain the correct number of deaths representing the true mortality amongst the population it is necessary to add 242 deaths of "residents" whose deaths occurred outside the Borough. The corrected number of deaths therefore belonging to this district is 469. This number represents a death-rate of 11.4 per 1,000 of the population. The death rate for the year for England and Wales was 12 4, and that for London 12.3. The death-rate of 11.4 for the year 1937 is slightly lower than the death-rate for 1936. The death-rates for both these years are higher than the average for the previous five years, this average being 10 5 per 1,000 of population. The increase in the higher death-rates during 7 1936 and 1937 was largely due to the unusually large number of deaths which occurred in persons of one particular age-period, viz., 65 years and over. The number of deaths of persons aged 65 years and over during 1937 represented 58 percent. of the total deaths for that year. Causes of Death. An analysis of the total (corrected) deaths for the whole district during 1937 is shown in Tables III and IV on pages 7 and 8 classified under various causes of death, and distributed for age, sex and locality. Table III.—Causes of Death during the Year 1937. Causes of Death Total Deaths Male Female 1 Typhoid and Paratyphoid fevers — — — 2 Measles — — — 3 Scarlet Fever — — — 4 Whooping Cough — — — 5 Diphtheria - — — 6 Influenza 12 4 8 7 Encephalitis Lethargica 2 2 — 8 Cerebro-spinal fever — — — 9 Tuberculosis of respiratory system 25 16 9 10 Other tuberculous diseases 4 1 3 11 Syphilis 1 1 1 12 General paralysis of the insane, tabes dorsalis 2 1 13 Cancer, malignant disease 80 37 43 14 Diabetes 6 3 3 15 Cerebral hæmorrhage, etc. 23 8 15 16 Heart Disease 121 58 63 17 Aneurism 2 1 1 18 Other circulatory diseases 21 9 12 19 Bronchitis 11 9 2 20 Pneumonia (all forms) 30 16 14 21 Other respiratory diseases 8 5 3 22 Peptic ulcer 2 1 1 23 Diarrhoea, etc. (under 2 years) — — — 24 Appendicitis 2 1 1 25 Cirrhosis of liver 2 1 1 26 Other diseases of liver, etc. 3 1 2 27 Other digestive diseases 9 5 4 28 Acute and chronic nephritis 11 4 7 29 Puerperal sepsis — — — 30 Other puerperal causes — — — 31 Congenital debility, premature birth, tions. etc. 11 7 4 32 Senility 30 6 24 33 Suicide 3 2 1 34 Other violence 18 7 11 35 Other defined diseases 30 18 12 36 Causes ill-defined or unknown — — — All Causes 469 224 245 Table IV.—Deaths during 1937 distributed for Sex, Age and Locality. Total Deaths. Sex Distribution. Age Distribution. Number of Deaths at subjoined ages. Deaths in or belonging to Localities (at all ages). Deaths in Institutions. Inquests Certified by Coroner, No Inquest Male. Female. Under 1 year. 1 and under 2 and under 5. 5 and under 15. 15 and under 25 25 and under 45 45 and under 65. 65 and over. Barnes. | Morllake. Deaths of Residents dying in the Borough 227 106 121 2 - - - - 13 50 161 108 119 2 9 17 Deaths of Residents dying outside the Borough (Inward Transfers) 235 112 123 11 1 1 5 6 32 72 107 109 126 183 20 10 Total Deaths— Nett Deaths of Residents, whether dying within or outside the Borough * 462 218 244 13 1 1 5 7 45 122 268 217 245 185 29 27 * Note.—The total number of deaths assigned to the Borough by the Registrar-General is 469. The total number of deaths, according to the death-returns from the Local Registrar of Deaths and the returns of inward and outward transfer deaths from the Registrar-General, amount to 462 only. It is not possible to include the additional seven deaths in the above Table as information ast o Sex, Age and Locality in the case of these seven deaths is not known. 8 9 In the subjoined Table V is given the number of deaths occurring from certain causes of death which are important in themselves or from the fact that they contributed a considerable share to the total mortality for the year. The absence of any death from diseases and accidents of child birth, or from zymotic diseases, is particularly worthy of note. Table V.—Principal Causes of Death: Annual Number of Deaths from these Causes during Five Years, 1932 to 1936, and during 1937. Cause of Death Number of Deaths in previous 5 years D'ths in Death Rate per 1,000 Population for 1937 1932 1933 1934 1935 1936 1937 Barnes Borough London Zymotic (Epidemic) Diseases 9 7 5 6 5 — 0.00 029 Influenza 11 23 9 3 9 12 0.29 038 Bronchitis 20 20 13 8 10 11 0.27 0.45 Pneumonia 29 22 20 21 20 30 0.73 0.84 Tuberculosis 29 25 21 20 27 29 0.71 0.75 Cancer 60 75 78 75 90 80 1.95 1.74 Heart Disease 83 83 85 92 100 121 2.94 3.41 Bright's Disease 21 15 22 10 8 11 0.27 0.32 Puerperal Fever 2 — 1 — — — 0.00 0.01 Other Puerperal Diseases 2 1 - - - - 0.00 0.02 Premature Birth, Etc. 8 7 7 9 12 11 0.27 0.27 Violence and Suicide 23 23 38 24 32 21 0.51 0.51 Zymotic Death-rate. The death-rates for 1937 from each of the seven principal epidemic diseases (zymotic diseases) are given separately in Table VI, and in Table VII the zymotic death-rate for the five years, 1932 to 1936 are contrasted with the rate for 1937. In each of these Tables the deathrates for London and for England and Wales for corresponding periods are shown for comparison; the death-rates for this district contrast very favourably with those. 10 Table VI.—Epidemic Diseases: Death-rate per 1,000 of the Population, 1937. Disease. Barnes. London. England and Wales. Small-pox 0.00 0.00 0.00 Enteric Fever 0.00 o.oo o.oo Measles 0.00 o.o1 0.02 Scarlet Fever 0.00 0.01 0.01 Whooping Cough 0.00 0.06 0.04 Diphtheria .00 0.05 0.07 Diarrhoea (under 2 years) 0.00 0.16 0.09 Zymotic Death Rate 0.00 0.29 0.23 Table VII.—Zymotic Death-rate for 1937, contrasted with the Death-rates for the previous Five Years. Year. Barnes. London. England and Wales. 1932 0.21 0.54 0.32 1933 0.16 0.35 0.28 1934 0.12 0.56 0.34 1935 0.14 0.26 0.24 1936 0.12 0.48 0.30 1937 0.00 0.29 0.23 Inquests. Inquests were held in respect of 29 or 6"2 per cent., of the 469 deaths assignable to the district. The causes of deaths in these cases were as follows:— Deaths from suicide 3 Violent deaths, excluding suicide 18 Deaths from natural causes 8 Deaths in Public Institutions. During 1937, 185 Barnes inhabitants died in public institutions ; this represents 40.0 per cent of the 469 total deaths assigned to this district. Of the 227 residents who died in the district, two died in an institution, viz., the Barnes Isolation Hospital, one from influenza and one from erysipelas. Of the 242 residents whose deaths occurred in other areas outside the Borough, 183 died in institutions; 88 of these deaths occurred in the Public Assistance Institution, Richmond, and 95 in various other public institutions outside the Borough. 11 Table VIII.—Infant Mortality during the Year 1937. Nett Deaths from stated Causes, at various Ages, under One 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 Borough Deaths outside the Borough. | Deaths in Institutions Small-pox Chicken-pox Measles Scarlet Fever Whooping Cough Diphtheria Erysipelas Tuberculous Meningitis Abdominal Tuberculosis Other Tuberculous Disease Meningitis (not Tuberculous) Convulsions Laryngitis Bronchitis Pneumonia (all forms) Diarrhoea and Enteritis Gastritis Syphilis Rickets Atrophy, Debility and Marasmus ... ... ... ... ... 1 ... ... ... l 1 ... ... l 1 Premature Birth 4 1 ... ... 5 1 ... ... ... 6 1 5 1 5 4 Congenital Malformations 1 l ... ... 2 2 ... ... ... 4 l 3 ... 4 4 Injury at Birth Atelectasis Suffocation (overlying) Violence 1 ... ... ... 1 ... ... ... ... 1 l ... l ... ... Other causes ... ... ... ... ... ... ... 1 ... 1 ... 1 ... 1 1 All causes 6 2 ... ... 8 4 1 ... 13 4 9 2 11 10 Nett Births in the Year: Total Births, 365; Legitimate, 337; Illegitimate, 28. Nett Deaths (under 1 year): Total Deaths, 13; Legitimate Infants, 12; Illegitimate Infants, 1. Infantile Mortality Rate: Total, 36; Legitimate, 33; Illegitimate, 36. 12 Infantile Mortality. During 1937 the number of deaths of infants under one year of age was only 13, representing a rate of infantile mortality of 36 per 1,000 registered births, the infantile mortality rate for England and Wales being 58 and that for London 60 per 1,000 registered births for the corresponding period. The infantile mortality rate of 36 per 1,000 registered births for the year 1937 is the lowest ever recorded for the district. The causes of death of infants dying under one year of age during 1937 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 Section VII of this Report which deals with Maternity and Child Welfare. Section II. GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. (1) PUBLIC HEALTH STAFF. (a) Medical Officer of Health. The Medical Officer of Health of the Borough in addition to undertaking the duties of District Medical Officer of Health acts also as Medical Superintendent of the Council's Isolation Hospital, and as Medical Officer for Maternity and Child Welfare. (b) Assistant Medical Officer. A part-time Assistant Medical Officer acts as Assistant Medical Officer for Maternity and Child Welfare (including Ante-natal work) and as Deputy Medical Superintendent of the Isolation Hospital when the Medical Officer of Health is off duty. (c) Medical Officer for Diphtheria Immunisation. The services of a Specialist Medical Officer experienced in diphtheria immunisation is employed to undertake this work in connection with the Council's Diphtheria Immunisation Clinic. (d) Consultant Medical Officers. The services of a Consultant Obstetrician for cases of puerperal fever or puerperal pyrexia and for cases of difficult or complicated labour, and of a Consulting Aural Surgeon to the Isolation Hospital, are available as occasion requires. 13 (e) Chief Sanitary Inspector. The Chief Sanitary Inspector holds the Sanitary Inspectors' Certificate of the Royal Sanitary Insitute, 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 HousingManager, Inspector under the Petroleum Acts, Inspector under the Shops Acts, and as Executive Officer under the Rats and Mice (Destruction) Act, 1919. (/) Assistant Sanitary Inspectors. There are two Assistant Sanitary Inspectors, each of whom holds the Certificate of the Royal Sanitary Institute and of the Sanitary Inspectors Examination Joint Board, and, in addition, a Certificate as an Inspector of Meat and other Foods. There is in addition a Junior Assistant Sanitary Inspector who assists in work under the Shops Acts as well as undertaking duties as an Assistant Sanitary Inspector ; this Inspector holds the Certificate of the Royal Sanitary Institute and Sanitary Inspectors Examination Joint Board, and recently (May, 1938) he obtained the Certificate as an Inspector of Meat and other Foods. (g) Health Visitors. There are three whole-time Health Visitors employed in the district. Their duties include work in connection with maternity and child welfare, and the supervision of foster children. They also undertake investigations into cases of infectious disease and assist at the Council's Diphtheria Immunisation Clinic. Each of the three Health Visitors holds a Certificate as a Generaltrained Nurse and the Certificate of the Central Midwives Board. Two of them hold the Health Visitors' Certificate of the Royal Sanitary Institute in addition ; the other holds a Certificate as a Fever-trained Nurse. (h) Clerical Staff. In addition to the chief clerk there are three assistant shorthandtypist clerks employed in the Public Health Department. One of these undertakes duties in connection with the work of the sanitary inspectors and another is employed as a general clerk. A female clerk is responsible for the clerical work connected with the Health Visitors' duties and assists at the various clinics. 14 (i) Isolation Hospital Staff. The staff consists of the following:— The Medical Officer of Health acts as Medical Superintendent; in his absence the Assistant Medical Officer acts as deputy. There is no Resident Medical Officer. The resident staff consists of a Matron, one Sister, twelve trained Nurses, thirteen domestic staff, and a lodge-porter and portress (the former acts also as an ambulance driver). The out-door staff consists of a seamstress, an ambulance driver, a gardener, and a boiler attendant. (j) Other Staff. Ratcatcher, who also acts as Disinfecting Officer and assists the Sanitary Inspectors in the testing of drains. A list of the members of the staff, with their qualifications, has been incorporated at the beginning of this Report. The Officers to whose salary contribution is made under the Public Health Acts or by Exchequer Grants are the Medical Officer of Health, the Assistant Medical Officer for Maternity and Child Welfare, the Chief Sanitary Inspector, and the three Health Visitors. (2) AMBULANCE FACILITIES. (a) For Infectious Cases. Two motor ambulances are provided by the Council for removal of patients suffering from infectious disease to the Isolation Hospital. Both ambulances are so constructed as to enable the infected bedding and clothing to be removed at the same time as the patient. The ambulances are stationed at the Hospital. (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. The Ambulance Service provided by the Council has been adequate to meet the needs of the area. 15 (3) CLINICS AND TREATMENT CENTRES. The Clinics provided in the Borough either by the Barnes Borough Council, or by the Surrey County Council, are given below, together with the days and hours of attendance at which the various clinics are held. Name of Clinic, etc. Address. Days of attendance. Provided by. (a) Situated in the District: Maternity and Child Welfare Centre— Essex House, Station Road, Barnes Barnes Borough Council Ante-natal Clinic ,, ,, 1st & 3rd Fridays, 2 p.m. ,, Infant Welfare Clinic ,, ,, Tuesdays & Thursdays at 2 p.m. ,, Diphtheria Immunisation Clinic ,, ,, Wednesdays, 2 p.m. ,, Day Nursery Oxford House, Upper Richmond Road, East Sheen Daily, Monday to Saturday Voluntary tion School Clinics— tion Minor Ailments Clinic School Clinic, Cleveland Road, Barnes Daily, Monday to Friday, 9.30 a.m. Surrey County Council Eye Clinic ,, ,, 1 st & 3rd Mondays, 2 p.m. ,, Dental Clinic ,, ,, Mon., Tues.,Wed. & Fri., 9.30 a.m. 2nd & 4th Saturdays, 9.30 a.m. 2nd & 4th Mondays, 1.45 p.m. ,, Tuberculosis Dispensary 38, Sheen Road, Richmond 1 st, 3rd & 5th Thursdays, 1.30 p.m. 2nd& 4thThursdays, 5.30 p.m. ,, (b) Situate outside District: Venereal Diseases Clinics West London Hospital, Hammersmith 1 Monday to Friday, 10-12 & 3-7. ' Saturday, 11-12 & ,, And at 21 other Hospitals in the County of London 5.30-6.30 Various times as advertised ,, * The Barnes Borough Council makes an annual contribution of £357 to this institution. (4) MIDWIFERY AND MATERNITY SERVICES. The Surrey County Council is the local supervising authority under the Midwives Acts, and for the purpose of providing the necessary domiciliary service for the Borough the County Council employ directly two whole-time salaried midwives. 16 During 1937 the number of midwives who gave notice of their intention to practise in this Borough was thirteen, ten of these (including the two municipal midwives) being resident within the Borough and three resident in adjacent areas. (5) MATERNITY AND NURSING HOMES. The Surrey County Council is the Local Supervising Authority for the registration and inspection of Nursing Homes and Maternity Homes in this Borough. There are four private Maternity Homes in the district registered by the County Council. No information has been received of any orders refusing or cancelling registration. (6) PUBLIC MORTUARY. The Council have provided a Public Mortuary situated in South Worple Way, Mortlake, adjacent to the Isolation Hospital. During 1937 23 bodies, on which post-mortem examinations were conducted or inquests held, were received ; of this number 8 were bodies of persons resident in the district, 12 were bodies of nonresidents whose deaths occurred in the district, and 3 were bodies of persons unknown. (7) LEGISLATION IN FORCE IN THE DISTRICT. The Adoptive Acts, Bye-laws and Regulations relating to public health, and Local Acts in force in the district were enumerated in my Annual Report for 1930 (page 17). The Bye-laws above referred to continued in force during the year under review. New Bye-laws to replace certain of these have been made and approved by the Minister of Health, coming into force in 1938. It is necessary that Regulations as to underground rooms should be in force in the Borough in order that semi-basement rooms which are used as dwellings, although unsuitable for such purpose, may be dealt with. Particulars of the administration of the various Acts, Byelaws, and Regulations will be found referred to under the various subjects to which they relate. 17 Section III. SANITARY CIRCUMSTANCES OF THE AREA. WATER SUPPLY. The water supply of all the houses in the district is from the Metropolitan Water Board's waterworks; the supply is constant and through storage cisterns. No case of waterborne disease has arisen. The supply is ample and of satisfactory quality. The results of the periodical chemical and bacteriological examinations of the Board's supply are available in the Metropolitan Water Board's Annual Report which is supplied to the Council. It has been the practice for me to bring to the notice of the Metropolitan Water Board the occurrence of notified cases of enteric fever, or other waterborne diseases, where it appears that the source of the disease may have been from drinking water. Special samples of water are taken in the district for examination whenever there is occasion to do so. RIVER AND STREAM POLLUTION. Instances in which waste-pipes from lavatory basins are found to have been wrongly connected and are discharging into the surface water drains, and thence into the River Thames or Beverley Brook, occur from time to time; in all such cases the waste-pipes are required to be so altered as to discharge into the foul-water drains. Apart from these instances no case of pollution of rivers or streams by effluents, solid refuse or filth has come to my notice during 1937. DRAINAGE, SEWERAGE AND SEWAGE DISPOSAL. The water-carriage system of sewage disposal is in use practically throughout the whole area. The defects in connection with drainage of occupied houses which have been discovered by the Sanitary Inspectors, and the defective conditions remedied, will be found on reference to Table X, on page 20. Closet Accommodation. There is now no privy or earth-closet in use in the district. All the water-closets are connected up to the main sewerage system except 6, which, being situated in low-lying positions where connection to a sewer is impossible, drain into cess-pools. The cess-pools have been found in a satisfactory condition; the cleansing of them is undertaken by the occupiers of the premises, and has been carried out in accordance with the Bye-laws. 18 Public Conveniences. There are 41 public conveniences in the district. Seven of these have been provided by the Council; one, though not provided, is maintained by the Council; thirty-two are conveniences in connection with public-houses, urinals in connection with six of these being available to the public outside licensing hours. There is a public convenience at the Sheen Gate entrance to Richmond Park. • 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. The system of house-refuse collection described in my Annual Report for 1934 has remained unchanged during the past year. During the year, in compliance with notices served by the Sanitary Inspector, 46 new movable sanitary dustbins were provided. Disposal of House Refuse. All house-refuse collected in the district is incinerated at the Council's Destructor; in addition to this refuse, the house-refuse from the Borough of Richmond is also destroyed at the Barnes Borough Council's Destructor. During 1937 the amount of refuse collected from the Barnes Borough was 11,612 tons, and the amount collected in Richmond Borough 11,662 tons, making a total of 23,274 tons to be disposed of. Cleansing and Scavenging of Streets. Mechanical sweepers are used for this purpose and the roadsweepings are removed by motor vehicles to a tip at the destructor works, or to a tip on Palewell Fields. The streets and roads in the district have been kept in a very cleanly condition. SANITARY INSPECTION OF THE DISTRICT. The work undertaken during the year under the various Public Health Acts, Bye-Laws and Regulations is shown below in the tabular statement, furnished by the Chief Sanitary Inspector under Article XIX of the Sanitary Officers Order, 1935, 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. 19 Table IX.—Showing the Number and Nature of the Inspections made by the sanitary inspectors during 1937, 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 54 124 — — — — Butchers' Shops 35 122 2 2 — — Fishmongers and Poulterers 17 43 1 1 - - Greengrocers Cooked- 56 165 2 2 - — provision shops 21 47 — — - — Ice-cream shops 34 35 — — - — Restaurants 31 77 1 1 - — Fried-fish shops 5 28 — — - — Slaughterhouses 1 10 — —- - — Bakehouses 13 53 2 2 - — Factories 17 17 2 2 1 1 Workshops 100 178 3 3 - — Workplaces 29 81 2 2 — Home-workers 8 23 — — - — Schools 29 83 — — - — Public Halls and Cinemas 8 19 - - - - Van Dwellers Servants' — — — — - — Registries 4 9 — — — — Marine Stores — - - — — — Stable Yards 32 159 5 4 - — Public Conveniences 41 183 3 2 — — Dwelling-houses (including houses let in lodgings) (1) House - toHouse Inspection 107 4212 426 264 8 8 (2) Inspected on complaint 603 (3) Inspected in course of other work:— (a) Housing work, etc 238 (b) For infectious diseases 28 Totals 1509 5669 449 285 9 9 20 Table X.—Defective Conditions Remedied. Drainage. Sewers cleared or repaired 7 Drains inspected on complaint 34 ,, water tests applied 48 ,, smoke tests applied 43 ,, cleansed or repaired 73 ,, relaid 45 ,, reconstructed 28 ,, ventilated 33 Inspection chambers repaired 15 ,, ,, new provided 10 Interceptors—Caps fixed 15 Soil pipes renewed 21 ,, ,, new provided 11 Ventilating shafts repaired 10 ,, ,, new provided 1 Fresh air inlets repaired or new provided 5 Rain-water pipes disconnected from drains 1 Water Closets. Pans and traps provided 57 Waste water preventers repaired 24 ,, ,, ,, new provided 19 „ ,, „ water supplied 1 Apartments repaired 51 „ lighted and ventilated Sinks and Baths. Repaired or newly fixed 36 Waste pipes repaired 30 ,, ,, newly fixed 25 ,, ,, trapped 37 Cesspools. Abolished Urinals. Repaired or cleansed 5 New provided Water Supply. Cisterns repaired or renewed 44 Taps off main provided 2 Dustbins. New dustbins provided 46 Ashpits abolished 21 Yards. Paving repaired 63 Newly paved 65 Dampness. Roofs repaired 272 Gutters and rain water pipes repaired 196 Damp courses provided 181 External walls repointed 289 Floor spaces ventilated 69 Sites below floors concreted 21 General. Dangerous structures repaired or rebuilt 14 Food larders ventilated or new provision made 87 Windows repaired 542 Windows made to open 21 Doors and frames repaired 199 Permanent ventilator provided to rooms 24 Lighting provided to stairs 41 Stairs repaired or handrails provided 38 Grates repaired or renewed 113 Smoky chimneys remedied 75 Washing coppers repaired 23 Walls and ceiling—plaster repaired 792 ,, ,, ,, stripped and redecorated 375 Floors repaired 197 Verminous premises fumigated and cleansed 26 „ bedding cleansed or destroyed 3 Offensive accumulations removed 38 Miscellaneous defects remedied 271 Animals improperly kept Stables. Premises cleansed 4 Manure receptacles provided or repaired 1 Floors and yards properly paved and drained Infected and Infested Rooms and Articles (dealt with by the Council). Rooms disinfected 222 Schools disinfected Lots of bedding disinfected 186 ,, „ destroyed 19 „ ,, disinfested (slum-clearance) ,, ,, disinfested (re-housing) 2 Council houses disinfested 4 Other houses disinfested 22 Apart from houses visited in connection with overcrowding the total number of premises visited by the Sanitary Inspectors under the various Acts, etc., in operation was 1,509, the total number of visits paid being 5,669. Particulars of visits made in connection with overcrowding and other visits not included in Table IX are as follows:— Overcrowding survey, 2,075 ; visits in relation to the management of Council houses, 379 ; for other purposes, 255. In addition to the above work undertaken by the Sanitary Inspectors, the Disinfecting Officer visited 123 premises for the purpose of disinfection after cases of infectious disease, and he carried out the disinfestation of 4 verminous premises. He was also engaged in the following work in connection with drainage:—Drain testing, 17; cleansing, 1. Legal Proceedings. The owner of a house having failed to comply with a Closing Order made on the 15th January, 1936 in respect of the basement part of a house, by allowing such part of the house to continue to be used for human habitation legal proceedings were taken against him. The proceedings resulted in a fine of 40s. and costs. The basement has since been vacated and is still unoccupied. FACTORY AND WORKSHOPS ACT. 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 the year were:—Factories 98, workshops and workplaces 129, homeworkers 8. The number of factories, workshops, workplaces and home-workers' premises visited, and the number of visits of inspection made to each are given in Table IX, on page 19. Two notifications were received during the year from H.M. Inspector of Factories as regards matters remediable under the Public Health Acts, but not under the Factory and Workshops Act, 1901, Sec. 101. The matters complained of were remedied and a report sent to H.M. Inspector. 23 Table XI.—Inspection of Factories, Workshops and Workplaces. Premises. Number of Inspections Written Notices. Prosecutions Factories (Including Factory Laundries) 17 2 — Workshops (Including Workshop Laundries) 178 3 - Workplaces (Other than Outworkers' premises) 81 2 - Total 276 7 - 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 2 2 — — Want of ventilation — — — — Overcrowding — — - — Want of drainage of floors — — - — Other nuisances - Sanitary accommodation insufficient 4 4 - - unsuitable or - - - - tive. — — - - not separate for sexes 1 — - - Offences under the Factory and Workshop Acts:— Illegal occupation of underground bakehouse (s. 101) Other offences - — - — (Excluding offences relating to out-work and offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories & Workshops Transfer of Powers) Order, 1921. Total 7 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. 24 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 Fancy Needleworkers 3 Tailors 4 Dressmaking 1 Total 8 SHOP ACTS, 1912-1934. Inspections under the Shops Acts 1912 to 1934 have been carried out by the Chief Sanitary Inspector with the assistance of the Junior Assistant Sanitary Inspector. During the past year 311 shop premises were inspected for the purposes of the above Acts. In 10 instances notice relating to the sanitary accommodation was given to the occupier. In nine of these cases the notices were complied with; in the remaining case the use of the premises as a shop was discontinued. SMOKE ABATEMENT. The chimneys of factories and other buildings were kept under observation with a view to detecting any contravention of the Byelaws. In three instances nuisances were detected, the nuisance being caused by the emission of black smoke. In each instance the premises concerned were immediately visited with a view to ascertaining the cause of the trouble. The attention of the responsible person was directed to the necessity of greater care being exercised, the personal visit of the Sanitary Inspector being followed up with a written warning. This has led to an improvement. RATS AND MICE (DESTRUCTION) ACT, 1919. There were 325 complaints of infestation of premises with rats. The rat-catcher made 662 visits to enclosed premises, and 305 visits to open spaces in connection with his duties under the Act. The number of rat-tails brought to the Public Health Office by the ratcatcher during 1937 was 1,520. Poison bait was laid at 70 premises, and 26 sewers were baited with poison. 25 RAG FLOCK ACTS, 1911 and 1928. There are no premises in the area coming within the provisions of these Acts. PREMISES AND OCCUPATIONS WHICH ARE CONTROLLED BY BYE-LAWS OR REGULATIONS. Houses let in Lodgings. During the past year 157 visits were made to premises on the register of houses let in lodgings. During the year 38 such premises were removed from the register, being no longer occupied by two or more families. The total number of such premises on the register at the end of the year was 118. Common Lodging Houses. There are no common lodging houses in the district. Underground Rooms. No closing order in respect of any basement dwelling was made during the year. Tent and Van-Dwellers. There are no tent or van-dwellers permanently located in the areaNo proceedings under the Bye-laws became necessary in connection with any caravans temporarily in the district. Servants' Registries. Registries for female domestic servants are controlled by bye-laws made under Part V of the Surrey County Council Act, 1925. There are 4 premises on the Register. No action for breach of the bye-laws was taken during the year. Offensive Trades. Fish-frying has been declared to be an "offensive trade" in the area and is controlled by bye-laws. The number of premises on the Register during 1937 in which fish-frying is permitted was 5. SWIMMING POOLS. There are no public swimming baths or pools, or privately owned swimming baths or pools open to the public, in the area. A privately owned swimming pool, belonging to the Roehampton Club, is open to the public, but this pool, whilst situated adjacent to, is not actually within the Barnes Borough. 26 SCHOOLS. There are 28 schools in the district. Of these 13 are Public Elementary Schools, 2 are County Secondary Schools, and 13 are private schools. Careful investigations have been made into all outbreaks of infectious diseases amongst scholars. Details of the incidence of scarlet-fever and diphtheria (two of the more serious, but relatively more preventable, infectious diseases) among children attending school during the year are given below :— Of 84 cases of scarlet fever notified during the year 53 were cases in children of school age. Of these 33 were children attending public elementary schools, and 20 were cases in children attending private schools (15 at private schools in Barnes, and 5 at private schools outside the district). Of the 3 cases of diphtheria notified during the year only one was a child of school age. This child attended a public elementary school. In the 13 public elementary school cases occurred as under:— Number of scholars on Register. Number of who suffered Scarlet Fever. scholars from:— Diphtheria Barnes Central Boys 221 — — ,, ,, Girls 245 1 — Lowther J.M. and Infants 284 3 1 Castelnau J.M. and Infants 55 — - Westfields Mixed 211 — - ,, Infants 119 1 - East Sheen J.M. and Infants 380 8 - Mortlake Central Boys 198 5 - ,, ,, Girls 228 — - Mortlake Council J.M. and Infants ts 341 4 - Mortlake C.E. Mixed 148 5 - ,, „ Infants 76 6 - Mortlake R.C. 162 — — Total 2,668 33 1 Of the 13 private schools in the district scarlet fever occurred in only 4 of them. No case of diphtheria occurred in a private school. The incidence of infectious diseases amongst children of school age was extremely low. It is very satisfactory to have been able to restrict the numbers of cases of scarlet-fever and diphtheria amongst a total of approximately 2,700 school children on the public elementary school registers to such small numbers as 33 scarlet-fever cases and 1 diphtheria case during the year. 27 ERADICATION OF BED BUGS. Particulars are given below of action taken during the year in the case of dwellings found on inspection to be bug-infested. (i) Disinfestation of houses. The number of infested houses dealt with was 30. Of this number 4 were Council houses, and 26 were houses not owned by the Council. Disinfestation of the 4 Council houses was carried out by the staff of the Public Health Department. Vermicine was employed in the case of 3 of these houses ; fumigation with sulphur dioxide was the method employed in the case of the remaining house. In the case of the 26 houses in which disinfestation was carried out by the owners, advice was given by officers of the Public Health Department as to the most suitable action to be taken in each particular case in dealing with the premises. During 1937 hydrogen cyanide was not employed for the disinfestation of any house. (it) Disinfestation of household effects (excluding bedding). No rehousing under the slum clearance programme was carried out durin; 1937, and accordingly no disinfestation of household effects by hydrogen cyanide was undertaken. (ii) Disinfestation of bedding and bedclothing. In all cases disinfestation of bug-infested bedding and bedclothing has been carried out by steam-disinfection at the Council's Disinfecting Station. 28 Section IV. HOUSING. (I) HOUSING STATISTICS FOR THE YEAR 1937. 1. Number of New Dwellings Erected during the Year :— Total erected 165 (i) By the Local Authority Nil (ii) By other Local Authorities Nil (iii) By other bodies or persons 165 2. Number of Dwellings Owned by the Local Authority:— Number of houses 237 „ „ flats 67 Total 304 3. Unfit Houses. (I) Inspection of Dwelling Houses during the Year:— (i) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 948 (b) Number of inspections made for the purpose 4141 (it) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 107 (b) Number of inspections made for the purpose 1707 (iii) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil (iv) 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 426 (II) Remedy of Defects during the Year without service of formal notices:— Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 264 29 (III) Action under Statutory Powers during the Year A.—Proceedings under sections 9, 10 and 16 of the Housing Act, 1936:— (i) Number of dwelling-houses in respect of which notices were served requiring repairs Nil (ii) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners Nil (b) By Local Authority in default of owners Nil B.—Proceedings under Public Health Acts:— (i) Number of dwelling houses in respect of which notices were served, requiring defects to be remedied 8 (ii) Number of dwelling houses in which defects were remedied after service of formal notices:— (a) By Owners 6 (b) By Local Authority in default of owners 2 C.—Proceedings under sections 11 and 13 of the Housing Act, 1936:— (i) Number of dwelling-houses in respect of which Demolition Orders were made Nil (ii) Number of dwelling houses demolished in suance of Demolition Orders Nil D.—Proceedings under section 12 of the Housing Act, 1936:—- (i) Number of separate tenements or underground rooms in respect of which Closing Orders were made Nil (ii) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement of room having been rendered fit Nil 4. Housing Act, 1936—Part IV—Overcrowding. (a) (i) Number of dwellings overcrowded at the end of the year 109 (ii) Number of families dwelling therein 109 (iii) Number of persons dwelling therein 701 (b) Number of new cases of overcrowding reported during the year 22 (c) (i) Number of cases of overcrowding relieved during the year 32 (ii) Number of persons concerned in such cases 106 (2) DWELLING-HOUSES UNFIT FOR HUMAN HABITATION. (i) PROCEEDINGS UNDER THE HOUSING ACT, 1925—SEC. 11. Premises. Represented by M.O.H. Closing Order Made. Premises Vacated. Closing Order Determined. Demolition Order Made. Demolished. 4 Hampton Square 4 Mar., 1930 11 Mar., 1930 8 April, 1935 — - - 5 Hampton Square 4 Mar., 1930 11 Mar., 1930 6 Oct., 1930 - Oct., 1934 7 Agate Yard 3 June, 1930 10 June, 1930 20 Dec., 1933 — — — 56 Hampton Square 3 June, 1930 10 June, 1930 Dec., 1931 6 June, 1932 - - 84 Sheen Lane 3 June, 1930 10 June, 1930 Dec., 1933 - - (April, 1938) (ii) PROCEEDINGS UNDER THE HOUSING ACT, 1930—SEC. 19. Premises. Represented by M.O.H. Closing Order Made. (undertaking given) Demolition Order Made. Premises Vacated. Demolished. 93 High Street, Mortlake 1 Sep., 1931 - 10 Oct., 1931 13 Dec., 1934 57 Railway Side 3 Nov., 1931 - 8 Dec., 1931 4 Jan., 1931 Dec., 1932 58 Railway Side 3 Nov., 1931 - 8 Dec., 1931 3 Mar., 1932 Mar., 1933 The Tea Cottage 5 Dec., 1933 - 14 Feb., 1934 11 Oct., 1934 Oct., 1934 3 Thames Bank 6 Feb., 1934 9 May, 1934 - 8 Aug., 1934 - 4 Thames Bank 6 Feb., 1934 9 May, 1934 - 8 Aug., 1934 - Railway Cottage 1 Mav, 1934 - 12 Sep., 1934 5 Mar., 1935 May, 1935 5 Lifford's Place 1 May, 1934 - 12 Sep., 1934 30 June, 1936 July, 1936 7 Lifford's Place 1 May, 1934 - 12 Sep.. 1934 14 May, 1936 July, 1936 Waldeck Cottage 3 July, 1934 - 13 Feb., 1935 23 Jan., 1936 June, 1936 95 High Street, Mortlake 11 Dec., 1935 - 12 Feb., 1936 3 Mar., 1936 — 30 (iii) PROCEEDINGS UNDER THE HOUSING ACT, 1930—SEC. 20. Premises. Represented by M.O.H. Closing Order Made. Premises Vacated. Closing Order Determined. 42 Lonsdale Road 1 May, 1934 15 January, 1936 31 March, 1937 46 Lonsdale Road 1 May, 1934 15 January, 1936 (Unoccupied) — 26 High Street, Barnes 11 Dec., 1935 11 March, 1936 (Unoccupied) — (iv) PROCEEDINGS UNDER THE HOUSING ACT, 1930—PART 1. Clearance Area. Represented by M.O.H. Declared by Council. Compulsory Purchase Order Made. C.P. Order Confirmed. Number of houses. Families to be displaced. Progress to 31 Dec., 1937. Families Re-housed. Houses Vacated. Houses Demolished. No. 1. (Bessants Cottages) 4 July, 1933 • 11 Oct., 1933 9 Nov., 1933 23 Mar., 1934 (Inquiry 19 Dec. 1933) 7 7 7 7 7 No. 2. (Martha Place) 4 4 4 4 4 No. 3. (Mullins Path, No. 1) 6 6 6 6 6 No. 4. (The Vineyard) 11 11 11 11 11 No. 5. (Wisteria Cottage) 3 3 3 3 2 No. 6. (Butlers Cotts., etc.) 3 Oct., 1933 4 4 4 4 4 No. 7. (Mullins Path, No. 2) 16 18 18 16 16 Total : Areas Nos.l to 7 51 53 53 51 50 No. 8. (Railway Street, etc.) 4 Dec., 1935 11 Dec., 1935 10 June, 1936 14 Jan., 1937 (Inquiry 26 Oct., 1936) 4 4 — (4) — (4) — (4) No. 9. (St. Ann's Passage) 20 22 — (22) -(20) — (20) Total : Areas, Nos. 1 to 9 75 79 53 (79) 51 (75) 50 (74) No. 10 (Hampton Square) 28 Sept., 1936 14 Oct., 1936 9 Dec., 1936 29 June, 1937 (Inquiry 27 April, 1937) 72 75 - (57) -(48) - (-) All Areas : Nos. 1 to 10 147 154 53 (136) 51 (123) 50 (74) Note.—The figures in brackets represent the progress at the time of writing. 31 32 (3) HOUSING CONDITIONS. The number of new dwellings erected in the area during 1937 was 165; all of these were houses erected by private enterprise. Slum Clearance. At the commencement of 1937 seven of the ten clearance areas included in the five-year programme had been dealt with, the tenants from these having been rehoused and the dwellings (with the exception of one) demolished. The Compulsory Purchase Orders made on the three remaining areas (Clearance Areas Nos. 8, 9 and 10), which were the subject of Public Inquiries during 1936, were confirmed by the Minister of Health on the 14th January, 1937 in the case of Clearance Areas Nos. 8 and 9, and on the 29th June, 1937 in the case of Clearance Area No. 10. Accommodation to re-house the tenants to be displaced from Clearance Areas Nos. 8, 9 and 10 was proceeded with during the year by the erection of a block of 146 flats, it being anticipated that approximately 90 of these flats would be required for re-housing the families from the Clearance Areas, the balance being available for the purpose of abatement of overcrowding. At the time of writing the flats have been completed and re-housing of the majority of the families has been effected. A summary of proceedings taken in connection with houses unfit for human habitation since 1930, the date of the last Survey Report, is given in tabular form in pages 30 and 31. Overcrowding—Housing Act, 1936—Part IV. (1). Ascertainment of "Permitted Numbers." The Housing Act, 1936 requires that every rent-book or similar document used in relation to any dwelling occupied by the working classes must contain a statement of the "permitted number" of persons who may occupy the dwelling. The local authority, on the application of the landlord or the occupier, is required to inform the applicant in writing of the "permitted number" in relation to the dwelling. For the purpose of ascertaining the "permitted number" of a dwelling it is necessary to obtain the measurements of the rooms in the dwelling. During 1937 the measurement of the 6,038 "dwellings" included in the overcrowding survey was proceeded with to ascertain the "permitted numbers" in respect of them. At the end of the year the "permitted numbers" had been assigned in respect of 5,969 " dwellings," there being a balance only of 69 awaiting measurement. 33 By the 31st December, 1937, applications from landlords, asking to be furnished with information as to "permitted numbers," had been received in respect of 2,903 of the "dwellings" included in the survey. Certificates giving the " permitted numbers " for these were issued. (2). Abatement of Overcrowding. There has been no instance during the year of any dwellinghouse having again become overcrowded after the Council had taken steps for the abatement of overcrowding. The overcrowding survey disclosed 140 "dwellings" in which statutory overcrowding existed. During the year 1936 20 further cases were discovered; during the same year 41 cases were abated leaving 119 awaiting abatement on 1st January, 1937. During 1937 22 new cases of overcrowding were reported and 32 cases abated, leaving a balance of 109 cases of overcrowding awaiting abatement on the 31st December, 1937. Of the 32 cases in which overcrowding was relieved during 1937 5 were relieved by rehousing the families in Council houses, 12 were rehoused by the London County Council in houses on the London County Council Castelnau Estate, and the remaining 15 had become relieved in various other ways, such as the families having removed to dwellings with more accommodation, some of the members of the households having left to reside elsewhere, etc. For the abatement of those existing cases of overcrowding which do not get relieved by other means the Council will have available a balance of about 40 dwellings remaining in the Chertsey Court block of flats after the families from the last of the slum-clearance areas have been rehoused. 34 Section v. INSPECTION AND SUPERVISION OF FOOD. MILK SUPPLY. The number of premises in the district registered as dairies is 5. The number of purveyors of milk who sell by retail in the Borough is 53. Thirty-nine of these purveyors retail milk from premises situated within the Borough (5 from registered dairies, and 34 from premises which do not constitute dairies); the remaining 14 purveyors retail milk in this area from premises situated outside the Borough. The number of visits paid by the sanitary inspectors to the premises of persons engaged in the milk trade during 1937 was 124. Designated Milk. During 1937, designated milk was retailed to customers in this district by the undermentioned 7 purveyors, (a) to (g), holding licences granted by the Council as follows :— (a) From 2 depots in the district "Tuberculin-tested " "Pasteurised " From 4 milk-shops in the district . . "Tuberculin-tested" "Pasteurised" (b) From 7 milk-shops in the district . . "Pasteurised" From 2 premises outside the district "Tuberculin-tested" "Pasteurised" (c) From 1 milk-shop in the district. "Pasteurised" From 1 depot outside the district . . "Tuberculin-tested" "Pasteurised" (d) From 1 milk-shop in the district .. "Tuberculin-tested" "Pasteurised" (e) From 1 milk-shop in the district . . "Pasteurised" (f) From premises outside the district .. "Tuberculin-tested" "Pasteurised" (g) From premises outiside the district "Pasteurised" No purveyor has applied for a licence to sell "Accredited " milk. Adulteration. Twenty-one samples of milk and two samples of cream were taken by the County Inspector under the Sale of Food and Drugs Acts, none of which was found to be adulterated. 35 Refusal or Revocation of Registration. The Council did not during 1937 refuse or revoke registration on the grounds that the public health was, or was likely to be, endangered by any act or default of any purveyor in relation to the quality, storage or distribution of milk. Tuberculous Milk and Tuberculous Cattle. There has been no instance where there was reason to suspect that tuberculosis was caused or likely to be caused by the consumption of milk sold in the district. There is no cowshed in the area. The Council is not a Local Authority for the purposes of the Diseases of Animals Act, 1894. MEAT. Inspection of Butchers' Shops. There are 35 butchers' shops in the area. The number of visits of inspection made by the Sanitary Inspectors, who are Certified Inspectors of Meat, was 122. No diseased meat was found in the course of these inspections. No proceedings were taken under the Public Health (Meat) Regulations, 1924. Slaughterhouses. There is no public slaughterhouse in the area. The only private slaughterhouse licenced in the Borough has been found to be kept in a satisfactory condition. During the year only one notice of intention to slaughter was received. Inspection at the time of slaughter was made by the Chief Sanitary Inspector. The animals slaughtered on this occasion were swine only, numbering 14. No disease was found in any of the carcases inspected. OTHER FOODS. Premises where food other than milk Or meat is sold or prepared for sale, which include fishmongers and poulterers (17), greengrocers (56), fried fish shops (5), cooked-provision shops (21), eating houses (31), ice-cream shops (34), bakehouses (13)—total 177, were inspected periodically. The number of visits of inspection made to these during the year totalled 448. Notices as to unsatisfactory conditions discovered were served in 6 instances and the requirements of the notice in each case were complied with. 36 There are 13 bakehouses in use in the area, one of which is an underground bakehouse. There are 5 bakehouses in the district which are no longer used, 4 of these are underground and are unfit for use as such. Fifty-three visits of inspection were made and in one instance an informal notice was issued in respect of defective conditions. SALE OF FOOD AND DRUGS ACTS : MILK AND CREAM REGULATIONS. The Council of this Borough 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, 1937. Articles. Analysed. Adulterated or deteriorated. Prosecutions. Convictions. Format. Informal. Total Formal Informal Total Milk 18 3 21 Cream 2 — 2 — — — — — Meat 6 — 6 - - - - Sausages 2 — 2 - - - — — Preserved Sau'ges 1 — 1 - - - - - Tea 1 — 1 - - - - - Flour — 1 1 — — — — — Whiskey 2 — j. — — — — — Malt Vinegar 1 — 1 - - - - - Barbados Sugar 3 — 3 — == — — — Lemon Cake 1 — 1 - - - - - Mincemeat 1 — 1 - — — — — Raisins 1 — 1 — — - - — Baking Powder — 1 1 — — — — — Icing Sugar — 1 1 — - — — — Totals 39 6 45 - - - - - UNSOUND FOOD. The following articles of food in an unsound condition were voluntarily surrendered and destroyed:— 1 carcase of a pig. 1 sheep's liver. 2 boxes of skate. 1 box of winkles. 37 Section VI. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS DISEASES. Particulars of the incidence and distribution of the cases of infectious disease notified during the year 1937 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 given. In Table XV the seasonal prevalence during 1937 is shown. The prevalence of the various notifiable infectious diseases during 1937 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 1937 arranged in Four-Weekly Periods. Fourweekly period ending Diphtheria. Scarlet Fever. Measles. Rubella. Enteric Fever. Pulmonary Tuberculosis. Non-pulmonary Tuberculosis. Pneumonia. Erysipelas Puerperal Pyrexia. Opthalmia Neonatorum. Poliomyelitis. Jan. 30 - 10 2 - - 4 4 10 1 - - - Feb. 27 — 7 5 — — — 2 4 — — — — Mar. 27 — 5 61 1 — 4 1 6 2 — — — April 24 — 7 16 — — 3 — 3 — 1 — — May 22 — 9 — — — 1 — 4 1 — — — June 19 — 6 1 — 1 3 — 1 1 — — 1 July 17 2 7 2 1 — 2 — 1 — — — — Aug. 14 — 8 8 — — 1 2 1 3 — — — Sept. 11 — 1 3 1 — 2 — 1 — — — — Oct. 9 — 3 — — 1 3 1 - - - - - Nov. 6 — 2 1 — 1 2 — — 2 — 1 — Dec. 4 1 13 1 3 — 1 — — 1 — — 1 Jan. 1 — 6 1 3 — 2 — 3 1 — — — Totals 3 84 101 9 3 28 10 34 12 1 1 2 38 Table XVI.—Notifiable Infectious Diseases, 1937. 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 25. 35 to 46. 45 to 65. 65 and over Barnes Mortlake. Diphtheria 3 - - - - 1 - 1 - - - l — — 1 2 3 — Scarlet Fever 84 — 2 2 10 7 38 13 3 2 5 l 1 — 26 58 69 — Measles 101 1 4 3 5 7 61 16 3 — 1 - - - 22 79 5 — Rubella 9 1 - - - - 3 1 1 1 2 — — — 5 4 1 — Enteric Fever 3 - - - - - - — — 1 — 2 — — 1 2 1 — Pul. Tuberculosis 28 - - - - - — 3 6 9 4 6 — — 13 15 37 25 Non.-Pul.T uberculosis 10 - - - - - 1 1 1 1 2 1 3 — 5 5 6 4 Pneumonia 34 1 — 1 1 — 1 — 1 — 6 3 11 9 19 15 9 30 Erysipelas 12 - - - - - - - 1 — — 3 6 2 4 8 3 1 Puerperal Pyrexia 1 - - - - - — — 1 — — — 1 - 1 — Ophth'lmia Neonat'rum 1 1 - - - - - - - - - - - - 1 — — — Poliomyelitis 2 - — - - — 1 — 1 — - — — — 1 1 1 — All Diseases 288 4 6 6 16 15 106 34 17 14 21 17 21 11 99 189 136 60 * Information as to admission to Hospitals will be found under the headings of the various diseases. †The deaths recorded in this column are the total corrected number of deaths assignable to the District, and are not necessarily deaths of persons recorded as notified during the year. 39 Table XVII.—Notifiable Infectious Diseases, 1927 to 1937. Year. 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 Diphtheria 10 33 46 41 16 1 72 29 31 4 3 Scarlet Fever 129 101 75 74 64 92 147 132 77 56 84 Enteric Fever 3 4 2 45 3 4 — 1 1 3 3 Puerperal Fever 3 2 1 - 1 1 1 1 - 2 \- „ Pyrexia 4 7 1 2 2 4 2 2 3 1 1 Erysipelas 12 15 11 8 7 10 16 11 16 11 12 Continued Fever — — — — — — - - - - - Relapsing Fever — — — — - - - - - - - Typhus Fever — — — — — - - - - - - Small-pox — — — — — - - - - - - Cholera — — — — — — - - - - - Plague — — — — — — - - - - - Tuberculosis, P. 41 39 51 43 41 44 30 42 21 39 28 Non-P 8 9 11 10 6 13 10 6 8 5 10 Cerebro-spinal Fever — 1 — — — — 2 1 — - - Poliomyelitis — — — — 1 — 1 - - - 2 Ophthalmia Neonatorum 5 5 1 1 - 1 — 1 1 1 1 Measles 18 726 126 397 31 790 50 551 7 517 101 Rubella 11 12 123 41 16 8 23 61 5 29 3 Encephalitis Lethargica - - 1 — — — — — — — — Polioencephalitis - — — — — - - - - - - Malaria 1 — 1 — — - - - - - - Dysentery — — — — — — - - - - - Pneumonia 47 25 52 16 28 30 35 36 13 21 34 Anthrax - - - - - - - - - - - NOTIFIABLE INFECTIOUS DISEASES (EXCLUDING TUBERCULOSIS). Small-pox. No case of small-pox occurred in this district during the year. 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. 40 The following particulars, with reference to the state as regards vaccination on the 31st December, 1937, in respect of the 262 infants whose births were registered between 1st January and the 31st December, 1936, have been supplied to me by the Vaccination Officer for the district:— Births Registered in 1936 262 Certificates of successful vaccination 118 Certificates of exemption 105 Certificates of postponement of vaccination 3 Insusceptible to vaccination — Died unvaccinated 5 Removed to other districts 20 Nor yet accounted for in Vaccination Register .. 11 Diphtheria. Three cases only of this disease were notified during 1937, a remarkably small number in a population of 41,100. All three cases occurred in the Borough. As regards age distribution of the 3 cases notified, 1 was a child under school age, 1 was a child of school age (attending a public elementary school) and the remaining case was an adult. The incidence-rate (cases per 1,000 of the population) was 0.07, the rate for London being 1.93, and for England and Wales 1.49. The incidence-rate of diphtheria in Barnes was less than one-twentieth of the incidence-rate of this disease in the country as a whole. All three cases were admitted to the Council's Isolation Hospital. No death occurred from the disease. The death-rate from diphtheria for London was 0.05, and that for England and Wales 0.07 per 1,000 of the population. The preventive measures taken have been the same as in previous years and were given in detail in my Annual Report for 1930 (page 59). As regards house-incidence the three cases which were notified in the Borough occurred in separate houses. 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. 41 Diphtheria Immunisation. During 1937 the Council have continued to hold a diphtheria immunisation clinic at the Essex House Maternity and Child Welfare Centre each Wednesday, the immunisation being undertaken by a specialist Medical Officer appointed by the Council for this purpose. (a) Work of the Clinic during the Year. Information is given below as to the work undertaken in connection with the scheme during the year ending 31st December, 1937 :— During the above-mentioned period leaflets were issued to 1933 mothers drawing their attention to the facilities available at the Clinic for their children. Requests for testing, and immunisation where necessary, were received from parents during 1937 in respect of 359 children. On the 1st January, 1937 there were 56 applications, received during 1936, which had not been dealt with by the end of that year. These cases and 304 of the applications received during 1937, making 360 in all, received appointments to attend at the Clinic. Fifteen of those appointed had not attended by the end of the year, the parents having withdrawn their applications or postponed attendance on account of ill-health of the child. The number of children dealt with at the Clinic during the year totalled 592, consisting of the above-mentioned 345 children plus 247 children whose course of injections had commenced in 1936 but which had not been completed by the end of that year. The position as regards these 592 children on the 31st December, 1937 is given in the accompanying Table (page 42). Forty-seven sessions of the Clinic were held and the attendances made by the 592 children numbered 2,169, an average of 46 children per session. The work of the clinic has run very smoothly and the attendance of the children has been regular. (b) Method of Procedure. The procedure which has been adopted at the clinic has been as under:— All the children (including those under 5 years of age) have received a primary Schick test to ascertain their susceptibility to the disease. The immunising agent used has been T.A.M., three immunising injections of which have been given. 42 Diphtheria Immunisation Clinic. The Following Table Shows the Position on 31st December, 1937, in Respect of the 592 Children who Attended the Clinic during 1937. Position on 31st Dec., 1937 TOTAL CASES dealt with during 1937 592 (A) Continued in Attendance. 573 (1) Primary-Schick Negative:— 80 (a) Re-Schick Negative (Certificate) 60* (b) Awaiting re-Schick test 9 (c) Re-Schick Positive:— 11 (i) 3-injections, Post-Schick Negative (Certificate) 10 (ii) ,, , awaiting Post-Schick test 1 (2) Primary Schick-Positive:— 493 (a) 3-injections and, Post-Schick Negative (Certificate) 345* (b) Awaiting Post-Schick reading 4 (c) Awaiting Post-Schick test 118 (d) 2-injections, awaiting further injection 10 (e) 1 -injection 4 (f) Awaiting immunisation 4 (g) 3-injections, Post-Schick Positive:— 8 (a)" 2nd Course . . of injections 2nd Post-Schick Negative (Certificate) 6 (b) Awaiting 2nd Post-Schick reading - (c) Awaiting 2nd Post-Schick test 2 (B) Discontinued Attendance. 19 (a) Left the District 12 (i) Primary-Schick, awaiting reading - (ii) Primary-Schick, Negative 4 (iii) ,, „ Positive 2-injections (1), 3-injections (7) 8 (b) Discontinued for other reasons:— 7 (i) Primary-Schick, awaiting reading 1 (ii) Primary-Schick, Negative 1 (iii) ,, ,, ,, , 3-injections 5 (C) Number Immunised and Certificates Issued. 421 Schick tests Negative throughout 60 ,, „ Negative after immunisation 361 * Cases in which Certificates of immunity have been issued. 43 The number of cases in which a second course of injections (usually two in number) has been required before complete immunity, as shown by the Schick test, was established has been very small. Only 10 instances have occurred in the year's work. In every case a Re-Schick test after a negative primary Schick test, or a Post-Schick test after immunising injections, has been performed and a negative result obtained before issuing a certificate of natural immunity, or of artificial immunity after protective injections. Reactions after injections have been very few in number, and those that occurred were only slight in degree. (c) Progress since the Commencement of the Clinic. A summary of the progress made under the scheme during two year's work, from June 1936 (when the scheme was commenced) to June 1938, is given hereunder Number of leaflets issued to parents 4,390 ,, ,, children for whom applications for treatment have been received . 789 ,, ,, children who have been appointed to attend the clinic . 765 ,, „ children who have so far attended 754 „ ,, children who have continued to attend to-date 726 ,, ,, children in respect of whom certificates of immunity have been issued 616 ,, ,, children awaiting Re-Schick test 84 ,, ,, children receiving immunising injections 26 ,, ,, children who failed to complete course 28 Number of Clinic sessions held 93 „ ,, attendances made by children 4,035 Average attendance per session . 45 There has been no instance of any child in the Borough who had reacted negatively to a primary Schick test, or who had been immunised after a positive Schick test, having been notified as a case of diphtheria. Scarlet Fever. The number of cases notified during the year was 84. Two of the cases in respect of whom notifications were received were patients who had developed the disease whilst in London general hospitals and were removed thence to London County Council infectious diseases hospitals. Of the remaining 82 cases which occurred in Barnes 67 were admitted to the Council's Isolation Hospital; in 15 cases isolation of the patient was carried out at home. 44 Of the 84 notified cases, 12 were young children under school age, 53 were of school age (33 attending puplic elementary schools, and 20 attending private schools), and 19 were above school age. The incidence-rate (cases per 1,000 of the population) for Barnes was 2.04, the rate for London being 2.09, and that for England and Wales being 2.33. No death occurred from this disease during the year. The death-rate for London and for England and Wales was 0.01 per 1,000 of the population. The preventive measures taken in previous years were continued in 1937 (an account of these was given in my Report for 1930, page 60). The house-incidence of the 84 cases of scarlet-fever which occurred in the district was as follows :— Number of houses in which 1 case occurred 54 ,, ,, ,, 2 cases ,, 8 ,, ,, ,, 3 ,, ,,2 ,, ,, ,, 4 ,, ,, 2 Total houses invaded 66 Use has not been made of the Dick test. Measles. This disease becomes epidemic in this district every second year. During 1936 there were 517 cases of measles notified ; the year 1937 was a non-epidemic year and only 101 cases of measles and 9 cases of german measles were notified. As has been the practice in past years all the cases notified were home-visited, a total of 161 home-visits being made by the Health Visitors with the object of lessening as far as possible the spread of the disease and of securing that appropriate medical attention was obtained. Cases which were very acute, or in which serious complications has supervened and which were likely to end fatally, and other cases occurring in homes in which the necessary care and nursing attention for the patients could not possibly be provided at home were admitted to the Borough's Isolation Hospital. Six patients were admitted for one or other of the above-mentioned reasons; all these patients recovered. No death occurred from the disease during 1937. The death-rate for England and Wales was 0.02 and that for London 0.01. 45 The death-rate from this disease during the past five years is given in the Table below, contrasted with that for London, and for England and Wales. Table XVIII.—Measles : Death-Rate per 1,000 of Population. Year. Barnes. London. England & Wales. 1933 0.00 0.02 0.05 1934 0.02 0.20 0.09 1935 0.00 0.00 0.03 1936 0.02 0.14 0.07 1937 0.00 0.01 0.02 Average Rate 1933-1937 0.01 0.07 0.05 Enteric Fever. Three cases of enteric fever were notified during the year. All three cases were sporadic, having no connection with one another. In two of the cases the history showed that the disease had been contracted outside the district. In two instances the type of infection was Bac. Typhosus and in the other case Bac. Paratyphosus " B." In two of the cases isolation of the patient was carried out at home, the remaining case being admitted to the Council's Isolation Hospital. None of the cases ended fatally. No secondary cases occurred. A summary of the three cases which occurred is given below:— (1) Female, aged 44 years; notified 29th May; onset of disease 4th May; isolation of the patient carried out at home. This patient had not been away from the Borough. Type of infection Bac. Typhosus. The source of infection was not discovered. (2) Male, aged 42 years; notified 9th September; onset of disease 28th August; removed to the Council's Isolation Hospital 9th September; discharged 24th September. The history in this case points to infection having occurred outside the Borough the patient having been on holiday in Ireland and having returned to this district on the day of onset. Type of infection Bac. Typhosus. The source of infection was not discovered. 46 (3) Male, aged 24 years; notified 25th October; onset of disease 17th October; isolation of the patient carried out at home. The history in this case unquestionably points to infection having occurred outside the area; the patient had been abroad and his illness commenced on the day before his return to this country. Type of infection Bac. Paratyphosus "B." The source of infection was not discovered. The three cases notified in the district correspond to an incidencerate of 0.07 per 1,000 of the population for the Borough ; the incidencerate for London and for England and Wales was 0.05. Acute Anterior Poliomyelitis. Two cases of this disease were notified during the year. The cases were sporadic ones, neither having any connection with the other. One case was that of a child aged 7 years. The patient was notified on the 17th June and was removed to one of the London County Council special hospitals on the 18th June. Some paralysis of the upper limbs, back and neck muscles occurred. Subsequently on the 12th July the patient was transferred to another Special Institution for the continuance of orthopaedic treatment. The other case was that of a boy aged 15 years. The case was notified on the 10th November, the onset of the disease being on the 18th October. Partial paralysis of some of the muscles of the upper extremities resulted and the patient received treatment for this condition at a London general hospital. Cerebro-spinal Fever. There was no case of this disease notified during 1937. Encephalitis Lethargica. Two deaths certified to be due to chronic encephalitis lethargica were assigned to this Borough, both males, aged 62 years and 75 years respectively. Neither had been notified in this area as suffering from "encephalitis lethargica." The former case was an "inward transfer "death of a patient who died in the National Hospital, Queen's Square. The latter was a "resident" death of a patient who had suffered from paralysis agitans of about 2 year's duration, but there is no history of an attack of acute encephalitis lethargica to be obtained in this case. Pneumonia. There were 34 cases of pneumonia notified. Nine cases were removed to institutions for treament, one of these was removed to the Council's Isolation Hospital, and eight were removed to General Hospitals. 47 Erysipelas. Twelve cases of this disease were notified. Three of these cases were removed to the Council's Isolation Hospital. NON-NOTIFIABLE INFECTIOUS DISEASES. Influenza. This disease was prevalent in the district during the early part of 1937; there were twelve deaths during the year. The death-rate for the district was 0.29 per 1,000 of the population, the death-rate for London being 0.38, and for England and Wales 0.45 per 1,000 of the population. Whooping Cough. The number of cases reported to me from notifications by Head Teachers and from other sources was 82. These cases were homevisited by the Health Visitors who made 121 re-visits in following up the cases—-203 home-visits in all. No death from this disease occurred during the year. Death-rates during the past five years, contrasted with the rates for London and for England and Wales during the same period, are given hereunder. Table XIX.—Whooping Cough : Death-Rate per 1,000 of the Population. Year. Barnes. London. England & Wales. 1933 0.00 0.08 0.05 1934 0.00 0.07 0.05 1935 0.00 0.04 0.04 1936 0.02 0.07 0.05 1937 0.00 0.06 0.04 Average Rate 1933-1937 0.00 0.06 0.05 TUBERCULOSIS. During 1937, 28 cases of pulmonary tuberculosis and 10 cases of non-pulmonary tuberculosis were notified, representing an incidencerate of 0.68 cases per 1,000 of the population for pulmonary tuberculosis, and 0.92 for all forms of the disease. 48 Particulars of the new cases of tuberculosis coming to the knowledge of the Medical Officer of Health, and of the deaths which occurred, during 1937 are given in Table XX below. Of the 47 new cases during the year 38 (28 pulmonary, 10 non-pulmonary) were primary notifications; the other 9 new cases (6 pulmonary, 3 non-pulmonary) were brought to my knowledge in the following manner: —notifications transferred from other areas on change of address, 6; information obtained from death returns, 3. Table XX.—Tuberculosis : New Cases and Mortality during 1937. Age-Periods. New Cases.* deaths.† P ulmonary. NonPulmonary. Pulmonary. NonPulmonary. Male Fem'le Male Fem'le Male Fem'le Male Fem'le 0-1 years - - - - - - - - 1-5 „ - - - — - - 1 — 5-10 „ — — — 1 — — — — 10-15 „ — — i — — — — — 15-20 „ 1 2 1 2 — 1 — 1 20-25 „ 4 2 1 25-35 „ 5 7 1 1 3 5 — 1 35-45 „ 2 3 — 1 2 2 — — 45-55 „ 3 2 3 — 5 1 — — 55-65 „ 2 — — 1 4 — — 1 65 „ and over 1 — — — 1 — — — All ages 18 16 7 6 15 9 1 3 * In addition to primary notifications, all other new cases coming to the knowledge of the M.O.H. are included in these figures. †The total number of deaths from pulmonary tuberculosis assigned to the Borough is 25 (16 male, 9 female). It has not been possible to include in the above Tables one of the male deaths from pulmonary tuberculosis as information as to age of the deceased is not available. The number of deaths during 1937 from tuberculosis was 29 (25 pulmonary, 4 non-pulmonary), corresponding to a death-rate per 1,000 of the population of 0.61 for pulmonary tuberculosis and 0.71 for all forms of the disease, the death-rate for London being 0.75 for all forms of tuberculosis. Notification of Tuberculosis. Information as to the ratio of non-notified tuberculosis deaths to total tuberculosis deaths for the year is given hereunder:— There were during 1937 25 deaths from tuberculosis assigned to this Borough; information regarding one male death from pulmonary tuberculosis is not available from the Registrar General. Of the 49 ing 24 deaths 9 were residents who died within the area, and 15 were transferable deaths of residents who died at addresses outside the area. Of the9 "resident" deaths there was only one instance in which the case had not been notified to me in accordance with the Tuberculosis Regulations during the lifetime of the patient. In this case it was ascertained on enquiry that the patient had been diagnosed to be suffering from tuberculosis whilst an inmate of a London general hospital. Of the 15 "transferable deaths" 13 had been duly notified in accordance with the Regulations. The remaining 2 deaths were residents whose deaths occurred in areas outside this area and knowledge of these was received from the Registrar-General on Inward Transfer Death-returns. In one of these cases diagnosis of tuberculosis was first made in the institution outside the district in which the patient died; the cause of death in this case was found upon post-mortem examination to be tuberculosis of the larynx. The remaining case was that of a patient who died from pulmonary tuberculosis in an asylum situated outside this Borough. The patient had been originally admitted to the asylum from an address in this area but tuberculosis was first diagnosed whilst the patient was a resident in the asylum. Notification of the case had been made to the Medical Officer of Health of the area in which the asylum was situated but the notification had not been transferred by the Medical Officer of Health of that area to me. No instance occurred of wilful neglect or refusal to notify. The Register of Notifications has been kept revised in accordance with the requirements of the Public Health (Tuberculosis) Regulations, 1930. The number of cases added to or removed from the Register during the year and the number remaining on the Register on December 31st, 1937 are as under :— Table XXI.—Tuberculosis Notification Register. Form of Disease. On Register 1st Jan. 1937. Cases Added. Removed from Register. Remaining on Register 31st Dec., 1937. Primary Notif'ns Otherwise. Total. Cured Left Disirict. Died. Total. Pulmonary 171 28 7* 35* 4 25 24 53 153 Non-Pulmonary 50 10 3 13 4 4 5 13 50 All Forms 221 38 . 10* 48* 8 29 29 66 203 *Note.—Included in these figures is one patient whose name was restored to the Register. 50 Preventive Work Carried Out by the Council. There has been no change made in the preventive measures which are routinely carried out by the Public Health Department and which have been referred to in detail in previous Reports. A total of 415 home-visits were made during the year by the Health Visitors in connection with patients notified to be 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 Borough. There were 43 residents of this district suffering from tuberculosis admitted to institutions during the year (37 of them suffering from pulmonary and 6 from non-pulmonary tuberculosis). Seven of these received institutional treatment at more than one institution. Admissions were as under Pulmonary Tuberculosis. To Surrey County Council Sanatorium 12 ,, Surrey County Hospitals 10 ,, other sanatoria 12 ,, general hospitals 1 „ Public Assistance Institution 1 ,, other institutions 5 Total 41 Non-pulmonary Tuberculosis. To sanatoria 3 ,, other institutions 6 Total 9 51 ISOLATION HOSPITAL. The number of cases admitted to the Isolation Hospital during the year was lower than the average, the total cases numbering only 91. Admissions and Deaths. The diseases under treatment at the Hospital during the year were as under :— Admissions. Deaths. Diphtheria 3 — Septic Throat sent in as Diphtheria 5 — Quinsy 1 — Stomatitis 1 — Scarlet Fever 67 — Rubella, sent in as Scarlet Fever 1 — Measles 5 — Enteric Fever 1 — Pneumonia 1 1 Erysipelas 1 1 Mumps 1 — Varicella 1 — Total 91 2 Diphtheria Cases Admitted. Only three cases of diphtheria were admitted during the year. One of the cases was an adult male who was affected with nasal diphtheria only. The other two cases were children aged 4 years and 8 years respectively. In the case of the elder of the two children the disease was limited to the fauces and tonsils but he suffered from severe diphtheritic paralysis. The four-year old child was dangerously ill at the time of admission, suffering from laryngeal diphtheria; tracheotomy was performed immediately after admission. All three patients recovered without any sequelae. No cases of cross-infection occurred in either of the Diphtheria Blocks. There was no "return case" of diphtheria during the year. Scarlet Fever Cases Admitted. Cases of scarlet fever admitted during 1937 numbered 67. In 37 of the patients the original attack was relatively mild; in 19 cases the attack was moderately severe, and in 11 the disease was of a severe type. Scarlet-fever anti-toxin was used in all suitable cases with most beneficial results. No death occurred. 52 Among the 67 cases the following complications occurred:— Secondary throat, 1; cervical adenitis, 7; parotid abscess, 1; rhinorrhœa, 7; otorrhcea, 6; mastoiditis, 1; mastoid abscess, 1; toxic heart, 1. Detention in hospital was not continued beyond six weeks in 48 of the cases; the remaining 19 cases were detained in hospital for varying periods of longer duration according to the nature of the complication which had occurred. No cross-infection occurred in either of the Scarlet Fever Blocks. There were three "return cases" during the year, the onset of the "return case" being 1 day, 3 days and 21 days respectively after the date of discharge of the infecting case. In all three instances there were no signs indicating infectiousness in the infecting patients at the time of their discharge; in the instance in which the "return case "arose 21 days after the infecting patient's discharge a rhinorrhoea had recurred a fortnight after he was discharged from hospital. Administration. (A) Cross-Infection. During 1937 the following were instances in which risk of crossinfection had to be guarded against:— Cases of mistaken diagnosis :— Admitted as Scarlet Fever—suffering from Rubella . . 1 ,, ,, ,, ,, ,, ,, Chicken-pox 1 No case of cross-infection, arising either from these cases or from the other patients in the hospital, occurred during the year. The Cubicle Block has continued to be of the utmost service in avoiding cross-infection. The number of patients under treatment in this Block during 1937 was 45. The nature of the 45 cases admitted to the Cubicle Block during the year, excluding staff, is given below :— Scarlet Fever (complicated or doubtful) 23 Diphtheria (complicated or doubtful) 1 Enteric fever 1 Measles 6 Chicken-pox 1 Mumps 1 Erysipelas 3 Rubella sent in as Scarlet Fever 1 9 Chicken-pox 1 Septic Throat sent in as Diphtheria 4 Quinsy 1 Stomatitis 1 Streptococcal Rhinitis 1 Total 45 53 Of the above-mentioned 45 cases, 40 were admitted direct to the Cubicle Block, and 5 cases were transferred to the Cubicle Block from the other Ward Blocks (namely, 1 from the Convalescent Scarlet Fever Ward, 3 from the Acute Scarlet Fever Ward and 1 from the Acute Diphtheria Ward). Forty-four of the 45 cases were retained in the Cubicles until their discharge. One patient died. (B) Incidence of Infectious Disease amongst the Staff. I am pleased to state that none of the members of the staff contracted any infectious disease during the year. (C) Accommodation for Staff. The accommodation for staff is quite satisfactory. (D) Accotnmodation for Patients. The accommodation for patients has been fully reviewed in previous Annual Reports. It is provided in six Ward Blocks. There are two Blocks for scarlet-fever patients and two for diphtheria patients, enabling acute cases and convalescent cases to be isolated in separate Blocks in the case of each of these two diseases. A Cubicle Block provides for the isolation and treatment of doubtful cases, cases with double infections and patients suffering from diseases other than scarlet fever and diphtheria. The remaining block is available for cases of infectious disease other than scarlet fever or diphtheria when prevalent. The accommodation provided is adequate for the needs of the area. LABORATORY FACILITIES. 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 undertaken in the Hospital laboratory. Specimens examined during the year were as follows:— For the detection of tubercle bacilli 65 „ „ „ ,, diphtheria bacilli 120 „ ,, ,, ,, typhoid bacilli (feces) 6 „ „ „ .. „ (urine) 1 Blood (Widal action) 1 Total 193 54 DISINFECTION OF ROOMS AND ARTICLES, AND DISINFESTATION. (a) Disinfection after infectious disease. Rooms vacated by persons suffering from infectious disease are disinfected by fumigation with formalin vapour ; this work is undertaken by the staff of the Public Health Department. The number of rooms disinfected after infectious disease during 1937 was 222. Infected bedding and clothing is steam-disinfected after removal to the Disinfecting Station attached to the Isolation Hospital. During 1937 186 lots of bedding and clothing were steam-disinfected. (b) Disinfestation. Bedding and bedclothing from bug-infested houses is disinfested also by steam at the Disinfecting Station. During 1937 2 lots of bedding, from houses from which the tenants were rehoused in Council houses, were dealt with by steam-disinfestation. Information with reference to action taken to disinfest buginfested houses and household effects other than bedding and bedclothing is given on page 27 of this Report. (c) Destruction of bedding and other articles. Nineteen lots of bedding, clothing or other articles which had been infected, or were infested with vermin, were destroyed on request. 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. During 1937 3 children were treated at the Cleansing Station for verminous condition of the head ; 10 children attended for the treatment of scabies and received treatment on 42 occasions. Nine adults were treated for scabies during the year, making 35 attendances for that purpose. For dealing with persistently verminous children cleansing at the Cleansing Station is the most satisfactory procedure. As a consequence of such action the number of children found verminous in the schools has shown a marked reduction. 55 Section VII. MATERNITY AND CHILD WELFARE. The Barnes Borough Council is the Welfare Authority for the area. As such the Council is responsible for carrying out the duties under the Public Health Act, 1936, Part VII in connection with notification of births, maternity and child welfare, and child life protection. The Council is not the Local Supervising Authority under the Midwives Act. Infantile Mortality. The total number of deaths of infants under one year of age assignable to the Borough for 1937 is 13 only. The various causes of death of these thirteen infants is given below:— cause of death. number of deaths. Found dead—newly-born 1 Congenital malformations 4 Marasmus 1 Prematurity 6 Calcinosis 1 Total 13 The ages at which the deaths occurred and the respective causes of death at each age is set out hereunder:— Age at Death. No. of Deaths. Cause of Death Under 24 hours . 4 Found dead, newly-born, inattention at birth. Prematurity (3). 1 to 7 days 2 Congenital malformation. Prematurity. 1 to 2 weeks 2 Prematurity (2). 2 to 3 weeks Nil 3 to 4 weeks Nil 1 to 3 months 4 Congenital malformation (2). Prematurity. Marasmus. 3 to 6 months Nil 6 to 9 months 1 Calcinosis. 9 to 12 months Nil Total 13 56 Of the total 13 infantile deaths assigned by the Registrar-General to the Borough of Barnes for the year 11 were deaths of infants who died outside the borough, but whose deaths are assignable to this area. The infantile deaths which occurred in the Borough during the year numbered 2 only. The thirteen deaths assigned to Barnes corresponds to a rate of infantile mortality for the Borough of 35.6 per 1,000 registered births. The infantile mortality rate for London was 60, and that for England and Wales was 58 per 1,000 registered births. The infantile mortality rate of 35.6 per 1,000 registered births for the year 1937 is the lowest ever recorded for this area. Analysing the age distribution it is found that 12 of the total thirteen deaths occurred before the infants attained the age of 3 months, and 8 of these died before the age of 2 weeks. It is equally of interest to note the causes of death in the case of these infants. Amongst the 12 infants who died before the age of three months 4 were newly-born babies who had been found dead, 3 died from congenital malformations, and in the case of the remaining 5 prematurity was the cause of death. The saving of life which has been effected in the later months, and the reduction in the number of deaths from those causes which are designated preventable, is evident. Maternal Mortality. It is extremely satisfactory to record that there was no death from maternal causes during 1937. This makes the third year in succession that no life has been lost as a result of childbirth. MIDWIFERY AND MATERNITY SERVICES. An ante-natal clinic, held at the Council's Maternity and Child Welfare Centre, Essex House, is available for expectant mothers and for post-natal cases. The work of the clinic is referred to on page 58. The number of confinements attended by midwives practising in the area during 1937 were as under :— (i) as Midwives155. (ii) as Maternity Nurses 81 Total 236 The number of cases in which medical aid was summoned by a Midwife under Sec. 14 (1) of the Midwives Act 1918 was 15. The services of a Consulting Obstetrician are available in cases of difficult or complicated labour, and in cases of puerperal fever or puerperal pyrexia. 57 Institutional provision for maternity cases under the Council's Maternity and Child Welfare Scheme was continued unchanged during 1937. Of the 365 total births assignable to the district 218 occurred in institutions (hospitals or maternity homes situated either within or without the Borough), a proportion of 60 per cent. These institutional confinements occurred as follows:— In institutions within the Borough 78 In registered maternity homes 78 In institutions outside the Borough . 140 In general hospitals 16 In maternity hospitals 69 In Public Health County hospitals 13 In Public Assistance institutions 23 In maternity homes 19 Total 218 Puerperal Fever and Puerperal Pyrexia. Only one case of puerperal pyrexia was notified during 1937 under the Puerperal Fever and Puerperal Pyrexia Regulations, 1926. The patient was an in-patient at the Richmond Institution where she had been admitted for her confinement. The pyrexia was not due to puerperal sepsis, the cause being mastitis. The patient recovered. Investigations into cases of puerperal fever and puerperal pyrexia are routinely made by the Medical Officer of Health and by the Health Visitors. The Surrey County Council being the Local Supervising Authority under the Midwives Act particulars of the notification in each case notified as puerperal fever or puerperal pyrexia are communicated by me forthwith to the County Medical Officer. The same preventive and remedial measures detailed in previous Reports have been continued during the year. NOTIFICATION OF BIRTHS. There were 286 births registered in the district during the year, 278 being live births and 8 still-births. Of the total 286 births registered, 280 or 98 per cent., had been duly notified in accordance with the provisions of the above-mentioned Act. In every instance in which there was a failure to notify a birth the person, or persons, responsible have been communicated with and reminded of their obligations under the Act. 58 During the year notifications were received in respect of 289 births, and of these 49 were notified by medical practitioners, 239 by midwives, and 1 by a person other than a doctor or midwife. Still-Births. There were 2 still-births notified during 1937, representing 0.7 per cent. of the total births occurring in the area in the year. An enquiry was made into both cases. Of the total number of "nett" births assignable to the district, namely, 375; live births numbered 365, and still-births 10. Of the 10 still-births, 4 were male and 6 female; two of these were illegitimate. The proportion of still-births was 2.7 per cent, of the total "nett" births. HOME-VISITING. Three whole-time Health Visitors, who are specially qualified for the purpose, undertake the home-visiting in connection with maternity and child welfare work. In carrying out these duties the Health Visitors have made special home-visits in connection with various matters, in addition to their visits to all newly-born infants among the working classes, and a summary of the work performed by them during the year is given below:— Year 1936. Year 1937. Visits to expectant mothers 151 401 First visits to newly-born infants 291 352 Revisits to infants under 1 year 1,059 1,646 Visits to children aged 1 to 5 years 1,873 2,857 Still-birth inquiries 5 2 Special visits to opthalmia cases 4 1 „ ,, ,, puerperal fever cases 1 1 „ ,, „ cases of measles 734 161 ,, ,, ,, ,, ,, whooping cough 58 203 ,, „ ,, „ ,, pneumonia 12 38 Visits to foster children 291 444 Visits in connection with infectious diseases other than those above specified 719 1,604 Total visits 5,198 7,710 In my Annual Report for 1935 I expressed the opinion that visits to children aged one to five years should be much more numerous than it had been found possible to undertake in the past with the staff employed, and that in the interest of the health of these children it should be possible to arrange for systematic periodical home-visiting 59 of them to be carried out. I recommended that the health visiting staff should be increased and that clerical assistance should be provided to relieve the Health Visitors of clerical work and so enable them to give a greater amount of time to the work they are specially qualified to undertake. The extension of work necessary to make the Maternity and Child Welfare Services efficient could not otherwise be accomplished. At the end of 1936 the Council appointed an additional health visitor, and a female clerk for maternity and child welfare purposes, both of whom commenced duties at the beginning of 1937. This addition to the staff has enabled the work undertaken in connection with maternity and child welfare not only to be widened in its scope, but made more effective. The number of home-visits it has been possible to make and the increase in the number of attendances at the clinics is some evidence of this. The number of attendances at the clinics has increased to such an extent as to cause a degree of overcrowding both at ante-natal and infant welfare clinics which tends to inefficient work and calls for additional weekly sessions. As soon as the new Centre in North Worple Way is ready for use it will be possible to arrange for an increase in the number of sessions to be held. MATERNITY AND CHILD WELFARE CENTRES. During 1937 ante-natal clinics have continued to be held twice monthly ; clinics for infant consultations have been held twice weekly at the Essex House Maternity and Child Welfare Centre. Ante-Natal Clinic. During the year 105 mothers attended at the clinic; amongst these 90 were expectant mothers who attended as new cases and 3 were post-natal cases. The number of attendances made by the mothers at the clinics was 308. Attendances, subsequent to the preliminary consultation and examination, for further observation and advice were made regularly by most of those expectant mothers who were not already under supervision by a medical practitioner or midwife. The number of expectant mothers who attended the Council's Ante-natal Clinics represented 27.9 per cent. of the total notified births for the year. In addition to those expectant mothers who attended at the Council's Clinic there were 30 mothers, who had booked their confinements at Hospitals, or Maternity Hospitals, and attended the Ante-natal Clinics of those institutions ; this 50 corresponds to a further 8.2 per cent. of the total births in which mothers, not under ante-natal supervision by doctors or midwives, attended at an ante-natal clinic, equalling a total of 36.1 per cent. under ante-natal clinic supervision. At each session of the clinic a medical officer with special gynaecological and obstetrical experience attends and is assisted by two health visitors, each of whom holds the Certificate of the Central Midwives Board. Under the new Midwives Act, 1936 provision has been made for the services of two whole-time salaried midwives employed by the Local Supervising Authority to be available for home confinements occurring in the Borough of Barnes. There has been close co-operation between these midwives and the officers connected with the work of the Council's ante-natal services which is essential if the objects at which the new Act aims are to be attained. Infant Consultations. The number of new cases, the total number of infants and young children attending at the Centre, and the total attendances made by them during 1937 are given below :— New Cases:— Year 1936. Year 1937. Infants under 1 year 173 206 Children 1 to 5 years 65 89 Total 238 295 Number of Children attending during the year:— Infants under 1 year 240 317 Children 1 to 5 years 200 247 Total 440 564 Number of attendances made by:— Infants under 1 year 2,624 3,688 Children 1 to 5 years 1,776 2,233 Total 4,400 5,921 Mothers 3,860 5,239 The average attendance per week has been 113 ; the average attendance of infants under one year being 70 per week, and of children aged 1 to 5 years, 43 per week. 81 The number of infants under one year of age attending for the first time during 1937, namely 206, represents 56.4 per cent. of the total births occurring in the year. A Medical Officer and two Health Visitors, kindly assisted by Voluntary Helpers, are in attendance at the Centre at each session. The number of consultations with the Medical Officer at the centre was 2,084 as contrasted with 1,100 in 1936. During the year 58 children under 5 years of age were referred to Hospitals for sick and ailing children, 14 of whom were admitted as in-patients; in addition to these there were 4 children referred to an Orthopaedic Hospital for treatment. The practice of supplying dried milk, etc. at the Centre at cost price, or free in necessitous cases, was continued during 1937. The total dried milk which was supplied during the year was 2,795 pounds. During the year fresh milk has also been supplied to expectant mothers and nursing mothers and to children under 5 years of age. The total fresh milk which was supplied during the year was 1,099 gallons. The following are the number of cases in which a supply of milk was granted:—to expectant mothers, 12; to nursing mothers, 23; to children under 5 years of age, 52: Total 87. In each instance, in accordance with the Council's Scheme, the supply of milk has not been granted for a period longer than a month at a time. The cases have been reviewed in every instance before continuing or renewing a supply. In all cases in which fresh milk has been supplied it has been stipulated that the milk supplied shall be "pasteurized" milk. LOCAL GOVERNMENT ACT, 1929. Under the above-mentioned Act it became the duty of the Council firstly, to perform the functions of a Local Authority under the Children Act, 1908 as regards Infant Life Protection, and secondly, to make contributions towards the expenses of certain Voluntary Associations (viz. two nursing associations and a day nursery) in so far as they were providing maternity and child welfare services within the area. The conditions subject to which the contributions are payable to these Voluntary Associations were included in the Council's Scheme and were set out briefly in my Annual Report for 1930, pages 98 to 100; one of these conditions is that the Council must be satisfied as to the efficiency of the maternity and child welfare services provided by the association. 62 Child Life Protection. In order to secure co-ordination of this work with the general child welfare work in the area, and to avoid duplication of visitors in the homes, the health visitors carry out the duties of Child Life Protection Visitors under Part VII of the Public Health Act, 1936. Visits are made to the homes of all foster-children once a month routinely, more frequent visits being made where the particular circumstances indicate a need for such. In carrying out the necessary supervision of foster-children the Health Visitors made 444 home-visits, giving advice as to the proper care and management of the children and ascertaining that the conditions under which they were living remained satisfactory. It was not found necessary to institute proceedings during the year for any contravention of the provisions of the Act. The following is a summary of the cases on the Register during 1937:— Foster-mothers on the Register at the beginning of the year 16 ,, ,, added to the Register 13 ,, „ removed from the Register, having ceased to have care of children 13 ,, ,, on the Register at the end of 1937 16 Foster-children on the Register at the beginning of the year 33 ,, ,, in respect of whom Notice of Reception was received 33 ,, ,, removed from the Register during the year :— Returned to care of parents 24 35 31 Adopted 2 Transferred to the care of fostermothers outside the area 1 Removed with foster-mother to another area 2 Admitted to institutions 2 No longer within provisions of Act 4, ,, ,, on the Register at the end of 1937 Voluntary Associations. (A) Voluntary Nursing Associations. (a) Nursing in connection with maternity and child welfare. The Council contributed £20 per annum to each of the two District Nursing Associations, this contribution being made, in accordance with the Council's scheme, in respect of maternity and child welfare services provided. Home nursing for expectant mothers, 63 cases of ophthalmia neonatorum, and cases of measles, whooping-cough, diarrhoea and poliomyelitis in children under five years of age are included in the services provided for under the scheme. No visits were paid by the Nursing Associations' nurses in respect of cases in the above-mentioned categories during 1937. (b) Nursing of general medical and surgical cases. In addition to the payment of £40 referred to above as a contribution authorised under the Maternity and Child Welfare Scheme, the Council made a further contribution of £80 towards the expenses of the two District Nursing Associations (£40 to each Association). In connection with nursing of general medical and surgical cases, other than those specifically provided for maternity and child welfare purposes, the number of home-visits made by the two District Nursing Associations' nurses respectively were as under:— Barnes District Nursing Association, 6,175 home-visits (66 being to cases of pneumonia and 56 to cases of influenza). Mortlake District Nursing Association, 8,567 home-visits (14 being to a case of pneumonia and 5 to a case of influenza). (B) Barnes and Mortlake Day Nursery. During the year the Council made a contribution of £357 towards the expenses of the Barnes and Mortlake Day Nursery in accordance with the Scheme made, for the provision of Maternity and Child Welfare Services, under Sec. 101 of the Local Government Act. In accordance with the Council's Scheme the provision of this service is made for children for whom adequate care cannot be provided in their own homes by reason of the unavoidable absence of the mothers at work, or other cause which necessarily prevents adequate care being provided at home; if the accommodation available cannot be filled with children whose mothers go out to work any vacancies should go to children requiring care and supervision owing to unsatisfactory home conditions. The number of attendances made by children during 1937 were as follows:—Whole-day attendances 4,615; half-day attendances 73. Notices were received in respect of 24 infants and young children newly admitted during the year; of these 12 had ceased to attend the Nursery before the end of the year. 64 Twenty-eight of the children who had been attending at the Day Nursery during 1937 discontinued attendance in the course of the year. The various reasons for cessation of attendance were as follows: 13 discontinued attending as the mother had ceased going out to work, 5 ceased to attend as other arrangements had been made for their care, 2 because the family had left the district, 2 were admitted to institutions, and 6 had reached school age. Of the 21 children attending at the end of 1937 4 were infants under one year of age; 7 were between 1 and 3 years, making a total of 11 under three years of age; 10 of the children in attendance were between 3 and 5 years of age. During March six children were excluded from the Day Nursery on account of suspected whooping cough and one as a contact. In the case of 4 of these children a diagnosis of whooping cough was subsequently made; the remaining 2 were found not to be suffering from that disease. The necessary notices of exclusion were issued in respect of each of the cases, and home-visits were made by the health visitors for the purpose of following-up the cases. Exclusions from other infectious diseases were as follows:—Three children were excluded as contacts of diphtheria, one child as a contact of scarlet fever, and one child as a contact of chicken-pox. The last mentioned child subsequently developed chicken-pox. OPHTHALMIA NEONATORUM. Only one case of ophthalmia neonatorum was notified during 1937. The confinement was attended by a medical practitioner with a midwife acting as a maternity nurse. The disease commenced on the seventh day after the birth. Institutional provision for the case was not found necessary ; both eyes recovered without any impairment of vision resulting. 65 INDEX PAGE Acute Anterior Poliomyelitis 46 Adoptive Acts 16 Ambulance Provision 14 Bacteriological Work . 53 Bakehouses 36 Birth Rate 6 Bye-laws and Regulations 16 Cerebro-spinal Fever 46 Child Life Protection 62 Cleansing Station 54 Common Lodging Houses 25 Dairies, Cowsheds and Milkshops Regulations 34 Day Nursery 63 Death Rate 6 Death, Causes of 7, 9 Death, Causes of, at age periods, Table 8 Deaths in Public Institutions 10 Diphtheria 37, 40, 51 Diphtheria Immunisation 41 Disinfection 55 Disinfestation 27, 54 Drainage Work. 20 Encephalitis Lethargica 46 Enteric Fever 45 Factories and Workshops 22 Fishmongers 19 Fried Fish Shops 25 Health Visitors, Duties and Work of 13, 58 PAGE Houses Let in Lodgings 25 Housing 28 33 „ Statistics, 1937 28 Infantile Mortality . . 12, 55 „ „ Rate of 11 „ ,, Causes of 55 „ Table, 1937 11 Infectious Diseases, Notifiable 39 ,, ,, Non-notifiable 47 Influenza 47 Inquests 10 Isolation Hospital 51-53 Laboratory Facilities 53 Legal Proceedings 22 Local Government Act, 1929 61 Maternal Mortality 56 Maternity and Child Welfare 55-64 „ Home Visiting 58 Centre 59 Measles . . 44 Meat 35 Midwives 15, 56 Milk Supply 34 Mortuary . 16 Notification of Births 57 Nursing Arrangements, Home Nursing, Etc 62 Offensive Trades 25 Ophthalmia Neonatorum 64 Overcrowding 32 Pneumonia 46 Population.. 2, 6 66 INDEX (continued). PAGE Public Conveniences 18 Puerperal Fever 57 Rats and Mice Destruction Act 24 Refuse, Collection of House Refuse 18 Refuse Disposal 18 Registries for Female Domestic Servants 25 River and Stream Pollution 17 Sale of Food and Drugs Act 36 Sanitary Administration 17-27 Sanitary Inspectors, Summary of Work of 19 Scarlet Fever 37, 43, 52 Scavenging of Streets 18 Schools and Schools Clinics 15, 26 Sewage Disposal 17 Shops Acts 24 Slaughter Houses 35 Slum Clearance 30-32 Small-pox 39 Smoke Abatement 24 PAGE Staff of Public Health Department 12 Statistics, Summary of 3 Swimming Pools 25 Tuberculosis Deaths 48 „ Incidence 47 „ Notification of 48 „ Preventive Measures 50 „ Treatment, Dispensary and Institutional 50 Unsound Food 36 Vaccination 39 Venereal Diseases Clinics 15 Verminous Persons 54 Vital Statistics 3-12 „ „ Tables . 4-5 Water Supply 17 Whooping Cough 47 Zymotic Diseases. 9 R. W. SIMPSON AND CO., LTD., PRINTERS, 15, BARNES HIGH STREET, S.W.13.