Barn 6 LIBRARY BOROUGH OF BARNES Annual Report of the Medical Officer of health For the Year 1938. BOROUGH OF BARNES THE Annual Report of the Medical Officer of Health for the year 1938 E. A. Freear Wilkes, m.r.c.s.Eng, l.r.c.p.Lond., D.p.H.c«mb. Medical Officer of Health. BOROUGH OF BARNES. Public Health Committee. Chairman. Alderman Stanley Sparkes, M.B.E., J.P. Members. The Mayor (Alderman E. Middleton, J.P.). The Deputy Mayor (Councillor G. S. Marler, J.P). Alderman A. W. Aldis Councillor A. J. Driver „ E.P.Barry „ J. D. Firmston,J.P. ,, J. N. P. Conlan, J.P. „ G. H. Freyberg, O.B.E. „ W. J. Lane, J.P. „ L. Gassman ,, F. G. Sutton-Mattocks „ R. G. W. Glasgow ,, W. Young ,, J. G. Hensman Councillor E. S. Bolton ,, L. J. Nicholls „ B. J. Capell „ H. C. Purcer Smith „ H. G. Curran „ J. W. J. Samels » E. T. Dailley „ E. S. Stevens ,, F. Davis „ H. Thomas „ T. E. Dixon „ D. Urquhart-Nicol ,, J. A. Dorey „ C. Williams Wood Hospital Sub-Committee. Chairman. Councillor E. S. Bolton Members. Alderman Stanley Sparkes, M.B.E., J.P. Councillor G. H. Freyberg, O.B.E. Councillor B. J. Capell „ L. J. Nicholls ,, H. G. Curran „ H. C. Purcer Smith „ F. Davis ,,E. S. Stevens Maternity and Child Welfare Committee. Chairman. Councillor B. J. Nicholls Council Members. Alderman J. N. P. Conlan, J.P. Councillor E. T. Dailley ,, W. J. Lane, J.P. ,, F. Davis Councillor E. S. Bolton ,, T. E. Dixon ,, B.J. Capell ,, J. A. Dorey Councillor H. Thomas Co-opted Members. Mrs. Boorman Mrs. Lovelace, J.P. Mrs. Halliday Mrs. Ludlow, J.P. Housing Committee. Chairman. The Deputy Mayor (Councillor G. S. Marler, J.P.) Members. The Housing Committee consists of the members of the Public Health Committee given above with the exception of Councillors L. Gassman and J. G. Hensman, and with the addition of Councillor R. H. C. Ashton. 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 of Health. A. V. B. Crawford, M.B., B.Ch., BA.O.Dub., D.P.H.Eng. 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., Cert. Health Visitor. Miss J. McNish, S.C.M.,Cert. Gen. and Fever Trained Nurse. Miss O. L. Wilson, S.R.N., S.C.M., Cert. Health Visitor. Chief Clerk. R. E. Forrest. Assistant Clerks. R. A. Billen. Miss D. M. Reed. 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 18 IV. Housing 29 V. Inspection and Supervision of Food 35 VI. Prevalence of, and Control over, Infectious Diseases 38 VII. Maternity and Child Welfare 55 Public Health Department, Mortlake High Street, S.W.14. 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 1938, 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 1938 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. I regret the preparation of this Report has been delayed; the delay has been occasioned by additional work in connection with the Borough Air Raid Precautions Scheme. 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, Medical Officer of Health. September, 1939. 2 BOROUGH OF BARNES. Report of the medical officer of health for the year 1938. 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, 1938, R.G. 40,960 Number of inhabited houses—Census, 1921 7,939 „ „ „ Census, 1931 10,575 „ ,, „ Rate-books, 1938 10,937 Number of Families, or Separate Occupiers—Census, 1921 8,654 „ „ „ „ Census, 1931 11,746 Rateable Value £515,470 Sum represented by a Penny Rate £2,043 3 SOCIAL CONDITIONS AND OCCUPATION OF THE INHABITANTS. The district is mainly a residential one; more than fifty per cent, 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, 1938. Births :— Birth-rate (per 1,000 of population) 9.2 Live Births:— Total. M. F. Legitimate 360 186 174 Illegitimate 18 7 11 Total 378 193 185 Still Birth-rate (per 1.000 total births) 28.3 Total. M. F. Still Births 11 7 4 Deaths :— Death-rate (per 1,000 of population) 10.8 Total. M. F. Deaths (all causes) 443 209 234 Percentage of all deaths occurring in Public Institutions 44% Death-rate from Maternal Causes (per 1,000 total births) 0.0 Deaths from Sepsis Nil ,, ,, Other causes Nil Death-rate from Zymotic Diseases 0.20 Deaths from Cancer (all ages) 83 ,, ,, Measles (all ages) 1 ,, ,, Whooping Cough (all ages) 1 ,, ,, Diarrhoea (under two years of age) 4 Death-rate of infants under one year of age 68.7 Death-rate for Legitimate infants 66.6 Illegitimate infants 111.1 Natural increment or decrease in the population for (excess of births over deaths or vice versa):— 1938 Decrease 65. Comparative vital statistics with reference to birth-rate, deathrate and infantile mortality are given in tabular form on pages 4 and 5. 4 Table I.—Vital Statistics of the Borough of Barnes during 1938 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. Of nonresidents registered in the District. Of residents not registered in the District. Under 1 year of age. At all ages. Number. Rate. Number. Rate per 1,000 nett births Number Rate Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 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 70.2 453 10.8 1935 42,030 288 393 9.4 205 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 1938 40,960 309 378 9.2 237 5.8 15 219 26 68.7 443 10. 8 5 Table II.—Birth-rate, Death-rate, and Analysis of Mortality during the Year 1938, with corresponding rates for england and wales, 126 great towns, 148 smaller towns, and for the County of London for comparison. The mortality rates refer to the whole population as tegards England and Wales, but only to civilians as regards London and the groups of towns. Birthrate per 1,000 Total Population. Annual Death-rue per 1,000 Population. Death rate per 1 000 Births. Maternal Mortality Hate per i,000 Total Births All Causes Enteric Fever. Small-pox .Measles. Scarlet Fever. Whooping Cough. Diphtheria. Influenza Diarrhœa and Enteritis (under 2 years). Total Deaths under One Year All Causes Pueiperal Sepsis Other Causes. England and Wales 15.1 11.6 0.00 0.00 0.04 0.01 0.03 0.07 0.11 5.5 53 2.97 0.86 2.11 126 County Boroughs and Great Towns, including London 15.0 11.7 0.00 0.00 0.05 0.01 0.03 0.07 0.10 7.8 57 Not available 148 Smaller Towns (Estimated Resident Populations 25,000 to 50,000 at Census, 1931) 15.4 11.0 0.00 0.00 0.03 0.01 0.02 0.06 0.11 3.6 51 London 13.4 11.4 0.00 0.00 0.06 0.01 0.03 0.05 0.06 13.1 57 Barnes Borough 9.2 10.82 0.02 0.00 0.02 0.00 0.02 0.02 0.07 10.6 69 0.00 0.00 0.00 6 Population. The Registrar General's estimate of the population of Barnes for mid-year 1938 is 40/, 60. This is a decrease of 140 persons on his estimate of the population for the previous year, and represents a decrease of 1,480 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 seven years since the 1931 Cent us a natural decrease from excess of deaths over births amounting to 479 persons, there have been during that same period 1,020 newly erected dwellings completed, and occupied, whilst only 96 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 309. After correction for inward and outward transfers the "nett" number of births assignable to the district was 378, corresponding to a birth-rate of 9*2 per 1,000 of the populatiqn. The birth-rate for the year for England and Wales was 15.1 and for London 13'4. 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 1938 was 237. Of these 15 were deaths of persons who were not "residents" of the Borough, and 222 were deaths of "residents." To obtain the correct number of deaths representing the true mortality amongst the population it is necessary to add 221 deaths of "residents" whose deaths occurred outside the Borough. The corrected number of deaths therefore belonging to this district is 443. This number represents a death-rate of 10.8 per 1,000 of the population. The death rate for the year for England and Wales was 11.6, and that for London 11.4. The death-rate of 10.8 for the year 1938 is markedly lower than the death-rates for the two previous years. 7 Causes of Death. An analysis of the total (corrected) deaths for the whole district during 1938 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 1938. Causes of Death Total Deaths Male Female 1 Typhoid and Paratyphoid fevers 1 — 1 2 Measles 1 — 1 3 Sc rlet Fever — — — 4 Whooping Cough 1 1 — 5 Diphtheria 1 1 — 6 Influenza 3 1 2 7 Encephalitis Lethargica — — — 8 Cerebro-spinal fever 1 — 1 9 Tuberculosis of respiratory system 16 12 4 10 Other tuberculous diseases 4 1 3 11 Syphilis 1 1 — 12 General paralysis of the insane, tabes dorsalis — — — 13 Cancer, malignant disease 83 43 40 14 Diabetes 7 1 6 15 Cerebral haemorrhage, etc. 21 4 17 16 Heart Disease 110 49 61 17 Aneurism 2 2 — 18 Other circulatory diseases 26 9 17 19 Bronchitis 8 2 6 20 Pneumonia (all forms) 16 6 10 21 Other respiratory diseases 3 2 1 22 Peptic ulcer 11 10 1 23 Diarrhoea, etc. (under 2 years) 4 3 1 24 Appendicitis 2 — 2 25 Cirrhosis of liver 4 2 2 26 Other diseases of liver, etc. 2 — 2 27 Other digestive diseases 8 4 4 28 Acute and chronic nephritis 7 5 2 29 Puerperal sepsis — — — 30 Other puerperal causes — — — 31 Congenital debility, premature birth, malformations, etc. 18 10 8 32 Senility 19 3 16 33 Suicide 5 4 1 34 Other violence 20 12 8 35 Other defined diseases 38 21 17 36 Causes ill-defined or unknown — — — All Causes 443 209 234 8 Table IV.—Deaths during 1938 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 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45 45 and under 65. 65 and over. Barnes. Mortlake. Deaths of Residents dying in the Borough 222 97 125 13 2 4 1 2 7 64 125 93 129 3 15 8 Deaths of Residents dying outside the Borough (Inward Transfers) 219 112 107 13 - 2 3 11 21 72 97 105 114 191 22 7 Total Deaths— Nett Deaths of Residents, whether dying within or outside the Borough 441 209 232 26 2 6 4 13 28 136 226 198 243 194 37 15 *Note.—The total number of deaths assigned to the Borough by the Registrar-General is 443. 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 441 only. It is not possible to include the additional two deaths in the above Table as information as to Sex, Age and Locality in the case of these two deaths is not known. 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. Table V.—Principal Causes of Death : Annual Number of Deaths from these Causes during Five Years, 1933 to 1937, and during 1938. Cause of Death Number of Deaths in previous 5 years D'ths in Death Rate per 1,000 Population for 1938 1933 1934 1935 1936 1937 1938 Barnes Borough London Zymotic (Epidemic) Diseases 7 5 6 5 - 8 0.20 0.31 Influenza 23 9 3 9 12 3 0.07 0.64 Bronchitis 20 13 8 10 11 8 0.20 0.32 Pneumonia 22 20 21 20 30 16 0.39 0.72 Tuberculosis 25 21 20 27 29 20 0.49 0.69 Cancer 75 78 75 90 80 83 2.03 1.74 Heart Disease 83 85 92 100 121 110 2.69 3.28 Bright's Disease 15 22 10 8 11 7 0.17 0.28 Puerperal Fever — 1 - — - 0.00 0.01 Other Puerperal Diseases 1 - - - - - 0.00 0.02 Premature Birth, Etc 7 7 9 12 11 18 0.44 0.26 Violence and Suicide 23 38 24 32 21 25 0.61 0.48 Zymotic Death-rate. The death-rates for 1938 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, 1933 to 1937 are contrasted with the rate for 1938. 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, 1938. Disease. Barnes. London. England and Wales. Small-pox 0.00 0.00 0.00 Enteric Fever 0.02 0.00 0.00 Measles 0.02 0.06 0.04 Scarlet Fever 0.00 0.01 0.01 Whooping Cough 0.02 0.03 0.03 Diphtheria 0.02 0.05 0.07 Diarrhoea (under 2 years) 0.10 0.18 0.08 Zymotic Death Rate 0.20 0.33 0.23 Table VII.—Zymotic Death-rate for 1938, contrasted with the Death-rates for the previous Five Years. Year. Barnes. London. England and Wales. 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 1938 0.20 0.33 0.23 Inquests. Inquests were held in respect of 37 or 8.4 per cent., of the 443 deaths assignable to the district. The causes of deaths in these cases were as follows:-—Suicide, 5; violent deaths, excluding suicide, 20; natural causes, 12. Deaths in Public Institutions. During 1938, 194 Barnes inhabitants died in public institutions: this represents 43.8 per cent of the 443 total deaths assigned to this district. Of the 222 residents who died in the district, three died in an institution, viz., the Barnes Isolation Hospital. Of the 219 residents whose deaths occurred in other areas outside the Borough, 191 died in institutions; 69 of these deaths occurred in the Public Assistance Institution, Richmond, and 122 in various other public institutions outside the Borough. 11 Table VIII.—Infant Mortality during the Year 1938. 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 W'ks 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 Institu'ns Small-pox Chicken-pox Measles Scarlet Fever Whooping Cough Diphtheria Erysipelas Tuberculous Meningitis Abdominal Tuberculosis Other Tuberculous Disease Meningitis (not Tuberculous) .. .. .. .. .. .. 1 .. .. 1 l .. .. 1 1 Convulsions Laryngitis Bronchitis ... ... ... ... ... l .. .. .. 1 .. 1 1 .. .. Pneumonia (all forms) Diarrhoea and Enteritis .. .. 1 .. 1 2 1 .. .. 4 3 1 1 3 3 Gastritis Syphilis Rickets Atrophy, Debility and Marasmus 1 .. ... ... 1 .. l .. .. 2 1 1 1 1 1 Premature Birth 6 2 .. .. 8 .. .. .. .. 8 3 5 4 4 4 Congenital Malformations 3 .. .. .. 3 ... .. 2 .. 5 2 3 2 3 3 Injury at Birth 3 .. .. .. 3 .. .. .. .. 3 .. 3 2 1 .. Atelectasis Suffocation (overlying) Violence 1 .. .. .. 1 1 .. .. .. 2 2 .. 2 .. .. Other causes All causes 14 2 1 .. 17 4 , 3 2 .. 26 12 14 13 13 12 Nett Births in the Year : Total Births, 378; Legitimate, 360 ; Illegitimate,1 8. Nett Deaths (under 1 year): Total Deaths, 26; Legitimate Infants, 24; Illegitimate Infants, 2. Infantile Mortality Bate : Total, 69; Legitimate, 66; Illegitimate, 111. 12 Infantile Mortality. During 1938 the number of deaths of infants under one year of age was only 26, representing a rate of infantile mortality of 69 per 1,000 registered births. The causes of death of infants dying under one year of age during 1938 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 of Health. A whole-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. (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 three 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. (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 District: Maternity and Child Welfare Centres:— Barnes 3orough Council Ante-natal Clinics "Essex House," Station Road, Barnes 1st & 3rd Fridays, 1 2 p.m. "Health Centre," North Worple Way, Mortlake 2nd & 4th Fridays, 2 p.m. Infant Welfare Clinics "Essex House" "Health Centre" Tues. &Thur., 2 p.m. VIon. & Wed., 2 p.m. Diphtheria Immunisation Clinic "Essex House," Station Road, Barnes Wednesdays, 10 a.m. „ Day Nursery "Oxford House," Upper Richmond Road, East Sheen Daily, Monday to Saturday *Voluntary Association School Clinics- Minor Ailments Clinic "Health Centre," North Worple Way, Mortlake Daily, Monday to Friday, 9.30 a.m. Surrey County Council Eye Clinic „ „ 1 st & 3rd Mondays, 9.30 a.m. Dental Clinic „ „ Mon., Tues., Wed. Fri., &Sat., 9.30 a.m. Tuesdays & Thursdays, 1.45 p.m. 1st 3rd & 5th Fridays, 1.45 p.m. Tuberculosis Dispensary "Health Centre," North Worple Way, Mortlake, and at 38, Sheen Road, Richmond 2nd & 4th Tuesdays, 2 p.m. 1st, 3rd & 5 th Thursdays, 1.30 p.m. 2nd& 4th Thursdays 5.30 p.m. (b) Situated outside District: Venereal Diseases Clinics West London Hospital, Hammersmith Monday to Friday 10-12 & 3-7. ft Saturday, 11-12 & 5.30-6.30 And at 21 other Hospitals in the County of London Various times as advertised „ *The Barnes Borough Council makes an annual contribution of £357 to this institution. 16 (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. During 1938 the number of midwives who gave notice of their intention to practise in this Borough was eleven, nine of these (including the two municipal midwives) being resident within the Borough and two 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 three 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 1938 22 bodies, on which post-mortem examinations were conducted or inquests held, were received ; of this number 12 were bodies of persons resident in the district, 7 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). 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 BYELAWS AND REGULATIONS RELATING TO PUBLIC HEALTH IN FORCE IN THE DISTRICT WITH DATE OF COMMENCEMENT OF OPERATION. Byelaws, Regulations, etc. Statute Date of coming into operation New Streets and Buildings Public Health (Amendment) Act, 1890 7th Feb., 1930 Drainage of Existing Buildings Public Health (Amendment) Act, 1890 13th Feb., 1930 Prevention of Nuisances Public Health Act, 1936 1st Mar., 1938 Cleansing of Earth Closets, etc. Public Health Act, 1936 1st Mar., 1938 Removal of Offensive or Noxious Matter through Streets Public Health Act, 1936 1st Mar., 1938 Offensive Trades (Fish Fryers) Public Health Act, 1936 1st Mar., 1938 Slaughter Houses Public Health Act, 1875 1st Mar., 1938 Public Mortuary Public Health Act, 1936 1st Mar., 1938 Common Lodging Houses Public Health Act, 1936 1st Mar., 1938 Houses Let in Lodgings Housing and Town Planning Act, 1919 11th July, 1922 Tents. Vans and Sheds Public Health Act, 1936 1st Mar., 1938 Fire Escapes in Factories and Workshops Factories Act, 1937 1st Mar., 1938 Notification of Measles, etc. City of Leeds (Measles and German Measles) Regulations, 1920 8th Mar., 1920 Notification of Human Anthrax Infectious Diseases (Notification) Act, 1899 5th Mar., 1921 Maternity Homes Surrey County Council Acts, 1925 (Part IV.) and 1936 28th June, 1926 Domestic Servants' Registeries Surrey County Council Act, 1925 (Part V.) 9th Sept., 1926 18 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 1938. 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 21. 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. 19 Public Conveniences. There are 40 public conveniences in the district. Seven of these have been provided by the Council; one, though not provided, is maintained by the Council; thirty-one are conveniences in connection with public-houses, urinals in connection with three 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, 164 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 1938 the amount of refuse collected from the Barnes Borough was 11,221 tons, and the amount collected in Richmond Borough 11,520 tons, making a total of 22,741 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. 20 Table IX.—Showing the Number and Nature of the Inspections made by the sanitary inspectors during 1938, 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 57 94 2 2 — — Butchers' Shops 34 136 1 1 — — Fishmongers and Poulterers 20 83 - - - - Greengrocers 52 129 1 1 - - Cookedprovision shops 20 75 - - - - Ice-cream shops 42 45 - - - - Restaurants 33 53 3 3 - - Fried-fish shops 6 39 - - - - Slaughterhouses 1 9 - - - - Bakehouses 14 45 4 4 - - Factories:— Mechanical 75 75 6 3 - - Non-mechanic' l 41 142 22 16 - - Workplaces 31 67 - - - - Home-workers 8 9 - - - - Schools 28 52 - - - - Public Halls and Cinemas 8 18 1 - - - Van Dwellers - - - - - - Servants' Registries 3 3 - - - - Marine Stores - - - - - - Stable Yards 31 105 - - - - Public Conveniences 40 87 - - - - Passageways 62 62 - - - - Dwelling-houses (including houses let in lodgings) (1) House - toHouse Inspection 187 3895 488 389 — — (2) Inspected on complaint 505 (3) Inspected in course of other work:— (a) Housing work, etc 150 (b) For infectious diseases 21 Totals 1469 5323 528 419 — — 21 Table X.—Defective Conditions Remedied. Drainage. Sewers cleared or repaired 8 Drains inspected on complaint 48 „ water tests applied 47 ,, smoke tests applied 38 ,, cleansed or repaired 86 ,, relaid 11 „ reconstructed 7 ,, ventilated 5 Inspection chambers repaired 14 ,, ,, new provided 10 Interceptors—Caps fixed 30 Soil pipes renewed 5 ,, „ new provided 5 Ventilating shafts repaired 46 ,, ,, new provided 3 Fresh air inlets repaired or new provided 17 Rairt-water pipes disconnected from drains 3 Water Closets. Pans and traps provided 47 Waste water preventers repaired 28 ,, ,, ,, new provided 18 „ „ ,, water supplied 2 Apartments repaired 181 ,, lighted and ventilated 8 Sinks and Baths. Repaired or newly fixed 64 Waste pipes repaired 24 ,, ,, newly fixed 14 ,, ,, trapped 28 Cesspools. Abolished — Urinals. Repaired or cleansed — New provided 2 Water Supply. Cisterns repaired or renewed 44 Taps off main provided 3 Dustbins. New dustbins provided 164 Ashpits abolished — 22 Yards. Paving repaired 57 Newly paved 46 Dampness. Roofs repaired 262 Gutters and rain water pipes repaired 142 Damp courses provided 143 External walls repointed 172 Floor spaces ventilated 56 Sites below floors concreted 1 General. Dangerous structures repaired or rebuilt 6 Food larders ventilated or new provision made 102 Rooms insufficiently lighted 8 „ „ ventilated 13 Windows repaired 1,062 Windows made to open 14 Doors and frames repaired 139 Permanent ventilator provided to rooms 39 Lighting provided to stairs 91 Stairs repaired or handrails provided 64 Grates repaired or renewed 184 Smoky chimneys remedied 77 Washing coppers repaired 49 Walls and ceiling—plaster repaired 1,012 „ ,, ,, stripped and redecorated 288 Floors repaired 247 Verminous premises fumigated and cleansed 38 „ bedding cleansed or destroyed 6 Offensive accumulations removed 43 Miscellaneous defects remedied 20 Animals improperly kept — Smoke nuisances abated 1 Stables. Premises cleansed 6 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 252 Schools disinfected — Lots of bedding disinfected 137 ,, „ destroyed 24 „ „ disinfested (slum-clearance) 276 ,, ,, disinfested (re-housing) 27 „ „ disinfested (overcrowding) 24 Council houses disinfested 18 Other houses disinfested 84 28 The total number of premises visited by the Sanitary Inspectors under the various Acts, etc., in operation was 1,469, the total number of visits paid being 5,323. Particulars of visits made in connection with overcrowding and other visits not included in Table IX are as follows:— Overcrowding survey, 213; visits in relation to the management of Council houses, 333; in connection with removals for re-housing from slum-clearance areas, 349. In addition to the above work undertaken by the Sanitary Inspectors, the Disinfecting Officer visited 102 premises for the purpose of disinfection after cases of infectious disease, and he carried out the disinfestation of 102 verminous premises. He was also engaged in the following work in connection with drainage :—Drain testing, 34 ; cleansed, 1 ; opened-up, 5. Legal Proceedings. It was not found necessary to institute legal proceedings during 1938. FACTORIES ACT, 1937. Factories and Home-workers. The above Act which repeals the Factory and Workshops Act, 1901, came into operation on the 1st of July, 1938. Under the new Act the term "Workshop" disappears, only one term "Factory" being employed, a distinction being made between mechanical and non-mechanical factories. A new register of factories is in course of preparation; the number of such at present on the register is, mechanical factories 95, non-mechanical factories 41. The number of visits paid to factories and action taken arising out of same is shown in the tabulated statement on page 24. Seven notifications were received from H.M. Inspector of Factories and the necessary action taken in respect of same. 24 Table XI.—Inspection of Factories. Premises. Number of Inspections Written Notices. Occupiers Prosecuted Factories with mechanical power 75 6 - Factories without mechanical power 142 22 - Other Premises under the Act - - - Total 217 28 - Table XII.—Defects Found in Factories. Particulars. Number of Defects. Number of Defects in respect of which Prosecutions were instituted. Found Remedied Referred to H.M. Inspector. Want of cleanliness 15 12 - - Overcrowding - - - - Unreasonable temperature - - - - Inadequate ventilation 2 1 - - Ineffective drainage of floors - - - - Sanitary conveniences insufficient 2 2 - - unsuitable or defective 2 1 - - not separate for sexes 4 2 - - Other offences (Not including offences relating to home-work or offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories & Workshops Transfer of Powers) Order, 1921, and re-enacted in the Third Schedule to the Factories Act, 1937) - - - - Total 25 18 - - 25 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 4 Tailors 4 Dressmaking 1 Total 9 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 Assistant Sanitary Inspectors. During the past year 266 shop premises were inspected for the purposes of the above Acts. In 3 instances notice relating to the sanitary accommodation was given to the occupier. In all of these cases the notices were complied with. SMOKE ABATEMENT. The chimneys of factories and other buildings were kept under observation with a view to detecting any contravention of the Byelaws. In one instance a nuisance was detected, the nuisance being caused by the emission of black smoke. The matter was investigated and, after a written notice had been sent to the responsible person, the nuisance was abated. RATS AND MICE (DESTRUCTION) ACT, 1919. There were 274 complaints of infestation of premises with rats. The rat-catcher made 585 visits to enclosed premises, and 281 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 1938 was 1,302. Poison bait was laid at 70 premises, and 17 sewers were baited with poison. RAG FLOCK ACTS, 1911 and 1928. There are no premises in the area coming within the provisions of these Acts. 26 PREMISES AND OCCUPATIONS WHICH ARE CONTROLLED BY BYE-LAWS OR REGULATIONS. Houses let in Lodgings. During the past year 122 visits were made to premises on the register of houses let in lodgings. During the year 13 such premises were removed from the register, being no longer occupied by two or more families, and 4 premises were added to the register. The total number of such premises on the register at the end of the year was 109. 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 area. No 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 3 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. During 1938 the number of premises on the Register in which fish-frying is permitted was 6, fish-frying was newly established at one shop in the Borough. 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. 27 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 52 cases of scarlet fever notified during the year 37 were cases in children of school age. Of these 26 were children attending public elementary schools, and 11 were cases in children attending private schools (7 at private schools in Barnes, and 4 at private schools outside the district). The only case of diphtheria notified during the year was an adult. In the 13 public elementary schools cases occurred as under:— Number of scholars on Register. Number of scholars who suffered from:— Scarlet Fever. Diphtheria Barnes Central Boys 212 1 - „ „ Girls 229 - - Lowther J.M. and Infants 257 - - Castelnau J.M. and Infants 52 1 - Westfields Mixed 202 1 - „ Infants 128 2 - East Sheen J.M. and Infants 424 6 - Mortlake Central Boys 191 1 - ,, ,, Girls 219 1 - Mortlake Council J.M. and Infarts 350 12 - Mortlake C.E. Mixed 157 1 - ,, „ Infants 77 - - Mortlake R.C. 153 - - Total 2,651 26 - 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 26 scarlet-fever cases and no case of diphtheria during the year. 28 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. (t) Disinfestation of houses. The number of infested houses dealt with was 140. Of this number 18 were Council houses, and 122 were houses not owned by the Council. Disinfestation of the 18 Council houses was carried out by the staff of the Public Health Department. Zaldecide was employed in the case of all these houses. In addition to the Council houses 84 vacant houses in clearance areas awaiting demolition were disinfested with sulphur dioxide. In the case of the 38 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 1938 hydrogen cyanide was not employed for the disinfestation of any house. (ii) Disinfestation of household effects (excluding bedding). The number of families rehoused whose household effects were disinfested by hydrogen cyanide in the course of removal during the year are given below:— Rehoused in Council houses:— (i) Under slum-clearance action: (a) From clearance areas 93 (b) From unfit houses, Sec. 19 — (ii) For the abatement of overcrowding 9 (iii) On general public health grounds 2 Transfer of tenants from one Council house to another 1 Total 105 (in) 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. 29 SECTION IV. HOUSING. (I) HOUSING STATISTICS FOR THE YEAR 1938. 1. Number of New Dwellings Erected during the Year:— Total erected 216 (i) By the Local Authority 147 (ii) By other Local Authorities Nil (Hi) By other bodies or persons 69 2. Number of Dwellings Owned by the Local Authority:— Number of houses 237 „ „ flats 207 Total 444 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) 681 (b) Number of inspections made for the purpose 3845 (ii) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 .. .. 187 (b) Number of inspections made for the purpose 1941 (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 488 (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 389 30 {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 {it) 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 Nil (ii) Number of dwelling houses in which defects were remedied after service of formal notices:— (a) By Owners Nil (b) By Local Authority in default of owners Nil 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 pursuance of Demolition Orders Nil D.—Proceedings under section 12 of the Housing Act, 1936:— (t) Number of separate tenements or underground rooms in respect of which Closing Orders were made Nil (a) 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 37 (ii) Number of families dwelling therein 37 (Hi) Number of persons dwelling therein 250 (b) Number of new cases of overcrowding reported during the year 14 (c) (i) Number of cases of overcrowding relieved during the year 86 (a) Number of persons concerned in such cases 530 31 (3) HOUSING CONDITIONS. The number of new dwellings erected in the area during 1938 was 216. Of this number 69 were houses erected by private enterprise, and 147 were erected by the C uncil. Slum Clearance. At the end of 1937 seven of the ten Clearance Areas included in the five-year slum clearance programme had been dealt with. The housing accommodation for the families to be displaced from the three emaining Clearance Areas Nos. 8, 9 and 10 was almost completed by the end of the year. During 1938 the whole of the families from the three Clearance Areas Nos. 8, 9 and 10 were re-housed, either in the Chertsey Court Flats or in Council houses, except a few families who did not wish to be re-housed by the Council. 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 32 and 33. 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 of only 69 awaiting measurement. This latter figure remained unchanged at the end of 1938. By the 31st December, 1938, applications from landlords, asking to be furnished with information as to "permitted numbers," had been received in respect of 2,954 of the "dwellings" included in the survey. Certificates giving the "permitted numbers" for these were issued. 32 (2) DWELLING-HOUSES UNFIT FOR HUMAN HABITATION. («) 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 May, 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 - 33 (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) — (it;) 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., 1938. 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. 1 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 79 75 74 No. 10 (Hampton Square) 28 Sept., 1936 14 Oct., 1936 9 Dec., 1936 29 June, 1937 (Inquiry 27 72 77 69 (74) 57 (63) - (22) All Areas: Nos. 1 to 10 147 156 148 (153) 132 (138) 74 (96) Note.—The figures in brackets represent the progress at the time of writing 34 (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 years 1936 and 1937 42 further cases were discovered; during the same period 73 cases were abated leaving 109 awaiting abatement on 1st January, 1938. During 1938 14 new cases of overcrowding were reported and 86 cases abated, leaving a balance of 37 cases of overcrowding awaiting abatement on the 31st December, 1938. Of the 86 cases in which overcrowding was relieved during 1938 29 were relieved by rehousing the families in Council houses, 3 were rehoused by the London County Council in houses on the London County Council Castelnau Estate, and the remaining 54 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. Very satisfactory progress in the abatement of overcrowding has been made to have reduced the number of known cases of overcrowding in the Borough to as low a figure as 37. 35 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 57. Forty-three of these purveyors retail milk from premises situated within the Borough (5 from registered dairies, and 38 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 1938 was 94. Designated Milk. During 1938, 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:— (а) From 2 depots in the district "Tuberculin-tested" "Pasteurised" From 4 milk-shops in the district "Tuberculin-tested" "Pasteurised" (б) From 6 milk-shops in the district "Pasteurised" From 2 premises outside the district "Tuberculin-tested" "Pasteurised" (c) From 2 milk-shops in the district "Pasteurised" From 1 depot outside the district "Tuberculin-tested" "Pasteurised" (d) From 1 milk-shop in the district "Pasteurised" (e) From 1 milk-shop in the district "Pasteurised" (/) 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-four samples of milk were taken by the County Inspector under the Sale of Food and Drugs Acts, none of which was found to be adulterated. 36 Refusal or Revocation of Registration. The Council did not during 1938 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 34 butchers' shops in the area. The number of visits of inspection made by the Sanitary Inspectors, who are Certified Inspectors of Meat, was 136: 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 nine notices of intention to slaughter were received. Inspection at the time of slaughter was made by the Chief Sanitary Inspector. The animals slaughtered on this occasion were swine only, numbering 23. 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 (20), greengrocers (52), fried fish shops (6), cooked-provision shops (20), eating houses (33), ice-cream shops (42), bakehouses (14)—total 187, were inspected periodically. The number of visits of inspection made to these during the year totalled 469. Notices as to unsatisfactory conditions discovered were served in 8 instances and the requirements of the notice in each case were complied with. 37 There are 14 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. Forty-five visits of inspection were made and in four instances informal notices were issued in respect of defective conditions. In every instance the notice was complied with. 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 thYear ending 31st December, 1938. Articles. Analysed. Adulterated or deteriorated. Prosecutions. Convictions. Formal. Informal. Total Formal Informal Total. Milk 21 3 24 - — — — — Butter 1 — 1 — — — — — Cheese — 2 2 — — — — — Lard 2 — 2 — — — — — Meat 2 — 2 — — — — — Liver 1 — 1 1 — 1 — — Sausages 3 — 3 — — — — — Preserved Sau'ges 5 — 5 — — — — — Sugar 4 — 4 3 — 3 — — - Jam 1 — 1 — — — — — Ginger Marm'lde — 1 1 — — — — — Grape Fruit Conserve 1 — 1 — — — — — Lemon Squash — 1 1 — — — — — Pure Malt Vinegar 1 — 1 — — — — — Raisins 1 — 1 — — — — — Sultanas 1 — 1 1 — 1 — — Lysol — 1 1 — — — — — Totals 44 8 52 5 — 5 — — 38 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 1938 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 1938 is shown. The prevalence of the various notifiable infectious diseases during 1938 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 1938 arranged in Four-Weekly Periods. Fourweekly period ending Diphtheria. Scarlet Fever. Measles. Rubella. Enteric Fever. Pulmonary 1 uberculosis. Non-pulmonary Tuberculosis. Pneumonia. Erysipelas Puenperal Pyrexia. Opthalmia Nenatorum. Poliomyelitis. Cerebrc-spinal Fever. Dysentery, Jan. 29 - 4 15 8 - 2 1 1 - - - 1 - Feb. 26 — 9 62 76 1 3 - 1 — 1 — — — — Mar. 26 1 4 79 129 — 2 2 6 — — 1 — 1 — April 23 - 1 114 126 — 1 — 2 — — — — — — May 21 - 5 64 51 — 2 — — 1 — — — — — June 18 - 12 22 28 — 2 3 3 — — — — — — July 16 - 2 5 8 — 4 — — 1 1 — 1 — — Aug. 13 - 6 — 2 — — — — — — - — — — Sept. 10 - 2 1 2 — 2 1 1 1 1 - — — — Oct. 6 - - 1 - - - 1 - - 1 - - - 1 Nov. 5 - 2 8 4 1 2 - - - - - - - — Dec. 3 - 2 14 4 — 2 1 2 1 — - — — — Dec. 31 - 3 2 1 — 3 - 2 1 — - - — — Totals 1 52 387 439 2 25 8 18 6 4 1 1 2 1 39 Table XVI.—Notifiable Infectious Diseases, 1938. Diseases. Total Cases Notified. Ages, in years. Parish Removed to Hospital.* Total Deaths of Resident!,† Under l year I to 2. 2 to 3. 3 to 4. 4 to 5. 5 to 10. 10 to 15. 15 to 20. 20 to 26. 25 to 35. 35 to 45. 45 to 65. 65 and over. Barnes Mortlake. Diphtheria 1 - - - - - - - - - l - - - — 1 1 1 Scarlet Fever 52 — 3 — 2 7 27 4 2 1 3 3 — — 15 37 49 — Measles 387 9 42 33 25 77 138 39 10 8 3 3 — — 212 175 9 1 Rubella 439 9 11 8 15 28 188 124 28 10 17 1 — — 204 235 1 — Enteric Fever 2 - - - - - 1 — — — — 1 — — 2 — 2 1 Pul. Tuberculosis 25 — - — — — 1 1 3 6 9 1 4 — 9 16 24 16 Non-Pul.Tuberculosis 8 — - — 1 — 1 1 — 3 1 — 1 — 3 5 6 4 Pneumonia 18 — - — — 2 2 — — — 1 2 7 4 6 12 4 16 Erysipelas 6 - - - - - — 1 — — — 2 3 — — 6 — — Puerperal Pyrexia 4 — - — - - - - 1 — 2 1 — - 3 1 3 — Ophth'lmiaNeonat'rum 1 1 - - - - - - - - - - - - 1 — — — Poliomyelitis 1 — - — — - 1 — — — — - — — 1 — 1 — Dysentery 1 - - - - - - - - - 1 — — — — 1 — — Cerebro-spinal Fever 2 1 - - - - - 1 - - - - - - 1 1 2 1 All Diseases 947 20 56 41 43 114 359 171 44 28 38 14 15 4 457 490 142 40 *Information as to admission to Hospitals will be found under theheadings 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. 40 Table XVII.—Notifiable Infectious Diseases, 1928 to 1938. Year. 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 Diphtheria 33 46 41 16 1 72 29 31 4 3 1 Scarlet Fever 101 75 74 64 92 147 132 77 56 84 b2 Enteric Fever 4 2 45 3 4 — 1 1 3 3 2 Puerperal Fever 2 1 — 1 1 1 1 — 2 - - „ Pyrexia 7 1 2 2 4 2 2 3 1 1 4 Erysipelas 15 11 8 7 10 16 11 16 11 12 6 Continued Fever - - - - - - - - - - - Relapsing Fever - - - - - - - - - - - Typhus Fever - - - - - - - - - - - Small-pox - - - - - - - - - - - Cholera — — — — — — — — — — — Plague — — — — — — — — — — — Tuberculosis, P. 39 51 43 41 44 30 42 21 39 28 25 Non-P. 9 11 10 6 13 10 6 8 5 10 8 Cerebro-spinal Fever 1 — — — — 2 1 — — — 2 Poliomyelitis — — — 1 — 1 — — — 2 1 Ophthalmia Neonatorum 5 1 1 - 1 - 1 1 1 1 1 Measles 726 126 397 31 790 50 551 7 517 101 387 Rubella 12 123 41 16 8 23 61 5 29 9 4S9 Encephalitis Lethargica - 1 - - - - - - - - - Polioencephalitis - - - - - - - - - - - Malaria — 1 - - - - - - - - - Dysentery — — — — — — — — — — 1 Pneumonia 25 52 16 28 30 35 36 13 21 34 18 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, 41 The following particulars, with reference to the state as regards vaccination on the 31st December, 1938, in respect of the 273 infants whose births were registered between 1st January and the 31st December, 1937, have been supplied to me by the Vaccination Officer for the district:— Births Registered in 1937 273 Certificates of successful vaccination 102 Certificates of exemption 125 Certificates of postponement of vaccination Insusceptible to vaccination 1 Died unvaccinated 4 Removed to other districts 28 Nor yet accounted for in Vaccination Register 13 Diphtheria. One case only of this disease was notified during 1938. The incidence of diphtheria has been extremely low for several years past. During the three years 1936-1938 a total of only eight cases have been notified in the Borough. The incidence-rate for Barnes for 1938 was only 0.02 cases per 1,000 of the population; the incidence-rate for London during 1938 was 1.90, and that for England and Wales 1.58 per 1,000 of population. The case notified, an adult male, was admitted in a moribund condition and died a few hours after his admission. The death corresponded to a death rate of 0.02 per 1,000 of the population, the the death-raje for London being 0.05, and that for England and Wales 0.07 per 1,000 of 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). 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. 42 Diphtheria Immunisation. During 1938 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, 1938:— During the above-mentioned period leaflets were issued to 539 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 1938 in respect of 127 children. On the 1st January, 1938 there were 55 applications, received during 1937, which had not been dealt with by the end of that year. These cases and the 127 applications received during 1938, making 182 in all, received appointments to attend at the Clinic. Eleven 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 attending for immunisation at the Clinic during the year totalled 323, consisting of the above-mentioned 171 children plus 152 children whose course of injections had commenced in 1937 but which had not been completed by the end of that year. The position as regards these 323 children on the 31st December, 1938 is given in the accompanying Table (page 43). In addition to the above 323 children, 46 children attended for second post-Schick test 2 years after immunisation, making a total of 369 children attending during the year. Forty-four sessions of the Clinic were held and the attendances made by the 369 children numbered 1,365, an average of 31 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. 43 Diphtheria Immunisation Clinic. The Following Table Shows the Position on 31st December, 1938, in Respect of the 323 Children who Attended the Clinic during 1938. Position on 31 st Dec., 1938 †TOTAL CASES dealt with during 1938 323 (A) Continued in Attendance. 303 (1) Primary-Schick Negative:— 31 (a) Re-Schick Negative (Certificate) 22* (b) Awaiting re-Schick test 7 (c) Re-Schick Positive:— 2 (i) 3-injections, Post-Schick Negative (Certificate) - (it) ,, , awaiting Post-Schick test 2 (2) Primary Schick-Positive:— 272 (a) 3-injections and, Post-Schick Negative (Certificate) 225* (b) Awaiting Post-Schick reading 7 (c) Awaiting Post-Schick test 30 (d) 2-injections, awaiting further injection 4 (e) 1-injection — (f) Awaiting immunisation 1 (g) 3-injections, Post-Schick Positive:— 5 (i) 2nd Course of injections 2nd Post-Schick Negative (Certificate) 3* (ii) Awaiting 2nd Post-Schick reading 1 (iii) Awaiting 2nd Post-Schick test 1 (B) Discontinued Attendance. 20 (a) Left the District:— 5 (i) Primary-Schick, awaiting reading - (ii) Primary-Schick, Negative - (Hi) ,, ,, Positive 2-injections (1), 3-injections (4) 5 (b) Discontinued for other reasons:— 15 (i) Primary-Schick, awaiting reading 5 (ii) Primary-Schick, Negative - (Hi) ,, ,, Positive, 2-injections 10 (C) Number Immunised and Certificates Issued. 250 Schick tests Negative throughout 22 ,, ,, Negative after immunisation 228 *Cases in which Certificates of immunity have been issued. †The figures in this Table do not include the 46 children, referred to on page 42, who attended at the Clinic merely for the purpose of a Re-Schick Test two years after the date of immunisation. 44 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 four 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 three years' work, from June 1936 (when the scheme was commenced) to June 1939, is given hereunder:— Number of leaflets issued to parents 4,910 ,, ,, children for whom applications for treatment have been received 880 ,, ,, children who have been appointed to attend the clinic 854 ,, ,, children who have so far attended 841 ,, ,, children who have continued to attend to-date 800 ,, ,, children in respect of whom certificates of immunity have been issued 746 ,, ,, children awaiting Re-Schick test 42 ,, ,, children receiving immunising injections 12 ,, ,, children who failed to complete course 41 Number of Clinic sessions held 132 „ ,, attendances made by children 5,042 Average attendance per session 38 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 52. Three 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 49 cases which occurred in Barnes 45 were admitted to the Council's Isolation Hospital, one was admitted to the London Fever Hospital, and in 3 cases isolation of the patient was carried out at home. 45 Of the 52 notified cases, 5 were young children under school age, 37 were of school age (26 attending puplic elementary schools, and 11 attending private schools), and 10 were above school age. The incidence-rate (cases per 1,000 of the population) for Barnes was 1.27, the rate for London being 2.05, and that for England and Wales being 2.41. 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 1938 (an account of these was given in my Report for 1930, page 60). The house-incidence of the 52 cases of scarlet-fever which occurred in the district was as follows:— Number of houses in which 1 case occurred 40 ,, ,, ,, 2 cases ,, 3 ,, ,, ,, 3,, ,, 2 Total houses invaded 45 Use has not been made of the Dick test. Measles. This disease becomes epidemic in this district every second year. During 1937 there were 101 cases of measles and 9 cases of german measles notified ; the year 1938 was an epidemic year and 387 cases of measles and 439 cases of german measles were notified. As has been the practice in past years all the cases notified were home-visited, a total of 1,186 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. Ten patients were admitted for one or other of the above-mentioned reasons. Only one death occurred from measles. This patient was a child aged 4 years, who was admitted to the Borough Isolation Hospital and died shortly after admission. The cause of death was due to pneumonia as a complication. 46 The death-rate for Barnes was 0.02 per 1,000 of the population; the death-rate for England and Wales was 0.04 and that for London 0.06. 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. 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 1938 0.02 0.06 0.04 Average Rate 1934.1938 0.01 0.08 0.05 Enteric Fever. Two cases of enteric fever were notified during the year. The cases were sporadic, having no connection with one another. In one instance the type of infection was Bac. Typhosus and in the other case Bac. Paratyphosus " B." Both cases occurred in London general hospitals and in one case the patient was transferred to a London County Council infectious diseases hospital. There was one death from this disease. No secondary case occurred. A summary of the two cases is given below:— (1) Female, aged 7 years; notified 4th February, 1938; onset of disease 22nd January. The patient was admitted to a London general hospital for observation and treatment on the 29th January, 1938; the disease was diagnosed on the 4th February, 1938, as enteric fever and the patient was transferred to a London County Council infectious diseases hospital on the 4th February. Type of infection Bac. Paratyphosus "B." The patient recovered. The source of infection was not discovered. 47 (2) Female, aged 42 years; notified 19th October; onset of disease 8th October. The patient was admitted to a London general hospital on the 11th October, 1938, for treatment and a diagnosis of enteric fever was made subsequent to admission. The patient was seriously ill on admission and the attack proved fatal. Type of infection Bac. Typhosus. The source of infection was not discovered. The above-mentioned death corresponds to a death-rate for the Borough of 0.02 per 1,000 of the population ; the death-rate for London and for England and Wales was 0.00. The two cases notified in the district correspond to an incidencerate of 0.05 per 1,000 of the population for the Borough; the incidence-rate for London was 0.05 and for England and Wales 0.03. Acute Anterior Poliomyelitis. One case of this disease was notified during 1938. The case was that of a child aged 9 years. The child was an in-patient at a London general hospital and was notified on the 9th July, 1938. Some paralysis of the muscles of the arms and legs occurred. Orthopaedic treatment for this condition wrs given in the hospital and the patient was discharged on the 12th December, 1938. Cerebro-spinal Fever. There were two cases of cerebro-spinal fever notified during 1938'. the two cases were not in any way connected. One of the cases was that of a child aged 3 months. The child had been admitted to a London general hospital for diagnosis and treatment; the case was notified on the 11th January, onset of the disease being on the 4th January. The disease proved fatal, the child dying on the 3rd February, 1938. The other case was that of a youth, aged 15 years, who was admitted on the 10th March to a London general hospital for diagnosis. The case was transferred on the same day, after diagnosis, to one of the London County Council infectious diseases hospitals. The patient recovered and was discharged from hospital on the 3rd April, 1938. Encephalitis Lethargica. There was no case of this disease notified during 1938. 48 Pneumonia. There were 18 cases of pneumonia notified. Four cases were removed to institutions for treatment, one of these was removed to the Council's Isolation Hospital, two were removed to general hospitals, and one to a Public Assistance institution. NON-NOTIFIABLE INFECTIOUS DISEASES. Influenza. This disease was not prevalent in the district during 1938; there were only three deaths during the year. The death-rate for the district was 0.07 per 1,000 of the population, the death-rate for London being 0.64, and for England and Wales 0.11 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 105. These cases were homevisited by the Health Visitors who made 150 re-visits in following up the cases—255 home-visits in all. Only one 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. 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 1938 0.02 0.03 0.03 Average Rate 1934-1938 0.01 0.05 0.04 49 TUBERCULOSIS. During 1938, 25 cases of pulmonary tuberculosis and 8 cases of non-pulmonary tuberculosis were notified, representing an incidencerate of 0.61 cases per 1,000 of the population for pulmonary tuberculosis, and 0.81 for all forms of the disease. Particulars of the new cases of tuberculosis coming to the knowledge of the Medical Officer of Health, and of the deaths which occurred, during 1938 are given in Table XX below. Of the 48 new cases during the year 33 (25 pulmonary, 8 non-pulmonary) were primary notifications; the other 15 new cases (11 pulmonary, 4 non-pulmonary) were brought to my knowledge in the following manner : —notifications transferred from other areas on change of address, 13 ; information obtained from death returns, 2. Table XX.—Tuberculosis: New Cases and Mortality during 1938. Age-Periods. New Cases. Deaths. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. Male Fem'le Male Fem'le Male Fem'le Male Fem'le 0-1 years — — — — — — — — 1-5 „ — — 2 — — — — — 5-10 „ — 1 1 — — — — — 10-15 „ 1 1 1 1 — — — 1 15-20 „ 1 1 1 — 1 — — — 20-25 „ 3 3 1 3 2 1 — 2 25-35 „ 4 12 — 1 1 1 1 — 35-45 „ 4 — — — 1 — — — 45-55 „ 1 3 — 1 4 1 — — 55-65 „ 1 — — — 2 1 — — 65 „ and over — — — — 1 — — — All ages 15 21 6 6 12 4 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 number of deaths during 1938 from tuberculosis was 20 (16 pulmonary, 4 non-pulmonary), corresponding to a death-rate per 1,000 of the population of 0.39 for pulmonary tuberculosis and 0.49 for all forms of the disease, the death-rate for London being 0.69 for all forms of tuberculosis. Notification of Tuberculosis. Information as to the ratio of non-notified tuberculosis deatln to total tuberculosis deaths for the year is given hereunder:— There were during 1938 20 deaths from tuberculosis assigned to this Borough. 50 Seven were residents who died within the area, and 13 were transferable deaths of residents who died at addresses outside the area. All 7 "resident" deaths had been notified to me in accordance with the Tuberculosis Regulations during the lifetime of the patient. Of the 13 "transferable deaths" 10 had been duly notified in accordance with the Regulations. The remaining 3 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 only discovered after death as a result of post-mortem examination ; in another case diagnosis of tuberculosis was made in the institution, outside the Borough, in which the patient died. The cause of death in each of these cases was pulmonary tuberculosis. 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, 1938 are as under :— Table XXI.—Tuberculosis Notification Register. Form of Disease. On Register 1st jan. 1938 Cases Added. Removed from Register Remaining on Register 31st Dec.. 1938. Primary Notif ns Otherwise. Total. Cured Left District. Died. Total. Pulmonary 153 25 13 38 7 18 17 42 149 Non-Pulmonary 50 8 5 13 1 7 5 14† 49† All Forms 203 33 18 51* 8 25 22 56† 198 *Included in these figures are three patients whose names were restored to the Register. †1 non-pulmonary tuberculosis transferred to pulmonary tuberculosis upon subsequent notification. 51 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 356 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 30 residents of this district suffering from tuberculosis admitted to institutions during the year (24 of them suffering from pulmonary and 6 from non-pulmonary tuberculosis). Five of these received institutional treatment at more than one institution. Admissions were as under:— Pulmonary Tuberculosis. To Surrey County Council Sanatorium 10 ,, Surrey County Hospitals 4 ,, other sanatoria 3 ,, general hospitals 8 ,, Public Assistance Institution 2 Total 27 Non-pulmonary Tuberculosis. To sanatoria 4 ,, other institutions 5 Total 9 52 ISOLATION HOSPITAL. The number of cases admitted to the Isolation Hospital during the year was lower than the average, the total cases numbering only 72. Admissions and Deaths. The diseases under treatment at the Hospital during the year were as under:— Admissions. deaths. Diphtheria 1 1 Diptheria carrier 1 — Septic Throat—sent in as Diphtheria 1 - Scarlet Fever 46 - Tonsilitis—sent in as Scarlet Fever 1 - Measles 10 1 Influenzal Pneumonia 1 1 Pneumonia—sent in as Enteric Fever 1 Whooping Cough 5 — Chicken Pox 3 — Mumps 1 — Acute Cellulitis—sent in as Erysipelas 1 — Total 72 3 Diphtheria Cases Admitted. Only one case of diphtheria was admitted during the year. The case was of extremely severe character and terminated fatally. Scarlet Fever Cases Admitted. Cases of scarlet fever admitted during 1938 numbered 46. In 26 of the patients the original attack was relatively mild; in 16 cases the attack was moderately severe, and in 4 the disease was of a severe type. Scarlet-fever anti-toxin was used in all suitable cases with most beneficial results. No death occurred. Among the 46 cases the following complications occurred:— Secondary throat, 1; cervical adenitis, 3; rhinorrhæœa, 3; otorrhœa, 2; toxic heart, 2. Detention in hospital was not continued beyond six weeks in 35 of the cases; the remaining 11 cases were detained in hospital for varying periods of longer duration according to the nature of the complication which had ocurred. No cross-infection occurred in either of the Scarlet Fever Blocks, and there was no "return case" during the year. 53 Administration. (A) Cross-Infection. No case of cross-infection 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 1938 was 47, 3 of whom were admitted during 1937 and were still under treatment at the beginning of 1938. The nature of the 44 cases admitted to the Cubicle Block during the year, excluding staff, is given below:— Scarlet Fever (complicated or doubtful) 20 Diphtheria (complicated or doubtful) 1 Measles 9 Rubella 1 Whooping Cough 5 Chicken-pox 3 Mumps 1 Influenzal Pneumonia 1 Septic Throat—sent in as Diphtheria 1 Pneumonia—sent in as Enteric Fever 1 3 Cellulitis of leg—sent in as Erysipelas 1 Total 44 All the above-mentioned 44 cases were admitted direct to the Cubicle Block. Forty of the 44 cases were retained in the Cubicles until their discharge. One patient was transferred to the Convalescent Scarlet Fever Ward and 3 patients 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) Accommodation 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. 54 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 57 „ „ ,, „ diphtheria bacilli 116 „ „ ,, „ typhoid bacilli (fæces) 3 „ „ „ „ „ „ (urine) 2 Blood (Widal action) 4 Total 182 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 1938 was 252. Infected bedding and clothing is steam-disinfected after removal to the Disinfecting Station attached to the Isolation Hospital. During 1938 137 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 1938 276 lots of bedding from houses in slum clearance areas, and 51 lots of bedding from other 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 28 of this Report. (c) Destruction of bedding and other articles. Twenth-four lots of bedding, clothing or other articles which had been infected, or were infested with vermin, were destroyed on request. 55 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 1938 3 children were treated at the Cleansing Station oi verminous condition of the head; 16 children attended for the treatment of scabies and received treatment on 108 occasions. Eight adults were treated for scabies during the year, making 49 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. 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. 56 Infantile Mortality. The total number of deaths of infants under one year of age assignable to the Borough for 1938 is 26 only. The various causes of death of these twenty-six infants is given below:— CAUSES OF DEATH. NUMBER OF DEATHS. Found dead—newly-born 1 Injury at birth 3 Congenital malformations 5 Congenital debility 1 Marasmus 1 Prematurity 8 Gastro-enteritis 4 Bronchitis 1 Meningitis 1 Accidental death 1 Total 26 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 10 Found dead, newly-born, inattention at birth. Injury at birth (2). Congenital malformation. Congenital debility. Prematurity (5). 1 to 7 days 4 Injury at birth. Congenital malformation (2). Prematurity. 1 to 2 weeks 2 Prematurity (2). 2 to 3 weeks 1 Gastro-enteritis. 3 to 4 weeks Nil 1 to 3 months 4 Gastro-enteritis (2). Bronchitis Accidental death. 3 to 6 months 3 Marasmus. Gastro-enteritis Meningitis. 6 to 9 months 2 Congenital malformation (2). 9 to 12 months Nil Total 26 Of the total 26 infantile deaths assigned by the Registrar-General to the Borough of Barnes for the year 13 were deaths of infants who died outside the borough, but whose deaths are assignable to this area, and 13 were infantile deaths which occurred in the Borough. 57 The twenty-six deaths assigned to Barnes corresponds to a rate of infantile mortality for the Borough of 68.7 per 1,000 registered births. The infantile mortality rate for London was 57, and that for England and Wales was 53 per 1,000 registered births. The infantile mortality rate of 68.7 per 1,000 registered births for the year 1938 is in striking contrast to the rate of 35.6 for 1937, which was the lowest ever recorded for the District. The exceptionally large proportion of neo natal deaths is a conspicuous feature of this unusually high mortality. Analysing the age distribution it is found that no less than 17 of the total 26 deaths occurred before the infants had reached the age of 3 weeks. It is further observed that 10 of the infants died within 24 hours of birth. From a consideration of the causes of death as certified it is difficult to assess precisely the various factors, or the extent to which any) particular factors, contributed to this high mortality under 1 month. The ages, and causes of death, of the 17 infantile deaths under 3 weeks are given for reference:— Age at death. Certified cause of death. Newly born Found dead (want of attention at birth). 10 minutes Malpresentation. 30 ,, Prematurity. 1 hour Congenital heart disease. 5 hours Prematurity (twin). 6 „ Prematurity. 8 „ Prematurity. 8 „ Injury at birth (difficult labour). 9 „ Prematurity (twin). (10) 15 ,, Injury at birth (breech presentation). 1 day Collapse of lung. 2 days Injury at birth (twin). 3 ,, Congenital malformation (imperforate anus). 4 ,, Prematurity (twin). 1 week Prematurity (7 months). 11 days Prematurity. (17) 2 weeks Intestinal indigestion. Maternal Mortality. It is extremely satisfactory to record that there was no death from maternal causes during 1938. This makes the fourth year in succession that no life has been lost as a result of childbirth. There has been nojjdeath from puerperal fever since 1934 and no death from other puerperal causes since 1933. 58 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 61. The services of a Consulting Obstetrician are available in cases of difficult or complicated labour, and in cases of puerperal fever or puerperal pyrexia. During 1938 these services were utilised on three occasions—one a case of puerperal pyrexia, another a difficult labour, and the third post-partum hæmorrhage with subsequent pyrexia. Information as to the number of midwives practising in the Borough, the number of confinements attended by these midwives, and the number of cases in which medical aid was summoned during the year, is given in the following table:— Domiciliary Midwives. Midwives in Institutions. Totals. 1. Total number of midwives practising at the end of the year in the Borough of Barnes:— (a) Employed by the Local Supervising Authority 2 - 2 (b) In private practice 2 6 8 2. Number of cases in the Borough of Barnes attended during the year by midwives:— (a) Employed by the Council— (i) As midwives 68 — 68 (ii) As maternity nurses 12 — 12 (b) In Drivate nractice— (i) As midwives 67 36 103 (ii) As maternity nurses 88 176 264 3. Number of cases in which medical aid was summoned during the year under Section 14(i)of the Midwives Act, 1918, by a midwife:— (i) Engaged in domiciliary practice 43 Total 44 (ii) For cases in institutions 1 Institutional provision for maternity cases under the Council's Maternity and Child Welfare Scheme was continued unchanged during 1938. Of the 378 total births assignable to the district 217 occurred in institutions (hospitals or maternity homes situated either within 59 or without the Borough), a proportion of 57 per cent. These institutional confinements occurred as follows:— In institutions within the Borough 70 In registered maternity homes 70 In institutions outside the Borough 147 In general hospitals IS In maternity hospitals 71 In Public Health County hospitals 13 In Public Assistance institutions 33 In maternity homes 15 Total 217 Puerperal Fever and Puerperal Pyrexia. Four cases were notified under the Puerperal Fever and Puerperal Pyrexia Regulations, 1926, during the year. These cases are summarised below:— 1. Confinement in a nursing home. On account of pyrexia the patient was seen by a consultant obstetrician and admitted to a London general hospital. The febrile condition on investigation was found to be due to a mild puerperal sepsis which completely cleared up and patient was discharged twelve days after admission. 2. Confinement in a nursing home. Post-partum hæmorrhage occurred and a consultant obstetrician was called in. Pyrexia supervened but was not of a severe degree. Patient made a good recovery. 3. Home confinement. Pyrexia supervened on the third day after delivery. Patient was admitted to Queen Charlotte's Isolation Block for observation and treatment. The pyrexia was not due to puerperal sepsis and the patient was discharged after 12 days' retention in hospital. 4. Confinement in a London general hospital. Pyrexia was not attributable to puerperal sepsis. Investigations into cases of 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 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. 60 NOTIFICATION OF BIRTHS. There were 316 births registered in the district during the year, 309 being live births and 7 still-births. Of the total 316 births registered, 310 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. During the year notifications were received in respect of 311 births, and of these 25 were notified by medical practitioners, 284 by midwives, and 2 by persons other than a doctor or midwife. Still-Births. There were 5 still-births notified during 1938, representing 1.6 per cent, of the total births occurring in the area in the year. An enquiry was made into all cases. Of the total number of "nett" births assignable to the district, namely, 389; live births numbered 378, and still-births 11. Of the 11 still-births, 7 were male and 4 female; two of these were illegitimate. The proportion of still-births was 2.8 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 Year 1937. 1938. Visits to expectant mothers 401 308 First visits to newly-born infants 352 373 Revisits to infants under 1 year 1,646 1,450 Visits to children aged 1 to 5 years 2,857 2,451 Still-birth inquiries 2 13 Special visits to ophthalmia cases 1 3 ,, ,, ,, puerperal fever cases 1 4 ,, ,, ,, cases of measles 161 1,186 ,, ,, ,, ,, ,, whooping cough 203 255 ,, ,, ,, ,, ,, pneumonia 38 25 Visits to foster children 444 410 Visits in connection with infectious diseases other than those above specified 1,604 1,472 Total visits 7,710 7,950 61 In consequence of the appointment, at the beginning of 1937, of an additional health visitor and a female clerk for maternity and child welfare purposes, the number of home-visits made increased from 5,198 visits during the year 1936 to 7,710 visits during 1937. The number of home-visits made by the health visitors during 1938 was 7,950. MATERNITY AND CHILD WELFARE CENTRES. During 1938 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. The number of attendances at this Centre, which had increased during the year 1937, continued to be so large during 1938 as to cause a degree of overcrowding, both at the Ante-natal and the Infantwelfare Clinics, which tended to inefficiency in the work. Fortunately soon after the end of the year, on the completion of the New Health Centre at North Worple Way, Mortlake, it became possible to transfer half of the work to that Centre. Early in the present year, March, 1939, it was arranged for four Infant-welfare sessions per week and four Ante-natal sessions per month to be held, the mothers and infants from the Barnes parish attending at the Essex House Centre and those from the Mortlake parish attending the clinics held at the North Worple Way Centre. Ante-Natal Clinic. During the year 146 mothers attended at the clinic; amongst these 126 were expectant mothers who attended as new cases and 2 were post-natal cases. The number of attendances made by the mothers at the clinics was 348. 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 37.4 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 24 mothers, who had booked their confinements at Hospitals, or Maternity Hospitals, and attended the Ante-natal Clinics of those institutions; this corresponds to a further 6.2 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 43.6 per cent, under ante-natal clinic supervision. 62 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. 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, has continued. 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 1938 are given below:— Year Year New Cases:— 1937. 1938. Infants under 1 year 206 238 Children 1 to 5 years 89 99 Total 295 337 Number of Children attending during the year:— Infants under 1 year 317 366 Children 1 to 5 years 247 326 Total 564 692 Number of attendances made by:— Infants under 1 year 3,688 4,078 Children 1 to 5 years 2,233 3,247 Total 5,921 7,325 Mothers 5,239 6,245 The average attendance per week has been 142; the average attendance of infants under one year heing 79 per week, and of children aged 1 to 5 years, 63 per week. The number of infants under one year of age attending for the first time during 1938, namely 238, represents 63.0 per cent. of the total births occurring in the year. 63 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 2,466 as contrasted with 2,084 in 1937. During the year 48 children under 5 years of age were referred to Hospitals for sick and ailing children, 13 of whom were admitted as in-patients ; in addition to these there were 2 children referred to an Orthopaedic Hospital for treatment, one of whom was admitted as an in-patient. The practice of supplying dried milk, etc. at the Centre at cost price, or free in necessitous cases, was continued during 1938. The total dried milk which was supplied during the year was 3,430 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 2,806 gallons. The following are the number of cases in which a supply of milk was granted:—to expectant mothers, 12; to nursing mothers, 25; to children under 5 years of age, 111: Total 148. 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. 64 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 410 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 1938:— Foster-mothers on the Register at the beginning of the year 16 ,, ,, added to the Register 6 ,, ,, removed from the Register, having ceased to have care of children 12 ,, ,, on the Register at the end of 1938 10 Foster-children on the Register at the beginning of the year 31 ,, ,, in respect of whom Notice of Reception was received 34 „ ,, removed from the Register during the year:— Returned to care of parents 26 Adopted 1 Transferred to the care of foster- mothers outside the area 4 Removed with foster-mother to another 48 area 14 Admitted to institutions 1 No longer within provisions of Act 1 Died 1 ,, ,, on the Register at the end of 1938 17 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, 65 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. (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). During the present year (March, 1939) the Council made an increase in the contribution payable in respect of the nursing of general medical and surgical cases from £40 to each of the two Associations, to £50 in the case of the Barnes District Nurisng Association, and £75 in the case of the Mortlake District Nursing Assooiaticn, respectively. 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, 6,026 home-visits (16 being to cases of pneumonia and 5 to a case of influenza). Mortlake District Nursing Association, 12,653 home-visits (8 being to a 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 1938 were as follows:—Whole-day attendances 3,805 ; half-day attendances 320. 66 Notices were received in respect of 35 infants and young children newly admitted during the year; of these 20 had ceased to attend the Nursery before the end of the year. Thirty-four of the children who had been attending at the Day Nursery during 1938 discontinued attendance in the course of the year. The various reasons for cessation of attendance were as follows: 10 discontinued attending as the mother had ceased going out to work, 12 ceased to attend as other arrangements had been made for their care, 5 because the family had left the district, 3 were admitted to institutions, and 4 had reached school age. Of the 23 children attending at the end of 1938 3 were infants under one year of age; 9 were between 1 and 3 years, making a total of 11 under three years of age; 11 of the children in attendance were between 3 and 5 years of age. Exclusions to prevent spread of infectious disease during 1938 were as follows1 child was excluded suffering from German measles and 3 as contacts of this disease; 2 suffering from whoopingcough and 2 suffering from mumps. OPHTHALMIA NEONATORUM. Only one case of ophthalmia neonatorum was notified during 1938. The birth occurred in a London general hospital, and the disease commenced a few days after birth whilst the infant was still in hospital. Special institutional provision was not required in this case: after discharge from hospital the District Nurse visited the child at home and treated the eye. The eye recovered without any impairment of vision resulting. 67 INDEX PAGE Acute Anterior Poliomyelitis 47 Adoptive Acts 16 Ambulance Provision 14 Bacteriological Work 54 Bakehouses 37 Birth Rate 6 Bye-laws and Regulations 17 Cerebro-spinal Fever 47 Child Life Protection 64 Cleansing Station 55 Common Lodging Houses 26 Dairies, Cowsheds and Milkshops Regulations 35 Day Nursery 65 Death Rate 6 Death, Causes of 7, 9 Death, Causes of, at age periods, Table 8 Deaths in Public Institutions 10 Diphtheria 38, 41, 52 Diphtheria Immunisation 42 Disinfection 54 Disinfestation 28, 54 Drainage Work 21 Encephalitis Lethargica 47 Enteric Fever 46 Factories and Workshops 23 Fishmongers 20 Fried Fish Shops 26 Health Visitors, Duties and Work of 13, 60 PAGE Houses Let in Lodgings 26 Housing 29 34 „ Statistics, 1938 29 Infantile Mortality 12, 56 „ „ Rate of 12 ,, ,, Causes of 56 „ Table, 1938 11 Infectious Diseases, Notifiable 38 „ „ Non-notifiable 48 Influenza 48 Inquests 10 Isolation Hospital 52-53 Laboratory Facilities 54 Legal Proceedings 23 Local Government Act, 1929 63 Maternal Mortality 57 Maternity and Child Welfare 55-66 „ Home Visiting 58 „ Centre 59 Measles 45 Meat 36 Midwives 16, 58 Milk Supply 35 Mortuary 16 Notification of Births 60 Nursing Arrangements, Home Nursing, Etc. 64 Offensive Trades 26 Ophthalmia Neonatorum 66 Overcrowding 31 Pneumonia 47 Population 2, 6 68 INDEX (continued). PAGE Public Conveniences 19 Puerperal Fever 59 Rats and Mice Destruction Act 25 Refuse, Collection of House Refuse 19 Refuse Disposal 19 Registries for Female Domestic Servants 26 River and Stream Pollution 18 Sale of Food and Drugs Act 37 Sanitary Administration 18-28 Sanitary Inspectors, Summary of Work of 20 Scarlet Fever 38, 44, 52 Scavenging of Streets 19 Schools and Schools Clinics 15, 27 Sewage Disposal 18 Shops Acts 25 Slaughter Houses 36 Slum Clearance 31-33 Small-pox 40 Smoke Abatement 25 PAGE Staff of Public Health Department 12 Statistics, Summary of 3 Swimming Pools 26 Tuberculosis Deaths 49 „ Incidence 49 „ Notification of 49 ,, Preventive Measures 51 „ Treatment, Dispensary and Institutional 51 Unsound Food 37 Vaccination 41 Venereal Diseases Clinics 15 Verminous Persons 55 Vital Statistics 3-12 „ ,, Tables 4-5 Water Supply 18 Whooping Cough 48 Zymotic Diseases 10 R. W. SIMPSON AND CO., LTD., PRINTERS, 15, BARNES HIGH STREET, S.W.13.