BARN 8 BOROUGH OF BARNES Annual Report of the Medical officer of Health For the Year 1940 BOROUGH OF BARNES the Annual Report of the Medical Officer of Health for the year 1940 W. F. Twining McMath, m.d.Beif.. M.R.c.p.Lond., l.m., d.p.h. Medical Officer of Health. BOROUGH OF BARNES. STAFF OF THE PUBLIC HEALTH DEPARTMENT. Medical Officer of Health. W. F. Twining McMath, M.D.Belf., M.R.C.P.Lond., L.M., D P.H. Assistant Medical Officer of Health. A. V. B. Crawford, M.B., B.Ch., B.A.O.Dub., D.P.H.Eng. Chief Sanitary Inspector. C. S. Perchard, Cert.R.San.Inst., Cert. Meat and Foodlnsp. Additional Sanitary Inspectors. G. G. Gardiner *A. A. Brown R. H. Street Cert.San.Insp., Cert. Meat and Food Insp. Temporary Sanitary Inspector. E. Kilner, Cert.San.Insp., Cert. Meat and Food Insp. 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 K. D. Elliott. *G. K. Shilleto. G. E. Tydeman. Temporary Clerks. Miss B. Haydon. Miss K. P. Morcom. Miss H. Wheatley. Matron of the Isolation Hospital. Miss P. Thompson, S.R.N., R.F.N. * (Serving with H.M. Forces). Public Health Department, 394, Upper Richmond Road, East Sheen, S.W.14. To the Mayor, Aldermen and Councillors of the Borough of Barnes. Mr. Mayor, Madam and Gentlemen, I have the honour to present my Annual Report for the year 1940, on the sanitary circumstances, the sanitary administration, and the vital statistics of the Borough. Upon the 5th June, 1940, I succeeded Dr. E. A. Freear Wilkes, who had been Medical Officer of Health for nearly twenty years and who left a well-organised department and one capable of extension. This is therefore my first report as your Medical Officer of Health and I regret that, firstly, it is belated owing to the greatly increased pressure of work in the department as a result of the circumstances of war and loss of staff, and, secondly, that it has had to be severely curtailed in accordance with instructions from the Ministry of Health. Owing to these instructions the report consists only of a preface commenting on any special matters which have affected or concerned the public health and an appendix containing tables and statistics relating to the borough. In presenting the report I should like to take the opportunity of expressing my appreciation of the support I have received from the Council since I took up office. I wish at the same time to express my thanks to the staff of the department for their co-operation and devotion to duty throughout a year which placed considerable strain upon all concerned, and during which they were called upon to perform additional duties and assume extra responsibilities, all of which were carried out with credit. I have the honour to be, Mr. Mayor, Madam and Gentlemen, Your obedient Servant, W. F. TWINING McMATH, Medical Officer of Health. BOROUGH OF BARNES. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1940. PREFACE. In accordance with the terms of Ministry of Health Circular 2,067, in view of the increasing pressure of work in the Public Health Departments of Local Authorities and the need for strict economy in the use of paper, this Report is confined to essential and urgent matters which have affected the public health during the year. Accordingly I have to make observations under the headings which follow. STAFF. Mr. A. A. Brown, an Assistant Sanitary Inspector, who had joined H.M. Forces in 1939, was not replaced until 13th December, 1940, there being considerable difficulty experienced in obtaining a suitable replacement. Mr. G. K. Shilleto, a clerk, joined H.M. Forces in January, 1940, and was replaced by a temporary female clerk. As the Medical Officer of Health is responsible for the organisation and control of the Civil Defence Casualty Services, including cleansing stations and the decontamination of foodstuffs, it was unavoidable that many of the members of the staff were called upon to shoulder additional duties and responsibilities involving considerable periods of overtime. SANITARY INSPECTION OF THE DISTRICT. Owing to the absence of one of the sanitary inspectors serving with H.M. Forces and the considerable amount of time taken in connection with billeting and rehousing of evacuees and persons rendered homeless by enemy action, and also other matters arising as a result of the war, the number of routine visits of the inspectors fell considerably. This was, in any event, in accordance with the directions of the Ministry of Health, which were that routine inspections of houses and similar inspections should be suspended for the duration of the war. RATS AND MICE DESTRUCTION ACT, 1919. Particular attention was given during the year to sites of buildings demolished by enemy action, steps being taken to prevent rats escaping from the sewers via damaged house drains. In addition, all allotments and piggeries were regularly visited by the ratcatcher and action taken to prevent rats harbouring on the sites. A systematic baiting with poison of the public sewers was also carried out. 5 PUBLIC AIR RAID SHELTERS. During the autumn of the year, which was ine time of the intensive air raid, public air raid shelters were inspected to ensure that as far as practicable hygienic conditions prevailed, and, in order to minimise the spread of infections, face-masks were obtained and distributed to each public air raid shelter for use by occupants who coughed or sneezed. A further precautionary measure adopted was the spraying of the shelters with a disinfectant solution. HOUSES LET IN LODGINGS. As a result of the suspension of routine visiting no action was taken in respcct of any premises so let, but it is anticipated that owing to war conditions the number of premises in the Borough so occupied will have considerably increased. FISH FRYERS. The Order made by the late Barnes Urban District Council declaring the trade of fish-frying to be an "offensive trade" expired on the 30th September, 1940, by virtue of Section 107 of the Public Health Act, 1936. An application by the Borough Council to the Ministry of Health for the Order to be renewed was refused. The trade, however, continues to be controlled by bye-laws. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS DISEASES. Particulars of the incidence and distribution of the cases of infectious disease notified during the year 1940 are set out in Tables 22-25 in the Appendix, in which the number of cases removed to hospital and the number of deaths in the district from these diseases are also given. It will be observed by reference thereto that the incidence of infectious disease in the Borough during 1940 was in every case very low, with the exception of cerebro-spinal fever, of which there were five cases notified. This was a considerable increase on previous years. Cerebro-spinal fever, however, is a disease which tends to become more prevalent under war-time conditions, and no special significance should be attached to the increased number of notifications. DIPHTHERIA IMMUNISATION. Owing to the declaration of war the Council's immunisation clinic at Essex House Centre was temporarily suspended at the end of 1939. Early in 1940 all outstanding applications were dealt with and the necessary injections given, the children attending at the Public Health Department offices for the purpose. In July the clinics re-commenced, Essex House Centre being again available. The inoculations were given by the Assistant Medical Officer of Health, and the clinics for immunisation against diphtheria have continued ever since. 6 INFECTIOUS DISEASES HOSPITAL. During September the Diphtheria Block and the Cubicle Block were destroyed by enemy action. The loss of the Cubicle Block in particular has been a great handicap in the proper administration of the hospital. CLEANSING AND DISINFESTATION OF VERMINOUS PERSONS. As a result of war conditions there has been a considerable increase in the incidence of scabies, for which treatment is given at the Borough Cleansing Station. INFANTILE MORTALITY. During the year 1940 the number of deaths of infants under one year was 12, representing a rate of infantile mortality of 35 per 1,000 registered births. This is the lowest rate ever recorded, the previous lowest being 36, in 1937. MATERNITY AND CHILD WELFARE CENTRES. As a result of the two existing maternity and child welfare centres being taken over for Civil Defence purposes, the alternative provision outlined in the Annual Report for 1939 continued until June, 1940, when it was found possible to resume use of Essex House Maternity and Child Welfare Centre. The use of the shop in the Barnes parish for the sale of food was then discontinued, the one in the Mortlake parish continuing in use. Efforts were made throughout the year, without success, to procure suitable temporary premises for a clinic in the Mortlake parish. Borough of Barnes. APPENDIX to the annual report of the Medical Officer of Health 1 940. STATISTICS and TABLES. 8 BOROUGH OF BARNES. VITAL STATISTICS. The following statistical information relating to the Borough has been completed on receipt of the Local and National Statistics issued by the Registrar-General in connection with Population, Birth-rate, Death-rates, Maternal Mortality, Infantile Mortality, and Incidence of Notifiable Infectious Diseases. TABLE 1.—STATISTICAL SUMMARY, 1940. Births:— Birth-rate (per 1,000 of population) 10.32 Live Births:— Total. M. F. Legitimate 345 190 155 Illegitimate 16 7 9 Total 361 197 164 Still Birth-rate (per 1,000 total births) 34.8 Total, . M. F. Still Births (Legit. 11; Illegit. 2) 13 8 5 Deaths:— (Comparability factor 0.88) Death-rate, all causes (per 1,000 of population) 13.9 Total. M. F. Deaths (all causes) 554 263 291 Death-rate from Cancer (per 1,000 of population), 87 deaths 2.49 Death-rate from Zymotic Diseases (per 1,000 of population) 0.06 Deaths from Measles (all ages) Nil ,, ,, Whooping Cough (all ages) Nil „ „ Diphtheria 1 ,, ,, Diarrhoea (under two years of age) 1 Death-rate from Maternal Causes (per 1,000 total births) 5.64 Deaths from Puerperal Sepsis Nil ,, ,, Other Puerperal causes 2 [Note: Births for purpose of this rate = 354 (Live, 341; Still, 13)] Death-rate of infants under one year (per 1,000 live births) 35.2 Death-rate for Legitimate infants (12 deaths) 36.5 Illegitimate infants (no deaths) — [Note: Births; for purpose of these rates=Total, 341 Legit., 328 ; Illeg., 13]. 9 Table 2.—Vital Statistics of the Borough of Barnes during 1940 and previous 5 Years Year. Registered Births Total Deaths Registered in Transferable Deaths Nett Deaths belonging to the District. Uncorrected Number. Nett. Number. Rate. Of nonresidents registered in the District. Of residents registered in the District. Under 1 year of age. At all ages. Number. Rate. Number. Rate per 1,000 nett births. Number Rate I 2 3 4 5 6 7 8 9 10 11 12 1935 288 393 9.4 205 4.9 18 204 19 48.3 391 9.3 1936 259 351 8.4 271 6.5 12 227 19 54.1 486 11.7 1937 278 365 8.9 252 6.1 25 242 13 35.6 469 11.4 1938 309 378 9.2 237 5.8 15 219 26 68.7 443 10.8 1939 307 397 9.6 215 5.5 14 221 16 40.9 422 10.8 1940 285 361 10.3 278 7.0 23 276 12 35.2 554 13.9 10 Table 3.—Birth-rate, Death-rate, and Analysis of Mortality during the Year 1940, with corresponding rates for england and wales, 126 great towns, 148 smaller towns, and for the County of London for comparison. Birthrate per 1,000 Total Population. Annual Death-rate per 1,000 Population. Death rate per l 000 Births. Matfrnal Mortality Rate per 1,000 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. Puerperal Infection. Other Causes. England and Wales 14.6 14.3 — — 0.02 0.00 0.02 0.06 0.32 4.6 55 2.16 0.52 1.64 126 County Boroughs and Great Towns, including London 16.0 15.8 - - 0.02 0.00 0.02 0.07 0.29 5.9 61 Not available 148 Smaller Towns (Estimated Resident Populations 25,000 to 50,000 at Census, 1931) 15.7 12.8 - - 0.02 0.00 0.02 0.05 0.30 4.4 54 London 13.7 17.8 — - 0.01 0.00 0.00 0.01 0.18 5.8 50 Barnes Borough 10.3 13.9 - - - — — 0.03 0.40 5.9 35 5.64 — 5.64 11 Table 4.—Causes of Death during the Year 1940. Causes of Death (Registrar-General's short list of causes). Total Deaths Male Female 1 Typhoid and Paratyphoid fevers — — — 2 Cerebro-spinal fever 1 — 1 3 Scarlet Fever — — — 4 Whooping Cough — — — 5 Diphtheria 1 — 1 6 Tuberculosis of respiratory system 26 14 12 7 Other forms of tuberculosis 4 1 3 8 Syphilitic diseases 3 3 — 9 Influenza 14 11 3 10 Measles — — — 11 Acute poliomyelitis and polioencephalitis — — — 12 Acute infectious encephalitis — — — 13 Cancer of buccal cavity and oesoph. (m); uterus (f) 5 2 3 14 „ stomach and duodenum 11 7 4 15 „ breast 12 — 12 16 ,, all other sites 59 36 23 17 Diabetes 3 — 3 18 Intra-cranial vascular lesions 38 16 22 19 Heart Disease 108 56 53 20 Other diseases of circulatory system 20 11 9 21 Bronchitis 24 11 13 22 Pneumonia 25 12 13 23 Other respiratory diseases 10 5 5 24 Ulceration of stomach or duodenum 7 4 3 25 Diarrhoea under 2 years 1 — 1 26 Appendicitis 3 1 2 27 Other digestive diseases 14 8 6 28 Nephritis 11 6 5 29 Puerperal and post-abortive sepsis — — — 30 Other maternal causes 2 — 2 31 Premature birth 4 2 2 32 Congenital malformations, birth injury, infantile diseases 5 2 3 33 Suicide 5 2 3 34 Road traffic accidents 2 1 1 35 Other violent causes 71 29 42 36 All other causes 65 23 41 All Causes 554 263 291 12 Table 5.—Infant Mortality during the Year 1940. Causes of death, at various ages, of infants under one year. 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 Deaths in the Borough Deaths outside the Borough. Deaths in Institu'ns Premature Birth 3 ... ... ... 3 1 ... ... ... 4 ... 4 4 Congenital Malformations ... ... ... 1 1 ... ... ... ... 1 ... 1 1 Injury at Birth 2 ... ... ... 2 ... ... ... ... 2 ... 2 2 Diarrhoea and Enteritis ... ... ... 1 1 ... ... ... ... 1 1 ... ... Pneumonia (all forms) ... ... ... ... ... ... 1 ... 1 2 1 1 1 Miliary Tuberculosis ... ... ... ... ... ... ... 1 ... 1 ... 1 1 Status lymphaticus 1 ... ... ... 1 ... ... ... ... 1 ... 1 1 All causes 6 ... ... 2 8 1 1 1 1 12 2 10 10 Infectious Diseases Mortality. The death-rate for 1940 from each of the seven principal epidemic diseases (zymotic diseases) are given separately in Table 6, and in Table 7, the zymotic death-rate for the five years, 1935 to 1939, are contrasted with the rate for 1940. In each of these Tables the death-rates for London and for England and Wales are shown for comparison. Table 6.—Epidemic Diseases: Death-rate per 1,000 of the Population, 1940. Disease. Barnes. London. England and Wales. Small-pox - — — Enteric Fever — 0.00 0.00 Measles — 0.01 0.02 Scarlet Fever — 0.00 0.00 Whooping Cough — 0.00 0.02 Diphtheria 0.03 0.01 0.06 Diarrhoea (under 2 years) 0.03 0.07 0.07 Zymotic Death Rate 0.06 0.09 0.17 13 Table 7.—Zymotic Death-rate for 1940, contrasted with the Death-rates for the previous Five Years. Year. Barnes. London. England and Wales. 1935 0.14 0.26 0.24 1936 0.12 0.48 0.30 1937 — 0.29 0.23 1938 0.20 0.33 0.23 1939 0.03 0.16 0.17 1940 0.06 0.09 0.17 Table 8.—Measles: Death-Rate per 1,000 of Population. Year. Barnes. London. England & Wales. 1936 0.02 0.14 0.07 1937 — 0.01 0.02 1938 0.02 0.06 0.04 1939 — 0.00 0.01 1940 — 0.01 0.02 Average Rate 1936-1940 0.01 0.04 0.03 Table 9.—Whooping Cough: Death-Rate per 1,000 of the Population. Year. Barnes. London. England & Wales. 1936 0.02 0.07 0.05 1937 — 0.06 0.04 1938 0.02 0.03 0.03 1939 — 0.03 0.03 1940 — 0.00 0.02 Average Rate 1936-1940 0.01 0.05 0.03 14 GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. Table 10.—Public Mortuary. Number of Bodies Received at Borough Public Mortuary During 1940 Resident NonResident Persons Unknown Total For post-mortem examination 34 3 1 38 For purposes other than postmortem 10 — — 10 Totals 44 3 1 48 Table 11.—Cleansing and Disinfestation of Verminous Persons. Treated at Borough Cleansing Station. For Verminous Head For Verminous Body For Scabies Totals No. of Persons Attendances No. of Persons Attendances No, of Persons Attendances No. of Persons Attendances Children under school-age - - - - 1 2 1 2 Schoolchildren 34 39 — — 6 29 40 68 Adults 1 1 — — 13 70 14 71 Totals 35 40 — — 20 101 55 141 Table 12—Infected and Infested Rooms and Articles (dealt with by the Council). Premises disinfected 28 Rooms disinfected 51 Lots of bedding disinfected 153 ,, ,, destroyed 12 „ ,, disinfested 26 Council houses disinfested 2 Other houses disinfested 4 Table 13.—Rats and Mice Destruction. Number of complaints received 90 Visits to (a) Enclosed premises 230 (b) Open spaces 843 Number of occasions on which (a) Poison bait was laid 135 (b) Gas (sulphurdioxide) was used 7 15 SANITARY CIRCUMSTANCES OF THE AREA. Table 14.—Showing the Number and Nature of the Inspections made by the sanitary inspectors during 1940, 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. Dairies 4 8 - — — — Milkshops 41 42 — — — — Butchers' Shops 33 212 5 5 — — Fishmongers and Poulterers 18 18 - - - - Greengrocers 37 87 1 1 — — Cookedprovision shops 30 108 - - - - Ice-cream shops 45 50 - — — — Restaurants 27 38 1 1 — — Fried-fish shops 3 17 - — — — Slaughterhouses 1 11 - — — — Bakehouses 11 14 2 2 — — Factories:— Mechanical 93 73 3 3 — — Non-mechanic'l 42 48 — — — — Workplaces 35 73 — — — — Home-workers 9 19 — — — — Schools — — — — Public Halls and Cinemas 3 3 - - — — Servants' Registries 4 4 - - — — Stable Yards 22 40 — — — — Public Conveniences 40 35 - - - - Dwelling-houses (including houses let in lodgings):- (1) House - toHouse Inspection - 1284 125 124 1 1 (2) Inspected on complaint 184 (3) Inspected in course of other work:— (a) Housing work, etc 213 (b) For infectious diseases 31 Totals 926 2184 137 136 1 1 Number of visits made by Sanitary Inspectors' Assistant — For purpose of drain-testing 31 16 Table 15.—Factories. No. of Premises on Register. Inspection. Number Written Notices Served. Factories with mechanical power 93 73 3 Factories without mechanical power 42 48 — Total 135 121 3 Discovered. Remedied. Defective conditions:— Sanitary conveniences insufficient 1 1 Other offences 8 8 Total 9 9 Matters referred to H.M. Inspector of Factories 1 Notifications received from H.M. Inspector of Factories Nil Table 16.—Home Workers. Work undertaken. No. on Register. Fancy Needlework 2 Dressmaking 3 Tailoring 2 Boot Repairing 2 Total 9 Table 17.—Shops Acts, 1938. Number of shop premises inspected during 1940 58 Number of Notices served on occupiers— Re Sanitary Accommodation 3 Number of such Notices complied with 3 Table 18.—Disposal of House Refuse, 1940. From Barnes Borough. From Richmond Borough. Refuse incinerated 7,999 tons. 8,474 tons. „ barged - 2,526 „ „ tipped 3,001 „ - Total refuse disposed of 11,000 „ 11,000 „ 17 HOUSING. Table 19.—HOUSING STATISTICS FOR THE YEAR 1940. 1. Number of Dwellings Owned by the Local Authority:— Number of houses 241 Total 448 „ „ flats 207 2. Unfit Houses. (I) Inspection of Dwelling Houses during the Year:— (i) (ai Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 393 (b) Number of inspections made for the purpose 1253 (ii) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 Nil (b) Number of re-inspections made under the Regulations 283 (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 125 (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 208 (III) Action under Statutory Powers during the Year:— During 1940 action was taken under Scction 39 of the Public Health Act, 1936. The owner having failed to comply with a Statutory Notice, the Council carried out the work and recovered the costs. No proceedings were taken under the following Statutory Powers: (a)—Sec. 9, 10 and 16, Housing Act, 1936—(Repair of dwellinghouses). (b)—Sec. 11 and 13, Housing Act, 1936—(Demolition Order). (c)—Sec. 12, Housing Act, 1936—(Closing Order, underground rooms). 18 3. Housing Act, 1936—Part IV—Overcrowding. (a) (i) Number of dwellings overcrowded at the end of the year 1 (ii) Number of families dwelling therein 1 (iii) Number of persons dwelling therein 6 (b) Number of new cases of overcrowding reported during the year 1 (c) (i) Number of cases of overcrowding relieved during the year 18 (ii) Number of persons concerned in such cases 98 Cases of Overcrowding. 1936 1937 1938 1939 1940 Awaiting abatement 1st January 140 119 109 37 18 New cases discovered 20 22 14 4 1 Total for abatement 160 141 123 41 19 Abated during the year 41 32 86 23 18 Awaiting abatement 31st December 119 109 37 18 1 INSPECTION AND SUPERVISION OF FOOD. Table 20.—Slaughterhouses. Private. Public. Total. No. of licensed slaughterhouses 1 — 1 No. of not'ces received of intention to slaughter during the year 17 — 17 No. of animals slaughtered:— Swine 13 — 13 Cattle 4 — 4 Sheep — — — Total 17 — 17 Meat discovered to be unfit for human consumption:— Liver of an ox affected with fluke and cirrhosis—destroyed. Table 21.—Unsound Food. In no instance was it found necessary to seize unsound food on any premises. The following articles were voluntanly surrendered and destroyed as being unfit for human consumption:— Beef 108 lbs. Sausages 37 lbs. Ox Liver 15 lbs. Fish 13 boxes. Ox Kidney 1 Rabbits 2 Tripe 12 lbs. Cooked Ham 28 lbs. Mutton 7 lbs. 19 PREVALENCE OF, AND CONTROL OVER, INFECTIOUS DISEASES. Incidence of Notifiable Infectious Diseases. Comparison between the incidence of certain of the notifiable infectious diseases in Barnes, and in London and England and Wales, is shown below:— Table 22.—Infectious Diseases : Incidence per 1,000 of the Population in 1940. Disease. Barnes. London. England and Wales. Small-pox - - 0.00 Scarlet Fever 1.18 0.82 1.63 Diphtheria 0.14 0.61 1.16 Enteric Fever 0.06 0.06 0.07 Erysipelas 0.11 0.35 0.33 Pneumonia 0.40 0.87 1.20 Table 23.—Showing the Notifications of Infectious Diseases Received during 1940 arranged in Four-Weekly Periods. Fourweekly period ending Diphtheria. Scarlet Fever. Measles. Enteric Fever. Pneumonia. Erysipelas Puerperal Pyrexia. Cerebrr-spinal Fever. Ophthalmia Neonatorum Whooping Cough Jan. 27 — 1 — — 2 — — 1 — — Feb. 24 — 6 4 — 2 — — 1 — — Mar. 23 — 1 3 1 2 — — 2 — 1 April 20 1 3 — — — — — 1 — — May 18 — 4 — — 3 — — — — — June 15 — 3 3 — 1 — — — — — July 13 — 3 — — — — 1 — — — Aug. 10 — 5 2 — 2 — — — — — Sept. 7 1 3 1 — 2 — — — — — Oct. 5 — 1 — — — 1 — — 1 —. Nov. 2 — 4 18 — — — — — — — Nov. 30 — 3 20 1 — 2 1 — 1 — Dec. 28 3 3 28 — — 1 — — — 1 Totals 5 39 79 2 14 4 2 5 2 2 20 Table 24.—Notifiable Infectious Diseases, 1940. Diseases. Total Cases Notified. Ages, in years. Parish Removed to Hospital. Total Deaths of Residents. † Under 1 year 1 to 2. 2 to 3. 3 to 4. 4 to 5. 5 to 10. 10 to 15. 15 to 20. 20 to 25. 25 to 35. 35 to 45. 45 to 65. 65 and over. Barnes Mortlake. Diphtheria 5 — — — — — 2 1 1 — l — — — 2 3 5 1 Scarlet Fever 39 — 1 2 — l 12 8 2 l 7 3 2 — 13 26 35 — Measles 79 2 12 5 3 12 33 3 5 3 4 — — — 13 66 3 — Enteric Fever 2 — — — — — — 1 — — 1 — — — 1 1 2 — Pul. Tuberculosis 32 — — — — — — — 3 4 9 7 9 — 11 21 33 26 Non-Pul. Tuberculosis — — — — — — 1 — 3 — — — — — 2 2 4 4 Pneumonia 14 — — — 1 — 1 1 1 1 — — 7 2 5 9 1 25 Erysipelas 4 — — — — — — — — — — 1 3 — 3 1 1 — Puerperal Pyrexia 2 — — — — — — — 1 1 — — — — — 2 1 — Ophthalmia Neonatorum 2 2 — — — — — — — — — — — — 1 1 1 — Cerebro-spinal Fever 5 — — 1 — — 1 1 1 — — — 1 — 1 4 5 1 Whooping Cough 2 — — 1 — — — — — 1 — — — — 1 1 — — All Diseases 190 4 13 9 4 13 50 15 17 11 22 11 22 2 53 137 91 57 † 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. 21 Table 25.—Notifiable Infectious Diseases, 1930 to 1940. Year. 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 Diphtheria 41 16 1 72 29 31 4 3 1 4 5 Scarlet Fever 74 64 92 147 132 77 56 84 52 36 89 Enteric Fever 45 3 4 — 1 1 3 3 2 1 2 Puerperal Fever — 1 1 1 1 — 2 — * * * ,, Pyrexia 2 2 4 2 2 3 1 1 4 3 2 Erysipelas 8 7 10 16 11 16 11 12 6 10 4 Continued Fever — — — — — — — — — — — Relapsing Fever — — — — — — — — — — — Typhus Fever — — — — — — — — — — — Small-pox — — — — — — — — — — — Cholera — — — — — — — — — — — Plague — — — — — — — — — — — Tuberculosis, P. 43 41 44 30 42 21 39 28 25 35 32 Non-P 10 6 13 10 6 8 5 10 8 3 4 Cerebro-spinal Fever — — — 2 1 — — — 2 1 5 Poliomyelitis — 1 — 1 — — — 2 1 — — Ophthalmia Neonatorum 1 — 1 — 1 1 1 1 1 — 2 Measles 397 31 790 50 551 7 517 101 387 8 79 Rubella 41 16 8 23 61 5 29 9 419 22 * Encephalitis Lethargica — — — — — — — — — — — Polioencephalitis — — — — — — — — — — — Malaria — — — — — — — — — — — Dysentery — — — — — — — — 1 — — Pneumonia 16 28 30 35 36 13 21 34 18 14 14 Anthrax — — — — — — — — — — — Whooping Cough (Not Notifiable). 5 2 * No longer notifiable. Table 26.—Schools. Number in Borough Number of who suffered Scarlet Fever scholars i from:— Diphtheria Public Elementary Schools:— 10 Barnes Central Boys 2 — ,, ,, Girls 1 — Lowther J.M. and Infants — — East Sheen J.M. and Infants 7 1 Mortlake Central Boys — — ,, ,, Girls — — Mortlake Council J.M. and Infants 5 — Mortlake C.E. Mixed 2 1 ,, ,, Infants — — Mortlake R.C. — — Secondary Schools:— 1 East Sheen and Richmond County Boys' School — — Private Schools 5 1 — Total 16 18 2 22 Table 27.—Diphtheria Immunisation Clinic. The Following Table Shows the Position on 31st December, 1940, in Respect of the 138 Children who Attended the Clinic during 1940. Position on 31st Dec., 1940 † TOTAL CASES dealt with during 1940 138 (A) Continued in Attendance. 126 (1) Primary-Schick Negative:— 3 (a) Re-Schick Negative (Certificate) 1* (b) Awaiting re-Schick test 2 (2) Primary Schick-Positive:— 123 (a) 3-injections and, Post-Schick Negative (Certificate) 45* (b) Awaiting Post-Schick reading 1 (c) Awaiting Post-Schick test 52 (d) Receiving inj ections at end of year 25 (B) Discontinued Attendance. 12 (C) Number Immunised and Certificates Issued. 46 Schick tests Negative throughout 1 ,, ,, Negative after immunisation 45 Children invited but did not attend 24 * Cases in which Certificates of immunity have been issued. † The figures in this Table do not include 90 children who attended at the Clinic during the year merely for the purpose of a Re-Schick Test two years after the date of immunisation. Table 28.—Laboratory Facilities. Specimens examined during the year were as follows:— Sputa for detection of tubercle bacilli 120 Swabs „ „ „ diphtheria bacilli 69 Fasces „ „ „ typhoid bacilli 2 Cerebro-spinal fluid 3 Total 194 23 TUBERCULOSIS. Notification Register. 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, 1940 are as under:— Table 29.—Tuberculosis Notification Register. Form of Disease. On Register, 1st Ian., 1940 Cases Added. Removed from Register. Remaining on Register 31st Dec 1940 Primary Notif ns Other- wise. Total. NonTub. Cured Left District Dead. Total. Pulmonary 152 32 15 47* 1 3 25 27 56 143 Non-Pulm'y 56 4 1 5 1 — 7 3 11 50 All Forms 208 36 16 52* 2 3 32 30 67 193 * Included in these figures are four patients whose names were restored to the Register. Table 30.—Tuberculosis : New Cases and Mortality, 1940. Age-Periods. New Cases.* Deaths. Pulmonary. NonPulmonarv. Pulmonary. NonPulmonary. Male Fem'le Male Fem'le Male Fem'le Male Fem'le 0-1 years — — — — — — — 1 1-5 — 1 — — — 1 — — 5-10 „ — — 1 — — — 1 — 10-15 „ — — — 1 — — — — 15-20 „ — 3 1 2 — — — 1 20-25 „ 5 1 — — — 1 — — 25-35 „ 5 6 — — 5 2 — 1 35-45 „ 5 7 — — 4 4 — — 45-55 „ 5 2 — — 4 2 — — 55-65 „ 1 2 — — 1 1 — — 65 „ and over — — — — — 1 — — All ages 21 22 2 3 14 12 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. Incidence-rate-Pulmonary 0.91 Non-pulmonary 0.12 All forms 1.03 Death-rate —Pulmonary 0.72 Non-Pulmonary 0.14 All forms 0.86 24 Table 31.—Institutional Treatment. Admissions during 1940 were as under:— Pulmonary Tuberculosis : To Surrey County Council Sanatorium 14 ,, Surrey County Hospitals 12 ,, other sanatoria . . 4 ,, general hospitals 8 ,, Public Assistance Institutions 3 Total 41 Non-pulmonary Tuberculosis: To sanatoria 1 „ Surrey County Hospitals 3 „ other institutions 1 Total 5 Number of patients admitted: Pulmonary 33 Non-pulmonary 4 INFECTIOUS DISEASES HOSPITAL. Table 32—Admissions & Deaths admissions. deaths. Diphtheria 5 1* Cellulitis—sent in as Diphtheria 1 1 Scarlet Fever 34 — Pneumonia Sent in as Scarlet Fever 1 — Measles 1 — Rubella 3 — Papula urticaria 1 — Chichenpox 1 — Cerebro-spinal Fever 2 — Influenza—sent in as Cerebro-Spinal Fever 1 — Measles 2 1 Urticaria—sent in as Measles 1 — Rubella 3 — Erysipelas 1 — Pneumonia 1 — Cerebro-hcemorrhage—sent in as Pneumonia 1 — Influenza 1 — 60 3* (*Death from Diphtheria during 1940 of patient admitted during 1939). Deaths. (1) Measles, admitted with tuberculous meningitis—died 4th day after admission. (2) Cellulitis of Neck, admitted as Diphtheria—tracheotomy performed— died 6th day after admission. Complications. (1) Scarlet Fever—Rheumatism, 2; secondary tonsilitis, 1; rhinorrhœa, 1, (2) Measles—Otorrhoea, 1, 25 MATERNITY AND CHILD WELFARE. Table 33.—Home-Visiting. A summary of the work performed by the three Health Visitors during the year is given below:— Visits to expectant mothers 566 First visits to newly-born infants 304 Revisits to infants under 1 year 2,562 Visits to children aged 1 to 5 years 4,096 Visits in connection with Council's scheme for the supply of milk 574 Still-birth inquiries 4 Special visits to cases of measles 117 ,, „ ,, „ ,, whooping cough 6 ,, ,, ,, ,, ,, pneumonia 22 Visits to foster children 112 Visits in connection with infectious diseases other than those above specified 1,225 Total visits 9,588 Table 34.—Notification of Births. (a) Registered in Borough:— Live Births Still Births, Totals. Number of births registered during 1940 as occurring in the Borough 285 8 293 Number of such births not notified in accordance with the Public Health Act, 1936, Part VII 4 - 4 (b) Notified. Number of births, live and still, notified during the year— by medical practitioners 11 by midwives 258 by other persons 4 Total notified 273 Number of still-births notified during the year 7 Percentage of still-births to total births occurring in the Borough 2.6 Table 35—Institutional Confinements. In institutions within the Borough 91 In registered maternity homes 91 In institutions outside the Borough 99 In general hospitals 13 In maternity hospitals 24 In Public Health County hospitals 28 In Public Assistance institutions 23 In maternity homes 11 Total 190 Number of above institutional confinements arranged through the Borough Ante-natal Clinic 32 26 MATERNITY AND CHILD WELFARE CENTRES. Table 36—Ante-Natal Clinic. Total number of expectant mothers attending Borough ante-natal Clinic during the year 196 Number of new cases attending for first time and included in total number 157 Number of attendances made by all mothers 508 Percentage of expectant mothers of total notified births attending Borough Clinic 60.1 Number of expectant mothers known to be attending Antenatal Clinics of Hospitals or Maternity Hospitals, etc. 19 Percentage of expectant mothers known to be under antenatal supervision 65.9 Table 37—Infant-Welfare Clinics.—Attendances. Year 1939. Year 1940, New Cases:— Infants under 1 year 211 256 Children 1 to 5 years 70 128 Total 281 384 Number of Children attending during the year:— Infants under 1 year 365 312 Children 1 to 5 years 501 364 Total 866 676 Number of attendances made by:— Infants under 1 year 3 281 2,027 Children 1 to 5 years 2,579 1,412 Total 5,860 3,439 Mothers 5,057 2,903 Number of consultations with Medical Officer 2,296 2,320 Average attendance per week: Infants under 1 year 39.8 Children 1 to 5 years 27.6 Total, all children 67.4 Number of children attending Centre for first time during the year : Percentage of total births represented by this figure 70.9 27 Table 38.—Child Life Protection. The following is a summary of the cases on the Register during 1940:— Foster-mothers on the Register at the beginning of the year 3 ,, ,, added to the Register 9 „ „ removed from the Register, having ceased to have care of children 7 ,, „ on the Register at the end of 1940 5 Foster-children on the Register at the beginning of the year 3 ,, „ in respect of whom Notice of Reception was received 14 „ ,, removed from the Register during the year:— Returned to care of parents 10 12 Transferred to the care of fostermothers outside the area 1 No longer within provisions of Act 1 ,, „ on the Register at the end of 1940 5 Number of visits of inspection made by Health Visitors during the year 112 Table 39.—Voluntary Associations. (1) Nursing Associations. Barnes District Nursing Association Mortlake District Nursing Association Totals Home-visits in connection with maternity and child welfare — — — „ „ to cases of—pneumonia 72 55 127 —influenza 41 — 41 „ ,, to other general and surgical cases 6,375 16,565 22,940 6,488 16,620 23,108 (2) Barnes and Mortlake Day Nursery. Accommodation for children under 5 years 26 Number of attendances—Whole-day 3,241 Half-day 939