BARN 9 BOROUGH OF BARNES Annual Report OF THS Medical Officer of Health For the Year 1941 BOROUGH OF BARNES the Annual Report of the Medical Officer of Health for the year 1941 W. F. Twining McMath, M.d. Belf., 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.,B.Ch., B.A.O., Belf., M.R.C.P. Lond., L.M., D.P.H. Assistant Medical Officer of Health. A. V. B. Crawford, M.A., M.B., B.Ch., B.A.O.(T.C.D.), D.P.H.(R.C.P.S.Lond.) Chief Sanitary Inspector. C. S. Perchard, Cert.R. San. Inst., Cert. Meat and Food Insp. Additional Sanitary Inspectors. G. G. Gardiner *A. A. Brown *R. H. Street Cert. San. Insp., Cert. Meat and Food Insp. Temporary Sanitary Inspectors. E. Kilner J.Plant 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 M. Sharp. *G. K. Shilleto. G. E. Tydeman. Temporary Clerks. Miss B. Haydon. Miss K. P. Morcom. Miss H. Wheatley. Mrs. M. Wall. Matron of the Infectious Diseases Hospital. Miss P. Thompson, S.R.N., R.F.N. * (Serving with H.M. Forces). 3 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 1941 on the sanitary circumstances, the sanitary administration, and the vital statistics of the Borough. In accordance with Ministry of Health instructions this Annual Report has been curtailed and has been set out on the lines indicated in the introductory letter contained in my Report for 1940. Once again I desire to express appreciation of the support afforded me by the Council and to the staff of the Public Health Department for their continued co-operation and devotion to duty in trying circumstances. 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 1941. PREFACE. In view of the pressure of work in public health departments of local authorities and the need for strict economy in the use of paper, this Report, in accordance with the requirements of Ministry of Health Circular No. 2,604, has been confined to essential and urgent matters which have affected the public health during the year. Accordingly I have to make observations only under the headings which follow. 4 STAFF. Mr. R. H. Street, Assistant Sanitary Inspector, joined H.M. Forces in July, 1941, and was replaced by a Temporary Sanitary Inspector, Mr. J. G. Plant, who commenced duties on the 13th October, 1941. Mr. R. H. Billen, a member of the clerical staff who had joined H.M. Forces in September, 1940, resigned his appointment on the 10th December, 1941. The vacancy on the permanent staff caused by this resignation has not been filled, a temporary clerk having been appointed when Mr. Billen joined the Forces. Miss K. D. Elliott, Clerk in the maternity and child welfare section of the department, resigned her appointment in April and was replaced by Miss M. Sharp, who commenced duties in this capacity on the 2nd June, 1941. During the year the staff of the Infectious Diseases Hospital was reviewed and the following new appointments on the permanent staff established:—Assistant Matron, Night and Ward Sisters. Sister A. M. Jones was promoted to fill the position of Assistant Matron. The ambulance driver at the hospital, Mr. M. A. Pearson, having been called to H.M. Forces, the position was filled by a temporary ambulance driver. SANITARY INSPECTION OF THE DISTRICT. The suspension of routine housing inspections and similar inspections in accordance with Ministry of Health instructions still continues. Work in connection with housing has been restricted to remedying defective conditions in dwelling-houses discovered in the course of other work, or on complaint. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS DISEASES. Particulars of the incidence and distribution of the cases of infectious disease notified during the year 1941 are set out in Tables 21-25 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 seen by reference to the statistics referred to that the incidence of infectious disease during 1941 was lower than those for London and for England and Wales as a whole in every case except whooping cough, which was slightly higher than both. There were 4 cases of cerebro-spinai fever in 1941 compared with 5 in the previous year. Increase in the incidence of this disease is common in war-time. Although the number of cases of diphtheria occurring in the Borough was higher than usual, the incidence rate for this disease was 5 still considerably lower than the rates for London and of the country as a whole. No case of this disease occurred in a child who had received a course of immunising injections. DIPHTHERIA IMMUNISATION. Following upon the resumption of the normal clinics during the previous year, attendances during 1941 were exceptionally good. In general the two-injection method of immunisation has been substituted in place of the original method, when three injections were given. The pre-Schick test was discontinued. IMMUNISATION AGAINST TYPHOID AND PARATYPHOID FEVERS. In January of this year, consequent upon a circular from the Ministry of Health upon the subject, a clinic for the inoculation against typhoid and paratyphoid fevers was commenced. Reference to Table 27 will show that 413 residents of the Borough, mainly adults, availed themselves of the facilities and received the full course of injections. HEALTH PROPAGANDA. In March a publicity campaign drawing the attention of the residents of the Borough to the health services provided by the Council was instituted. This included the distribution of leaflets to all houses in the Borough, the exhibition of posters and the dissemination of health propaganda by medical practitioners, ministers of religion and the staff of the Public Health Department. INFECTIOUS DISEASES HOSPITAL. Under the Local Government Act, 1929, a reciprocal scheme for the provision of adequate hospital accommodation for the treatment of infectious diseases was inaugurated, covering the whole of the hospital authorities in Surrey with one or two exceptions, and including the Borough of Barnes. Charges for the treatment, maintenance and care of patients admitted under the arrangements were agreed upon by the hospital authorities participating. Details of the cases admitted to the Borough of Barnes Infectious Diseases Hospital from other areas, and of non-civilians, will be found on reference to Table 32 in the Appendix. Central heating was installed during the year in Ward Block F and a new boiler for heating domestic water in the Administration Block in order to economise in the use of fuel. As a war-time measure a large portion of the lawns of the Hospital were dug up for the purpose of food production. 6 PUBLIC MORTUARY, No bodies were received at the Borough of Barnes Public Mortuary during the year. Although the mortuary is still available for use if required, owing to war conditions in practice the police authorities, who mainly make use of the mortuary, have arranged as a matter of convenience that bodies on which post-mortems, etc., are required are sent to the mortuary at Richmond. CLEANSING STATION. Owing to the increase in the number of persons requiring treatment at the Borough Cleansing Station it was decided during the year to appoint whole-time male and female cleansing attendants. INFANTILE MORTALITY RATE. During 1941 the number of deaths of infants under one year of age was 24, representing a rate of infantile mortality of 75 per 1,000 registered births. This is the highest rate on record for the Borough, the lowest being that recorded the previous year. It is worthy of comment that of these 24 deaths, 14 occurred during the first week of life, 9 of which being due to prematurity, possibly associated with the intense air-raiding in the early part of the year. Eleven of the deaths occurred in hospitals and 5 in private nursing homes—eight only occurring at home. MATERNITY AND CHILD WELFARE. Early in the year, as a result of continued efforts, suitable temporary premises were obtained to enable maternity and child welfare clinics to be held in the Mortlake Parish. Cod liver oil and orange juice, provided by the Ministry of Food, were distributed throughout the year to expectant mothers and children under 5 years of age at each of the two maternity and child welfare centres in the Borough. An arrangement for the issue of additional clothing coupons to expectant mothers was instituted by the Board of Trade, in co-operation with the Ministry of Health. These coupons were issued from the Public Health Department. As a result of reports and investigation it became apparent in the course of the year that some additional day nursery provision would be required for the care of children of mothers in employment Representations were made to the Ministry of Health for permission to establish additional day nurseries. The matter was still under consideration at the end of the year. Borough of Barnes. APPENDIX to the annual report of the Medical Officer of Health 1941. 8 STATISTICS and TABLES. 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, 1941. Births:— Birth-rate (per 1,000 of population) 11 '6 Live Births:— Total. M. F. Legitimate 334 176 158 Illegitimate 26 13 13 Total 360 189 171 Still Birth-rate (per 1,000 total births) 37.4 Total . M. F. Still Births (Legit. 11; Illegit. 3) 14 7 7 Deaths:— Death-rate, all causes (per 1,000 of population) 14.4 Total. M. F. Deaths (all causes) 449 222 227 Death-rate from Cancer (per 1,000 of population), 77 deaths 2.47 Death-rate from Zymotic Diseases (per 1,000 of population) 0.13 Deaths from Whooping Cough (all ages) 1 ,, ,, Diarrhoea (under two years of age) 3 Death-rate from Maternal Causes (per 1,000 total births) 2.99 Deaths from Puerperal Sepsis Nil ,, ,, Other Puerperal causes 1 [Note : Births for purpose of this rate = 334 (Live, 322 ; Still, 12)] Death-rate of infants under one year (per 1,000 live births) 74.5 Death-rate for Legitimate infants (22 deaths) 74.3 Illegitmate infants (2 deaths) 76.9 [Note: Births for purpose of these rates=Total, 322 Legit., 296 ; 1 Illeg., 26]. 9 Table 2.—Vital Statistics of the Borough of Barnes during 1941 and previous 5 Years Year. Registered Births Total Deaths Registered in the District. Transferabl1 Deaths Nett Deaths belongino to the District. Uncorrected Number. Nett. Of nonresidents registered in the District. Of residents registered outside 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 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 10.3 301 7.6 23 276 12 35.2 554 13.9 1941 248 360 11.6 215 69 14 248 22 74.5 419 14.4 10 Table 3.—Birth.rate, Death.rate, and Analysis of Mortality during the Year 1941, with corresponding rates for England and Wales, 126 Great Towns, 148 Smaller Towns, and for the County of London for comparison. Birthrate perl,000 total Population. Annual Death.rate per 1,000 Population. Death.rate per 1000 Births. Maternal Mortality Rate per 1,000 Total Births All Causes. Enteric Fever. Small.pox Measles. Scarlet Fever. Whooping Cough. Diphtheria. Influenza. Diarrhoea and Enteritis (under 2 years). Total Deaths under One Year. All Causes. Puerperal Infection. Other Causes. England and Wales 14.2 12.9 0.00 — 0.03 0.00 0.06 0.07 0.19 5.1 59 2.23 0.48 1.75 126 County Boroughs and Great Towns, including London 14.7 14.9 0.00 — 0.03 0.00 0.07 0.08 0.17 7.5 71 Not avail able 148 Smaller Towns (Estimated Resident Populations 25,000 to 50,000 at Census, 1931) 16.4 13.0 0.00 — 0.03 0.00 0.06 0.06 0.20 4.6 56 London 8.9 16.3 0.01 — 0.02 0.00 0.04 0.03 0.15 6.8 68 Barnes Borough 11.6 14.4 1 — — — 0.03 — 0.06 9.3 75 2.99 — 2.99 11 Table 4.—Causes of Death during the Year 1941. Causes of Death (Registrar-General's short list of causes). Total Deaths Male Female 1 Typhoid and Paratyphoid fevers — — -l 2 Cerebro-spinal fever 1 1 — 3 Scarlet Fever — — — 4 Whooping Cough 1 1 — 5 Diphtheria — — — 6 Tuberculosis of respiratory system 20 15 5 7 Other forms of tuberculosis 1 — 1 8 Syphilitic diseases 2 2 — 9 Influenza 2 1 1 10 Measles — — — 11 Acute poliomyelitis and polioencephalitis — — — 12 Acute infectious encephalitis — — — 13 Cancer of buccal cavity and oesoph. (m) ; uterus (f) 10 3 7 14 „ stomach and duodenum 10 6 4 15 „ breast 7 — 7 16 „ all other sites 50 27 23 17 Diabetes 3 1 2 18 Intra-cranial vascular lesions 40 13 27 19 Heart Disease 102 44 58 20 Other diseases of circulatory system 13 6 7 21 Bronchitis 19 11 8 22 Pneumonia 20 10 10 23 Other respiratory diseases 9 3 6 24 Ulceration of stomach or duodenum 2 1 1 25 Diarrhoea under 2 years 3 2 1 26 Appendicitis — — — 27 Other digestive diseases 9 9 — 28 Nephritis 19 9 10 29 Puerperal and post-abortive sepsis — — — 30 Other maternal causes 1 — 1 31 Premature birth 11 7 4 32 Congenital malformations, birth injury, infantile diseases 7 6 1 33 Suicide 1 1 — 34 Road traffic accidents 3 1 2 35 Other violent causes 29 15 14 36 All other causes 54 27 27 All Causes 449 222 227 12 Table 5.—Infant Mortality during the Year 1941. 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 9 1 l . 11 . . . . 1 11 7 4 4 Congenital Malformations 3 1 l 5 . . . . 5 2 3 3 Marasmus 1 . . . 1 . . . . 1 1 . . Diarrhoea and Enteritis . . . . . 1 . . 2 3 1 2 2 Whooping Cough . . . . . 1 . . . 1 1 1 Violence 1 . . . 1 1 . . 1 3 2 1 1 All causes 14 2 2 . 18 3 . . 3 24 14 10 11 Infectious Diseases Mortality. The death-rate for 1941 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, 1936 to 1940, are contrasted with the rate for 1941. 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, 1941. Disease. Barnes. London. England and Wales. Small-pox — — — Enteric Fever — 0.01 0.00 Measles — 0.02 0.03 Scarlet Fever — 0.00 0.00 Whooping Cough 0.03 0.04 0.06 Diphtheria — 0.03 0.07 Diarrhoea (under 2 years) 0.10 0.06 0.07 Zymotic Death Rate 0.13 0.16 0.23 Table 7.—Zymotic Death-rate for 1941, contrasted with the Rates for the previous Five Years. Year. Barnes. London. England and Wales. 1936 012 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 1941 0.13 0.16 0.23 13 Table 8.—Measles : Death-Rate per 1,000 of Population. Year. Barnes. London. England & Wales. 1937 — 0.01 0.02 1938 0.02 0.06 0.04 1939 1940 — 0.00 0.01 0.01 0.02 1941 — 0.02 0.03 Average Rate 1937-1941 0.00 0.02 0.02 Table 9.—Whooping Cough : Death-Rate per 1,000 of the Population. Year. Barnes. London. England & Wales. 1937 — 0.06 0.04 1938 0.02 0.03 0.03 1939 — 0.03 0.03 1940 — 0.00 0.02 1941 0.03 0.04 0.06 Average Rate 1937-1941 0.01 0.05 0.04 GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. Table 10.—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 — — — — 15 80 15 80 Schoolchildren 11 13 — — 21 170 32 183 Adults — — — — 68 313 68 313 Totals 11 13 — — 104 563 115 576 u Table 11—Infected and Infested Rooms and Articles (dealt with by the Council). Premises disinfected 68 Rooms disinfected 71 Lots of bedding disinfected 122 ,, „ destroyed 8 „ „ disinfested — Council houses disinfested 3 Other houses disinfested 6 Table 12.—Rats and Mice Destruction. Number of complaints received 104 Visits to (a) Enclosed premises 233 (b) Open spaces 470 Number of occasions on which (a) Poison bait was laid 233 (b) Gas (sulphurdioxide) was used 21 HOUSING. Table 13.—HOUSING STATISTICS FOR THE YEAR 1941. 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) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 814 (b) Number of inspections made for the purpose 2480 (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 14 (iii) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 1 (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 388 15 (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 301 (III) Action under Statutory Powers during the Year:— During 1941 representation under Section 11 of the Housing Act, 1936, was made in respect of one house to the effect that it was unfit for human habitation. The owner was served with a notice to appear before the Council to show cause why the premises should not be demolished. No proceedings were taken under the following Statutory Powers: (a)—Sec. 9, 10 and 16, Housing Act, 1936—(Repair of dwellinghouses). (b)—Sec. 13, Housing Act, 1936—(Demolition Order). (c)—Sec. 12, Housing Act, 1936 — (Closing Order, underground rooms). 3. Housing Act, 1936—Part IV—Overcrowding. (a) (i) Number of dwellings overcrowded at the end of the year — (ii) Number of families dwelling therein — (iii) Number of persons dwelling therein — (b) Number of new cases of overcrowding reported during the year — (c) (i) Number of cases of overcrowding relieved during the year 1 (ii) Number of persons concerned in such cases 6 Cases of Overcrowding. 1936 1937 1938 1939 1940 1941 Awaiting abatement 1st January 140 119 109 37 18 1 New cases discovered 20 22 14 4 1 — Total for abatement 160 141 123 41 19 1 Abated during the year 41 32 86 23 18 1 Awaiting abatement 31st Dec. 119 109 37 18 1 — 16 SANITARY CIRCUMSTANCES OF THE AREA. Table 14.—Showing the Number and Nature of the Inspections made by the Sanitary Inspectors during 1941, the Number or 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 on Register. 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 16 2 2 — — Milkshops 12 32 — — — — Butchers' Shops 31 100 — — — — Fishmongers and Poulterers 12 29 — — — — Greengrocers 36 54 — — — — Cookedprovision shops 30 14 — — — — Ice-cream shops 25 25 — — — — Restaurants 28 15 1 1 — — Fried-fish shops 2 9 — — — — Slaughterhouses 1 10 — — — — Bakehouses 11 18 — — 1 1 Factories:— Mechanical 79 47 3 3 — — Non-mechanic'l 16 9 — — — — Air Raid Shelters 113 218 — — — — Home-workers 11 11 — — — — Schools — — — — — — Public Halls and Cinemas 1 1 — — — — Servants' Registries 4 4 — — — — Stable Yards 22 15 — — — — Public Conveniences 40 32 — — — — Dwelling-houses (including houses let in lodgings) No. of Premises Visited. (1) House - toHouse Inspection — 2492 388 296 5 4 (2) Inspected on complaint 252 (3) Inspected in course of other work:— (a) Housing work, etc 562 (b) For infectious diseases 12 Totals 826 3151 393 301 6 5 17 Table 15.—Factories. No. of Premises on Register. Inspection. Number Written Notices Served. Factories with mechanical power 79 47 3 Factories without mechanical power 16 9 — Total 95 55 3 Defective conditions:— Discovered. Remedied. Sanitary conveniences insufficient 1 1 Other offences 6 6 Total 7 7 Matters referred to H.M. Inspector of Factories 1 Notifications received from H.M. Inspector of Factories 2 Legal proceedings:— The proprietor of a Factory Bakehouse was prosecuted for failing to keep the bakehouse and machinery in a clean condition. A fine of £20 was imposed by the Court. Table 16.—Home Workers. Work undertaken. No. on Register. Fancy Needlework 1 Dressmaking 4 Tailoring 4 Boot Repairing 1 Glove making 1 Total 11 INSPECTION AND SUPERVISION OF FOOD. Table 17.—Dairies and Milkshops. Number of purveyors of milk:— Dairies situated within Borough 4 Milkshops (not dairies) within Borough 12 Purveyors of milk from outside Borough 3 Total 19 Designated milk is sold from:— (a) Premises within Borough 4 (b) „ outside „ 2 6 18 Table 18.—Slaughterhouses. Private. Public. Total. No. of licensed slaughterhouses 1 — 1 No. of notices received of intention to slaughter during the year 16 — 16 No. of animals slaughtered:— Swine 80 — 80 Cattle — — — Sheep — — — Total 80 — 80 Meat discovered to be unfit for human consumption:— One pig, weight 18 stone, diseased—destroyed. Table 19.—Unsound Food. In no instance was it found necessary to seize unsound food on any premises. The following articles were voluntarily surrendered and destroyed as being unfit for human consumption Tripe 1½ lbs. Turkey One Fish (Dabs) 5 stone Cheese 43½ lbs. Periwinkles 2 bags Fish Roll 6 lbs. Bacon 15 lbs. Baked Beans 1 tin Eggs 546 Lunch Tongue 1 tin Rabbits (2 boxes) 120 lbs. Pineaple 6 tins FOOD AND DRUGS ACT, 1938. Table 20.—Return of Samples Analysed during the Year ending 31st December, 1941. Articles Analysed Adulterated or deteriorated Prosecutions Convictions Formal Informal Total Formal Informal Total Milk 4 — 4 — — — — — Coffee 1 — 1 — — — — — Sausages 1 — 1 — — — — — Chicken and Ham Paste 1 — 1 — — — — — Totals 7 — 7 — — — — — 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 21.— Infectious Diseases: Incidence per 1,000 of the Population in 1941. Disease. Barnes. London. England and Wales. Typhoid Fever - 0.04 0.03 Paratyphoid Fever 0.03 0.05 0.09 Cerebro-spinal Fever 0.13 0.30 0.25 Scarlet Fever 0.67 1.01 1.47 Whooping Cough 4.85 3.50 4.39 Diphtheria 0.42 0.93 1.25 Erysipelas 0.16 0.50 0.30 Small-pox — — — Measles 2.02 4.77 10.33 Pneumonia 0.67 1.07 1.25 Table 22.— Showing the Notifications of Infectious Diseases Received during 1941 arranged in Four-Weekly Periods. Fourweekly period ending Diphtheria. Scarlet Fever. Measles. Enteric Fever. Pneumonia. Erysipelas. Puerperal Pyrexia. Cerebro-spinal Fever. Ophthalmia Neonatorum Whooping Cough Dysentery. Food Poisoning Jan. 25 1 - 34 - 1 - - 1 - - - - Feb. 22 1 3 8 — 8 — — 2 — — — — Mar. 22 — 4 2 — 2 — — — — 6 — — April 19 1 — 5 — 1 — — — — 2 — — May 17 1 1 3 — 2 — — — — 6 — — June 14 — 1 2 — 5 1 — 1 — 34 — 2 July 12 — 1 3 - - - - - - 26 — 3 Aug. 9 — — 2 — — 1 — — — 28 — — Sept. 6 1 — 1 — 1 — — — — 20 — — Oct. 4 2 — 2 1 1 — — — 1 16 — — Nov. 1 2 2 - - - - 1 - - 4 - - Nov. 29 4 5 1 - - 1 - - - 2 - - Dec. 27 — 4 1 — — 2 — — — 7 1 1 Totals 13 21 63 1 21 5 1 4 1 151 1 6 20 Table 23.—Notifiable Infectious Diseases, 1941. 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 13 — — 2 2 l 1 2 2 2 1 — — — 3 10 13 — Scarlet Fever 21 — 1 1 1 3 4 3 3 — 1 3 1 — 4 17 21 — Measles 63 3 16 5 5 6 20 2 2 1 3 — — — 18 45 2 — Enteric Fever 1 - - - - - — — 1 — — — — — 1 — 1 — Dysentery 1 - - - - - - - 1 - - - - - — 1 1 — Pul. Tuberculosis 39 - - - - - — 1 10 4 6 7 10 1 19 20 30 20 Non-Pul. Tuberculosis 4 — 2 - - - - - 1 - - 1 - - 2 2 — 1 Pneumonia 21 — 2 - - - - - 2 1 — 2 7 7 5 16 6 20 Erysipelas 5 - - - - - — - - - - - 4 1 2 3 3 — Puerperal Pyrexia 1 - - - - - - - - - - 1 — — — 1 1 — Ophthalmia Neonatorum 1 1 — — - - — - - - - - - - 1 - 1 - Cerebro-spinal Fever 4 - 2 - - - - - 1 1 - - - - 1 3 4 1 Whooping Cough 151 11 25 18 7 32 53 3 1 — — — — 1 49 102 8 1 Food Poisoning 6 - - — 2 — 1 — — 1 2 - - - 1 5 — — All Diseases 331 15 48 26 17 42 79 11 24 10 13 14 22 10 106 225 91 43 † The deaths recorded in this column are the total corrected number of dcath9 assignable to the District, and are not necessarily deaths of persons recorded as notified during the year. 21 Table 24.—Notifiable Infectious Diseases, 1931 to 1941. Year. 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 Diphtheria 16 1 72 29 31 4 3 1 4 5 13 Scarlet Fever 64 92 147 132 77 56 84 52 36 39 21 Enteric Fever 3 4 — 1 1 3 3 2 1 2 1 Puerperal Fever 1 1 1 1 — 2 — * * * * „ Pyrexia 2 4 2 2 3 1 1 4 3 2 1 Erysipelas 7 10 16 11 16 11 12 6 10 4 5 Continued Fever — — — — — — — — — — — Relapsing Fever - - - - - - - - - - - Typhus Fever - - - - - - - - - - - Small-pox - - - - - - - - - - - Cholera - - - - - - - - - - - Plague - - - - — — — — — - — Tuberculosis, P. 41 44 30 42 21 39 28 25 35 32 39 „ Non-P. 6 13 10 6 8 5 10 8 3 4 4 Cerebro-spinal Fever — — 2 1 — — — 2 1 5 4 Poliomyelitis 1 — 1 — — — 2 1 — — — Ophthalmia Neonatorum - 1 - 1 1 1 1 1 - 2 1 Measles 31 790 50 551 7 517 101 387 8 79 63 Rubella 16 8 23 61 5 29 9 439 22 * * Encephalitis Lethargica - - - - - - - - - - - Polioencephalitis - - - - - - - - - - - Malaria - - - - - - - - - - - Dysentery — — — — — — — 1 — — 1 Pneumonia 28 30 35 36 13 21 34 18 14 14 21 Anthrax - - - - - - - - - - - Whooping Cough -(Not Notifiable)- 5 2 151 * No longer notifiable. Table 25.—Schools. Number in Borough Number of scholars who suffered from:— Scarlet Fever Diphtheria Public Elementary Schools:— 10 Barnes Central Boys — 1 „ „ Girls — — Lowther J.M. and Infants — — East Sheen J.M. and Infants 1 2 Mortlake Central Boys 1 — „ „ Girls — — Mortlake Council J.M. and Infants 2 — Mortlake C.E. Mixed — — „ „ Infants 1 - Mortlake R.C. 3 — Secondary Schools:— 1 East Sheen and Richmond County Boys' School - - Private Schools 5 — - Total 16 8 3 22 Table 26.—Diphtheria Immunisation Clinic. The Following Table Shows the Position on 31st December, 1941, in Respect of the 1,186 Children who Attended the Clinic during 1941. Position on 31 Dec., 1941 1. TOTAL NEW CASES dealt with during 1941 1096 (A) Continued in Attendance:— 840 (a) Post-Schick Negative (Certificate) 628 (b) Completed injections, awaiting Post-Schick test 159* (c) Receiving injections at end of year 53 (B) Discontinued Attendance:— 256 (a) Completed injections—failed to attend for PostSchick test 237* (b) Did not complete injections 19 (c) Left district before completion of injections 1 2. CHILDREN attending for Re-Schick Test two years after immunisation:— 90 (a) Re-Schick test negative—immunisation confirmed 87 (b) Re-Schick test positive—further injections given 3 TOTAL CHILDREN attending Clinic during year 1186 Children invited but did not attend 62 Note.— In addition to the 628 children in respect of whom certificates were given, 396* additional children completed courses of immunising injections during the year, making in all 1,024 children immunised during the year. Table 27.—Clinic for Inoculation against Typhoid Fever. Adults. Children under 16. Total. Number of applications received during 1941 428 73 501 Number of applications withdrawn 25 1 26 Total invited 403 72 475 Number who attended Clinic:— (a) Completed course of injections 346 67 413 (b) Failed to complete course of injections 9 1 10 Number invited but did not attend 48 4 52 Number of injections given 1048 203 1251 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, 1941 are as under:— Table 28.—Tuberculosis Notification Register. Form of Disease. On Register, 1st Jan., 1941 Cases Added. Removed from Register. Remaining on Register 31st Dec., 1941 Primary Notif' ns Otherwise. Total. NonTub. Cured Left District Dead. Total. Pulmonary 143 39 20 59* 1 - 24 29 54 148 Non-Pulm'y 50 4 — 4 1 — 4 4 9 45 All Forms 193 43 20 63* 2 — 28 33 63 193 * Included in these figures are two patients whose names were restored to the Register. Table 29.—Tuberculosis: New Cases and Mortality, 1941. 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 „ - - - - - - - - 10-15 „ 1 - - - - - - - 15-20 „ 10 — — 1 1 — — — 20-25 „ 5 3 — — 3 — — — 25-35 „ 7 7 — — 2 3 — — 35-45 „ 6 4 1 - 3 2 - — 45-55 „ 6 4 — - 5 — - — 55-65 „ 2 - - - - - - - 65 „ and over — 2 — - 1 — - 1 All ages 37 20 1 3 15 5 - 1 * 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 1.25 All forms 1.38 Non-pulmonary 0.13 Death-rate -Pulmonary 0.64 All forms 0.67 Non-pulmonary 0.03 24 Table 30.—Institutional Treatment. Admissions during 1941 were as under:— Pulmonary Tuberculosis: To Surrey County Council Sanatorium 7 „ Surrey County Hospitals 12 „ other sanatoria 8 „ general hospitals 4 „ Public Assistance Institutions — Total 31 Number of patients admitted : Pulmonary 30 Non-pulmonary Nil INFECTIOUS DISEASES HOSPITAL. Table 31.—Admissions and Deaths. Residents of Borough. Nonresidents admitted under reciprocal arrangements Noncivilians. TOTALS. Admitted. Died. Admitted. Died. Admit ted. Died. Admit ted. Died. Diphtheria 9 - - - - - 9 - Scarlet Fever—sent in as Diphtheria 1 - - — — — 1 — Diphtheria and Scarlet Fever 2 — - — — — 2 — Scarlet Fever 18 - - - - - 18 — Diphtheria Measles sent in as Scarlet Fever 1 - - - - - 1 — 1 - - - - - 1 — Scarlet Fever and Chicken-pox 1 - - - - - 1 — Scarlet Fever and Whooping Cough 1 - - - - - 1 — Cerebro-spinal Meningitis 5 — — — — — 5 — Pneumonia Double Otorrhoea and Mastoiditis sent in as Cerespinal 1 - - - - - 1 — Meningitis 1 - - - - - 1 — Enteric Fever—Paratyphoid 1 - - - - - 1 — Measles—sent in as Enteric Fever 1 - - - - - 1 — Measles 1 - 5 — — — 6 — German Measles - - - - 1 — 1 — Whooping Cough 7 1 9 — — — 16 1 Chickenpox - - 5 — — — 5 — Pediculosis and septic scalp sent in as Chickenpox — — — — 1 — 1 — Arteriosclerosis 1 - - - - - 1 — Erysipelas 1 — 1 — — — 2 — Erysipelas and Chickenpox 1 - - - - - 1 — Gastro-enteritis — — 2 — — — 2 — Dysentery, Sonne — — 16 — — — 16 — Cellulitis—sent in as Mumps 1 - - - - - 1 — Totals 55 1 38 — 2 — 95 1 25 Deaths. (1) Whooping cough, complicated by broncho-pneumonia on admission— child six weeks old—died 4th day after admission. Complications. (1) Diphtheria. (4) Cerebrospinal Meningitis. Strabismus, 4. Facial paralysis, 1. Dipththeritic myocarditis, 4. Arthritis, 1. Paralysis—Palate, 2. —Face 1. (5) Whooping Cough. Serum reaction, 1. Broncho-pneumonia, 10. Tonsillitis. Enteritis, 1. (2) Scarlet Fever. (6) Chickenpox. Rheumatism, 1. Impetigo, 1. Necrosis, 2. Otorrhœa, 1. Adenitis, 3. Secondary tonsillitis, 1. C) Paratyphoid. Anaemia, 1. Rheumatism, 1. Serous meningitis, 1. (8) Dysentery Sonne. (3) Measles. Broncho-pneumonia, 1. Congestion of lungs, 1. Tonsillitis, 1. Broncho-pneumonia, 4. Otorrhœa, 1. Table 32.—Laboratory Facilities. Specimens examined during the year were as follows:— Sputa for detection of tubercle bacilli 57 Swabs „ „ „ diphtheria bacilli 185 Fæces „ „ „ typhoid bacilli 64 Urine „ „ „ „ „ 13 Cerebro-spinal fluid 5 Blood (Widal) 2 „ (Blood-count) 1 Pus 1 Smears 4 Total 332 26 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 384 First visits to newly-born infants 306 Revisits to infants under 1 year 2,085 Visits to children aged 1 to 5 years 3,175 Visits in connection with Council's scheme for the supply of milk 43 Still-birth inquiries 5 Special visits to cases of measles 90 „ „ „ „ „ whooping cough 391 „ „ „ „ „ pneumonia 16 Visits to foster children 72 Visits in connection with infectious diseases other than those above specified 1,111 Total visits 7,678 Table 34.- Notification of Births. (a) Registered in Borough:— Live Births. Still Births. Totals. Number of births registered during 1941 as occurring in the Borough 248 6 254 Number of such births not notified in accordance with the Public Health Act, 1936, Part VII 1 2 3 (b) Notified. Number of births, live and still, notified during the year— by medical practitioners 10 by midwives 246 by other persons 1 Total notified 257 Number of still-births notified during the year 6 Percentage of still-births to total births occurring in the Borough 2.3 Table 35—Institutional Confinements. In institutions within the Borough 127 In registered maternity homes 127 In institutions outside the Borough 108 In general hospitals 8 In maternity hospitals 29 In Public Health County hospitals 35 In Public Assistance institutions 22 In maternity homes 14 Total 235 Number of above institutional confinements arranged through the Borough Ante-natal Clinic 50 27 MATERNITY AND CHILD WELFARE CENTRES. Table 36—Ante-Natal Clinic. Year 1940 Year 1941 Total number of expectant mothers attending Borough ante-natal Clinic during the year 196 244 Number of new cases attending for first time and included in total number 157 202 Number of attendances made by all mothers 508 618 Percentage of expectant mothers of total notified births attending Borough Clinic 60.1 78.6 Table 37—Infant-Welfare Clinics.— Attendances. Year 1940. Year 1941. New Cases:— Infants under 1 year 256 279 Children 1 to 5 years 128 167 Total 384 446 Number of Children attending during the year:— Infants under 1 year 312 369 Children 1 to 5 years 364 396 Total 676 765 Number of attendances made by:— Infants under 1 year 2,027 3,718 Children 1 to 5 years 1,412 2,619 Total 3,439 6,337 Mothers 2,903 5,681 Number of consultations with Medical Officer 2,320 3,769 Average attendance per week: Infants under 1 year 39.8 72.9 Children 1 to 5 years 27.6 51.4 Total, all children 67.4 124.3 Number of children attending Centre for first time during the year: Percentage of total births represented by this figure 70.9 77.5 28 Table 38.—Child Life Protection. The following is a summary of the cases on the Register during 1941:— Foster-mothers on the Register at the beginning of the year 5 „ „ added to the Register 4 „ „ removed from the Register, having ceased to have care of children 4 „ „ on the Register at the end of 1941 5 Foster-children on the Register at the beginning of the year 5 „ „ in respect of whom Notice of Reception was received 10 „ „ removed from the Register during the year:— Returned to care of parents 5 8 Evacuated 1 Adopted 1 Admitted to Hospital 1 ,, „ on the Register at the end of 1941 7 Number of visits of inspection made by Health Visitors during the year 72 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—whooping cough 31 — 31 —pneumonia 141 67 208 —influenza — 26 26 „ „ to other general and surgical cases 6,103 15,198 21,301 6,275 15,291 21,566 (2) Barnes and Mortlake Day Nursery. Accommodation for children under 5 years 26 Number of attendances—Whole-day 3,745 Half-day 696