BARN 11 library BOROUGH OF BARNES Annual Report of the Medical Officer of Helth For the Year 1943 BOROUGH OF BARNES the Annual Report of the Medical Officer of Health for the year 1943 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., B.Ch., B.A.O.,Belf., M.R.C.P.Lond., L.M., D.P.H. Assistant Medical Officer of Health (Temporary Appointment). Merton Harrison, M.R.C.S., L.R.C.P.(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 Cert.San.Insp., Cert. Meat and Food Insp. Vacancy 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. Miss M. Sharp. *G. K. Shilleto. *G. E. Tydeman. Temporary Clerks. Miss L. M. Fairclough. Miss K. P. Morcom. Miss J. Campbell. Miss H. Wheatley. Mrs. J. Scullard. D. Rundle. Matron of the Infectious Diseases Hospital (Temporary Appointment; Mrs. P. Manger, S.R.N., R.F.N. Matrons, War-Time Day Nurseries. 47 Castelnau, Barnes— Mrs. M. Heard, S.R.C.N. 2 and 4 Sheen Gate Gardens—Mrs. C. Dyer, S.R.N., R.F.N. *(Serving with H.M. Forces). 4 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, Ladies and Gentlemen, I have the honour to present my Annual Report for the year 1943 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. As before 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. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, W. F. TWINING McMATH, Medical Officer of Health. 5 BOROUGH OF BARNES. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1943. 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 the Ministry of Health, 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. STAFF. There have been several changes in Staff during the year, the names of those members actually remaining on the Staff at 31st December, 1943, are given on page 3. The following alterations occurred during the year:— Dr. A. V. B. Crawford, Assistant Medical Officer of Health, left the service on the 2nd July, and Dr. Merton Harrison was appointed as temporary Assistant Medical Officer of Health, commencing duties on the 13th September. During the interim period the services of private medical practitioners were used for attendance at the various clinics. Mr. J. H. Plant, a temporary Sanitary Inspector, left on the 2nd September, upon the return of Mr. R. H. Street from service with the Royal Air Force. On the 10th October Mr. Street left the service of the Corporation upon obtaining a similar position in another borough. The vacancy thus resulting had not been filled by the end of the year. Miss B. Hayden, one of the temporary clerks, left on the 31st March. She was replaced by another temporary who only remained for two months. From the 9th June until the 15th November, when Miss L. M. Fairclough commenced duties, the position remained vacant. Upon Mr. G. E. Tydeman being called for service with the Royal Navy, Mr D. Rundle commenced duties on the 19th July as temporary junior clerk. 6 On the 1st November, Mrs. I. Beck, Matron of Castelnau Wartime Day Nursery, left the Corporation's service and was replaced by Mrs. M. Heard, who commenced duties upon the 15th November. 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 1943 are set out in Tables 21-24 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. Two cases of typhoid fever and one of paratyphoid fever occurred in the borough during the year. Despite the assistance of an expert from the Ministry of Health, the sources of infection in these cases were not definitely traced. There was an epidemic of scarlet fever in the borough amounting to 184 cases. The incidence was mainly among infants and junior school children. One baby died of toxic scarlet fever, so raising the death rate for this disease to 0.03 per 1,000 population. None of the cases of diphtheria occurring during the year had received a course of immunising injections. DIPHTHERIA IMMUNISATION. During the year, consequent upon the Ministry of Health Circular 2,713, a personal canvass of parents with children under five years of age was carried out by the Health Visitors in an endeavour to get every child in that age group protected against diphtheria at an early age. Propaganda of this character is, of course, a routine practice of the health visiting staff, but this intensive canvass produced very good results among those who had not already been persuaded to have their children immunised. PROTECTION AGAINST WHOOPING COUGH. The Council's scheme for the free inoculation of children against whooping cough continues in operation. Children attending war-time day nurseries and those whose parents are home-visited by Health Visitors have been offered the facilities. The response has not been as good as in the case of diphtheria immunisation, possibly because 7 of the larger number of injections required to secure protection. It is hoped that before long a two-injection method may be available and this should encourage more parents to take advantage of the protection against the disease. INOCULATION AGAINST TYPHOID FEVER. Only two applications, adults, were received during 1943 and these received the necessary courses of injections. At the beginning of the year the 347 persons who had received a course of injections in 1942, were invited to have a further one injection. 143 responded and received this additional precautionary injection. The balance of those invited either declined to avail themselves of the offer, or did not attend. INFECTIOUS DISEASES HOSPITAL. The Infectious Diseases Hospital was busy during the year, mainly as a result of the scarlet fever epidemic. During 1943 the Council adopted the application of the First Report of the Nurses Salaries Committee under the chairmanship of Lord Rushcliffe. CLEANSING STATION. During the year the Borough Cleansing Station has been well used, the majority of treatments being for scabies. Two alterations in the method of treatment have been adopted (a) following upon the recommendations contained in the Ministry of Health Circular 2,831, lethane hair oil has been used for the treatment of head lice and (b) benzyl-benzoate emulsion substituted for the previous sulphur treatment of scabies. A full time male cleansing attendant is employed, but although a female cleansing attendant was appointed during the year, she subsequently relinquished her position and it has not been possible to replace her. Consequently, the duties which she carried out at the cleansing station have been undertaken by nursing auxiliaries of the First-Aid Post Service. BOROUGH ACCIDENT AND GENERAL PURPOSES AMBULANCE SERVICE. This service, which although transferred to the control of the Medical Officer of Health in 1941, continued to be manned by the personnel of the National Fire Service until the 17th June, 1943, when the Accident Ambulance was transferred from the Fire Station, Mortlake High Street, to Essex House, Station Road, Barnes, and 8 manned by personnel of the Civil Defence Ambulance Service, assisted by certain members of the Civil Defence Rescue Service. During the year the ambulance was used for the removal of 1,043 persons, 188 of these being accident cases and 195 removals of expectant mothers to institutions, nursing homes etc., for confinement. MATERNITY AND CHILD WELFARE. The birth rate for 1943 in Barnes was 18.0 per 1,000 population. This is the highest rate recorded since 1921, when it was 19.1. There has been a steady rise in the birth rate for the borough since 1938, when it was 9.2. The increased birth rate is partly due to the smaller population of Barnes, resulting from war-time conditions, upon which the rate is based, but, nevertheless, the actual number of births occurring has increased considerably. During the year, as a result of the recommendation contained in Ministry of Health Circular 2,729 the Council decided to provide the services of Home Helps, to carry out domestic duties where confinements take place at home. Some difficulty was experenced in obtaining suitable persons for these duties, and it was not until the end of the year that such a person was appointed. Consequently, in only one case during the year were the services of a Home Help provided under the scheme. This service provides a very necessary adjunct to the maternity and child welfare services, especially during war-time, when it is not always possible to arrange for institutional provision for confinement. When the Home Help is not engaged in the specific duties connected with confinements she has been employed to augment the staffs of the two war-time day nurseries. Later in the year it was decided to extend the scheme for the provision of Home Helps to include attendance at other types of cases, such as serious illness, where some home help is required in emergency, this extension being subject to the condition that maternity cases take precedence. As reported in my Annual Report for 1942 two war-time day nurseries were opened during that year. In the Appendix, Table 39, details of the admissions, discharges and attendances made by children during the part of 1942 from the opening of the nurseries, and during the whole of 1943, are given for information as to the use made of this very necessary war-time provision. On the 1st June, 1943, the Adoption of Children (Regulation) Act, 1939, came into operation. This has been introduced to regulate the making of arrangements by Adoption Societies and other persons in connection with the adoption of children. The Health Visitors, who are already appointed Infant Life Protection Visitors, are undertaking the necessary visitation and enquiries in connection with the new Act. Borough of Barnes. APPENDIX to the Annual Report OF THE Medical Officer of Health 1943. 10 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, 1943. Births:— Birth-rate (per 1,000 of population) 18.0 Live Births:— Total. M. F. Legitimate 566 291 275 Illegitimate 41 23 18 Total 607 314 293 Still Birth-rate (per 1,000 total births) 304 Total. M. F. Still Births (Legit. 15; Illegit. 4) 19 4 15 Deaths:— Death-rate, all causes (per 1,000 of population) 13-8 Total. M. F. Deaths (all causes) 465 213 252 Death-rate from Cancer (per 1,000 of population), deaths 75 2.23 Death-rate from Zymotic Diseases (per 1,000 of population) 0.06 Deaths from Scarlet Fever (all ages) 1 ,, ,, Diarrhoea (under two years of age) 1 Death-rate from Maternal Causes (per 1,000 total births) 0-03 Deaths from Puerperal Sepsis Nil ,, ,, Other Puerperal causes 1 Death-rate of infants under one year (per 1,000 live births) 32.9 Death-rate for Legitimate infants (16 deaths) 28.3 Illegitimate infants (4 deaths) 97.6 11 Table 2.—Vital Statistics of the Borough of Barnes during 1943 and previous 5 Years Ykar. 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 registered outside the District. Under 1 year of age. At alt ages. Number. Rate per 1,000 nett births. Number Rate Number. Rate. Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 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 16 409 422 10.8 1940 285 361 10.3 301 7.6 23 276 12 35.2 554 13.9 1941 248 360 11 215 6.9 14 248 22 74.5 449 14.4 1942 382 473 14.5 221 6.8 17 270 23 48.6 474 14.5 1943 487 607 18.0 210 6.2 15 270 20 32.9 465 13.8 12 Table 3.—Birth-rate, Death-rate, and Analysis of Mortality during the Year 1943, 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 l 000 Births. Maternal Mortality Hate 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 16.5 12.1 0.00 - 0.02 0.00 0.03 0.03 0.37 5.3 49 2.29 0.73 1.56 126 County Boroughs and Great Towns, including London 18.6 14.2 0.00 - 0.02 0.00 0.03 0.04 0.36 7.9 58 Not available 148 Smaller Towns (Estimated Resident Populations 25,000 to 50,000 at Census, 1931) 19.4 12.7 0.00 - 0.02 0.00 0.03 0.04 0.37 4.4 46 London 15.8 15.0 000 — 0.02 0.00 0.03 0.02 0.27 10.4 58 Barnes Borough 18.0 13.8 — — — 0.03 — — 0.36 1.6 33 0.03 — 0.03 13 Table 4.—Causes of Death during the Year 1943. Causes of Death (Registrar-General's short list of causes). Total Deaths Male Female 1 Typhoid and Paratyphoid fevers — — — 2 Cerebro-spinal fever — — — 3 Scarlet Fever 1 — 1 4 Whooping Cough — — — 5 Diphtheria — — — 6 Tuberculosis of respiratory system 18 13 5 7 Other forms of tuberculosis 4 2 2 8 Syphilitic diseases 1 — 1 9 Influenza 12 8 4 10 Measles — — — 11 Acute poliomyelitis and polioencephalitis — — — 12 Acute infectious encephalitis 1 1 — 13 Cancer of buccal cavity and oesoph. (m); uterus (f) 7 — 7 14 ,, stomach and duodenum 9 4 5 15 ,, breast 10 — 10 16 ,, all other sites 49 26 23 17 Diabetes 8 4 4 18 lntra-cranial vascular lesions 43 12 31 19 Heart Disease 125 59 66 20 Other diseases of circulatory system 15 6 9 21 Bronchitis 27 15 12 22 Pneumonia 21 8 13 23 Other respiratory diseases 12 8 4 24 Ulceration of stomach or duodenum 4 4 — 25 Diarrhoea under 2 years 1 — 1 26 Appendicitis 2 1 1 27 Other digestive diseases 16 5 11 28 Nephritis 9 6 3 29 Puerperal and post-abortive sepsis — — — 30 Other maternal causes 1 — 1 31 Premature birth 2 2 — 32 Congenital malformations, birth injury, infantile diseases 11 6 5 33 Suicide 5 2 3 34 Road traffic accidents 2 2 — 35 Other violent causes 5 — 5 36 All other causes 44 19 25 All Causes 465 213 252 14 Table 5.—Infant Mortality during the Year 1943. 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 4W'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 2 ... ... ... 2 ... ... ... ... 2 1 1 ... Congenital Malformations 7 2 1 ... 10 ... 1 ... ... 11 6 5 5 Diarrhoea and Enteritis ... ... ... 1 1 ... ... ... ... 1 ... 1 ... Bronchitis ... ... ... ... ... 1 1 ... ... 2 2 ... ... Broncho-pneumonia ... ... ... ... ... ... ... 1 ... 1 1 ... ... Whooping Cough ... ... ... ... ... ... ... ... 1 1 1 ... 1 Other causes ... 2 ... ... 2 ... ... ... ... 2 ... 2 2 All causes 9 4 1 1 15 1 2 1 1 20 11 9 8 Infectious Diseases Mortality. The death-rate for 1943 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, 1938 to 1942, are contrasted with the rate for 1943. 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, 1943. Disease. Barnes. London. England and Wales. Small-pox — — — Enteric Fever — 0.00 0.00 Measles — 0.02 0.02 Scarlet Fever 0.03 0.00 0.00 Whooping Cough — 0.03 0.03 Diphtheria — 0.02 0.03 Diarrhoea (under 2 years) 0.03 0.16 0.09 Zymotic Death Rate 0.06 0.23 0.17 Table 7.—Zymotic Death-rate for 1943, contrasted with the Rates for the previous Five Years. Year. Barnes. London. England and Wales. 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 1942 0.06 0.17 0.16 1943 0.06 0.23 0.17 15 Table 8.—Measles: Death-Rate per 1,000 of Population. Year. Barnes. London. England & Wales. 1939 - 0.00 0.01 1940 — 0.01 0.02 1941 — 0.02 0.03 1942 0.06 0.01 0.01 1943 — 0.02 0.02 Average Rate 1939-1943 0.01 0.01 0.02 Table 9.—Whooping Cough: Death-Rate per 1,000 of the Population. Year. Barnes. London. England & Wales. 1939 - 0.03 0.03 1940 - 0.00 0.02 1941 0.03 0.04 0.06 1942 0.03 0.04 0.02 1943 — 0.03 0.03 Average Rate 1939-1943 0.01 0.03 0.03 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 1 1 - - 39 72 40 73 Schoolchildren 26 29 — - 69 119 95 148 Adults 3 3 — — 161 292 164 295 Totals 30 33 - — 269 483 299 516 16 Table 11—Infected and Infested Rooms and Articles (dealt with by the Council). Premises disinfected 253 Rooms disinfected 277 Lots of bedding disinfected 319 „ „ „ destroyed 3 „ „ disinfested 9 Council houses disinfested (by hydrogen cyanide 1, by liquid insecticides 9) 10 Other houses disinfested 8 Table 12.—Rats and Mice Destruction. Number of complaints received 289 Visits to (a) Enclosed premises 511 (b) Open spaces 193 Number of occasions on which (a) Poison bait was laid 331 (6) Gas was used 9 HOUSING. Table 13.—HOUSING STATISTICS FOR THE YEAR 1943. 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) 1664 (b) Number of inspections made for the purpose 2352 (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 Nil 17 (tii) 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 665 (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 501 (Ill) Action under Statutory Powers during the Year:— No proceedings were taken under any of the following Statutory Powers during the year:— (a)—Sec. 9, 11, 10 and 16, Housing Act, 1936—(Repair of dwelling-houses). (b)—Sec. 13, Housing Act, 1936—(Demolition Order). (c)—Sec. 12, Housing Act, 1936 — (Closing Order, ground rooms). 3. Housing Act, 1936—Part IV—Overcrowding. (a) (i) Number of dwellings overcrowded at the end of the year 8 (ii) Number of families dwelling therein 16 (iii) Number of persons dwelling therein 72 (b) Number of new cases of overcrowding reported during the year 14 (c) (i) Number of cases of overcrowding relieved during the year 8 (ii) Number of persons concerned in such cases 65 Cases of Overcrowding. 1936 1937 1938 1939 1940 1941 1942 1943 Awaiting abatement 1st January 140 119 109 37 18 1 - 2 New cases discovered 20 22 14 4 1 — 4 14 Total for abatement 160 141 123 41 19 - 4 16 Abated during the year 41 32 86 23 18 — 2 8 Auatiing abatement 31st December 119 109 37 18 1 - 2 8 18 SANITARY CIRCUMSTANCES OF THE AREA. Table 14.—Showing the Number and Nature of the Inspections made by the sanitary inspectors during 1943, 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 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 3 36 — — — — Milkshops 13 81 — — — — Butchers' Shops 31 137 — — — — Fishmongers and Poulterers 11 30 — — — — Greengrocers 30 44 — — — — Fried Fish Shops 3 13 — — — — Restaurants 32 41 — — — — Other food premises 34 74 2 2 — — Slaughterhouses 1 19 — — — — Bakehouses 11 53 3 3 — — Factories:— Mechanical 112 152 9 9 — — Non-mechanic'l 23 48 3 3 — — Air Raid Shelters 113 231 — — — — Home-workers 10 8 — — — — Schools 16 19 — — — — Public Halls and Cinemas 3 3 — — — — Servants' Registries 4 4 — — — — Piggeries and Stable Yards 25 188 — — — — Public Conveniences 40 146 2 2 — — Dwelling-houses (including houses let in lodgings) No. of Premises Visited. (1) House - toHouse Inspection — 4016 665 501 12 11 (2) Inspected on complaint 1111 (3) Inspected in course of other work:— (a) Housing work, etc 533 (b) For infectious diseases 283 Totals 1927 5343 684 520 12 11 19 Table 15.—Factories. No. of Premises on Register. Inspection. Number Written Notices Served. Factories with mechanical power 112 152 9 Factories without mechanical power 23 48 3 Total 135 200 12 Defective conditions:- Discovered. Remedied. Sanitary conveniences insufficient 2 2 Other offences 14 14 Total 16 16 Matters referred to H.M. Inspector of Factories . 1 Notifications received from H.M. Inspector of Factories Nil Legal proceedings:— No legal proceedings were necessary during 1943. Table 16.—Home Workers. Work undertaken. No. on Register. Fancy Needlework .. .. 2 Dressmaking .. .. 4 Tailoring .. .. 2 Boot Repairing . . .. .. 2 Total .. 10 INSPECTION AND SUPERVISION OF FOOD. Table 17.—Dairies and Milkshops. Number of purveyors of milk :— Dairies situated within Borough 3 Milkshops (not dairies) within Borough 13 Purveyors of milk from outside Borough 4 Total . . 20 Designated milk is sold from :— (a) Premises within Borough 11 (b) „ outside „ 4 15 20 FOOD AND DRUGS ACT, 1938. Table 18.—Return of Samples Analysed during the Year ending 31st December, 1943. ARTICLES. ANALYSED. ADULTERATED OR DETERIORATED. Prosecutions Convictions Formal Informal Total Formal Informal Total Milk (New) Bottled 52 9 61 3 — 3 — — „ „ Loose 2 3 5 — — — — — „ „ In course of delivery 6 - 6 — — — — — Butter 1 — 1 — — — — — Margarine 1 — 1 — — — — — Lard 1 — 1 - — — — — Tea 1 — 1 — — — — — Sugar 1 — 1 — — — — — Jam—Full fruit 1 — 1 — — — — — Dried Egg—loose 1 — 1 — — — — — Saccharin 1 — 1 — — — — — Fish Paste 3 — 3 — — — — — Essence of Lemon 1 — 1 — — — — — Faggots 1 — 1 — — — — — Lemon Barley Cordial 1 — 1 — — — — — Blancmange — Powder Substitute 1 - 1 — — - — - Vinegar 2 — 2 1 — 1 1 1 Pepper 2 — 2 — — — — — Fish Galantine 1 — 1 — — — — — Ground Coffee 2 — 2 — — — — — Zinc Ointment 1 — 1 — — — — — Aspirin 2 — 2 — — — — — Liquorice Powder 1 — 1 — — — — — Peppermint Cordial 1 — 1 — — — — — Mixed Spice 3 — 3 — — — — — Camphorated Oil 1 — 1 — — — — — Castor Oil 1 — 1 — — - — — Curry Powder 1 — 1 — — — — — Baking Powder 1 — 1 — — — — — Yorkshire Pudding and Pancake Mixture with Egg 1 — 1 — — — — — Epsom Salts 1 — 1 — — — — — Glycerine Lemon and Ipecac Balsam 1 - 1 — — — — — Beef & Vegetable Extract 1 — 1 — — — — — Beef Sausage — 2 — — — — — Syrup of Figs 1 — 1 — — — — — Lemon Cordial 1 — 1 — — — — — Chocolate flavour Pudding Mixture 1 — 1 — — — — — Mint Sauce in Malt Vinegar 1 - 1 — — — — — Cocoa 1 — 1 — — — — — Flour (self-raising) 1 — 1 — — — — — Lemonade Crystals (sweetened) 1 - 1 — — — — — Meat Paste 1 — 1 — — — — — Totals 108 12 120 4 - 4 1 1 21 Table 19.—Slaughterhouses. Private. Public. Total. No. of licensed slaughterhouses 1 — 1 No. of notices received of intention to slaughter during the year 18 — 18 No. of animals slaughtered:— Swine 49 - 49 Cattle — — — Sheep - - - Total 49 — 49 Meat discovered to be unfit for human consumption:— One pig's head and pluck—destroyed. Table 20.—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 :— Meat 21 lbs. Cheese 36½ lbs. Meat—tins 115 Meat Paste—jars 2 Fruit 18 lbs. Fish Paste—jars 1 Fruit—tins 168 Jam—tins 8 Fruit—bottles 23 Cereals—tins 3 Vegetables—tins 117 Bacon 75J lbs. Fish 112 lbs. Margarine—packets 9 Fish—tins 202 Milk Pudding—packets 1 Fish—jars 1 Dried Eggs—packets 2 Milk—tins 130 Vinegar—bottles 2 Soup—tins 24 Cocoa Spread—packets 1 Beetox—jars 1 Coffee Essence—bottles 1 Pickles—jars 1 22 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 1943. Disease. Barnes. London. England and Wales. Typhoid Fever 0.06 0.01 0.01 Paratyphoid Fever 0.03 0.01 0.01 Cerebro-spinal Fever 0.06 0.09 0.08 Scarlet Fever 5.47 3.80 3.01 Whooping Cough 2.44 2.68 2.54 Diphtheria 0.09 0.74 0.88 Erysipelas 0.15 0.42 031 Small-pox — — — Measles 3.30 9.17 9.88 Pneumonia 0.59 1.27 1.34 Table 22.—Notifiable Infectious Diseases, 1943. Diseases. Total Cases Notified. Under 1 year l to 2. 2 to 3. 3 to 4. Ages, in years. Parish Removed to Hospital. Total Deaths of Residents. † 4 to 5. 5 to 10 - 10 to 15. 15 to 20. 20 to 25. 1 25 to 35. 35 to 45. 45 to 65. ! 65 and over. Barnes Mortlake. Diphtheria 3 — — — — — — — 1 2 — — — 2 1 3 — Scarlet Fever 184 1 7 8 16 21 105 15 6 2 3 — — — 87 97 184 1 Measles 111 5 16 13 22 17 26 6 — 2 2 2 — — 46 65 5 — Typhoid Fever 2 — — — — — 1 — — — 1 — — 2 2 — Paratyphoid Fever 1 — — — — — — 1 — — — — — — — 1 1 — Dysentery 2 — — — — — — — — 2 — — — — — 2 2 — Pul. Tuberculosis 43 — — 1 — — 2 — 11 8 5 7 8 1 18 25 34 18 Non-Pul. Tuberculosis 7 — — — — — — — 1 — 1 1 1 — 5 2 6 4 Pneumonia 20 — 1 2 — — 1 1 1 — — — 9 5 8 12 4 21 Erysipelas 5 — — — — — — — — — — 1 3 1 2 3 2 — Puerperal Pyrexia 1 — — — — — — — — — 1 — — — — 1 1 — Opthalmia neonatorum 1 1 — — — — — — — — — — — — 1 — 1 — Cerebro-spinal Fever ? 1 — — — — — — — — 1 — — — — 2 2 — Whooping Cough 82 4 13 9 18 17 18 — — — 2 — 1 — 7 75 8 — Malaria 1 — — — — — — — — — — — 1 1 — — — All Diseases 465 12 371 33 56 55 152 24 19 18 17 12 22 8 177 288 255 44 † 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. 23 Table 23.—Notifiable Infectious Diseases, 1933 to 1943. Year. 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 Diphtheria 72 29 31 4 3 1 4 5 13 6 3 Scarlet Fever 147 132 77 56 84 52 36 39 21 34 184 Typhoid Fever — 1 — 3 2 1 — 1 — — 2 Paratyphoid Fever — — 1 — 1 1 1 1 1 — 1 Puerperal Fever 1 1 — 2 — # # # # # # „ Pyrexia 2 2 3 1 1 4 3 2 1 4 1 Erysipelas 16 11 16 11 12 6 10 4 5 6 5 Continued Fever — — — — — — — — — — — Relapsing Fever — — — — — — — — — — — Typhus Fever — — — — — — — — — — — Small-pox — — — — — — — — — — — Cholera — — — — — — — — — — — Plague — — — — — — — — — — Tuberculosis, P. 30 42 21 39 28 25 35 32 39 42 43 „ Non-P. 10 6 8 5 10 8 3 4 4 7 7 Cerebro-spinal Fever 2 1 — — — 2 1 5 4 3 2 Poliomyelitis 1 — — — 2 1 — — — 1 — Ophthalmia Neonatorum — 1 1 1 1 1 — 2 1 — 1 Measles 50 551 7 517 101 387 8 79 63 712 111 Rubella 23 61 5 29 9 439 22 * * * * Encephalitis Lethargica — — — — — — — — — — — Polioencephalitis — — — — — — — — — — — Malaria — — — — — — — — — — 1 Dysentery — — — — — 1 — 1 1 2 Pneumonia 35 36 13 21 34 18 14 14 21 16 20 Anthrax — — — — — — — — — — — Whooping Cough (Not Notifiable) 5 2 151 73 82 * No longer notifiable. Table 24.—Showing the Notifications of Infectious Diseases Received during 1943 arranged in Four-Weekly Periods. Fourweekly period ending Diphtheria. Scarlet Fever. Measles. Typhoid Fever. Paratyphoid Fever. Pneumonia. 1 Erysipelas Puerperal Pyrexia. Cerebro -spinal Fever. Ophthalmia Neonatorum. Whooping Cough Dysentery. Malaria. Jan. 30 1 5 39 — — 2 — — 1 — 5 — — Feb. 27 — 7 10 — — 1 — — — 3 — — Mar. 27 1 7 9 — — — — — — — 6 — — April 24 — 8 16 — — 5 — — — — 4 — — May 22 — 8 8 — — 1 1 — — 25 — — June 19 1 9 5 — — — 1 — — — 9 — — July 17 — 19 12 2 — 1 1 — — — — — — Aug. 14 — 7 7 — — — — — — — 1 — 1 Sept. 11 — 13 2 — — — — — — — 1 1 — Oct. 9 — 26 1 — 1 — — 1 — — 15 1 — Nov. 6 — 35 2 — — 2 — — — 1 3 — — Dec. 4 — 23 — — 1 — — — 3 — — Jan. 1 — 17 — — — 8 1 — 1 — 7 — — Totals 3 184 111 2 1 20 5 1 2 1 82 2 1 24 Table 25.—Diphtheria Immunisation Clinic. The Following Table Shows the Position on 31st December, 1943, in Respect of the 751 Children who Attended the Clinic during 1943. Position on 31 Dec., 1943 1. TOTAL NEW CASES dealt with during 1943 533 (A) Continued in Attendance:— 396 (a) Post-Schick Negative (Certificate) 229 (b) Completed injections, awaiting Post-Schick test 151* (c) Receiving injections at end of year 16 (B) Discontinued Attendance:— 137 (a) Completed injections—failed to attend for PostSchick test 120* (b) Did not complete injections 12 (c) Left district before completion of injections 5 2. CHILDREN attending for Re-Schick Test two years after immunisation :— 218 (a) Re-Schick test negative—immunisation confirmed 212 (b) Re-Schick test positive—further injections given . . 6 TOTAL CHILDREN attending Clinic during year 751 Children invited but did not attend 73 Note.— In addition to the 229 children in respect of whom certificates were given, 271* additional children completed courses of immunising injections during the year, making in all 500 children immunised during the year. Table 26.—Clinic for Inoculation against Whooping Cough. Position on 31 Dec., 1943 Number of children attending :— (a) Completed course of injections 73 (b) Receiving injections at end of year.. 18 (c) Discontinued injections—left district 1 —ceased attending 13 Total attending clinic during year 105 Children invited but did not attend 11 25 Table 27.—Schools. Number in Borough Number of scholars who suffered from:— Scarlet Fever Diphtheria Public Elementary Schools:— 10 Barnes Central Boys 2 — ,, ,, Girls 1 — Lowther J.M. and Infants 9 — East Sheen J.M. and Infants 17 — Mortlake Central Boys 2 — ,, ,, Girls 1 — Mortlake Council J.M. and Infant 21 — Mortlake C.E. Mixed 18 — ,, ,, Infants 14 — Mortlake R.C. 11 — Secondary Schools:— 1 East Sheen and Richmond County Boys School 3 — Private Schools 5 9 — Total 16 108 — 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, 1943 are as under:— Table 28.—Tuberculosis Notification Register. Form of Disease. On Register 1st an 1943 Cases Added. Removed from Register. Remaining on Register 31st Dec.. 1943 Primary Notifins Otherwise Total. NonTub. Cured Left District Dead. Total. Pulmonary 175 43 11 55* - - 8 21 29 201 Non-Pulm'y 52 7 2 10* — — 2 4 6 56 All Forms 227 50 13 65 — — 10 25 35 257 * Included in each of these totals is one patient whose name was restored to the Register. 26 Table 29.—Tuberculosis : New Cases and Mortality, 1943. Age-Periods. New Cases.* Deaths. Pulmonary. NonPulmonarv. Pulmonary. NonPulmonary. Male Fem'le Male Fem'le Male Fem'le Male Fem'le 0-1 years — — — — — — — — 1-5 „ — 1 — — — — — — 5-10 „ — 3 — — — 1 — — 10-15 „ — — — — — — — — 15-20 „ 6 5 — 1 — 1 2 — 20-25 „ 7 2 1 2 — — — — 25-35 „ 5 6 — 1 1 2 — — 35-45 „ 6 3 — 1 2 1 — 1 45-55 „ 1 1 1 — 5 — — — 55-65 „ 6 1 1 4 1 65 „ and over 1 — 1 1 — — All ages 32 22 2 7 13 5 2 2 * 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 1.28 Non-pulmonary 0.21 All forms 1.49 Death-rate —Pulmonary 0.54 Non-pulmonary 0.12 All forms 0.65 Table 30.—Institutional Treatment. Admissions during 1943 were as under :— Pulmonary Tuberculosis : To Surrey County Council Sanatorium 2 ,, Surrey County Hospitals 19 ,, other sanatoria 14 ,, general hospitals 2 ,, Public Assistance Institutions — Total 37 Non-pulmonary Tuberculosis : To sanatorium 1 „ Surrey County Hospitals 2 „ general hospitals 3 Total 6 Number of patients admitted : Pulmonary 34 Non-pulmonary 6 27 INFECTIOUS DISEASES HOSPITAL. Table 31.—Admissions and Deaths. Residents of Borough. Hon- residents admitted under reciprocal arrangements Noncivilians. TOTALS. Admitted. Died. Admitted. Died. Admitted. Died. Admitted. Died. Diphtheria 2 — 1 — — — 3 — Diphtheria and Scarlet Fever 2 — — — — — 2 — Cartarrhal laryngitis 1 — — — — — 1 — Thrush sent in as Diphtheria 1 — — — — — 1 — Tonsillitis 1 — — — — — 1 — Scarlet Fever 122 1 14 — 1 — 137 1 No appreciable disease — sent in as S.F 1 — — — — — 1 — Measles 4 — 1 8 — Rubella 1 — 1 — 1 — 3 — Urticaria—sent in as Rubella 1 — — — — — 1 — Typhoid Fever 2 — — — — — 2 — Pleural effusion sent in as Typhoid Fever 1 — 1 — Dysentery, Sonne 1 — — — — — 1 — Paratyphoid Fever 1 — — — — — 1 — Whooping Cough 6 — 2 1 — — 8 1 Pneumonia 7 1 — — — — 7 1 Pneumonia and Enteritis 1 — — — — — 1 — Erysipelas 2 — — — 1 — 3 Chickenpox — — 1 — — — 1 — Mumps 2 — — — 2 — 4 — Dysentery—Flexner 1 — — — — — 1 — Enteritis . . f — — — — — 2 — Encephalitis 1 Sent in asCerebro1 spinal Meningitis — 1 1 — — 1 1 Rubella — — — — 1 — 1 — Otitis media 1 — — — — — 1 — Totals 163 2 23 2 7 — 193 4 General. One case of scarlet fever was suffering from severe chorea on admission and another developed mastoiditis necessitating the performance of an onen oneratinn In addition to this latter case a child suffering from scarlet fever and admitted during 1942 developed double mastoiditis during 1943 for which a double mastoid operation had to be performed. Complications. (1) Scarlet Fever. (2) Diphtheria. Albuminuria, 3. Serum reaction, 2. (3) Measles. Broncho-pneumonia, 4. Adenitis, 4. Chiekenpox, 4. Styes, 1. Rheumatism, 1. Stomatitis, 1. Otorrhoea, 6. Conjunctivitis, 1. Perionychia, 3. (4) Whooping Cough. Abscess, 3. Broncho-pneumonia, 3. Impetigo, 2. Bronchitis, 1. Secondary attack, 3 (5) Enteritis. Laryngitis, 2. Broncho-pneumonia, 1. Vaginal discharge, 1. (6) Chickenpox. Mastoiditis, 1. Impetigo, 1. 28 Deaths. (i) Scarlet Fever, toxic—child 7 months old—died morning after admission. (ii) Whooping Cough, complicated by broncho-pneumonia on admission —child 11 months old—died third day after admission. (iii) Encephalitis, admitted as suspected meningitis—child aged 10 years— died ninth day after admission. (iv) Influenzal pneumonia, complicated by chronic rheumatic heart disease on admission—adult male aged 54 years—died second day after admission. Mixed Infections. Two cases of scarlet fever were incubating chickenpox at the date of admission to hospital resulting in one secondary cross infection of chickenpox in the ward to which the patient was admitted. Return Case. There has been one return case of scarlet fever during the year. Table 32.—Laboratory Facilities. Specimens examined during the year were as follows :— Sputa for detection of tubercle bacilli 32 Swabs „ „ ,, diphtheria bacilli 326 Fasces ,, ,, ,, typhoid bacilli 65 Urine ,, ,, 22 Cerebro-spinal fluid 4 Blood (Widal) 18 ,, (Blood-count) 8 „ (for organisms) 1 ,, (Kahn Test) 1 Pleural fluid 1 Total 478 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 618 First visits to newly-born infants 798 Revisits to infants under 1 year 1,184 Visits to children aged 1 to 5 years 2,575 Still-birth inquiries 9 Special visits to cases of measles 150 ,, ,, ,, ,, ,, whooping cough 94 ,, ,, ,, ,, „ pneumonia 7 Visits to foster children 20 Visits in connection with infectious diseases other than those above specified 460 Visits in connection with special Diph. Immunisation Campaign 2,682 Total visits 9,297 29 Table 34.—Notification of Births. (a) Registered in Borough :— Live Births. Still Births. Totals. Number of births registered during 1943 as occurring in the Borough 503 12 515 Number of such births not notified in accordance with the Public Health Act, 1936, Part VII 3 9 12 (b) Notified. Number of births, live and still, notified during the year— by medical practitioners 14 by midwives 485 by other persons — Total notified 499 Number of still-births notified during the year 12 Percentage of still-births to total births occurring in the Borough 2*4 Table 35—Institutional Confinements. In institutions within the Borough .. 226 In registered maternity homes 226 In institutions outside the Borough .. 250 In general hospitals 27 In maternity hospitals 78 In Public Health County hospitals 72 In Public Assistance institutions 42 In maternity homes 31 Total 476 Number of above institutional confinements arranged through the Borough Ante-natal Clinic 120 MATERNITY AND CHILD WELFARE CENTRES. Table 36—Ante-Natal Clinic. Year 1942 Year 1943 Total number of expectant mothers attending Borough ante-natal Clinic during the year 415 369 Number of new cases attending for first time and included in total number 302 308 Number of attendances made by all mothers 842 1,001 Percentage of expectant mothers of total notified births attending Borough Clinic 731 61-7 Table 37—Infant-Welfare Clinics.—Attendances. Year Year 1942. 1943, New Cases :— Infants under 1 year 388 491 Children 1 to 5 years 168 141 Total 556 632 30 Number of Children attending during the year :— Infants under 1 year 558 699 Children 1 to 5 years 525 513 Total 1,083 1,212 Number of atte7idances made by :— Infants under 1 year 5,201 6,866 Children 1 to 5 years 3,633 3,742 Total 8,834 10,608 Mothers 7,916 9,666 Number of consultations with Medical Officer 4,459 4,334 Average attendance per week : Infants under 1 year 1020 133.3 Children 1 to 5 years 71.2 72.7 Total, all children 173.2 206.0 Number of children attending Centre for first time during the year : Percentage of total births represented by this figure 82.0 80.9 Table 38.—Child Life Protection. The following is a summary of the cases on the Register during 1943 :— Foster-mothers on the Register at the beginning of the year 3 ,, ,, added to the Register 4 ,, „ removed from the Register, having ceased to have care of children 3 ,, ,, on the Register at the end of 1943 4 Foster-children on the Register at the beginning of the year 4 „ ,, in respect of whom Notice of Reception was received 5 ,, ,, removed from the Register during the year :— Returned to care of parents 1 5 Transferred to care of adoption societies 2 Admitted to an institution 1 No longer within provisions of Act 1 ,, ,, on the Register at the end of 1943 4 Number of visits of inspection made by Health Visitors during the year 20 31 Table 39.—War Time Day Nurseries. BARNES NURSERY MORTLAKE NURSERY BOTH NURSERIES Date of opening 23rd September, 1942 26th October, 1942 — Age-groups 0-1 1—2 2—5 Total 0-1 1-2 2—5 Total 0—1 1—2 2—5 Total Places available in Nursery 5 15 25 45 5 15 30 50 10 30 55 95 Children admitted during 1942 5 15 33 53 7 11 23 41 12 26 56 94 ,, ceased attending ,, ,, 2 — 7 9 — — 2 2 2 — 9 11 Still in attendance 31 Dec., 1942 2 16* 26 44 5 13* 21 39 7 29* 47 83 Children admitted during 1943 11 15 13 39 7 16 21 44 18 31 34 83 13 31 39 83 12 29 42 83 25 60 81 166 „ ceased attending ,, ,, 9 21 9 39 11 18 12 41 20 39 21 80 Still in attendance 31 Dec., 1943 4 10 30* 44 1 11 30 42 5 21 60* 86 (* Children in one age-group transferred to another.) 1942 1943 1942 1943 1942 1943 Total attendances made by children 2,126 8,609 1,325 8,904 3,451 17,513 Average daily attendance 25 28 23 29 8 57 32 Table 40.—Voluntary Associations. (1) Nursing Associations. Barnes District Nursing Association Mortlake District Nursing Association Totals Home-visits in connection with maternity and child welfare 3 3 „ ,, to cases of—measles 6 6 „ „ „ „ —pneumonia 105 131 236 „ „ ,, „ —influenza 31 18 49 „ „ to other general and surgical cases 7,159 10,538 17,797 7,304 10,787 18,091 (2) Barnes and Mortlake Day Nursery. Accommodation for children under 5 years 26 Number of attendances—Whole-day 5,577 Half-day 214