LIBRARY BOROUGH OF BARNES Annual Report of the Medical Officer of Health For the Year 1944 BOROUGH OF BARNES the Annual Report of the Medical Officer of Health for the year 1944 W. F. Twining McMath, m.d., b.ch., b.A.o.,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. W. L. Leach J 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. Social Welfare Worker (Joint appointment with Borough of Richmond). Miss H. Oliver. Chief Clerk. R. E. Forrest. Assistant Clerks. Vacancy. *G. K. Shilleto. *G. E. Tydeman. Temporary Clerks. Miss L. M. Fairclough. Miss K. P. Morcom. Miss J. Campbell Vacancy. Mrs. M. Gazzard. 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 1944 upon the Health Services 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 1944. 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. During the year the Second Report of the Nurses' Salaries Committee, under the Chairmanship of Lord Rushcliffe, was adopted in respect of the health visitors employed in the borough. There have been several changes in Staff during the year, the names of those members actually remaining on the Staff at 31st December, 1944, are given on page 3. The following alterations occurred during the year:— Mr. W. L. Leach was appointed Additional Sanitary Inspector, and took up duties on the 17th July, 1944, thus filling the vacancy which had occurred when Mr. Street left the service of the Corporation. A new, joint appointment was made during 1944 in collaboration with the Borough of Richmond—that of Social Welfare Worker. This was done in accordance with the terms of Ministry of Health Circular 2,866 as part of the scheme for the care of unmarried mothers and illegitimate children. Miss H. Oliver was appointed to this position and commenced duties on the 8th August, 1944. On the 29th April, Miss M. Sharp, a member of the permanent clerical staff, dealing with maternity and child-welfare matters, left the services of the Corporation. Great difficulty was experienced in obtaining suitable candidates for the position, and this has consequently not been filled. It is with regret I have to report that Miss H. Wheatley, who had been employed in the Public Health Department as a temporary shorthand-typist, since November, 1939, died on the 20th September. Mrs. J. Scullard, a temporary clerk, resigned her appointment towards the end of the year. The vacancy had not been filled by the 31st December. Mrs. M. Gazzard was appointed a part-time shorthand-typist on the 9th October, 1944. 6 SANITARY INSPECTION OF DISTRICT. The remarks contained in the Annual Report for 1943 equally applied throughout 1944. The advent of the flybomb and rocket made considerable call upon the time of the sanitary inspectors in endeavouring to re-house those unfortunate families who suffered the loss of their homes. Undoubtedly the effects upon property from bombs and gunfire will continue to be evidenced over a long period and must inevitably lead to considerable calls upon the services of the sanitary inspectors. WATER SUPPLY. The whole of the area of the borough is supplied by water from the Metropolitan Water Board direct to the houses. During the year the supply was satisfactory in quality and in quantity. In view of the fact that samples of the water supplied are taken regularly by the Metropolitan Water Board it has not been considered necessary for the Public Health Department to do so also. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS DISEASES. Particulars of the incidence and distribution of the cases of infectious disease notified during the year 1944 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. During the year there was an increase in the number of cases of diphtheria notified, 15 being received. There was a noticeable shift in the age-groups towards adolescents and adults, 8 of those notified being over 15 years of age. One death occurred, a child aged 17 months, which resulted in a death-rate for the Borough of 0.03 per 1,000 population. It is pleasing to note that there were no deaths at all from measles or whooping cough during the year, although there were five deaths from diarrhoea under two years of age, an unusually high number for the area. The rate for Barnes for this disease was 8.4 per 1,000 births, compared with 10.1 for London, and only 4.8 per 1,000 for the country as a whole. DIPHTHERIA IMMUNISATION. The routine propaganda to encourage parents to have their children immunised has continued unabated throughout the year. The number of children attending during 1944 was slightly less than in the previous year, but this can be no doubt largely accounted for by the increased aerial activity during the twelve months reviewed. 7 In the case of two children contracting diphtheria injections for immunisation had been given, one at the Borough clinic and the other privately. In neither case had the child attended for a post-schick test. 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. Although the number of children attending for this purpose is not comparable with those attending for immunisation against diphtheria, it is pleasing to record that the number attending during 1944 was more than double that of the previous year. As whooping cough so commonly occurs among the very young children, parents have often not decided to agree to inoculation before the child actually contracts the disease. This stresses the importance of giving protective inoculation against whooping cough at the earliest possible moment, preferably at six months of age. CLEANSING STATION. The Borough Cleansing Station has been well used during the year, the treatments carried out there having increased by about 20% when compared with the figures for 1943. The following is a summary of the steps taken to combat infestation:— (i) All persons infested with vermin coming to the knowledge of the department are treated at the cleansing station—those with verminous heads with lethane oil. (ii) Persons suffering from scabies receive two treatments of benzyl benzoate. The other members of the family are pressed to have one precautionary treatment and to this they almost invariably agree. (iii) While undergoing treatment the patients' clothing is disinfested at the cleansing station. (iv) In severe cases of infestation the bedding is collected and disinfested at the Borough Steam Disinfector. (v) Co-operation of the local doctors, the school medical services, etc., has been obtained and the services available for the cleansing of such cases have been brought to the notice of all concerned. In no case during the year was it found necessary to take statutory action. <3 BOROUGH ACCIDENT AND GENERAL PURPOSES AMBULANCE SERVICE. The manning of the Borough Ambulance continued to be carried out by whole-time women members of the Civil Defence Ambulance Service, with the assistance of two whole-time paid male attendants. I would like to record my appreciation of the excellent way in which this service was carried out by these women members of the Civil Defence services throughout the whole of the period they undertook the work. On the 19th December the manning of the ambulance was transferred to a staff of paid men employed solely for the purpose. During the year the Council decided to purchase a new Austin Accident and General Purposes Ambulance, and this was received on the 20th December, the old Talbot ambulance being retained as a reserve vehicle. Details of the number of journeys made and the types of cases dealt with are given in Table 19. MATERNITY AND CHILD-WELFARE. The birth-rate for 1944 for Barnes remained the same as that of the previous year—18.0 per 1,000 population. Regular ante-natal clinics have been held four times each month, and, where the numbers justified it, two additional clinics a month have been held at each centre on Saturday mornings. As previously mentioned, a Social Welfare Worker was appointed during the year, and commenced duties in August. The post is a joint one with the Borough of Richmond and has fulfilled a need in the borough. Table 35 gives details of the work performed by this officer during the last four months of the year. At the beginning of the year one Home Help was employed. On the 18th May a part-time Home Help was appointed, who later in the year undertook full-time duties. Details of the work of this new service are given in Table 40. During the year Ministry of Health Circular No. 20/44 was received requiring special provisions to be made for the care of premature infants. Notification of any birth of a child whose birth weight is five and a half pounds or less is now specifically required, and provision for this information has been incorporated in the Notification of Birth cards. The provision of suitable equipment for use in the home, and special arrangements for the conveyance and admission to hospital of the mother and child where this is indicated, is being arranged in collaboration with the Surrey County Council. The services of a Home Help are supplied wherever necessary and available. Borough of Barnes. APPENDIX to the annual report of the Medical Officer of health 1 944. 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, 1944. Births:— Birth-rate (per 1,000 of population) 18.0 Live Births :— Total. M. F. Legitimate 543 302 241 Illegitimate 51 24 27 Total 594 326 268 Still Birth-rate (per 1,000 total births) 43.5 Total. M. F. Still Births (Legit. 23; Illegit. 4) ..27 18 9 Deaths:— Death-rate, all causes (per 1,000 of population) 13.9 Total. M. F. Deaths (all causes) 458 233 225 Death-rate from Cancer (per 1,000 of population), 73 deaths 2.2 Death-rate from Zymotic Diseases (per 1,000 of population) 0.18 Deaths from Diphtheria (all ages) 1 ,, ,, Diarrhoea (under two years of age) 5 Death-rate from Maternal Causes (per 1,000 total births) 3.22 Deaths from Puerperal Sepsis Nil ,, ,, Other Puerperal causes 2 Death-rate of infants under one year (per 1,000 live births) 43.8 Legitimate infants (23 deaths) 42.4 Death-rate for Illegjtimate Infants (3 deaths) 58.8 11 Table 2.—Vital Statistics of the Borough of Barnes during 1944 and previous 5 Years Year. 1 Registered Births Total Deaths Registered in the District. Transferable Deaths Nett Deaths belonging to the District. Uncorrected Number. 2 Nett. Of nonresidents registered in the District. 7 Of residents registered outside the District. 8 Under 1 year of afie At all ages. Number. 5 Rate. 6 Number. 9 Rate per 1,000 nett births 10 Number 11 Rate 12 Number. 3 Rate. 4 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 11.0 215 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 62 15 270 20 32.9 465 13.8 1944 415 594 18.0 260 79 18 352 26 43.8 458 13.9 12 Table 3.—Birth-rate, Death-rate, and Analysis of Mortality during the Year 1944, 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 fate pek l 000 BIRTHS. Maternal Mortality Hate per 1,000 Total Births All Causes Enteric Fever. Small-pox Measles. Scarlet Fever. Whooping Cough. Diphtheria. Influenza Diarihœa and Enleritis (under 2 years). Total Deaths under One Year. All Causes Puerperal Infection. Other Causes. England and Wales 17.6 11.6 0.00 0.00 0.01 0.00 0.03 0.02 0 .12 4.8 46 1.93 0.59 1.34 126 County Boroughs and Great Towns, cluding London 20.3 13.7 0.00 - 0.01 0.00 0.03 0.03 0.10 7.3 52 148 Smaller Towns (Estimated Resident Populations 25,000 to 50,000 at Census, 1931) 20.9 12.4 0.00 - 0.01 0.00 0.02 0.03 0.11 4.4 44 Not available London 15.0 15.7 0.00 — 0.00 0.00 0.04 0.01 0.08 10.1 61 Barnes Borough 18.0 13.9 - - - - - 0.03 0.18 8.4 44 3.22 — 3.22 13 Table 4.—Causes of Death during the Year 1944. 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 — — — 4 Whooping Cough — 1 — 5 Diphtheria 1 — 6 Tuberculosis of respiratory system. . 11 6 5 7 Other forms of tuberculosis 3 1 2 8 Syphilitic diseases 1 — 1 9 Influenza 6 3 3 10 Measles — — — 11 Acute poliomyelitis and polioencephalitis — — — 12 Acute infectious encephalitis 3 3 — 13 Cancer of buccal cavity and oesoph. (m) ; uterus (f) 11 6 5 14 „ stomach and duodenum 10 4 6 15 „ breast 6 — 6 16 „ all other sites 46 24 22 17 Diabetes 4 2 2 18 Intra-cranial vascular lesions 33 9 24 19 Heart Disease 116 67 49 20 Other diseases of circulatory system 15 5 10 21 Bronchitis 15 9 6 22 Pneumonia 13 8 5 23 Other respiratory diseases 16 8 8 24 Ulceration of stomach or duodenum 3 3 — 25 Diarrhoea under 2 years 5 4 1 26 Appendicitis 1 — 1 27 Other digestive diseases 9 4 5 28 Nephritis 7 3 4 29 Puerperal and post-abortive sepsis — — — 30 Other maternal causes 2 — 2 31 Premature birth 4 2 2 32 Congenital malformations, birth injury, infintile diseases 12 8 4 33 Suicide 6 4 2 34 Road traffic accidents 2 1 1 35 Other violent causes 49 30 19 36 All other causes 48 18 30 All Causes 458 233 225 14 Table 5.—Infant Mortality during the Year 1944. Causes of death, at various ages, of infants under one year. Cause op 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 5 1 ... 1 7 ... ... ... ... 7 4 3 4 Congenital Malformations 3 1 1 ... 5 ... ... ... ... 5 1 4 5 Atelectasis 1 ... ... ... 1 ... ... ... ... 1 1 ... 1 Diarrhoea and Enteritis . ... ... ... ... ... 1 2 1 ... 4 ... 4 4 Bronchitis ... 1 ... ... 1 ... ... ... ... 1 ... 1 1 Broncho-pneumonia ... ... 1 ... 1 ... ... 1 ... 2 ... 2 2 Injury at Birth ... ... 1 ... 1 ... ... ... ... 1 ... 1 1 Violence 1 ... ... ... 1 ... 2 ... 1 4 4 ... ... All causes 10 3 3 1 17 1 4 2 l 25* 10 15 14 *The number of deaths under one year of age assigned to the Borough is 26. One death has not been traced in the death returns, consequently details of this cannot be included in the table. Infectious Diseases Mortality. The death-rate for 1944 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, 1939 to 1943, are contrasted with the rate for 1944. 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, 1944. Disease. Barnes. London. England and Wales. Small-pox - — 0.00 Enteric Fever — 0.00 0.00 Measles — 0.00 0.01 Scarlet Fever — 0.00 0.00 Whooping Cough — 0.04 0.03 Diphtheria 003 0.01 0.02 Diarrhoea (under 2 years) 015 0.16 0.08 Zymotic Death Rate 0.18 0.21 0.14 Table 7.—Zymotic Death-rate for 1944, contrasted with the Rates for the previous Five Years. Year. Barnes. London. England and Wales. 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 1944 0.18 0.21 0.14 15 Table 8.—Measles: Death-Rate per 1,000 of Population. Year. Barnes. London. England & Wales. 1940 - 0.01 0.02 1941 — 0.02 0.03 1942 0 .06 0.01 0.01 1943 — 0.02 0.02 1944 — 0.00 0.01 Average Rate 1940-1944 0.01 0.01 0.02 Table 9.—Whooping Cough: Death-Rate per 1,000 of the Population. Year. Barnes. London. England & Wales. 1940 - 0.00 0.02 1941 0.03 0.04 0.06 1942 0.03 0.04 0.02 1943 - 0.03 0.03 1944 — 0.04 0.03 Average Rate 1940-1944 0.01 0.03 0.03 HOUSING. Table 10.—HOUSING STATISTICS FOR THE YEAR 1944. 1. Number of Dwellings Owned by the Local Authority:— Number of houses 241) „ „ flats 207 Total 448 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) 1278 (b) Number of inspections made for the purpose 1751 16 (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 Ni (b) Number of re-inspections made under the Regulations Nil (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 541 (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 509 (III) 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, underground rooms). OVERCROWDING. The question of persons living in overcrowded or other unsatisfactory conditions in the borough is one that must receive attention in the near future. Unquestionably many such cases exist, the position having been brought about by war-time conditions. The true position, however, can only be ascertained by a survey of the borough similar to that carried out under the Housing Act, 1935. 17 SANITARY CIRCUMSTANCES OF THE AREA. Table 11.—Showing the Number and Nature of the Inspections made by the sanitary inspectors during 1944, 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 12 1 1 - - Milkshops 13 40 — — — — Butchers' Shops 31 60 — — - — Fishmongers and Poulterers 13 16 - - - - Greengrocers 35 15 1 1 — — Fried Fish Shops 3 3 - - — — Restaurants 39 40 1 1 — — Other food premises 40 102 - - - - Slaughterhouses 1 4 - - — — Bakehouses 11 25 - - - — Factories:— Mechanical 103 112 2 2 - - Non-mechanic'l 38 40 — — — — Air Raid Shelters 113 35 — — — — Home-workers 12 12 — — — — Schools 16 16 1 1 — — Public Halls and Cinemas 5 5 1 1 - - Servants' Registries 4 - - - - - Piggeries and Stable Yards 31 74 3 3 - - Public Conveniences 40 42 - - - - Total 551 Dwelling-houses (including houses let in lodgings) No. of Premises Visited. (1) House - toHouse Inspection (2) Inspected on complaint 603 (3) Inspected in course of other work:— - 3029 541 509 11 11 (a) Housing work, etc 675 (b) For infectious diseases 283 Totals 1399 3682 551 519 11 11 18 Table 12.—Factories. No. of Premises on Register. Inspection. Number Written Notices Served. Factories with mechanical power 103 112 2 Factories without mechanical power 38 40 — Total 141 152 2 Defective conditions:— Sanitary conveniences insufficient Other offences Discovered. Remedied. 3 3 Total 3 3 Matters referred to H.M. Inspector of Factories Nil Notifications received from H.M. Inspector of Factories 1 Legal proceedings:— No legal proceedings were necessary during 1944. Table 13.—Home Workers. Work undertaken. No. on Register. Fancy Needlework 3 Dressmaking 4 Tailoring 3 Boot Repairing 2 Total 12 INSPECTION AND SUPERVISION OF FOOD. Table 14.—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:— (а) Premises within Borough 12 (b) „ outside „ 4 16 19 FOOD AND DRUGS ACT, 1938. A summary of the samples taken under the above Act during the year is given in the following Table. In no instance was it necessary to institute Court proceedings. FOOD AND DRUGS ACT, 1938. Table 15.—Return of Samples Analysed during the Year ending 31st December, 1944. ARTICLES ANALYSED. BELOW STANDARD. Prosecutions Convictions Formal Informal Total Formal Informal Total Milk 36 - 36 1 - 1 - - Other Foods. Barley 1 - 1 - - - - - Coffee - 1 1 - - - - - Ground Ginger 1 2 - - - - - - Ground Nutmeg - 1 1 - - - - - Ground Rice 1 - 1 - - - - - Lard 1 - 1 - - - - - Malt and Chocolate Spread - 1 1 - - - - - Meat Extract - 1 1 - - - - - Mixed Spice - 1 - - - - - - Mustard - 1 1 - - - - - Sausages—Pork 2 - - - - - - - Semolina - 1 1 - - - - - Drugs. Aspirin 3 - 3 - - - - - Boracic Ointment - 1 1 - - - - - Camphorated Oil - 1 1 - - - - - Cinnamon—Essence - 1 1 - - - - - Epsom Salts - 1 1 - - - - - Eucalyptus Oil - 1 1 - - - - - Iodine—Tincture - 1 1 - - - -- - Zinc Ointment 1 1 2 - - - - - Totals 46 16 62 1 - 1 - - Note.—The report of the Public Analyst upon the sample of milk shown to be below standard was such that no legal action was justified. Previous and subsequent samples from the same source were found to be genuine. Table 16.—Slaughterhouses. No. of licensed slaughterhouses Private. Public. Total. 1 - 1 No. of notices received of intention to slaughter during the year 10 - 10 No. of animals slaughtered :— Swine 27 - 27 Cattle - - - Sheep - - - Total 27 - 27 20 Table 17.—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:- Coffee lbs. 7 Beef lbs. 6 ,, . bottles 2 Pork lbs 73 Cordial ,, 5 Mutton lbs. 60 Custard Powder packets 39 Bacon lbs. 70 Eggs—Shell No. 96 Sausages lbs. 406 „ —Dried packets 73 Tinned Meat tins 75 Egg Substitute ,, 57 Tinned Meat and Vegetables tins 4 Flour lbs. 175 Gravy Salt packets 30 Meat Extract jars 19 Honey jar 1 Meat Pies—Pork No. 72 Jam tins 79 „ „ Steak No. 33 ,, jars 34 Rabbits lbs. 90 Lemon Curd jar 1 Poultry lbs. 53 Lemon Squash bottles 2 Fish:- Lemon Essence bottle 1 Macaroni lb. 1 Cod lbs. 42 Margarine lbs. 4 Herrings lbs. 49 Marmalade tins 13 Shellfish bushels 1 jars 3 Canned Fish tins 250 Milk" tins 127 Fruit:- Mustard tins 9 Oranges lbs. 67 Oats lbs. 80 Pickles jars 12 Dried Fruit lbs. 189 Pudding Mixture packets 55 Canned Fruit tins 33 Powdered Gelatine lbs. 6 Vegetables:- Rennet bottles 2 Canned Vegetables tins 86 Rice lbs. 92 Sauce bottles 27 Other Foods:- Sausage Rusk lbs 100 Barley lbs. 12 Soup tins 68 Batter Flour packets 10 ,, packets 6 Biscuits lbs. 14 Spread ,, 52 Bread loaves 3 Spices—Mixed lbs. 3 Bun & Cake Mixture packets 51 Stuffing packets 49 Butter lbs. 47½ Sugar lbs. 233 Cakes lbs. 128 Sweets ,, 13 Cereals packets 9 Tea ,, 20 ½ Cheese lbs. 12 Vinegar bottles 13 Cocoa packets 16 Whisky bottle 1 21 GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. J able 18.—Cleansing and Disinfestation of Verminous Persons. Treated at borough cleansing station. For Verminous Head For Verminous Body For Scabies Totals No. of Per-.ons Attendances No. of Persons Attendances No, of Persons Attendances No. of Persons Attendances Children under school-age 1 1 - - 40 60 41 61 Schoolchildren 35 36 - - 123 196 158 232 Adults 5 7 - - 162 285 167 292 Totals 41 44 - - 325 541 366 585 Table 19.—Borough Accident and General Purposes Ambulance Service. Number of Cases Mileage Borough Amb. C.D. Vehicle Total Borough Amb. C.D. Vehicle Total Accidents 184 - 184 873 - 873 Removals after accident 26 9 35 159 55 214 Maternity 219 5 224 2127 85 2212 Other purposes 544 11 555 4489 173 4662 Totals 973 25 998 7648 313 7961 Table 20—Infected and Infested Rooms and Articles (dealt with by the council). Premises disinfected 109 Rooms disinfected 113 Lots of bedding disinfected 136 ,, „ destroyed 6 ,, ,, disinfested 13 Council houses disinfested by liquid insecticides 1 Other houses disinfested (hydrogen cyanide 1, by liquid insecticides 19) 20 Other premises etc., disinfested (air raid shelters 5, C.D. buildings 5) 10 Table 21.—Rats and Mice Destruction. Number of complaints received 256 Visits to (a) Enclosed premises 567 (b) Open spaces 161 Number of occasions on which (a) Poison bait was laid 316 (b) Gas was used 8 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 22.—Infectious Diseases: Incidence per 1,000 of the Disease. Population in 1944. England and Wales. Barnes. London. Typhoid Fever - 0.01 0.01 Paratyphoid Fever - 0.01 0.01 Cerebro-spinal Fever - 0.06 0.05 Scarlet Fever 1.52 1.57 2.40 Whooping Cough 3.27 2.96 2.49 Diphtheria 0.46 0.31 0.58 Erysipelas 0.30 0.37 0.29 Small-pox - 0.00 0.00 Measles 2.06 2.98 4.16 Pneumonia 0.55 0.93 0.97 Table 23.—Notifiable Infectious Diseases, 1944. Diseases. Ages, in years. Parish Kemoved to Hospital. Total Deaths of Residents.† total Cases Notified. Uncel 1 year l to 2. 2 to 1. 3 to 4. 4 to 5. 5 to 10. 10 to 15. 15 to 20. | 20 to 25. 25 to 35. 35 to 45. 1 45 to 65. 65 and over. Barnes Mortlake. Diphtheria 15- — 2 - 2 - 1 2 2 1 3 2 - - 7 8 15 l Scarlet Fever 50 1 5 7 3 18 8 2 2 2 1 1 - 22 28 47 - Measles 68 - 2 9 9 4 34 2 3 2 1 - 2 - 51 15 7 - Dysentery 1 - - 1 - - - - - - - - - - 1 - - 50 - - 1 - - 1 8 8 11 6 13 2 13 37 46 11 Non-Pul. Tuberculosis 1 - - - - - - - - - 1 - - - 1 - 5 3 Pneumonia 18 - 1 - 1 1 3 1 - - - 3 7 1 5 13 6 13 Erysipelas 10 - 1 - - - - - - - 2 - 4 3 5 5 - - Ophthalmia neonator'm 1 1 - - - - - - - - - - - - - 1 1 - Whooping Cough 108 9 14 12 19 12 40 - - - - 1 1 - 27 81 12 - All Diseases 322 10 21 28 38 20 97 13 15 13 20 13 28 6 133 189 141 28 † 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 24.—Notifiable Infectious Diseases, 1934 to 1944. Year. 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 Diphtheria 29 31 4 3 1 4 5 13 6 3 15 Scarlet Fever 132 77 56 84 52 36 39 21 34 184 50 Typhoid Fever 1 - 3 2 1 - 1 - - 2 - Paratyphoid Fever - 1 - 1 1 1 1 1 - 1 - Puerperal Fever 1 - 2 - * * * * * * * ,, Pyrexia 2 3 1 1 4 3 2 1 4 1 - Erysipelas 11 16 11 12 6 10 4 5 6 5 10 Continued Fever - - - - - - - - - - - Relapsing Fever - - - - - - - - - - - Typhus Fever - - - - - - - - - - - Small-pox - - - - - - - - - - - Cholera - - - - - - - - - - - Plague - - - - - - - - - - - Tuberculosis, P. 42 21 39 28 25 35 32 39 42 43 50 Non-P. 6 8 5 10 8 3 4 4 7 7 1 Cerebro-spinal Fever 1 - - - 2 1 5 4 3 2 - Poliomyelitis - - - 2 1 - - - 1 - - Ophthalmia Neonatorum 1 1 1 1 1 - 2 1 - 1 1 Measles 551 7 517 101 387 8 79 63 712 111 68 Rubella 61 5 29 9 439 22 * * * * * Encephalitis Lethargica - - - - - - - - - - - Polioencephalitis - - - - - - - - - - - Malaria - - - - - - - - - 1 - Dysentery - - - - 1 - - 1 1 2 1 Pneumonia 36 13 21 34 18 14 14 21 16 20 18 Anthrax - - - - - - - - - - - Whooping Cough - Not Notifiable - 5 2 151 73 82 108 * No longer notifiable. Table 25.—Showing the Notifications of Infectious Diseases Received during 1944 arranged in Four-Weekly Periods. Fourweekly period ending Diphtheria. Scarlet Fever. Measles. Pneumonia. Erysipelas. Ophthalmia Neonatorum. Whooping Cough Dysentery. Jan. 29 2 12 - 3 - - 10 - Feb. 26 - 17 3 4 4 1 11 - Mar. 25 1 3 4 - 1 - 6 - April 22 3 3 2 - 1 - 13 - May 20 - 5 - - - - 6 - June 17 1 2 2 3 1 - 6 - July15 - 1 - 3 - - 4 - Aug. 12 1 2 1 - - 7 - Sept .9 4 - 1 - 1 - - 1 Oct. 7 - 1 2 - 2 - - - Nov. 4 1 1 - 2 - - 2 - Dec. 2 2 3 13 2 - - 18 - Dec. 30 — — 40 1 — — 25 — Totals 15 50 68 18 10 1 108 1 24 Table 26.—Diphtheria Immunisation Clinic. Thf Following Table Shows the Position on 31st December, 1944, in Respect of the 722 Children who Attended the Clinic during 1944. Position on 31 Dec., 1944 1. TOTAL NEW CASES dealt with during 1944 459 (A) Continued in Attendance:— 423 (a) Post-Schick Negative (Certificate) 184 (6) Completed injections, awaiting Post-Schick test 196* (c) Receiving injections at end of year 43 (B) Discontinued Attendance:— 36 (a) Completed injections — failed to attend for PostSchick test - (b) Did not complete injections 18 (c) Left district before completion of injections 8 2. CHILDREN attending for Re-Schick Test two years after immunisation:— 263 (a) Re-Schick test negative—immunisation confirmed 219 (b) Re-Schick test positive—further injections given 7 (c) Attended for Re-Schick test—did not attend for reading 7 TOTAL CHILDREN attending Clinic during year 722 Children invited but did not attend 16 Note.—In addition to the 184 children in respect of whom certificates were given, 196* additional children completed courses of immunising injections during the year, making in all 380 children immunised during the year. Table 27.—Clinic for Inoculation against Whooping Cough. Position on 31 Dec., 1944 Number of children attending:— (a) Completed course of injections 168 (b) Receiving injections at end of year 55 (c) Discontinued injections—left district 2 —ceased attending 11 Total attending clinic during year 236 Children invited but did not attend 4 25 Table 28.—Schools. Number in Borough Number of scholars who suffered from:— Scarlet Fever Diphtheria Public Elementary Schools:— 10 Barnes Central Boys - - ,, ,, Girls - 1 Lowther J.M. and Infants 5 1 East Sheen J.M. and Infants 10 - Mortlake Central Boys — - ,, ,, Girls 1 — Mortlake Council J.M. and Infants 2 — Mortlake C.E. Mixed 1 — ,, ,, Infants 1 — Mortlake R.C. 3 - Secondary Schools :— 1 East Sheen and Richmond County Boys' School 1 - Private Schools 5 2 — Total 15 26 2 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, 1944 are as under:— Table 29.—Tuberculosis Notification Register. Form of Disease. On Register 1st Ian., 1944 Cases Added. Removed from Register Remaining, on Register 31st Dec 1044 Primary Notifns Otherwise. Total. NonTub. Cured Left District Dead. Total. Pulmonary 201 50 17 69* - 1 17 16 34 236 Non-Pulm'y 56 1 2 4* - - 3 1 4 56 All Forms 257 51 19 73* - 1 20 17 38 292 * Included in each of these totals are three patients (2 Pul, 1 Non-Pul) whose names were restored to the Register during the year. 26 Table 30.—Tuberculosis : New Cases and Mortality, 1944. 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 „ 1 - - - - - - 1 5-10 „ - 1 - - - - - - 10-15 „ - - - - - - - - 15-20 „ 4 5 - 1 - - - 1 20-25 „ 6 6 - - 1 - 1 - 25-35 „ 8 5 1 1 - - - - 35-45 5 4 - - - 2 - - 45-55 „ 6 5 - - 1 - - - 55-65 „ 4 2 - - 2 2 - - 65 „ and over 4 1 — - 2 1 - - All ages 38 29 1 2 6 5 1 2 * In addition to primary notifications, all other new cases coming to the knowledge of the Medical Officer of Health are included in these figures. Incidence-rate—Pulmonary 152 A|1 forms 1.55 Non-pulmonary 0.03 Death-rate -Pulmonary 0.03 All forms 0.42 Non-pulmonary 0 .09 Table 31.—Institutional Treatment. Admissions during 1944 were zs under:— Pulmonary Tuberculosis: To Surrey County Council Sanatorium 4 ,, Surrey County Hospitals 17 „ other sanatoria 22 ,, general hospitals 13 Total 56 Non-pulmonary Tuberculosis: To sanatorium 2 „ Surrey County Hospitals - „ general hospitals 3 Total 5 Number of patients admitt Pulmonary 46 Non-pulmonary 5 27 INFECTIOUS DISEASES HOSPITAL. Table 32.—Admissions and Deaths. Residents of Borough. Nonresidents admitted under reciprocal arrangements Noncivilians. TOTALS Admit ted. Died. Admit ted. Died. Admit ted. Died. Adml led. Died. Diphtheria 12 1 - - 1 - 13 1 Diphtheria and Vincent's Angina 3 - - - - - 3 - Diphtheria and Scarlet Fever 1 - - - - - 1 - Carrier Nasal Catarrh Tonsillitis Influenza No appreciable disease Sent in as Diphtheria 2 - - - - - - - 1 - - - - - 1 - 5 - - - - - 5 - - - - - 1 - 1 - - - - - 1 - 1 - Scarlet Fever 39 - 3 - 1 - 43 - Scarlet Fever and Whooping Cough 1 - - - - - - - Scarlet Fever and Rubella 5 - - - - - - - Scarlet Fever and Chickenpox 1 - - - - - 1 - Measles Rubella Tonsillitis No appreciable disease Sent in as Scarlet Fever 1 - - - - - 1 - 1 - 2 - - - - - 1 - - - - - 1 - 1 - - - - - - - Measles 2 - 1 - - - 4 - Rubella - - 1 - 1 - 2 - Whooping Cough 9 - 1 - - - 10 - Whooping Cough and Pneumonia Bronchial Catarrh No appreciable disease Broncho- Sent in as Whooping Cough 1 - - - - - 1 - 1 - - - - - 1 - 1 - - - - - 1 - Chikenpox 1 - - - l - 2 - Pneumonia 4 - - - - - 4 - Influenzal Pneumonia 1 - - - - - 1 - Mumps - - - - 1 - 1 - Pneumococcal Meningitis Broncho-Pneumonia Sub-arachnoid Haemorrhage Sent in as Cerbrospinal Fever 1 1 — — — — 1 1 1 — — — — — 1 - - - - - - - - - 1 - - - - - 1 - Constipation Sent in as Dysentery 1 - - - - - 1 - Totals 98 2 8 - 8 - 116 2 General. There was a diminution in the number of scarlet fever cases admitted during the year, but two cases required the services of a surgeon for mastoiditis. During 1944, there was an increase in the number of cases of diphtheria admitted—two suffering from laryngeal diphtheria, one of whom died. There has been a noticeable change in the age-grouping, in that the bigger proportion affected were adults. 28 Deaths. (i) Diphtheria—faucial and laryngeal—aged 17 months—died on the day of admission. (ii) Pneumococcal Meningitis—aged two years—died on the day following admission. Cross Infection. A nurse attached to a scarlet fever ward developed rubella, which resulted in five secondary cases of rubella occurring among the scarlet fever patients. All made uneventful recoveries. Complications. (1) Diphtheria. (3) Whooping Cough. Squint, 7. Broncho-pneumonia, 1. Peripheral neuritis, 1. (4) Influenzal Pneumonia. Myocarditis, 4 Furunculosis, 1. secondary tonsillitis, 1. Serum reaction, 2. (5) Scarlet Fever Otorrhoea, 4. (2) Measles. Mastoiditis, 2. Broncho-pneumonia, 3. Secondary tonsillitis, 1. Table 33.-Laboratory Facilities Specimens examined during the year were as follows:- Sputa for detection of tubercle bacilli 41 Swabs „ ,, „ diphtheria bacilli 364 Fasces for pathogenic organisms 3 Urine „ „ „ 2 Cerebro-spinal fluid 4 Blood (Widal) 1 „ (Blood-count) 4 ,, (for pathogenic organisms) 3 Pleural fluid 1 Total 423 MATERNITY AND CHILD WELFARE. Table 34.—Home-Visiting. A summary of the work performed by the three Health Visitors during the year is given below:— Visits to expectant mothers 473 First visits to newly-born infants 574 Revisits to infants under 1 year 2,825 Visits to children aged 1 to 5 years 3,572 Still-birth inquiries 23 Special visits to cases of measles 85 ,, ,, ,, ,, ,, whooping cough 95 ,, ,, ,, ,, ,, pneumonia 14 Visits to foster children Visits in connection with infectious diseases other 30 than those above specified 368 Total visits 8,057 29 Table 35—Social Welfare Worker. Number of cases visited 46 „ „ visits and re-visits made 441 Number of children— for whom adoption was arranged 1 who were placed with relatives 2 Number of mothers— Admitted to hostels 1 „ „ Church homes 1 for whom work was found 2 for whom housing accommodation was found 3 Table 36.—Notification of Births. (a) Registered in Borough:- Live Births. Still Births. Totals. Number of births registered during 1944 as occurring in the Borough 406 9 415 Number of such births not notified in accordance with the Public Health Act, 1936, Part VII 2 2 4 (b) Notified. Number of births, live and still, notified during the year— by medical practitioners Residents. Outward Transfers, . Total 9 1 10 by midwives 286 125 411 by other persons - - - Total notified 295 126 421 Number of still-births notified during the year Percentage of still-births to total births 9 - 9 occurring in the Borough 3.1 - 2.1 Table 37.—Institutional Confinements. In institutions within the Borough 203 In registered maternity homes 203 In institutions outside the Borough 266 In general hospitals 25 In maternity hospitals 87 In Public Health County hospitals 91 In Public Assistance institutions 45 In maternity homes 18 Total 469 Number of above institutional confinements arranged through the Borough Ante-natal Clinic 126 30 MATERNITY AND CHILD WELFARE CENTRES. Table 38.—Ante-Natal Clinic. Year Year 1943 1944 Total number of expectant mothers attending Borough ante-natal Clinic during the year 369 369 Number of new cases attending for first time and included in total number 308 274 Number of attendances made by all mothers Percentage of expectant mothers of total notified 1,001 1,123 births attending Borough Clinic 61.7 65.3 Table 39.—Infant-Welfare Clinics.—Attendances. Year 1943. Year 1944. New Cases:— - - Infants under 1 year 491 466 Children 1 to 5 years 141 59 Total 632 525 Number of Children attending during the year:— Infants under 1 year 699 708 Children 1 to 5 years 513 482 Total 1,212 1,190 Number of attendances made by:— Infants under 1 year 6,866 5,064 Children 1 to 5 years 3,742 2,599 Total 10,608 7,663 Mothers 9,666 7,109 Number of consultations with Medical Officer 4,334 2,710 Average attendance per week: Infants under 1 year 133.3 99.8 Children 1 to 5 years 72.7 52.1 Total, all children 206.0 151.9 Number of children attending Centre for first time during the year: Percentage of total births assigned to the Borough represented by this figure 80.9 78.5 31 Table 40 —Home Help Service. Number of applications received during 1944 ,, ,, ,, outstanding from 1943 27 28 11 Number of confinements attended ,, other types of Maternity cases attended 131 15 2 Number of other types of cases attended .. .. 8 ,, applications withdrawn .. .. 3 „ confinements booked and yet to be attended .. .. 2 Table 41.—Child Life Protection. The following is a summary of the cases on the Register during 1944:— Foster-mothers on the Register at the beginning of the year 4 ,, ,, added to the Register 2 ,, „ removed from the Register, having ceased to have care of children 2 ,, „ on the Register at the end of 1944 4 Foster-children on the Register at the beginning of the year 4 ,, ,, in respect of whom Notice of Reception was received 3 ,, ,, removed from the Register during the year:— Evacuated with foster-mother 2 ,, ,, on the Register at the end of 1944 5 Number of visits of inspection made by Health Visitors during the year 30 Table 42.—Adoption of Children. Number of Notices of Reception received during 1943 still on Register at 1st January, 1944 1 Number of Notices of Reception received during 1944 Number of children adopted during year 5 1 „ „ removed from Register for other reasons - Number of children still on Register awaiting adoption at 31st December, 1944 5 Table 43.—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 107 - 107 „ „ „ „ —influenza 10 - 10 „ „ to other general and surgical cases 6,587 16,728 13,315 6,704 16,728 l3,432 (2) Barnes and Mortlake Day Nursery. Accommodation for children under 5 years 26 Number of attendances—Whole-day 4,105 Half-day 332 32 Table 44.—War Time Day Nurseries. BARNES NURSERY MORTLAKE NURSERY BOTH NURSERIES 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 in attendance 31st December, 1943 4 10 30 44 1 11 30 42 5 21 60 86 Children admitted during 1944 11 20 25 56 9 20 24 53 20 40 49 109 Total children attending 15 30 55 100 10 31 54 95 25 61 109 195 „ ceased attending 3 26 39 68 7 23 37 67 10 49 76 135 Still in attendance 31 Dec., 1944 5* 11* 16 32 1* 10* 17 28 6* 21* 33 60 (* Children under one year transferred to next age group upon attaining one year of age.) Total attendances made by children 1943 1944 1943 1944 1943 1944 8,609 8,301 8,504 8,564 17,513 16,865 Average daily attendance 28 27 29 28 57 55 R. w. Simpson & Co.. Ltd., Printers, 70, Sheen Road, Richmond, and Barnes High Street.