AL 439 (1) SOUTHAN SOUTS M Middy BOROUGH OF SOUTHALL ANNUAL REPORT OF THE Medical Officer of Health for the Year 1937 E. GRUNDY, M.D., D.P.H., Medical Officer of Health. broad and co., typo., chiswick, w. 4. BOROUGH OF SOUTHALL ANNUAL REPORT OF THE Medical Officer of Health for the Year 1937 E. GRUNDY, M.D., D.P.H., Medical Officer of Health. THE COUNCIL OF THE BOROUGH OF SOUTHALL, 1937 Members of the Public Health Committee (which also functions as a Maternity and Child Welfare Committee) are denoted by an asterisk. HIS WORSHIP THE MAYOR *ALDERMAN E. B. HAMBLIN, J.P. Deputy Mayor : Alderman W. A. Hillier Aldermen; *Amos, Mrs. F. S. (Chairman of the Public Health and Housing Committees). *Neighbour, D. C. *Pargiter, G. A. Councillors: *Brown, S. Luckett, F. H. Creesey, G. *Marks, F. J. Dale, W. *Parker, F. A. W. Dane, A. T. Reason, W. J. *Evans, J. A. *Reed, G. Hill, J. Salmon, W. G. *Hopkins, W. H. *Saxon, J. A. *Hutchings, C. Sturgeon, J. M. Tunbridge, F. J. 2 To the Mayor, Aldermen and Councillors of the Borough of Southall. MR. MAYOR, LADIES AND GENTLEMEN, I have the honour to present the forty-first Annual Report on the health and sanitary circumstances of the district. This is the first year in which the full powers of Borough status have been enjoyed by the Council and now at its close all relevant re-organisation of the health department has taken place. Statistics continue to be kept separately for the six wards and in a few years' time it is hoped that there will be a body of information capable of assisting in the suitable provision of services most required in each area. The differences to be anticipated may not be significant as the social conditions and general hygienic environment in each ward are similar, but an analysis of the pooled statistics when available will afford answers to questions which are at present mere conjecture. The vital statistics show that the Registrar-General's estimate of the mid-year population is now 51,560. This is of importance in so far as the arbitrary level of 50,000 is fixed by several statutes as a minimum population which entitles a Borough to enjoy certain powers. Southall has now passed this standard and derives incidental benefits. The increase of population in one year of over two thousand justifies laudible comment and gives re-assurance as to the ultimate destiny of the district. The birth-rate has fallen slightly to 15.79 per 1,000 of the population, but this figure is still considerably above the general rate for England and Wales which in 1937 was 14.9. The crude death rate of 9.19 and the comparable rate of 10.47 both compare very favourably with figures for this country in general and also with figures for analogous areas. The infantile mortality rate of 58.96 is a considerable fall on the very high figure for 1936 and indeed is equal to the rate for the country generally, but it fails to reach the admirable standard of the last preceding years and efforts will be directed to reduce still further this figure. The Midwives Act, 1936, made it incumbent upon local supervising authorities to provide full-time municipal midwives and the Council under an agency for the Middlesex County Council appointed in December five midwives who commenced duties as whole-time servants of the Corporation. This direct employment of professional women who attend mothers during the most anxious times of their existence, and when they are making a supreme contribution to the community, must strengthen that chain of social service in which Great Britain is leading every country in the world. The death of a woman in child-birth is, with few exceptions, a grave reflection on the maternity provisions of any district, and it is a matter of experience that in those areas where an adequate service of salaried midwives is available the maternal mortality rate is well below the national average. The fees charged to patients 3 for the services of a midwife or maternity nurse are such that no patient need fail to obtain adequate attention, and assistance is granted by the Council to necessitous cases to whom the whole or part of the service is gratuitous. A very important subsidiary provision of the Act is that the local supervising authority can require any midwife who by reason of age or from any other cause is considered incompetent, to surrender her certificate and refrain from the practice of midwifery on payment of compensation to the person concerned. It is hoped that the employment of midwives by local authorities will enhance the status of the profession and attract competent and cultured women to its ranks, with an all-round improvement in the general practice of obstetrics. The activity of the legislature in enacting new statutes to be administered by the health department continued during the year, and several important Acts were added to the statute book. The Factories Act, 1937, consolidates previous legislation and embodies many reforms suggested by past experience or necessitated by the increased physical demands of modern industry. Specific requirements of the new statute include a higher standard of general hygienic surroundings, adequate heating, lighting and ventilation and the protection of the workers from many of the hazards inseparably associated with industrial life. Executive reorganisation as a result of this Act will be apparent in future reports in the section concerned with the inspection and supervision of factories. The Physical Training and Recreation Act, 1937, enables local authorities to provide improved facilities for athletic exercises and games, and so far as these appeal to the younger members of the community will result in an improvement in physical well being. It is however to be hoped that many, past the age when strenuous physical exertion is beneficial, will not goad themselves into harmful activity but will realise that for them recreation can best be attained by muscular relaxation rather than muscular exhaustion. The Air Raid Precautions Act, 1937, requires local authorities to prepare schemes for the protection of the civil population from the risks of aerial bombardment and if this is to be accomplished or attempted throws an enormous burden of work on all concerned. Schemes are in process of preparation and will occupy the attention of the Council during the forthcoming year. Other enactments during the year were concerned with the fumigation of infested premises and the drainage of trade effluents. I wish to take this opportunity of thanking my predecessor, Dr. E. H. R. Smithard, who was Medical Officer of Health for the Borough during the period of this Report, for his valued assistance and advice which have helped materially in its preparation. The Report is in general concord with the requirements of the Ministry of Health. 4 HEALTH DEPARTMENT STAFF for the year 1937 Medical Officer of Health EDWARD H. R. SMITHARD, M.D., B.S.(Lond.), LRC.P.,M.R.C.S.(Eng.), D.P.H.(Lond). (Resigned December, 1937). Ernest Grundy, m.d., B.s.(Lond.)., m.r.c.s., l.r.c.p., d.p.h.(Eng.) (Appointed December, 1937). * Deputy Medical Officer of Health C. W. SECCOMBE, M.r.c.s. (Eng.), L.r.c.p. (Lond.). ‡ Assistant Medical Officers Mrs. A. S. HALL-CRAGGS, M.R.C.S.(Eng.), L.R.C.P.(Lond.)., Mrs. I. I. G. Adams, m.R.C.s.(Eng.), LR.C.P.(Lond.). d.P.H. Miss j. Moore, f.r.c.s. Sanitary Inspection Staff:— Chief Sanitary Inspector Ivor A. Stephenson, cert, r.s.i., Cert. m. & f. Sanitary Inspectors A. D. GOOLD, Cert. R.S.I., Cert. M. & F. K. R. WAGENER, Cert. R.S.I., Cert M. & F. Health Visiting Staff:— Miss E. S. BOYD, S.R.N., S.C.M. (Senior Health Visitor and Child Protection Visitor). Miss E. L. Perrett, s.r.n. Miss B. M. STANBRIDGE, S.R.N., H.V., Cert. R.S.I. Miss G. M. leverett, S.r.n., S.C.M., h.V.,Cert. r.S.i. Miss F. M. MARTLEW, S.R.N., S.C.M., H.V., Cert. R.S.I. (Appointed November, 1937). Midwives Miss V. ROBINSON, S.R.N. (Appointed November, 1937). Miss G. Robinson „ ,, Mrs. Delahaye, s.r.n. ,, „ Miss Sandell. ,, ,, Miss Johnson, s.r.n. „ „ Shops Inspector and Sanitary Inspector J. D. WALKER, Cert. R.S.I., Cert. M. & F. (Resigned January, 1937). A. JOHN, Cert. R.S.I. (Appointed March, 1937). Died May, 1937. A. J. WHITE, Cert. R.S.I. (Appointed September, 1937). Clerical Staff:— Chief Clerk J. W. CRONK, Cert. r.S.I. Clerks, Shorthand- Typists Miss D. Dungate. (Resigned April, 1937). Miss P. Ashton. Miss M. V. SAGE. (Appointed July, 1937). Miss J. D. winterburn. (Appointed June, 1937). K. W. Skeates. ‡Consulting Obstetrician J. W. Rait Bell, Esq., f.r.c.s. Matron of the Isolation Hospital Miss E. James, s.r.n., r.f.n. * Part time. ‡Part lime, maternity and child welfare. 5 STATISTICS AND SOCIAL CONDITIONS OF THE BOROUGH Area (acres) : Land, 2554.5. Water, 50. Total 2,604.5. Population—Registrar General's estimate—mid-1937 *51,560 Number of inhabited houses according to Rate Book 13,381 Rateable value £399,770 Sum produced by a penny rate £1,538 * This includes about 2,800 Patients and Staff resident in St. Bernard's Hospital. The Borough of Southall is traversed by the main road from London to Oxford and is about nine miles from the Marble Arch. It is roughly triangular in shape and is bounded on the east and north by the Borough of Ealing, on the west by the Urban District of Hayes and Harlington, and on the south by the Borough of Heston and Isleworth. The greatest length of the district from north to south is 2.8 miles and the greatest breadth is 3.1 miles. The soil is mainly gravel, overlaid with clay and brick earth. The highest point in the district is at the Water Tower in Allenby Road, and is 143 feet above ordnance datum ; the lowest is at the old Sewage Disposal Works and is 32 feet above ordnance datum. The average rainfall over a period of twenty-one years is 23.4 inches per annum. The nearest Meteorological station is Hangar Hill, and from its records it appears that the driest year in the last twenty-one years was 1921, when there was a rainfall of 14.74 inches, and the wettest year was 1927, when there was a rainfall of 35.95 inches. The rainfall in Southall in 1937 was 29.38 inches (compared with 24.07 inches in 1936). The Council control the following parks and open spaces:— Southall Park 26 acres Recreation Ground 18 acres Manor House Grounds 2 acres Norwood Green 7.25 acres Frogmore Green 35 acre Wolf Green 18 acre Wolf Fields 3.33 acres 6 Southall Municipal Sports Ground 20 acres Jubilee Park 11.13 acres Durdans Park 29.5 acres Viaduct Field 4.22 acres Dairy Meadow 6.21 acres Swimming Bath Site 10.5 acres I am indebted to Mr. J. B. Thomson, the Engineer and Surveyor, for the above information. For general administrative purposes and for the main statistical purposes of this Report the district is divided into six Wards with boundaries roughly as follows :— No. 1. Waxlow Manor Ward.—This ward occupies the northern-most part of the Borough, its southern boundary being Spikes Bridge Playing Fields, Cranleigh Gardens, Denbigh Road, Dormers Avenue, Allendale Avenue, Cornwall Avenue and Allenby Road. No. 2. Northcote Ward.—This ward is bounded on the north by the Waxlow Manor Ward as far as Allendale Avenue, on the east by North Road, on the south by the Uxbridge Road and on the west by the boundary of the Borough. No. 3. Hambrough Ward is bounded on the north by the Northcote Ward, on the east by South Road, on the south by the Great Western Railway line, and on the west by the boundary of the Borough. No. 4. Dormers Wells Ward is bounded on the north by the Waxlow Manor Ward and the boundary of the Borough, on the east by the boundary of the Borough, on the south by the Great Western railway branch line to Brentford, and on the west by the Hambrough and Northcote Wards. No. 5. Glebe Ward is bounded on the north by the Great Western Railway, on the east by King Street and Regina Road, and on the south and west by the boundaries of the Borough. No. 6. Norwood Green Ward is bounded on the north and east by Dormers Wells Ward, on the south by the boundary of the Borough, and on the west by the Glebe Ward. 7 The estimated populations of these wards at the beginning of 1936 were as follows :— Waxlow Manor Ward 6,900 Northcote Ward 7,150 Hambrough Ward 8,050 Dormers Wells Ward 8,950* Glebe Ward 10,250 Norwood Green Ward 7,800 * This included the resident population of St. Bernard's Hospital (late Hanwell Mental Hospital), which amounted to about 2,800. The majority of the houses in the district are occupied by good-class working people, chiefly engaged in the local factories and workshops. These include food, jam and chemical works, engineering, hosiery, paint, dye and wood works, laundries, etc. There are no trades carried on which are at present scheduled as offensive trades. Unemployment. It is impossible to give an exact estimate of the amount of unemployment in the district as for unemployment purposes the district is part of a slightly larger area of Middlesex, and the figures are not kept distinct. The following table, however, from statistics kindly supplied by the Manager of the Southall Labour Exchange, shows the unemployment figures on days during different months for this part of Middlesex :— Table No. 1. 1937. Men. Women. T otal. January 4th 1069 412 1481 February 2nd 1209 586 1795 March 1st 1097 423 1520 April 5th 1097 442 1539 May 3rd 880 473 1353 June 7th 846 461 1307 July 5th 788 417 1205 August 2nd 786 311 1097 September 7th 761 251 1012 October 5th 817 293 1110 November 1st 1056 424 1480 December 6th 1334 627 1961 8 It is probable that Southall accounts for just about seven-eighths of the totals. It will be noticed that the highest total occurred at the beginning of December and the lowest at the beginning of September. The average is slightly higher than it was for 1936 (1384 against 1406). Growth of he District. The following table is appended to show the progressive increase in population of the district since 1883 :— Table No. 2. Year No. of Dwellings Population Authority Averag e Individuals per Dwelling 1883 — 4,164 — — 1891 1,021 5,188 Census 5.08 1901 1,920 13,200 ,, 6.89* 1911 5,058 26,323 ,, 5.21 1921 5.405 30,287 ,, 5.60 1922 5,518 30,287 Registrar-General's Estimate 5.49 1923 5,620 31,360 ,, 5.58 1924 5,758 31,800 ,, 5.52 1925 5,843 32,220 ,, 5.51 1926 6,074 32 870 ,, 5.41 1927 6,493 33,480 ,, 5.16 1928 6,838 35,340 ,, 5.17 1929 7,190 35,370 ,, 4.92 1930 8,101 37,560 ,, 4.64 1931 9,300 38,932 Census 4.19 1932 10,279 41,530 Registrar-General's Estimate 4.04 1933 11,149 44,780 ,, 4.02 1934 11,839 46,680 ,, 3.94 1935 12,360 48,270 ,, 3.90 1936 13,300 49,550 ,, 3.73 1937 13,381 51.560 ,, 3.85 * This relatively high figure may indicate that the number 1920 referred to structurally separate houses and not, as with the others to separate dwellings or tenements. 9 EXTRACTS FROM VITAL STATISTICS Total Male Female Comparative figures for 1936 Live Births—Legitimate 776 393 383 773 Illegitimate 38 16 22 24 Stillbirths—Legitimate 32 21 12 30 Illegitimate 1 1 — Deaths 474 244 230 424 Birth rate per 1,000 of estimated population 15.79 16.09 Stillbirth rate per 1,000 total (live and still) births 38.95 36.27 * Crude death rate per 1,000 of the estimated population 9.19 8.55 ‡ Comparability factor 1.14 1.14 * Comparable death rate 10.47 9.74 Deaths from Puerperal Causes (Headings 29 and 30 of the Registrar-General's Short List) : Deaths. Rate per 1,000 total (live and still) births. No. 29. Puerperal sepsis 2 2.37 2.4 No. 30. Other puerperal causes _ 4.8 Total 2 2.37 7.2 Death rate of infants under one year of age :— All infants per 1,000 live births 58.96 66.49 Legitimate infants per 1,000 legitimate live births 52.83 65.97 Illegitimate infants per 1,000 illegitimate live births 184.2 83.3 Deaths from cancer (all ages) 70 52 Deaths from measles (all ages) _ 1 Deaths from whooping cough (all ages) 3 4 Deaths from diarrhoea, etc. (under 2 years of age) 10 4 * The estimated population includes the patients in the St. Bernard's Hospital whose deaths however are not included in the rate. A more exact rate therefore could be obtained by taking the population exclusive of patients in the St. Bernard's Hospital. The death rate on this basis would be 9.72 and the comparable death rate would be 11.08. J See Note 2 on page 12 of the report for 1934. 10 Causes of Deaths, 1937. Table No. 3. Male Female Total 1937 Total 1936 1. Typhoid fever, etc — — — — 2. Measles — — — 1 3. Scarlet fever — — — 1 4. Whooping cough 3 — 3 4 5. Diphtheria 2 4 6 1 6. Influenza 4 11 15 7 7. Encephalitis lethargica 1 — 1 — 8. Cerebro-spinal fever 1 — 1 1 9. Tuberculosis—respiratory 14 13 27 32 10. Other tuberculosis 5 2 7 3 11. Syphilis — — — 1 12. General paralysis of the insane, etc. 1 — 1 — 13. Cancer 42 28 70 52 14. Diabetes 2 2 4 2 15. Cerebral haemorrhage 8 8 16 11 16. Heart disease 54 54 108 82 17. Aneurysm — 2 2 1 18. Other circulatory diseases 12 26 38 26 19. Bronchitis 7 7 14 28 20. Pneumonia (all forms) 16 9 25 36 21 Other respiratory diseases 3 3 6 10 22. Peptic ulcer 4 — 4 4 23. Diarrhoea, etc. (under 2 years) 5 5 10 4 24. Appendicitis 3 1 4 — 25. Cirrhosis of liver 1 1 2 1 26. Other liver diseases — 2 2 5 27. Other digestive diseases 3 6 9 10 28. Nephritis 8 2 10 3 29. Puerperal sepsis — 2 2 3 30. Other puerperal causes — — — 4 31. Congenital causes, etc. 9 13 22 35 32. Senility 2 5 7 8 33. Suicide 2 2 4 4 34. Other violence 11 6 17 20 35. Other defined causes 21 16 37 24 36. Ill-defined causes — — — — Special Causes (included in No. 35) M. F. Smallpox — —- Poliomyelitis — 1 Polioencephalitis — — Total Deaths 244 230 474 424 11 Deaths and Death Rate—Whole District. Total deaths 474. (Males 244, Females 230). Crude Death Rate : 9.19 per 1,000. The total number of deaths registered of persons belonging to the district and dying within the district at all ages and from all causes was 210 (males 92 and females 118). For statistical purposes it is necessary to add to this figure the deaths of persons ordinarily resident in the district who died in various London Hospitals, the Hillingdon County Hospital, other Middlesex County Hospitals and elsewhere outside the district. These " outside " deaths were 264 in number (males 152 and females 112). The total number of deaths therefore belonging to the district is 474, and the crude death-rate 9.19. The deaths of non-Southall residents in the St. Bernards Hospital (not included in the above figures) numbered 149 (males 59 and females 90). The death rate since 1883 grouped in five-yearly periods is shown in Appendix C. Deaths in the various Wards. The following table shows the distribution of deaths in the various Wards :— Table No. 4. Ward Male Female Total Waxlow Manor 30 18 48 Northcote 39 33 72 Hambrough 42 38 80 Dormers Wells 38 31 69 Glebe 45 52 97 Norwood Green 50 58 108 Total 244 230 474 For the purpose of comparison Table No. 5 is given to show the more detailed birth and death rates and the rates of infantile and maternal mortality in England and Wales during the year 1937, the figures being provisional. 12 Table No. 5. Vital Statistics compared with other Areas. BIRTH-RATES, DEATH-RATES, ANALYSIS OF MORTALITY, MATERNAL DEATHRATES, AND CASE-RATES FOR CERTAIN INFECTIOUS DISEASES IN THE YEAR 1937. (England and Wales, London, 125 Great Towns and 148 Smaller Towns.) (Provisional Figures based on Weekly and Quarterly Returns) England and Wales 125 County Boroughs and Great Towns including London 148 Smaller Towns (Resident Populations 25,000 to 50,000 at 1931 Census) London Administrative County Southall Rates per 1,000 Population Births :— Live 14. 9 14. 9 15.3 13. 3 15.79 Still 0.60 0.67 0.64 0.54 0.64 Deaths :— All Causes 12. 4 12. 5 11. 9 12. 3 9.19 Typhoid & Paratyphoid fevers 0.00 0.01 0.00 0.00 0.00 Smallpox — — — — — Measles 0.02 0.03 0.02 0.01 0.00 Scarlet fever 0.01 0.01 0.01 0.01 0.00 Whooping Cough 0.04 0.04 0.03 0.06 0.05 Diphtheria 0.07 0.08 0.05 0.05 0.11 Influenza 0.45 0.39 0.42 0.38 0.29 Violence 0.54 0.45 0.42 0.51 0.41 Notifications :— Smallpox 0.00 — 0.00 — — Scarlet fever 2.33 2.56 2.42 2.09 2.73 Diphtheria 1.49 1.81 1.38 1.93 2.30 Enteric feve 0.05 0.06 0.04 0.05 0.01 Erysipelas 0.37 0.43 0.34 0.44 0.32 Pneumonia 1.36 1.58 1.20 1.18 1.18 Rates per 1,000 Live Briths Deaths under 1 year of age 58 62 55 60 58 Deaths from Diarrhoea and Enteritis under 2 years of age 5.8 7.9 3.2 12.0 12.2 Maternal Mortality :— Puerperal Sepsis 0.97 Not available 2.4 Others 2.26 Total 3.23 Rate s per 1,000 To tal Births (i.e. Live and S till) Maternal Mortality :— Puerperal Sepsis 0.94 Not available 2.37 Others 2.17 Total 3.11 Notifications— Puerperal fever 13.93 17.59 11.52 4.15 11.8 Puerperal pyrexia 14.34 13 Births and Birth Rate (figures for 1936 are given in brackets). The total number of births notified to the Health Department under the Notification of Births Acts was 860 (762). The total number of registered births in the district (under the Births and Deaths Registration Act—included in the notified births above) was 499 (524). The total number of live births belonging to the district whether occurring within or outside the district was 814 (797). The illegitimate live births were 38 (24). There were 33 stillbirths (30), and these with one exception were legitimate. This gives a live birth rate per 1,000 population of 15.79 (16.69) and a stillbirth rate per 1,000 total (live and still) births of 38.95 (36.27). The birth rate grouped in five-yearly periods since. 1892 is shown in Appendix C. The monthly registration of births classified as to Wards is given in the following table. Table No. 6. Monthly Registration of Births. Waxlow Manor Northcote Hambrough Dormers Wells Glebe Norwood Green Total January 7 1 6 8 12 7 41 February 10 7 4 2 7 2 32 March 10 2 3 4 12 9 40 April 11 2 6 11 9 4 43 May 7 9 4 6 6 5 37 June 9 8 14 4 8 9 52 July 9 11 10 9 11 4 54 August 11 8 6 6 9 6 46 September 10 7 5 5 11 6 44 October 6 6 3 7 9 6 37 November 7 4 5 3 12 9 40 December 6 3 5 5 11 3 33 103 68 71 70 117 70 499* * This figure does not include 348 births which, although belonging to the district, were registered in other districts. Table No. 7. The following table gives an analysis of the places of confinement. Total Confinements (live births and still births)—847. No. born in Hillingdon County Hospital 153 or 18.08% No. born in London voluntary hospitals 121 or 14.29% No. born in nursing homes or other hospitals 143 or 16.87% No. confined in their homes by midwives or doctors 430 or 50.76% 14 Infant Mortality. The total number of deaths under one year of age was 48. The rate per 1,000 births was 58. The corresponding rate for England and Wales was 58, for London 60, and for the 148 smaller towns 55 per 1,000. This shows an infant mortality rate considerably lower than last year when it was 66. The infant mortality rate in five-yearly periods since 1892 is shown in Appendix C. The various deaths from stated causes at ages under one year of age are shown in the subjoined table. Table No. 8. Certified Cause of Death. Under 1 week 1-2 weeks 2-3 weeks 3-4 weeks Total under 4 weeks 1-3 months 3-6 months 6-9 months 9-12 months J Total deaths under i year Bronchitis, Pneumonia, etc. 1 — — — 1 3 3 1 1 9 Peritonitis — — — — — — 1 — — 1 Toxaemia — — 1 — 1 — — 1 1 3 Congenital Malformations 4 — — — 4 — — — 1 5 Convulsions — — — — — — — — 1 1 Cerebral Haemhorrage — 1 — — 1 — _ __ _ 1 Gastro-enteritis, Diarrhoea, etc. _ — — 2 2 7 2 — 1 12 Inanition 3 — — — 3 — — — — 3 Marasmus 1 _ _ _ 1 — 1 _ _ 2 Want of Attention 1 _ _ _ 1 _ _ _ _ 1 Prematurity 5 1 — — 6 — — _ — 6 Pyloric Stenosis — — — — — 1 — — — 1 Suffocation _ — _ _ — _ — 1 _ 1 Icterus Neonatorum 2 — — — 2 — — — — 2 17 2 1 2 22 11 7 3 5 48 Live Births. Infant Deaths. Legitimate 776. Legitimate 41. Illegitimate 38. Illegitimate 7. Maternal Morbidity and Mortality. The Council has an informal agreement with the London County Council for the admission of cases of puerperal pyrexia and puerperal fever to the North Western Hospital, Hampstead. Patients are usually, however, admitted to Queen Charlotte's Hospital (isolation block), Shepherd's Bush. During the year nine cases of puerperal pyrexia and one case of puerperal fever were notified. Four of these were admitted to Queen Charlotte's Hospital and one occurred after confinement at Queen Charlotte's Hospital, while four cases occurred in Hillingdon County Hospital, and one case was nursed at home. There were two maternal deaths during the year in connection with childbirth and both occurred in Hillingdon County Hospital. 15 GENERAL PROVISION OF HEALTH SERVICES IN THE BOROUGH. Nursing in the Home. General Nursing. The local District Nursing Association provides three nurses in the district for the home nursing of cases of ordinary sickness and accidents. During 1937, 457 patients were treated and the total number of visits made by the nurses was 11,091. A certain number of these patients were referred to the Nursing Association from the Maternity and Child Welfare Clinics. The Council makes a monetary grant towards the service generally, and a specific grant per visit to toddlers treated under the Maternity and Child Welfare scheme. Infectious Disease (Measles). The Health Visitors act if need be as nurses in the case of Measles outbreaks. No call was made on their services during the year. Clinics and Treatment Centres. Table No. 9 shows the services provided in the district. A report on the work in the diphtheria prevention clinic is given on page 53. First Aid Dressing Station and Medical Comforts Depot. These Departments of honorary public service, organised by the St. John Ambulance Brigade, were started in 1928. The men of the 55th Division. No. 1 District, are detailed for rotation duty, and a great deal of praiseworthy work continues to be done. The Medical Comforts Depot, in charge of Nursing Sisters (55th Division Nursing) is open daily from 7.30 to 8.30 p.m., for the issue of all nursing requisites for the sick on presentation of a voucher signed by a District Nurse, a Certified Midwife, or a Medical Practitioner. A small charge is made for the loan of articles, and such money is used towards replacements. The Council makes monetary grants towards these services. Laboratory Work. There has been no change in the arrangements for laboratory work since the last report. 16 Table No. 9. Clinics and Treatment Centres. Situation Services Provided Day and Time By whom provided M. and C.W. Ante-Natal Clinics Manor House Medical Supervision Tuesday 2 p.m. Thursday 10 a.m. The Council Branch Centre Medical Supervision Tuesday 10 a.m. M. and C.W. Mothercraft Manor House Teaching of Mothercraft Tuesday 2.30 p.m. The Council Branch Centre Teaching of Mothercraft Wednesday 2 p.m. M. and C.W. Birth Control Clinic Manor House Birth Control Advice, etc. The second and fourth Mondays at 10 a.m. The Council M. and C.W. Dental Clinic Featherstone Road School Dental Inspection and Treatment of expectant and nursing mothers and children under 5 years Friday 2 p.m. and by appointment The Council M. and C.W. General Clinics Manor House Supervision of mothers and children under five years New Cases : Friday 10 a.m. Re-visits : Monday 2 p.m. Wednesday 2 p.m. The Council Branch Centre ditto New cases: : Thursday 10 a.m Re-visits : Monday 2 p.m. Thursday 2 p.m. M. and C.W. Toddlers' (Special) Clinic Manor House Medical Inspection of pre-school children First and third Wednesday 10 a.m. The Council Branch Centre ditto Second and fourth Wednesday 10 a.m. The Council Diphtheria Prevention Manor House Immunisation against diphtheria Thursday 2-3 p.m. The Council School Clinics Featherstone Road School Medical Inspection and Treatment of School Children Daily at 10 a.m. Middlesex Education Authority Venereal Diseases Various London Hospitals Examination and Treatment Daily, 7.30 a.m. to 7.30 p.m. Middlesex County Council Tuberculosis Dispensary Green Man Passage, Ealing, W.13 Dispensary treatment and supervision Monday 1.30 p.m. Tues., Wed. and Fri., 10 a.m. Middlesex County Council 17 The Council affords facilities to all medical men practising in the district for the examination of pathological specimens, and this work is carried out by the Lister Institute of Preventive Medicine. The following table shows the work done during the year 1937 (exclusive of work done for the Isolation Hospital). Table No. 10. Positive. Negative. Swabs for diphtheria 89 1460 Sputa for tubercle 38 121 Other specimens for T.B. 1 2 Wasserman reaction 1 2 Swabs for haemolytic streptococci 7 4 Faeces for enteric - 2 Total Examinations 136 1591 Ambulance Facilities. For Infectious Cases. A Morris motor ambulance, purchased in October, 1929, is in use for conveying infectious patients to hospital and for disinfection work. The mileage for the year was 3,132. For non-infectious and accident cases. Two motor ambulances under the charge of the Chief Officer of the Fire Brigade are provided by the Council for the use of residents, to remove noninfectious and accident cases to hospital and for other ambulance work. One ambulance is a W. & G. du Cros, purchased in January, 1930, and the other is a Commer De Luxe, purchased in July, 1932. Efficient service continues to be rendered. The following figures show the year's working of the motor ambulances for non-infectious and accident cases :— Table No. 11. Ordinary cases removed to hospital 1285 Accidents 152 Maternity Cases 154 Persons taken ill in the street 54 Out of district cases 10 Total 1655 18 Miles travelled in the year 1937 15,770 Cash received £7 Total expenditure £708 Cost per mile (exclusive of depreciation) 10.6 pence Poor Law Medical Relief. The Relieving Officer issued 259 Medical Orders during 1937. Some of these cases also received outdoor relief or institutional treatment. Hospitals. There are three hospitals in the district—the Authority's isolation hospital for fever cases, St. Bernard's Hospital, which is governed by the London County Council, and the Southall-Norwood General Hospital. The Southall-Norwood General Hospital was opened in November, 1935 ; it contains 18 ordinary beds, 5 cots and 2 private wards. The Isolation Hospital report is given on pages 61 to 65. The Council makes grants to the following hospitals in the neighbourhood :— Southall-Norwood General Hospital. King Edward Memorial Hospital, Ealing. No formal arrangements have been made with regard to the admission to the County hospitals of cases sent by the Council. Health Education. Mothercraft sessions were started at the Manor House in March, 1936, and it is hoped to hold them also at the new Branch Centre when this is completed. They are held at the Manor House on Tuesday afternoons from January until Easter; from Easter until the end of July; and from September until Christmas. The sessions start at 2.30 p.m. and are of about an hour to an hour and a-half's duration. They are of course free, but a penny is charged if biscuits and tea are had at the end of the session. The objects of mothercraft are to enable expectant mothers and mothers of infants to learn in a detailed manner the best ways of preparing for and 19 bringing up their children ; to enable them to obtain material at cost price for baby's clothes ; to receive advice and instruction with regard to cutting out, needlework, etc. ; and generally, by collective and individual advice, to help them in any difficulties which may concern them in regard to their babies. One of the Health Visitors who has had special experience in the teaching of mothercraft is in charge of the session, and a medical or other appropriate talk of about ten minutes duration is given during each session on subjects of general interest. Individual advice and instruction is given to mothers attending the health centres, and pamphlets and posters on health services are issued from time to time. 20 MATERNITY AND CHILD WELFARE Health Visiting. The district is divided into five health visitors' areas, in which each officer does all health visiting work, including infectious diseases home-visiting and visiting schools in connection with infectious disease, but excluding child life protection visiting which, as heretofore, is done by the senior health visitor who is also Child Protection Visitor. The work done by the health visitors during the year is as shown below:— Table No. 12. Summary of Health Visiting Work for the Year 1937. Visits to infants— First visits 848 Re-visits 2,202 Visits to children— First visits 85 Re-visits 4,033 Visits to expectant mothers 649 Visits for infectious disease 1,157 Visits to schools 98* Child Life Protection visits 378 Miscellaneous visits 1,101 Removals 316 No access 959 Total 11,826 *At these visits a total of 4,015 children were examined. Child Life Protection. The general arrangements as outlined in the report for 1934 remain unaltered. The Council during the year decided that the register of foster mothers and children should be reviewed annually. This expedites the removal from the register of foster mothers who do not wish to take in further foster children, and so keeps the register in a live condition. 21 Below are the statistical particulars for the year :— Table No. 13. (1) Number of foster parents on register— (a) At the beginning of the year 49 (b) At the end of the year 56 (2) Number of foster parents receiving foster children— (a) At the beginning of the year 32 (b) At the end of the year 34 (3) Number of children on the register— (a) At the beginning of the year 48- (b) At the end of the year 63 (4) Number of children received by foster parents during the year 82 (5) Number of foster children— (a) Reached the age of nine during the year Nil (b) Removed during the year to different foster parents or to children's societies 47 (c) Adopted — (d) Returned to parents 17 (e) Removed at the request of the medical officer of health (f) Died during the year 3 (g) On whom inquests were held 1 (6) Total number of visits made during the year 378 (7) Number of cases in which court proceedings were taken Nil All foster children, as soon as reasonably possible after arrival, are subjected to a medical examination by the medical officer of health, or by the medical officers at the infant welfare centres. Consultant Aid in Difficult Labour. The arrangements outlined in the report for 1934 remain unaltered. During the year the consultant was called in on seven occasions. An economic circumstance scale is in force and includes the payment of fees in these cases. Institutional Provision for Unmarried Mothers, Illegitimate Infants and Homeless Children in the District. None. 22 Birth Control. The arrangement with the North Kensington Women's Welfare Centre by which suitable patients are sent to the centre from this district, was continued during the first nine months of the year. A grant was made by the Council to the centre to cover the cost of the services rendered. During this period the total number of attendances made at the North Kensington Women's Welfare Centre by Southall residents was 133. Of these, 40 were with respect to new patients and 93 were re-attendances. On the 13th September sessions of a new Post-Natal and a Birth Control Clinic were commenced. These are held at the Manor House at 10 a.m. on the second and fourth Monday in the month, and the services of Dr. Jocelyn Moore, a specialist in this particular branch of work, have been secured. Pamphlets are available and are distributed indicating the advantages to be derived from an examination by a competent specialist about six weeks after child-birth and the attendances at the clinic have been satisfactory. Injuries not apparent to the mother may be detected and at this early stage cure is frequently brought about rapidly and without any great inconvenience to the patient. The Birth Control Clinic is available to all married women in whom pregnancy for health reasons is undesirable, and a decision as to what is detrimental to health is left to the discretion of the Medical Officer in charge. The desirability of adequate spacing of births is important in maintaining physical well being and perfect health which enables a woman to enjoy her rightful place in modern society. Attendances at these clinics from the 13th September to the 31st December are included in the sub-joined table. Table No. 14. Post- Natal. Birth Control. First visits 33 31 Re-attendances 13 28 Ante-Natal Clinics. Sessions :— Manor House, Tuesday 2 p.m.-4 p.m., Thursday 10 a.m.-12 noon. Branch Centre, Tuesday 10 a.m.-12 noon. 23 The arrangements detailed in the report for 1934 were unaltered during 1937. The number of patients seen at the ante-natal clinics during the year 1937 was 407, and the total number of attendances was 1,740. 225 cases were completed during the year, and the attendances in respect of these were as follows:— No. of cases. One attendance 56 Two attendances 43 Three attendances 32 Four attendances 37 Five attendances 36 Six or more attendances 146 The following table gives the figures for the last seven years and the proportion of new cases to re-visits. Table No. 15. First visits Re-visits Average number of re-visits per patient Total number of births in the District Percentage of new cases to total births 1931 260 528 2.03 672 38.7 1932 289 604 2.09 776 37.2 1933 264 782 2.96 734 35.9 1934 244 518 2.12 780 31.3 1935 265 867 3.27 835 31.7 1936 300 998 3.33 827 36.3 1937 407 1333 3.27 848 47.9 These figures show an increase in 1937 both in the number of cases and the proportion of cases to births. Of the 1,740 total attendances, 1,005 occurred at the Manor House centre and 735 at the Branch centre. Of the 407 new cases seen during the year, 382 were pregnant women and the remaining 25 were non-pregnant or post-natal cases. Of the 382 pregnant women 115 were either uncompleted cases at the end of the year or had left the district. These therefore are omitted from this report which deals with 350 completed cases, 83 for 1936 and 267 occurring in 1937. Of these cases 319 were normal and 31 showed abnormalities. 24 Table No. 16. Primipara Multipara Delivered at home Admitted to hospital or Nursing Home Primipara Multipara Primipara Multipara Normal cases 128 191 29 114 99 77 Abnormal cases 21 10 3 4 18 6 Of the cases dealt with therefore 149, or 42 per cent., were priniiparae (against 38 per cent. in 1936) and of these 117, or 78 per cent. (against 71 per cent. in 1936) were confined in hospital, while 83 cases or 41 per cent. (against 37 per cent.) of the multiparae were also confined in hospital. The following table gives the chief abnormalities found during the year:— Table No. 17. (a) Abnormalities of the foetus— (i) twins 3 cases (ii) abortions 7 „ (iii) stillbirths 11 „ (iv) other conditions 6 „ (b) Abnormalities of the mother— (i) unsatisfactory measurements 43 (ii) heart disease 1 (iii) ante partum haemorrhage 3 (iv) albuminuria 7 (v) high blood pressure (exceeding 140 systlic or 90 diastolic other than on the first attendance) 50 (vi) other conditions 19 Neo- Natal Mortality (before the seventh day) 2 Maternity and Child Welfare Clinics. In October, 1936, a special session for pre-school medical inspection and treatment was started: at the Manor House on the first and third Wednesdays in the month at 10 a.m. ; at the Branch centre on the second and fourth Wednesdays in the month at the same time. 25 The attendances at the clinics during 1937 are shown in the following table:- Table No. 18. Manor House— Seen by medical officer: Infants 3,196 Children at ordinary clinics 1,150 Children at toddlers' clinics 304 Weighing only: Infants 1,182 Children 593 New cases (included in above): Infants 337 Children 296 Branch Centre— Seen by medical officer: Infants 3,119 Children at ordinary clinics 1,039 Children at toddlers' clinic 291 Weighing only: Infants 1,215 Children 413 New cases (included in above): Infants 261 Children 291 Total attendances 12,502 The total attendances at the clinics during the past six years have been as follows:— 1932 7,105 1935 9,682 1933 7,427 1936 11,329 1934 6,856 1937 12,502 It will be noticed that there was again a rather large increase in the total number of attendances in 1937 compared with the figure for 1936. This increase amounts to 10 per cent. It is encouraging that the services available in this way appear to be appreciated. 26 From Table 19 below, it will also be seen that last year there was a slight increase in the total number of new infants (under 12 months of age) seen at the Infant Welfare clinics and despite the increase in live births, there was again a slight increase in the proportion of new infants attending to the total live births for the district. It is probable that last year not less than two-thirds of all babies born in the district subsequently attended the Infant Welfare clinic. This proportion is quite satisfactory and indicates the trouble the present-day mother will take to get advice with regard to the maintenance of her baby's health. The present centres are quite well situated with regard to accessibility except for small areas at the extreme north end and the extreme south-west end of the district. The former will be helped when the centre in Jubilee Gardens is opened, although this will make an even farther journey for those living on the Wharncliffe estate. The subjoined table shows the proportion of new infant cases attending the clinics to the total live births in the district:— Table No. 19. (1) New Infant Cases (2) Total live births (3) Percentage of (1) to (2)* 1931 337 657 51 1932 408 745 54 1933 350 705 49 1934 395 759 52 1935 563 809 69 1936 558 797 70 1937 1598 814 73 *This percentage is a little in excess of the true percentage of live births subsequently attending the clinics as it includes cases born in and belonging to other districts who have since moved to Southall and attended the clinics here during their first year of life. Pre-school Medical Inspection (Toddlers' Clinics). The toddlers' clinic which was started in October, 1936, and the details of which were given on page 31 of the Annual Report for that year, was continued on Wednesday mornings during 1937. 582 attendances were made, 304 of these being at the Manor House, and 278 at the Branch centre. The results for the year are shown in the statistical tables given below. 27 It will be seen that the numbers of children requiring treatment, and the state of nutrition of all the children examined, did not materially differ between the two sides of the district. Taken as a whole the state of nutrition of Southall children under 5 years of age is satisfactory, but the mere fact that 49 out of 494 children assessed were regarded as being below the normal for nutrition, cannot but be a source of concern to the Council. Closely allied with the general assessment of nutrition are the numbers of defects of such conditions as genu valgum (bent knees) and dental diseases, and from the figures quoted in the table of defects found, it is obvious that a relatively large proportion of pre-school children require treatment for these conditions. The results for the year are shown in the following statistical tables:— Table No. 20. Number of Inspections in stated Groups: Manor House Branch Centre Total 18 months 93 93 186 2 years 75 70 145 3 years 51 39 90 4 years 42 31 73 Total Routine 261 233 494 Other inspections 43 45 88 Total 304 278 582 Table No. 21. Number of Individual Children found at Routine Medical Inspection to require Treatment (excluding Dental Disease): Manor House Branch Centre Total 18 months 19 24 43 2 years 32 31 63 3 years 27 25 52 4 years 20 14 34 Total 98 94 192 28 Table No. 22. Number requiring Dental Treatment : Manor House Branch Centre Total 18 months - - - 2 years 2 2 4 3 years 16 16 32 4 years 24 17 41 Total 42 35 77 Nutrition. Nutrition is assessed for each age group in four grades (A—excellent, B—good, C—slightly subnormal, and D—bad) according to the recommendations of the Board of Education. Table No. 23. Manor House Branch Centre Total a B C D 18 months A 55 53 108 64 14 — B 31 33 C 7 7 D — — 2 years A 37 37 74 63 7 1 B 33 30 C 4 3 D 1 — 3 years A 14 9 23 52 15 — B 28 24 C 9 6 D -- — 4 years A 12 8 20 41 11 1 B 24 17 C 5 6 D 1 - 261 233 Total 225 220 47 2 29 Defects Found. Table 24 shows the individual defects found at medical inspection. It must be remembered that one child may show several defects, and that all defects, however slight, are recorded. Table No. 24. Manor House Branch Centre Total Skin 1. Ringworm - - - 2. Scabies - - - 3. Impetigo 2 — 2 4. Other diseases (non-tubercular) 20 12 32 Total 1-4 20 12 34 Eye 5. Blepharitis 3 4 7 6. Conjunctivitis 4 1 5 7. Keratitis and opacities - - — 8. Other conditions (excl. defective vision and squint) 1 - - Total 5-8 8 5 13 9. Defective vision 2 — 2 10. Squint 6 3 9 Ear 11. Defective hearing - 1 1 12. Otitis media 1 1 2 13. Other ear diseases - - - Nose and Throat 14. Chronic tonsils and/or adenoids 13 11 24 15. Other conditions - 2 2 16. Enlarged cervical glands (non-tubercular) 19 12 31 17. Defective speech - — — Heart and Circulation 18. Organic heart disease - 4 4 19. Functional heart disease 5 1 6 20. Anaemia 8 6 14-" Lungs 21. Bronchitis 4 — 4 22. Other non-tubercular diseases 2 — 2 23. Pulmonary tuberculosis - - - Tuberculosis 24. Glands - - - 25. Bones and joints — — - Nervous system 26. Chorea - — — 27. Other conditions 3 1 4 Deformities 28. Rickets deformities — 3 3 29. Genu valgum 18 months 10 16 26 2 years 21 27 48 3 years 21 18 39 4 years 17 11 28 30. Other forms 3 4 7 31. Other defects and diseases 9 8 17 32. Dental diseases 18 months - — - 2 years 2 2 4 3 years 16 16 32 4 years 24 17 41 30 Treatment. Cases of acute illness, and of chronic illness where indicated, are referred to their own doctors for treatment. For other cases of chronic illness the following arrangements have been made with London and local hospitals:— Defect. Hospital. Tonsils and Adenoids King Edward Hospital, Ealing. Orthopaedic conditions King Edward Hospital, Ealing. Royal National Orthopaedic Hospital. Orthoptic „ Western Ophthalmic Hospital, Marylebone Road. Rheumatic ,, Hospital for Sick Children, Great Ormond St., W.C. Child guidance West End Hospital for Nervous Diseases, Welbeck Street, W. 1. There are disadvantages in this variety of hospitals, but with the geographical position of Southall some disadvantages are unavoidable. Help is given with payment of fares if the family income is below a certain scale. A system of following-up has been instituted whereby the health visitors make enquiries to see if the proper treatment has been carried out and, if not, steps are taken to persuade the parent to obtain the necessary treatment. Voluntary Help at Clinics. The voluntary workers continue to give considerable help in the running of the Infant Welfare clinics. As has been pointed out before, the help given greatly aids the efficient running of the clinics and it also saves considerable expense to the Council, who are deeply appreciative of the work done. Midwives. The number of midwives who during January, 1937, gave notice of their intention to practise in Southall was 18. Of these, 11 were resident in Southall and 7 were resident outside the district. The number of midwives who were added to this list between the 31st January, 1937, and the end of the year was two, all of whom resided in Southall. The total number of midwives practising in Southall during the year was therefore 20, of whom 13 were resident in the district and 7 were resident outside. Towards the end of the year five municipal midwives commenced duties as employees of the Borough Council under an agency for the Middlesex County Council, but it is thought desirable to delay a report on this new service until the next Annual Report, when a more comprehensive and fuller survey of the scheme will be possible. 31 The following table, based on material kindly supplied by Dr. Tate, the County Medical Officer of Health, gives information which deals with notifications relating to Southall, received from midwives resident in Southall during the year:— Table No. 25. Medical Help (a) Mother 51 (b) Child 11 paying out dead body — Liability to be a source of infection 3 Death of child 3 Stillbirths 3 Artificial feeding 7 The reasons for sending 62 notifications for medical help were as follows:— Table No. 26. Ante-natal conditions 4 Inflammation of, or discharge from, infant eyes 3 Ruptured perineum 18 Difficult or prolonged labour 11 Haemorrhage in the mother 3 Feeble or premature baby 4 Miscarriage 3 Other conditions (a) Mother 12 (b) Child 4 Maternity and Nursing Homes. The Middlesex County Council is the local authority under the Acts relating to the registration of maternity and other nursing homes. There are two private nursing homes in the district. The following information, relating to maternity and nursing homes in Southall, has been kindly supplied by the County Medical Officer:— Table No. 27. Total number of registered nursing homes in Southall 2 Total accommodation 19 Number of deletions during the year 1937 1 Number of additional applications re registration during the year 1937 Nil 32 Number so registered 1 Refusals or cancellations of registration Nil Number of applications for exemption of registration Nil Result of such applications — Grants of Milk. Milk is supplied free or at a reduced rate to expectant mothers (from the third month of pregnancy), to nursing mothers, and to children under five years of age, according to a scale which has been adopted by the Council. There were 1,448 applications granted during the year, as follows :— Table No. 28. Cow's milk free Cow's milk at 50% cost Dried milk free Dried milk at 50% cost 1937 1018 274 135 21 1936 087 170 115 23 This shows a large increase on the number in 1936, when a total of 995 applications were granted. Dental Treatment. By arrangement between this Council and the County Education Authority, expectant and nursing mothers and children under five years of age attending the Maternity and Child Welfare Centres are enabled to have dental treatment and advice, including if necessary- the provision of dentures. Below are the details of the year's working of the clinic:— Table No. 29. Expectant and nursing Mothers:— Number sent to the dentist for inspection 120 Number inspected 101 Number for whom treatment was completed 56 Number of completed dentures 39 Number of fillings 20 Number of extractions under local anaesthetic 156 33 Number of extractions under gas 248 Total number of attendances and re-attendances 374 Children under five years of age:— Number sent for inspection 136 Number inspected 134 Number for whom treatment was completed 115 Number of fillings 89 Number of extractions under local anaesthetic 26 Number of extractions under gas 300 Total number of attendances and re-attendances to dentist 229 These figures show a total number of 603 attendances compared with 395 in 1936, and 298 in 1935. Assisted Services. The expansion of the Maternity and Child Welfare services commented on on page 31 of the report for 1935, continued during 1937. Apart from those included in the above tables, the figures of applications for services which were granted were as follows:— Table No. 30. Service Free Part cost 1. Provision of a midwife at confinement: (a) Primiparae 3 4 (b) Multiparae 22 16 2. Provision of home help at confinement 25 19 3. Provision of sterilised accouchement sets 8 7* 4. Provision of consultant for cases of difficult labour 7 — 5. Provision of consultant for Puerperal cases - — * In addition, about 31 sets were supplied at "full cost." 34 SANITARY CIRCUMSTANCES OF THE BOROUGH Water Supply. Water is supplied to nearly the whole of the district by the South West Suburban Water Company. The Metropolitan Water Board supplies a small area in the southern part of the district, and the Rickmansworth and Uxbridge Valley Water Company a small area in the northern part. The supply is satisfactory both in quality and in quantity. Samples are taken from time to time from the mains of the companies supplying the district. During the year four such samples were taken with the results indicated in Nos. 1, 2, 3 and 4 in the following table. In addition two samples were taken of wells used for drinking, and the results are put against Nos. 5 and 6 in the table. Table No. 31. Date Gelatin 20 degrees for 3 days Agar 37 degrees for 2 days B. Coli Streptococci B. Welchii Remarks l 18/0/37 256 21 0 in 100 c.c. 0 in 30 c.c. 0 in 100 c.c. Satisfactory 2 6/7/37 10 4 0 in 100 c.c. 0 in 30 c.c. 0 in 100 c.c. Satisfactory 3 16/7/37 24 23 + in 100 c.c. 0 in 30 c.c. 0 in 100 c.c. Satisfactory 4 14/12/37 178 25 + in 100 c.c. 0 in 30 c.c. -|- in 100 c.c. Satisfactory 5 4/6/37 394 37 0 in 100 c.c. 0 in 30 c.c. + in 100 c.c. Fairly Satisfactory 6 25/11/37 14 3 0 in 100 c.c. 0 in 30 c.c. 0 in 100 c.c. Satisfactory Rivers and Streams. One complaint was forwarded to the Middlesex County Council in connection with the contamination of the Yeading Brook. This was polluted by effluent discharged from a Rubber Factory outside the boundary. Drainage and Sewerage. The Middlesex County Council's main drainage scheme now takes the whole of the sewerage matter from the Borough of Southall and treatment is carried on at Mogden Sewerage Works. Excepting in portions of the district not fully developed, the whole of the houses are supplied with water closets and are drained to the sewerage system. 35 Public Cleansing. The whole of the district is scavenged directly by the Council. House refuse is collected in low-loading covered mechanically-drawn vehicles and is transported to an incinerator which deals adequately with the work. There is a weekly collection of household refuse and during the year a total of 8,712 tons was removed from the houses in the district. The practice of recovering waste paper continues and this is collected by the Council, baled and sold. There are 11 cesspools in the district, six of which serve private houses and five of which serve trade premises. No cesspools are emptied or cleansed by the local authority, the few which remain in the district being supervised by their owners. Closet Accommodation. Thirty-one closets, from houses not on the water carriage system, still require to be emptied each week. Thirty of these are emptied by the Surveyor's Department. In addition there are seven trade premises not on the water carriage system, two of which have chemical closets and five dry earth closets which are attended to by the owners. The number of non water-closet systems remaining at the end of the year was a follows: 36 earth closets, no privies, no pail closets, and two chemical closets. Sanitary Inspection of the District. The total number of inspections of premises made in connection with the work of the Health Department during the year was 14,310. The following table shows an analysis of the number and nature of such inspections:— Table No. 32. Visits and re-visits to premises on complaints 1,585 House-to-house inspections 1,201 Inspections and re-inspections of houses, premises etc. 6,429 Visits in connection with the Overcrowding Survey 1,216 Drain tests 53 Factories, workshops, workplaces and outworkers 247 Visits to canal for canal boat inspections 20 36 Petroleum and carbide stores 39 Slaughterhouses 11 Food sampling 166 Dairies and milk shops 94 Bakehouses 71 Other premises where food is prepared 1,213 Smoke observations 30 Tents, vans, sheds, etc. 35 Deposits and accumulations of refuse 169 Stables 12 Farms 13 Schools 8 Cinemas, cafes, public houses, etc. 27 Miscellaneous 1,338 Rent books 333 14,310 The following table shows the number and nature of complaints received during the year:— Table No. 33. Nuisances caused by the keeping of animals 13 Accumulations of refuse, etc. 50 Other complaints in relation to house refuse 39 Offensive smells 36 Vermin 85 Choked drains 184 Dampness 88 Defective roofs, gutters, etc. 40 Defective sanitary fittings 67 Dirty condition of houses 8 Miscellaneous 78 Other defective conditions of houses 144 832 Court Proceedings. Legal proceedings were instituted under the Public Health Act for the sale of unsound veal, ham and egg pie. The case was heard at the Ealing Court and the defendant was fined two guineas and two guineas costs. 37 Verminous Persons and their Belongings. The department has under consideration the possibility of using naphtha in routine disinfestation work. Experiments are still being carried out and carefully watched with a view of determining the relative value of this process of disinfestation. It is hoped that in the near future that naphtha disinfestation will be given a trial and from reports that have already been received it will be safer and more economical to do the disinfestation by heavy naphtha than the method already adopted by this authority which is disinfestation by HCN gas. Eradication of Bed Bugs. Statistics for the year:— (a) Number of Council houses (1) found to be infested 15 (2) disinfested during the year 15 (b) Number of other houses (1) found to be infested 18 (2) disinfested during the year ... 18 Methods employed for Disinfestation. For houses it is considered that fumigation by hydrocyanic acid gas is the only really effective method of dealing with the serious degrees of infestation. With slighter degrees of infestation general cleanliness only may be sufficient, but in any case which comes to the knowledge of the department some form of spray with insecticide is used. HCN gas for use in the ordinary concentration of 1½- to 2 per cent. for six hours will penetrate the egg capsule and kill the germ inside. HCN gas is extremely poisonous to all animals including man, so great care has to be exercised in the management of this gas. When HCN gas is used in a house all the furniture excepting bedding is allowed to remain inside the house. The bedding is removed to the Isolation Hospital and disinfested by steam. This is in order to avoid any localised accumulation of gas in the bedding. Disinfestation by Insecticide. Disinfestation by spray is carried out by the Health Department at a charge of 5/- per room. The owner or occupier is required to loosen the picture rails, skirting and architraves and after the room has been thoroughly sprayed with this insecticide they are inserted at the expiration of 24 hours. 38 Smoke Abatement. Thirty smoke observations were made on chimneys during the year and in a few cases the cause of the nuisance was improper stoking, and advice given to the stokers was effective in causing an abatement. In one or two cases the fue was found to be the cause of the emission of dense black smoke. In another case attention was drawn to a chimney outside the Borough emitting black smoke so as to be a nuisance. This matter was taken up by the authority and the nuisance abated. Noise Nuisance. Section 56 of the Middlesex County Council Act, 1930, provides that a noise nuisance shall be liable to be dealt with in accordance with the provisions relating to nuisances in the Public Health Act, 1875, with the proviso that if the noise is occasioned in the course of any trade, business, or occupation it shall be a good defence to say that the best practical means of preventing or mitigating it having regard to the cost have been adopted. During the year three cases of noise nuisance have been dealt with and action taken in all three. Schools. There are seven Elementary Schools in the district maintained by the County Council and there are two Church Schools supervised by the County Council. In addition there are six private schools. Secondary education is provided for by the County Secondary School and by the Southall Technical College. All the Schools were inspected at least twice during the year and were found to be in a satisfactory sanitary condition and to have a satisfactory water supply. When infectious disease is reported from a school, the school is visited by the Health Visitor and if necessary the children are inspected and other measures, such as swabbing, exclusion from school, are taken for preventing the spread of the infection. The total number of children examined in the schools was 4,015. Canal Boats. During the year 20 visits were paid to the canal and 25 boats were inspected. The general condition of the boats and their occupants was satisfactory. Four infringements of the regulations were found and these have 39 been remedied. There were no complaint notes issued by other authorities and no cases of infectious disease were notified upon any of the boats. It has therefore not been necessary to detain any vessel for the purpose of cleansing and disinfection. Swimming Bath. The swimming bath is normally open between the 30th April and the 30th September. The water is kept clean by a system of continuous filtration, sedimentation and chlorination and subsequent aeration. The amount of chlorine added varies with the number of persons using the bath, and an attempt is made to keep the water with a content a little over 0.2 part per million of free chlorine near the outflow. At the inflow, of course, the free chlorine content has to be a little higher. During the season four samples of the water were taken with the results shown in the table. Table No. 34. Date Gelatin 20 degrees for 3 days Agar 37 degrees for 2 days B. Coli Streptococci B. Welchii No. of bathers in previous 60 hours Remarks l 8/6/37 77 40 0 in 100 c.c. + in 30 c.c. — 1757 Satisfactory 2 13/7/37 22 5 0 in 100 c.c. 0 in 30 c.c. — 558 Satisfactory 3 17/8/37 130 62 +in l00c.c. + in 10 c.c. — 600 Satisfactory 4 14/9/37 8660 2840 + in 25 c.c. + in 10 c.c. — 92* Not Satisfactory *Previous 50 hours only. Samples are taken regularly throughout the season, and to make them more comparable they are taken at approximately the same time on the same day of the week (a Tuesday). The bacteriological count varies not only with the amount of chlorine added but with the total number of bathers for the past few days. These are shown in the above table. The free chlorine is increased during peak periods, but if it gets beyond the usual maximum, complaints are made with regard to the chemical effects produced on the eyes, nose, ears, etc., of bathers. The unsatisfactory count found in the September sample was due to the fact that the ehlorination plant was out of commission for a few days, but arrangements have been made to avoid difficulty in future. There are no privately owned swimming baths or pools used by the public. 40 Mortuary and Post-mortem Room. The Mortuary is situated in the Cemetery Ground, Havelock Road. It is antiquated and out of date. During the year 22 bodies were deposited in the Mortuary. Premises and Workshops which can be controlled by Byelaws. Tents, Vans, Sheds and similar Structures. There are two "permanent" caravans or similar structures in the district, and one of these at the end of the year was engaging the attention of the Council. Offensive Trades. There are none at present scheduled in the district. Underground Dwellings. There are no underground dwellings within the meaning of Section 12 of the Housing Act, 1936. Common Lodging Houses. There are no common lodging houses in the district. Factories and Workshops. The following table shows the number of inspections and the results thereof made during the year:— Table No. 35. Premises No. of Inspections Written Notices Occupiers Prosecuted Factories, workshops and workplaces 348 10 - The following table shows the number and nature of the defects found in connection with factories and workshops during the year:— 41 Table No. 36. Particulars No. of Defects No. of offences in respect of which proceedings were instituted Found Remedied Referred to H.M. Inspector Nuisances under the Public Health Acts—* Want of cleanliness 10 10 — — Want of ventilation 2 2 — — Overcrowding — — — — Want of drainage to floors 1 1 — — Other nuisances 8 8 — — Sanitary Accommodation— Insufficient 2 2 — — Unsuitable or defective 4 4 — — Not separate for sexes 1 1 — — Offences under the Factory and Workshops Acts— Illegal occupation of underground bakehouses - - - - Other offences — - — — 28 28 — — *Including those specified in Sections 2, 3, 7 and 8 of the Factory and Workshops Act, 1901, as remediable under the Public Health Acts. Petroleum and Carbide. During the year 50 applications were received for the renewal of petrol licences for similar quantities as hitherto; six applications were received for licences to store an increased quantity. In each instance the application was granted. Six new applications were received to store petrol, and six were granted. One application was received for the renewal of licence to store carbide of calcium, and this was granted. All the licensed premises have been regularly inspected and no infringements of the terms of the licences were recorded. The number of licences in force at the end of 1937 within the Borough was 62 for petroleum and 1 for carbide. The quantity of petrol covered by the petrol licences was 341,720 gallons and the quantity of carbide covered by the licence was 6 cwt. Celluloid and Cinematograph Films Act, 1922. There are only two licences issued by the Council in force. These are for the purpose of stripping and making celluloid solution from cinematograph films. The premises were periodically inspected during the year. 42 ADMINISTRATION OF THE SHOPS ACTS The general arrangements for the administration of the Shops Acts were set out on page 43 of the Report for 1935. There are about 700 shops in Southall, and legislation in recent years has been both progressive and rapid. There is therefore still a considerable amount of routine work which requires to be done in the district to bring the local standard up to the advantages allowed by the Acts. Unfortunately there was a gap in the office of Shops Inspector from January to September, except for a period from April 15th to May 23rd. On the former date a newly appointed Inspector commenced duty and on the 23rd May he met with a fatal accident. A successor was appointed and commenced duty on September 13th, 1937. The Shops (Sunday Trading) Restrictions Act, 1936, came into force on 1st May, 1937, and inspection has been intensified to ensure that the provisions of this Act are not violated. The requirements of the district are such that the Council has not deemed it necessary to make any orders enabling shops to open for the sale of articles named in Schedule II or III and such establishments therefore are unable legally to open at any time on a Sunday. No person of Jewish religion has made application to have premises registered under Section 7 of the Act. The provisions in the Act requiring compensatory holiday for Sunday work improve the labour conditions in this sphere of employment but demand frequent and constant re-inspections if employees are to enjoy their statutory rights. The statistics for the year are shown in the following table:— Table No.37 Number of shops inspected 1,213 Number of infringements re exhibition of notices 237 Number of infringements re hours of employment — Number of infringements under Section 10 of the 1934 Act 15 Number of infringements of the Shops (Hours of Closing) Act, 1928 4 Number of applications for exemption certificates under Section 10 of the Shops Act, 1934 1 Number of cases in which such certificate was granted Number of police court proceedings 1 Number of infringements of Sec. 10 of the Act of 1912 3 Number of infringements of Sec. 4 of the Act of 1912 3 Number of infringements of Sec. 3 of the Act of 1912 1 43 HOUSING Statistics. 1. Inspection of Dwelling-houses during the year— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 2,786 (b) Number of inspections made for the purpose 9,216 (2) (a) Number of dwelling-houses (included under sub-head (1) above (which were inspected and recorded under the Housing Consolidated Regulations, 1925 1,201 (b) Number of inspections made for the purpose 6,429 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 17 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 752 2. 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 615 3. Action under Statutory Powers during the year— (a) Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936: (1) Number of dwelling-houses in respect of which notices were served requiring repairs 35 (2) Number of dwelling-houses which were rendered fit after service of formal notices : (a) By owners 21 (b) By local authority in default of owners 0 (b) Proceedings under Public Health Acts: (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 22 (2) Number of dwelling-houses in which defects were remedied after service of formal notices: (a) By owners 22 (b) By local authority in default of owners 0 44 (c) Proceedings under Sections 11 and 13 of the Housing Act, 1936 : (1) Number of dwelling-houses in respect of which Demolition Orders were made 17 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 4 (d) Proceedings under Section 12 of the Housing Act, 1936 : (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made 0 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit 0 4. Housing Act, 1936—Overcrowding— (a) (1) Number of dwellings overcrowded at the end of the year 106 (2) Number of families dwelling therein 106 (3) Number of persons dwelling therein 768 (b) Number of new cases of overcrowding reported during the year 7 (c) (1) Number of cases of overcrowding relieved during the year 109 (2) Number of persons concerned in such cases 758 (d) Particulars of any case in which dwelling-houses have again become overcrowded after the local authotiry have taken steps for the abatement of overcrowding 0 Since the appointed day, 1st January, 1937, seven cases of overcrowding were found by the Department. These seven cases have now been relieved after notices served by the local authority. During the year plans for the erection of 222 houses at the Dane Road Housing Site were drawn up and building operations begun. In several cases these houses have relieved cases of overcrowding which will be continued in 1938. (e) Any other particulars with respect to overcrowding conditions upon which the Medical Officer of Health may consider it desirable to report: In addition to the 222 houses in course of erection on the Dane Road Housing Site the Council have prepared plans for the erection of 122 houses to relieve overcrowded houses on the Mount Pleasant, Dormers Wells Site. It is anticipated that building operations will take place during 1938. 45 INSPECTION AND SUPERVISION OF FOOD Milk. There is one cowkeeper on the register as a producer of accredited milk. During the year one purveyor of milk was added to the register. At the end of the year there were 41 purveyors of milk on the register. This number includes 15 who were registered with respect to premises occupied for other purposes for them to retail milk in sealed receptacles only. Under the Milk (Special Designations) Order, 1936, 35 licences were granted during the year, 14 for the sale of Tuberculin Tested Milk and the sale of accredited milk, 18 for the sale of Pasteurised Milk, and 2 for Pasteurisation. Control. Samples of milk, designated and undesignated, are examined for bacterial count. These examinations are performed at the National Institutefor Research in Dairying, at Reading. Immediately after the samples are taken they are sent by train to the Institute and they are nearly always examined between four and six hours after being taken. It is difficult to compare any two samples unless they are taken and examined under exactly the same conditions, and normally the general bacterial count is much higher in the summer than in the winter, and is much higher the longer the time that has elapsed since milking. A large count of general bacteria, together with the presence of b. colt in 0.1 c.c. or smaller numbers of bacteria together with b. coli in 0.01 c.c., is usually taken as an indication that the milk is unsatisfactory. In these cases the attention of the vendors is drawn to the fact, and advice is given to them in order to help them exercise more care in the handling of the milk and utensils. On the whole a bacterial count is a very good indication of general cleanliness, especially if the same laboratory is used and regular samples are taken. During the year 132 samples were taken in this way and it was considered that of these samples 18 were unsatisfactory. A rather more stringent method of bacteriological examination is made than has been standardised by the Ministry of Health, and therefore inquiries and advice are given to the retailers rather than that proceedings should be taken against them in Court. In case of grossly unsatisfactory results, however, this latter alternative would be used. A new test for the efficiency of the pasteurising process has recently been evolved. This is called the phosphatase test and depends on the principle that 46 milk when heated loses some of the enzyme it normally contains and which acts as a reducing agent. The originators of the test claim that it can show— (a) whether milk has been heated to 1½ degrees F. below the minimum temperature for pasteurisation, or (b) whether it has been heated (at 145 degrees F.) for 20 minutes or less, instead of the required 30 minutes, or (c) whether raw milk (down to 0.25 per cent.) has been mixed with properly pasteurised milk. If, on the other hand, milk has been heated over 145 degrees F. or for a longer period, this is not necessarily shown in the result of the test except that the test remains negative as with properly pasteurised milk. This, however, is of no importance from the health point of view as the greater the heating or the longer the period for which the milk is heated the safer the milk becomes bacteriologically. During the year 24 samples were tested in this way at the National Institute for Research in Dairying. The 24 samples consisted of 21 samples of officially pasteurised milk and 3 samples of milk which were not being sold as officially pasteurised. All were negative except the three which were not pasteurised. Milk Vessels. Considerable attention continues to be given to improving the methods of cleansing and sterilising milk bottles and utensils. Under Article 21 of the Milk and Dairies Order the use of steam or boiling water for scalding all milk vessels is required. The cleansing of bottles in which milk is delivered is a matter which often receives insufficient attention. Milk bottles are included under Article 21 of the Order and therefore should be cleansed by means of steam or boiling water in the same way. Exposure of milk bottles and utensils to steam is necessary for the protection of the public. It is also an advantage commercially as when the bottles and milk receptacles are sterilised the milk keeps better and the dairyman gains thereby. A problem to which attention has been called before but, because of its importance, is again repeated here is one which affects both the milk retailers and the general public, and is that of the disposition of empty milk bottles. These, if they are not handed to the milk purveyor at his next call, should be placed in a position where they cannot easily be contaminated. The door-step is not ideal for this purpose, but is very much better than the method commonly adopted of leaving the bottle on the pavement. This latter method gives rise 47 both to a great deal of bother from bottles which become broken through being knocked over while on the pavement, and it also allows the bottle to become much more easily contaminated than it would be otherwise. When it is realised that the usual methods of sterlising bottles are gauged so as to sterilise bottles which are only contaminated in a minor degree, it will be realised that if a bottle is heavily contaminated the attempt at sterilisation may be ineffective. Meat and Other Foods. It is constantly borne in mind that unsound food may be exhibited for sale, consequently regular visits are made to inspect the carcases of recently slaughtered animals and watch is kept on premises where meat, fish and other foods are sold or prepared for sale. Most of the meat supplied to the district comes from the London Smithfield Market. During the year a total number of 1,213 visits were paid to places where food is prepared. During 1937 there was one registered slaughterhouse in the district. There is no public abattoir. During the year 44 animals were slaughtered in the slaughterhouse and all the meat was inspected as shown in the following table. Table No. 38. No. of animals killed No. of carcases inspected Condemnations Parts of carcases or organs condemned for tuberculosis for other diseases Cattle (other than Cows) 0 0 0 0 Calves 4 4 0 0 Pigs 40 40 0 0 Sheep and Lambs 0 0 0 0 Total 44 44 0 0 In connection with the inspection of meat and other foods the following were found to be diseased or unsound and were voluntarily surrendered for destruction :— Pork 355½ lbs. Lunch Tongue 35 lbs. 12 ozs. Tinned Ham 14 lbs. Rabbits 86 lbs. Roe 17 lbs. 48 Slaughter of Animals Act, 1933. Under Section 3 of the Act, four licences each of three years' duration were issued to slaughtermen during 1937. No contraventions of the Act were noted during the year. Adulteration. The Food and Drugs (Adulteration) Act is administered by the County Council, and the following figures, which were kindly supplied by the Chief Officer of the Public Control Department of the County Council, show the number of samples taken during the year by the Council's officers in Southall, and the result of the analyses :— Table No. 39. Article. No. of Samples. Adulterated. Milk 88 Camphorated Oil 2 — Gin 1 — Gooseberries 1 — Meat 2 — Jam 1 — Peas 1 — Sheep's Diver* 14 6 * No. of Prosecutions ... 5. No. of Convictions ... 5. In addition, under Section 16 of the above Act, the following samples were taken by officers of the Health Department:— Table No. 40. Sausages 17 Bloater Paste 1 Mint Paste 1 Paste 1 Peas 3 Sauce 2 Pickles 1 Tinned Peas 2 Salad Cream 1 Chemical and Bacteriological Examination of Food. The chemical or bacteriological analyses of samples taken by the Health Department are carried out either by the Clinical Research Association or by the Public Analyst. 49 PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. The Southall Isolation Hospital continued during the year, and along with reciprocal arrangements with the Ealing, Brentford and Chiswick Hospital, it was possible to deal with all the cases of infectious disease notified. Little progress was made in the negotiations for the formation of a joint management of the hospitals in this area of the County. The difficulty referred to in the last Report in the proper isolation of suspicious cases continues because of the lack of cubicle accommodation. It will, therefore, be an advantage when the question of the isolation accommodation in this area generally is finally settled. Provision of Antitoxin. The Council provides antitoxin free to local medical practitioners for cases of diphtheria in the district. During 1937 48,000 units were supplied in this way. The Ministry of Health has also sanctioned the supply of tetanus antitoxin by the Council to local practitioners if such is required. In 1937 38,000 units were supplied. Diphtheria and tetanus antitoxin can always be obtained at the Health Department during office hours or at the Isolation Hospital at other times. Vaccination. The total number of successful vaccination certificates received during the year was 287. The following table gives details of the percentage of children successfully vaccinated during the last seven years:— Table No. 41. Year Live Births Vaccination Certificates Exemptions Percentage of vaccinations to live births 1931 657 254 246 39 1932 745 302 331 41 1933 705 228 306 33 1934 759 282 259 37 1935 809 301 286 37 1936 797 312 299 39 1937 814 287 309 35 50 It will be seen from the above table that only a relatively small percentage of infants are immunised against smallpox. This is probably due in part to the innate objection to inoculation of any sort and it is also due to a certain extent to the absence of bad cases of smallpox which normally stir up fear among parents ; further, parents may have been influenced by the reports in the papers of complications from vaccination. It is well, however, to point out that serious complications are practically non-existent if vaccination is first performed under six months of age, and similarly complications do not occur in children or adults who are re-vaccinated, having been vaccinated in infancy. Complications however are possible, and do occur from time to time, in primary vaccinations done over the age of six months, and in fact are more common the older the person is. If therefore there should be an outbreak of virulent smallpox in the future and a large number of children and adults are vaccinated for the first time as the result of this, there may be cases of bad complications. This can be avoided by having the baby vaccinated before six months of age. Disinfection. In cases of infectious disease, rooms, clothing, etc., are disinfected— rooms by sealing and fumigating with formalin or a formalin preparation; clothing, bedding, etc., and infected articles which can be removed for steam disinfection by treatment in the disinfector at the hospital. Table No. 42. List of premises, articles, etc., disinfected during the year:— Rooms 284 Covers 312 Beds 381 Eiderdowns 111 Blankets 700 Pillows 600 Bolsters 199 Sheets 450 Books 155 Miscellaneous168 Total 3,360 The following articles were destroyed: 24 mattresses, 8 bolsters, 4 sheets, 10 pillows, 4 blankets, 1 eiderdown, 150 articles of clothing. Cancer. It will be seen by the table of causes of death (page11) that in 1937 70 cases (42 males, 28 females) died from cancer. The following table shows the number of deaths from cancer (male and female), the estimated population of the district, and the deaths from cancer per 1,000 population since 1922. It will be seen that in 1937 there was an increase in the cancer mortality. 51 Table No. 43. Year Male Female Total Estimated population Rate per 1,000 population 1922 18 18 36 30,261 1.18 1923 21 14 35 31,360 1.11 1924 20 18 38 31,800 1.19 1925 ? ? 40 32,220 1.24 1926 12 11 23 32,870 0.69 1927 13 13 26 33,480 0.77 1928 18 27 45 35,340 1.27 1929 12 10 22 35,370 0.62 1930 17 29 46 37,560 1.22 1931 20 28 48 39,280 1.22 1932 22 23 45 41,530 1.08 1933 23 28 51 44,780 1.13 1934 22 27 49 46,693 1.04 1935 30 27 57 48,270 1.18 1936 22 30 52 49,550 1.05 1937 42 28 70 51,560 1.35 The following table shows the age distribution of the cancer deaths:— Table No. 44. Ages at Death in Cancer Cases. Age 0-15 15-30 30-40 40-50 50-60 60-70 70-80 80 + Male — — 2 3 17 13 4 3 Female — — — 2 9 5 9 3 Total - — 2 5 26 18 13 6 Special Infectious Diseases. Smallpox (Variola). No patients with smallpox or contacts of cases of smallpox were notified to the Department during the year. No work was done under the Public Health (Small-pox prevention) Regulations, 1917. Scarlet Fever (Scarlatina). The number of notifications received during the year was 141 as compared with 205 for the previous year. Of these, 134 were removed to the Isolation Hospital. Infection appears to have been mainly due to case-to-case contact. Most of the cases were of a very mild character. In some cases the rash was of fleeting duration; in other cases there were very few signs in the throat. 52 Administration of Prontosil alba, the new therapeutic agent of use in the treatment of streptococcal infections, of which scarlatina is a typical example, was commenced in the Isolation Hospital during the year. An analysis of the results of this treatment is contained in the report on the Isolation Hospital. Diphtheria. There were 119 cases of diphtheria notified as compared with 80 in 1936. One hundred and twenty-two suspected cases were removed to the Isolation Hospital. There were four deaths from diphtheria of residents in the district during the year. Several of the cases were of a severe type and the numbers were markedly in excess of the previous year and were mainly accounted for by the epidemics which occurred in various schools. Diphtheria Prevention. It was mentioned in the Report for 1935 that the Ministry of Health had approved a scheme for the immunisation of children against diphtheria. The scheme may best be explained by reproducing the wording of a pamphlet which has been distributed through the health centres and clinics, and which is as follows:— DIPHTHERIA PREVENTION DIPHTHERIA IS A SERIOUS DISEASE. OF THOSE ATTACKED, ABOUT ONE IN TWELVE DIES. CHILDREN ARE MORE SUSCEPTIBLE THAN ADULTS, AND YOUNG CHILDREN MORE THAN OLDER CHILDREN. It is now possible to prevent diphtheria in the vast majority of cases, and where it is not completely prevented the disease takes a relatively mild form. The Urban District Council of Southall-Norwood has arranged that children between the ages of one and 14, whose parents or guardians so wish, and who are not taken to their own doctor for the purpose, may be inoculated against diphtheria, if they are not already immune. Whether children are already immune to the ordinary dose of diphtheria infection may be shown by a simple skin test. Since however very few children below the age of seven years have obtained this immunity, this test will only be done on children over that age. If the test is negative nothing further is required for the child. If the test is positive, or if the child is below seven years of age, an attempt should be made to immunise the child against diphtheria. This, in nine cases out of ten, can be brought about by the injection of a small dose or doses of a special preparation. With some preparations a course of three injections is needed ; With others only one injection is required. A few weeks elapse before the injections take complete effect, but in every case, about three months after the last injection, a skin test will be done to see if the child has been sufficiently immunised. If so, a certificate to this effect will be given ; if not, a further injection will be advisable. The injections themselves are practically painless. In some cases a little hard lump may remain for many weeks. Very occasionally, in especially susceptible children, there will be some redness round the site of the injection and perhaps a little swelling or tenderness in that area, or the child may feel out of sorts for a day. These symptoms very quickly clear up and leave the child quite well. In any event the number of such cases is very small indeed and they practically never occur in young children. THE DIPHTHERIA IMMUNISATION CLINIC IS HELD FROM 2 TO 3 P.M. ON THURSDAY AFTERNOONS AT THE MANOR HOUSE, THE GREEN SOUTHALL. IT IS HOPED THAT ALL PARENTS WILL AVAIL THEMSELVES OF THIS OPPORTUNITY OF BENEFITTING THEIR CHILDREN AND OF SAVING THEMSELVES A LARGE AMOUNT OF ANXIETY IN THE FUTURE. Arrangements have been made with the schools in order that school children who are treated may have their attendance regarded as a schoolattendance. E. H. R. SMITHARD, M.D., D.P.H. Medical Officer of Health. 53 The results for the year are shown in the following statistics:— Number of sessions held 52 Number of new patients 588 Total attendances made 2,748 Average attendance per session 53 Highest attendance at a session 159 Lowest attendance at a session 10 Of the 588 new patients, 197 were given a preliminary (anterior Schick) test in order to see if they were already immune and not needing the injections ; nine of these gave a doubtful history of having been immunised previously, and were found negative. Of the 188, 187 re-attended for reading of the test. Of the 187, 162, or 87 per cent., were positive; 25, or 13 per cent., were negative. The age distribution of the preliminary-Schick tested patients is shown in Table 45. Table No. 45. Preliminary (Anterior-Schick) Tests. Age Groups (attaining the age stated during 1937) 6 or under 7 8 9 10 11 12 13 14 14+ Positive (162) 4 _ 27 33 29 28 20 16 4 1 Negative (25) 2 _ 1 3 8 2 3 4 1 1 Of the preliminary-Schick tested patients the 162 positives needed immunisation. Of these 1 had 1 injection only. 4 had 2 injections only (2 were still under treatment at the end of the year). 157 completed the course of 3 injections. Of the 157 who completed the course 37 were awaiting final (posterior Schick) test at the end of the year. 9 had not attended for final test. 111 had been finally tested. Of the 111, 2 did not attend for reading of the test. 103, or 94.5 per cent., were negative (i.e., protected). 6, or 5.5 per cent., were still positive. These six received further injections and were still under treatment at the end of the year. 54 Of the other patients who received injections and were completed by the end of the year, 15 were positive, and were receiving or had received further treatment. Reactions. Only very few cases were reported in which any reaction occurred. These were mostly in nervous children, or children with nervous parents, and consisted merely of being off-colour for a few hours after the injection, or sick that evening. Only one case was reported with a swollen arm—and this quickly subsided. General. The immunising material used throughout the period was Burroughs Wellcome & Co.'s Toxoid Antitoxin Floccules (T.A.F.) in dosages of 1 c.c. at not less than fortnightly intervals. The disadvantage of this material is that it requires three doses, but the high percentage of successful results and the freedom from reaction make it difficult to use any other. It is proposed to re-test any patients who like to re-attend after one year to see if any of them have relapsed into an unprotected state. The opportunity will be taken to offer them all one further dose of the immunising substance to increase still further the protection they have. At present, however, it is evident that the statement made in the pamphlet, namely, that protection can be conferred on children in " nine cases out of ten," is more than justified by the present figures which show that, to put the figures the other way round, instead of protection failing in one case in ten, it fails in only one case in twenty. The response to the institution of a diphtheria clinic has been pretty well as expected. It is most difficult to get the public actively interested except when the danger is immediate. For several weeks in the summer few people attended, but as soon as some cases of diphtheria occurred in a school there was a great rush to the clinic by the local children. This occurred during most of the autumn, and accounts for the satisfactory size of the figures for this first period. But with no further cases of diphtheria occurring in the district, interest again waned. It appears that prevention is recognised as sound by parents only when the alternative is thrust in their face; the tragedy is when recognition takes place too late. Ophthalmia Neonatorum. There was one case of ophthalmia neonatorum notified in 1937, as is shown in Table No. 47. 55 The Council has an arrangement with the London County Council by which cases of ophthalmia neonatorum are treated at St. Margaret's Hospital, Hampstead, N.W. In some cases the mothers are admitted with the child in order that breast feeding may be continued. Table No. 46. Cases notified 1 Cases treated at home _ Cases treated in hospital 1 Vision unimpaired 1 Vision impaired _ Total blindness _ Deaths _ Acute Poliomyelitis. In the Annual Report for 1936 there was a special paragraph describing an outbreak of 12 cases of poliomyelitis. Only one case of this disease has occurred during the year, but it was thought desirable to follow up those cases previously reported. Each child has been visited and the following summary indicates the progress they have made. Two are perfectly well; four continue to exhibit some paralysis, but are improving; four are paralysed to various degrees, and are stationary; one is dead and one cannot be traced. The following table shows the various infectious diseases (other than tuberculosis) notified during the year and also their age incidence:— Table No. 47. Notifiable Diseases during the year (other than Tuberculosis). Diseases Ages Total cases notified Cases admitted to hospital Deaths Under 1 year 1 to 2 2 to 3 3 to 4 4 to 5 5 to 10 10 to 15 15 to 25 25 to 35 35 to 45 45 to 65 65 and over Smallpox - - - - - - - - - - - - - - - Scarlet fever - 4 18 13 5 64 24 11 8 2 2 - 141 132 - Diphtheria 1 3 4 5 5 60 17 11 10 _ 3 - 119 119 6 Enteric fever - - - - - - - - 1 - - - 1 1* - Puerperal fever - - - - - - -- 5 5 - - - 10 9* - Puerperal Pyrexia Erysipelas _ _ _ _ - - - 1 2 4 7 3 17 9* - Pneumonia 1 2 1 3 2 7 3 8 7 7 13 7 61 33* 25 Ophthalmia neonatorum 1 _ _ _ _ _ _ _ _ _ _ _ 1 1* - Dysentery _ _ _ _ _ _ _ _ _ 1 - - 1 1 — Cerebro-spinal fever - 1 - - - - - - - - - - 1 1* _ Anterior poliomyelitis _ _ _ 1 _ _ _ _ _ _ 1 _ — * To London hospitals or institutions outside the district. 56 The number of eases of infectious diseases (including tuberculosis) notified during the year, according to their locality, are shown below:— Table No. 48. Diseases Total Waxlow | Manor Northcote Ham-brough Dormers Wells Glebe Norwood Green Admitted to Hospital Total deaths Scarlet fever 141 28 28 17 10 37 21 132 - Diphtheria 119 11 29 11 19 17 32 119 6 Puerperal fever 10 2 3 3 2 9* - Puerperal pyrexia Pneumonia 61 9 7 14 12 10 9 33* 25 Cerebro-spinal fever 1 — — — 1 — 1* - Ophthalmia neonatorum 1 — — — — 1 — 1* — Tuberculosis (all forms) 67 12 13 10 7 16 10 - 34 Anterior-poliomyelitis 1 — — 1 — — — - — Erysipelas 17 1 1 1 10 2 2 9* — Enteric fever 1 — 1 — — — — 1* — Dysentery 1 — — 1 — — — 1* — Totals 420 61 79 57 61 86 76 306 65 * To London hospitals and institutions outside the district. Cases of infectious diseases occurred during the year among school children as follows:— Table No. 49. School Scarlet Fever Diphtheria Beaconsfield Road 9 1 Biscoe's School, Church of England — 4 Clifton Road 15 16 County School 1 — Dormers Wells 11 11 Featherstone Road 6 5 North Road 11 10 St. Anselm's R.C. 5 2 Talbot Road Special School — 1 Technical School, Acton 1 — Tudor Road 10 18 Western Road 7 3 Miss Abdo's, Portland Road Beaconsfield Road Preparatory School — — Crosby House — Norwood Green Preparatory School 1 — Southall P.N.E.U. School — Southall Preparatory School 2 Ravenor Park School, Greenford 1 — 78 73 Infectious Disease Visits. During the year, the Health Visitors paid 1,255 visits with reference to cases of infectious disease. One thousand, one hundred and fifteen swabs were 57 taken and eight antitoxin injections were given. The total number of children examined by the Health Visitors in the schools was 4,015. The following table shows the number of children excluded from the schools and the reasons for their exclusion:— Table No. 50. Scarlet fever contacts 119 Diphtheria contacts 207 Sore throat 15 Various 11 352 Uncleanliness and Verminous conditions in School-children. I am obliged to Dr. Tate, the school medical officer, for the information on this subject:— Number of children on roll at 31st December, 1937 6,349 Total number of examinations of children in the schools by the school nurses 9,151 Number of individual children found unclean 335 Number of children cleansed under arrangements made by the Local Education Authority 4 No legal proceedings were taken during the year with regard to uncleanliness or verminous conditions relating to children attending schools in the Borough. Prevention of Blindness. No action has been taken under Section 176 of the Public Health Act, 1936, by this authority for the prevention of blindness or for the treatment of persons suffering from any disease or injury to the eyes. Several persons are, however, receiving assistance from organisations who care for the blind. Tuberculosis. Pulmonary Tuberculosis. The number of new cases notified during the year was 51. Thirty of these were notified from Institutions (Sanatoria 7, County Council Hospitals 8, General Hospitals 15). Other Forms of Tuberculosis. The number of new cases notified during the year was 16. 58 Deaths from Tuberculosis. Tuberculosis of the respiratory system 27 ; other forms 7. The following table shows the new cases notified and the deaths in 1937. Table No. 51. Age Periods New Cases Deaths Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary Male Female Male Female Male Female Male Female 0- - - - - - - - - 1- - - - 1 - - - - 5- 1 - - 5 - - - - 15- 14 9 5 1 4 2 1 - 25- 8 7 1 2 2 5 1 - 35- 2 2 1 - 3 4 1 2 45- 3 2 - - 2 2 1 - 55- 3 - - - 1 - 1 - 65 and upwards — - - - 2 - - - Totals 31 20 7 9 14 13 5 2 Of the 34 deaths, 31—or 91 per cent.- —were of notified cases. The occupations of the new cases were as follows:— Table No. 52. Occupations Pulmonary Non-Pulmonary Male Female Male Female Building and decorating trades 1 - 1 - School children 1 - 1 4 Clerical work 4 1 1 1 Clothing and dressmaking - 1 - - Domestic duties - 8 - - Factory hands 6 3 - 3 Furnishing trades - - - - Sale of food and drinks 2 - 1 - No occupation 4 3 1 1 Various 13 4 2 - Totals 31 20 7 9 The table hereunder gives the notification rate per 100,000 population and the mortality rate per 100,000 population during each of the last seven years. 59 Table No. 53. Year 1931 1932 1933 1934 1935 1936 1937 Estimated mid-year population (excluding Hanwell Asylum) 36,432 39.030 42,280 44,180 46,000 47,200 48,760 M. F. M. F. M. F. M. F. M. F. M. F. M. F. No. of new eases notified each year— Pulmonary 28 26 29 28 26 31 31 19 33 17 27 23 31 20 Non-pulmonary 3 9 8 4 5 4 6 6 3 2 4 2 7 9 Total 66 69 66 62 55 56 67 Notifications per 100,000 population 181 177 156 140 119 118 137 M. F. M. F. M. F. M. F. M. F. M. F. M. F. No. of deaths each year— Pulmonary 10 15 14 10 18 19 17 10 13 10 19 13 14 13 Non-pulmonary 1 2 - 2 4 3 1 2 3 3 1 2 5 2 Total 28 26 44 30 29 35 34 Deaths per 100,000 population 77 67 104 68 63 74 69 Public Health (Prevention of Tuberculosis) Regulations, 1925. Public Health Act, 1936, Section 172. Action under these powers was not necessary during the year. 60 REPORT ON THE BOROUGH ISOLATION HOSPITAL. During the year 256 patients were admitted to the Isolation Hospital as compared with 265 in 1936. Of these, 134 were sent in as scarlatina (186 in 1936) and 122 as diphtheria (79 in 1936). Of the cases sent in as scarlatina two were unconfirmed and were diagnosed as suffering from other diseases. Similarly, of the cases sent in as diphtheria or suspected diphtheria, 22 were unconfirmed. The following two tables show the figures for the year and for each month respectively. Table No. 54. Remaining on 1.1.37 Admitted during year as Subsequently diagnosed as Discharged recovered Died Mort. per cent. Remaining 31.12.37 Scarlatina 12 134 132 137 — — 7 Diphtheria 14 122 100 84 4 4 26 Other diseases — — 24 24 — — — Table No. 55. Number Admitted (Final Diagnosis) Number Discharged Deaths Transfers ReAd. Scarlet Fever Diphtheria Others Scarlet Fever Diphtheria Others Scarlet Fever Diphtheria Diphtheria Diphtheria January 8 4 1 10 13 — — — — — February 5 3 2 8 3 2 — — _ _ March 15 3 2 5 3 2 _ — _ — April 8 _ 2 13 5 2 — — — — May 16 7 1 12 1 2 _ — _ _ June 22 12 2 15 6 1 — 1 _ — July 20 5 5 21 7 3 _ — _ _ August 10 4 2 19 5 4 — 2 _ — September 8 18 2 14 6 3 _ _ _ _ October 7 26 2 7 4 1 — _ _ — November 6 13 2 7 14 2 _ 1 — _ December 7 5 1 6 17 2 — — 4 4 Total 132 100 24 137 84 24 — 4 4 4 Scarlatina. The following table shows the incidence and age groups of the 134 cases of scarlatina which were nursed at the hospital:— 61 Table No. 56. Age (years) 0-5 5-15 15-25 25-35 35+ Number 32 80 10 8 2 The disease on the whole was fairly mild. Four were return cases, i.e., cases admitted from a household within 28 days of the return of a case of scarlatina to that household. This gives a return case rate of 3 per cent., which is fairly low. Two minor operations were performed for abscess in the neck. There were three cases of cross infection in the scarlet fever wards during the year. Two cases developed epidemic parotitis 8 days and 19 days respectively after admission but there was no connection between these two cases; one case contracted pertussis in circumstances suggesting that the infection might have been acquired after admission to the hospital. During the year an attempt was made to assess the value of the new sulphanilamide drugs which have been introduced for the treatment of streptococcal infection, and of alternate cases admitted one received the usual dose of anti-streptococcal globulin by injection and one received by mouth prontosil alba in doses appropriate to the age in years. In this way half the cases admitted fall into the serum group and the other half were in the group receiving prontosil, and the subjoined table analyses the complications experienced by each group of cases. Complications of the cases of Scarlatina which were treated by: Prontosil. Serum. Total. Cervical adenitis 9 5 14 Rhinorrhoea 3 3 6 Otorrhoea 3 3 6 Nephritis 1 — 1 Quinsy 1 — 1 Septic fingers — 3 3 Secondary attacks 1 1 2 Mixed Infections. Two of the scarlatina cases on admission were found to be suffering in addition from another disease, one from faucial diphtheria and one from acute Stomatitis. 62 Diphtheria. One hundred and twenty-two cases notified as diphtheria were admitted to the hospital. One hundred of these were confirmed as diphtheria; the rest were diagnosed as Suffering from other conditions. The clinical types in the cases in which the diagnosis was substantiated were as follows:— Anterior-nasal 20 Laryngeal 1 Faucial 44 Naso-pharyngeal 15 Bacteriological 20 Five of the cases were double infections on admission, suffering coincidentally from streptococcal pharyngitis. One case developed epidemic paratitis the day after admission. There was no secondary case. Five of the cases were double infections on admission, suffering coincidentally from streptococcal pharyngitis. One case developed epidemic paratitis the day after admission. There was no secondary case. The following table shows the incidence of the disease in age groups of the 100 cases diagnosed as Diphtheria in the hospital:— Table No. 57. Age (years) 0-5 5-15 15-25 25-35 35+ Number 11 72 8 8 1 The complications recorded were as follows :— Table No. 58. Bull Neck 2 Myocarditis 13 Cardiac Failure 2 Palatal Paresis 2 Acute Nephritis 1 Otitis Media 2 In the four instances where the disease was fatal, three were of the nasopharyngeal type and one laryngeal. In all, 2,770,000 units of antitoxin were given to 100 cases of diphtheria, the highest dosage being 94,000 and the average being 28,000. In six cases antitoxin was given intravenously as well as intramuscularly, and in the rest it was given only intramuscularly. 63 Other Diseases. Twenty-four patients admitted as scarlatina or diphtheria were subsequently diagnosed as suffering from other diseases. These were as follows:—(The case notified as diphtheria and subsequently diagnosed as scarlatina is included in the return of this second disease):— Diseases notified as scarlatina : Urticaria 1 Ulcerative stomatitis 1 Diseases notified as diphtheria: Tonsillitis etc. 15 Rhinitis 1 Scarlatina 1 Adenitis 2 Laryngitis3 Stay in Hospital. The average stay in hospital was as follows:— Scarlatina: All cases 34.98 days Patients remaining over 56 days 67.6 „ Patients remaining under 56 days32.52 „ Diphtheria : All cases 51.28 „ Patients remaining over 56 days 86.45 „ Patients remaining under 56 days 32.3 „ Other diseases: All cases 12.1 „ Laboratory Work. The laboratory work for the hospital continues to be done by the Lister Institute of Preventive Medicine. During the year the following examinations were performed:— Table No. 59. Swabs for diphtheria bacilli 1,121 Swabs for virulence tests for diphtheria 17 Haemolytic streptococci 57 Cytological Test 3 64 Sick Staff. Costs. The following particulars, kindly supplied by the Borough Treasurer, show the expenditure in connection with the Isolation Hospital for the year ended 31st March, 1938:— £ Salaries and Wages 1457 Superannuation and National Insurance Contributions 198 Repairs and maintenance of buildings and plant and upkeep of grounds 185 Heating, lighting, cleaning and water 688 Rates, Taxes and Insurance 267 Furniture, fittings, equipment and uniforms 96 Bacteriological examinations 219 Medical requisites and instruments 254 Printing, stationery, postages and telephones 41 Provisions 743 Ambulance 31 Other expenditure 67 4246 Maintenance in Other Hospitals 81 Total £4327 I am, your Worship, Ladies and Gentlemen, Your obedient Servant, E. GRUNDY, Medical Officer of Health. Manor House, SouthaLL. May, 1938. 65 Table No. 60. Permanent. Temporary. Number of staff off duty for 24 hours or more 4 1 Total number of days off duty 145 15 Casual conditions— Scarlatina - - Diphtheria 58 - Other 87 15 APPENDIX A. Adoptive Acts, Byelaws, etc., in force in the District. The following Acts have been adopted by the Council and are in force in the area:— Baths and Wash-houses Acts, 1846-1925. Infectious Diseases (Prevention) Act, 1890. Public Health Acts (Amendment) Act,1890, with the exception of Part IV. Public Libraries Acts, 1892 and 1893. Public Health Acts (Amendment) Act, 1907, Part II, Part III, Part IV (except Sections 61 and 66), Part V, Part VI, Part VIII, Part IX and Part X. Local Government and Other Officers Superannuation Act, 1922. Small Dwellings Acquisition Acts, 1899-1923. The following orders, byelaws, and regulations are in force in the area:— Parks and Open Spaces. Regulations as to Public Baths. Cleansing of Earth Closets, Privies, Ashpits and Cesspools (1892). Nuisances—Keeping of Animals, etc. (1892). Nuisances—Removal of Snow and Filth (1892). Houses let in Lodgings (1892). Common Lodging Houses (1892). Slaughter Houses (1892). Tents, Vans, Sheds and Similar Structures (1898). Regulations and Control of Hoardings and Advertisements (1923). New Streets and Buildings (1926). Early Closing Orders under Shops Acts. In addition, the various Middlesex County Council Acts and Byelaws confer certain powers on the Borough Council. 66 APPENDIX B Acts of Parliament, Local Government Orders, Memoranda, and Circular Letters issued by Government Departments with regard to the Public Health and Maternity and Child Welfare Services during the year 1937. Statutes. Air Raid Precautions Act, 1937. Factories Act, 1937. Hydrogen Cyanide (Fumigation) Act, 1937. Local Government Superannuation Act, 1937. Physical Training and Recreation Act, 1937. Public Health Drainage of Trade Premises Act, 1937. Ministry of Health. Circulars. No. 1519. Expectant Mothers. Supply of Milk. No. 1522. Public Health (Imported Food) Regulations, 1937. No. 1591. Overcrowding—duties of local authorities. No. 1596. Notification and treatment of ophthalmia neonatorum. No. 1597. Public Health Act, 1936. No. 1598. (i) Annual Reports of Medical Officers of Health. (ii) Special Reports of Medical Officers of Health to Minister of Health. No. 1599. Public Health (Imported Food) Regulations, 1925. Public Health (Imported Food) (Amendment) Regulations, 1933 No. 1600. Public Health Act, 1936—Moveable dwellings. No. 1602. Housing (Rural Workers) Acts : Publicity. No. 1605. Local Government Act, 1929—Welfare of blind persons— Contributions Scheme. No. 1609. Departmental Committee on the cost of hospitals. No. 1611. Housing Acts, 1935 and 1936—Housing (Rural Workers) Acts, and Small Dwellings Acquisition Acts. Interest on loans, etc. No. 1614. Treatment of tuberculosis. No. 1620. Supervision of midwives. No. 1621. Prevention of blindness. No. 1622. Maternal mortality. No. 1639. Public Health (Imported Food) Regulations, 1937. 67 No. 1640. Building byelaws. No. 1641. Therapeutic Substances Act, 1925. No. 1643. Local Health Services—Information at post offices No. 1643a. Ditto. No. 1643b. Ditto. No. 1644. Local Government Superannuation Act, 1937. No. 1646. Midwives Act, 1936. No. 1647. Casual Poor. No. 1648. Physical Training and Recreation Act, 1937. No. 1651. Meat Inspection. No. 1652. Housing Acts, 1935 and 1936, Housing (Rural Workers) Acts, and Small Dwellings Acquisition Acts. Interest on Loans, etc. No. 1662. Administration of outdoor relief. No. 1663. S/4—Local Government Superannuation Act, 1937. No. 1666. Public Health (Imported Food) Regulations, 1937. No. 1672. S/5—Local Government Superannuation Act, 1937, Model Combination Scheme. Memoranda. Publicity Material about the Housing (Rural Workers) Acts. Town and Country Planning—Points to be watched in the preparation and submission of planning schemes, and subsequent procedure. Local Government Acts, 1929 and 1937. Meat inspection (supplementary memorandum). Local Government Acts, 1929 and 1937—Regulations as to the application in county districts of Exchequer Grants. Statutory Rules and Orders. (S.R. & O.,1937, No. 35) Public Health (Ophthalmia Neonatorum) Amendment Regulations, 1937. (S.R. & O., 1937, No. 78) Housing Act (Forms of Orders and Notices) Regulations, 1937. (S.R. & O., 1937, No. 80) Housing Act (Overcrowding and Miscellaneous Forms) Regulations, 1937. (S.R. & O., 1937, No. 79) Housing Act (Extinguishment of Public Right of Way) Regulations, 1937. (S.R. & O., 1937, No. 329) Public Health (Imported Food) Regulations, 1937. (S.R. & O., 1937, No. 750) Local Government (Adjustment of Gains and Losses in County Districts) Regulations, 1937. 68 (S.R. & O., 1937, No. 784) Midwives (Certifying Hospitals and Institutions) Order, 1937. (S.R. & O., 1937, No. 398) Midwives (Qualifications of Supervisors) Regulations, 1937. (S.R. & O., 1937, No. 885) Certificates of Births, Deaths and Marriages (Requisition) Regulations, 1937. Home Office. Circulars. Air raid precautions. Air raid wardens. Air raid precautions. Badges for volunteers. Air raid precautions. Contacts. Anti-gas training. Emergency Fire Brigade Organisation Scheme. Statutory Rules and Orders. Shops (Procedure for Jewish Tribunals) Regulations, 1937 (S.R. &0., 1937, No. 1038). APPENDIX C Five-yearly Period Statistics for the District. Years Average Population Birth Rate per 1,000 population Death Rate per 1,000 population Infantile Mortality per 1,000 live births Tuberculosis Death Rate per 100,000 population 1883-1886* 4,321 20.0 - 1887-1891 4,876 14.1 - - 1892-1896 6,056 32.8 12.6 129.9 - 1897-1901 9,886 32.5 13.8 136.7 - 1902-1906 15,851 34.8 11.9 133.8 123 1907-1911 22.907 29.4 9.7 101.7 111 1912-1916 26,978 24.4 9.7 91.3 117 1917-1921 30,154 18.1 9.7 68.5 98 1922-1926 31,724 16.5 8.2 50.0 82 1927-1931 36.166 15.3 8.6 53.4 71 1932-1936 46,162 17.1 8.2 50.6 71 * Four years. 69 APPENDIX D Records of decisions of the Council during the year 1937 on matters of Public Health, Maternity and Child Welfare and Isolation Hospital interest other than those which have been mentioned in the body of the report. (The figures in brackets refer to the page and item in the minutes). Public Health General:— Clearance Area—Woodland Place (429.4). Shops:— Early Closing Order (374.2, 431.6, 558.9). Maternity and Child Welfare:— Domiciliary service of midwives (118.4, 307.13, 498.18, 559.16, 73.8). Proposed health centre (311.26). Proposed massage and remedial exercise clinic (431.9, 18.14). Revision of economic circumstances scale (636.2). Maternity hospital accommodation (640.15). Isolation Hospital:— Regulations as to staff (561.18). 70 INDEX Acute poliomyelitis 56 Adoptive Acts in force 66 Ambulance facilities 18 Ante-natal clinics 23 Antitoxin 50 Area of borough 6 Assisted services 34 Bed bugs 38 Blindness, Prevention of 58 Birth Control 23 Births and birth rate 13-14 Bye-laws 66 Canal boats 39 Cancer 51 Causes of death 11 Celluloid and Cinematograph Film Act 42 Child Life Protection 21 Clinics, List of 17 Closet accommodation 36 Common lodging houses 41 Consultant aid 22 Deaths and death rates 11-12 Dental treatment 33 Diphtheria 53, 63 Diphtheria Prevention Clinic 53-54-55 Disinfection 51 Disinfestation 38 Drainage and Sewerage 35 Factories, Workshops and Workplaces 41 First Aid Station 16 Food 46-49 Foster Children 21 Health Education 19 Health Services, General provision of 16-20 Health visiting 21, 58 Hospitals 19 Houses—Number inhabited 6 Housing 44-45 Infant mortality 15 Infectious Disease—Prevalence of 50-60 Infant welfare clinics 25 Inspection and Supervision of Food 46-49 Isolation Hospital 61-65 Laboratory facilities and work 16, 64 Maternal morbidity and mortality 15 Maternity and Child Welfare 21 Maternity and Child Welfare Committee 2 Maternity and Nursing Homes 32 Meat and other foods 48 Medical Comforts Depot 16 Medical relief 19 Midwives 31 Milk supply 46 Milk grants 33 Mortuary 41 Noise 39 Notifiable diseases 50-60 Nursing in the Home 16 Offensive trades 41 Official publications 67-69 Ophthalmia Neonatorum 55 Orthopaedic treatment 27-30 Overcrowding 45 Parks and Open Spaces 6, 7 Petroleum Acts 42 Physical feature of district 6 Poor Law medical relief 19 Population 6 Premises and occupations controllable by bye-laws 41 Pre-school medical inspection 27-30 Public cleansing 36 Public Health Committee 2 Puerperal fever and pyrexia 15 Rainfall 6 Rateable value 6 Refuse collection 36 Sanitary circumstances 35-42 Sanitary inspection 36 Scarlet fever 52,61 Schools 39 School children 58 71 INDEX—continued Sewerage 35 Shops 43 Slaughter of Animals Act 49 Slaughterhouses 48 Smoke abatement 39 Social conditions 6 Staff 5 Statistics—General and Vital 6, 10, 13 Stillbirths 10 Swimming bath 40 Tents, vans, sheds, etc. 41 Tuberculosis 58-60 Underground sleeping rooms 41 Unemployment 8 Unsound food 48 Vaccination 50 Venereal disease clinics, etc 17 Verminous persons 38 Vital statistics 10, 13, 69 Voluntary help 31 Water supply 35 Wards 7 Workshops 41 72