Ac 439 (1) SOUTHALL M Sout 6 Middy BOROUGH OF SOUTHALL ANNUAL REPORT OF THE Medical Officer of Health for the Year 1938 E. GRUNDY, M.D., D.P.H., Medical Officer of Health. Board and co., typo., chiswick, w. 4 BOROUGH OF SOUTHALL ANNUAL REPORT OF THE Medical Officer of Health for the Year 1938 E. GRUNDY, M.D., D.P.H., Medical Officer of Health. THE COUNCIL OF THE BOROUGH OF SOUTHALL, 1938 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 G. A. PARGITER, J.P. Deputy Mayor: *Alderman E. B. Hamblin, J.P. Aldermen: *Amos, Mrs. F. S. (Chairman of the Public Health Committee) *Hillier, W. A. *Neighbour, D.C. *Smith, F. G. Councillors : Bill, H. R. *Hutchings, C. *Creesey, G. *Luckett, F. H. Dale, W. *McGuigan, Mrs. D. M. Dane, A. T. *Marks, F. J. Evans, J. A. Reason, W. J. Gardner, F. E. Reed, G. Harris, G. Salmon, W. G. *Hill, J. Saxon, J. A. Hopkins, W. H. *.Sturgeon, J. M. To the Mayor, Aldermen and Councillors of the Borough of Southall. MR. MAYOR, LADIES AND GENTLEMEN, I have the honour to present the forty-second Annual Report on the health and sanitary circumstances of the district. The vital statistics of the area for the year reveal on the whole that hygienic conditions are in a very satisfactory state. Continued growth in the population which has now reached 52,400 is worthy of comment, whilst increase in the birth rate to 10.34 per 1,000 of the population demonstrates the direction of trend will be towards an increasing population for some few years. The crude and comparable death rates for the borough are 8.64 and 9.85 per thousand of the population respectively, which figures are considerably below those of the country as a whole. An increase to 65 per 1,000 live births has occurred in the infantile mortality rate, and this is chiefly due to 14 deaths of premature infants occurring in the first week of life. Particular attention is paid to the early visiting of infants by staff of the department and an increasing vigilance is obviously necessary. On the 28th May, 1938, the new Branch Health Centre was opened and a brochure published describing the building. Need for this provision has been justified by the fact that it is fully used on every working day, and attendances now are greater than at the Manor House. It is with some pleasure that I direct attention to the continued success of the clinical services provided by the Council. Attendances at the ante-natal sessions during the year reached a total of 2,688 which is 948 greater than during last year. This is not a mere exaltation of figures, as during the year 531 new attendances were recorded which is 62.03 per cent, of the total births. The total of persons attending the child welfare sessions has now reached an annual figure of 14,537, which is an increase of 1,849. The number of new infant cases seen was 711, equivalent to 86 per cent, of the total live births. Despite the consequent additional work thrown upon the health visitors, 14,457 domiciliary visits were paid during the year—an increase of over 3,600 on the preceding year. The Food and Drugs Act, 1938, reached statute form during the year and in addition to departmental re-organisation an application was made to the Minister requesting him to direct that the Borough Council should, in lieu of the County Council, be the Food and Drugs authority as respects this district. 3 The Young Persons (Employment) Act, 1938, extended to those employed in a variety of occupations the advantages enjoyed by young persons under the Shops Acts, and all the employers in Southall concerned elected, as they were permitted to do, that the Shops Act would apply in the case of their staff. I wish to express to the staff of the Health Department my warmest thanks for their assistance and co-operation in the sen-ice of the Council. This report is in general concord with the requirements of the Ministry of Health. 4 HEALTH DEPARTMENT STAFF for the year 1938 Medical Officer of Health Ernest Grundy, M.D., B.S.(Ivond.), M.R.C.S., L.R.C.P., D.P.H.(Eng.). * 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. Grant-Adams, M.R.C.S.(Eng.), L.R.C.P.(U>nd.), 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.S.I.E.J.B., Cert. M. & F. K. R. Wagener, Cert. R.S.I., Cert. M. & F. (Resigned February 1938) L. Mair, Cert. S.I.E.J.B., Cert. M. & F. (Appointed April 1938) 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. (Resigned June 1938) Miss M. Williams, S.R.N., S.C.M., H.V., Cert. R.S.I, (appointed November 1938) Midwives Miss V. Robinson, S.R.N. Miss G. Robinson Mrs. Delahaye, S.R.N. Miss Sandell Miss Johnson, S.R.N. Shops Inspector and Sanitary Inspector A. J. White, Cert. S.I.E.J.B. Clerical Staff Chief Clerk J. W. Cronk, Cert. R.S.I. Clerks, Shorthand- Typists Miss P. Ashton Miss M. V. Sage Miss J. D. Winterburn K. W. Skeates (Resigned October 1938) N. V. Saunders (Appointed October 1938) ‡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 time, 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-1938 *52,400 Number of inhabited houses according to Rate Book 13,457 Rateable value £405,192 Sum produced by a penny rate £1,603 * This includes about 2,800 patients ami staff resident at 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 Islewortli. 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 tweuty-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 1938 was 19.02 inches (compared with 29.38 inches in 1937). The Council control the following parks and open spaces Southall Park 20 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, 011 the east by North Road, on the south by the Uxbridge Road and 011 the west by the boundary of the Borough. No. 3. Hambrough Ward is bounded on the north by the Northcote Ward, 011 the east by South Road, 011 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, 011 the east by the boundary of the Borough, 011 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, 011 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 110 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 1938. Men. Women. Total. January 17th 1699 818 2517 February 14th 1534 808 2342 March 14th 1388 745 2133 April 4th 1276 888 2164 May 16th 1329 908 2237 June 13th 1234 832 2066 July 18th 1237 768 2005 August 15th 1104 678 1782 September 12 th 1081 610 1691 October 17 th 1263 379 1642 November 14th 1440 400 1840 December 12th 1379 540 1919 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 January and the lowest in October. The average is higher than it was for 1937 (1405 against 2028). Growth of the 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 Average 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 1938 13,457 52,400 ,, 3.88 * 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 1937 Live Births—Legitimate 794 392 402 776 Illegitimate 31 19 12 38 Stillbirths—Legitimate 30 19 11 33 Illegitimate 1 1 - Deaths 453 249 204 474 Birth rate per 1,000 of estimated population 16.34 15.79 Stillbirth rate per 1,000 total (live and still) births 36.21 38.95 * Crude death rate per 1,000 of the estimated population 8.64 9.19 ‡Comparability factor 1.14 1.14 * Comparable death rate 9.85 10.47 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 2.36 2.37 No. 30. Other puerperal causes - — Total 2 2.36 2.37 Death rate of infants under one year of age:— All infants per 1,000 live births 65.45 58.96 Legitimate infants per 1,000 legitimate live births 59.20 52.83 Illegitimate infants per 1,000 illegitimate live births 258.06 184.2 Deaths from cancer (all ages) 57 70 Deaths from measles (all ages) 1 - Deaths from whooping cough (all ages) 2 3 Deaths from diarrhoea, etc. (under 2 years of age) 8 10 *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 9.12 and the comparable death rate would be 10.39. J See Note 2 on page 12 of the report for 1934. 10 Causes of Deaths, 1938. Table No. 3. Male Female Total 1938 Total 1937 1. Typhoid fever, etc - - — — 2. Measles - 1 1 — 3. Scarlet fever - - - - 4. Whooping cough 1 1 2 3 5. Diphtheria 4 4 8 6 6. Influenza 1 2 3 15 7. Encephalitis lethargica - - - 1 8. Cerebro-spinal fever 1 - 1 1 9. Tuberculosis—respiratory 16 12 28 27 10. Other tuberculosis 2 3 5 7 11. Syphilis - - - - 12. General paralysis of the insane, etc. 1 - - 1 13. Cancer 27 30 57 70 14. Diabetes 5 5 10 4 15. Cerebral haemorrhage 5 10 15 16 16. Heart disease 67 36 103 108 17. Aneurysm 1 1 2 2 18. Other circulatory diseases 13 22 35 38 19. Bronchitis 5 5 10 14 20. Pneumonia (all forms) 14 10 24 25 21. Other respiratory diseases 4 2 6 6 22. Peptic ulcer 3 2 5 4 23. Diarrhoea, etc. (under 2 years) 6 2 8 10 24. Appendicitis 4 2 6 4 25. Cirrhosis of liver 1 1 2 2 26. Other liver diseases 1 2 3 2 27. Other digestive diseases 6 3 9 9 28. Nephritis 3 3 6 10 29. Puerperal sepsis - 2 2 2 30. Other puerperal causes - - - ' - 31. Congenital causes, etc. 22 13 35 22 32. Senility 4 6 10 7 33. Suicide 1 3 4 4 34. Other violence 14 4 18 17 35. Other defined causes 18 17 35 37 36. Ill-defined causes — — — — Special Causes (included in No. 35) M. F. Smallpox - - Poliomyelitis - 1 Polioencephalitis — — Total Deaths 249 204 453 474 11 Deaths and Death Rate—Whole District. Total deaths 453. (Males 249, Females 204). Crude Death Rate : 8.04 per l.,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 208 (males 100 and females 102). 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 245 in number (males 143 and females 102). The total number of deaths therefore belonging to the district is 453 and the crude death rate 8.04. The deaths of non-Southall residents in the St. Bernard's Hospital (not included in the above figures) numbered 180 (males 84 and females 102). The death rate since 1883 grouped in five-yearly periods is shown in Appendix B. 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 47 28 75 Northcote 31 21 52 Hambrough 35 43 78 Dormers Wells 40 30 70 Glebe 56 48 104 Norwood Green 40 34 74 Total 249 204 453 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 1938, 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 1938. (England and Wales, London, 126 Great Towns and 148 Smaller Towns). (Provisional Figures based on Weekly and Quarterly Returns) England and Wales 126 County Boroughs and Great Towns including London 148 Smaller Towns (Resident Populations 25,000 to 50,000 at 1931 Census) London Administrative County Soutliall Rates per 1,000 Population Births :— Live 15. 1 15. 0 15. 4 13. 4 15.75 Still 0.60 0.65 0.60 0.48 0.59 Deaths :— All Causes 11. 6 11. 7 11. 0 11. 4 8.64 Typhoid & Paratyphoid fevers 0.00 0.00 0.00 0.00 0.00 Smallpox — — — — — Measles 0.04 0.05 0.03 0.06 0.01 Scarlet fever 0.01 0.01 0.01 0.01 0.00 Whooping Cough 0.03 0.03 0.02 0.03 0.03 Diphtheria 0.07 0.07 0.06 0.05 0.15 Influenza 0.11 0.10 0.11 0.06 0.57 Notifications :— Smallpox 0.00 0.00 0.00 — — Scarlet fever 2.41 2.60 2.58 2.05 6.01 Diphtheria 1.58 1.85 1.53 1.90 1.89 Enteric fever 0.03 0.03 0.04 0.05 0.01 Erysipelas 0.40 0.46 0.39 0.46 0.34 Pneumonia 1.10 1.28 0.98 0.98 0.55 Rates per 1,000 Live Births Deaths under 1 year of age 53 57 51 57 65 Deaths from Diarrhoea and Enteritis under 2 years of age 5.5 7.8 3.0 13.1 9.69 Maternal Mortality :— Puerperal Sepsis 0.89 Not available 2.43 Others 2.19 Total 3.08 Rate s per 1,000 To|tal Births (i.e. Live and S till) Maternal Mortality:— Puerperal Sepsis 0.86 Not available 2.33 Others 2.11 Total 2.97 Notifications— Puerperal fever 14.42 18.08 12.51 3.53 4.67 Puerperal pyrexia 15.46 13 Births and Birth Rate (figures for 1937 are given in brackets). The total number of births notified to the Health Department under the Notification of Births Acts was 885 (860). The total number of registered births in the district (under the Births and Deaths Registration Act—included in the notified births above) was 479 (499). The total number of live births belonging to the district whether occurring within or outside the district was 825 (814). The illegitimate live births were 31 (38). There were 31 stillbirths (38), and these with one exception were legitimate. This gives a live birth rate per 1,000 population of 15.75 (15.79) and a stillbirth rate per 1,000 total (live and still) births of 30.21 (38.95). The birth rate grouped in five-yearly periods since 1892 is shown in Appendix B. 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 8 0 7 5 9 9 43 February 4 6 o 2 10 8 32 March 12 9 6 o 14 7 50 April 8 5 6 3 12 4 38 May 7 3 6 3 12 8 39 June 8 7 10 1 17 8 51 July 14 4 7 2 14 5 46 August 5 1 6 6 9 6 33 September 10 5 5 7 8 4 39 October 2 4 4 5 10 7 32 November 13 7 G 4 11 5 46 December 8 2 3 6 6 5 30 99 58 68 46 132 76 479* * This figure does not include 377 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)—856. No. born in Hillingdon County Hospital 166 or 19.40% No. born in London voluntary hospitals 103 or 12.03% No. born in nursing homes or other hospitals . 76 or 8.87% No. confined in their homes by midwives or doctors 511 or 59.70% 14 Infant Mortality. The total number of deaths under one year of age was 54. The rate per 1,000 births was 65. The corresponding rate for England and Wales was 53, for London 57, and for the 148 smaller towns 51 per 1,000. This shows an infant mortality rate higher than last year when it was 58. The infant mortality rate in five-yearly periods since 1892 is shown in Appendix B. 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 Total deaths under 1 year Bronchitis, Pneumonia, etc. 2 2 - 2 6 - - - 2 8 Peritonitis 1 — _ 1 - - - 2 3 Toxaemia - - 1 1 - - - - 1 Congenital Malformations 3 - — 3 - - - - 3 Cerebral Haemhorrage 4 - — - 4 - - 1 - 5 G astro-enteritis. Diarrhoea, etc. - - - - - 3 2 3 - 8 Inanition 2 - — — 2 — — - — 2 Intestinal Obstruction 2 - - - 2 - - - - 2 Want of Attention 2 - _ - 2 — — — — 2 Prematurity 14 3 - 1 18 - - - 18 Pulmonary Oedema - - - - - 1 - - - 1 Tubercular Meningitis - - — - - — 1 — 1 30 5 - 4 39 4 2 5 4 54 Live Births. Infant Deaths. Legitimate 794. Legitimate 46. Illegitimate 31. Illegitimate 8. Maternal Morbidity and Mortality. The Council has an informal agreement with the London County Council for the admission of cases of puerperal pyrexia to the North Western Hospital, Hampstead. Patients are usually, however, admitted to Queen Charlotte's Hospital (isolation block), Shepherd's Bush. During the year four cases of puerperal pyrexia were notified. Two of these were admitted to Queen Charlotte's Hospital and one occurred after confinement at Queen Charlotte's Hospital, and one case occurred in Hillingdon County Hospital. There were two maternal deaths during the year in connection with childbirth; one occurred in Hillingdon County Hospital, and one in the West Middlesex 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 1038 the total number of visits made by the nurses was 7,520. 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. 0 shows the services provided in the district. A report on the work in the diphtheria prevention clinic is given on page 56. 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 these services. 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. 10 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 : Tuesday 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 10 a.m. & 2 Thursday 2 p.m. [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 Remedial Exercise Clinic Branch Centre Remedial exercises for Mothers and Toddlers Wed. and Friday— Mothers 2 p.m. Toddlers 3 p.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 leister Institute of Preventive Medicine. The following table shows the work done during the year 1938 (exclusive of work done for the Isolation Hospital). Table No. 10 Positive. Negative. Swabs for diphtheria 70 636 Sputa for tubercle 50 130 Wasserman reaction 1 2 Swabs for haemolytic streptococci 2 2 Faeces for enteric 1 4 Miscellaneous ... 5 Total Examinations 124 779 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 4,384. The total mileage of this ambulance now is 29,000 and its condition dilapidated. The Council during the year considered the question of replacement or extensive general overhaul, and it is possible that the vehicle may be replaced in the near future. 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 Morris, purchased in 1938, and the other is a Commer De Luxe, purchased in July, 1932. Efficient service continues to be rendered, and is quite adequate for peace-time requirements. 18 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 1556 Accidents 154 Persons taken ill in the street 40 Out of district cases 5 Total 1755 Miles travelled in the year 1938 16,092 Cash received £6 Total expenditure £1,242* Cost per mile (exclusive of depreciation) 10.1 pence * This includes £579 for the purchase of a new ambulance. Poor Law Medical Relief. The Relieving Officer issued 242 Medical Orders during 1938. 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 21 ordinary beds, 5 cots and 2 private wards. The Isolation Hospital report is given on pages 65 to 69. 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 at the Branch Health Centre in May of this year. They are held each Tuesday and Wednesday afternoon from January until Easter ; from Easter until the end of July; and from September until Christmas. 19 The sessions commence at 2.30 p.m. and are of about an hour and a-half's duration. They are open without payment to any expectant or nursing mother living within the borough, and tea is available at the end of the session on payment of a penny. The objects are to teach child nurture enabling the mothers to appreciate their infants' needs and to ensure that infants do not suffer by reason of their parents' lack of understanding. In addition to advice and instructions, substantial assistance is given in the purchase of fabrics necessary to make infants' clothing etc. General discussion enables mothers to solve many difficulties they have concerning their babies. One Health Visitor who has had special experience in the teaching of motliercraft is in charge of the session, at each centre, 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 1938 Visits to infants— First visits 856 Re-visits 3,288 Visits to children— First visits 80 Re-visits 5,218 Visits to expectant mothers 726 Visits for infectious disease 1,333 Visits to schools 153* Child Life Protection visits 381 Miscellaneous visits 699 Removals 406 No access 1,317 Total 14,457 * At these visits a total of 0,085 children were examined. Child Life Protection. The general arrangements as outlined in the report for 1934 remain unaltered. The Council has 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 56 (b) At the end of the year 44 (2) Number of foster parents receiving foster children— (a) At the beginning of the year 34 (b) At the end of the year 29 (3) Number of children on the register— (a) At the beginning of the year 63 (b) At the end of the year 44 (4) Number of children received by foster parents during the year 62 (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 67 (c) Adopted 2 (d) Returned to parents 8 (e) Removed at the request of the medical officer of health (f) Died during the year 4 (g) On whom inquests were held 1 (6) Total number of visits made during the year 381 (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 not called in. 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 were sent to the centre from this district has been discontinued. During 1937 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 for 1938 are included in the subjoined table. Table No. 14 Post- Natal Birth Control. First visits 107 80 Re-attendances 53 148 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. The arrangements detailed in the report for 1934 were unaltered during 1938. The number of new patients seen at the ante-natal clinics during the year was 531, and the total number of attendances was 2,688. 23 319 cases were completed during the year, and the attendances 111 respect of these were as follows:— No. of cases One attendance 39 Two attendances 39 Three attendances 42 Four attendances 48 Five attendances 53 Six or more attendances 205 The following table gives the figures for the last eight 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 1938 531 2157 4.06 856 32.03 These figures show an increase in 1938 both in the number of cases and the proportion of cases to births. Of the 2,688 total attendances, 1,544 occurred at the Manor House centre and 1,144 at the Branch centre. Of the 531 new cases seen during the year, 515 were pregnant women and the remaining 16 were non-pregnant or post-natal cases. Of the 515 pregnant women 227 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 438 completed cases, 119 for 1937 and 319 occurring in 1938. Of these cases 378 were normal and 60 showed abnormalities. 24 Table No. 16. Primipara Multipara Delivered at home Admitted to hospital or Nursing Home Primipara Multipara Primipara Multipara Normal cases ... 146 232 50 137 96 95 Abnormal cases 29 31 7 10 22 21 Of the cases dealt with therefore 175, or 39 per cent., were primiparae (against 42 per cent. in 1937) and of these 118, or 67 per cent. (against 78 per cent. in 1937) were confined in hospital, while 116 cases or 44 per cent. (against 41 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 9 cases (ii) abortions 7 „ (iii) stillbirths 24 „ (iv) other conditions 15 „ (b) Abnormalities of the mother— (i) unsatisfactory measurements 6 (ii) heart disease 1 (iii) ante partum haemorrhage 4 (iv) albuminuria 7 (v) high blood pressure (exceeding 140 systolic or 90 disatolic other than on the first attendance) 24 (vi) other conditions 57 Neo- Natal Moriality (before the seventh day) 7 25 Maternity and Child Welfare Clinics. The attendances at the Child Welfare clinics during 1938 are shown in the following table:— Table No. 18 Manor House— vSeen by medical officer: Infants 3,591 Children at ordinary clinics 1,238 Children at toddlers' clinics 229 Weighing only: Infants 1,628 Children 629 New cases (included in above): Infants 361 Children 106 Branch Centre— Seen by medical officer : Infants 3,798 Children at ordinary clinics 1,498 Children at toddlers' clinic 321 Weighing only: Infants 1,005 Children 414 New cases (included in above): Infants 350 Children 91 Total attendances 14,351 The total attendances at the clinics during the past six years have been as follows:— 1933 7,427 1936 11,329 1934 6,856 1937 12,502 1935 9,682 1938 14,351 It will be noticed that there was again a rather large increase in the total number of attendances in 1938 compared with the figure for 1937. This increase amounts to 14 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 is helped now 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 598 814 73 1938 711 825 86 * 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 1938. 550 attendances were made, 229 of these being at the Manor House, and 321 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. The general physical condition of children under five years of age in Southall is on the whole satisfactory as the defects found, although apparently large in number, contain several of a minor degree which are present fortuitously at the time of examination and are quickly relieved. Many children were selected during the year for treatment at the remedial exercise classes where defects of posture and slight deformities are corrected by specially arranged courses of exercise. Beneficial results are achieved in early cases and small defects prevented from having serious debilitating effects in later life. Treatment is arranged by the department for all defects found, and parents are very happy to take advantage of the facilities. 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 75 89 164 2 years 49 87 136 3 years 37 67 104 4 years 35 35 70 Total Routine 196 278 474 Other inspections 33 43 76 Total 229 321 550 Table No. 21. Number ok Individual Children found at Routine Medical Inspection to require Treatment (excluding Dental Disease) : Manor House Branch Centre  18 months 12 21 33 2 years 14 19 33 3 years 11 25 36 4 years 6 10 16 Total ... 43 75 118 28 Table No. 22. Number requiring Dental Treatment : Manor House Branch Centre Total 18 months - - - 2 years - 1 1 3 years 4 10 14 4 years 9 6 18 Total 13 20 33 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 9 17 26 132 6 — B 65 67 C 1 5 D — — 2 years A 7 16 23 106 7 — B 38 68 C 4 3 D — 3 years A 11 11 22 78 4 — B 24 54 C 2 2 D - — 4 years A 10 6 1 16 J 54 — — B 25 29 C - - D - - 196 278 Total 87 370 17 — 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 - - - 4. Other diseases (non-tubercular) 5 8 13 Total 1-4 5 8 13 Eye 5. Blepharitis - 1 1 0. Conjunctivitis 1 1 2 7. Keratitis and opacities — — - 8. Other conditions (excl. defective vision and squint) 2 - 2 Total 5-8 3 2 5 9. Defective vision - - - 10. Squint 2 4 6 Ear 11. Defective hearing — - - 12. Otitis media — 2 2 13. Other ear diseases 2 3 5 Nose and Throat 14. Chronic tonsils and/or adenoids 7 16 23 15. Other conditions 2 5 7 16. Enlarged cervical glands (non-tubercular) 1 6 7 17. Defective speech - — — Heart and Circulation 18. Organic heart disease 1 - 1 19. Functional heart disease - — - 20. Anaemia - - - Lungs 21. Bronchitis 2 — 2 22. Other non-tubercular diseases — - - 23. Pulmonary tuberculosis - - - Tuberculosis 24. Glands - - - 25. Bones and joints - - — Nervous system 26. Chorea — — - 27. Other conditions - - - Deformities 28. Rickets deformities — 5 5 29. Genu valgum 18 months 4 6 10 2 years 3 11 14 3 years 1 8 9 4 years - 1 1 30. Other forms - — - 31. Other defects and diseases 20 23 43 32. Dental diseases 18 months - - - 2 years — - - 3 years 3 10 13 4 years 9 8 17 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. Remedial Exercises. In October this year two afternoon sessions of special Margaret Morris Movement exercises were instituted at the Branch Health Centre. The duration of the session is two hours, the first half being devoted to children and the second to expectant mothers. For children the special play exercises are scientifically modelled to hold the attention, inculcate a sense of rhythm and benefit the recipient by controlled activity of each muscle group. Many toddlers exhibit tendencies towards physical deformity and frequently show a particularly bad posture when resting in the erect position. These defects, slight in themselves, are frequently overlooked by the parents and even if the child is taken to consultation at hospital are discounted by the examining physician, who is unconsciously comparing with marked deformities with which he is more familiar. Children are selected by members of the medical staff who supervise all the treatment given, and it has been found that many incipient defects in this early state can easily be remedied. The Ante-Natal exercises were evolved along lines suggested by the physiological event of labour and are designed to acquaint the woman with 31 movements and efforts which she will be required to make during the time her child is being born. It is unfair and cruel to expect an untutored patient to respond to orders she cannot understand when experiencing the anxiety and pain of confinement. Now she calmly prepares in advance, is reassured and confident that she knows what is expected of her and need not fear any deterioration in her looks or her physique as a consequence of her pregnancy. The friendship and association with others dispels that dread replacing it with a sense of strength in which the event can be regarded as a wonderful experience and the period of gestation one which can be devoted to improvement both of health and figure. The attendances from October until the end of December are tabulated below:— Infants M others First visits 54 23 Re-attendances 155 33 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. This is the first complete year of the Council's Domiciliary Midwifery Service, and five midwives have been employed constantly throughout the period. The borough is divided into five districts, and so far as is convenient one midwife attends all the confinements in her area. The personal preference of any expectant mother, however, is respected, and she is allowed to retain the services of any particular midwife she chooses, if this can be arranged with expedience. Leaflets have been issued describing the services provided, and these are available at the Manor House and the Branch Health Centre. Midwives attend regularly at the ante-natal clinics, where in consultation with the doctor any anticipated difficulties can be discussed and a solution found. The scheme has resulted in an improvement of the standard of domestic obstetrics, and an increasing number of bookings is made each month. 32 The monthly bookings for each district are included below:— Districts No. 1 No. 2 No. 3 No. 4 No. 5 January 1 9 - 3 1 February 5 4 3 2 2 March 5 2 2 2 2 April 6 1 1 3 4 May 2 6 3 4 2 June 8 6 4 8 4 July 4 2 1 4 2 August 7 8 3 3 2 September 4 4 4 7 3 October 6 5 2 9 2 November 8 7 3 3 1 December 4 3 7 2 4 The number of midwives who during January 1038 gave notice of their intention to practise in Southall was 13. Of these, 10 were resident in Southall and 3 were resident outside the district. No midwives were added to this list between the 31st January 1938 and the end of the year. The following table, based on material kindly supplied by Dr. J. Tate, the County Medical Officer of Health, gives information which deals with notifications relating to Southall, received from all midwives resident in Southall during the year:— Table No. 25. Medical Help (a) Mother 81 (b) Child 23 Laying out dead body 2 Liability to be a source of infection 1 Death of child 3 Stillbirths 8 Artificial feeding 6 The reasons for sending 104 notifications for medical help were as follows:— Table No. 26 Ante-natal conditions 3 Inflammation of, or discharge from, infant eyes 6 Ruptured perineum 36 Difficult or prolonged labour 24 Haemorrhage in the mother 4 Feeble or premature baby 11 Miscarriage 7 Other conditions (a) Mother 7 (b) Child 6 33 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 18 Number of deletions during the year 1038 0 Number of additional applications re registration during the year 1938 Nil Number so registered — 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 2,857 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 1938 2246 396 182 33 1937 1018 274 135 21 This shows a large increase on the number in 1937, when a total of 1,448 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 34 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 159 Number inspected 104 Number for whom treatment was completed 45 Number of completed dentures 30 Number of fillings 37 Number of extractions under local anaesthetic 138 Number of extractions under gas 313 Total number of attendances and re-attendances 405 Children under five years of age:— Number sent for inspection 166 Number inspected 152 Number for whom treatment was completed 136 Number of fillings 86 Number of extractions under local anaesthetic 20 Number of extractions under gas 351 Total number of attendances and re-attendances to dentist 284 These figures show a total number of 689 attendances compared with 603 in 1937 and 395 in 1936. Assisted Services. The expansion of the Maternity and Child Welfare services commented on on page 31 of the report for 1935, continued during 1938. Apart from those 35 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 10 39 (b) Multiparae 95 121 2. Provision of home help at confinement 30 20 3. Provision of sterilised accouchement sets 11 2* 4. Provision of consultant for cases of difficult labour - - 5. Provision of consultant for Puerperal cases - - * In addition, about 155 sets were supplied at " full cost." 36 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 each quarter from the mains of the companies supplying the district. Samples Nos. 1 and 2 were taken from well water supplying cottages owned by the Grand Union Canal Company. As soon as the results were obtained, the wells were immediately closed and the company's water installed. With regard to No. 11, this water was supplied from a well to a farm, and this was immediately substituted by the company's supply. Table No. 31 shows the result of the samples taken during the year. Table No. 31 No. Date Gelatin 20 degrees for 3 days Agar 37 degrees for 2 days B. coli Streptococci B. Welchii Remarks 1 26/1/38 1,050 345 + in 5 c.c. + in 10 c.c. 0 in 100 c.c. Unsatisfactory 2 26/1/38 2,630 864 + in 5 c.c. +in 10 c.c. 0 in 100 c.c. Unsatisfactory 3 15/3/38 9 7 0 in 100 c.c. 0 in 30 c.c. + in 100 c.c. Satisfactory 5 17/3/38 10 4 0 in 100 c.c. 0 in 30 c.c. 0 in 100 c.c. Satisfactory 4 23/3/38 8 2 0 in 100 c.c. 0 in 30 c.c. 0 in 100 c.c. Satisfactory 6 19/5/38 15 4 0 in 100 c.c. 0 in 30 c.c. 0 in 100 c.c. Satisfactory 7 10/5/38 7 6 0 in 100 c.c. 0 in 30 c.c. 4- in 100 c.c. Satisfactory 8 5/5/38 75 3 0 in 100 c.c. 0 in 30 c.c. 0 in 100 c.c. Satisfactory 9 10/5/38 7 6 0 in 100 c.c. 0 in 30 c.c. + in 100 c.c. Satisfactory 10 5/6/38 75 3 0 in 100 c.c. 0 in 30 c.c. 0 in 100 c.c. Satisfactory 11 27/4/38 142 33 + in 10 c.c. + in 30 c.c. + in 100 c.c. Unsatisfactory 12 2/8/38 8 1 0 in 10 c.c. 0 in 30 c.c. 0 in 100 c.c. Satisfactory 13 3/8/38 38 7 0 in 100 c.c. 0 in 30 c.c. + in 100 c.c. Satisfactory 14 3/8/38 496 7 0 in 100 c.c. 0 in 30 c.c. 0 in 100 c.c. Satisfactory 15 4/10/38 6 1 0 in 100 c.c. 0 in 30 c.c. 0 in 100 c.c. Satisfactory 16 13/10/38 9 2 0 in 100 c.c. 0 in 30 c.c. 0 in 100 c.c. Satisfactory 17 13/10/38 28 6 0 in 100 c.c. 0 in 30 c.c. 0 in 100 c.c. Satisfactory Rivers and Streams. There were no complaints of contamination of rivers and streams in the district. 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 37 is carried out at Mogden Sewerage Works. Except 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. During the year a length of main sewer has been added to the sewer system, namely, Havelock Road, and it is hoped that all factories and houses in Havelock Road will be connected to the sewer in due course. 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 8,690 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. No cesspools are emptied or cleansed by the local authority, the few which remain in the district being supervised by their respective owners. Closet Accommodation. Thirty closets, from houses not on the water carriage system, still require to be emptied each week. These are emptied by the Surveyor's Department. In addition there are seven trade premises not 011 the water carriage system, two of which have chemical closets and live 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 as follows: 30 earth closets, 110 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 14,668. 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 1,403 House-to-house inspections 835 Inspections and re-inspections of houses, premises etc. 6,043 38 Visits in connection with the Overcrowding Survey 1,994 Drain tests 37 Factories 471 Visits to canal for canal boat inspections 4 Petroleum and carbide stores 58 Slaughterhouses 3 Food sampling 155 Dairies and milk shops 36 Bakehouses 55 Other premises where food is prepared 1,162 Smoke observations 21 Tents, vans, sheds, etc. 16 Deposits and accumulations of refuse 149 Stables 10 Farms 4 Schools 46 Cinemas, cafes, public houses, etc. 29 Miscellaneous 1,560 Rent books 577 14,668 The following table shows the number and nature of complaints received during the year:— Table No. 33 Nuisances caused by the keeping of animals 11 Accumulation of refuse, etc. 34 Other complaints in relation to house refuse 17 Offensive smells 21 Vermin 63 Choked drains 96 Dampness 38 Defective roofs, gutters, etc 35 Defective sanitary fittings 68 Dirty condition of houses 8 Miscellaneous 130 Other defective conditions of houses 150 671 39 Court Proceedings. Legal proceedings were instituted under the Public Health Act for the following infringements:— Exchange of rags for toys: Defendant was fined £1 and 40s. costs. Filling milk bottles on unregistered premises. Fouling of the footpath by dogs. Chimney firing under Town Police Clauses Act: the Defendant was fined 5s. and costs. 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. Eradication of Bed Bugs. Statistics for the year:— (a) Number of Council houses (1) found to be infested 59 (2) disinfested during the year 59 (b) Number of other houses (1) found to be infested 39 (2) disinfested during the year 39 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 11½ 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. 40 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 replaced at the expiration of 24 hours. Smoke Abatement. Twenty-one 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. 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, 1936, 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 reported and action taken in all three cases. Schools. There are eight 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 6,085. 41 Canal Boats. During the year 4 visits were paid to the canal and 57 boats were inspected. The general condition of the boats and their occupants was satisfactory. Fifteen notices were sent out, seven being complied with, one boat being taken out of commission, and there are seven outstanding cases. There were 110 complaint notices issued by other authorities. 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 five 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 1 10/5/38 215 62 + in 2 c.c. + in 30 c.c. — Moderately Satisfactory 2 14/6/38 2 -1 0 in 100 c.c. 0 in 30 c.c. — 1778 Satisfactory 3 5/7/38 12 5 0 in 100c.c. + in 15 c.c. — 1868 Satisfactory 4 28/8/38 635 270 + in 25 c.c. + in 10 c.c. — 3609 Not Satisfactory 5 13/9/38 4 3 0 in 100 c.c. 0 in 33 c.c. - 504 Satisfactory 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 August sample was due to the fact that the chlorination plant was out of commission for a few days, but arrangements have been made to avoid difficulty in future. 42 There are no privately owned swimming baths or pools used by the public. Mortuary and Post-mortem Room. The Mortuary is situated in the Cemetery Ground, Havelock Road. It is antiquated and out of date. The provision of alternative accommodation is being considered. During the year 27 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 510 36 - 43 The following table shows the number and nature of the defects found in connection with factories and workshops during the year:— 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 14 14 — — Want of ventilation 1 1 — — Overcrowding — — — — Want of drainage to floors 1 1 — — Other nuisances . 6 6 — — Sanitary Accommodation— Insufficient 4 4 — — Unsuitable or defective 10 10 — — Not separate for sexes — — — — Offences under the Factory and Workshops Acts— Illegal occupation of underground bakehouses — — — — Other offences — — — — 36 36 — — * 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 56 applications were received for the renewal of petrol licences for similar quantities as hitherto; seven applications were received for licences to store an increased quantity. In each instance the application was granted. Seven 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 one infringement of the terms of the licences was recorded. The number of licences in force at the end of 1938 within the Borough was 63 for petroleum and 1 for carbide. The quantity of petrol covered by the petrol licences was 342,580 gallons and the quantity of carbide covered by the licence was 6 cwt. 44 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. 45 The statistics for the year are shown in the following table:— Table No. 37 Number of shops inspected 2,527 Number of infringements re exhibition of notices 219 Number of infringements re hours of employment 4 Number of infringements under Section 10 of the 1934 Act 74 Number of infringements of the Shops (Hours of Closing) Act, 1928 15 Number of applications for exemption certificates under Section 10 of the Shops Act, 1934 — Number of cases in which such certificate was granted — Number of police court proceedings — Number of infringements of Sec. 10 of the Act of 1912 1 Number of infringements of Sec. 4 of the Act of 1912 6 Number of infringements of Sec. 3 of the Act of 1912 6 re Notices under Sunday Trading (Restriction) Act, 1936 46 re Section 1 of the Sunday Trading (Restriction) Act, 1936 10 re Early Closing Orders 5 re Section (1) 1 of the Shops Act, 1912 10 re Sec. 2 of the Shops (Hours of Closing) Act, 1928 1 40 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) 1,695 (b) Number of inspections made for the purpose 8,125 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 835 (b) Number of inspections made for the purpose 6,043 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 31 (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 567 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 335 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 42 (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 3 (1) Number of dwelling-houses in which defects were remedied after service of formal notices: (a) By owners 3 (b) By local authority in default of owners 0 47 (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 18 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 18 (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 — (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement room having been rendered fit 4. Housing Act, 1936—Overcrowding— (a) (1) Number of dwellings overcrowded at the end of the year 28 (2) Number of families dwelling therein 28 (3) Number of persons dwelling therein 336 (b) Number of new cases of overcrowding reported during the year 40 (c) (1) Number of cases of overcrowding relieved during the year 118 (2) Number of persons concerned in such cases 667 (d) Particulars of any case in which dwelling-houses have again become overcrowded after the local authority have taken steps for the abatement of overcrowding 0 Since the appointed day, 1st January, 1937, three cases of overcrowding were found by the Department, two of which are receiving the attention of the Department. During the year 222 houses at the Dane Road Housing Site were completed, and plans have been prepared and estimates submitted for a further 122 houses on the Dormers Wells housing site. (e) Any other particulars with respect to overcrowding conditions upon which the Medical Officer of Health may consider it desirable to report: Nil. 48 INSPECTION AND SUPERVISION OF FOOD Milk. During the year one purveyor of milk was added to the register. At the end of the year there were 42 purveyors of milk on the register. This number includes 14 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, 1 for accredited milk, 21 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 Institute for 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. During the year 133 samples were taken in this way, and it was considered that of these samples 19 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. During the year 34 samples were taken for the phosphatase test; 31 samples were officially pasteurised and were negative. 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 49 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 liis 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 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 sterilising 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 contantly 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 1,162 visits were paid to places where food is prepared. During 1938 there was one registered slaughterhouse in the district. There is no public abattoir. During the year 20 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 0 0 0 0 Pigs 20 20 0 0 Sheep and Lambs 0 0 0 0 Total 20 20 0 0 50 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 218 lbs. Turkey 10 Pickled Walnuts 742 lbs. Herring Roe 142 lbs. Tomatoes 1 lb. Tongue 36 lbs. Gooseberries 14¾ cwts. Beef 8 cwts. 7 lbs. Pears 368 lbs. Fish 38 lbs. Jellied Veal 18 lbs. Slaughter of Animals Act, 1933. Under Section 3 of the Act, two licences each of three years' duration were issued to slaughtermen during 1938. 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:— 51 Table No. 39 Article Taken Adulterated Milk 114 - Ammoniated Tincture of Quinine 1 - Aspirin 2 - Boracic Acid Ointment 1 - Camphorated Oil 1 - Eucalyptus Oil 1 - Gin 4 - Jam 1 - Rum 1 - Sausages 1 1 Sheep's liver 1 1 Sild 1 - Tincture of Iodine 2 - Whisky 3 - White Precipitate Ointment 1 - Zinc Ointment 1 - 136 2 No. of Prosecutions 1. No of Convictions 1. In addition, under Section 16 of the above Act, the following samples were taken by officers of the Health Department:— Table No. 40 Sausages 20 Bloater Paste 1 Salmon Paste 1 Paste 3 Peas 2 Chicken and Ham Paste 1 Kipper Paste 2 Tomato Cream 1 Sandwich Paste 1 Tomato Sauce 1 Chemical and Bacteriological Examination of Food. The chemical or bacteriological analyses of samples taken by the Health Department are carried out by the Clinical Research Association. 52 PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. The Southall Isolation Hospital continued to take cases 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 1938, 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 1938 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 265. 53 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 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 1938 825 265 298 32 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 402 Covers 477 Beds 670 Eiderdowns 137 Blankets 1,241 Pillows 1,061 Bolsters 336 Sheets 797 Books 236 Miscellaneous 406 Total 5,763 The following articles were destroyed: 33 mattresses, 4 bolsters, 2 sheets, 19 pillows, 2 blankets, 1 eiderdown, 100 articles of clothing. Cancer. It will be seen by the table of causes of death (page 11) that in 1938 57 cases (27 males, 30 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 1938 there was a decrease in the cancer mortality. 54 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 1933 30 27 57 48,270 1.18 1936 22 30 52 49,550 1.05 1937 42 28 70 51,560 1.35 1938 27 30 57 52,400 0.51 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 — — — 4 10 1 11 1 Female — 1 3 3 4 6 9 4 Total — 1 3 7 14 7 20 5 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 315 as compared with for 141 the previous year. Of these, 261 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. 55 Administration of Prontosil alba, the new therapeutic agent of use in the treatment of streptococcal infections, of which scarlatina is a typical example, was continued 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 99 cases of diphtheria notified as compared with 119 in 1937. Ninety cases were removed to the Isolation Hospital. There were eight deaths from diphtheria of residents during the year. Several of the cases were of a severe type and this accounts for the high fatality rate. Dipththeria 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 Council of the Borough of Southall 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. 56 THE DIPHTHERIA IMMUNISATION CLINIC IS HELD PROM 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 BENEFITING 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. GRUNDY, M.D., D.P.H., Medical Officer of Heal III. A general report of the attendances at clinical sessions during the year is shown in the following table No. 45. Table No. 45 Number of sessions held 52 Number of new patients 273 Total attendances made 1,899 Average attendance per session 36 Highest attendance at a session 96 Lowest attendance at a session 5 During 1938 the number of new cases was 273 The number of children over the age of 6 years who were tested and found to be Schick negative, therefore not requiring immunisation 13 The number of patients in whom treatment was completed and a Schick test done afterwards found to be negative 133 The number of patients in which treatment was completed but who were waiting tests at the end of 1938 88 The number of patients with regard to whom treatment was unfinished in the year 1938 and will be completed later 14 The number of patients who failed to attend for final test after Three injections 1 Two injections 18 One injection 5 Only one child attended for a preliminary Schick test and subsequently failed to make any further attendance. It is the practice to Schick test all children at the age of 6 years and over who attend requesting immunisation, and during the year 68 children 57 were so tested. The age distribution of the preliminary Schick tested patients is shown in Table . Table No. 46 Age Groups (attaining the age stated during 1938) 6 or under 7 8 9 10 11 12 13 14 14 + Positive (55) 0 1 6 21 13 8 3 2 1 — Negative (13) 1 0 3 3 0 1 2 2 1 — Reactions. During the year there were no cases of local reaction as a result of an injection of the antigen, but on one occasion a child fainted when receiving her first injection; she subsequently attended quite cheerfully, and no further trouble was experienced. General. One interesting observation was made during the year that two siblings each required six injections of antigen in order to become Schick negative. After the first three injections in each case the test was positive and other injections were subsequently given. It was interesting that this only occurred on two occasions and the children concerned were brother and sister. The immunising material used throughout the year was Burroughs Wellcome & Co.'s Toxoid Antitoxin Floccules in dosages of 1 c.c. at not less than fortnightly intervals. Three doses of this material are required, but reactions are extremely rare and successful immunisation is accomplished in a high percentage of cases. After immunisation is completed, patients are requested to re-attend at the expiration of one year in order that a Schick test can be repeated with a view to ascertaining if there has been a relapse or if they still remain protected. During the year three children who had attended the immunisation clinic were admitted to the Southall Isolation Hospital. In two of these, diphtheria bacilli had been found in the throat but the children were not suffering from the disease itself. The third child, a boy of 6 years, was admitted suffering from a very mild attack of diphtheria and recovered without any serious complication. 58 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. 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 were two cases of ophthalmia neonatorum notified in 1938, as is shown in Table No. 47. 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. 47 Cases notified 2 Cases treated at home - Cases treated in hospital 2 Vision unimpaired 2 Vision impaired - Total blindness - Deaths — Acute Poliomyelitis. No case was notified in the Borough during the year. 59 The following table shows the various infectious diseases (other than suberculosis) notified during the year and also their age incidence:— Table No. 48 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 - 2 8 16 20 192 44 21 8 4 - — 315 261 — Diphtheria - 3 3 8 7 52 11 7 5 2 1 - 99 90 8 Enteric fever - - - - - - - 1 - — - 1 1* — Puerperal fever - - - - - - - - 4 - - — 4 4 — Puerperal Pyrexia Erysipelas - - - - - - 3 3 3 3 4 2 18 15* — Pneumonia - 1 - - - 3 - 2 6 7 8 2 29 20* 24 Ophthalmia 2 - - - - - - - - - - - 2 2* - Dysentery - - - - - 1 - - - - - - 1 1* - * To London hospitals or institutions outside the district. The number of eases of infectious diseases (including tuberculosis) notified during the year, according to their locality, are shown below:— Table No. 49. Diseases Total Waxlow Manor Northcote Hambrough Dormers Wells Glebe Norwood Green Admitted to Hospital Total deaths Scarlet fever 315 42 30 36 37 120 50 261 - Diphtheria 99 19 17 30 8 15 10 90 8 Puerperal fever 4 1 — — 1 1 1 4 - Puerperal pyrexia Pneumonia 29 9 2 1 6 11 — 20* 24 Ophthalmia neonatorum 2 1 — 1 — 1 — 2* — Tuberculosis (all forms) 60 13 12 12 2 12 9 — 33 Erysipelas 18 4 4 2 4 - 3 15* - Enteric fever 1 1 — — — - — 1* — Dysentery 1 — — — 1 - — 1* — Totals 529 90 65 82 59 160 73 394 65 * To London hospitals and institutions outside the district. 60 Cases of infectious diseases occurred during the year among school children as follows:— Table No. 50. School Scarlet Fever Diphtheria Beaconsfield Road 23 25 Biscoe's School, Church of England — — Clifton Road 27 6 County School 1 — Dormers Wells 10 8 Featherstone Road 42 2 North Road 90 2 St. Anselm's R.C. 9 - Talbot Road Special School — 2 Technical School, Beaconsfield Road l — Tudor Road 14 6 Western Road 62 3 Lady Margaret Road School 15 3 Burlington Park School, Greenford 1 — Westbourne School, Paddington, W. 1 — Drayton Manor County School 1 — St. Mark's School, Hanwell, W. 7 1 — Hadley Gardens Private School, Norwood Green 1 - Ravenor Park School, Greenford 1 - 232 57 Infectious Disease Visits. During the year, the Health Visitors paid 1,486 visits with reference to cases of infectious disease. Four hundred and fifty-eight swabs were taken. The total number of children examined by the Health Visitors in the schools was 6,085. The following table shows the number of children excluded from the schools and the reasons for their exclusion:— Table No. 51 Scarlet fever contacts 136 Diphtheria contacts 7 Sore throat 11 Various 34 188 61 Uncleanliness and Verminous conditions in School-children. I am obliged to Dr. J. Tate, the school medical officer, for the information on this subject:— Number of children on roll at 31st December, 1938 6,713 Total number of examinations of children in the schools by the school nurses 17,328 Number of individual children found unclean 657 Number of children cleansed under arrangements made by the Local Education Authority Nil 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 52; 19 of these were notified from Institutions (Sanatoria 5, County Council Hospitals 1, General Hospitals 13). Other Forms of Tuberculosis. The number of new cases notified during the year was 8. Deaths from Tuberculosis. Tuberculosis of the respiratory system 28; other forms 5. 62 The following table shows the new cases notified and the deaths in 1938. Table No. 52. Age Periods New Cases Pulmonary Non-Pulmonary Deaths Pulmonary Non-Pulmonary Male Female Male Female Male Female Male Female 0-1 - - - - - - - - 1-5 - — - - - - - 1 5-10 - - 1 1 - - - - 10-15 1 1 - - - - - - 15-25 8 12 1 1 4 6 1 - 25-35 9 9 1 1 7 5 1 2 35-45 4 4 - 2 2 1 - - 45-65 4 - - - 3 - - - 65+ - - - - - - - - Totals 26 26 3 5 16 12 2 3 Of the 33 deaths, 32—or 27 per cent.—were of notified cases. The occupations of the new cases were as follows:— Table No. 53. Occupations Pulmonary Non-Pulmonary Male Female Male Female Building and decorating trades 4 - - - School children 1 1 1 - Clerical work 1 2 - - Clothing and dressmaking 1 1 - - Domestic duties - 6 - 2 Factory hands 5 4 - 1 Furnishing trades 2 - — - Sale of food and drinks 2 - - No occupation 6 6 1 1 Various 6 4 1 1 Totals 26 26 3 5 63 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. Table No. 54. Year 1932 1933 1934 1935 1936 1937 1938 Estimated mid-year population (excluding Hanwell Asylum) 39.030 42,280 44,180 46,000 47,200 48,760 49,600 M. F. M. F. M. F. M F M F. M. F. M. F. No. of new cases notified each year— Pulmonary 29 28 26 31 31 19 33 17 27 23 31 20 26 26 Non-pulmonary 8 4 5 4 6 6 3 2 4 2 7 9 3 5 Total 69 60 62 55 56 67 60 Notifications per 100,000 population 177 156 140 119 118 137 114 M. F. M. F. M. F. M. F. M. F. M. F. M. F. No. of deaths each year— Pulmonary 14 10 18 19 17 10 13 10 19 13 14 13 16 12 Non-plumonary - 2 4 3 1 2 3 3 1 2 5 2 2 3 Total 26 44 30 29 35 34 33 Deaths per 100,000 population 67 104 68 63 74 69 62 Public Health (Prevention of Tuberculosis) Regulations, 1925. Public Health Act, 1936, Section 172. Action under these powers was not necessary during the year. 64 REPORT ON THE BOROUGH ISOLATION HOSPITAL. During the year 351 patients were admitted to the Isolation Hospital as compared with 256 in 1937. Of these, 261 were sent in as scarlatina (134 in 1937 ) and 90 as diphtheria ( 122 in 1937 ). Of the cases sent in as scarlatina, 7 were unconfirmed and were diagnosed as suffering from other diseases. Similarly, of the cases sent in as diphtheria or suspected diphtheria, 14 were unconfirmed. The following two tables show the figures for the year and for each month respectively. Table No. 55. Remaining on 1.1.38 Admitted during year as Subsequently diagnosed as Discharged recovered Died Mort. per cent. Remaining 31.12.38 Scarlatina 7 261 254 241 - - 20 Diphtheria 26 90 76 96 5 5 3 Other diseases — — 21 20 1 4.7 1 Table No. 56 Number admitted. Final diagnosis Number discharged Deaths Transfers Readmissions Sc. F. Diph. Others Sc. F. Diph. Others Diph. Others Diph. Sc. F. Diph. Sc. F. January 17 14 4 7 22 - 1 - — — - — February 20 6 1 16 9 5 1 - 3 - 4 - March 29 1 - 19 4 - — - - - - — April 25 4 2 27 9 1 - - - - 1 - May 26 15 1 24 3 1 - - - - 1 — June 14 3 2 27 6 3 - - - - - — July 17 9 1 15 7 1 1 - - - — - August 11 5 19 4 1 - 1 2 1 2 1 September 19 13 3 11 15 2 2 — - - - — October 31 4 3 18 7 4 - - - - - - November 28 2 9 30 8 2 - - - - - - December 17 - 1 28 2 - - - - - - - 254 76 21 241 96 20 5 1 5 1 8 1 Included in the above table are four cases of diphtheria and one case of scarlatina who were transferred for tonsilectomy to another hospital and readmitted after the lapse of a few days. 65 Scarlatina. Of the 261 cases notified 254 were finally diagnosed, and the following table shows the incidence in age groups of the 254 cases of scarlatina which were nursed at the hospital:— Table No. 57. Age (years) 0-5 5-15 15-25 25-35 35+ Number 33 193 17 8 3 The disease on the whole was fairly mild. Five 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 1.97 per cent., which is low. One minor operation was performed for abscess in the arm. Six cases of scarlatina were admitted incubating other diseases, and of these two developed Rubella on separate occasions, one after five days and one after 18 days. One patient who had been in contact with morbilli at home developed this disease eight days after admission, but the four hospital contacts were given human immune serum with complete protection. One patient developed an illness strongly resembling morbilli 18 days after admission although no cases of this disease were present in the hospital at that time. Two contacts developed a similar condition with mild rash 17 days later. One child developed Pertussis a few days after admission, but no secondary cases followed. One child developed erysipelas in addition to the scarlatina for which she was admitted, despite the fact that prontosil alba was being used for treatment. Two cases were double infection on admission suffering coincidently from scarlatina. One case developed scarlatina six days after admission, and one case developing morbilli 10 days after admission produced two mild secondary infection despite the use of specific immune serum. 66 In all 2,308,000 units of antitoxin were given to the 76 cases of diphtheria, the highest dosage being 86,000 units. In four cases antitoxin was given intravenously in addition to the routine intramuscular injection. The use of prontosil alba was continued for alternate cases, and the table below indicates the complication experienced in the 254 patients. Complications of the cases of scarlatina which were treated by: Prontosil. Serum. Total. Cervical adenitis 5 7 12 Rhinorrhoea 1 1 2 Otorrhoea 8 6 14 Nephritis 1 3 4 Septic fingers 1 3 4 Secondary attacks 4 2 6 Bacteriological Diphtheria 3 3 6 Mixed Infections. One of the scarlatina cases on admission was found to be suffering in addition from faucial diphtheria. Diphtheria. Ninety cases notified as diphtheria were admitted to the hospital. Seventy-six of these were confirmed as diphtheria. The following table shows the incidence of the cases in age groups:— Table No. 58. Age (years) 0-5 5-15 15-25 25-35 35+ Number 14 49 8 4 1 The clinical types in which the diagnosis was substantiated were as follows:— Anterior Nasal 10 Laryngeal — Tonsillor (Faucial) 34 Naso-pharyngeal 15 "Bacteriological" 17 67 The disease was of a severe type, and in 20 cases there was marked toxaemia on admission. The complications recorded were as follows:— Myocarditis 3 Cardiac Failure 1 Paresis of the eye 2 Paresis of the palate 4 Otitis media 2 Pulmonary oedema 1 In five instances the disease was fatal. Other Diseases. Twenty-three patients admitted as scarlatina or diphtheria were subsequently diagnosed as suffering from other diseases. These were as follows (two cases notified as diphtheria and subsequently diagnosed as scarlatina are included in the return of this second disease):— Diseases notified as scarlatina: Tonsilitis 3 Rubella 2 Morbilli 1 Catarrhal Jaundice 1 Pustular dermatitis 1 Impetigo 1 Diseases notified as diphtheria: Tonsillitis etc. 9 Rhinitis 1 Scarlatina 2 Bronchial Asthma 1 Tetany 1 Stay in Hospital. The average stay in hospital was as follows:— Scarlatina : All cases (254) 39.1 days Patients remaining over 56 days 81.0 „ Patients remaining under 56 days 36.5 „ Diphtheria: All cases (76) 61.8 „ Patients remaining over 56 days 94.2 „ Patients remaining under 56 days 32.6 „ Other diseases: All cases (21) 11.1 „ 68 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 1,160 Swabs for virulence tests for diphtheria 42 Haemolytic streptococci 10 Wasserman Reaction 3 Sputum for tubercle 1 Urine for organisms 1 Sick Staff. Table No. 60 Permanent. Temporary. Number of staff off duty for 24 hours or more 3 3 Total number of days off duty 63 235 Casual conditions— Scarlatina — 45 Diphtheria — — Other 63 190 69 Costs. The following particulars, kindly supplied by the Borough Treasurer, W. Hadyn Perkins, Esq., show the expenditure in connection with the Isolation Hospital for the year ended 31st March, 1939:— £ Salaries and Wages 1,612 Superannuation and National Insurance Contributions 229 Repairs and maintenance of buildings and pland and upkeep of grounds 195 Heating, lighting, cleaning and water 705 Rates, Taxes and Insurance 266 Furniture, fittings, equipment and uniforms 110 Bacteriological examinations 133 Medical requisites and instruments 237 Printing, stationer}-, postages and telephones 57 Provisions 843 Ambulance 39 Other expenditure 30 4,456 Maintenance in other Hospitals 641 Total £5,097 I am, your Worship, Ladies and Gentlemen, Your obedient Servant, E. GRUNDY, Medical Officer of Health. Manor House, Southale. June, 1939. 70 APPENDIX A Statutes. Food and Drugs Act, 1938. Housing (Financial Provisions) Act, 1938. Young Persons (Employment) Act, 1938. Ministry of Health. Circulars. No. 1674—Registration of Nursing Homes. 1675—Public Health (Imported Food) Regulations, 1937. 1678—Midwives Act, 1936. 1684—Water Supplies. 1685—Agriculture Act, 1937. Part IV Milk and Dairies Acts and Orders— Tuberculosis Order, 1938. 1687—Capital Expenditure: Survey of Prospective Works. 1688—Building By-laws. 1690—Public Health (Imported Food) Regulations, 1937. 1693—Midwifery Training. 1694—Health Visitors—Training. 1695—Interference with Radio Reception caused by Electro-Medical Apparatus. 1696—Housing (Financial Provisions) Act, 1938. 1697—Housing (Financial Provisions) Act, 1938. 1698—Poor Law (Amendment) Act, 1938. 1702—Departmental Committee on the Cost of Hospitals—Final Report. 1704—Housing (Financial Provisions) Act, 1938. 1705—Maternal Mortality, Medical Practitioners called in by Midwives. 1706—Housing (Financial Provisions) Act, 1938, manual. 1707—Public Health (Imported Food) Regulations, 1937. 1714—Midwives Act, 1936. 1716—Housing (Rural Workers) Amendment Act, 1938. 1719—Public Health (Imported Food) Regulations, 1937. 1724—Smallpox. 1727—Public Health (Imported Food) Regulations, 1937. 1732—Air Raid Precautions—Provision of Hospital Accommodation. 1741—Public Health (Imported Food) Regulations, 1937. 1743—Local Government Acts, 1929 and 1938—Modification of provisions relating to the supplementary Exchequer grants of county districts. 1755—Food and Drugs Act, 1938. 1756—Building By-laws. 71 Statutory Rules and. Orders. Public Health (Nursing Homes Registration Form) Regulations, 1938 (S.R. & O., 1938, No. 32). Midwives (Certifying Hospitals and Institutions) Order, 1938 (S.R. & O., 1938, No. 147). Milk and Dairies Amendment Order, 1938 (S.R. & O., 1938, No. 217). Milk (Special Designations) Amendment Order, 1938 (S.R. & O., 1938, No. 218). Public Health (Aircraft) Regulations, 1938 (S.R. & O., 1938, No. 299). Registration of Births, Stillbirths and Deaths Regulations (S.R. & O., 1938, No. 569). Midwives (Certifying Hospitals and Institutions) Order (No. 2) (S.R. & 0 1938, No. 689). Memoranda. Conditions upon which grants will be made by the Minister of Health in aid of Midwifery training. Factories Act, 1937. Memorandum as to duties of local authorities. Memorandum on Smallpox. Bacteriological Investigation with reference to puerperal sepsis. Secretary of State. Statutory Rides and Orders. Factories (Cleanliness of Walls and Ceilings) Order, 1938 (S.R. & O., 1938. No. 487). Sanitary Accommodation Regulations, 1938 (S.R. & O., 1938, No. 611). Poisons (Amendment) Rules, 1938 (S.R. & O., 1938, No. 1548). Factories (Notification of Diseases) Regulations, 1938 (S.R. & O., 1938, No. 1386). Young Persons (Employment) Adaptation Order, 1938 (S.R. & O., 1938, No. 1502). Poisons List (Amendment) Order, 1938 (S.R. & O., 1938, No. 1547). Young Persons (Employment) Order, 1938 (S.R. & O., 1938, No. 1501). 72 APPENDIX B 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. 73 INDEX Acute poliomyelitis 59 Ambulance facilities 18 Ante-natal clinics 23-25 Antitoxin 53 Area of borough 6 Assisted services 35 Bed bugs 40 Birth Control. 23 Births and birth rate 10, 14 Canal boats 42 Cancer 54 Causes of death 11 Celluloid and Cinematograph Film Act 4 5 Clinics 16, 17 Closet accommodation 38 Common lodging houses 43 Consultant aid 22 Deaths and death rates 10, 11, 12 Dental treatment 34 Diphtheria 56 Diphtheria Prevention Clinic 56-58 Disinfection 54 Disinfestation 40 Drainage and Sewerage 37 Factories, Workshops and Workplaces 43 Food 49-52 Foster Children 21 Health Education 19 Health Services, General provision of 16-23 Health visiting 21, 61 Hospitals 19 Houses—Number inhabited 6 Housing 47, 48 Infant life protection 21 Infant mortality 10, 15 Infant welfare clinics 16, 17 Inspection and Supervision of Food 49-52 Isolation Hospital 65-70 Laboratory facilities and work 16, 18, 69 Maternal morbidity and mortality 15 Maternity and Child Welfare 21, 26 Maternity and Child Welfare Committee 2 Maternity and Nursing Homes 34 Meat and other foods 50 Medical relief 19 Midwives 32 Milk supply 49 Milk grants 34 Mortuary 43 Notifiable diseases 53-64 Nursing in the Home 16 Nutrition 29 Offensive trades 43 Official publications 71, 72 Ophthalmia Neonatorum 59 Orthopaedic treatment 31 Overcrowding 48 Petroleum Acts 44 Physical feature of district 6 Poor Law medical relief 19 Population 6 Premises and occupations controllable by bye-laws 43 Pre-school medical inspection 27-31 Public cleansing 38 Public Health Committee 2 Puerperal fever and pyrexia 15 Rainfall 6 Rateable value 6 Refuse collection 38 Remedial Exercises 31 Sanitary circumstances 37-45 Sanitary inspection 38 Scarlet fever 55 Schools 41 Sewerage 37 Shops 46 Slaughter of Animals Act 51 Slaughterhouses 50 Smoke abatement 41 Social conditions 6 75 index—continued Staff 5 Statistics—General and Vital 6 Stillbirths 10 Swimming bath 42 Tents, vans, sheds, etc. 43 Tuberculosis 62-64 Underground sleeping rooms 43 Unemployment 8 Unfit houses 47 Vaccination 53 Venereal disease clinics, etc. 17 Verminous persons 40 Vital statistics 10, 11, 12, 13 Voluntary help 32 Water supply 37 Wards 7 Workshops 43 76