SouT 7 BOROUGH OF SOUTHALL ANNUAL REPORT OF THE Medical Officer of Health for the Year 1939 E. GRUNDY, M.D., D.P.H., Medical Officer of Health. R 2294 614.09421 25-11-41 THE COUNCIL OF THE BOROUGH OF SOUTHALL, 1939. 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 : *Abbott, Mrs. M. *Hutchings, C. Bill, H. R. *Lowe, J. Braine, E. W. H. *Luckett, F. H. Dane, A. T. *McGuigan, Mrs. D. M. Eldridge, J. T. *Marks, F. 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-third Annual Report on the health and sanitary circumstances of the district. I am, your Worship, Ladies and Gentlemen, Your obedient Servant, E. GRUNDY, Manor House, Medical Officer of Health. Southall. December, 1940. 3 PUBLIC LIBRARY, HEALTH DEPARTMENT STAFF for the year 1939. Medical Officer of Health: Ernest Grundy, M.D., B.S.(Lond.), 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: Miss M. A. Glass, B.Sc., M.B., Ch.B., D.P.H. (Appointed April 1939). †Miss J. Moore, F.R.C.S. Sanitary Inspection Staff: Chief Sanitary Inspector: Ivor A. Stephenson, Cert.R.S.I., Cert. M. & F. (resigned December, 1938). R. W. McDonald, M.S.I.A. (appointed April, 1939). Sanitary Inspectors: A. D. Goold, Cert.S.I.E.J.B., Cert. M. & F. A. J. White, Cert. S.I.E.J.B. L. Mair, Cert. S.I.E.J.B., Cert. M. & F. F. C. Hills, Cert. R.S.I., Cert. M. & F. (appointed August, 1939). 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, (called up for Army Nursing Service, October, 1939). Miss M. Williams, S.R.N., S.C.M., H.V., Cert. R.S.I. Midwives:. Miss V. Robinson, S.R.N., S.C.M. Miss G. Robinson, S.C.M. Mrs. Delahaye, S.R.N., S.C.M. Miss Sandell, S.C.M. Miss Johnson, S.R.N., S.C.M. 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. N. V. Saunders. † 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. 4 STATISTICS AND SOCIAL CONDITIONS OF THE BOROUGH. Area (acres): Land, 2,554 5. Water, 50. Total, 2,604 5. Population—Registrar-General's estimate—mid-1938 *†52,680 Number of inhabited houses according to Rate Book 14,560 Rateable value £413,121 Sum produced by a penny rate £1,614 * This includes about 2,800 patients and staff resident at St. Bernard's Hospital. † This figure is used for calculation of birth rate. Population figure for calculating death and infectious disease rates is 52,430. The Borough of Southall is traversed by the main road from London to Oxford and is about nine miles from the Marble Arch. It is roughly triangular in shape and is bounded on the east and north by the Borough of Ealing, on the west by the Urban District of Hayes and Harlington, and on the south by the Borough of Heston and Isleworth. The greatest length of the district from north to south is 2 8 miles and the greatest breadth is 31 miles. The soil is mainly gravel, overlaid with clay and brick earth. The Council control the following parks and open spaces:— Southall Park 26 acres. Recreation Ground 18 acres. Manor House Grounds 2 acres. Norwood Green 7.25 acres. Frogmore Green .35 acre. Wolf Green .18 acre. Wolf Fields 3.33 acres. 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. West Middlesex Golf Course 136.16 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. 5 No. 2. Northcote Ward.—This ward is bounded on the north by the Waxlow Manor Ward as far as Allendale Avenue, on the east by North Road, on the south by the Uxbridge Road and on the west by the boundary of the Borough. No. 3. Hambrough Ward is bounded on the north by the Northcote Ward, on the east by South Road, on the south by the Great Western Railway line, and on the west by the boundary of the Borough. No. 4. Dormers Wells Ward is bounded on the north by the Waxlow Manor Ward and the boundary of the Borough, on the east by the boundary of the Borough, on the south by the Great Western railway branch line to Brentford, and on the west by the Hambrough and Northcote Wards. No. 5. Glebe Ward is bounded on the north by the Great Western Railway, on the east by King Street and Regina Road, and on the south and west by the boundaries of the Borough. No. 6. Norwood Green Ward is bounded on the north and east by Dormers Wells Ward, on the south by the boundary of the Borough, and on the west by the Glebe Ward. 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 The majority of the houses in the district are occupied by good class working people, chiefly engaged in the local factories and workshops. These include food, jam and chemical works, engineering, hosiery, paint, dye and wood works, laundries, etc. There are no trades carried on which are at present scheduled as offensive trades. Unemployment. It is impossible to give an exact estimate of the amount of unemployment in the district as for unemployment purposes the district is part of a slightly larger area of Middlesex, and the figures are not kept distinct. The following table, however, from statistics kindly supplied by the Manager of the Southall Labour Exchange, shows the unemployment figures on days during different months for this part of Middlesex:— * This included the resident population of St. Bernard's Hospital (late Hanwell Mental Hospital), which amounted to about 2,800. 6 Table No. 1. 1939. Men. Women. Total. January 17th 1700 588 2288 February 14th 1655 555 2210 March 14th 1418 626 2044 April 4th 1003 688 1691 May 16th 824 648 1472 June 13th 606 568 1174 July 18th 589 407 996 August 15th 521 297 818 September 12th 490 530 1020 October 17th 1208 636 1844 November 14th 942 601 1543 December 12 th 1015 639 1654 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 August. The average is lower than it was for 1938 (1,563 against 2,028). 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 1939 14,560 52,680 „ 3.61 * 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. 7 EXTRACTS FROM VITAL STATISTICS Total Male Female Comparative figures for 1938. Live Births—Legitimate 771 379 392 794 Illegitimate 34 17 17 31 Stillbirths—Legitimate 18 11 7 31 Illegitimate 1 1 - Deaths 455 236 219 453 Birthrate (live and stillbirths) per 1,000 of estimated population 15.64 16.34 Stillbirth rate per 1,000 total (live and still) births 23.06 36.21 *Crude death rate per 1,000 of the estimated population 8.68 8.64 ‡ Comparability factor 1.14 1.14 *Comparable death rate 9.89 9.85 Deaths from Puerperal Causes (Headings 29 and 30 of the RegistrarGeneral's Short List): Deaths. Rate per 1,000 total (live and still) births. No. 29. Puerperal sepsis 1 1.21 2.36 No. 30. Other puerperal causes 2 2.43 — Total 3 3.65 2.36 Death rate of infants under one year of age:— All infants per 1,000 live births 58.60 65.45 Legitimate infants per 1,000 legitimate live births 54.68 59.20 Illegitimate infants per 1,000 illegitimate live births 147.15 258.06 Deaths from cancer (all ages) 74 57 Deaths from measles (all ages) — 1 Deaths from whooping cough (all ages) 1 2 Deaths from diarrhoea, etc. (under 2 years of age) 4 8 * 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 9.17 and the comparable death rate would be 10.45. ‡ See Note 2 on page 12 of the report for 1934. 8 Causes of Deaths, 1939. Table No. 3. Male Female. Total I939. Total 1938. 1. Typhoid fever, etc. — - - - 2. Measles - — — 1 3. Scarlet fever - - - - 4. Whooping cough 1 - 1 2 5. Diphtheria - 1 1 8 6. Influenza 4 — 4 3 7. Encephalitis lethargica - 1 1 - 8. Cerebro-spinal fever - 1 1 1 9. Tuberculosis—respiratory 19 11 30 28 10. Other tuberculosis 3 5 8 5 11. Syphilis - 1 1 - 12. General paralysis of the insane, etc. - — — — 13. Cancer 33 41 74 57 14. Diabetes 1 5 6 10 15. Cerebral haemorrhage 4 8 12 15 16. Heart disease 66 45 111 103 17. Aneurysm 1 1 2 2 18. Other circulatory diseases 14 26 40 35 19. Bronchitis 7 4 11 10 20. Pneumonia (all forms) 12 10 22 24 21. Other respiratory diseases 2 2 4 6 22. Peptic ulcer 3 - 3 5 23. Diarrhoea, etc. (under 2 years) 1 3 4 8 24. Appendicitis 3 2 5 6 25. Cirrhosis of liver 1 - 1 2 26. Other liver diseases 2 - 2 3 27. Other digestive diseases 3 3 6 9 28. Nephritis 3 1 4 6 29. Puerperal sepsis - 1 1 2 30. Other puerperal causes - 2 2 — 31. Congenital causes, etc. 13 18 31 35 32. Senility 5 7 12 10 33. Suicide 1 - 1 4 34. Other violence 16 5 21 18 35. Other defined causes 18 13 31 35 36. Ill-defined causes - - - - 37. Diarrhoea - 2 2 - Special Causes (included in No. 35):— M. F. Smallpox - - - - - - Poliomyelitis - - - - - 1 Polioencephalitis - - - - - - Total Deaths 236 219 455 453 9 Deaths and Death Rate—Whole District. Total deaths, 455. (Males, 236; Females, 219.) Crude Death Rate, 8 68 per 1,000. The total number of deaths registered of persons belonging to the district and dying within the district at all ages and from all causes was 189 (males 89 and females 100). 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 266 in number (males 147 and females 119). The total number of deaths therefore belonging to the district is 455 and the crude death rate 8.68. The deaths of non-Southall residents in the St. Bernard's Hospital (not included in the above figures) numbered 178 (males 85 and females 93). The death rate since 1883 grouped in five-yearly periods is shown in Appendix A. / 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 25 29 54 Northcote 38 26 64 Hambrough 41 34 75 Dormers Wells 33 34 67 Glebe 59 51 110 Norwood Green 40 45 85 Total 236 219 455 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 1939, the figures being provisional. 10 Table No. 5. Vital Statistics compared with other Areas. BIRTH.RATES, DEATH.RATES, ANALYSIS OF MORTALITY, MATERNAL DEATH. RATES, AND CASE.RATES FOR CERTAIN INFECTIOUS DISEASES IN THE YEAR 1939. (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 Southall Rates per 1,000 Population Births:— Live 15.00 14.8 15.6 12.3 15.28 Still 0.59 0.59 0.57 0.04 0.36 Deaths:— All Causes 12.1 12.00 11.2 11.9 8.68 Typhoid & Paratyphoid fevers 0.00 0.00 0.00 0.00 0.00 Smallpox — — — — — Measles 0.01 0.01 0.01 0.00 0.00 Scarlet fever 0.01 0.00 0.00 0.00 0.00 Whooping Cough 0.03 0.03 0.02 0.03 0.02 Diphtheria 0.05 0.05 0.04 0.02 0.02 Influenza 0.21 0.19 0.20 0.18 0.57 Notifications:— Smallpox 0.00 — — — — Scarlet fever 1.89 1.96 1.78 1.53 2.34 Diphtheria 1.14 1.21 1.16 0.98 0.30 Enteric fever 0.04 0.03 0.04 0.03 0.01 Erysipelas 0.34 0.40 0.31 0.37 0.22 Pneumonia 1.02 1.21 0.89 0.99 0.61 Rates per 1,000 Live Births Deaths under 1 year of age 50 53 40 48 58 Deaths from Diarrhoea and Enteritis under 2 years of age 4.6 6.3 3.00 8.2 49.1 Maternal Mortality:— Puerperal Sepsis 0.77 Not available 3.74 Others 2.16 Total 293 Rates per 1,000 Total Births (i.e. Live and Still) Maternal Mortality:— Puerperal Sepsis 0.74 Not available 3.65 Others 2.08 Total 2.82 Notifications:— Puerperal fever 14.35 17.26 12.99 3.31 9.74 Puerperal pyrexia 14.22 11 Births and Birth Rate (figures for 1938 are given in brackets). The total number of births notified to the Health Department under the Public Health Act, 1936, was 797 (885). The total number of registered births in the district (under the Births and Deaths Registration Act—included in the notified births above) was 454 (479). The total number of live births belonging to the district whether occurring within or outside the district was 805 (825). The illegitimate live births were 34 (31). There were 19 stillbirths (31), and these with one exception were legitimate. This gives a live birth rate per 1,000 population of 15.28 (1575) and a stillbirth rate per 1,000 total (live and still) births of 23.06 (36.21). The birth rate grouped in five-yearly periods since 1892 is shown in Appendix A. 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 13 7 4 4 14 4 46 February 2 4 8 6 15 11 46 March 4 6 6 3 4 4 27 April 8 4 3 2 10 5 32 May 14 8 5 2 14 13 56 June 13 10 4 — 9 4 40 July 13 2 3 2 15 8 43 August 3 4 — 1 7 5 20 September 5 7 5 1 13 8 39 October 7 8 8 2 10 7 42 November 7 8 6 4 10 5 40 December 6 8 1 3 4 1 23 95 76 53 30 125 75 454 Table No. 7. The following table gives an analysis of the places of confinement. Total Confinements (live births and still births), 824. No. born in Hillingdon County Hospital 146 or 17.72% No. born in London voluntary hospitals 112 or 13.59% No. born in nursing homes or other hospitals 204 or 24.76% No. confined in their homes by midwives or doctors 362 or 43.93% Infant Mortality. The total number of deaths under one year of age was 47. The rate per 1,000 births was 58. The corresponding rate for England and Wales was 50, for London 48, and for the . 148 smaller towns 40 per 1,000. This shows an infant mortality rate higher than last year when it was 54. The infant mortality rate in five-yearly periods since 1892 is shown in Appendix A. The various deaths from stated causes at ages under one year of age are shown in the subjoined table. 12 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. 1 2 - - 3 3 1 - - 7 Atelectasis 3 — 2 — 5 — — — — 5 Sarcoma — — — — — — — — 1 1 Congenital Malformations, etc. 5 - - - 5 - 1 1 - 7 Cerebral Haemhorrage 3 1 1 — 5 — — — 1 6 Gastro-enteritis, Diarrhoea, etc. - - - - 1 3 2 - - 6 Marasmus - - 1 — 1 1 — — - 2 Heart Disease - - - 1 1 2 1 1 - 5 Prematurity 7 - - - 7 — - - - 7 Septicaemia - - - - - - 1 - - 1 19 3 4 2 28 9 6 2 2 47 Live Births. Legitimate, 771. Illegitimate, 34. Infant Deaths. Legitimate, 42. Illegitimate, 5. 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 seven cases of puerperal pyrexia were notified. One occurred after confinement at Mile End Hospital, and three in Hillingdon County Hospital, and one in West Middlesex Hospital. There were three maternal deaths during the year in connection with childbirth; two occurred in Hillingdon County Hospital, and one in King Edward Hospital. 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 1939 the total number of visits made by the nurses was 8,658. A certain number of these patients were referred to the Nursing Association from the Maternity and Child Welfare Clinics. The Council makes a monetary grant towards the service generally, and a specific grant per visit to toddlers treated under the Maternity and Child Welfare scheme. Infectious Disease {Measles). The Health Visitors act if need be as nurses in the case of Measles outbreaks. No call was made on their services during the year. Clinics and Treatment Centres. Table No. 9 shows the services provided in the district. A report on the work in the diphtheria prevention clinic is given on page 34. Laboratory Work. There has been no change in the arrangements for laboratory work since the last report. 13 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. Friday 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 North Road School Dental Inspection and Treatment of expectant and nursing mothers and children under 5 years Friday 2 p.m. and by appointment The Council M. and C.W. General Clinics Manor House Supervision of mothers and children under five years New Cases : Friday 2 p.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. Tuesday 2 p.m. Thursday 2 p.m. M. and C.W. Toddlers' (Special) Clinic Manor House Medical Inspection of pre-school children First and third Wednesday 10 a.m. The Council Branch Centre ditto Second and fourth Wednesday 10 a.m. The Council 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 The Council affords facilities to all medical men practising in the district for the examination of pathological specimens, and this work is carried out by the Lister Institute of Preventive Medicine. The following table shows the work done during the year 1939 (exclusive of work done for the Isolation Hospital). 14 Table No. 10. Positive. Negative. Swabs for diphtheria 13 247 Sputa for tubercle 24 110 Wasserman reaction 1 1 Swabs for haemolytic streptococci 2 2 Faeces for enteric - 4 Miscellaneous 2 - Total Examinations 42 264 Ambulance Facilities. For Infectious Cases. A Bedford motor ambulance, purchased in 1939, is in use for conveying infectious patients to hospital and for disinfection work. 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 non-infectious and accident cases to hospital and for other ambulance work. Efficient service continues to be rendered, and is quite adequate for peace-time requirements. The following figures show the year's working of the motor ambulances for noninfectious and accident cases:— Table No. II. Ordinary cases removed to hospital 1,111 Accidents 98 Persons taken ill in the street 49 Out of district cases 5 Total 1,263 Miles travelled in the year 1939 14,867 Poor Law Medical Relief. The Relieving Officer issued 262 Medical Orders during 1939. Some of these cases also received outdoor relief or institutional treatment. 15 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 health visitors during the year is as shown below:— Table No. 12. Summary of Health Visiting Work for the year 1939. Visits to infants— First visits 754 Re-visits 2,384 Visits to children— First visits 21 Re-visits 3,639 Visits to expectant mothers 513 Visits for infectious disease 526 Visits to schools 45* Child Life Protection visits 300 Miscellaneous visits 222 Removals 345 No access 746 Total 9,495 * At these visits a total of 1,771 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. 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 44 (b) At the end of the year 38 (2) Number of foster parents receiving foster children— (a) At the beginning of the year 29 (b) At the end of ;the year 24 (3) Number of children on the register— (a) At the beginning of the year 44 (b) At the end of the year 33 (4) Number of children received by foster parents during the year 79 (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 61 16 (c) Adopted 1 (d) Returned to parents 28 (e) Removed at the request of the medical officer of health - (f) Died during the year — (g) On whom inquests were held — (6) Total number of visits made during the year 300 (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. Ultra-Violet Light Clinic. Table No. 14. Number of sessions held: 30. Number of attendances:— First Visits. Re-visits. Mothers 18 127 Infants 72 706 Post-Natal and Birth Control Clinic. Table No. 15. Number of sessions held: 22. Number of attendances:— Post-Natal. Birth Control. First Visits 40 44 Re-attendances 39 207 Ante-Natal Clinics. Sessions:— Manor House, Tuesday, 2 p.m.-4 p.m., Thursday, 10 a.m.-12 noon. Branch Centre, Tuesdays and Fridays, 10 a.m.-12 noon. The arrangements detailed in the report for 1934 were unaltered during 1939. The number of new patients seen at the ante-natal clinics during the year was 506, and the total number of attendances was 2,615. 432 cases were completed during the year, and the attendances in respect of these were as follows:— No. of Cases. One attendance 41 Two attendances 40 Three attendances 31 Four attendances 38 Five attendances 50 Six or more attendances 232 17 The following table gives the figures for the last eight years and the proportion of new cases to re-visits. Table No. 16. 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 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 62.03 1939 506 2109 4.53 824 61.42 Of the 2,615 total attendances, 1,417 occurred at the Manor House centre and 1,198 at the Branch centre. Of the 506 new cases seen during the year, 490 were pregnant women and the remaining 16 were non-pregnant or post-natal cases. Of the 490 pregnant women 58 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 432 completed cases, 162 for 1938 and 270 occurring in 1939. Of these cases 389 were normal and 43 showed abnormalities. Table No. 17. Primipara Multipara Delivered at home Admitted to hospital or Nursing Home Primipara Multipara Primipara Multipara Normal cases 136 253 46 174 90 79 Abnormal cases 21 22 2 6 19 16 Of the cases dealt with therefore 157, or 36 per cent., were primiparae (against 39 per cent. in 1938) and of these 109 or 69 per cent. (against 67 per cent. in 1938) were confined in hospital, while 95 cases or 27 per cent. (against 44 per cent.) of the multiparae were also confined in hospital. The following table gives the chief abnormalities found during the year:— Table No. 18. (a) Abnormalities of the foetus— (i) twins 7 (ii) abortions 4 (iii) stillbirths 6 (iv) other conditions 4 18 (b) Abnormalities of the mother— (i) unsatisfactory measurements 12 (ii) heart disease 2 (iii) ante partum haemorrhage 3 (iv) albuminuria 9 (v) high blood pressure (exceeding 140 systolic or 90 diastolic other than on the first attendance) 58 (vi) other conditions 29 Neo-Natal Mortality (before the seventh day) 7 Maternity and Child Welfare Clinics. The attendances at the Child Welfare clinics during 1939 are shown in the following table:— Table No. 19. Manor House— Seen by medical officer: Infants 3,232 Children at ordinary clinics 1,310 Children at toddlers' clinics 257 Weighing only: Infants 2,171 Children 714 New cases (included in above): Infants 342 Children 87 Branch Centre— Seen by medical officer: Infants 3,934 Children at ordinary clinics 2,193 Children at toddlers' clinic 242 Weighing only: Infants 946 Children 453 New cases (included in above): Infants 310 Children 131 Total attendances 15,452 The total attendances at the clinics during the past six years have been as follows:- 1934 6,856 1937 12,502 1935 9,682 1938 14,351 1936 11,329 1939 15,452 It will be noticed that there was again a rather large increase in the total number of attendances in 1939 compared with the figure for 1938. This increase to 7 per cent. It is encouraging that the services available in this way appear to be appreciated. The subjoined table shows the proportion of new infant cases attending the clinics to the total in the district:- 19 Table No. 20. (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 1939 652 805 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. 502 attendances were made, 230 of these being at the Manor House, and 272 at the Branch centre. The results for the year are shown in the statistical tables given below. 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. 21. Number of Inspections in stated Groups: Manor House Branch Centre Total 18 months 81 94 175 2 years 51 68 119 3 years 50 46 96 4 years 34 43 77 Total Routine 216 251 467 Other inspections 14 21 35 Total 230 272 502 20 Table No. 22. Number of Individual Children found at Routine Medical Inspection to require Treatment (excluding Dental Disease): Manor House Branch Centre Total 18 months 23 13 36 2 years 18 25 43 3 years 14 14 28 4 years 9 14 23 Total 64 66 130 Table No. 23. Number requiring Dental Treatment: Manor House Branch Centre Total 18 months — - — 2 years — 1 1 3 years 5 — 5 4 years 11 12 23 Total 16 13 29 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. 24. Manor House Branch Centre Total A B C D 18 months A 11 28 39 128 8 — B 66 62 C 4 4 D — — 2 years A 21 19 40 74 5 — B 27 47 C 3 2 D — — 3 years A 14 20 34 59 3 — B 35 24 C 1 2 D — — 4 years A 18 14 32 41 4 - B 16 25 C — 4 D — — Total 216 251 145 302 20 — 21 Defects Found. Table 25 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. 25. Manor House Branch Centre Total Skin 1. Ringworm — — - 2. Scabies - — — 3. Impetigo - - - 4. Other diseases (non-tubercular) 8 7 15 Total 1-4 8 7 15 Eye 5. Blepharitis 3 3 6 6. Conjunctivitis — 1 1 7. Keratitis and opacities — — — 8. Other conditions (excl. defective vision and squint) 2 — 2 Total 5-8 5 - 5 9. Defective vision - - - 10. Squint 4 5 9 Ear 11. Defective hearing - - - 12. Otitis media 1 — 1 13. Other ear diseases 1 2 3 Nose and Throat 14. Chronic tonsils and/or adenoids 9 18 27 15. Other conditions 3 — 3 16. Enlarged cervical glands (non-tubercular) - 1 1 17. Defective speech 2 - 2 Heart and Circulation 18. Organic heart disease - 1 1 19. Functional heart disease - - — 20. Anaemia 1 - 1 Lungs 21. Bronchitis 2 2 4 22. Other non-tubercular diseases 2 — 2 23. Pulmonary tuberculosis - - - Tuberculosis 24. Glands - - - 25. Bones and joints - - - Nervous system 26. Chorea — - — 27. Other conditions - - - Deformities 28. Rickets deformities — — - 29. Genu valgum 18 months 4 7 11 2 years - 8 8 3 years 3 1 4 4 years 3 5 8 30. Other forms 1 - 1 31. Other defects and diseases 18 17 35 32. Dental diseases 18 months - - - 2 years - 1 1 3 years 5 - 5 4 years 11 12 23 22 Treatment. Cases of acute illness, and of chronic illness where indicated, are referred to their own doctors for treatment. For certain 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 Street, W.C. Child guidance West End Hospital for Nervous Diseases, Welbeck Street, W.r. 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. Two afternoon sessions of special Margaret Morris Movement exercises are held each week 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 deformityand 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 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. 23 Owing to the outbreak of war the sessions were not continued after the August recess and the attendances from January until the end of July are tabulated below:— Infants. Mothers. First visits 25 47 Re-attendances 426 235 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. Arrangements in the Council's Domiciliary Midwifery Service remain unchanged and leaflets are issued describing the services provided. 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 a satisfactory number of bookings is made each month. The monthly bookings for each district are included below:— Districts No. 1 No. 2 No. 3 No. 4 No. 5 January 9 2 2 9 3 February 4 6 4 5 3 March 8 4 5 5 2 April 9 2 1 6 7 May 8 5 2 3 4 June 7 4 3 6 5 July 3 3 3 5 8 August 1 5 7 5 5 September 7 7 4 8 7 October 9 8 3 2 6 November 9 6 2 8 1 December 9 3 5 5 7 The number of midwives who during January, 1939, 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. The following table, based on material kindly supplied by Dr. H. M. C. Macaulay, 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. 26. Medical Help, Mothers and Children 100 Laying out dead body 2 Liability to be a source of infection 6 Death of child 5 Stillbirths 3 Artificial feeding 12 24 The reasons for sending 100 notifications for medical help were as follows:— Table No. 27. Ante-natal conditions 12 Difficult or prolonged labour 59 Miscarriage 3 Other conditions (a) Mother 12 (b) Child 14 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. 28. Total number of registered nursing homes in Southall 2 Total accommodation 21 Number of deletions during the year 1939 0 Number of additional applications re registration during the year 1939 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 3,379 applications granted during the year, as follows:— Table NO. 29. Cow's milk free Cow's milk at 50% cost Dried milk free Dried milk at 50% cost 1938 2,246 396 182 33 1939 2,683 341 329 26 This shows a large increase on the number in 1938, when a total of 2,857 applications were granted. 25 Dental Treatment. By arrangement between this Council and the County Education Authority, expectant and nursing mothers and children under five years of age attending the Maternity and Child Welfare Centres are enabled to have dental treatment and advice, including if necessary the provisions of dentures. Below are the details of the year's working of the clinic:— Table No. 30. Expectant and Nursing Mothers:— Number sent to the dentist for inspection 124 Number inspected 95 Number for whom treatment was completed 69 Number of completed dentures 60 Number of fillings 36 Number of local anaesthetics 25 Number of gas cases 108 Total number of attendances and re-attendances 505 Children under five years of age:— Number sent for inspection 178 Number inspected 155 Number for whom treatment was completed 154 Number of fillings 64 Number of local anaesthetics 2 Number of gas cases 130 Total number of attendances and re-attendances to dentist 308 These figures show a total number of 813 attendances compared with 689 in 1938, 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 1939. Apart from those included in the above tables, the figures of applications for services which were granted were as follows:— Table No. 31. Service Free Part cost 1. Provision of a midwife at confinement : (a) Primiparae 22 69 (b) Multiparae 88 115 2. Provision of home help at confinement 59 10 3. Provision of sterilised accouchement sets 44 5* 4. Provision of consultant for cases of difficult labour — — 5. Provision of consultant for Puerperal cases — — * In addition, about 202 sets were supplied at "full cost." 26 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. 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 6,188. The following table shows an analysis of the number and nature of such inspections:— Table No. 32. Visits to premises on complaints 738 House-to-house inspections 199 Re-inspections of houses, premises, etc. 3,370 Visits in connection with overcrowding 151 Drain tests 12 Factories 45 Visits to canal for canal boat inspections 15 Petroleum and carbide stores 5 Slaughterhouses 3 Food sampling 36 Dairies and milk shops 7 Bakehouses 2 Other premises where food is prepared 198 Smoke observations 23 Tents, vans, sheds, etc. 1 Deposits and accumulations of refuse 172 Stables 3 Ditches 30 Cinemas, cafes, public houses, etc. 27 Miscellaneous 830 Rent books 118 Vermin 202 6,188 27 The following table shows the number and nature of complaints received during the year:— Table No. 33. Nuisances caused by the keeping of animals 8 Accumulation of refuse, etc. 59 Other complaints in relation to house refuse 31 Offensive smells 33 Vermin 66 Choked drains 142 Dampness 54 Defective roofs, gutters, etc. 62 Defective sanitary fittings 51 Dirty condition of houses 13 Miscellaneous 88 Other defective conditions of houses 205 Overcrowding 12 824 Eradication of Bed Bugs. Statistics for the year:— (a) Number of Council houses (1) found to be infested 15 (2) disinfested during the year 15 (b) Number of other houses (1) found to be infested 16 (2) disinfested during the year 16 Canal Boats. During the year 15 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 no 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. 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 25 bodies were deposited in the Mortuary. 28 Petroleum and Carbide. During the year 66 applications for the renewal of petrol licences for similar quantities as hitherto, and three new applications were received to store petrol. All these applications were granted. One application for the renewal of licence to store carbide of calcium, and one new application were received. Both these applications were granted. All the licensed premises have been regularly inspected. The number of licences in force at the end of 1939 within the Borough was 69 for petroleum and 2 for carbide. The quantity of petrol covered by the petrol licences was 362,130 gallons and the quantity of carbide covered by the licences was 26 cwts. Celluloid and Cinematograph Films Act, 1922. There is only one licence issued by the Council in force. This is for the purpose of stripping and making celluloid solution from cinematograph films. The premises were periodically inspected during the year. Statistics. HOUSING 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) 983 (b) Number of inspections made for the purpose 3,170 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 199 (b) Number of inspections made for the purpose 1,570 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation — (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 100 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 345 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 28 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners 68 (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 54 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 31 (b) By local authority in default of owners 0 29 (c) Proceedings under Sections n and 13 of the Housing Act, 1936:— (1) Number of dwelling-houses in respect of which Demolition Orders were made 0 (2) Number of dwelling-houses demolished in pursuance of tion Orders 0 (d) Proceedings under Section 12 of the Housing Act, 1936:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made 0 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement room having been rendered fit 0 4. Housing Act, 1936—Overcrowding:— (a) (1) Number of dwellings overcrowded at the end of the year 25 (2) Number of families dwelling therein 26 (3) Number of persons dwelling therein 164 (b) Number of new cases of overcrowding reported during the year 6 (c) (1) Number of cases of overcrowding relieved during the year 4 (2) Number of persons concerned in such cases 32 (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 ADMINISTRATION OF THE SHOPS ACTS The general arrangements for the administration of the Shops Acts were set out on page 43 of the Report for 1935. There are approximately 750 shops in Southall, and legislation in recent years has been both progressive and rapid. There is therefore still a considerable amount of routine work which requires to be done in the district to bring the local standard up to the advantages allowed by the Acts. 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 36 purveyors of milk on the register. This number includes 12 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, 54 licences were granted during the year, 16 for the sale of Tuberculin Tested Milk, 2 for accredited milk, 34 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. 30 Milk Vessels. Considerable attention continues to be given to improving the methods of cleansing and sterilising milk bottles and utensils. Under Article 21 of the Milk and Dairies Order the use of steam or boiling water for scalding all milk vessels is required. The cleansing of bottles in which milk is delivered is a matter which often receives insufficient attention. Milk bottles are included under Article 21 of the Order and therefore should be cleansed by means of steam or boiling water in the same way. Exposure of milk bottles and utensils to steam is necessary for the protection of the public. It is also an advantage commercially as when the bottles and milk receptacles are sterilised the milk keeps better and the dairyman gains thereby. A problem to which attention has been called before but, because of its importance, is again repeated here, is one which affects both the milk retailers and the general public, and is that of the disposition of empty milk bottles. These, if they are not handed to the milk purveyor at his next call, should be placed in a position where they cannot easily be contaminated. The doorstep 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 constantly borne in mind that unsound food may be exhibited for sale, consequently regular visits are made to inspect the carcases of recently slaughtered animals and watch is kept on premises where meat, fish and other foods are sold or prepared for sale. Most of the meat supplied to the district comes from the London Smithfield Market. During the year a total number of 210 visits were paid to places where food is prepared. During 1939 there was one registered slaughterhouse in the district. There is no public abattoir. 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 88 lbs. Carrots 58 1bs. Potatoes 672 1bs. Assorted tinned goods 2,823 1bs. Fish 59 1bs. Adulteration. The Food and Drugs (Adulteration) Act is administered by the County Council. No figures are available for 1939. 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. 31 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. The Ministry of Health has also sanctioned the supply of tetanus antitoxin by the Council to local practitioners if such is required. 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 278, and the number of certificates of exemption issued were 285. The following table gives details of the percentage of children successfully vaccinated during the last seven years:— Table No. 34. Year Live Births Vaccination Certificates Exemptions Percentage of vaccinations to live births 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 1939 805 278 285 34 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. List of premises, articles., etc., disinfected during the year:— Rooms 149 Covers 120 Beds 244 Eiderdowns 46 Blankets 831 Pillows 388 Bolsters 109 Sheets 206 Books 110 Miscellaneous 99 Total 2,302 The following articles were destroyed:18 mattresses, 4 bolsters, 2 sheets. 3 pillows, 2 blankets, 1 eiderdown, 56 articles of clothing. 32 Cancer. It will be seen by the table of causes of death (page 9) that in 1939 74 cases (33 males, 41 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 1939 there was an increase in the cancer mortality. Table No. 35. 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 35.34° 1.27 1929 12 10 22 35.370 0.62 1930 17 29 46 37.56o 1.22 1931 20 28 48 39,280 1.22 1932 22 23 45 41,53° 1.08 1933 23 28 51 44,78o 1.13 1934 22 27 49 46,693 1.04 1935 30 27 57 48,270 1.l8 1936 22 30 52 49,55° 1.05 1937 42 28 70 51,560 1.35 1938 27 30 57 52,400 0.51 1939 33 41 74 52,430 1.41 The following table shows the age distribution of the cancer deaths:— Table No. 36. Ages at Death in Cancer Cases. Age 1 0-15 15-30 30-40 40-50 50-60 60-70 70-80 80+ Male — 1 1 3 11 12 5 — Female — — 2 3 7 13 12 4 Total — 1 3 6 18 25 17 4 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 123 as compared with 315 for the previous year. 33 Of these, 117 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. Administration of Prontosil alba, the therapeutic agent of special 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 20 cases of diphtheria notified as compared with 99 in 1937. All the cases were removed to the Isolation Hospital. There was one death from diphtheria of residents during the year. Several of the cases were of a severe type. Diphtheria Prevention. It was mentioned in the Report for 1935 that the Ministry of Health had approved a scheme for the immunisation of children against diphtheria. A general report of the attendances at clinical sessions during the year is shown in the following table No. 37. Table No. 37. Number of sessions held 52 Number of new patients 187 Total attendances made 1,083 Average attendance per session 20 Highest attendance at a session 42 Lowest attendance at a session 6 During 1939 the number of new cases was 187 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 75 The number of patients in which treatment was completed but who were waiting tests at the end of 1939 82 The number of patients with regard to whom treatment was unfinished in the year 1939 and will be completed later 9 The number of patients who failed to attend for final test after Three injections 0 Two injections 6 One injection 8 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 29 children were so tested. The age distribution of the preliminary Schick tested patients is shown in Table 38. 34 Table No. 38. Age Groups (attaining the age stated during 1939) 6 or under 7 8 9 10 11 12 13 14 14 + Positive (17) - 1 3 2 7 2 2 - - - Negative (12) 3 - - - 4 1 3 - 1 - During the year there were no cases of local reaction as a result of an injection of the antigen. Ophthalmia Neonatorum. There were two cases of ophthalmia neonatorum notified in 1939, as is shown in Table No. 39. 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. 39. Cases notified 2 Cases treated at home - Cases treated in hospital 2 Vision unimpaired 2 Vision impaired - Total blindness - Deaths - Acute Poliomyelitis. Two cases were notified in the Borough during the year. The following table shows the various infectious diseases (other than tuberculosis) notified during the year and also their age incidence:— Table No. 40. Notifiable Diseases during the year (other than Tuberculosis). Diseases Ages Total cases notified Cases admitted to hospital Deaths Under i 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 1 6 3 14 12 61 8 9 8 1 - - 123 117 - Diphtheria 3 1 3 2 2 1 4 3 - - 1 20 20 1 Enteric fever - - - 1 - - - - - - - - 1 1* - Puerperal Pyrexia - - - - - - - 3 4 - - - 7 5* - Erysipelas - - - - - - 1 1 3 2 2 3 12 5* - Pneumonia - 1 - - - 2 1 6 10 8 4 - 32 18* 22 Ophthalmia neonatorum 2 - - - - - - - - - - - 2 2* - Poliomyelitis - - - - - - 1 1 - - - - 2 2* - *To London hospitals or institutions outside the district. 35 The number of cases of infectious diseases (including tuberculosis) notified during the year, according to their locality, are shown below:— Table No 41 Diseases Total Waxlow Manor Northcote Hambrough Dormers Wells Glebe Norwood Green Admitted to Hospital Total deaths Scarlet fever 123 48 23 7 8 26 11 117 — Diphtheria 20 4 2 4 2 3 5 20 1 Puerperal pyrexia 7 2 2 1 — — 2 5 — Pneumonia 32 8 7 7 3 4 3 18* 22 Ophthalmia neonatorum 2 1 — — — i — 2* — Tuberculosis (all forms) 45 10 3 7 1 15 9 — 38 Erysipelas 12 1 — 1 4 5 1 5* — Enteric fever 1 — — 1 — — — 1* — Poliomyelitis 2 2 — — — — — 2* — Totals 244 76 37 28 18 54 31 170 61 *To London hospitals and institutions outside the district. Cases of infectious diseases occurred during the year among school children as follows:— Table No. 42. School Scarlet Fever Diphtheria Beaconsfield Road 7 1 Biscoe's School, Church of England 1 — Clifton Road 10 _ Dormers Wells 1 — Featherstone Road 6 2 North Road 5 — Tudor Road 6 — Western Road 4 — Lady Margaret Road School 32 — Norwood Green Preparatory School 1 — Grange Park School, Hayes 1 — 72 3 Infectious Disease Visits. During the year, the Health Visitors paid 571 visits with reference to cases of infectious disease. One hundred and forty-two swabs were taken. The total number of children examined by the Health Visitors in the schools was 1,771. Uncleanliness and Verminous conditions in Schoolchildren. I am obliged to Dr. H. M. C. Macaulay, the school medical officer, for the information on this subject:— Number of children on roll at 31st December, 1939 6,711 Total number of examinations of children in the schools by the •school nurses 9,115 Number of individual children found unclean 234 Number of children cleansed under arrangements made by the Local Education Authority 3 No legal proceedings were taken during the year with regard to uncleanliness or verminous conditions relating to children attending schools in the Borough. 36 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 34; 18 of these were notified from Institututions (Sanatoria 5, County Council Hospitals 5, General Hospitals 8). Other Forms of Tuberculosis. The number of new cases notified during the year was 11. Deaths from Tuberculosis. Tuberculosis of the respiratory system, 30; other forms, 8. The following table shows the new cases notified and the deaths in 1938. Table No. 43. Age Periods New Cases Deaths Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary Male Female Male Female Male Female Male Female 0-1 1 — _ _ _ _ _ _ 1-5 — — — — — — — — 5-10 1 — — — — — 1 — 10-15 — — — 2 — 1 — — 15-25 6 10 1 2 4 3 — 1 25-35 5 2 1 3 5 2 2 2 35-45 5 2 1 — 3 2 — 2 45-65 2 — 1 — 5 1 — — 55+ — — — — 2 2 — — Totals 20 14 4 7 19 11 3 5 Of the 38 deaths, 23—or 92 per cent.—were of notified cases. The occupations of the new cases were as follows:— Table No. 44. Occupations Pulmonary Non-Pulmonary Male Female Male Female Building and decorating trades 1 — — — School children — 2 — 2 Clerical work 1 — — 1 Clothing and dressmaking — — — 1 Domestic duties — 2 — 1 Factory hands 7 5 2 — Furnishing trades — — 1 — Sale of food and drinks 3 — — 1 No occupation 1 4 — — Various 7 1 1 1 Totals 20 14 4 7 37 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. 45. Year Estimated mid-year population (excluding Hanwell Asylum) 1933 1934 1935 1936 1937 1938 1939 42,280 44,180 46,000 47,200 48,760 49,600 49,800 M. F. M. F. M. F. M. F. M. F. M. F. M. F. No. of new cases notified each year— Pulmonary 26 31 31 19 33 17 27 23 31 20 26 26 20 14 Non-pulmonary 5 4 6 6 3 2 4 2 7 9 3 5 4 7 Total 66 62 55 56 67 60 45 Notifications per 100,000 population 156 140 119 118 137 114 90 M. F. M. F. M. F. M. F. M. F. M. F. M. F. No. of deaths each year— Pulmonary 18 19 17 10 13 10 19 13 14 13 16 12 19 11 Non-pulmonary 4 3 1 2 3 3 1 2 5 2 2 3 3 5 Total 44 30 29 35 34 33 38 Deaths per 100,000 population 104 68 63 74 69 62 76 Public Health (Prevention of Tuberculosis) Regulations, 1925. Public Health Act, 1936, Section 172. Action under these powers was not necessary during the year. REPORT ON THE BOROUGH ISOLATION HOSPITAL During the year 138 patients were admitted to the Isolation Hospital as compared with 351 in 1938. Of these, 117 were sent in as scarlatina (261 in 1938) and 20 as diphtheria (90 in 1938) and one as chickenpox. Of the cases sent in as scarlatina, 6 were unconfirmed and were diagnosed as suffering from other diseases. Similarly, of the cases sent in as diphtheria or suspected diphtheria, 11 were unconfirmed. The following two tables show the figures for the year and for each month respectively. Table No. 46. Remaining on 1.1.39 Admitted during year as Subsequently diagnosed as Discharged recovered Died Mort. per cent. Remaining 31.12.39 Scarlatina 20 117 112 124 - - 8 Diphtheria 3 20 9 11 - - 1 Chickenpox - 1 1 1 - - - Other diseases 1 - 16 15 2 12 - One death was due to bronchitis and cardiac failure in a male of 70 years, and the other due to septicaemia and double otitis media in a child of 4½ months. 38 Table No. 47. Number admitted. Final diagnosis Number discharged Deaths Transfers Readmissions Sc. F. Diph. Others Sc. F. Diph. Others Diph. Others Diph. S,.F. Diph. Sc. F. January 2 2 3 17 3 3 — — — — — — February 8 — 3 11 i 3 — 1 — — — — March 22 — 2 1 — — — 1 — — — — April 8 2 — 18 1 1 — — — — — — May 10 — 1 10 1 1 — —— — — — — June 15 - 1 11 1 1 — — — — — — July 11 2 1 16 — 1 — — — — — — August 14 I 5 10 1 3 — — — — — — September 5 I — 13 2 2 — — — — — — October 4 — — 6 1 — — — — — — — November 7 I 1 6 — — — — — — — — December 6 — — 5 — 1 — — — — — —- 112 9 17 124 11 16 — 2 — — — — Scarlatina. Of the 117 cases notified 112 were finally diagnosed, and the following table shows the incidence in age groups of the 112 cases of scarlatina which were nursed at the hospital:— Table No. 48. Age (years) 0-5 5-15 15-25 25-35 35+ Number 25 73 7 5 2 The disease on the whole was fairly mild. Three were return cases, i.e., cases admitted from a household within 28 days of the return of a case of scarlatina to that household. No case was severe. Two minor operations were performed, one for a large boil and one for a submental abscess. Four cases of scarlatina were admitted incubating other diseases; one patient developed pertussis 43 days after admission; one developed varicella 10 days after admission; and one mumps 13 days after admission. The pertussis case and the varicella case each gave rise to one secondary infection. Mixed Infections. Three of the scarlatina cases on admission were found to be suffering from an additional infection; one from bronchitis, one from varicella, and one from pharyngitis. The use of prontosil alba was continued for alternate cases, and the table below indicates the complication experienced in the 112 patients. 39 Complications of the cases of scarlatina which were treated by:— Prontosil. Serum. Total. Cervical adenitis 2 5 7 Rhinorrhoea 4 1 5 Otorrhoea 2 6 8 Nephritis 1 i 2 Boils - 2 2 Secondary attacks 1 1 2 Quinsy - 1 1 Albuminuria 1 - 1 Sub-mental abscess - 1 1 Diphtheria. Twenty cases notified as diphtheria were admitted to the hospital. Nine of these were confirmed as diphtheria. The following table shows the incidence of the cases in age groups:— Table No. 49. Age (years) 0-5 5-15 15-25 25-35 35+ Number 1 4 2 2 - The clinical types in which the diagnosis was substantiated were as follows:— Laryngeal — Tonsillor (Faucial) 6 Naso-pharyngeal 2 "Bacteriological" 1 The disease was of a mild type. The complications recorded were as follows:— Myocarditis 1 Cardiac irregularity 1 Other Diseases. Seventeen patients admitted as scarlatina or diphtheria were subsequently diagnosed as suffering from other diseases. These were as follows (one case notified as diphtheria and subsequently diagnosed as scarlatina is included in the return of this second disease):— Diseases notified as scarlatina:— Tonsilitis 3 Rubella 1 Morbilli 1 Toxic dermatitis 1 40 Diseases notified as diphtheria:— Tonsilitis, etc. 7 Erysipelas 1 Scarlatina 1 Bronchitis 1 Septicaemia and otitis 1 Stay in Hospital. The average stay in hospital was as follows:— Scarlatina : All cases (112) 36.7 days Patients remaining over 56 days 80.5 „ Patients remaining under 56 days 33.2 „ Diphtheria: All cases (9) 50.2 „ Patients remaining over 56 days 72.0 „ Patients remaining under 56 days 30.0 „ Other diseases: All cases (17) 11.7 „ 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. 50. Swabs for diphtheria bacilli 100 Swabs for virulence tests for diphtheria 1 Haemolytic streptococci 6 Cerebro-spinal fluid 1 Sputum for tubercle 1 Urine for organisms 2 Smear for gonococci 1 Sick Staff. Table No. 51. Permanent. Temporary. Number of staff off duty for 24 hours or more 1 2 Total number of days off duty 15 44 Casual conditions:— Scarlatina — 39 Diphtheria — — Other 15 5 41 APPENDIX A 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 five 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 46,162 170.1 8.2 50.6 71 *Four years. 42 INDEX. Acute poliomyelitis 35 Ambulance facilities 15 Ante-natal clinics 17 Antitoxin 32 Area of borough 5 Assisted services 26 Bed bugs 28 Birth Control 17 Births and birth rate 12 Canal boats 28 Cancer 33 Causes of death 9 Celluloid and Cinematograph Film Act 29 Child life protection 16 Clinics 14 Consultant aid 17 Deaths and death rates 9, 10 Dental treatment 26 Diphtheria 34. 40 Diphtheria Prevention Clinic 34 Disinfection 32 Food 30 Foster Children 16 Health Services, General provision of 13 Health visiting 16 Houses—Number inhabited 5 Housing 29 Infant mortality 12 Infant welfare clinics 14 Inspection and Supervision of Food 30 Isolation Hospital 38 Laboratory facilities and work 13, 15, 41 Maternal morbidity and mortality 13 Maternity and Child Welfare 16 Maternity and Child Welfare Committee 3, 19 Maternity and Nursing Homes 25 Meat and other foods 31 Medical relief 15 Midwives 24 Milk supply 30 Milk grants 25 Mortuary 28 Notifiable diseases 32, 35, 39 Nursing in the Home 13 Nutrition 21, 25 Ophthalmia Neonatorum 35 Orthopaedic treatment 23 Overcrowding 30 Petroleum Acts 29 Physical feature of district 5 Poor Law medical relief 15 Population 5 Pre-school medical inspection 20-23 Public Health Committee 3 Puerperal pyrexia 13 Rateable value 5 Remedial Exercises 23 Sanitary circumstances 27 Sanitary inspection 27 Scarlet fever 33, 39 Shops 30 Slaughterhouses 31 Social conditions 5 Staff Statistics—General and Vital 5, 8, 11 Stillbirths 8 Swimming bath 28 Tuberculosis 37 43 INDEX—continued Unemployment 6 Unfit houses 29 Vaccination 32 Venereal disease clinics, etc. 14 Verminous persons 36 Vital statistics 8, 11 Voluntary help 24 Ultra-violet Clinic 17 Water supply 27 Wards 5 44 SOUTHALL PUBLIC LIBRARY REFERENCE DEPARTMENT Stock No. R 2713 Class No. 614.09421