Sout 8 BOROUGH OF SOUTHALL ANNUAL REPORT OF THE Medical Officer of Health for the Year 1940 E. GRUNDY, M.D., D.P.H., Medical Officer of Health. R 2713 614.09421 7.3.47. THE COUNCIL OF THE BOROUGH OF SOUTHALL, 1940. 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. Bill, H. R. Braine, E. W. H. Dane, A. T. Eldridge, J. T. *Gardner, F. E. Harris, G. *Hill, J. Hopkins, W. H. *Hutchings, C. *Lowe, J. Luckett, F. H. *Marks, F. J. Salmon, W. G. Saxon, J. A. *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-fourth 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. 3 HEALTH DEPARTMENT STAFF for the year 1940. 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. †Miss J. Moore, F.R.C.S. (Resigned 23.12.40.) Sanitary Inspection Staff: Chief Sanitary Inspector: R. W. McDonald, M.S.I.A. Sanitary Inspectors : A. D. Goold, Cert.S.I.E.J.B., Cert. M. & F. (Resigned 18.3.40.) A. J. White, Cert. S.I.E.J.B. L. Mair, Cert. S.I.E.J.B., Cert. M. & F. F. C. Hills, S.I.E.J.B., Cert M. & F. (Called up for Army Service 16.5.40.) 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. (Returned from Army Nursing Service, 15.7.40.) 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. (Resigned 7.10.40.) Miss J. D. Winterburn. N. V. Saunders. G. Woodrow. (Appointed 4.11.40.) †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-1939 *51,670 Number of inhabited houses according to Rate Book 14,718 Rateable value £416,968 Sum produced by a penny rate £1,668 * This includes about 2,800 patients and 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 Isleworth. The greatest length of the district from north to south is 2 8 miles and the greatest breadth is 3.1 miles. The soil is mainly gravel, overlaid with clay and brick earth. The 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 as detailed in previous annual reports. The estimated populations of these wards at the beginning of 1936 were as follows:— Waxlow Manor Ward 6,900 Northcote Ward 7,I5° Hambrough Ward 8,050 Dormers Wells Ward 8,950* Glebe Ward 10,250 Norwood Green Ward 7,800 * This includes the resident population of St. Bernard's Hospital (late Hanwell Mental Hospital) which amounted to about 2,800 The majority of the houses in the district are occupied by good class working people, chiefly engaged in the local factories and workshops. These include food, jam and chemical works, engineering, hosiery, paint, dye and wood works, laundries, etc. There are no trades carried on which are at present scheduled as offensive trades. 5 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 unemloyment figures on days during different months for this Dart of Middlesex:— Table No. 1. 1940 Men. Women. Total. January 15 th 1003 493 1496 February, 12 th 1060 520 1580 March, nth 893 499 1392 April 15th 722 577 1299 May 20th 506 543 1049 June 17th 261 318 579 July 15th 217 345 562 August 12th 165 257 422 September 16th 201 274 475 October 14th 145 243 388 November 11th 66 201 267 December 9th 32 127 159 it is probable that southall accounts tor just about seven-eighths or the totals. It will be noticed that the highest total occurred in February and the lowest in December. The average is lower than it was for 1939 (806 against 1563). Growth of the District. . The following table is appended to show the progressive increase in population 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 1940 14,718 51,670 „ 3.51 *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 tenetments. 6 EXTRACTS FROM VITAL STATISTICS Total Male Female Comparative figures for 1939 Live Births—Legitimate 686 368 318 771 Illegitimate 31 16 15 34 Stillbirths—Legitimate 15 9 6 19 Illegitimate — — — Deaths • 535 282 253 455 Birthrate (live and stillbirths) per 1,000 of estimated population 14.17 15.64 Stillbirth rate per 1,000 total (live and still) births 18.92 23.06 *Crude death rate per 1,000 of the estimated population IO.35 8.68 ‡Comparability factor 1.17 1.14 *Comparable death rate 12.10 9.89 Deaths from Puerperal Causes (Headings 29 and 30 of the RegistrarGeneral's Short List): Deaths. Rate per 1,000 total (1live and still) births. No. 29. Puerperal sepsis - - 1.21 No. 30. Other puerperal causes 4 5.4 2.43 Total 4 3 65 Death rate of infants under one year of age:— All infants per 1,000 live births 72.52 58.60 Legitimate infants per 1,000 legitimate live births 65.60 54.68 Illegitimate infants per 1,000 illegitimate live births 225.8 I47.I5 Deaths from cancer (all ages) 64 74 Deaths from measles (all ages) - - Deaths from whooping cough (all ages) - - Deaths from diarrhoea, etc. (under 2 years of age) 14 4 * The estimated population includes the patients in the St. Bernard's Hospital whose deaths however are not included in the rate. A more exact rate therefore could be obtained by taking the population exclusive of patients in the St. Bernard's Hospital. The death rate on this basis would be 10-94 and the comparable death rate would be 12.79. ‡ See Note 2 on page 12 of the report for 1934. 7 Causes of Deaths, 1940. Table No. 3. Male. Female. Total 1940. Total 1939 1. Typhoid fever, etc — — — — 2. Cerebro-spinal fever i 2 3 — 3. Scarlet fever — — — — 4. Whooping cough — — — 1 5. Diphtheria 3 — 3 1 6. Tuberculosis—Respiratory 18 10 28 28 7. Other tuberculosis — 2 2 8 8. Syphilis 2 i 3 1 9. Influenza 2 4 6 4 10. Measles — — — — i1. Ac. poliomyelitis and polioencephalitis — — — — 12. Ac. inf. encephalitis 1 — 1 — 13/16. Cancer (all forms) 28 36 64 74 17. Diabetes 3 3 6 6 18. Intra-cran. vase. lesions 20 26 46 15 19. Heart disease 57 49 106 iii 20. Other circulatory diseases 4 16 20 40 21. Bronchitis 25 22 47 11 22. Pneumonia (all forms) 18 14 32 22 23. Other respiratory diseases 6 4 10 4 24. Peptic ulcer 9 2 11 3 25. Diarrhoea, etc. (under 2 years) 10 4 14 4 26. Appendicitis 4 1 5 5 27. Other digestive diseases 5 6 11 6 28. Nephritis 7 7 14 4 29. Puerperal sepsis — — — 1 30. Other puerperal causes — 4 4 2 31. Premature birth 7 3 I0 3i 32. Congenital malformations, etc 6 7 13 33. Suicide 1 1 2 1 34. Road traffic accidents 3 — 3 21 35. Other violence 14 11 25 36. All other causes 28 18 46 3i Special Causes: M. F. Smallpox — — — — — — Poliomyelitis — — — — — — Polioencephalitis — — — — — — Total Deaths 282 253 535 455 s Deaths and Death Rate—Whole District. Total deaths, 535. (Males, 282; Females, 253.) Crude Death Rate, 10.35 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 293 (males 149 and females 144). 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 242 in number (males 133 and females 109). The total number of deaths therefore belonging to the district is 535 and the crude death rate 10.35. The deaths of non-Southall residents in the St. Bernard's Hospital (not included in the above figures) numbered 188 (males 91 and females 97). 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 42 34 76 Northcote 44 37 81 Hambrough 45 43 88 Dormers Wells 49 46 95 Glebe 51 51 102 Norwood Green 51 42 93 Total 282 253 535 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 1940, the figures being provisional. 9 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 1940. (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 Civilian Population Births:— Live 14.6 16.0 15.7 13.7 13.88 Still 0.55 0.64 0.55 0.44 0.29 Deaths:— All Causes 14.3 15.8 12.8 17.8 10.35 Typhoid & Paratyphoid fevers 0.00 0.00 0.00 0.00 0.00 Smallpox — — — - — Measles 0.02 0.02 0.02 0.01 0.00 Scarlet Fever 0.00 0.00 0.00 0.00 0.00 Whooping Cough 0.02 0.02 0.02 0.00 0.00 Diphtheria 0.06 0.07 0.05 0.01 0.05 Influenza 0.32 0.29 0.30 0.18 0.11 Notifications:— Smallpox 0.00 — — — — Scarlet fever 1.63 1.53 1.57 0.82 1.1O Diphtheria 1.l6 1 29 1.21 0.61 1.87 Enteric fever 0.07 0.06 0.10 0.06 0.00 Erysipelas 0.33 0.36 0.30 0.35 0 .13 Pneumonia 1.20 1.37 1.00 0.87 083 Measles 10.24 9.23 9.99 1.78 5.98 Cerebro-spinal fever 0.32 0.33 0.29 0.28 - Rates per 1,000 Live Births Deaths under 1 year of age 55 61 54 5° 72 Deaths from Diarrhoea and Enteritis under 2 years of age 46 59 4.4 5.8 19.53 Rates per 1,000 Total Births (i.e. Live and Still) Maternal Mortality:— Puerperal Sepsis 0.52 Not available 5.4 Others 1.64 Total 2.16 Notifications:— Puerperal fever 11.96 13.90 9.73 3.34 9.56 Puerperal pyrexia 13.30 10 Births and Birth Rate (figures for 1939 are given in brackets). The total number of births notified to the Health Department under the Public Health Act, 1936, was 747 (797). The total number of registered births in the district (under the Births and Deaths Registration Act—included in the notified births above) was 453 (454). The total number of live births belonging to the district whether occurring within or outside the district was 717 (805). The illegitimate live births were 31 (34). There were 15 stillbirths (19), and these were legitimate. This gives a live birth rate per 1,000 population of 13 88 (15.28) and a still birth rate per 1,000 total (live and still) births of 18.92 (23.06). 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 15 7 - 1 9 8 40 February 6 3 3 3 10 5 30 March 6 3 6 1 14 5 35 April 9 .7 9 5 16 7 53 May 12 9 7 3 10 4 45 June 2 6 2 1 11 7 29 July 5 9 10 1 8 8 41 August 10 4 6 — 15 6 41 September 3 6 4 1 5 8 27 October 9 8 8 7 15 6 53 November 1 4 6 7 9 7 34 December 6 2 2 4 6 5 25 84 68 63 34 128 76 453 Table No. 7. The following table gives an analysis of the places of confinement. Total Confinements (live births and still births), 732. No. born in. Hillingdon County Hospital 138 or 19% No. born in London voluntary hospitals 41 or 5% No. born in nursing homes or other hospitals 182 or 25% No. confined in their homes by midwives or doctors 371 or 51% Infant Mortality. The total number of deaths under one year of age was 52. The rate per 1,000 births was 72. The corresponding rate for England and Wales was 55, for London 50, and for the 148 smaller towns 54 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 A. The various deaths from stated causes at ages under one year of age are shown in the subjoined table. 11 Table No. 8. Certified Cause of Death. Under 1 week 1-2 weeks 2-3 weeks 3-4 weeks Total under weeks 1-3 months 3-6 months 6-9 months | 9-12 months Total deaths under i year Bronchitis, Pneumonia, etc - 3 4 3 10 4 2 2 1 19 Atelectasis 1 - - - 1 - - - - 1 Meningitis - - - - - - 1 - - 1 Congenital Malformations, etc. 4 1 - - 5 1 1 - - 7 Gastro-enteritis, Diarrhoea, etc. - - 3 - 3 i 3 - - 7 Marasmus 2 - - 2 4 3 1 - 1 9 Heart Disease - - - 1 i - - - - 1 Prematurity 3 1 - - A 1 - - - 5 Want of Attention at Birth 2 - - - 2 - - - - 2 12 5 7 6 30 10 8 2 2 52 Live Births. Legitimate, 686. Illegitimate, 31. Infant Deaths. Legitimate, 45. Illegitimate, 7. Maternal Morbidity and Mortality. The Council has an informal agreement with the London County Council for the admission of cases of puerperal pyrexia 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 in Central Middlesex County Hospital, and two in West Middlesex Hospital. There were four maternal deaths during the year in connection with childbirth; three occurred in Hillingdon County Hospital, and one in Dilke Hospital, Cinderford. 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 1940 the total number of visits made by the nurses was 8,399. 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. 12 Laboratory Work. There has been no change in the arrangements for laboratory work since the last reDort. 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 * Suspended during war. 13 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 1940 (exclusive of work done for the Isolation Hospital). Table No. 10. Positive. Negative. Swabs for diphtheria 33 339 Sputa for tubercle 19 94 Wasserman reaction - 4 Swabs for haemolytic streptococci 1 - Miscellaneous 1 - Total Examinations 54 437 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. 11. Ordinary cases removed to hospital 1,293 Accidents 234 Persons taken ill in the street 51 Out of district cases 3 i Total 1,581 Miles travelled in the year 1940 15,383 Poor Law Medical Relief. The Relieving Officer issued 328 Medical Orders during 1940. Some of these cases also received outdoor relief or institutional treatment. 14 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 1940. Visits to infants— First visits 808 Re-visits 2,479 Visits to children— First visits 39 Re-visits 4,490 Visits to expectant mothers 442 Visits for infectious disease .539 Visits to schools 86* Child Life Protection visits 272 Miscellaneous visits 361 Removals 380 No access 864 Total 10,760 * At these visits a total of 624 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 38 (b) At the end of the year 22 15 (2) Number of foster parents receiving foster children— (a) At the beginning of the year 38 (b) At the end of the year 21 (3) Number of children on the register— (a) At the beginning of the year 33 (b) At the end of the year 32 (4) Number of children received by foster parents during the year 45 (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 22 (c) Adopted 9 (d) Returned to parents 7 (e) Removed at the request of the medical officer of health 1 (f) Evacuated with foster mother 7 (g) Died during the year Nil (h) On whom inquests were held Nil (6) Total number of visits made during the year 272 (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 no 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 12 32 Infants 130 1,392 Post-Natal and Birth Control Clinic. Table No. 15. Number of sessions held: 22 Number of attendances:— Post-Natal. Birth Control. First Visits 43 17 Re-attendances 30 135 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 1940. The number of new patients seen at the ante-natal clinics during the year was 433, and the total number of attendances was 2,469. 422 cases were completed during the year, and the attendances in respect of these v were as follows:— No. of Cases. One attendance 34 Two attendances 35 Three attendances 38 Four attendances 54 Five attendances 55 Six or more attendances 206 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 1933 264 782 296 734 35.9 1934 244 518 212 780 31.3 1935 265 867 327 835 31.7 1936 300 998 333 827 36.3 1937 407 1333 327 848 47.9 1938 531 2157 406 856 62.03 1939 506 2109 453 824 61.42 1940 433 2036 5.70 732 59.16 Of the 2,469 total attendances, 1,458 occurred at the Manor House centre and 1,011 at the Branch centre. 17 Of the total cases seen, 599 (433 new cases and 166 brought forward from 1939), 422 were completed during the year, 7 were non-pregnant, 40 left the district, and 130 were uncompleted at the end of the year. This report, therefore, deals with 422 completed cases, 166 for 1939 and 278 occurring in 1940. Of these cases 386 were normal and 36 showed abnormalities. Table No. 17. Primipara Multipara Delivered at home Admitted to hospital or Nursing Home - Primipara Multipara Primipara Multipara Normal cases 141 245 69 181 72 64 Abnormal cases 24 12 5 2 19 10 Of the cases dealt with therefore 165, or 39 per cent., were primiparae (against 36 per cent. in 1939) and of these 72 or 43 per cent. (against 69 per cent, in 1939) were confined in hospital, while 74 cases or 29 per cent. (against 27 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 2 (iii) stillbirths 6 (iv) other conditions 18 (b) Abnormalities of the mother— (i) unsatisfactory measurements 12 (ii) post partum haemorrhage 4 (iii) ante partum haemorrhage 3 (iv) albuminuria 11 (v) high blood pressure (exceeding 140 systolic or 90 diastolic other than on the first attendance) 69 (vi) other conditions 24 Neo-Natal Mortality (before the seventh day) 3 Maternity and Child Welfare Clinics The attendances at the Child Welfare clinics during 1940 are shown in the following Table:— Manor House— Table no. 19. Seen by medical officer: Infants 2,455 Children at ordinary clinics 1,241 Children at toddlers' clinics 284 18 Weighing only: Infants 1,748 Children 686 New cases (included in above): Infants 329 Children 103 Branch Centre— Seen by medical officer: Infants 2,473 Children at ordinary clinics 1,780 Children at toddlers' clinic 289 Weighing only: Infants 720 Children 357 New cases (included in above): Infants 238 Children 98 Total attendances 12,033 The total attendances at the clinics during the past six years have been as follows:— 1935 9,682 1936 11,329 1937 12,502 1938 14,351 1939 15,452 1940 12,033 * It will be noticed that there was a decrease in the total number ot attendances in 1940 compared with the figure for 1939. This decrease amounts to 20 per cent. The subjoined table shows the proportion of new infant cases attending the clinics to the total live births in the district:— 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 1940 567 717 79 * 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. 19 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 1940. 573 attendances were made, 284 of these being at the Manor House, and 289 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 97 101 198 2 years 64 ' 63 127 3 years 59 61 120 4 years 51 50 101 Total Routine 271 275 546 Other inspections 13 14 27 Total 284 289 573 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 26 14 40 2 years 15 19 34 3 years 12 15 27 4 years 7 15 22 Total 60 63 123 Table No. 23. Number requiring Dental Treatment : Manor House Branch Centre Total 18 months — — — 2 years 1 3 4 3 years 12 3 15 4 years 9 9 18 Total 22 15 37 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. 1 ABLE NO. 24. Manor House Branch Centre Total - - A B C D 18 months A 21 24 45 141 12 — H 71 70 C 5 7 D — — 2 years A 23 26 49 75 3 — B 39 36 C 2 1 D — — 3 years A 22 17 39 77 4 — B 35 42 C 2 2 D _ — 4 years A 22 15 62 62 2 — B 28 34 C 1 1 D — — Total 271 275 170 355 21 — 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 1 - 1 4. Other diseases (non-tubercular) 4 6 10 Total 1-4 5 6 11 Eye 5. Blepharitis 1 - 1 6. Conjunctivitis 2 2 4 7. Keratitis and opacities —• - - 8. Other conditions (excl. defective vision and squint) 3 3 6 Total 5-8 6 5 11 9. Defective vision - - - 10. Squint 3 3 6 Ear 11. Defective hearing - - - 12. Otitis media - — - 13. Other ear diseases - - - Nose and Throat 14. Chronic tonsils and/or adenoids 14 19 33 15. Other conditions 2 4 6 16. Enlarged cervical glands (non-tubercular) 1 1 17. Defective speech - — - Heart and Circulation 18. Organic heart disease - - - 19. Functional heart disease - — - 20. Anaemia - - -1 Lungs - - - 21. Bronchitis 2 i 3 22. Other non-tubercular diseases 1 1 2 23. Pulmonary tuberculosis -s. - - - Tuberculosis 24. Glands - - - 25. Bones and joints - - - Nervous system 26. Chorea - - - 27. Other conditions - - - Deformities 28. Rickets deformities - - - 29. Genu valgum 18 months 4 2 6 2 years 3 1 4 3 years - 6 6 4 years — 1 1 30. Other forms 1 3 4 31. Other defects and diseases 18 9 27 32. Dental diseases' 18 months 1 1 2 2 years 3 - 3 3 years 2 12 14 4 years 9 9 18 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, but during the war, St. Bernard's Hospital treat these defects. 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.I. 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. , The attendances from July until the end of the year are tabulated below:— Infants. Mothers. First visits 21 4 Re-attendances 191 4 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. 23 The monthly bookings for each district are included below:— Districts No. 1 No. 2 No. 3 No. 4 No. 5 January 6 4 5 7 3 February 5 9 3 9 5 March 6 4 9 9 6 April 8 5 9 7 3 May 3 8 1 8 4 June 3 4 5 6 5 July 5 6 6 8 4 August 5 4 5 7 5 September 7 5 3 10 2 October 8 3 4 8 4 November 8 5 12 9 5 December 4 8 5 5 7 The number of mid wives who during January, 1940, 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 124 Laying out dead body Nil Liability to be a source of infection 8 Death of child 4 Stillbirths 6 Artificial feeding 13 The reasons for sending 124 notifications for medical help were as follows:— Table No. 27. Ante-natal conditions 9 Difficult or prolonged labour 70 Miscarriage 3 Other conditions (a) Mother 19 (b) Child 23 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 three 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 3 Total accommodation (No. of beds) 32 Number of deletions during the year 1940 Nil Number of additional applications re registration during the year 1940 1 Number so registered 1 Refusals or cancellations of registration Nil Number of applications for exemption of registration Nil Result of such applications — 24 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 2,570 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 1939 2,683 341 329 26 1940 1,986 261 301 22 This shows a large decrease on the number in 1939, when a total of 3,379 applications were granted. The decrease in the number of applications for cow's milk is due to the commencement of the scheme by the Ministry of Food of supplying milk free or at 2d. per pint, according to income, to children under five years of age, and to nursing and expectant mothers. 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 93 Number inspected 93 Number for whom treatment was completed 89 Number of completed dentures 51 Number of fillings 48 Number of local anaesthetics 12 Number of general anaesthetics 75 Total number of attendances and re-attendances 484 Children under five years of age:— Number sent for inspection 118 Number inspected 118 Number for whom treatment was completed 114 Number of fillings 26 Number of local anaesthetics 1 Number of general anaesthetics 105 Total number of attendances and re-attendances to dentist 240 These figures show a total number of 724 attendances compared with 813 in 1939, 689 in 1938 and 603 in 1937. Assisted Services. The expansion of the Maternity and Child Welfare services commented on on page 31 of the report for 1935, continued during 1940. 25 SANITARY CIRCUMSTANCES OF THE BOROUGH. Water Supply. Water is supplied to nearly the whole of the district by the South West Surburban 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 3,652. The following table shows an analysis of the number and nature of such inspections:— Table No. 31. Visits to premises on complaints 762 House-to-house inspections 4 Re-inspections of houses, premises, etc. 811 Visits in connection with overcrowding 18 Drain tests 228 Factories 9 Visits to canal for canal boat inspections 12 Petroleum and carbide stores 3 Slaughterhouses Nil Food sampling Nil Dairies and milk shops 17 Bakehouses 9 Other premises where food is prepared (food shops) 51 Smoke observations 97 Tents, vans, sheds, etc. I Deposits and accumulations of refuse 42 Ditches 24 Cinemas, cafes, public houses, etc. 1 Miscellaneous 503 Rent books Nil Vermin 168 Unsound food 143 Outworkers 4 Piggeries 1 Billeting 150 Shops Acts 12 War damaged property 507 War-damaged food 60 Air raid shelters 15 3,652 26 The following table shows the number and nature of complaints received during the year:— Table No. 32. Nuisances caused by the keeping of animals 10 Accumulation of refuse, etc 26 Other complaints in relation to house refuse 4 Offensive smells 18 Vermin 52 Choked drains 128 Dampness 29 Defective roofs, gutters, etc. 22 Defective sanitary fittings 38 Rats, mice, etc. 21 Miscellaneous 101 Other defective conditions of houses 98 Overcrowding 7 Air raid shelters 8 War-damaged houses 14 576 Eradication of Bed Bugs. Statistics for the year:— (a) Number of Council houses (1) found to be infested 31 (2) disinfested during the year 31 (6) Number of other houses (1) found to be infested 24 (2) disinfested during the year 24 Canal Boats. During the year 12 visits were paid to the canal and 7 boats were inspected. The general condition of the boats and their occupants was satisfactory. 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 24 bodies were deposited in the Mortuary. Petroleum and Carbide. During the year 69 applications for the renewal of petrol licences for similar quantities as hitherto, and one new application were received to store petrol. All these applications were granted. Two applications for the renewal of licences to store carbide of calcium, and one new application were received. All these applications were granted. All the licensed premises have been regularly inspected. The number of licences in force at the end of 1940 within the Borough was 70 for petroleum and 3 for carbide. The quantity of petrol covered by the petrol licences was 373,280 gallons and the quantity of carbide covered by the licences was 11 cwts. . 28 lbs. 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) 132 (b) Number of inspections made for the purpose 697 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 6 (b) Number of inspections made for the purpose) 547 (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 36 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 153 28 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 8 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners 9 (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 38 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 21 (b) By local authority in default of owners 0 (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 0 (2) Number or dwelling-houses demolished in pursuance of Demolition 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 (2) Number of families dwelling therein (3) Number of persons dwelling therein (b) Number of new cases of overcrowding reported during the year * (c) (1) Number of cases of overcrowding relieved during the year (2) Number of persons concerned in such cases (d) Particulars of any case in which dwelling-houses have again become overcrowded after the local authority have taken steps for the ment of overcrowding * Owing to the stress of civil defence work and to the rapid changes in the population due to the influx of refugees and evacuees, and the migration of Southall residents it has been impossible for the Sanitary Inspection staff to cope with overcrowding. 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. 29 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, 50 licences were granted during the year, 16 for the sale of Tuberculin Tested Milk, 1 for accredited milk, 31 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. 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 77 visits were paid to places where food is prepared. There are no registered slaughterhouse or public abattoir in the district. In connection with the inspection of meat and other foods the following tables show the action taken during the year:— Table No. 33. Food Inspection. Total Inspected Total Surrendered Net Total Unsound Surrendered (a) Food Factories—Production. tons cwt qr. lb. tons cwt. qr. lb. tons cwt. qr. lb. Bacon 36 12 1 7 1 3 0 17 Lamb 15 11 3 8 15 11 3 8 Edible Offal 4 14 0 4 4 14 0 4 Pork 1 2 16 1 2 16 Pork (Canned) 2 4 2 4 Citrons 8 0 0 Jam 1 2 11 1 2 11 Preserved fruit (in cans and bottles) 16 13 2 6 16 13 2 6 Dried fruit 19 3 1 19 3 1 Assorted canned goods 4 13 3 21 4 13 3 21 Total Inspected 44 8 0 4 (b) Factory Canteens. Pork (canned) 1 14 1 14 1 14 Total Inspected 1 14 (c) At Shops. In the course of routine inspections. Beef 2 2 26¾ 2 2 26¾ Bacon 1 75/8 1 75/8 Fish 14 14 Fowls 3 14 3 14 Ham (boiled) 3 3 Ham (canned) 1 1 22 1 1 22 Mutton 19 19 Edible Offal 1 21¼ 1 21¼ 6 0 155/8 Total Inspected 6 0 155/8 30 (d) From Shops damaged by enemy action. The following damaged foodstuffs were inspected and dealt with as indicated:— Inspected Sound Salvaged Destroyed tons cwt. qr. lb. Description Tons. cwt. qrs. lbs. Tons. cwt. qrs. lbs. Tons. cwt. qrs. lbs. Tons. cwt. qrs. lbs. Confectionery 2 3 2 3 10 2 3 Groceries 1 19 0 20 1 3 16 1 3 0 0 Jams 3 20 1 20 Bacon 8 7 8 7 Butcher's meat 6 2 14 6 2 14 1 4 0 9 Assorted packets 1,223 675 9 539 Tinned fruit 12,623 1915 10,492 216 Bottled foods* 2,194 667 198 1,329 *This figure includes the preserved fruit in cans and bottles, the weight of which is given in (a) above. (e) The following foodstuffs were found to be unsound and were seized, with the result indicated :— Description Action Taken Result Amount tons cwt. qr- lb. Miscellaneous Prosecution Fine £10 cwt. 1 qr 2 lb. 15 1 2 15 Grapefruit (tinned) Magistrate's Order obtained for destruction. No prosecution. Total unsound food surrendered 46 I 2 145/8 Adulteration. The Food and Drugs (Adulteration) Act is administered by the County Council. No figures are available for 1940. 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. SANITARY STAFF—WORKING LOSS, 1940. Due to: Civil Defence % Sickness % Vacant % Total Loss % Chief Sanitary Inspector 50 — — 50 District Sanitary Inspectors: No. 1 District 33.3 - — 33.3 No. 2 District 20 60 80 No. 3 District 16.65 16.65 33.3 No. 4 District 80 80 119.95% 16.65% 140% 276.6% Note.—The loss in working time during 1^40 was, therefore, approaching the equivalent of three Inspectors. 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 289, and the number of certificates of exemption issued were 184. 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 vaccinationsv 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 1940 717 289 184 40 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. 32 List of premises, articles, etc., disinfected during the year :— Rooms 153 Covers 112 Beds 106 Eiderdowns 65 Blankets 429 Pillows 335 Bolsters 101 Sheets 192 Books 67 Miscellaneous 194 Total 1,754 The following articles were destroyed: 21 mattresses, 3 sheets, 5 pillows, 2 blankets, 1 rug, 24 articles of clothing. Cancer. It will be seen by the table of causes of death (page 8) that in 1940,64 cases (28 males, 36 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 1940 there was a decrease 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 35,340 1.27 1929 12 10 22 35,370 0.62 1930 17 29 46 37,560 1.22 1931 20 28 48 39,280 1.22 1932 22 23 45 41,530 1.08 1933 23 28_ 51 44,780 1.13 1934 22 27 49 46,693 1.04 1935 30 27 57 48,270 1.18 1936 22 30 52 49,550 1. 05 1937 42 28 70 51,560 1.35 1938 27 30 57 52,400 0.51 1939 33 41 74 52,430 1.41 1940 28 36 64 51,670 1.23 The following table shows the age distribution of the cancer deaths:— Table No. 36. Ages at Death in Cancer Cases. Age 0-15 15-30 30-40 40-50 50-60 60-70 70-80 80 + Male... - - - 2 9 8 6 3 Female - - - 5 10 9 10 2 Total - - - 7 19 17 16 5 33 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) Regulation, 1917. Scarlet Fever (Scarlatina). The number of notifications received during the year was 57 as compared with 123 for the previous year. Of these, 52 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, 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 55 cases of diphtheria notified as compared with 20 in 1939. All the cases were removed to the Isolation Hospital. There were three deaths 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 51 Number of new patients 217 Total attendances made 889 Average attendance per session 17 Highest attendance at a session 47 Lowest attendance at a session 4 During 1940 the number of new cases was 217 The number of children over the age of 6 years who were tested and found to be Schick negative, therefore not requiring immunisation 1 The number of patients in whom treatment was completed and a Schick test done afterwards found to be negative 158 The number of patients in which treatment was completed but who were waiting tests at the end of 1940 47 The number of patients with regard to whom treatment is unfinished in the year 1940 and may be completed later 11 217 During the year there were no cases of local reaction as a result of an injection of the antigen. 34 Ophthalmia Neonatorum. There was one case of ophthalmia neonatorum notified in 1940, 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. 38. Cases notified 1 Cases treated at home 1 Cases treated in hospital — Vision unimpaired 1 Vision impaired — Total blindness — Deaths — Acute Poliomyelitis. No 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. 39. 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 Whooping cough 3 3 2 2 6 7 — — — — — 23 — _ Scarlet fever — 1 2 6 3 28 8 7 2 — — — 57 — — Diphtheria 3 4 2 4 2 11 13 12 4 — — — 55 — 3 Measles 13 18 33 35 32 158 8 12 — — — 309 — — Puerperal Pyrexia — — — — — — — 4 3 _ _ — 7 4* — Erysipelas — — — — — — — _ 3 2 2 7 4* —- Pneumonia - 2 1 1 1 4 2 5 5 9 8 5 43 17 32 Ophthalmia neonatorum 1 — — — — — — — — — — — 1 — — Cerebro-spinal 'meningitis — — — — — — — — — — 1 — 1 1* — Meningococcal meningitis — — 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. 40: Diseases Total Waxlow Manor Northcote Hambrough Dormers Wells Glebe Norwood Green Admitted to Hospital Total deaths Scarlet fever 57 14 8 9 4 15 7 — _ Diphtheria 55 7 7 11 6 20 4 — 3 Puerperal pyrexia 7 2 1 1 — 3 — 4 — Pneumonia 43 11 6 4 7 11 4 17* 32 Ophthalmia neonatorum 1 — — — — 1 — — Tuberculosis (all forms) 96 14 13 23 10 25 11 — 30 Erysipelas 7 2 1 1 3 — — 4* — Measles 309 27 23 75 19 81 84 — — Whooping cough 23 6 — 1 1 14 1 — — Cerebro-spinal meningitis 1 1 — — — — — 1* — Meningococcal meningitis 2 — I — — 1 — 2* — Totals 601 84 60 125 50 171 111 28 65 % *To London hospitals and institutions outside the district. Cases of infectious diseases occurred during the year among schoolchildren as follows :— Table No. 41. School Scarlet Fever Diphtheria Beaconsfield Road 3 1 Clifton Road 4 1 Dormers Wells 3 4 Featherstone Road 1 6 North Road 5 1 Tudor Road 2 2 Western Road 2 - Lady Margaret Road School 6 - 26 15 Infectious Disease Visits. During the year, the Health Visitors paid 625 visits with reference to cases of infectious disease. Two hundred and twenty swabs were taken. The total number of children examined by the Health Visitors in the schools was 624. 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, 1940 5,554 Total number of examinations of children in the schools by the school nurses 15,851 Number of individual children found unclean 413 Number of children cleansed under arrangements made by the Local Education Authority 1 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 73. Other Forms of Tuberculosis. The number of new cases notified during the year was 23. Of the total notifications 72 were notified from Institutions (Sanatoria 39, County Council Hospitals 12, General Hospitals 21). Deaths from Tuberculosis. Tuberculosis of the respiratory system, 28 ; other forms, 2. The following table shows the new cases notified and the deaths in 1940. Table No. 42. Age Periods New Cases Deaths Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary Male Female Male Female Male Female Male Female 0-1 — — — — — — — — 1-5 — — 1 1 — — — — 5-10 — 2 — 2 — — — — 10-15 - - 2 2 - — — — 15-25 7 10 1 5 2 6 — i 25-35 17 13 2 1 6 i — -1 35-45 7 2 1 1 2 1 — i 45-65 11 2 2 2 6 2 — — 65+ 2 — 2 2 — — Totals 44 29 9 14 18 10 — 2 Of the 30 deaths, 22—or 73 per cent.—were of notified cases. The occupations of the new cases were as follows :— Table No. 43. Occupations Pulmonary Non-Pulmonary Male Female Male Female Building and decorating trades 5 — 1 — Schoolchildren 1 1 i 6 Clerical work 3 — i 1 Domestic duties — 13 — 1 Factory hands 3 2 i — No occupation 1 2 i 2 Various 31 11 4 4 Totals 44 29 9 14 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. 44. Year 1934 1935 1936 1937 1938 1939 1940 Estimated mid-year population (excluding Hanwell Asylum) 44,180 46,000 47,200 48,760 49,600 49,800 48,915 m. f. m. f. m. f. m. f. m. f. m. f. m. f. No. of new cases notified each year— Pulmonary 31 19 33 17 27 23 3i 20 26 26 20 14 44 29 Non-Pulmonary 6 6 3 2 4 2 7 9 3 5 4 7 9 14 Total 62 55 56 67 60 45 53 43 Notifications per 100,000 population 140 119 118 137 114 90 196 M. f. M. f. M. f. M. F. M. f. M. f. M. f. No. of deaths each year— Pulmonary 17 10 13 10 19 13 14 13 16 12 19 11 18 10 Non-pulmonary 1 2 3 3 1 2 5 2 2 3 3 5 — 2 Total 30 29 35 34 33 38 18 12 Deaths per 100,000 population 68 63 74 69 62 76 61 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 119 patients were admitted to the Isolation Hospital as compared with 138 in 1939. Of these, 52 were sent in as scarlatina (117 in 1939) and 55 as diphtheria (20 in 1939), two as chickenpox, 5 as measles, and 5 as rubella. Of the cases sent in as scarlatina, 3 were unconfirmed. Similarly, of the cases sent in as diphtheria or suspected diphtheria, 2 were unconfirmed. The following two tables show the figures for the year and for each month respectively. Table No. 45. Remaining on 1.1.40 Admitted during year as Subsequently diagnosed as Discharged recovered Died Mort. per cent. Remaining 31.12.40 Scarlatina 8 52 49 54 - - '3 Diphtheria 1 155 53 43 4 7 7 Chickenpox - 2 2 2 - - - Measles - 5 5 4 - - 1 Rubella - 5 5 5 - - - Other diseases - 5 5 5 - - - One diphtheria death was due to oedema of glottis and pharyngitis. 38 Table No. 46. Number admitted. Final diagnosis Number discharged Deaths Transfers Re- admissions Sc. F. Diph. Others Sc. F. Diph. Others Diph. Others Diph. Sc. F. Diph. Sc. F. January 6 4 1 7 — — 1 — — — — February 4 2 2 6 3 2 — — — — — — March 2 3 5 3 6 — — — — — — April 3 4 3 2 1 1 — — — — — — May 6 5 — 2 1 — 1 — — — — — June 2 5 — 6 3 — — — — — — 1 July 8 5 — 3 6 — — — — — — — August 5 1 2 7 9 — — — — — — — September 6 11 — 7 1 i 1 — — — — — October 3 7 1 7 7 i — — — — — — November 2 3 4 1 6 3 — — — — — — December 2 3 1 1 3 2 1 — — — — — 49 53 17 54 43 16 4 — — — — 1 Scarlatina. Of the 52 cases admitted 49 were finally diagnosed, and the following table shows the incidence in age groups of the 49 cases of scarlatina which were nursed at the hospital:— Table No. 47. Age (years) 0-5 5-15 15-25 25-35 35 + Number 12 27 8 2 - The disease on the whole was fairly mild. There were no 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 septic finger and one for an axillary abscess. Two cases of scarlatina were on admission found to be suffering from other diseases; one from pleural effusion, and one from impetigo. The use of prontosil alba was continued for alternate cases, and the table below indicates the complication experienced in the 49 patients. Complications of the cases of scarlatina which were treated by:— Prontosil. Serum. Total. Cervical adenitis... 2 - 2 Rhinorrhoea axillary abscess 1 - 1 Otorrhœa 1 - 1 Nephritis 2 - 2 39 Nasal discharge - 2 2 Secondary attacks 1 2 3 Rheumatism 1 - 1 Colitis 1 - 1 Diphtheria. Fifty-five cases notified as diphtheria were admitted to the hospital. Fiftythree of these were confirmed as diphtheria. The following table shows the incidence of the cases-in age groups:— Table No. 48. Age (years) 0-5 5-15 15-25 25-35 35 + Number 15 21 11 3 3 The clinical types in which the diagnosis was substantiated were as follows:— Laryngeal 4 Tonsillor (Faucial) (4 severe cases) 27 Naso-pharyngeal 8 Anterior-nasal 6 " Bacteriological" 8 The complications recorded were as follows:— Myocarditis 3 Cardiac irregularity 6 Cervical œdema 2 Tonsillitis 1 Nasal discharge 1 Mixed Infections. Two cases of diphtheria were on admission found to be suffering from additional infection, one from whooping cough, and one from pneumonia. There was no secondaryinfection from the case of whooping cough. Diseases notified as scarlatina:— Tonsillitis 1 Bronchitis 1 Diseases notified as diphtheria Tonsillitis, etc 2 Stay in Hospital. The average stay in hospital was as follows:— Scarlatina: Air cases (49) 365 days Patients remaining over 56 days 620 ,, Patients remaining under 56 days 35 35.0 ,, 40 Diphtheria: All cases (53) 54.3 ,, Patients remaining over 56 days 78.5 ,, Patients remaining under 56 days 35.8 ,, Other diseases: All cases (17) 14.5 ,, 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. 49. Swabs for diphtheria bacilli 373 Swabs for virulence tests for diphtheria 8 Haemolytic streptococci 2 Sputum for tubercle 1 Smear for gonococci 1 Sick Staff. Table No. 50. Permanent. Temporary Number of staff off duty for 24 hours or more 3 2 Total number of days off duty 152 24 Casual conditions:— Scarlatina 74 — Diphtheria 60 — Other 18 24 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 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. 41 INDEX. Acute poliomyelitis 35 Ambulance facilities 14 Ante-natal clinics 17 Antitoxin 32 Area of borough 5 Assisted services 25 Bed bugs 27 Birth Control 17 Births and birth rate 11 Canal boats 27 Cancer 33 Causes of death 8 Celluloid and Cinematograph Film Act 28 Child life protection 15 Clinics 13 Consultant aid 16 Deaths and death rates 9 Dental treatment 25 Diphtheria 34, 40 Diphtheria Prevention Clinic 34 Disinfection 32 Food 30 Foster Children 16 Health Services, General provision of 12 Health visiting 15 Houses—Number inhabited 5 Housing 28 Infant mortality 11 Infant welfare clinics 13 Inspection and Supervision of Food 30 Isolation Hospital 38 Laboratory facilities and work 13, 14, 41 Maternal morbidity and mortality 12 Maternity and Child Welfare 15, 16 Maternity and Child Welfare Committee 3, 18 Maternity and Nursing Homes 24 Meat and other foods 30 Medical relief 14 Midwives 23 Milk supply 30 Milk grants 25 Mortuary 28 Notifiable diseases 32, 35, 39 Nursing in the Home 12 Nutritution 21, 25 Ophthalmia Neonatorum 35 Orthopaedic treatment 23 Overcrowding 29 Petroleum Acts 28 Physical feature of district 5 Poor Law medical relief 14 Population 5 Pre-school medical inspection 20-23 Public Health Committee 3 Puerperal pyrexia 12 Rateable value 5 Remedial Exercises 23 Sanitary circumstances 26 Sanitary inspection 26 Scarlet Fever 34, 39 Shops 29 Slaughterhouses 31 Social conditions 5 Staff 4,31 Statistics—General and Vital 5, 7, 10 Stillbirths 7 Swimming bath 27 Tuberculosis 37 Unemployment 6 Unfit houses 29 Vaccination 32 Venereal disease clinics, etc. 13 Verminous persons 36 Vital statistics 7,10 Voluntary help 23 Ultra-violet Clinic 16 Water supply 26 Wards 5 42