Journal Rebind Co. Ltd Uvit 4, pier Wharf. Grays, Essex. AC 439(1) Southall Sout 9 BOROUGH OF SOUTHALL ANNUAL REPORT OF THE Medical Officer of Health for the Year 1941 E. GRUNDY, M.D., D.P.H., Medical Officer of Health. King & Hutchings, Ltd., Printers. Southall. BOROUGH OF SOUTHALL ANNUAL REPORT OF THE Medical Officer of Health for the Year 1941 E. GRUNDY, M.D., D.P.H., Medical Officer of Health. THE COUNCIL OF THE BOROUGH OF SOUTHALL, 1941. 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 F. G. SMITH, J.P. Deputy Mayor: *Alderman G. A. Pargiter, J.P. Aldermen: *Amos, Mrs. F. S. (Chairman of the Public Health Committee). Hillier, W. A. Hamblin, E. B. *Neighbour, D. C. Councillors: Abbott, Mrs. M. Bill, H. R. Braine, E. W. H. Dane, A. T. Davies, R. L. *Douglas, H. C. Eldridge, J. T. *Gardner, F. E. Harris, G. *Hill, J. Hopkins, W. H. *Hutchings, C. *Lowe, J. Luckett, F. H. *Marks, F. J. *Knott, Mrs. A. 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-fifth Annual Report on the health and sanitary circumstances of the district. Certain vital statistics have been excluded from the Report on the instructions of the Ministry of Health for security reasons. I am, your Worship, Ladies and Gendemen, Your obedient Servant, E. GRUNDY, Manor House, Medical Officer of Health. Southall. 3 HEALTH DEPARTMENT STAFF for the year 1941. 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: Margaret A. Glass, B.Sc., M.B., Ch.B., D.P.H. †H. Bower Alcock, M.R.C.S.(Eng.), L.R.C.P.(Lond.). (Appointed 27.1.41.) *Joan McMichael, M.B., Ch.B. Sanitary Inspection Staff: Chief Sanitary Inspector: R. W. McDonald, M.S.I.A. Sanitary Inspectors: A. J. White, Cert. S.I.E.J.B. (Resigned 7.4.41.) 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.) R. w. Bashford, S.I.E.J.B. (Appointed 23.12.40.) 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. (Retired 28.8.41.) Miss B. M. Stanbridge, S.R.N., H.V., Cert. R.S.I. Miss G. M. Leverett, S.R.N., S.C.M., H.V., Cert. R.S.I. Miss M. Williams, S.R.N., S.C.M., H.V., Cert. R.S.I. Mrs. M. D. Cattle, S.R.N., S.C.M., H.V., Cert. R.S.I. (Appointed 8.9.41.) 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 J. D. winterburn. N. V. Saunders. (Joined H.M. G. Woodrow. † 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. t Part time. Maternity and Child Welfare. 4 Miss D. Mash. Miss V. Fuggle. Forces 8.1.41.) Miss H. Heatlie. STATISTICS AND SOCIAL CONDITIONS OF THE BOROUGH. Area (acres): Land, 2,554.5. Water, 50. Total, 2,604 5. Population—Registrar-General's estimate - Number of inhabited houses according to Rate Book - Rateable value £419,320 Sum produced by a penny rate £1,599 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 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:— Table No. 1. 1941. Men. Women. Total. January 43 251 294 February 32 124 156 March 15 115 130 April 18 109 127 May 14 71 85 June 8 51 59 July 18 63 81 August 6 54 60 September 9 59 68 October 11 40 51 November 15 32 47 December 8 14 22 It is probable that Southall accounts for just about seven-eighths of the totals. It will be noticed that the highest total occurred in January and the lowest in December. The average is lower than it was for 1940 (98 against 806). 5 EXTRACTS FROM VITAL STATISTICS Total Male Female Comparative figures for 1940 Live Births—Legitimate 683 346 337 686 Illegitimate 30 13 17 31 Stillbirths—Legitimate 22 13 9 15 Illegitimate 2 2 — Deaths 509 266 243 535 Birthrate (live and stillbirths) per 1,000 of estimated population — — Stillbirth rate per 1,000 total (live and still) births — — *Crude death rate per 1,000 of the estimated population — — 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 - — No. 30. Other puerperal causes 1 1.3 5.4 Total 1 1.3 Death rate of infants under one year of age:— All infants per 1,000 live births 69.31 72.52 Legitimate infants per 1,000 legitimate live births 63.52 65.60 Illegitimate infants per 1,000 illegitimate live births 200.0 225.80 Deaths from cancer (all ages) 71 64 Deaths from measles (all ages) 2 — Deaths from whooping cough (all ages) — — Deaths from diarrhoea, etc. (under 2 years of age) 20 14 6 Causes of Deaths, 1941. Table No. 2. Male. Female. Total 1941. Total 1940. 1. Typhoid fever, etc. - - - - 2. Cerebro-spinal fever - 1 1 3 3. Scarlet fever - - - - 4. Whooping cough - - - - 5. Diphtheria 3 1 4 3 6. Tuberculosis—Respiratory 21 13 34 28 7. Other tuberculosis - 4 4 2 8. Syphilis 3 - 3 3 9. Influenza 2 2 4 6 10. Measles 1 1 2 - 11. Ac. poliomyelitis and polioencephalitis 1 - 1 - 12. Ac. inf. encephalitis - 1 1 1 13/16. Cancer (all forms) 34 37 71 64 17. Diabetes 2 1 3 6 18. Intra-cran. vase. lesions 16 21 37 46 19. Heart disease 46 53 99 106 20. Other circulatory diseases 6 16 22 20 21. Bronchitis 22 20 42 47 22. Pneumonia (all forms) 22 23 45 32 23. Other respiratory diseases 3 3 6 10 24. Ulcer of stomach or duodenum 4 - 4 11 25. Diarrhoea, etc. (under 2 years) 13 7 20 14 26. Appendicitis - - - 5 27. Other digestive diseases 3 3 6 11 28. Nephritis 6 5 11 14 29. Puerperal sepsis - - - — 30. Other maternal causes - 1 1 4 31. Premature birth 4 2 6 10 32. Congenital malformations, etc. 6 6 12 13 33. Suicide - 2 2 2 34. Road traffic accidents 5 - 5 3 35. Other violence 12 4 16 25 36. All other causes 31 16 47 46 Total Deaths 266 243 509 535 7 Deaths and Death Rate—Whole District. Total deaths, 509. (Males, 266 ; Females, 243.) Crude Death Rate — 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 267 (males 122 and females 145). 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 145 and females 97). The total number of deaths therefore belonging to the district is 509. The deaths of non-Southall residents in the St. Bernard's Hospital (not included in the above figures) numbered 300 (males 143 and females 157). Deaths in the various Wards. The following table shows the distribution of deaths in the various Wards:— Table No. 3. Ward Male Female Total Waxlow Manor 41 28 69 Northcote 44 37 81 Hambrough 43 38 81 Dormers Wells 36 39 75 Glebe 56 53 109 Norwood Green 46 48 94 Total 266 243 509 For the purpose of comparison Table No. 4 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 1941, the figures being provisional. 8 Table No. 4. 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 1941. (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 14.2 14.7 16.4 8.9 Still 0.51 0.58 0.60 0.33 Deaths:— All Causes 12.9 14.9 13.0 16.3 Typhoid & Paratyphoid fevers 0.00 0.00 0.00 0.01 Smallpox — — — — — Measles 0.03 0.03 0.03 0.02 Scarlet Fever 0.00 0.00 0.01 0.00 Whooping Cough 0.06 0.07 0.06 0.04 Diphtheria 0.07 0.08 0.06 0.03 Influenza 0.19 0.17 0.20 0.15 Notifications:— Smallpox 0.00 - - - - Scarlet fever 1.47 1.49 1.51 1.01 Diphtheria 1.25 1.53 1.19 0.93 Enteric fever 0.09 0.12 0.09 0.05 Erysipelas 0.30 0.36 0.27 0.50 Pneumonia 1.25 1.53 1.04 1.07 Measles 10.33 8.27 10.47 4.77 Cerebro-spinal fever 0.25 0.31 0.20 0.30 — Whooping Cough 4.39 4.37 45.0 3.50 Rates per 1,000 Live Births Deaths under 1 year of age 59 71 56 68 Deaths from Diarrhoea and Enteritis under 2 years of age 5.1 7.5 4.6 6.8 Rates per 1,000 T otal Births (i.e. Live and Still) Maternal Mortality:— Puerperal Sepsis 0.48 Not available Others 1.75 Total 2.23 Notifications:— Puerperal fever 11.91 15.64 943 2.29 Puerperal pyrexia 19.3 9 Births and Birth Rate (figures for 1940 are given in brackets). The total number of births notified to the Health Department under the Public Health Act, 1936, was 769 (747). The total number of registered births in the district (under the Births and Deaths Registration Act—included in the notified births above) was 445 (453). The total number of live births belonging to the district whether occurring within or outside the district was 713 (717). The illegitimate live births were 30 (31). There were 14 stillbirths (15), and these were legitimate, with two exceptions. The monthly registration of births classified as to Wards is given in the following table. Table No. 5. Monthly Registration of Births. Waxlow Manor Northcote Hambrough Dormers Wells Glebe Norwood Green Total January 7 7 4 1 9 5 33 February 5 2 3 5 8 2 25 March 4 8 4 4 13 5 38 April 3 5 13 2 9 6 38 May 7 6 7 7 17 6 50 June 7 5 2 3 5 6 28 July 4 5 4 5 10 2 30 August 10 4 8 5 13 12 52 September 5 6 1 3 12 4 31 October 9 5 9 2 8 6 39 November 11 4 12 10 7 4 48 December 9 5 5 1 6 7 33 81 62 72 48 117 65 445 Table No. 6. The following table gives an analysis of the places of confinement. Total Confinements (live births and still births), 727. No. born in Hillingdon County Hospital 181 or 24% No. bom in London voluntary hospitals 17 or 4% No. born in nursing homes or other hospitals 178 or 24% No. confined in their homes by midwives or doctors 351 or 48% Infant Mortality. The total number of deaths under one year of age was 49. The rate per 1,000 births was 67. The corresponding rate for England and Wales was 59, for London 68, and for the 148 smaller towns 56 per 1,000. This shows an infant mortality rate lower than last year when it was 72. The various deaths from stated causes at ages under one year of age are shown in the subjoined table. 10 Table No. 7. 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. - 1 1 - 2 3 3 1 1 10 Epilepsy - - - 1 1 - - - - 1 Accidental - - 1 - 1 1 - - 1 3 Congenital Malformations, etc. 3 - - - 3 1 2 1 - 7 Gastro-enteritis, Diarrhoea, etc. - - 3 2 5 6 5 1 - 17 Marasmus - — - — - 1 1 - - 2 Heart Disease - - - - - - - - 1 1 Prematurity 3 1 - - 4 1 - - - 5 Injury at Birth 1 1 1 3 - - - - 3 7 2 6 4 19 13 11 3 3 49 Live Births. Legitimate, 683. Infant Deaths. Legitimate, 43. Illegitimate, 30. Illegitimate, 6. 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, or the Hillingdon County Hospital. During the year four cases of puerperal pyrexia were notified. One occurred after confinement in Hillingdon County Hospital. There was one maternal death during the year in connection with childbirth; this occurred in Hillingdon County 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 1941 the total number of visits made by the nurses was 8,400. 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. 8 shows the services provided in the district. A report on the work in the diphtheria prevention clinic is given on page 34. 11 Table No. 8. 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 County and London Hospitals Examination and Treatment Daily, 7.30 a.m. to 7.30 p.m. Middlesex County Council Tuberculosis Dispensary Uxbridge Chest Clinic, High Street, Uxbridge Dispensary treatment and supervision Mon. and Thurs., 1.30 p.m. Wed. and Fri., 10 a.m. Middlesex County Council Scabies and Verminous Conditions Crosby House, Osterley Park Road Treatment of Scabies, etc., and cleansing of verminous conditions Scabies: Mon. and Thurs., 10 a.m. Verminous conditions: Tues. and Fri., 10 a.m. The Council * Suspended during war. 12 The Council affords facilities to all medical men practising in the district for the examination of pathological specimens. This work was carried out by the Lister Institute of Preventive Medicine until the end of March, since which date it has been done by the Ministry of Health Emergency Laboratory. The following table shows the work done during the year 1941 (exclusive of work done for the Isolation Hospital). Table No. 9. Lister Inst. Emer. Lab. Positive. Negative. Positive. Negative. Swabs for diphtheria 14 184 16 190 Sputa for tubercle 10 37 11 70 Wasserman reaction - 3 — - Faeces and urine - 1 27 Miscellaneous - - 19 Total Examinations 24 225 333 Scabies Clinic. A clinic for the treatment of Scabies and other skin conditions, and for the cleansing of verminous heads, was opened at Crosby House in May of this year, and I append below the number of cases dealt with up to the end of the year. First Visits. Re-attendances. Scabies 234 229 Other skin conditions: Impetigo 11 83 Other 18 - Verminous heads 162 422 Ambulance Facilities. For Infectious Cases. A Commer 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 control of this Department, are provided by the Council for the use of residents, to remove non-infectious and accident cases to hospital and for other ambulance work. Prior to August, these ambulances were under the control of the Chief Officer of the Fire Brigade. Efficient service continues to be rendered, and is quite adequate for peace-time requirements. Figures for the whole year are not available, but the following table shows the work done since August to the end of the year. Table No. 10. Ordinary cases removed to hospital 783 Accidents 109 Persons taken ill in the street 4 Out of district cases 28 Total 924 Miles travelled in the period 7,691 Poor Law Medical Relief. The Relieving Officer issued 350 Medical Orders during 1941. Some of these cases also received outdoor relief or institutional treatment. 13 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 one of the health visitors, who is also Child Protection Visitor. The work done by health visitors during the year is as shown below:— Table No. 11. Summary of Health Visiting Work for the year 1941. Visits to infants— First visits 717 Re-visits 3,030 Visits to children— First visits 25 Re-visits 4,128 Visits to expectant mothers 588 Visits for infectious disease 945 Visits to schools 29* Child Life Protection visits 191 Miscellaneous visits 282 Removals 271 No access 905 Total 11,111 *At these visits a total of 449 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. 12. (1) Number of foster parents on register— (a) At the beginning of the year 22 (b) At the end of the year 28 14 (2) Number of foster parents receiving foster children— (a) At the beginning of the year 21 (b) At the end of the year 17 (3) Number of children on the register— (a) At the beginning of the year 32 (b) At the end of the year 24 (4) Number of children received by foster parents during the year 21 (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 14 (c) Adopted 1 (d) Returned to parents 14 (e) Removed at the request of the medical officer of health - (f) Evacuated with foster mother — (g) Died during the year Nil (h) On whom inquests were held Nil (6) Total number of visits made during the year 191 (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. 13. Number of sessions held: 30. Number of attendances:— First Visits. Re-visits. Mothers 15 59 Infants 95 1,452 15 Post-Natal and Birth Control Clinic. Table No. 14. Number of sessions held: 22 Number of attendances:— Post-Natal. Birth Control. First Visits 90 46 Re-attendances 40 132 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 1941. The number of new patients seen at the ante-natal clinics during the year was 549, and the total number of attendances was 2,907. 430 cases were completed during the year, and the attendances in respect of these were as follows:— No. of Cases. One attendance 41 Two attendances 42 Three attendances 38 Four attendances 49 Five attendances 55 Six or more attendances 205 The following table gives the figures for the last eight years and the proportion of new cases to re-visits. Table No. 15. First visits Re-visits Average number of re-visits per patient Total number of births in the District Percentage of new cases to total births 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 1940 433 2036 5.70 732 59.16 1941 549 2358 4.33 713 76.30 Of the 2,907 total attendances, 1,512 occurred at the Manor House centre and 1,395 at the Branch centre. 16 Of the total cases seen, 568 (544 new cases and 24 brought forward from 1940), 430 were completed during the year, 12 were non-pregnant, 24 left the district, and 102 were uncompleted at the end of the year. This report, therefore, deals with 422 completed cases, 48 for 1940 and 382 occurring in 1941. Of these cases 363 were normal and 67 showed abnormalities. Table No. 16. Primipara Multipara Delivered at home Admitted to hospital or Nursing Home Primipara Multipara Primipara Multipara Normal cases 155 208 81 151 74 57 Abnormal cases 37 3° 7 19 30 11 Of the cases dealt with therefore 192, or 44 per cent., were primiparae (against 39 per cent. in 1940) and of these 104, or 54 per cent. (against 43 per cent. in 1940), were confined in hospital, while 68 cases, or 28 per cent. (against 29 per cent.) of the multiparae were also confined in hospital. The following table gives the chief abnormalities found during the year Table No. 17. (a) Abnormalities of the foetus— (i) twins 6 (ii) abortions 13 (iii) stillbirths 9 (iv) other conditions (b) Abnormalities of the mother— 12 (i) unsatisfactory measurements 26 (ii) post partum haemorrhage 4 (iii) ante partum haemorrhage (iv) albuminuria 3 13 (v) high blood pressure (exceeding 140 systolic or 90 diastolic other than on the first attendance) 43 (vi) other conditions 27 Neo-Natal Mortality (before the seventh day) 1 Maternity and Child Welfare Clinics The attendances at the Child Welfare clinics during 1941 are shown in the following table:— Manor House— Table No. 18. Seen by medical officer: Infants 2,771 Children at ordinary clinics 878 Children at toddlers' clinics 202 17 Weighing only: Infants 2,145 Children 510 New cases (included in above): Infants 321 Children 65 Branch Centre— Seen by medical officer: Infants 2,894 Children at ordinary clinics 1,578 Children at toddlers' clinic 181 Weighing only: Infants 446 Children 230 New cases (included in above): Infants 265 Children 71 Total attendances 11,109 The total attendances at the clinics during the past six years have been as follows:— 1936 11,329 1939 15,452 1937 12,502 1940 12,033 1938 14,351 1941 11,109 It will be noticed that there was a decrease in the total number of attendances in 1941 compared with the figure for 1940. This decrease amounts to 7 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. 19. (1) New Infant Cases (2) Total live births (3) Percentage of (1) to (2)* 1931 337 657 51 1932 408 745 54 1933 350 705 49 1934 395 759 52 1935 563 809 69 1936 558 797 70 1937 598 814 73 1938 711 825 86 1939 652 805 86 1940 567 717 79 1941 586 713 82 * 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. 18 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 1941. 333 attendances were made, 160 of these being at the Manor House, and 173 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. 20. Number of Inspections in stated Groups: Manor House Branch Centre Total 18 months 56 42 98 2 years 32 53 85 3 years 36 29 65 4 years 34 48 82 Total Routine 158 172 330 Other inspections 2 1 3 Total 160 173 333 19 Table No. 21. Number of Individual Children found at Routine Medical Inspection to require Treatment (excluding Dental Disease) : Manor House Branch Centre Total 18 months 22 20 42 2 years 15 29 44 3 years 18 21 39 4 years 15 27 42 Total 70 97 167 Table No. 22. Number requiring Dental Treatment : Manor House Branch Centre Total 18 months – – – 2 years – 3 3 3 years 5 4 9 4 years 6 6 12 Total 11 13 24 Nutrition. Nutrition is assessed for each age group in four grades (A—excellent, B—good, C—slightly subnormal, and D—bad) according to the recommendations of the Board of Education. Table No. 23. Manor House Branch Centre Total A B C D 18 months A 32 26 58 36 4 – B 20 16 C 4 – D – – 2 years A 9 29 38 45 2 – B 21 24 C 2 – D – – 3 years A 16 16 32 32 1 – B 19 13 C 1 – D – – 4 years A 19 16 35 46 1 – B 15 31 C – 1 D – – Total 158 172 163 159 8 – 20 Defects Found. Table 24 shows the individual defects found at medical inspection. It must be remembered that one child may show several defects, and that all defects, however slight, are recorded. Table No. 24. Manor House Branch Centre Total Skirt 1. Ringworm – – – 2. Scabies – – – 3. Impetigo – – – 4. Other diseases (non-tubercular) 2 1 3 Total 1-4 2 1 3 Eye 5. Blepharitis – – – 6. Conjunctivitis 6 1 7 7. Keratitis and opacities – – – 8. Other conditions (excl. defective vision and squint) 1 8 9 Total 5-8 7 9 16 9. Defective vision – – – 10. Squint 5 2 7 Ear 11 Defective hearing – – – 12. Otitis media 1 1 2 13. Other ear diseases – – – Nose and Throat 14. Chronic tonsils and/or adenoids 42 50 92 15. Other conditions 1 1 16. Enlarged cervical glands (non-tubercular) 2 1 3 17. Defective speech 2 – 2 Heart and Circulation 18. Organic heart disease 1 1 2 19. Functional heart disease 7 1 8 20. Anaemia 1 – 1 Lungs 21. Bronchitis 1 2 3 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 3 – 3 29. Genu valgum 18 months – 5 5 2 years – 1 1 3 years – 1 1 4 years 2 5 7 30. Other forms – 9 9 31. Other defects and diseases 12 39 51 32. Dental diseases 18 months – – – 2 years – 3 3 3 years 5 4 9 4 years 6 9 15 21 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.1. There are disadvantages in this variety of hospitals, but with the geographical position of Southall some disadvantages are unavoidable. Help is given with payment of fares if the family income is below a certain scale. A system of following-up has been instituted whereby the health visitors make enquiries to see if the proper treatment has been carried out and, if not, steps are taken to persuade the parent to obtain the necessary treatment. Remedial Exercises. 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 58 9 Re-attendances 586 68 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. 22 The monthly bookings for each district are included below:— Districts No. 1 No. 2 No. 3 No. 4 No. 5 January 2 6 7 6 8 February 4 4 6 6 4 March 5 10 9 5 2 April 7 6 7 11 8 May 5 7 5 7 3 June 3 7 1 7 2 July 8 4 5 4 6 August 11 6 4 7 8 September 5 8 5 5 1 October 6 6 6 8 5 November 4 6 4 8 6 December 6 2 4 5 6 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. 25. Medical Help, Mothers and Children 89 Laying out dead body Nil Liability to be a source of infection 9 Death of child – Stillbirths 7 Artificial feeding 18 The reasons for sending 89 notifications for medical help were as follows:— Table No. 26. During pregnancy 12 For miscarriage 6 During labour 50 During puerperium 10 Infant conditions 11 Maternity and Nursing Homes. The Middlesex County Council is the local authority under the Acts relating to the registration of maternity and other nursing homes. There are two private nursing homes in the district. The following information, relating to maternity and nursing homes in Southall, has been kindly supplied by the County Medical Officer:— Table No. 27. Total number of registered nursing homes in Southall 2 Total accommodation (No. of beds) 26 Number of deletions during the year 1941 1 Number of additional applications re registration during the year 1941 – Number so registered – Refusals or cancellations of registration Nil Number of applications for exemption of registration Nil Result of such applications – 23 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 672 applications granted during the year, as follows:— Table No. 28. Cow's milk free Cow's milk at 50% cost Dried milk free Dried milk at 50% cost 1940 1,986 261 301 22 1941 38 – 577 57 This shows a large decrease on the number in 1940, when a total of 2,570 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. 29. Expectant and Nursing Mothers:— Number sent to the dentist for inspection 103 Number inspected 103 Number for whom treatment was completed 96 Number of completed dentures 57 Number of fillings 154 Number of local anaesthetics 8 Number of general anaesthetics 69 Total number of attendances and re-attendances 475 Children under five years of age:— Number sent for inspection 103 Number inspected 103 Number for whom treatment was completed 99 Number of fillings 17 Number of local anaesthetics – Number of general anaesthetics 92 Total number of attendances and re-attendances to dentist 206 These figures show a total number of 681 attendances compared with 724 in 1940, 813 in 1939 and 689 in 1938. Assisted Services. The expansion of the Maternity and Child Welfare services commented on on page 31 of the report for 1935, continued during 1941. 24 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. Sampling: six samples were taken during the year and found to be satisfactory. Sanitary Inspection of the District. The total number of inspections of premises made during the year in connection with the work of the Sanitary Inspectors was 3,394. The following table shows an analysis of the number and nature of such inspections:— Table no. 30. Visits to premises on complaints 646 Re-inspections of houses, premises, etc. 1,116 Visits in connection with overcrowding 24 Drain tests 11 Factories 137 Petroleum and carbide stores 3 Food sampling 17 Dairies and milk shops 25 Bakehouses 21 Other premises where food is prepared (food shops) 115 Deposits and accumulations of refuse 12 Ditches 1 Miscellaneous 595 Vermin 108 Unsound food 290 Billeting 95 Shops Acts 9 War-damaged property 148 War-damaged food 19 Water sampling 2 3,394 The following table shows the number and nature of complaints received during the year. Table No. 31. Nuisances caused by the keeping of animals 13 Accumulation of refuse, etc 8 Offensive smells 16 Vermin 37 Choked drains 73 Dampness 31 Defective roofs, gutters, etc 41 Defective sanitary fittings 27 25 Rats and mice 14 Miscellaneous 69 Other defective conditions of houses 20 Overcrowding 6 Air raid shelters 5 War-damaged houses 1 Smoke 3 Noise 1 Food 40 405 Eradication of Bed Bugs. Statistics for the year:— (а) Number of Council houses (1) found to be infested 13 (2) disinfested during the year 13 (b) Number of other houses (1) found to be infested 3 (2) disinfested during the year 3 . Total (1) 16 (2) 16 Canal Boats. Visits merged with other duties were paid to the canal and 3 boats were inspected. The condition of both boats and occupants was satisfactory. There were no complaint notices issued by other authorities. Mortuary and Post-mortem Room. The new Mortuary situated in Havelock Road, provides adequate accommodation for the Borough. During the year 24 bodies were deposited in the Mortuary. Petroleum and Carbide. During the year 59 applications for licences to store petroleum were granted and three applications were granted for licences to store carbide of calcium. The licensed premises have been inspected at regular intervals during the year. Celluloid and Cinematograph Films Act, 1922. There is one licence in force for the purpose of stripping and making celluloid solution from cinematograph films, and the premises used 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) 507 (b) Number of inspections made for the purpose 1114 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 – 26 (b) Number of inspections made for the purpose – (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 3 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 3 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 – (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners – (b) By local authority in default of owners – (b) Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 175 (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 – (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 – (2) Number of dwelling-houses demolished in pursuance of tion Orders – (d) Proceedings under Section 12 of the Housing Act, 1936:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made – (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement room having been rendered fit – 4. Housing Act, 1936—Overcrowding:— (a) (1) Number of dwellings overcrowded at the end of the year (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 abatement 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. 27 ADMINISTRATION OF THE SHOPS ACTS The adjustment of hours to meet wartime conditions and the obvious endeavour of shopkeepers generally to co-operate to secure the best result, offset the unavoidable neglect of this work. The routine inspection of food shops which was maintained enabled some control to be exercised on other trades. INSPECTION AND SUPERVISION OF FOOD Milk. The following licences under the Milk (Special Designations) Order, 1936, were granted during 1941:— for the sale of Tuberculin Tested milk 9 for the sale of Accredited milk 1 for the sale of Pasteurised milk 21 for Pasteurisation 2 Supplementary Licences 4 a total of 37 licences being in force at the end of the year. Sampling. Forty-two samples of milk, designated and undesignated, were sent during the year for bacterial count. The examinations are carried out at the National Institute for Research in Dairying, Reading, or at the Public Health Emergency Laboratory, Ealing. The samples are sent by train to the Institute or delivered at the Laboratory, and are invariably examined within four to six hours of being taken. Food Sampling. The chemical or bacteriological analyses of four food samples taken during the year by the Sanitary Inspectors were carried out by the Public Analyst. The Food and Drugs (Adulteration) Act is administered by the County Council. The figures for 1941 are not available. Food Inspection. Inspections are made of the carcases of recently slaughtered animals, and of premises where meat, fish and other foods are sold or prepared for sale. There is no registered slaughterhouse or public abattoir in the district, and most of the meat supplied comes from the Ministry of Food Distribution Centre. FOOD INSPECTION. Table No. 32. Summary. Total Weight of Food Inspected Passed as Sound Destroyed Passed for Animal Feeding Passed for Salvage (lbs.) (lbs.) (lbs.) (lbs.) (lbs.) (a) At Food Factories—Production (plus 8 kegs, 40 cases) 50,517 29,700 6,274 2,191 12.352 (b) At Factory Canteens – – – – – (c) At Shops in the Borough 4,130 – 2,791 1,294 45 (d) Damaged by Enemy Action 103,556 – – – 103,556 (e) At Ministry of Food Depots 38 – 38 – (f) In connection with Prosecutions 99¼ – 99¼ – – Total 158,340 29,700 9,202 3,485 1115,953 FOOD INSPECTION. Details. Total Weight of Food Inspected Passed as Sound Destroyed Passed for Animal Feeding Passed for Salvage (lbs.) (lbs.) (lbs.) (lbs.) (lbs.) (a) At Food Factories—Production: Corned beef 3,203 – 1,597 1,606 – Jordan almonds 1,487 – 1,487 – – Venison 2,608 – 2,608 – – Livers 1,824 – – – 1,824 Hearts 560 – – – 560 Hams 454 – – – 454 Bacon 5,095 2,437 – 585 2,073 Lamb 25,680 19,613 – – 6,067 Beef 9,024 7,650 – – 1,374 Salmon 292 – 292 – – Tomato puree 290 – 290 – – Total 50,517 29,700 6,274 2,191 12,352 Assorted canned goods 8 kegs – 8 kegs – – 40 cases – 40 cases – – (b) At Factory Canteens – – – – – (c) At Shops in the Borough: Beef 6½ – 6½ – – Brisket 12 – 12 – – Corned beef 6 – 6 – – Ox tongue 12 – 12 – – Cod 283 – 238 – 45 Rabbits 517 – 517 – – Winkles 64 – 64 – – Milk 36 – 36 – – Peas 615 – 55 560 – Carrots 48½ – 48½ – – Pilchards 3¾ – 3¾ – – Pears 10 – 10 – – Sausage meat 4½ – 4½ – – Crabs 56 – 56 – – Cake 11 – 11 – – Sugar 90 – 90 – – Salt 6 – 6 – – Rice 134 – 92 42 – Beans 762 – 70 692 – Currants 1 – 1 – – Flour 292 – 292 – – Tea 119 – 119 – – Lentils 112 – 112 – – Sago 143 – 143 – – Cheese 31 – 31 – – Eggs 755 – 755 – – Total 4,130 – 2,791 1,294 45 29 Food Inspection. Details—continued. Total Weight of Food Inspected Passed as Sound Destroyed Passed for Animal Feeding Passed for Salvage (lbs.) (lbs.) (lbs.) (lbs.) (lbs.) (d) Damaged by Enemy Action: Corned beef 5,276 – – – 5,276 Canned fruit 44,953 – – – 44,953 Jam 40,714 – – – 40,714 Flour 17,656 – – – 17,656 Custard Powder 224 – – – 224 Assorted canned goods 9 – – – 9 Total 103,556 – – – 103,556 (e) At Ministry of Food Depots: Milk 38 – 38 – – (f) The following prosecutions were taken during the year, with the results indicated:— Description Action taken Result Weight Luncheon sausage Liver sausage Prosecution Fine £20 and £8. 8s. costs (lbs.) 45 52 Potatoes Prosecution Case dismissed on payment of costs 2 Butter Prosecution (by the Middlesex County Council) Fine £10 ¼ Total weight 99¼ At the food factories, three large consignments were inspected during the year at the request of the Port Authority and the Ministry of Food. These were as follows:— Corned beef 45,436 12-oz. cans (34,077 lbs.) salvaged from a raided area, of which number 7,034 cans (4,900½ lbs.) were salvaged for animal feeding, the remainder being passed as fit for consumption. Oranges 3,496 cases were dealt with during the first four months, and inspections of smaller consignments continued throughout the year. Corned beef 30,000 cans (22,500 lbs.), of which 1,813 cans (1,359¾ lbs.) were salvaged for animal feeding, the remainder being passed as fit for human consumption. 30 During the year a total of more than 161 visits were paid to places where food is prepared (as compared with 77 in 1940) and the tables which follow show the action taken during the year in connection with the inspection of meat and other foods. It will first be seen from the following, however, that this work was carried out despite the total loss in working time, due to Civil Defence and other duties, and vacancies, of 241%, or the equivalent of more than 2 inspectors. SANITARY INSPECTION STAFF—WORKING LOSS, 1941. Table No. 33. Due to: Civil Defence °/ /o Sickness % Vacant % Total Loss % Chief Sanitary Inspector... 50 – – 50 District Sanitary Inspectors: No. 1 District – – – – No. 2 District – – 67 67 No. 3 District – – 25 25 No. 4 District – – 99 99 50% – 191% 241% Note.—The loss in working time during 1941 was, therefore, approaching the equivalent of three Inspectors. 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. 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 267, and the number of certificates of exemption issued were 173. 31 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 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 1941 713 267 173 37 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 hosDital. List of premises, articles, etc., disinfected during the year:— Rooms 124 Beds 186 Blankets 488 Bolsters 109 Books187 Covers 141 Eiderdowns 52 Pillows 466 Sheets 325 Miscellaneous 450 Total 2,528 The following articles were destroyed: 11 mattresses, 4 pillows, 2 blankets, 12 articles of clothing. Cancer. It will be seen by the table of causes of death (page 7) that in 1941, 71 cases (34 males, 37 females) died from cancer. The following table shows the number of deaths from cancer (male and female). It will be seen that in 1941 there was an increase in the cancer mortality. 32 Table No. 35. Year Male Female Total Estimated population Rate per 1,000 population 1922 18 18 36 1923 21 14 35 1924 20 18 38 1925 – – 40 1926 12 11 23 1927 13 13 26 1928 18 27 45 1929 12 10 22 1930 17 29 46 1931 20 28 48 1932 22 23 45 1933 23 28 51 1934 22 27 49 1935 30 27 57 1936 22 30 52 1937 42 28 70 1938 27 30 57 1939 33 41 74 1940 28 36 64 1941 34 37 71 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 – 1 1 5 6 13 6 2 Female – 1 1 3 6 12 13 1 Total – 2 2 8 12 25 19 3 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 (Smallpox prevention) Regulation, 1917. Scarlet Fever (Scarlatina). The number of notifications received during the year was 59 as compared with 57 for the previous year. Of these, 56 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. 33 Diphtheria. There were 60 cases of diphtheria notified as compared with 55 in 1940. All the cases were removed to the Isolation Hospital. There were four 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 68 Number of new patients 1,707 Total attendances made 6,957 Average attendance per session 102 Highest attendance at a session 230 Lowest attendance at a session 16 During 1941 the number of new cases was 1,707 During the year there were no cases of local reaction as a result of an injection of the antigen. Ophthalmia Neonatorum. There was one case of ophthalmia neonatorum notified in 1941, 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 – Cases treated in hospital 1 Vision unimpaired 1 Vision impaired – Total blindness – Deaths – Acute Poliomyelitis. Five cases were notified in the Borough during the year. 34 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 17 16 37 23 29 82 4 – – – – – 208 – – Scarlet fever – 1 3 2 1 30 14 4 2 2 – – 59 56 – Diphtheria 1 1 3 3 3 29 12 5 3 – – – 60 59 4 Measles 17 40 59 70 84 281 13 6 5 – – – 575 2 Puerperal Pyrexia – – – – – – – 2 2 – – – 4 3* – Erysipelas – – – – – – – – 2 3 10 – 15 7* – Pneumonia 2 – 1 2 3 7 2 5 10 6 6 3 47 22 45 Ophthalmia neonatorum 1 – – – – – – – – – – – 1 1 Cerebro-spinal fever, &c. 2 – 1 2 – – 1 – 2 2 – – 10 10* 1 Poliomyelitis 2 1 1 – – – 1 – – – – – 5 5* 2 Typhoid and Paratyphoid – – – – 1 2 2 – – – 1 – 6 6* – *To London hospitals or institutions outside the district. 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 59 6 8 9 10 13 13 56 – Diphtheria 60 5 16 9 5 15 10 59 4 Puerperal pyrexia 4 – 1 1 1 1 – 3 – Pneumonia 47 7 5 6 22 4 3 22* 45 Ophthalmia neonatorum 1 – – 1 – – – 1 – Tuberculosis (all forms) 64 9 10 8 14 14 9 – 38 Erysipelas 15 2 3 1 9 – – 15* – Measles 575 181 59 50 103 118 64 – – Whooping cough 208 63 16 34 31 34 30 – – Cerebro-spinal fever, &c. 10 – 2 1 3 4 – 9* 2 Typhoid and Paratyphoid 6 3 – 1 1 1 – 6* – Totals 1,049 276 120 121 199 204 129 171 89 *To London hospitals and institutions outside the district. 35 Cases of infectious diseases occurred during the year among schoolchildren as follows:— Table No. 41. School Scarlet Fever Diphtheria Beaconsfield Road 5 6 Clifton Road 6 2 Dormers Wells 3 2 Feather stone Road 6 2 North Road 4 1 Tudor Road 5 5 Western Road 3 1 Lady Margaret Road 2 2 Other Schools 2 2 36 23 Infectious Disease Visits. During the year, the Health Visitors paid 945 visits with reference to cases of infectious disease. Three hundred and eight-four swabs were taken. The total number of children examined by the Health Visitors in the schools was 449. 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, 1941 6,138 Total number of examinations of children in the schools by the school nurses 16,827 Number of individual children found unclean 552 Number of children cleansed under arrangements made by the Local Education Authority 9 No legal proceedings were taken during the year with regard to uncleanliness or verminous conditions relating to children attending schools in the Borough. Prevention of Blindness. No action has been taken under Section 176 of the Public Health Act, 1936, by this authority for the prevention of blindness or for the treatment of persons suffering from any disease or injury to the eyes. Several persons are, however, receiving assistance from organisations who care for the blind. Tuberculosis. Pulmonary Tuberculosis. The number of new cases notified during the year was 59. Other Forms of Tuberculosis. The number of new cases notified during the year was 5. 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, 34 ; other forms, 4. The following table shows the new cases notified and the deaths in 1941. 36 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 – – – – – – – – 5-10 1 1 – 1 – – – – 10-15 1 1 – – – – – – 15-25 6 9 1 1 3 4 – 1 25-35 10 9 1 – 6 7 – 2 35-45 8 2 – – 3 2 – 1 45-65 7 3 1 – 7 – – – 65+ – 1 – – 2 – – – Totals 33 26 3 2 21 13 – 4 Of the 38 deaths, 25—or 65 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 6 – 1 – Schoolchildren 2 3 – 1 Clerical work 3 2 – 1 Domestic duties – 10 – – Factory hands 4 3 – – No occupation 5 3 – – Various 13 5 2 – Totals 33 26 3 2 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 126 patients were admitted to the Isolation Hospital as compared with 119 in 1940. Of these, 56 were sent in as scarlatina (52 in 1940) and 59 as diphtheria (55 in 1940), 4 as measles, and 6 as scabies and impetigo. Of the cases sent in as scarlatina, 3 were unconfirmed. Similarly, of the cases sent in as diphtheria or suspected diphtheria, 8 were unconfirmed. The following two tables show the figures for the year and for each month respectively. 37 Table No. 44. Remaining on 31.12.40 Admitted during year as Subsequently diagnosed as Discharged recovered Died Mort. per cent. Remaining 31.12.41 Scarlatina 3 56 55 52 – – 6 Diphtheria 7 59 51 50 2 3 6 Measles 1 4 6 7 – – – Scabies – 6 6 3 – – 3 Other diseases – 1 8 5 – – 3 One case of naso-pharyngeal diphtheria died 14 hours after admission and one, a laryngeal case, died 2 hours after admission, following tracheotomy. Table No. 45. 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 3 7 2 2 2 1 – – – – – – February 1 3 1 4 4 – – – – – – – March 6 6 3 2 3 4 – – – – – – April 6 9 – 5 4 1 – – – – – – May 5 2 – 4 5 – – – – – – – June 6 1 1 7 12 1 – – – – – 1 July 4 1 2 6 2 1 – – – – – – August 8 3 2 5 1 4 1 – – – – – September 3 3 – 7 4 – – – – – – – October 6 8 – 2 4 – – – – – – – November 1 6 – 6 3 – – – – – – – December 6 2 9 2 6 3 1 – – – – – 55 51 20 52 50 15 2 – – – – 1 Scarlatina. Of the 56 cases admitted 55 were finally diagnosed, and the following table shows the incidence in age groups of the 55 cases of scarlatina which were nursed at the hospital:— Table No. 46. Age (years) 0-5 5-15 15-25 25-35 35 + Number 6 39 4 4 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. 38 One minor operation was performed for an axillary abscess. One case developed measles the day after admission. Two cases of scarlatina were on admission found to be suffering from other diseases: one from diphtheria, and one from extensive scalding of foot. Five cases were transferred from St. Bernard's Hospital and found to be suffering from additional infections, one from jaundice, one from gastritis, one from impetigo and post-auricular abscess, one from erythema nodosum, and one from chorea. Complications of the cases of scarlatina were:— Albuminuria 1 External otitis 1 Adenitis 2 Secondary attacks 3 Jaundice 1 Otorrhoea 1 Rheumatism 1 Axillary abscess 1 Diphtheria. Fifty-nine cases notified as diphtheria were admitted to the hospital. Fifty-one of these were confirmed as diphtheria. The following table shows the incidence of the cases in age groups:— Table No. 47. Age (years) 0-5 5-15 15-25 25-35 35 + Number 9 32 8 2 – The clinical types in which the diagnosis was substantiated were as follows :— Laryngeal 4 Tonsillor (Faucial) 24 Naso-pharyngeal 8 Anterior-nasal 13 "Bacteriological" 2 The complications recorded were as follows:— Myocarditis 2 Otitis media 1 Infective jaundice 1 Palatal paralysis 1 There were 3 operations: Tracheotomy, 2; Teeth extraction, 1. Measles. Six cases confirmed as measles were admitted to the hospital; three of the cases on admission were found to be suffering from an additional infection—one from whooping cough and two from broncho-pneumonia. 39 Other Diseases. Twelve cases admitted as scarlatina, diphtheria or measles were subsequently diagnosed as suffering from other diseases. These were as follows (cases notified as diphtheria and diagnosed as scarlatina are also included in the return of scarlatina):— Diseases notified as scarlatina: Tonsilitis, 1. Measles, 2. Diseases notified as measles: Scarlatina, 1. Diseases notified as diphtheria: Laryngitis, 1. Laryngitis and bronchopneumonia, 1. Vincent's angina, 1. Scarlatina, 2. Tonsilitis, 3. Stay in Hospital. The average stay in hospital was as follows:— Scarlatina: All cases (55) 33 5 days. Patients remaining over 56 days 56.0 „ Patients remaining under 56 days 33.1 „ Diphtheria: All cases (51) 66.4 „ Patients remaining over 56 days 125.0 „ Patients remaining under 56 days 47.0 ,, Other diseases: All cases (20) 24.6 „ Laboratory Work. The laboratory work for the hospital was done by the Lister Institute of Preventive Medicine until March and after that date by the Emergency Laboratory, Ealing. During the year the following examinations were performed:— Table No. 48. Lister Inst. Emer. Lab. Swabs for diphtheria bacilli 197 280 Swabs for virulence tests for diphtheria 1 3 Gonococci – 2 Widal test – 1 Smear for gonococci – 2 Sick Staff. Table No. 49. Permanent. Temporary. Number of staff off duty for 24 hours or more 3 – Total number of days off duty 97 – Casual conditions:— Gastro-enteritis and jaundice 79 – Other 18 – 40 INDEX. Acute poliomyelitis 34 Ambulance facilities 13 Ante-natal clinics 16 Antitoxin 31 Area of borough 5 Assisted services 24 Bed bugs 26 Birth Control 16 Births and birth rate 6, 10 Canal boats 26 Cancer 32 Causes of death 7 Celluloid and Cinematograph Film Act 26 Child life protection 14 Clinics 12 Consultant aid 15 Deaths and death rates 8 Dental treatment 24 Diphtheria 34, 40 Diphtheria Prevention Clinic 34 Disinfection 32 Food 28 Foster Children 14 Health Services, General provision of 11 Health visiting 14 Houses—Number inhabited 5 Housing 26 Infant mortality 10 Infant welfare clinics 12, 17 Inspection and Supervision of Food 28 Isolation Hospital 37 Laboratory facilities and work 13, 40 Maternal morbidity and mortality 11 Maternity and Child Welfare 14, 17 Maternity and Child Welfare Committee 3 Maternity and Nursing Homes 23 Meat and other foods 28 Medical relief 13 Midwives 22 Milk supply 28 Milk grants 24 Mortuary 26 Notifiable diseases 31 Nursing in the Home 11 Ophthalmia Neonatorum 34 Petroleum Acts 26 Physical feature of district 5 Poor Law medical relief 13 Population 5 Pre-school medical inspection 19 Public Health Committee 3 Puerperal pyrexia 11 Rateable value 5 Remedial Exercises 22 Sanitary circumstances 25 Sanitary inspection 25 Scabies Clinic 13 Scarlet Fever 33 Shops 28 Slaughterhouses 28 Social conditions 5 Staff 4,31 Statistics—General and Vital 5, 6 Stillbirths 6 Tuberculosis 36 Unemployment 5 Ultra-Violet Light Clinic 15 Unfit houses 26 Vaccination 31 Venereal disease clinics, etc 12 Verminous persons 36 Vital statistics 6, 9 Voluntary help 22 Water supply 25 41