BOROUGH OF SOUTHALL ANNUAL REPORT of the Medical Officer of Health for the Year 1943 M. A. GLASS, Medical Officer of Health. King & Hutchings, Ltd., Printers Southall. BOROUGH OF SOUTHALL ANNUAL REPORT of the Medical Officer of Health for the Year 1943 M. A. GLASS, Medical Officer of Health. THE COUNCIL OF THE BOROUGH OF SOUTHALL, 1943. 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 D. C. NEIGHBOUR, J.P. Deputy Mayor: *Alderman Mrs. F. S. Amos (Chairman of the Public Health Committee). Aldermen: *Gardner, F. E. Hamblin, E. B. *Pargiter, G. A. *Smith, F. G. Councillors: Bill, H. R. Braine, E. W. H. *Cox, E. W. Dane, A. T. Davies, R. L. *Douglas, H. C. Harris, G. Hill, J. Hopkins, W. H. *Hutchings, C. *Lewis, J. F. *Lowe, J. Luckett, F. H. Lye, A. E. *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-seventh Annual Report on the health and sanitary circumstances of the district. Certain vital statistics still require to be excluded from the Report for security reasons, on instructions from the Ministry of Health. The general health of the population continues to be good. The birth rate remained at the higher level which it reached in 1942, but there was a slight increase in the death rate. There was a slight reduction in the infant mortality rate, 53.01 as compared with 56.9 in 1942, and while this is satisfactory, as it followed a considerable decrease on the previous year's figure, there is still room for improvement. During the year, the district was affected by the epidemic of influenza which was widespread over England during the latter part of the year, and in October and November there was an outbreak of Scarlet Fever, which reached considerable proportions, but did not last very long, and was not of a severe type. The cleansing station continued to do useful work in the treatment of scabies and verminous conditions. Two additional wartime day nurseries for the children of mothers engaged in war work were opened, one at the Recreation Ground and one at Jubilee Gardens. There had been a long waiting list for children for whom places in day nurseries were required, and the opening of these nurseries relieved the lists to a considerable extent. The clinic attendances continued good, the increase in the numbers attending the ante-natal clinics being considerable. The work of the Health Visitors was expanded during the year to increase propaganda for anti-diphtheria immunisation, and special care of the 2-5 age children. The work of the Sanitary Inspectors continued to increase. The stoppage of building and the continued influx of persons from areas more vulnerable to air attack make overcrowding problems of much more frequent occurrence, and the number of food inspections increased to almost 100 per cent. over the previous year. Casualty Service work in Civil Defence still took up a considerable proportion of the time of the clerical and other staff. I am, your Worship, Ladies and Gentlemen, Your obedient Servant, MARGARET A. GLASS, Manor House, Southall. Medical Officer of Health. 3 HEALTH DEPARTMENT STAFF for the year 1943. Medical Officer of Health : Ernest Grundy, M.D., B.S.(Lond.), M.R.C.S., L.R.C.P., D.P.H.(Eng.). (Called up for Army Service 1.5.43.) Assistant Medical Officer : Margaret A. Glass, B.Sc., M.B., Ch.B., D.P.H. (appointed Medical Officer of Health from 1.5.43). Sanitary Inspection Staff: Senior Sanitary Inspector : R. W. McDonald, Cert. S.I.B., Cert. M. & F., M.S.I.A. Sanitary Inspectors : L. Mair, Cert. S.I.B., Cert. M. & F., M.S.I.A. F. C. Hills, Cert. S.I.B., Cert. M. & F. R. W. Bashford, Cert. S.I.B., M.S.I.A., A.R.S.I. Health Visiting Staff: Miss E. Gibson, S.R.N., S.C.M., Cert. R.S.I. (Appointed 18.5.42.) Miss B. M. Stanbridge, S.R.N., H.V., Cert. R.S.I. (Child Life Protection Officer.) 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. Miss F. Keynes, S.R.N., S.C.M., H.V., Cert. R.S.I. Midwives: Miss V. Robinson, S.R.N., S.C.M. (Resigned 15.5.43.) 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 (Directed to Industry 18.9.43). R. Stockley (Appointed 29.3.43) (Called up 30.8.43). *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. Miss D. Mash (Directed to Industry 5.5.43). Miss V. Fuggle (Resigned 27.3.43). Miss H. Heatlie. Miss N. Ketteridge. Mrs. B. Pollard (Appointed 9.9.43). *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 — Number of inhabited houses according to Rate Book — Rateable value £419,320 Sum produced by a penny rate £1,530 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. DEATHS AND DEATH RATE Whole District. Total deaths, 492. (Males, 249 ; Females, 243). Crude Death Rate,— For extracts from vital statistics and causes of death see Appendix Tables II and III. It will be observed that the total number of deaths is higher in 1943 than in 1942. The number of deaths from notifiable infectious diseases, excluding pneumonia and tuberculosis was 2 in 1943, as compared with 7 in 1942. There were no deaths from diphtheria. There was again an increase in the deaths from tuberculosis and other respiratory diseases, but in 1943 the increase was very much less than in 1942. In view of the fact that there was a country-wide influenza epidemic during 1943, the smallness of this increase is very satisfactory. The increase in tuberculosis deaths gives cause for some anxiety, as persons affected were mainly between the ages of 20 to 40. There can be observed also a persistent increase in the number of deaths from cancer of all forms. As cancer is a curable disease if diagnosed in the early stages, it seems that the public is still unwilling to undergo investigation of symptoms until the disease has reached an intractable phase. 5 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 228 (males 108 and females 120). For statistical purposes it is necessary to add to this figure the deaths of persons ordinarily resident in the district who died in various London Hospitals, the Hillingdon County Hospital, other Middlesex County Hospitals and elsewhere outside the district. These "outside" deaths were 264 in number (males 141 and females 123). The total number of deaths therefore belonging to the district is 492. The deaths of non-Southall residents in the St. Bernard's Hospital (not included in the above figures) numbered 250 (males 108 and females 142). For the distribution of deaths in the various Wards see Appendix Table IV, and for the comparison of general birth and death rates and rates of maternal mortality, see Appendix Table V. Births and Birth Rate (figures for 1942 are given in brackets). The total number of births notified to the Health Department under the Public Health Act, 1936, was 922 (921). The total number of registered births in the district (under the Births and Deaths Registration Act—included in the notified births above) was 422 (498). The total number of live births belonging to the district whether occurring within or outside the district was 830 (826). The illegitimate live births were 39 (38). There were 25 stillbirths (23), and these were legitimate, with two exceptions. It will be noted that the number of births belonging to the district was approximately the same as in 1942. This means that the birth rate increase which was noted between the years 1941 and 1942 has been maintained. The proportion of expectant mothers wishing to have hospital confinement still remains high. The reasons for this fact, explained in the Report for 1942, still obtain. The table below gives the analysis of the places of confinement and monthly registration of births classified in Wards, is given in Appendix Table VI. Details of abnormalities in confinements during 1943 are t0 be found in Appendix Table XI. The following table gives an analysis of the places of confinement. Total Confinements (live births and still births), 855. No. born in Hillingdon County Hospital 305 or 35.6% No. born in London voluntary hospitals 26 or 3.2% No. born in nursing homes or other hospitals 209 or 24.4% No. confined in their homes by midwives or doctors 315 or 36.8% Infant Mortality. The total number of deaths under one year of age was 44. The rate per 1,000 live births was 53.01. The corresponding rate for England and Wales was 49, for London 58, and for the 148 small towns 46 per 1,000. The infant mortality rate, while showing a decrease on die rates during the years 1938 to 1941, was only slightly lower than the rate in 1942. While this rate still appears favourable compared with the general rate for London, there appears still to be room for improvement when the figures for England and Wales as a whole are considered, and also when it is considered that the infant mortality rate in New Zealand and certain other countries, has been as low as 27 per 1,000. It must be remembered that Southall is an industrial area, and the effects of overcrowding, long hours of work, and necessity for shelter living at times, because of the vulnerability of the area to enemy attacks, are liable to have an influence on the health of the expectant mother, and therefore a resulting effect on infant mortality. For details of cases of deaths of infants in the year see Appendix Table VII. 6 Maternal Morbidity and Mortality. During the year four cases of puerperal pyrexia were notified. There was one maternal death during the year in connection with childbirth. It will be noted in Table V that statistics are now given for England and Wales of the maternal mortality due to, or associated with, abortion. There was no death in this district due to, or associated with, abortion during 1943. 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 1943 the total number of visits made by the nurses was 8,693. 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. During the fourth quarter of 1943, there was a considerable epidemic of influenza in the country, and Southall was affected by it, though not so seriously as other areas. Because of the possibility of medical and nursing services becoming hard pressed, arrangements were made on the lines of Circular 2897 of the Ministry of Health, for temporary nursing and home helps in case of distress. The Womens' Voluntary Service, the District Nursing Association, the British Red Cross Society and the St. John Ambulance Association, and the Health Visitors, were all prepared to co-operate, but fortunately the epidemic subsided rapidly, and it was unnecessary to call upon these volunteers to a great degree. Clinics and Treatment Centres. The services provided in the district are shown in Appendix Table I. A report on the work in the diphtheria prevention clinic is given on page 15. The Council affords facilities to all medical men practising in the district for the examination of pathological specimens. This work is carried out by the Ministry of Health Emergency Laboratory, Ealing. The following table shows the work done during the year 1943 (including work done for the Isolation Hospital). Table A. Emer. Lab. Swabs for diphtheria 647 Sputa for tubercle 156 Faeces 5 Total 808 Scabies Clinic. The total number who attended the clinic for treatment of scabies and other skin conditions during 1943 was 3,086. Details of the cases were as follows :— Scabies First Visits 476, Reattendances 769, Total 1,245 Other skin conditions „ „ 2333, „ 1,477 „ 1,710 Verminous heads „ „ „ 54 „ 131 7 The figures of attendances at the Cleansing Station increased during 1943 by 72 per cent. This clinic is working very successfully, and appears to enjoy the confidence of the General Practitioners and of the Public. Very heavy cases of infestation are becoming much less frequent, a sign that more care is being taken by the Public to ask for advice and treatment before infestation of scabies or vermin becomes too heavy. It has been unnecessary to use the compulsory powers under the Scabies Order to obtain attendances during the year. A few refractory cases have required to be visited by the Health Visitors, or School Attendance Officers. Ambulance Facilities. 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. The vehicles are stationed at the Salisbury Road Civil Defence Depot, and are manned by the members of the Casualty Service. There are increasing demands on this service which functions successfully. Details of the work of this service are as follows:— Table B. Ordinary cases removed to hospital or home 2,825 Accidents 236 Total 3,061 Miles travelled in the period 22,485 Poor Law Medical Relief. The Relieving Officer issued 362 Medical Orders during 1943. Some of these cases also received outdoor relief or institutional treatment. MATERNITY AND CHILD WELFARE. Health Visiting. The district is divided into five health visitor's 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. See Appendix Table VIII for summary of visits during 1943. It will be noted that the number of examinations in schools was greatly increased. This was because of the increase in infectious disease during the year, which meant the examination of large numbers of contacts in the schools. Child Life Protection. The Senior Health Visitor is specially appointed to deal with Child Life Protection work. This work increased during 1943, and consists of visits monthly to foster mothers, and the inspection of children under their care. Under the Adoption of1 Children (Regulation) Act, 1939, the Child Life Protection Officer must now report on, and keep under observation, all persons who wish to adopt children, and children who are to be adopted, until such time as legal adoption has been carried out. See Appendix Table IX for statistics of this work. Consultant Aid in Difficult Labour. A consultant obstetrician for difficult cases of labour is available to medical practitioners practising in Southall. 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. 8 Institutional Provision for Unmarried Mothers, Illegitimate Infants and Homeless Children in the District. None. Ultra-Violet Light Clinic. The clinic for the treatment of expectant mothers and children by Ultra-Violet Light is held at the Manor House twice a week, from October to May. There has been overcrowding at, and a long waiting list for, this clinic, and it is proposed to increase the facilities by providing a new lamp at the Branch Health Centre. Treatment by this method, in the majority of cases, has produced definite improvement in the general condition of patients. All patients are weighed at the commencement and finish of a course of treatment, and these comparative weights have been highly satisfactory in a large proportion of the cases treated. Table C. Number of sessions held: 30. Number of attendances:— First Visits. Re-visits. Mothers 5 56 Infants 130 1,275 Post-Natal and Birth Control Clinic. Table D. Number of sessions held : 22. Number of attendances:— Post-Natal. Birth Control. First Visits 100 34 Re-attendances 93 112 The post-natal clinic is of great value in preventing chronic ill-health in mothers. Small difficulties discovered and remedied at the post-natal clinic can have an immensely beneficial effect on the permanent physical condition of these patients, and it is desirable that, after the war, the facilities for post-natal examinations should be increased in the borough. Ante-Natal Clinics. The number of new patients seen at the ante-natal clinics during the year was 674, and the total number of attendances was 3,822 (2,141 at the Manor House and 1,681 at the Branch Centre). 551 cases were completed during the year, and the attendances in respect 01 these were as follows:— No. of Cases. One attendance 46 Two attendances 34 Three attendances 44 Four attendances 53 Five attendances 56 Six or more attendances 302 No attendance 16 For table of comparison of figures for last eight years, and the proportion of new cases to re-visits, see Appendix Table X. The total number of attendances at the ante-natal clinics again show an increase over that of 1942. From these figures, which showed a great increase also in 1942, it can be observed that the ante-natal clinics are becoming somewhat overcrowded, and considera- 9 tion of the provision of increased facilities for ante-natal examinations will have to be made. The figure for six or more attendances is an excellent one, showing a 50 per cent. increase over 1942 in the number who have attended regularly during a considerable portion of their ante-natal period, and this in spite of conditions which I mentioned in last year's Report still obtaining, i.e., that many of the mothers are, of necessity, working through a considerable period of their pregnancy. Table E.I. Completed cases 551 Uncompleted cases 286 Non-pregnant 26 Removals from district 42 (New cases : 674. Brought forward from 1942, 231) 905 Table E.II. Primipara (1st Pregnancy) Multipara (2nd or Subsequent Pregnancy) Delivered at home Admitted to hospital or Nursing Home Primipara Multipara Primipara Multipara Normal cases 144 303 43 158 101 145 Abnormal cases 56 48 6 16 50 32 Of the cases dealt with therefore 36 per cent. were primiparae (against 38 per cent. in 1942) and of these 75 per cent. (against 64 per cent. in 1942) were confined in hospital, while 50 per cent. (against 41 per cent.) of the multiparae were also confined in hospital. Table XI in Appendix gives the chief abnormalities found during the year. Child Welfare Clinics. The attendances at the Child Welfare clinics during 1943 are shown in Table XII in Appendix. The total number of attendances at the Infant Welfare and Toddlers' Clinics during 1943 was 12,852, as compared with 13,346 for 1942. These figures show a slight decrease on the total figure for 1942, but it will be noted that the proportion of new infant cases attending the clinics, to total live births in the district, (see Appendix Table XIII), has increased in 1943, and that the attendance is very good in spite of wartime conditions. Also, a considerable number of mothers who have been regular clinic attenders have been able to have their children cared for by putting them in the wartime nurseries, where they are under constant medical and nursing supervision and therefore need not also attend clinics. Pre-school Medical Inspection (Toddlers' Clinics). Toddlers' Clinics are held fortnightly at each centre. The total attendances at these clinics were 432, 269 at the Manor House and 163 at the Branch Centre. (See Appendix, Tables XIV, XV, XVI, XVII, and XVIII.) 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 many of a minor degree which are present fortuitously at the time of examination and are quickly remedied. 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 10 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. 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 North Road School Clinic. 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. This clinic is of considerable value for children with mild degrees of bone deformity, i.e., knock knees, bow legs, flat feet, etc. Minor forms of these complaints are treated experimentally by means of wedging of shoes and corrective exercises. If good results are being obtained there is then no need for a specialist's advice, the services of the specialist thus being available for more serious cases. Several children found to have slight orthopaedic defects at the wartime nurseries have been treated in this way. It will be noted that only one expectant mother was persuaded to attend this clinic, and while the total attendances of infants means that the teacher had plenty of work, I feel that propaganda is required in order that mothers should make use of this clinic, which can be a valuable one for them. The demands of war work have prevented several mothers, who would have been willing to take advantage of the clinic, from doing so. The attendances during the year are tabulated below:— Infants. Mothers. First visits 38 1 Re-attendances 497 15 Health Propaganda. During the year, Health Visitors were asked to emphasise during their visits, the importance of anti-diphtheria immunisation, and to increase their efforts in the training of mothers to realise the importance of the prevention of head lice and scabies, and their immediate treatment. The Health Visitors also acted on Ministry of Health Circular 2831, which suggested that more attention should be paid to the 2 to 5 age group in the home, with special reference to dietetics and hygiene. A scheme was commenced during the year, whereby mothers of infants, ascertained from the birth notifications to be now one year old, were sent a birthday card, which contained, as well as a greeting message, a reminder that the child was now old enough to be immunised against diphtheria. 11 In November, the Central Council for Health Education arranged a Brains Trust, the first of its kind in this country, in the Maypole Institute, Southall. Questions were put on general health, with special reference to venereal disease. Because of air raid activity, the attendance was not so large as it had been hoped for, but those who did attend showed a keen interest and many useful questions were asked and answered. Voluntary Help at Clinics. The help given by voluntary workers at the clinics has continued throughout the year. There are several ways in which this work is carried out, i.e., filing work, looking after toddlers, etc., and this service given by the voluntary workers enables the clinics to work much more smoothly, and efficiently ; it is deeply appreciated by members of the staff. 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. (See Appendix, Tables XIX and XX for information dealing with notifications relating to Southall received from midwives resident in Southall during the year. This information is based on material kindly supplied bv the Countv Medical Officer of Health.) The monthly bookings for each district are included below, Table F:— Districts No. 1 No. 2 No. 3 No. 4 No. 5 January 4 7 4 7 7 February 4 5 5 6 3 March 5 6 4 6 6 April 10 7 3 12 7 May 6 5 7 3 7 June 2 6 - 8 7 July 8 7 3 5 7 August 4 6 1 2 6 September 2 6 4 6 3 October 2 9 1 8 2 November 2 2 2 4 3 December 2 2 4 4 3 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 supplied by the County Medical Officer:— Table G. Total number of registered nursing homes in Southall 2 Total accommodation (No. of beds) 26 Number of deletions during the year 1943 Nil Number of additional applications re registration during the year 1943 Nil Number so registered Nil Refusals or cancellations of registration Nil Number of applications for exemption of registration Nil Result of such applications Nil 12 Grants of Milk. Under the Ministry of Food scheme, expectant mothers, nursing mothers, and children under five years of age, are supplied with dried milk or liquid milk, free or at 2d. a pint, according to income. This means that the Borough Council scheme for supplying these milks is required very little now, but babies requiring Cow & Gate or Ostermilk, instead of National Dried Milk, can still be supplied by the Council's clinics. National Cod Liver Oil, Orange Juice and Vitamin tablets are also supplied under the Ministry of Food scheme, and can be obtained at the clinics during the usual clinic session hours. There were 97 applications granted during the year, as follows:— Table H. Cow's milk free Cow's milk at 50% cost Dried milk free Dried milk at 50% cost 1943 — — 90 7 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. (For statistics of dental treatment see Appendix, Table XXI. The figures show a grand total of 648 attendances, compared with 659 for 1942.) Wartime Day Nurseries. Two additional Wartime Day Nurseries were opened during the year, one in the Recreation Ground, and one in Jubilee Park. Both nurseries were built to take 50 children each, and all three nurseries are well utilised. The help given by Civil Defence staff and other voluntary workers at these nurseries is much appreciated. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. During the latter part of the year, an epidemic of Scarlet Fever occurred, and the hospital became very crowded during this time. Overcrowding lasted about six weeks, and then the epidemic was got under control. As neighbouring hospitals were all overfull at the same time; only two patients could be transferred, and they went to the Willesden Municipal Hospital. It was possible to arrange for all other cases, except those which were nursed at home, to be admitted to the Isolation Hospital. Home nursing, in view of the crowded condition of many of the homes in the district, was only possible in a limited number of cases. Arrangements for nursing and feeding patients at the Isolation Hospital were very much strained during this period, but somehow all difficulties were overcome. The number of complications following infection was extremely low, in spite of the full condition of the hospital. 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. 13 Diphtheria and tetanus antitoxin can always be obtained at the Health Department during office hours or at the Isolation Hospital at other times. Following Ministry of Health Circular 2734, the Southall Borough Council resolved that insulin should be supplied to cases not covered by other schemes, patients' income to be assessed and insulin provided free or at part cost. Under this scheme, six cases were dealt with during 1943. Vaccination. The total number of successful vaccination certificates received during the year was 316, and the number of certificates of exemption issued was 179. Table XXII in Appendix gives details of the percentage of children successfully vaccinated during the last seven years. It will be noted that the proportion of vaccinated infants to unvaccinated infants is very low, i.e., 38 per cent. vaccinated, to 62 per cent. unvaccinated. In view of the risk of smallpox infection being brought to this country, which can happen much more readily with large numbers of troops going abroad and coming home again, it seems as if some propaganda for vaccination is required. Disinfection. In cases of infectious disease, rooms, clothing, etc., are disinfected—rooms by sealing and fumigating with formalin or a formalin preparation ; clothing, bedding, etc., and infected articles which can be removed for steam disinfection, by treatment in the disinfector at the hospital. Table I. List of premises, articles, etc., disinfected during the year:— Rooms 289 Covers 228 Beds 425 Eiderdowns 96 Blankets 855 Pillows 695 Bolsters 197 Sheets 504 Books 214 Miscellaneous 227 Scabies clinic: Bags of clothing 311 Total 4,041 The following articles were destroyed: 12 mattresses, 3 sheets, 1 bolster and 7 pillows. Cancer. It will be seen by the table of causes of death (page 24) that in 1943, 97 cases (51 males and 46 females) died from cancer. (See Appendix, Tables XXIII and XXIV.) The increase in the cancer mortality follows an increase in 1942, and mention has already been made in the paragraph on Deaths and Death Rate. 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 269 as compared with 100 for the previous year. Of these, 255 were removed to the Isolation Hospital. 14 One hundred and twenty-five scarlet fever cases were admitted during the last quarter of the year, when scarlet fever reached minor epidemic proportions. The disease was of a mild type, and complications were not numerous, but for several weeks the hospital was very full, and heavy demands were made on the staff during this time. Diphtheria. There were 27 cases of diphtheria notified as compared with 22 in 1942. All the cases were removed to the Isolation Hospital. There were no deaths from diphtheria of residents during the year. There was a big reduction in the number of cases of diphtheria notified in 1942, as compared with 1941. There has not been a further reduction in 1943. The types of cases were very mild, and there were very few complications, and these of only a temporary nature. It seems as if the practice of diphtheria immunisation is now producing results in the improvement of diphtheria statistics, though the time that this can be positively ascertained has not yet come, because of the periodicity which is associated with infectious disease epidemics. Diphtheria Prevention. The number of children immunised during 1943 is disappointingly low. Certainly a big proportion of children whose parents consent to have immunisation done had been dealt with during the campaign, but there is still a large proportion of children between 1 and 15 years in Southall, who have not been immunised. The Health Visitors have been making a special point of mentioning immunisation, when on their home visits, and during the year a scheme was instituted for sending an attractive birthday card to children reaching the age of one year, and the birthday card was also a reminder of the need for immunisation against diphtheria. As compared with the number of children born in 1943, the number of new cases immunised, i.e., 681, constitutes approximately 80 per cent. Diphtheria immunisation is carried out on Monday afternoons at the Branch Health Centre, and on Thursday afternoons at the Manor House clinic. Table J. Number of sessions held 102 Total attendances made 2,473 Average attendance per session 24 Highest attendance at a session 64 Lowest attendance at a session 7 During 1943 the number of new cases was 681 During the year the number of sessions for diphtheria immunisation at Council clinics was increased by the commencing of a weekly clinic on Monday afternoons at the Branch Health Centre. Ophthalmia Neonatorum. There was one case of ophthalmia neonatorum notified in 1943. Acute Poliomyelitis. No case was notified in the Borough during the year. Notifiable Diseases during the Year. For the incidence of various infectious diseases, excluding tuberculosis, notified during the year, under age groups, locality, and certain cases occurring among school children, see Appendix, Tables XXV, XXVI, and XXVII. 15 Infectious Disease Visits. During the year, the Health Visitors paid 899 visits with reference to cases of infectious disease. One hundred and twenty-seven swabs were taken. The total number of children examined by the Health Visitors in the schools was 2,078. Uncleanliness and Verminous conditions in Schoolchildren. I am obliged to Dr. H. M. C. Macaulay, the County School Medical Officer, for the information on this subject:— Number of children on roll at 31st December, 1943 6,545 Total number of examinations of children in the schools by the school nurses 19,617 Number of individual children found unclean 646 Number of children cleansed under arrangements made by the Local Education Authority 637 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 71. Other Forms of Tuberculosis. The number of new cases notified during the year was 9. Of the total notifications 41 were notified from Institutions (Sanatoria 8, County Council Hospitals 20, General Hospitals 13). Deaths from Tuberculosis. Tuberculosis of the respiratory system, 34; other forms, 6. For details of new cases notified and deaths in 1943, see Appendix, Table XXVIII, and the occupations of new cases, see Appendix, Table XXIX. Public Health (Prevention of Tuberculosis) Regulations, 1925. Public Health Act, 1936, Section 172. Action under these powers was not necessary during the year. Venereal Diseases. The Middlesex County Council is the authority under the Public Health (Venereal Disease) Regulations, for the treatment of Venereal Disease in the County. 16 REPORT ON THE BOROUGH ISOLATION HOSPITAL. During the year 313 patients were admitted to the Isolation Hospital as compared with 146 in 1942. Of these, 255 were sent in as scarlatina (94 in 1942) and 27 as diphtheria (24 in 1942), 16 as measles, and 1 as erysipelas, 1 as rubella, and 8 as chickenpox. Of the cases sent in as scarlatina, 4 were unconfirmed. Similarly, of the cases sent in as diphtheria or suspected diphtheria, 10 were unconfirmed. For details of cases during the year, and dealt with each month of the year, see Appendix, Tables XXX and XXXI. Scarlatina. Of the 255 cases admitted 252 were finally diagnosed, and the following table shows the incidence in age groups of the 252 cases of scarlatina which were nursed at the hospital:— Table K. Age (years) 0-5 5-15 15-25 25-35 35 + Number 77 162 10 2 1 Three minor operations were performed, two for abscess and one for removal of toe-nail. One case of scarlatina developed mumps 25 days after admission—no secondary case. One case was admitted suffering from chickenpox in addition—one secondary case. Three cases developed rubella. Complications of the cases of scarlatina were:— Cervical adenitis 11 Impetigo 2 Rhinitis 13 Staph, dermatitis 1 Nephritis 1 Styes 1 Secondary attacks 4 Preauricular abscess 1 Conjunctivitis 2 Sub-maxilliary abscess 1 Septic sores 5 Scabies and impetigo 3 Septic finger 8 Scabies 3 Rheumatism 2 Stomatitis 1 Bronchitis 10 Chorea 1 Cardiac irregularity 4 Herpes zostin 3 Boils 1 Septicaemia 1 Pneumonia 1 Anaemia 1 Otorrhoea 18 Tonsilitis 3 Diphtheria. Twenty-seven cases notified as diphtheria were admitted to the hospital. Seventeen of these were confirmed as diphtheria. The following table shows the incidence of the cases in age groups:— Table L. Age (years) 0-5 5-15 15-25 25-35 35 + Number 1 9 6 — 1 17 The clinical types in which the diagnosis was substantiated were as follows :— Tonsillor (Faucial) 7 Naso-pharyngeal 3 "Bacteriological" 7 Four of the cases were severe. The complications recorded were as follows:— Cardiac irregularity 4 Palatal paralysis 1 Staphlococcal throat 1 Three cases became convalescent carriers and were in hospital 135,149 and 172 days respectively. Tonsillectomy was performed at Willesden Municipal Hospital. Other Diseases. Fourteen cases admitted as scarlatina or diphtheria were subsequently diagnosed as suffering from other diseases. These were as follows:— Diseases notified as scarlatina: Tonsilitis, 1. Measles, 1. Rubella, 2. Diseases notified as diphtheria: Scarlatina, 1. Tonsilitis, 4. Laryngitis and bronchitis, 1. Tonsilitis and bronchitis, 1. Vincents angina, 1. Peritonsillar abscess, 2. Stay in Hospital. The average stay in hospital was as follows:— Scarlatina : All cases (252) 30.8 days. Patients remaining over 56 days 63.8 „ Patients remaining under 56 days 29.3 „ Diphtheria : All cases (17) 73.6 „ Patients remaining over 56 days 95.8 „ Patients remaining under 56 days 34.0 „ Other diseases : All cases (44) 20..4 „ Laboratory Work. The laboratory work for the hospital was done by the Emergency Laboratory, Ealing, and is included in the figures given in Table A, page 7. Sick Staff. Table M. Permanent. Temporary. Number of staff off duty for 24 hours or more 5 1 Total number of days off duty 172 7 Causal conditions:— Tonsilitis 11 days — Bronchitis 35 „ — Influenza 34 „ 7 days Bruised leg 5 „ — Influenza and rheumatism 79 „ — Rubella 8 „ — 18 SANITARY CIRCUMSTANCES OF THE BOROUGH. Water Supply. Water is supplied to nearly the whole of the district by the South West Suburban Water Company. The Metropolitan Water Board supplies a small area in the southern part of the district, and the Rickmansworth and Uxbridge Valley Water Company a small area in the northern part. The supply is satisfactory both in quality and in quantity. 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 6,886. Tables XXXII and XXXIII show an analysis of the number and nature of such inspections, and the number of complaints received during the year. Eradication of Bed Bugs. Table N. Statistics for the year:— (a) Number of Council houses Total (1) 38 (2) 38 (1) found to be infested 15 (2) disinfested during the year 15 (b) Number of other houses (1) found to be infested 23 (2) disinfested during the year 23 Canal Boats. Visits were paid to the canal and 4 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. Petroleum and Carbide. During the year 55 applications for licences to store petroleum were granted and four 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. Housing. A reliable overcrowding estimate will have to be made immediately conditions permit, as there is general evidence of an increase in sub-letting. Wartime experience has emphasised a lack of proper facilities for cleansing of persons and effects before transfer to new housing. For statistics see Table XXXIV in the Appendix. 19 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 1942:— for the sale of Tuberculin Tested milk 13 for the sale of Accredited milk — for the sale of Pasteurised milk 20 for Pasteurisation 2 Supplementary Licences 2 a total of 37 licences being in force at the end of the year. Sampling. Fifty-six 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. 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 56 food samples taken during the year by the Sanitary Inspectors were carried out by the Public Health Emergency Laboratory. The Food and Drugs (Adulteration) Act is administered by the County Council. The figures for 1943 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 INSPECTIONS. Table O. Details: Total Inspected Passed as Sound Destroyed Passed for Human Consumption Passed for Animal Feeding (lbs.) (lbs.) (lbs.) (lbs.) (lbs.) Canned 272,122 217,867 28,062 3,996 18,784 Raw 16,906 8,598 926 273 4,292 Totals 289,028 226,465 28,988 4,269 23,076 20 APPENDICES 21 Table I. 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 Branch Centre Immunisation against diphtheria Thursday 2-3 p.m. Monday 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 T reatment 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. 22 EXTRACTS FROM VITAL STATISTICS. Table II. Total Male Female Comparative figures for 1942 Live Births—Legitimate 791 401 390 788 Illegitimate 39 16 23 38 Stillbirths—Legitimate 23 10 13 23 Illegitimate 2 1 I Deaths 492 249 243 444 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 (alive nd still) births. No. 29. Puerperal sepsis 1 1.19 1.76 No. 30. Other puerperal causes — — Total 1 1.19 Death rate of infants under one year of age:— All infants per 1,000 live births 53.01 56.90 Legitimate infants per 1,000 legitimate live births 51.83 57.11 Illegitimate infants per 1,000 illegitimate live births 76.91 52.62 Deaths from cancer (all ages) 97 72 Deaths from measles (all ages) 2 — Deaths from whooping cough (all ages) — — Deaths from diarrhoea, etc. (under 2 years of age) 12 8 23 Causes of Deaths, 1943. Table III. Male. Female. Total 1943. Total 1942. 1. Typhoid fever, etc _ _ _ _ 2. Cerebro-spinal fever - - - 2 3. Scarlet fever — — _ - 4. Whooping cough - - - - 5. Diphtheria - - - i 6. Tuberculosis—Respiratory 20 14 34 24 7. Other tuberculosis 3 3 6 7 8. Syphilitic diseases 5 5 6 9. Influenza 2 3 5 - 10. Measles 1 1 2 — 11. Ac. poliomyelitis and polioencephalitis - - - 1 12. Ac. inf. encephalitis - - - 2 13/l6 Cancer (all forms) 51 46 97 72 17. Diabetes 3 3 8 18. Intra-cran. vase. lesions 10 23 33 41 19. Heart disease 43 5i 94 82 20. Other circulatory diseases 7 22 29 21 21. Bronchitis 12 18 30 14 22. Pneumonia (all forms) 15 15 30 35 23. Other respiratory diseases 4 3 7 4 24. Ulcer of stomach or duodenum 8 2 10 9 25. Diarrhoea, etc. (under 2 years) 7 5 12 8 26. Appendicitis - - - 1 27. Other digestive diseases 9 2 11 12 28. Nephritis 6 3 9 3 29. Puerperal sepsis - 1 1 1 30. Other maternal causes - — - 2 31. Premature birth 5 4 9 13 32. Congenital malformations, etc 9 5 14 16 33. Suicide 3 1 4 3 34. Road traffic accidents - 2 35. Other violence 8 4 12 13 36. All other causes 21 14 35 41 Total Deaths 249 243 492 444 Table IV. Ward Male Female  Waxlow Manor 37 26 63 Northcote 42 28 70 Hambrough 48 45 93 Dormers Wells 36 37 73 Glebe 43 61 104 Norwood Green 43 46 89 Total 249 243 492 24 Table V. Vital Statistics compared with other Areas. BIRTH-RATES, CIVILIAN DEATH-RATES, ANALYSIS OF MORTALITY, MATERNAL DEATH-RATES, AND CASE-RATES FOR CERTAIN INFECTIOUS DISEASES IN THE YEAR 1943. (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 16.5 18.6 19.4 15.8 Still 0.51 0.63 0.6l 0.45 Deaths :— All Causes 12.1 14.2 12.7 15.0 Typhoid & Paratyphoid fevers 0.00 0.00 0.00 0.01 Smallpox — — — — — Measles 0.02 0.02 0.02 0.02 Scarlet Fever 0.00 0.00 0.00 0.00 Whooping Cough 0.03 0.03 0.03 0.03 Diphtheria 0.03 0.04 0.04 0.02 Influenza 0.37 0.36 0.37 0.27 Notifications:— Smallpox 0.00 0.00 — 0.00 — Scarlet fever 3.01 3.29 3.54 3.80 Diphtheria 0.88 1.12 0.77 0.74 Typhoid fever 0.01 0.01 0.02 0.01 Erysipelas 0.31 0.35 0.27 0.42 Pneumonia 1.34 1 .62 1.16 1.27 Measles 9.88 9.23 9.77 9.17 Cerebro-spinal fever 0.08 0.10 0.06 0.09 — Whooping Cough 2.54 2.82 2.25 2.68 Rates per 1,000 Live Births Deaths under 1 year of age 49 58 46 58 Deaths from Diarrhoea and Enteritis under 2 years of age 5.3 7.9 4.4 10.4 Rates per 1,000 Total Births (i.e . Live and Still) Notifications:— Puerperal fever n.68 1511 926 3.05 Puerperal pyrexia 15.23 MATERNAL MORTALITY (England and Wales). Abortion with Sepsis Abortion without Sepsis Puerperal Infections Other 0.34 0.11 0.39 1.45 Abortion—Mortality per Million Women aged 15-45 (England and Wales). With Sepsis Without Sepsis 25 8 25 Monthly Registration of Births. The monthly registration of births classified as to Wards is given in the following table. Table VI. Waxlow Manor Northcote Hambrough Dormers Wells Glebe Norwood Green Total January 5 4 7 7 10 5 38 February 5 12 3 4 12 5 41 March 11 5 6 4 9 4 39 April 4 8 3 5 7 14 41 May 12 5 7 9 8 12 53 June 7 2 8 4 7 3 31 July 7 5 3 1 11 12 39 August 4 6 1 6 3 7 27 September 6 4 5 4 2 6 27 October 4 5 4 6 13 8 40 November 2 5 2 8 7 1 25 December 6 - 3 1 8 3 21 73 61 52 59 97 80 422 Live Births. Legitimate, 791. Illegitimate, 39. Infant Deaths. Legitimate, 41, Illegitimate, 3. Table VIII. Summary of Health Visiting Work for the Year 1943. Visits to infants- First visits 755 Re-visits 2,446 Visits to children- First visits 108 Re-visits 4,224 Visits to expectant mothers 818 Visits for infectious disease 899 Visits to schools 81* Child Life Protection visits 211 Miscellaneous visits 495 Removals 121 No access 1,168 Total 11,326 *At these visits a total of 2,078 children were examined. 26 Table VII. 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 l 9-12 months Total deaths under 1 year Bronchitis, Pneumonia, etc. - - 2 2 4 1 1 _ 2 8 Measles - - - - - - 1 - 1 Congenital Malformations, etc. 3 2 2 - 7 i - - - 8 Gastro-enteritis, Diarrhoea, etc. - - - - 5 3 1 12 Congenital Heart Disease 1 - - - 1 1 - 2 Prematurity 9 - - - 9 - - - - 9 Miscellaneous 4 - - - 4 - - - - 4 17 2 4 2 25 7 5 4 3 44 Table IX. (1) Number of foster parents on register— (a) At the beginning of the year 22 (b) At the end of the year 23 (2) Number of foster parents receiving foster children— (a) At the beginning of the year 22 (b) At the end of the year 22 (3) Number of children on the register— (a) At the beginning of the year 27 (b) At the end of the year 27 (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 10 (c) Adopted — (d) Returned to parents 8 (e) Removed at the request of the medical officer of health — (f) Evacuated with foster mother — (g) Died during the year 1 (h) On whom inquests were held 1 (6) Total number of visits made during the year 189 (7) Number of cases in which court proceedings were taken Nil Table X. 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 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 1942 642 2912 4.55 826 77.71 1943 674 3148 4.067 830 81.21 Of the 3,822 total attendances, 2,141 occurred at the Manor House centre and 1,681 at the Branch centre. 27 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. Table XI. (a) Abnormalities of the foetus— (i) twins 6 (ii) abortions 18 (iii) stillbirths 11 (iv) other conditions 17 (b) Abnormalities of the mother— (i) unsatisfactory measurements 20 (ii) post partum hemorrhage 10 (iii) ante partum haemorrhage 2 (iv) albuminuria 4 (v) high blood pressure (exceeding 140 systolic or 90 diastolic other than on the first attendance) 32 (vi) other conditions 32 Neo-Natal Mortality (before the seventh day) 4 Table XII. Manor House— Seen by medical officer: Infants 2,125 Children at ordinary clinics 626 Children at toddlers' clinics 226 Weighing only: Infants 3,409 Children 358 New cases (included in above): Infants 331 Children 48 Branch Centre— Seen by medical officer: Infants 3,077 Children at ordinary clinics 1,120 Children at toddlers' clinics 251 Weighing only: Infants 1,349 Children 311 New cases (included in above): Infants 301 Children 29 Total attendances 12,852 The total attendances at the clinics during the past six years have been as follows:— 1938 I4,351 1941 11,109 1939 I5,452 1942 13,346 1940 12,033 1943 12,852 28 Table XIII. (1) (2) (3) New Infant Cases Total live births Percentage of (1) to (2)* 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 1942 605 826 73 1943 632 830 76 * 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. Table XIV. Number of Inspections in stated Groups: Manor House Branch Centre Total 18 months 85 90 175 2 years 49 59 108 3 years 53 41 94 4 years 35 58 93 Total Routine 222 248 470 Other inspections 4 8 12 Total 226 256 482 Table XV. Number of Individual Children found at Routine Medical Inspection to require Treatment (excluding Dental Disease): Manor House Branch Centre Total 18 months 15 9 24 2 years 9 18 27 3 years 13 18 31 4 years 12 26 38 Total 49 71 120 29 Table XVI. Number requiring Dental Treatment: Manor House Branch Centre Total 18 months — — — 2 years — — — 3 years 7 7 14 4 years 9 11 20 Total 16 18 34 Table XVII. Nutrition. Manor House Branch Centre Total a b c d 18 months a 64 54 118 46 9 2 b 19 27 c 2 7 d — 2 2 years a 34 25 59 35 13 1 b 10 25 c 5 8 d - 1 3 years a 38 14 52 34 8 — b 12 22 c 3 5 d - — 4 years a 17 25 42 45 6 — b l6 29 c 2 4 d — — Total 222 248 271 160 36 3 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. 30 Table XVIII 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 XVIII. Defects Found. Manor House Branch Centre Total Skin 1. Ringworm - - - 2. Scabies - - - 3. Impetigo 1 - 1 4. Other diseases (non-tubercular) - 1 1 Total 1-4 1 1 2 Eye 5. Blepharitis - - - 6. Conjunctivitis 2 1 3 7. Keratitis and opacities - - - 8. Other conditions (excl. defective vision and squint) 5 1 6 Total 5-8 7 2 9 9. Defective vision _ _ _ 10. Squint 5 5 Ear 11. Defective hearing - - - 12. Otitis media - - - 13. Other ear diseases - - - Nose and Throat 14. Chronic tonsils and/or adenoids 13 24 37 15. Other conditions 16. Enlarged cervical glands (non-tubercular) - - - 17. Defective speech - - - Heart and Circulation 18. Organic heart disease - - - 19. Functional heart disease - - - 20. Ansemia - - - Lungs 21. Bronchitis - - - 22. Other non-tubercular diseases - - - 23. Pulmonary tuberculosis - - - Tuberculosis 24. Glands - - - 25. Bones and joints - - - Nervous system 26. Chor - - - 27. Other conditions - - - Deformities 28. Rickets deformities 1 4 5 29. Genu valgum 18 months 3 4 7 2 years 7 7 14 3 years 6 6 12 4 years - 8 8 30. Other forms - - - 31. Other defects and diseases 11 10 21 32. Dental diseases 18 months - - - 2 years - - - 3 years 7 7 14 4 years 9 11 20 31 Table XIX. Medical Help, Mothers and Children 95 Laying out dead body — Liability to be a source of infection 16 Death of child 1 Stillbirths 9 Artificial feeding 15 The reasons for sending 95 notifications for medical help were as follows :— Table XX. During pregnancy 6 For miscarriage 3 During labour 61 During puerperium 10 Infant conditions 15 Table XXL Expectant and Nursing Mothers:— Number sent to the dentist for inspection 131 Number inspected 113 Number for whom treatment was completed 68 Number of completed dentures 65 Number of fillings 65 Number of local anaesthetics 15 Number of general anaesthetics 103 Total number of attendances and re-attendances 511 Children under five years of age:— Number sent for inspection 86 Number inspected 74 Number for whom treatment was completed 61 Number of fillings 9 Number of local anesthetics — Number of general anaesthetics 44 Total number of attendances and re-attendances to dentist 137 These figures show a total number of 648 attendances compared with 659 in 1942, 681 in 1941 and 724 in 1940. 32 Table XXII. Year Live Births Vaccination Certificates Exemptions Percentage of vaccinations to live births 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 1942 826 294 168 35 1943 830 316 179 38 Table XXIII. 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 1942 34 38 72 1943 51 46 97 The following table shows the age distribution of the cancer deaths:— Table XXIV. 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 17 17 • 11 4 Female - 1 2 2 10 18 9 4 Total - 1 3 3 27 35 20 8 33 The following table shows the various infectious diseases (other than tuberculosis) notified during the year and also their age incidence:— Table XXV. Notifiable Diseases during the year (other than Tuberculosis). Diseases Ages Total cases notified Cases admitted to hospital Deaths Under i year 1 to 2 2 to 3 3 to 4 4 to 5 5 to 10 10 to 15 15 to 25 25 to 35 35 to 45 45 to 65 65 and over Whooping cough 5 12 7 n 14 26 4 1 - - 82 5 - Scarlet fever — 12 7 22 42 147 8 28 8 3 - - - 269 255 — Diphtheria - i 3 - 3 6 2 - - - 26 27 - Measles 14 29 21 51 47 126 5 - - - - - 293 16 2 Puerperal pyrexia — - - - - 2 2 - - - 4 3* - Erysipelas — - - - - - 1 - 3 1 1 - 6 1* — Pneumonia 8 — I - 2 2 3 3 4 12 11 2 48 30 Ophthalmia neonatorum 1 - - - - - - - - - - - 1 1* - Cerebro-spinal fever, &c. 2 - - - - - - - - - - - 3 3* *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 XXVI. Diseases Total Waxlow Manor North- cote Hambrough Dormers Wells Glebe Norwood Green Admitted to Hospital Total deaths Scarlet fever 269 75 51 36 26 55 26 255 - Diphtheria 26 6 4 6 4 2 4 27 - Puerperal pyrexia 4 2 - — - 1 1 3* - Pneumonia 48 10 3 4 16 11 4 - 30 Ophthalmia neonatorum 1 - — 1 - — - 1* - Tuberculosis (all forms) 80 15 5 12 15 15 18 40 Erysipelas 6 2 - — 2 2 — 1* - Measles 293 121 47 31 45 26 23 16 2 Whooping cough 82 19 13 17 11 15 7 5 - Cerebro-spinal fever, &c. 3 — 2 1 - - 3* - Totals 812 250 125 107 120 127 83 3ii 72 *To London hospitals and institutions outside the district. 34 Cases of infectious diseases occurred during the year among schoolchildren as follows:- Table No. XXVII. School Scarlet Fever Diphtheria Beaconsfield Road 17 1 County School 5 - Clifton Road 14 _ Dormers Wells 2 1 Featherstone Road 11 _ North Road 24 2 St. Anselms 9 _ Tudor Road 13 3 Western Road 10 Lady Margaret Road 43 1 Other Schools 6 - 154 8 Table No. XXVIII. Age Periods New Cases Deaths Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary Male Female Male Female Male Female Male e 0-1 1-5 - 2 3 - - - 3 1 5-10 - - - 1 - - - - 10-15 1 1 - - - - - - 15-25 14 12 - 1 1 1 - - 25-35 5 11 - 2 5 8 - 2 35-45 8 5 - 1 7 2 - - 45-65 5 5 1 - 5 2 - - 65+ 1 1 - - 2 i - - Totals 34 37 4 5 20 14 3 3 Of the 40 deaths, 33-or 82 per cent.-were of notified cases. The occupations of the new cases were as follows:- Table No. XXIX. Occupations Pulmonary Non-Pulmonary Male Female Male Female Building and decorating trades 3 _ 1 _ Schoolchildren 1 I _ 1 Clerical work 1 3 - - Domestic duties _ 16 _ 1 Factory hands 10 10 _ 1 No occupation 3 2 2 1 Various 16 5 1 1 Totals 34 37 4 5 35 Table No. XXX. Remaining on 31.12.42 Admitted during year as Subsequently diagnosed as Discharged recovered Died Mort. per cent. Remaining 31.12.43 Scarlatina 10 255 252 229 - - 33 Diphtheria - 27 17 14 - - 3 Measles 2 16 17 18 1 - - Whooping Cough - 5 5 5 - - - Rubella - 1 3 3 - - - Chickenpox 10 8 8 18 - - - Mumps 1 - - 1 - - - Erysipelas - 1 1 1 - - Table No. XXXI. Number admitted Final diagnosis Number discharged Deaths Sc. Fv. Diph. Measles Rubella ChickenPox Mumps Erysipelas Other Sc. Fv. Diph. Measles Rubella ChickenPox Mumps Erysipelas Other Diph. Others January 8 - i _ 6 - 1 2 6 - 3 - 11 1 - - - - February 3 - 8 - 2 - - i 4 - 2 - 3 - i 3 - i March 11 2 2 - - - - . 2 8 - 6 - 4 - - 1 - - April 21 - 2 - - - - 2 14 - 2 - - - 1 - - May 20 4 3 2 - - - 2 19 2 2 2 - - - 4 - - June 11 3 - - - - - - 21 1 2 July 8 1 - - - - - 1 10 1 - - - - - 1 - - August 6 1 - - - - - 2 10 3 - - - - - - - - September 39 1 - - - - - 2 8 1 - - - - - 2 - - October 61 3 1 1 - - - 1 44 2 i 1 - - - 3 - - November 38 1 - - - - - - 50 2 - - - - - - - - December 26 1 - - - - - - 36 2 - - - - - - - - 252 17 17 3 8 - 1 15 229 14 18 3 18 1 1 15 - 1 36 Table XXXII. Houses, Public Health Act, 1936 4,249 Houses, Housing Act, 1936 255 Overcrowding 83 Disinfestation 302 War Damage 34 Shops Act 1 Food Shops 657 Fried Fish 15 Cafes, etc 37 Factories, Mechanical 69 Factories, Non-Mechanical 3 Outworkers 5 Food Factories 706 Smoke 9 Offensive Trades 1 Bakehouses 31 Dairies 58 Water Sampling 3 Milk Sampling 38 Other Foods Sampling 23 Rats and Mice 128 Stables 63 Accumulations 42 Petrol, etc 55 Canal Boats 1 Slaughterhouses 18 Total Inspections 6,886 Table XXXIII. Nuisances caused by the keeping of animals 14 Accumulation of refuse, etc. 8 Offensive smells 20 Vermin 32 Choked drains 108 Dampness 49 Defective roofs, gutters, etc. 88 Defective sanitary fittings 45 Rats and mice 11 Miscellaneous 77 Other defective conditions of houses 170 Overcrowding 36 Air raid shelters 2 War-damaged houses 7 Smoke 7 Food 89 773 37 Table XXXIV. Statistics. HOUSING. i. Inspection of Dwelling-houses during the year:— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 321 (b) Number of inspections made for the purpose 5,013 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 (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 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. 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 1 (2) Number of dwelling-houses which were rendered fit after service of formal notices :— (a) By owners 1 (b) By local authority in default of owners — (b) Proceedings under Public Health Acts:— 0 (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 296 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 117 (b) By local authority in default of owners — 38 Table XXXIV.—continued. (c) Proceedings under Sections n and 13 of the Housing Act, 1936:— (1) Number of dwelling-houses in respect of which Demolition Orders were made - (2) Number of dwelling-houses demolished in pursuance of Demolition 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 18 (c) (1) Number of cases of overcrowding relieved during the year 2 (2) Number of persons concerned in such cases 14 (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 None *No reliable figure can be given in the absence of systematic inspections. 39 INDEX. Ambulance facilities 8 Ante-natal clinics 9, 27, 28 Antitoxin 13 Area of borough 5 Assisted Services 12, 13 Bed bugs 19 Birth Control 9 Births and birth rate 6, 25, 26 Canal boats 19 Cancer 14, 33 Causes of death 24, 26 Celluloid and Cinematograph Film Act 19 Child life protection 8, 27 Clinics 7, 9, 22 Consultant aid 8 Deaths and death rates 5, 25 Dental treatment 13, 32 Diphtheria 15,17 Diphtheria Prevention Clinic 15 Disinfection 14 Food 20 Foster Children 27 Health Services, General provision of 7 Health visiting 8, 16, 26 Houses—Number inhabited 5 Housing 19, 38 39 Infant mortality 6, 26 Infant welfare clinics 9, 22, 28 Inspection and Supervision of Food 20 Isolation Hospital 17, 36 Laboratory facilities and work 7 Maternal morbidity and mortality 7,25 Maternity and Child Welfare 8 Maternity and Child Welfare Committee 3 Maternity and Nursing Homes 12 Meat and other foods 20 Medical help 32 Midwives 12 Milk supply 20 Milk grants 13 Mortuary 19 Notifiable diseases 13, 15, 34, 35 Nursing in the Home 7 Ophthalmia Neonatorum 15 Petroleum Acts 19 Physical feature of district 5 Poor Law medical relief 8 Population 5 Pre-school medical inspection 10, 29, 30, 31 Public Health Committee 3 Puerperal pyrexia 7 Rateable value 5 Remedial Exercises 11 Sanitary circumstances 19 Sanitary inspection 19, 37 Scabies Clinic 7 Scarlet Fever 14, 17, 36 Shops 20 Slaughterhouses 37 Social conditions 5 Staff 4 Statistics—General and Vital 5, 23 Stillbirths 6, 23 Tuberculosis 16, 34, 35 Ultra-Violet Light Clinic 9 Unfit houses 38 Vaccination 14, 33 Venereal disease clinics, etc. 16 Verminous persons 16 Vital statistics 23, 25 Voluntary help 12 Wartime Nurseries 13 Water supply 19 40