439(1) Southall Sout 12 BOROUGH OF SOUTHALL ANNUAL REPORT OF THE Medical Officer of Health for the Year 1944 M. A. GLASS, Medical Officer of Health. KING ASTD HUTCHINGS, LTD., PRINTERS, SOUTHALL BOROUGH OF SOUTHALL ANNUAL REPORT > of the Medical Officer of Health for the Year 1944 M. A. GLASS, Medical Officer of Health. THE COUNCIL OF THE BOROUGH OF SOUTHALL, 1944. 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 COUNCILLOR J. M. STURGEON, J.P. Deputy Mayor: *Alderman D. C. Neighbour, J.P. Aldermen: *Gardner, F. E. Hamblin, E. B. *Pargiter, G. A. *Smith, F. G. Councillors: *Amos, Mrs. F. S. (Chairman of Public Health Committee) 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. *Kimberley, T. *Lewis, J. F. *Lowe, J. Luckett, F. H. Lye, A. E. *Marks, F. J. *Knott, Mrs. A. Saxon, J. A. Sturgeon, J. M. Tunbridge, F. J. To the Mayor, Aldermen and Councillors of the Borough of Southall. MR. MAYOR, LADIES AND GENTLEMEN, I have the honour to present the forty-eighth Annual Report on the health and sanitary circumstances of the district. 1944 was the year of V.i and V.2 activity, when Southall was first declared an evacuation area. The difficulties caused by enemy activity were immense and included the deterioration of living conditions of the people because of the increased, and for Southall the first substantial, use of the air raid shelters, also the nervous strain would have a deleterious effect on the health and resistance of many. It is the more gratifying, therefore, to be able to report once again that the general health of Southall's population continued to be good. A substantial fall in the death rate, fewer deaths from tuberculosis, a rising birth rate following on a continuous birth rate increase every year since 1941, and a decrease in infant mortality are noteworthy in a year of tension, shelter living, displacement of individuals and continued shortage of food and coal. 3 Clinic attendances were good, an increase in ante-natal clinic attendances corresponded with the birth rate increase. There was no major epidemic of infectious disease during 1944. In the early part of the year measles of a mild type was fairly widespread ; no deaths from measles occurred. The amount of work done by the Casualty Service members in manning ambulances for civil use and in staffing the Cleansing Station increased during the year, and a scheme was prepared to come into operation on 31st December for the Borough Council to take complete control of the Civil Ambulance and Cleansing of Persons services. A new Day Nursery was opened at the Municipal Sports Ground, bringing the number of nursery places in the Borough to 184. All four nurseries were running satisfactorily by the end of the year, and this service began to show the benefits of nursery care for small children. Good regular meals, regular rest, careful habit training, kindergarten teaching, and constant medical supervision resulted in some remarkable improvements physically and mentally in individual children, and some degree of improvement in the majority. The demand for nursery places continued to increase. Health Propaganda was increased during the year, by means of posters, talks and films in the clinics, individual teaching of mothers in the homes by the Health Visiting Staff, in the nurseries by the matrons and staffs, and health talks to members of Youth Organisations. The Isolation Hospital continued to work efficiently, and since there was no epidemic of scarlet fever or diphtheria it was possible to help local practitioners and the Services by taking individual cases of milder infections. A new ultra-violet light apparatus for the Branch Centre was obtained in 1944, and came into use in April. Lack of space prevents the increase in the numbers of ultraviolet light sessions to more than two a week at each end of the Borough, and the provision of a Sunlight Centre or Ultra-Violet Rooms in future new clinics might well be considered in view of the useful results obtained by this treatment. The delegation of powers to the Southall Borough Council under the Rats and Mice (Destruction) Act added to the duties of the Sanitary Inspectors. A rat catcher was appointed, and the work of surveying infestation in the Borough and planning treatment was commenced in the early part of the year. An increase in the work on Food Inspection and on house inspections for overcrowding is noteworthy. I should like to take this opportunity of thanking all members of the Health Department Staff for the co-operation and loyal support they have given me. I am, your Worship, Ladies and Gentlemen, Your obedient Servant, MARGARET A. GLASS, Manor House, Southall. Medical Officer of Health. 4 HEALTH DEPARTMENT STAFF for the year 1944 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.). Deputy Medical Officer : E. S. Stuart, M.B., Ch.B. (Appointed 24.1.44). 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. Miss B. M. Stanbridge, S.R.N., H.V., Cert. R.S.I. (Child Life Protection Officer). (Resigned 31.12.44). 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. (Resigned on 25.3.44). Miss F. Keynes, S.R.N., S.C.M., H.V., Cert. R.S.I. Miss M. D. Fairbrass, S.R.N., R.F.N., S.C.M., H.V., Cert. R.S.I., A.R.S.I. (Appointed 17.4.44). Miss M. G. Sawkins, S.R.N., C.M.B. (Appointed 11.4.44). Midwives: 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. Miss E. Simpson, S.R.N., R.F.N., S.C.M. (Appointed 6.1.44). Clerical Staff : Chief Clerk : J. W. Cronk, Cert. R.S.I. Clerks, Shorthand- Typists : Miss P. Ashton Miss K. Snowden. Miss H. Heatlie. Mrs. E. Richards (Appointed 30.8.44). Miss N. Ketteridge. E. Stonestreet (Appointed 12.3.44). Mrs. B. Pollard D. Champion (Directed to Industry 8.1.44). *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, Maternity and Child Welfare. 5 STATISTICS AND SOCIAL CONDITIONS OF THE BOROUGH. Area (acres): Land, 2,554 5. Water, 50. Total, 2,604 5. Population—Registrar-General's estimate (Mid 1944) 48,970 Number of inhabited houses according to Rate Book 13,122 Rateable value £419,142 Sum produced by a penny rate £1,630 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, 443 (Males, 239, Females, 204). Crude Death Rate, 9 04. For extracts from vital statistics and causes of death see Appendix Tables II and III. A marked decrease in the total number of deaths within the Borough occurred during 1944, and the death rate was lower by 10 per cent. The analysis of the causes of death showed a satisfactory decrease in the number of deaths from tuberculosis, 20 in 1944 as compared with 40 in 1943. The persistent increase in the deaths from cancer noted over the past few years was not maintained during 1944. The reduction was from 97 deaths from cancer in 1943 to 69 in 1944. There was a slight increase in the number of deaths from intra-cranial vascular lesions amongst elderly people. This may be the result of war strain, but the deaths from heart disease and respiratory troubles were not increased. 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 202 (males 99 and females 103). 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 241 in number (males 140 and females 10l). The total number of deaths therefore belonging to the district was 443. 6 The deaths of non-Southall residents in the St. Bernard's Hospital (not included in the above figures) numbered 135 (males 47 and females 88). 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 1943 are given in brackets). The total number of births notified to the Health Department under the Public Health Act, 1936, was 1,049 (922). The total number of registered births in the district (under the Births and Deaths Registration Act—included in the notified births above) was 449 (422). The total number of live births belonging to the district whether occurring within or outside the district was 914 (830). The illegitimate live births were 55 (39). There were 21 stillbirths (25), and these were legitimate, with two exceptions. The birth rate in the Borough has risen every year since 1941. These have been 1418 in 1941; 16 26 in 1942. This increase was maintained in 1944 and the birth (live and still) rate of 19.09 was the highest recorded in this Borough since 1920, when the figure was 23 4. Interesting figures for comparison are the birth rate in 1891=40.9; 1901=34.3; 1911=29.2; 1921 = 18.8. The corresponding rate for the whole country in 1944 was 17.6. The table below gives the analysis of the places of confinement. The monthly registration of births classified in Wards is given in Appendix Table VI. Details of abnormalities in confinements during 1944 are to be found in Appendix Table XI. Total Confinements (live births and still births), 935. No. born in Hillingdon County Hospital 280 or 30% No. born in London voluntary hospitals 46 or 5% No. born in nursing homes or other hospitals 311 or 33% No. confined in their homes by midwives or doctors 298 or 32% Infant Mortality. The total number of deaths under one year of age was 42. The rate per 1,000 live births was 45.9. The corresponding rate for England and Wales was 46, for London 61, and for the 148 small towns 44 per 1,000. The infant mortality rate was markedly less for 1944. This rate has decreased since 1938 by a greater or less amount annually, but the 1944 figure brings the infant mortality rate below the corresponding rate for the whole of England and Wales. This is highly satisfactory in an industrial and overcrowded area of the nature of Southall. The comparative figure of London's infant mortality, i.e., 61, is worthy of note. For details of causes of death of infants in the year, see Appendix Table VII. Maternal Morbidity and Mortality. During the year 14 cases of puerperal pyrexia were notified, but no maternal death and no deaths associated with abortion. 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 1944 the total number of visits made by the nurses was 9,000. 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. Nq call was made on their services during the year. 7 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 16. 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. The following table shows the work done during the year 1944 (including work done for the Isolation Hospital). Table A. Positive Negative Swabs for diphtheria 11 162 Sputa for tubercle 22 79 Faeces 4 9 Other 4 81 41 331 Scabies Clinic The total number who attended the clinic for treatment of scabies and other skin conditions during 1944 was 2,251. Details of the cases were as follows :— Scabies First Visits 370, Re-attendances 819, Total 1189. Other skin conditions „ „ 142 „ 657 „ 799. Verminous heads „ „ 193 „ 70 „ 263. There was a decrease in the attendances at the vermin and scabies clinic during 1944. The reduction in these figures was partly due, however, to the reduced number of re-attendances for skin conditions other than scabies or verminous infestation and is no real indication of improvement in the figures for the occurrence of scabies and vermin, as will be noted by an inspection of the number of first visits. Many other skin condition cases were referred back for continued treatment to the school clinics during 1944 as attendances at the scabies clinic resulted in non-attendance at school, which was not necessary with cases not of an infective nature. The number of vermin-infested cases attending was more than double, but the majority of these cases were suffering from a mild attack of infestation and were cleansed rapidly, resulting in a decrease in the number of re-attendances for this condition also. Ambulance Service. During 1944 the ambulance vehicles were stationed at Salisbury Road Civil Defence Depot, and were manned by the members of the casualty service. Emergency and extra calls were covered by the use of the Civil Defence ambulances and these became increasingly necessary as the year went on because of the greater demand from the public for this service. All users of the civil ambulance service are expected to produce a medical certificate to justify the free use of the ambulance. With the reduction of the Civil Defence Casualty Service in the imminent future, the Borough Council had to consider the provision of civil ambulance facilities as completely separate from the Casualty Service and from the Fire Service. A tentative scheme for the provision of sufficient civil ambulance vehicles and staff was proposed. The new arrangements came into force on the 31st December, 1944. Details of the work of this service are as follows:— Poor Law Medical Relief. The Relieving Officer issued 391 Medical Orders during 1944. Some of these cases also received outdoor relief or institutional treatment. 8 Table B. Ordinary cases removed to hospital or home 4,497 Accidents 445 Total 4,942 Miles travelled in the period 29,634 MATERNITY AND CHILD WELFARE. Health Visiting. This year the Borough Council area which was previously divided into five sections for health-visiting purposes, was re-divided into six. The appointment of the sixth health visitor was made necessary because of the continual increase in the requirements of home visiting, the establishment of the new Ultra-Violet Light Clinic; new requirements in connection with Infant Life Protection and Moral Welfare, and the Ministry of Health's request that more attention should be paid to the tracing of contacts of vermin-infested children in the homes, and home instructions to mothers on feeding and hygiene of toddlers. One health visitor is responsible in each of the six districts, for all the health-visiting work, including infectious disease, visiting of expectant mothers, first visits to new-born infants and re-visits to infants and children and the investigation of infectious disease in schools. Special work in child life protection in connection with the adoption of children is carried out by the Senior Health Visitor as Child Life Protection Officer. The special moral welfare work is carried out by a health visitor, who was appointed to deal with this work in addition to her normal health-visiting duties. The figure for no access is extremely high, even higher than last year. Most of this is due to the fact that there are so many mothers working in the district and that shopping difficulties cause those who are not working, to be out of their homes for a considerable portion of the day. To limit the number of no access visits, a scheme is being commenced whereby the health visitor who cannot obtain access to the house, leaves a card to the effect that she has called and suggesting times when the clinics may be visited and doctors or health visitors consulted. This should prevent three or four visits being paid to the same house without success. Child Life Protection. The Senior Health Visitor is specially appointed to deal with Child Life Protection work. This work continued during 1944, and consists of visits monthly to foster mothers, and the inspection of children under their care. Under the Adoption of 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. Institutional Provision for Unmarried Mothers, Illegitimate Infants and Homeless Children in the District. None. Moral Welfare. The increase in incidence of illegitimate children throughout the country led to a recommendation by the Ministry of Health that special arrangements be made for the supervision and care of the unmarried mothers and illegitimate children. Following the Minister's circular, the Southall Borough Council decided that a special health visitor should be appointed in the area to deal with these cases, and Miss M. Fairbrass was appointed on 17.4.44. Arrangements were made for her to have a short course of training in this work under the auspices of the London Diocesan Council for Moral Welfare Work. All cases of unmarried expectant mothers are now referred from the other members of the staff to this health visitor, who endeavours to obtain pre-natal accommodation, hospital and post-natal accommodation for these mothers. Various other social aspects in these 9 cases have necessarily to be dealt with by this health visitor. Arrangements with the Middlesex County Council have been made for the admission of cases to the pre-natal home at Golders Green and the post-natal home at Hendon. It will be noted that a rise in the figure of illegitimate live births occurred in 1944 which emphasises the need for this special work. Ultra-Violet Light Clinics. A new ultra-violet light apparatus was provided at the Branch Health Centre and a Sunlight Clinic started there in April. Two sessions a week were held at the Branch Centre in addition to the clinic held twice weekly at the Manor House. The treatment is for expectant mothers and children under five years of age and produces very good results in the majority of cases. Ultra-violet light treatment is especially necessary for young children showing early traces of rickets infection, as the amount of natural sunlight during winter months is so limited. All patients are weighed at the commencement and finishing of a course of treatment, and the majority show a distinct gain in weight, improvement in appetite and general tone. It will be noted from the figures, that there was a very large increase in the number of expectant mothers attending this clinic, and there is no doubt that ultra-violet light treatment for expectant mothers may have a good effect on the infant mortality rate. Table C. Number of sessions held : 85. Number of attendances:— First Visits. Re-visits Mothers 44 579 Infants 178 1,434 Post-Natal and Birth Control Clinic. Table D. Number of sessions held: 21. Number of attendances:— Post-Natal Birth Control. First Visits 86 25 Re-attendances 69 111 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 710, and the total number of attendances was 3,894 (3,348 at the Manor House and 1,646 at the Branch Centre). 527 cases were completed during the year, and the attendances in respect of these were as follows:— No. of Cases. One attendance 6 Two attendances 47 Three attendances 59 Four attendances 77 Five attendances 116 Six or more attendances 182 No attendance 30 For table of comparison of figures for last eight years, and the proportion of new cases to re-visits, see Appendix Table X. 10 There was a further increase in the number of attendances at the ante-natal clinics during the year 1944 over that of 1943. The figures have risen steadily since 1940, as would be expected from the rising birth rate and it will be necessary to consider in the near future the provision of further clinics for expectant mothers. The number attending at one session has been as high as 31. These figures while showing a lower percentage of attendances of expectant mothers in proportion to the total number of live births, are the more gratifying since this year the enemy attacks were very heavy and frequently during the fly-bomb period it was necessary to arrange for the expectant mothers to be in shelters during the clinic times and brought into the clinic only in very small numbers. Delay was often caused and it required a fair amount of goodwill and patience both on the part of the mothers and of the staff, to keep this clinic up to the normal standard of efficiency. Table E.I. Completed cases 527 Uncompleted cases 135 Non-pregnant 19 Removals from district 89 (New cases : 710. Brought forward from 1943, 60) 770 Table E.II. Details of Completed Cases Primipara (1 St Pregnancy) Multipara (2nd or Subsequent Pregnancy) Delivered at home Admitted to hospital or Nursing Home Primipara Multipara Primipara Multipara Normal cases 198 285 97 196 101 89 Abnormal cases 27 17 5 8 22 9 Of the cases dealt with therefore 42 per cent. were primiparae (against 36 per cent, in 1943), and of these 23 per cent, (against 75 per cent. in 1943) were confined in hospital, while 32 per cent. (against 50 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 1944 are shown in Table XII in Appendix. The total number of attendances at the Infant Welfare and Toddlers' Clinics during 1944 was 11,013, as compared with 12,852 for 1943. These figures while showing a slight decrease on the total figure for 1943, are quite satisfactory in view of the conditions prevailing as mentioned in the previous paragraph. Also, the number of nursery children who were able to be inspected medically at the nurseries without attending the clinics during the year was 180. These children who are under constant medical and nursing supervision would have been clinic attendants and would have, by their weekly or monthly attendances, swollen the clinic numbers considerably. During the year Southall became an evacuation area and many expectant mothers and children of all ages were transferred to the country. Most of these mothers would normally have been clinic attendants. 11 Pre-school Medical Inspection (Toddlers' Clinics). Toddlers' Clinics are held fortnightly at each centre. The total attendances at these clinics were 464, 252 at the Manor House and 212 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 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. Deafness Metropolitan Ear, Nose and Throat Hospital. 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. Voluntary Workers. The Voluntary Workers' Association has continued in spite of wartime difficulties to supply helpers for the clinics where they do much useful work. This service given so generously and in so public-spirited a manner makes for the easier running of busy clinics, and the Health Department Staff appreciated it very much. Government Evacuation Scheme. During the year, Southall was scheduled as an evacuation area and facilities were provided for mothers with young children, parties of schoolchildren and individual expectant mothers to obtain accommodation in safe areas. These arrangements were made very hurriedly but an endeavour was made to have as many of the evacuees as possible examined medically and for cleanliness. 1,852 were examined and 9 found to be in need of special medical attention at the reception end; 123 were found to be suffering from scabies or vermin infestation and were cleansed before travelling. 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 12 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. The attendances during the year are tabulated below :— Infants. Mothers. First visits 71 4 Re-attendances 683 11 Health Propaganda. At clinics, in the homes, in the nurseries, in the hospital, there is a continual and persistent education in health matters in progress; children are learning the reasons for being clean, for having correct diet, and how to prevent disease, and parents are advised about these things and in more detail the dangers of dirty homes, unsound and badly cooked food, housefly and vermin infestation, the importance of sleep and a regular life for young children and so on. Health posters supplied by the Ministry of Food, Central Council for Health Education and other educative bodies were displayed on the Council's posterboards and in clinics and libraries and with the recommencement of Mothercraft sessions it was possible to give health talks to small groups of mothers at these sessions. The birthday card scheme whereby infants of one year received a greeting card with a reminder that anti-diphtheria immunisation should now be undertaken had some success in obtaining attendances at the Immunisation Clinic. 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 by the County 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 Totals January 3 8 2 8 3 24 February 5 4 4 7 2 22 March 7 7 3 9 6 32 April 7 5 6 7 4 29 May 8 1 4 10 5 28 June 4 6 1 8 6 25 July 5 4 5 6 6 26 August 6 11 3 10 3 33 September 6 10 6 9 2 33 October 3 6 3 7 3 22 November 3 11 6 8 4 32 December 6 6 7 4 3 26 Totals 63 79 50 93 47 332 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. 13 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) 27 Number of deletions during the year 1944 Nil Number of additional applications re registration during the year 1944 Nil Number so registered Nil Refusals or cancellations of registration Nil Number of applications for exemption of registration Nil Result of such applications Nil 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. Babies requiring special feeding, i.e., Cow & Gate, or Ostermilk instead of National Dried Milk, were supplied through 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 90 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 1944 — — 85 5 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. The increase in this figure is encouraging as it shows that a larger number of mothers are realising the value of dental treatment for themselves and the desirability of dental inspection for younger children. In the past it has been difficult to obtain co-operation from mothers with regard to the examination and the care of milk teeth as they considered that temporary teeth are bound to be lost in the course of nature, and did not require special care and attention. (For statistics of dental treatment see Appendix, Table XXL The figures show a grand total of 709 attendances, compared with 648 for 1943.) Wartime Day Nurseries. The three day Nurseries already functioning were filled during the year, and in November a fourth day Nursery was opened in the Municipal Sports Ground. This Nursery was again of the fifty-place pre-fabricated type, and by the end of the year a good proportion of the children's places were taken. Civil Defence auxiliaries and other voluntary workers gave a considerable amount of help in each of our Wartime Nurseries which was much appreciated, and the attendance of girls from schools in their spare time was of value, not only to the Nurseries but for their own education in health and mothercraft. There is no doubt now that these Wartime Nurseries are of immense value as second homes for young children whose own homes are 14 either temporarily or permanently inadequate for them, i.e., because of the absence of the mother through illness or from economic necessity. They are also of value as places for education of the only child, and of mal-adjusted children. They are excellent training places for young girls who feel drawn towards a career in nursing or child education, and, as mentioned above, under the heading "Health Propaganda," the mothers come under constant influence of persons trained in Child Care, and are taught from day to day many things concerning health and hygiene, which otherwise they might not so easily learn. During the year, affiliation with the National Society of Children's Nurseries was confirmed after inspection by the Association's representative. This means that all persons appointed as students in the nurseries are eligible to sit for the Nursery Nurses Diploma offered by the Association for students over 17 years of age who have the standard of training. Five sat for the examination during the year and three passed. By the courtesy of the Middlesex County Council, arrangements were made for the X-ray examination of all day nursery staffs to prevent the possibility of concealed cases of tuberculosis being at work amongst so many young children. I am glad to be able to report that no cases of tuberculosis were discovered. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. In the early part of 1944 there was a considerable number of measles cases. This epidemic was of a nation-wide character and the greatest number of cases were developed in the industrial towns of the country. The disease, however, was of a rnild type on the whole, as is evidenced by the pneumonia figures in the same table, which were increased only by two for the figures for 1943, and there were no deaths recorded from measles. There were no epidemics of other diseases and the diphtheria notifications were 15 as compared with 26 in 1943. There were no deaths from diphtheria. 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. 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 17 cases were dealt with during 1944. Vaccination. The total number of successful vaccination certificates received during the year was 353) and the number of certificates of exemption issued was 185. Table XXII in Appendix gives details of the percentage of children successfully vaccinated during the last seven years. The proportion of vaccinated to unvaccinated infants is still much too low, i.e., 38 to 61 per cent. unvaccinated. The danger of smallpox infection being brought into this country becomes greater each year with the development of air transport and with the return of troops from countries where this disease is still epidemic, and it is proposed to increase the propaganda for vaccination by means of handbills to the mothers. 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. 15 Table I. List of premises, articles, etc., disinfected during the year:— Rooms 133 Covers 122 Beds 294 Eiderdowns 56 Blankets 736 Pillows 395 Bolsters 69 Sheets 210 Books 96 Miscellaneous 3i Scabies clinic: Bags of clothing 156 Total 2,298 The following articles were destroyed: 4 mattresses, 1 bolster, 3 pillows and 24 articles of clothing. Cancer. It will be seen by the table of causes of death (page 26) that in 1944, 69 cases (37 males and 32 females) died from cancer. (See Appendix, Tables XXIII and XXIV.) The decrease in cancer is very marked and the figure is the lowest for some years. This figure has been showing an upward trend since 1940 which was very disturbing but the present figure is not unduly high. 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 115 as compared with 269 for the previous year. Of these, 109 were removed to the Isolation Hospital. Diphtheria. A further drop in the number of notifications of diphtheria has resulted in a corre sponding drop in the admission of cases to the Isolation Hospital. 16 were admitted during the year, 4 of which were not confirmed as diphtheria, making a total of 12 positive cases. There were no deaths from diphtheria. None of the cases was of a severe type and there were no complications. Diphtheria Prevention. The immunisation figures for 1944 are still extremely unsatisfactory, but again attention should be drawn to the fact that it was a very difficult year because of enemy activity and the Government evacuation scheme. Propaganda has been intensified in this direction and all mothers attending the clinics and visited in their homes are asked individually concerning the immunising of their children. In the Wartime Nurseries consent is obtained from the parents on the child's admission and arrangements are made at the earliest possible date for the attendance of the children at the Diphtheria Immunisation Clinic for this purpose. The proportion of immunised one-year old children to the total estimated number in the district is fairly good, i.e., 78 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 98 Total attendances made 2,174 Average attendance per session 22 Highest attendance at a session 43 Lowest attendance at a session 5 During 1944 the number of new cases was 504 16 Ophthalmia Neonatorum. There were 3 cases of ophthalmia neonatorum notified in 1944. Two of the cases were reported as having unimpaired vision at the end of treatment and 1 case was still under treatment at the end of the year. Acute Poliomyelitis. Two cases were notified in the Borough during the year, 1 of whom died. 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. Infectious Disease Visits. During the year, the Health Visitors paid 671 visits with reference to cases of infectious disease. 131 swabs were taken. The total number of children examined by the Health Visitors in the schools was 809. 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, 1944 5,711 Total number of examinations of children in the schools by the school nurses 21,489 Number of individual children found unclean 477 Number of children cleansed under arrangements made by the Local Education Authority 240 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 66. . Other Forms of Tuberculosis. The number of new cases notified during the year was 9. Of the total notifications 35 were notified from Institutions (Sanatoria —, County Council Hospitals 19, General Hospitals 16). Deaths from Tuberculosis. Tuberculosis of the respiratory system, 18 ; other forms, 2. For details of new cases notified and deaths in 1944, see Appendix, Table XXVIII, and the occupations of new cases, see Appendix, Table XXIX. Public Health (Prevention of Tuberculosis) Regulationsy 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, 17 REPORT ON THE BOROUGH ISOLATION HOSPITAL. During the year 184 patients were admitted to the Isolation Hospital, as compared with 3x3 in 1943. Of these, 109 were sent in as scarlatina, 16 as diphtheria, 7 as measles and pneumonia, 10 as impetigo and scabies, 1 as meningitis carrier, 3 as erysipelas, 1 as dysentery, 5 as mumps, 6 as chicken-pox, and 26 as rubella. Of the cases sent in as scarlatina, 6 were unconfirmed and were diagnosed as suffering from other diseases. Similarly, of the cases sent in as diphtheria or suspected diphtheria 4 were unconfirmed. (Tables No. XXX and XXXI show the figures for the year and for each month, respectively.) Scarlatina. Of the 109 cases notified as scarlatina, 103 were finally diagnosed, and the following table shows the incidence in age groups of the 103 cases which were nursed in the hospital :— Table K. Age (years) 0-5 5-15 15-25 25-35 35 + Number 33 60 5 5 One minor operation was performed for incision of abscess of groin. One case of scarlatina developed mumps 25 days after admission—no secondary case. 1 case was admitted suffering from chicken-pox in addition—1 secondary case. 3 cases developed rubella. Complications of the cases of scarlatina were:— Cervical adenitis 2 Boils 1 Rhinitis 13 Otorrhoea 5 Nephritis 2 Blepharitis 1 Secondary attacks 1 Abscess 1 Septic sores 1 Anaemia 1 Septic finger 1 Tonsilitis 2 Bronchitis 7 Otitis Media 1 Cardiac irregularity, etc. 13 Diphtheria. Sixteen cases notified as diphtheria were admitted to the hospital. 12 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 — 8 2 — 2 The clinical types in which the diagnosis was substantiated were as follows:— Tonsillar (Faucial) 6 Naso-pharyngeal 2 "Bacteriological" 3 Laryngeal 1 The complications recorded were as follows:— Cardiac irregularity 2 Palatal paralysis 1 18 Other Diseases. Ten cases admitted as scarlatina or diphtheria were subsequently diagnosed as suffering from other diseases. These were as follows:— Diseases notified as scarlatina :Measles, 2. Rubella, 4. Diseases notified as diphtheria : Tonsilitis, 2. Vincents angina, 1. Urticarial oedema, 1. Stay in Hospital. The average stay in hospital was as follows:— Scarlatina : All cases (103) 35 83 days. Patients remaining over 56 days (10) 69.2 „ Patients remaining under 56 days (93) 32.24 „ Diphtheria : All cases (12) 51.0 „ Patients remaining over 56 days (4) 85.0 „ Patients remaining under 56 days (8) 34.0 „ Measles and Pneumonia (7) Patients remaining over 56 days — Patients remaining under 56 days (7) 22 8 „ 3 ordinary measles cases included in " Others." Other diseases : All cases (62) 13.7 „ Patients remaining under 56 days 13.7 „ 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 8. Sick Staff. Table M. Permanent. Temporary. Number off duty for 24 hours or more 5 2 Total number of days off duty 89 128 Casual conditions:— Migraine and neuritis 12 days — Otitis media 20 „ — Sickness due to pregnancy 10 „ — Acute hepalitis 31 „ — . Tonsillectomy 16 „ — Influenza and bronchitis — 67 days Tonsilitis — 23 „ Meningitis — 38 „ 19 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 sm?ll 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 : 6 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 5,440. 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 (1) found to be infested 17 Total: 37 ,(2) disinfested during the year 17 (b) Number of other houses (1) found to be infested 20 (2) disinfested during the year 20 Canal Boats. Visits were paid to the canal and 7 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. 11 bodies were deposited in the mortuary during the year. Petroleum and Carbide. During the year 54 applications for licences to store petroleum were granted and 4 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 are 2 licences 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. There was a further fluctuation in overcrowding figures which strengthened the opinion that war conditions would leave a problem of overcrowding which must be properly assessed when conditions are stable. For statistics see Table XXXIV in the Appendix. 20 ADMINISTRATION OF THE SHOPS ACTS. The inspection of shops was merged more into general district work. Standards of cleanliness were raised and co-operation from shopkeepers generally is excellent. INSPECTION AND SUPERVISION OF FOOD. Milk. The following licences under the Milk (Special Designations) Order, 1936, were granted during 1944 :— for the sale of Tuberculin Test Pasteurised 1 for the sale of Tuberculin Tested milk 7 for the sale of Accredited milk — for the sale of Pasteurised milk 8 for Pasteurisatio 1 Supplementary Licences 3 a total of 20 licences being in force at the end of the year. Sampling. Forty-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 4 to 6 hours of being taken. Food Sampling. The chemical or bacteriological analyses of 174 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 1944 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 (lbs.) SOUND UNSOUND Total (lbs.) Production (lbs.) Stock (lbs.) Total (lbs.) Animal Feeding (lbs.) ByeProducts (lbs.) Destruction (lbs.) Canned 201,555 73,048 46,508 26,540 128,507 104,672 669 23,166 Raw 45,1761 50,224 8,587 21,637 15,537 5,727 7,655 2,155 Totals 247,316 103,272 55,095 48,177 144,044 110,399 8,324 25,321 21 RATS AND MICE (DESTRUCTION) ACT, 1919. Infestation Order, 1943. The date of formal delegation of the powers formerly executed by the Middlesex County Council to this Council was the 1st April, 1944. Pending such formal delegation this Council acted as from the 1st February, 1944, as a statutory authority. The survey of infestations was completed by the Sanitary Inspectors in spite of staff shortage and they continued to direct in their districts the work of the Rat Catcher, who commenced on the 1st February, 1944. During the year this work necessarily involved a great deal of the time of the Rat Catcher in checking the range and intensity of infestations to secure a later economy by block treatment. 22 APPENDICES 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 Cquncil 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 Treatment Daily, 7.30 a.m. to 7.30 p.m. Middlesex County Council Tuberculosis Dispensary Uxbridge Chest Clinic, High Street, U xbridge 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 Ultra-Violet Light Clinics Manor House, Branch Centre Artificial Sunlight Tues. and Fri. 10 a.m. Wed. and Fri. 2 p.m. The Council *Suspended during war. 24 EXTRACTS FROM VITAL STATISTICS. Table II. Total Male Female Comparative figures for 1943 Live Births—Legitimate 859 429 430 791 Illegitimate 55 27 28 39 Stillbirths—Legitimate 19 ii 8 } 25 Illegitimate 2 i 1 Deaths 443 239 204 492 Birthrate (live and stillbirths) per 1,000 of estimated population 1909 1718 Stillbirth rate per 1,000 total (live and still) births — 2922 Crude death rate per 1,000 of the estimated population 904 989 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 — } -.9 No. 30. Other puerperal causes . — Total . — — Death rate of infants under 1 year of age :— All infants per 1,000 live births 45.9 53.01 Legitimate infants per 1,000 legitimate live births 41.9 51.83 Illegitimate infants per 1,000 illegitimate live births 109.1 76.91 Deaths from cancer (all ages) 69 97 Deaths from measles (all ages) — 2 Deaths from whooping cough (all ages) 1 — Deaths from diarrhoea, etc. (under 2 years of age) 4 12 25 Causes of Deaths, 1944. Table III. Male. Female. Total 1944. Total 1943. 1. Typhoid fever, etc. — — — — 2. Cerebro-spinal fever 1 — 1 — 3. Scarlet fever — — — — 4. Whooping cough — 1 1 — 5. Diphtheria — — '— — 6. Tuberculosis—Respiratory 11 7 18 34 7. Other tuberculosis 1 1 2 6 8. Syphilitic diseases — 2 2 5 9. Influenza 2 1 3 5 10. Measles — — 2 11. Ac. poliomyelitis and polioencephalitis 1 — 1 — 12. Ac. inf. encephalitis — — — — 13/16. Cancer (all forms) 37 32 69 97 17. Diabetes — 3 3 3 18. Intra-cran. vase, lesions 18 25 43 33 19. Heart disease 55 43 98 94 20. Other' circulatory diseases 5 12 17 29 21. Bronchitis 15 9 24 30 22: Pneumonia (all forms) 14 11 25 30 23. Other respiratory diseases 7 3 10 7 24. Ulcer of stomach or duodenum 5 1 6 10 25. Diarrhoea, etc. (under 2 years) 4 — 4 12 26. Appendicitis 1 1 2 — 27. Other digestive diseases 7 5 12 11 28. Nephritis 4 6 10 9 29. Puerperal sepsis — — — i 30. Other maternal causes — — — — 31. Premature birth 7 5 12 9 32. Congenital malformations, etc. 10 8 18 14 33. Suicide 2 1 3 4 34. Road traffic accidents 1 — 1 — 35. Other violence 11 10 21 12 36. All other causes 20 17 37 35 Total Deaths 239 204 .443 492 Table IV. Ward Male Female Total Waxlow Manor 34 31 65 Northcote 29 24 53 Hambrough 46 35 81 Dormers Wells 27 33 60 Glebe 55 34 89 Norwood Green 48 47 95 Total 239 204 443 26 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 1944. (England and Wales, London, 126 Great Towns and 148 Smaller Towns.) (Provisional Figures based on Weekly and Quarterly Returns) England and Wales 126 Comity 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 176 20.3 2.09 15.0 1866 Still 050 0.64 0.61 0.42 0.43 Deaths :— All Causes n-6 13.7 1.24 15.7 9.04 Typhoid & Paratyphoid fevers o-oo 0.00 0.00 0.00 0.00 Smallpox — — — — - Measles o-oi 0.01 0.01 0.00 0.00 Scarlet fever o-oo 0.00 0.00 0.00 0.00 Whooping cough 0-03 0.03 0.02 0.04 0.02 Diphtheria 0-02 0.03 0.03 0.01 0.00 Influenza 0-12 0.10 . 0.11 0.08 0.06 Notifications :— Smallpox 000 0.00 — 0.00 — Scarlet fever 2 40 2.41 2.67 1.57 0.23 Diphtheria 0-58 0.67 0.69 0.31 0.31 Typhoid fever o-oi 0.01 0.01 0.01 0.01 Erysipelas 0-29 0.32 0.28 0.37 0.03 Pneumonia 0-97 1.13 0.82 0.93 0.10 Measles 416 4..51 3.94 2.98 7.49 Cerebro-spinal fever 005 0.06 0.04 0.06 — Whooping cough 249 2.49 2.29 2.90 2.26 Rates per 1,000 Live Births Deaths under 1 year of age 46 52 44 61 45 Deaths from Diarrhoea and Enteritis under 2 years of age 4.8 7.3 4.4 10.1 4.3 Rates per 1,000 Total Births (1\e. Live and Still) Notifications :— Puerperal fever 1034 13.13 9.25 3.61 1497 Puerperal pyrexia 14.14 MATERNAL MORTALITY (England and Wales). Abortion with Sepsis Abortion without Sepsis Puerperal Infections Other 0.31 009 0.28 1.25 Abortion—Mortality per Million Women aged 15.45 (England and Wales). With Sepsis Without Sepsis 25 7 27 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 4 3 6 7 8 8 36 February 8 4 3 3 13 4 35 March 8 9 4 3 13 12 49 April 16 10 7 4 15 7 59 May 6 3 4 6 9 6 34 June 4 2 3 2 6 5 22 July 8 5 7 9 12 13 54 August 4 i 3 1 7 3 19 September 6 5 8 9 5 4 37 October i 4 2 6 6 3 22 November 5 7 8 4 10 2 36 December 9 7 6 8 7 9 46 79 60 61 62 111 76 449 Table VII. Certified Cause of Death. Under I 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 1 year Bronchitis, Pneumonia, etc. _ 1 2 — 3 3 1 2 - 9 Congenital Malformations, etc. 6 3 1 — 10 1 — - - 11 Gastro-enteritis, Diarrhoea, etc. — 2 - — 2 2 1 - - 5 Prematurity 11 2 1 — 14 — — — - 14 Miscellaneous — — — — — 3 — — 3 17 8 4 - 29 6 5 2 42 Live Births Legitimate, 859 Illegitimate, 55 Infant Deaths Legitimate, 36 Illegitimate, 6 Table VIII Summary of Health Visiting Work for the Year 1944 Visits to infants— First visits 846 Re-visits 1,886 Visits to children— First visits 276 Re-visits 2,904 Visits to expectant mothers 688 Visits for infectious disease 671 Visits to schools 35* Child Life Protection visits 170 Miscellaneous visits 533 Removals 120 No access 1,497 Re adoptions 34 Total 9,660 *At these visits a total of 809 children were examined 28 Table IX. (1) Number of foster parents on register— (a) At the beginning of the year 23 (b) At the end of the year 40 (2) Number of foster parents receiving foster children— (a) At the beginning of the year 22 (b) At the end of the year 23 (3) Number of children on the register— (a) At the beginning of the year 27 (b) At the end of the year 28 (4) Number of children received by foster parents during the year 34 (5) Number of foster children— (a) Reached the age of 9 during the year 1 (b) Removed during the year to different foster parents or to children's societies 14 (c) Adopted 2 (d) Returned to parents 14 (e) Removed at the request of the medical officer of health — (/) 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 170 (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. . Adoption of Children (Regulation) Act, 1939. (a) Number of persons who gave notice under Sec. 7 (3) during the year 14 (b) Total number of children in respect of whom notice was "given under Sec. 7 (3) during the year 14 (c) (1) Number of children under supervision at end of year 14 (2) Number who died Nil (3) Number on whom inquests held Nil (d) Proceedings taken during year 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 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 4.67 830 81.21 1944 710 3184 4.48 935 76.74 Of the 3,894 total attendances, 2,248 occurred at the Manor House Centre and 1,646 at the Branch Centre, 29 Table XI. (a) Abnormalities of the foetus— (i) twins 7 (ii) abortions 13 (iii) stillbirths 7 (iv) other conditions 5 (b) Abnormalities of the mother— (i) unsatisfactory measurements 17 (ii) post partum haemorrhage 3 (iii) ante partum haemorrhage 5 (iv) albuminuria 10 (v) high blood pressure (exceeding 140 systolic or 90 diastolic other than on the first attendance) 7 (vi) other conditions 1 Neo-Natal Mortality (before the seventh day) 1 Table XII. Manor House— Seen by medical officer : Infants 1,932 Children at ordinary clinics 476 Children at toddlers' clinics 252 Weighing only : Infants 2,316 Children 206 New cases (included in above): Infants 369 Children 22 Branch Centre— Seen by medical officer : Infants 3,403 Children at ordinary clinics 623 Children at toddlers' clinics 212 Weighing only : Infants 1,328 Children 265 New cases (included in above): Infants 355 Children 20 Total attendances 11,013 The total attendances at the clinics during the past six years have been as follows :— 1939 15,452 1942 13,346 1940 12,033 1943 12,852 1941 11,109 1944 11,013 30 Table XIII. (1) New Infant Cases (2) Total live births (3) Percentage of (1) to (2)* 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 1944 724 914 79 * This percentage is a little in excess of the true percentage of live births subsequently attending the clinics as it includes cases born in and belonging to other districts who have since moved to Southall and attended the clinics here during their first year of life. Table XIV. Number of Inspections in stated Groups : Manor House Branch Centre Total 18 months 95 67 162 2 years 32 59 ill 3 years 57 42 99 4 years 48 44 92 Total Routine 252 212 464 Other inspections 5 7 12 Total 257 219 476 Table XV. Number of Individual Children found at Routine Medical Inspection to require Treatment (excluding Dental Disease) : Manor House Branch Centre Total 18 months 12 16 28 2 years 5 17 22 3 years 9 22 31 4 years 17 21 38 Total 43 176 119 31 Table XVI. Number requiring Dental Treatment : Manor House Branch Centre Total 18 months — — — 2 years — — — 3 years 8 5 13 4 years 9 14 23 Total 17 19 36 Table XVII. Nutrition. Manor House Branch Centre Total A B C D 18 months A 73 42 115 39 8 — B 18 21 D 4 4 2 years A 35 34 69 36 5 1 B C 12 5 24 D 1 3 years A 39 13 52 41 4 2 B C 14 3 27 1 D 1 1 4 years A 29 18 47 43 2 — B C 18 1 25 1 D — — Total 252 212 283 159 19 3 Nutrition is assessed for each age group in four grades (A—excellent, B—good C—slighdy subnormal, and D—bad) according to the recommendations of the Board of Education. 32 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 i. Ringworm - - - 2. Scabies - - - 3. Impetigo - - - 4. Other diseases (non-tubercular) - - - Total 1-4 - - - Eye 5. Blepharitis - - - 6. Conjunctivitis 3 3 6 7. Keratitis and opacities - - - 8. Other conditions (excl. defective vision and squint) 7 2 9 Total 5-8 - - 9. Defective vision - - - 10. Squint 4 - 4 Ear 11. Defective hearing - 1 1 12. Otitis media - - — 13. Other ear diseases - - Nose and Throat 14. Chronic tonsils and/or adenoids 15 9 24 15. Other conditions — — 16. Enlarged cervical glands (non-tubercular) - - - 17. Defective speech - — — Heart and Circulation 18. Organic heart disease - - - 19. Functional heart disease - - — 20. Anaemia - - - Lungs 21. Bronchitis - - — 22. Other non-tubercular diseases - — — 23. Pulmonary tuberculosis - - - Tuberculosis 24. Glands - - - 25. Bones and joints - - - Nervous system 26. Chorea — - - 27. Other conditions - - - Deformities 28. Rickets deformities 3 3 6 29. Genu valgum 18 months 2 5 7 2 years 3 8 11 3 years 1 — 1 4 years — — — 30. Other forms — — — 31. Other defects and diseases 6 11 17 32. Dental diseases 18 months - - - 2 years - - - 3 years 8 5 13 4 years 9 14 23 33 Table XIX. Notifications from Midwives. Medical Help, Mothers and Children 115 Laying out dead body — Liability to be a source of infection 11 Death of child 4 Stillbirths 2 Artificial feeding 4 The reasons for sending 115 notifications for medical help were as follows :— Table XX. During pregnancy 12 For miscarriage 1 During labour 64 During puerperium 17 Infant conditions 21 Table XXI. Dental Inspection and Treatment. Expectant and Nursing Mothers :— Number sent to the dentist for inspection 126 Number inspected 106 Number for whom treatment was completed 105 Number of completed dentures 76 Number of fillings 177 Number of local anaesthetics 14 Number of general anaesthetics 114 Total number of attendances and re-attendances 601 Children under five years of age :— Number sent for inspection 64 Number inspected 57 Number for whom treatment was completed 44 Number of fillings 15 Number of local anaesthetics — Number of general anaesthetics 46 Total number of attendances and re-attendances to dentist 108 These figures show a total number of 709 attendances compared with 648 in 1943 659 in 1942, and 681 in 1941. 34 Table XXII. Vaccinations. Year Live Births Vaccination Certificates Exemptions Percentage of vaccinations to live births 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 1944 914 353 185 386 Table XXIII. Deaths from Cancer. Year Male Female Total Estimated population Rate per 1,000 population 1923 21 14 35 31,360 1.11 1924 20 18 38 31,800 1.19 1925 ? ? 40 32,220 1.24 1926 12 11 23 32,870 0.69 1927 13 13 26 33,480 0.77 1928 18 27 45 35,340 1.27 1929 12 10 22 35,370 0.62 1930 17 29 46 37,560 1.22 1931 20 28 48 39,280 1.22 1932 22 23 45 41,530 1.08 1933 23 28 51 44,780 1.13 1934 22 27 49 46,693 1.04 1935 30 27 57 48,270 1.18 1936 22 3° 52 49,550 1.05 1937 42 28 70 51,560 1.35 1938 27 30 57 52,400 0.51 1939 33 41 74 52,430 1.41 1940 28 36 64 51,670 1.23 1941 34 37 71 50,280 1.41 1942 34 38 72 50,350 1.43 1943 51 46 97 49/730 1.95 1944 37 32 69 48,970 1.41 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 — — — 2 4 20 11 — Female — — 1 2 4 13 9 3 Total — — 1 4 8 33 20 3 35 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 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 10 22 23 12 22 19 — 2 1 — — 1 111 4 1 Scarlet fever 1 8 1 15 15 45 14 4 4 1 — — 115 89 — Diphtheria — — - 1 3 5 4 - 1 1 — 15 15 — Measles 7 58 34 75 151 2 — — — — — 367 15 — Puerperal pyrexia — — — — — — — 5 5 4 — — 14 12* — Erysipelas — — — — — 1 — 1 3 5 — — 10 5* — Pneumonia — 2 1 1 — 9 2 4 12 3 12 4 56 26 25 Ophthalmia neonatorum 3 — — — — — — — — — — — 3 3* — Cerebral-spinal fever, &c. 1 — 1 — — — 1 — — — — — 3 3* 1 *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 Northcote Hambrough Dormers Wells Glebe Norwood Green Admitted to Hospital Total deaths Scarlet fever 115 24 27 14 15 24 11 89 - Diphtheria 15 4 6 i 2 1 1 15 - Puerperal pyrexia 14 1 3 3 3 2 2 12* - Pneumonia 50 8 6 6 12 13 5 26 25 Ophthalmia neonatorum 3 — 1 — — 2 - 3* - Tuberculosis (all forms) 75 13 3 10 20 17 12 - 20 Erysipelas 10 2 1 — 4 2 1 5* - Measles 367 99 17 13 26 138 74 15 - Whooping cough 111 37 3 11 14 30 16 4 1 Cerebro-spinal fever, &c. 3 1 i i - 3* 1 Totals 763 189 67 59 96 230 122 172 47 *To London hospitals and institutions outside the district. 36 Cases of infectious diseases occurred during the year among schoolchildren as follows :— Table XXVII. School Scarlet Fever Diphtheria Beacons field Road 7 1 County School - — Clifton Road 3 — Dormers Wells 3 i Feather stone Road 5 — North Road 7 — St. Ansel's 3 — Tudor Road 12 — Western Road 10 i Lady Margaret Road 19 — Other Schools 3 i 72 4 Table XXVIII. Age Periods New Cases Deaths Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary Male Female Male Female Male Female Male Female 0-1 — — 1 — — — 1 — 1-5 1 — — — — — — — 5-10 — 1 — — — — — — 10-15 i - 1 — — — — — 15-25 8 16 1 3 3 2 1 — 25-35 12 9 i 2 2 — — 35-45 6 5 — 1 1 — — — 45-65 5 3 — — 6 2 — — 65+ 1 1 — — 2 — — — Totals 33 34 4 4 12 6 2 — Of the 20 deaths, 18—or 86 per cent.— were of notified cases. The occupations of the new cases were as follows :— Table XXIX. Occupations Pulmonary Non-Pulmonary Male Female Male Female Building and decorating trades 4 — — — Schoolchildren 1 1 1 _ Clerical work 2 3 1 1 Domestic duties — 8 — 2 Factory hands 10 7 — — No occupation 2 2 1 — Various 14 13 1 1 Totals 33 34 4 4 37 Table XXX. Remaining on 31.12.43 Admitted during year as Subsequently diagnosed as Discharged recovered Died Mort. per cent. Remaining on 31.12.44 Scarlatina 33 109 103 122 — — 14 Diphtheria 3 16 12 14 — — 1 Measles — 7 10 5 — — 5 Whooping Cough — — — — — — — Rubella — 26 29 29 — — — Chicken pox — - - - — — — Varicella — 6 6 6 — — — Mumps 1 5 5 5 — — — Erysipelas — 3 3 3 — — — Scabies and Impetigo — 10 10 — — — 3 Meningitis Carrier — 1 1 1 — — — Dysentery — 1 1 1 — — — Others — — 4 4 — — — Table XXXI. Number admitted Final diagnosis Number discharged Scarlet Fever Diphtheria Measles Rubella Chicken pox Mumps Scabies and Impetigo Meningitis Carrier Dysentery Carrier Erysipelas Others Scarlet Fever Diphtheria j Measles Rubella Chicken pox Mumps Scabies and Impetigo Meningitis Carrier Dysentery Carrier Erysipelas Others January 15 — 1 — — — — — — 28 1 — — — — — — — — — February 10 — — — — — — — — 16 1 — — — — — — — — — March 12 — — 9 2 — — — _ — 1 11 1 2 9 1 — — — — — — April 4 2 2 13 2 — — — — — 16 — 1 11 3 2 — — — — — May 9 — — 2 — — — — _ — 1 5 — 1 3 — — — — — — — June 12 6 — 4 1 — — — — — — 6 — — 5 1 1 — — — — 1 July 11 — — — — — — — — — — 11 5 — 1 — 1 — — — — — August 2 — — — — — — — — — 1 10 3 — — 1 — — — — — 1 September 2 — — — — — — — — 1 — 5 — — — — 1 — — — 1 — October 5 — 1 — — — 4 — 1 1 — 2 — — — — — 4 — — 1 — November 9 4 _ _ _ 4 1 — 1 1 5 1 1 — — — 2 — 1 — — December 12 — 6 — — — 2 — — — — 7 2 — — — — 1 1 — 1 1 103 12 10 29 6 5 10 1 1 3 4 122 14 5 29 6 5 7 I 1 3 4 38 Table XXXII. Houses, Public Health Act, 1936 2,835 Houses, Housing Act, 1936 18 Overcrowding 56 Disinfestation 374 War Damage 30 Vans and Sheds 1 Food Shops 522 Fried Fish 4 Cafes, etc 37 Factories (Mechanical) 23 Factories (Non-Mechanical) 3 Outworkers 4 Food Factories 632 Smoke 4 Bakehouses 16 Dairies 12 Water Sampling 10 Milk Sampling 38 Other Foods Sampling 42 Schools 1 Stables 22 Accumulations 2 Slaughterhouses 5 Rats and Mice 547 Shelters 139 Petrol 63 5,44° Table XXXIII. Nuisances caused by the keeping of animals 18 Accumulation of refuse, etc. 15 Offensive smells 13 Vermin 54 Choked drains 133 Dampness 21 Defective roofs, gutters, etc. 54 Defective sanitary fittings 47 Rats and mice 81 Miscellaneous 73 Other defective conditions of houses xi9 Overcrowding ... ... 26 Air-raid shelters 8 War-damage houses 25 Smoke 5 Food 301 988 39 Table XXXIV. 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) 961 (b) Number of inspections made for the purpose 3,283 (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 — (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 214 (2) Number of dwelling-houses in which defects were remedied after service of formal notices :— (a) By owners 87 (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 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 — 40 Table XXXIV.—continued. 4. Housing Act, 1936—Overcrowding :— (a) (I) 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 10 (c) (1) Number of cases of overcrowding relieved during the year 8 (2) Number of persons concerned in such cases 44 (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. 41 INDEX. Ambulance facilities 8 Ante-natal clinics 10, 24, 29, 30 Antitoxin 15 Area of Borough 6 Assisted Services 14 Bed bugs 20 Birth Control 10 Births and birth rate 7,25,28 Canal boats 20 Cancer 6, 35 Causes of death 6, 26 Celluloid and Cinematograph Film Act 20 Child life protection 9 Clinics 8, 9, 10, 11, 24 Consultant aid 9 Deaths and death rates 6, 25 Dental treatment 14,34 Diphtheria 16, 18 Diphtheria prevention clinic 16,24 Disinfection 15, 16 Food 20 Foster children 29 Health Services, General provision of 7 Health visiting 9,28 Houses—Number inhabited 6 Housing 20, 40 Infant mortality 7,28 Infant welfare clinics 8, 11, 24, 29, 30 Inspection and Supervision of Food .21 Isolation Hospital 18, 19, 38 Laboratory facilities and work 8 Maternal morbidity and mortality 7, 27 Maternity and Child Welfare 11 Maternity and Child Welfare Committee 3 Maternity and Nursing Homes 13 Meat and other foods 21 Medical help 34 Midwives 13, 34 Milk supply 20 Milk grants 14 Mortuary 20 Moral Welfare 9 Notifiable diseases 15, 36 Nursing in the Home Ophthalmia neonatorum 17 Petroleum Acts 20 Physical feature of district 6 Poor Law medical relief 8 Population 6 Pre-school medical inspection 12, 31, 32, 33 Public Health Committee 3 Puerperal pyrexia 7 Rats and Mice 22 Rateable value 6 Remedial exercises 11, 24 Sanitary circumstances 20 Sanitary inspection 20, 39 Scabies clinic 8, 24 Scarlet Fever 16, 18 Shops 20 Social conditions 6 Staff 5, 19 Statistics—General and Vital 6, 7, 25 Stillbirths 7,25 Tuberculosis 17, 37 Ultra-violet Light clinic 10, 24 Unfit houses 40 Vaccination 15, 35 Venereal disease clinics, etc 17, 24 Verminous persons 8 Vital statistics 6, 7, 25, 27 Voluntary help 11 Wartime nurseries 14 Water supply 20 42