AC 439 (1) Southhall Sout 13 BOROUGH OF SOUTHALL ANNUAL REPORT of the Medical Officer of Health for the Year 1945 M. A. GLASS, Medical Officer of Health. KING AND HUTCHINGS, LTD., PRINTERS, SOUTHALL BOROUGH OF SOUTHALL ANNUAL REPORT of the Medical Officer of Health for the Year 1945 M. A. GLASS, Medical Officer of Health. THE COUNCIL OF THE BOROUGH OF SOUTH ALL, 1945. 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 F. J. MARKS, J.P. Deputy Mayor : *Councillor J. M. Sturgeon, J.P. Aldermen : *Amos, Mrs. F. S. *Gardner, F. E. Hamblin, E. B. *Hutchings, C. Neighbour, D. C. *Smith, F. G. (Chairman of the Public Health Committee). Braine, E. W. H. *Cox, E. W. Dane, A. T. Davies, R. L. *Douglas, H. C. Dormer, J. G. Councillors : Hopkins, W. H. *Kimberley, T. *Lewis, J. F. *Lowe, J. Luckett, F. H. *Lye, A. E. Pargiter, G. A. Steed, Mrs. J. S. *Tunbridge, F. J. Ward, J. H. To the Mayor, Aldermen and Councillors of the Borough of Southall. MR. MAYOR, LADIES AND GENTLEMEN, I have the honour to present the 49th Annual Report on the health and sanitary circumstances of the Borough for the year 1945. This has been a year of re-establishment and expansion of public health work in Southall. The end of the war and the return of evacuees from their various billets in other areas has resulted in a more stable population, enabling health visiting and propaganda work to become more continuous and effective. The health of the population continues to be good. The Birth Rate showed a slight decrease following a regular increase every year since 1941, but it remains comparatively high at 16.68. The death rate showed a slight increase, but the most notable feature of the vital statistics is the very great decrease in the infant mortality rate from 45 9 in 1944 to 30.8 in 1945, and this figure compared very favourably with most districts whether urban or rural. The low figure for puerperal pyrexia and the absence of maternal deaths is also satisfactory. 3 During the year, services in connection with school medical inspection and treatment were transferred to the control of the Public Health Department by agreement between the Southall Borough Council and the Middlesex County Council. This entailed a reconstruction of the whole system of the care of infants and school children, with the aim of providing continuous records for children from birth to school leaving age. The amount of health visiting carried out during the year was increased by 50%, and this was the probable cause of the improvement in the figures of attendances at all the clinics and treatment centres. A considerable number of measles cases was notified during the early part of the year; the disease was of a mild type and there were no fatalities. In the summer there were a few cases of dysentery, but no epidemic resulted. From the beginning of the year, the ambulance service came under the control of the Borough Council, and staff and equipment were organised to provide an efficient service for the free conveyance of Southall ratepayers requiring this type of assistance. The call on this service was heavy and continuous throughout the year. The four day nurseries established during the war period continued to function throughout the year, and places in these nurseries were always in demand. This is one of the most satisfying services provided by the Council, as children benefit in health, manners, in appearance and intelligence. A Health Week of continuous propaganda with demonstrations and lectures held at the Maypole Institute, facilities for the public to observe the various activities of the Health Department, talks in schools, etc., was a feature of the work for 1945. The week was opened by Sir Weldon Dalrymple-Champneys, of the Ministry of Health, and had a notable effect on the figures of attendances at the various centres and the demand for health leaflets and health instructions during the months immediately following. The work at the Isolation Hospital continued normally, the number of admissions never reaching a very high level. Overcrowding due to housing difficulty in the Borough increased the responsibility of the health department, as overcrowded conditions tend to increase the problems of cleanliness and infection with which it is the Department's duty to deal and, during the year, the Sanitary Inspectors commenced a survey of the overcrowding of houses in the district. 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, and the members of the Voluntary Workers Association for the time they have so freely given. I am, your Worship, Ladies and Gentlemen, Your obedient servant, Manor House, Southall. MARGARET A. GLASS, Medical Officer of Health. 4 HEALTH DEPARTMENT STAFF for the year 1945 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 : Elizabeth G. Stuart, M.B., Ch.B. 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. (Resigned 7.3.45). H. Gatehouse, Cert. S.I.B., Cert. M. & F., M.S.I.A. (Appointed 29.6.45). General Assistant : N. V. Saunders. Health Visiting Staff: Miss E. Gibson, S.R.N., S.C.M., Cert. R.S.I. Miss G. M. Leverett, S.R.N., S.C.M., H.V., Cert. R.S.I. (Child Life Protection Officer). 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. (Resigned 24.11.45). Miss M. G. Sawkins, S.R.N., C.M.B. Miss F. E. Woodhouse, S.R.N., S.C.M., H.V. Cert. (Appointed 17.9.45). Mrs. I. F. Dykes, S.R.N., S.C.M., H.V. Cert. (Appointed 4.6.45). Midwives : Miss G. Robinson, S.C.M., S.R.N., S.F.N. 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. Clerical Staff: Chief Clerk : J. W. Cronk, Cert. R.S.I. Clerks, Shorthand-Typists : Miss P. Ashton. Mrs. H. Hurl. Miss N. Ketteridge. Mrs. B. Pollard. Mrs. K. Jones. Mrs. E. Richards. T. Buchanan (Appointed 5.3.45). * 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 1945) 49,880 Number of inhabited houses according to Rate Book 13,592 Rateable value £419,412 Sum produced by a penny rate £1,540 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, 462. (Males, 231; Females, 231). Crude Death Rate, 9 26. For extracts from vital statistics and causes of death, see Appendix, Tables II and III. A slight rise in the death rate, which was 9 26, as against 9 04 in 1944, is to be observed. An analysis of the causes of death shows that the increases are mainly in deaths from tuberculosis, cancer and heart and other circulatory diseases. The increase in the deaths from tuberculosis from 20 in 1944 to 31 in 1945 is rather grave when considered in conjunction with the slight increase in tuberculosis notifications. The increase in the total number of deaths from cancer does not, however, bring the figure as high as in previous years. The rise in the death rate from heart disease and other circulatory diseases is possibly a manifestation of war strain. 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 214 (males no and females 104). 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 248 in number (males 121 and females 127). The total number of deaths therefore belonging to the district was 462. 6 The deaths of non-Southall residents in the St. Bernard's Hospital (not included in the above figures) numbered 108 (males 41 and females 67). 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 1944 are given in brackets). The total number of births notified to the Health Department under the Public Health Act, 1936, was 922 (1,049). The total number of registered births in the district (under the Births and Deaths Registration Act—included in the notified births above) was 339 (449). The total number of five births belonging to the district whether occurring within or outside the district was 810 (914). The illegitimate live births were 60 (55). There were 22 stillbirths (21), and these were legitimate, with six exceptions. For the first year since 1941, there has not been an increase in the birth rate in Southall, but a decrease from 19 09 to 16 68. This, however, is not an absolute decrease as percentages are calculated per 1,000 estimated population, which has increased by 910 since the last estimate was made in 1.944. This increase is mainly due to the return of men and women from war service. The corresponding rate for the whole country in 1945 was 16 2. 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 1945 are to be found in Appendix, Table XI. Total Confinements (live births and still births), 832. No. born in Hillingdon County Hospital 300 or 36% No. born in London voluntary hospitals 213 or 26% No. born in nursing homes or other hospitals 106 or 12% No. confined in their homes by midwives or doctors 213 or 26% Infant Mortality. The total number of deaths under one year of age was 25. The rate per 1,000 live births was 30.8. The corresponding rate for England and Wales was 46, for London 44, and for the 148 small towns 44 per 1,000. The infant mortality rate of 30 8 is of the greatest importance. This rate, which has been decreasing steadily since 1938, has now dropped by 33% in one year. While the corresponding rate for England and Wales has remained stationary, such a drop was not to be hoped for in an industrial and overcrowded district such as Southall and it is reasonable to suggest that the persistent propaganda and help in ante-natal care, the increase in midwifery facilities and infant welfare services have brought it about that Southall can boast of an infant mortality rate for 1945 which compares with some of the best world rates. The rate for Australia in 1945 was 31 and for New Zealand was 29. For details of causes of death of infants in the year, see Appendix, Table VII. Premature Infants. Thirty-seven infants were born prematurely during the year of whom 26 survived. Arrangements have been made in accordance with Ministry of Health circular 20/44 for the provision of equipment to be supplied to the homes where premature infants have been born, and the equipment includes draught-proof cots, electric blankets, hot water bottles, mucus catheters, thermometers, etc. Arrangements were also made to obtain supplies of breast milk at short notice from the Queen Charlotte Hospital in cases where the mother's milk is insufficient for the infant for whom breast milk is absolutely essential. 7 Maternal Morbidity and Mortality. During the year 3 cases of puerperal pyrexia were notified, but no maternal death and no deaths associated with abortion. It is gratifying to know that in 1945 the drop in the number of cases of puerperal pyrexia from 1944 to 1945 was from 14 to 3, and this in spite of increasing difficulties which face expectant mothers, i.e., lack of hospital accommodation, overcrowded homes, etc. 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 1945 the total number of visits made by the nurses was 9,500. A certain number of these patients were referred to the Nursing Association from the Maternity and Child Welfare Clinics. It must be noted that the services of the District Nurses are being used to an increasing extent throughout the year. The increase in 1945 was 500 over the 1944 figure. The Council makes a monetary grant towards the service generally, and a specific grant per visit to toddlers treated under the Maternity and Child Welfare scheme. Infectious Disease {Measles). The Health Visitors act if need be as nurses in the case of measles outbreaks. No call was made on their services during the year. Clinics and Treatment Centres. 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 17. 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 1945 (including work done for the Isolation HosnitalV Table A Positive Negetive Swabs for diphtheria 7 254 Sputa for tubercle 18 52 Faeces 47 52 Other - 35 72 393 Scabies Clinic. The total number of attendances at the clinic for treatment of scabies and other skin conditions during 1945 was 3,946. Details of the cases were as follows :— Scabies First Visits 389, Re-attendances 1,228, Total 1,617. Other skin conditions ,, „ 207 „ 15614 „ 1,821. Verminous heads „ „ 281 „ 227 „ 508. Attendances at the cleansing station increased considerably during 1945. The total number—3,946—compares with a total number of 2,251 in 1944. A large part of this increase was caused by the increase in the number of skin conditions other than scabies or vermin which were sent to the clinic by general practitioners or the general clinics for diagnosis and treatment. 8 The treatment of many of these conditions saved the patients wearisome attendances at London hospitals and in many cases hospital attendance would have been very difficult for the patients affected because of the considerable areas of skin diseased and the resultant difficulty in travelling. The increase in attendances for the treatment of vermin is possibly due to the fact that in July routine inspection for cleanliness in schools came under the aegis of the Public Health Department, a greater number of children subsequently being cleansed at the cleansing station by arrangement with the Middlesex County Council instead of being treated on school premises. Ambulance Service. During 1945 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 :— Table B. Ordinary cases removed to hospital or home 4,894 Accidents 430 Total 5,324 Miles travelled in the period 50,176 Poor Law Medical Relief. The Relieving Officer issued 93 Medical Orders during 1945. Some of these cases also received outdoor relief or institutional treatment. MATERNITY AND CHILD WELFARE Health Visiting. This year arrangements for health visiting were altered considerably in the middle of the year, because of the transfer of school medical duties to the Public Health Department. Two additional health visitors were appointed. In order to obtain a complete sequence of visiting throughout the child's life, it was desirable that the districts should be so divided that each health visitor should be responsible for visiting expectant mothers, infants and school children in designated areas, and that they should, as far as possible, conduct clinics to which the various members of these families would be attending, and therefore the Borough was divided into eight districts and one health visitor allotted to each area. Each health visitor was therefore responsible in her own area for all health visiting work, including infectious disease, visiting of expectant mothers, visits and re-visits to infants and school children, following-up of defaulters from dental clinics, and the cleansing station, and for special clinics and for the investigation of infectious disease in schools. 9 The increase in the number of attendances at the various clinics (and which has also been apparent at the school minor ailment clinics) is a most satisfactory piece of evidence that the new method of combining health visitors and school nurses is a good one. 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. Child Life Protection. The Senior Health Visitor is specially appointed to deal with Child Life Protection work. This work continued during 1945, 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. It is the duty of one member of the health visiting staff, who is designated Moral Welfare Officer, to deal with all cases of unmarried expectant mothers referred from all districts in Southall, and she endeavours to obtain pre-natal accommodation and hospital and post-natal accommodation for these mothers. Arrangements were made in 1944 with the Middlesex County Council for the admission of cases to the pre-natal home at Golders Green, and to the post-natal home at Hendon, and these arrangements continued. During the year, 15 cases were dealt with under this scheme. The Moral Welfare Officer also assists with the various social problems that arise in cases of this nature, and every assistance possible is given to unmarried mothers who are willing to continue to look after their own children. The proportion of illegitimate live births to legitimate in 1945 was 60 to 750—8%. Ultra-violet Light Clinics. Four sessions a week for treatment by ultra-violet light were held during 1945— two at the Manor House, and two at the Branch Centre. Treatment was given to expectant mothers and children under five years of age. Ultra-violet light treatment is especially necessary for young children showing eariy 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. Table C. Number of sessions held : 115. Number of attendances :— First Visits. Re-visits. Mothers 17 128 Infants 285 2,348 10 Post- Natal and Birth Control Clinic. Table D. Number of sessions held : 24. Number of attendances :— Post-Natal. Birth Control. First Visits 74 43 Re-attendances 46 119 Ante-Natal Clinics. The number of new patients seen at the ante-natal clinics during the year was 719, and the total number of attendances was 3,534 (2,066 at the Manor House and 1,468 at the Branch Centre). 547 cases were completed during the year, and the attendances in respect of these were as follows :— No. of Cases. One attendance 61 Two attendances 38 Three attendances 45 Four attendances 59 Five attendances 68 Six or more attendances 276 No attendance — For table of comparison of figures for last eight years, and the proportion of new cases to re-visits, see Appendix, Table X. The number of attendances continued to be very high. The optimum attendance at an ante-natal session should be 22 ; this would give time for a reasonable consultation, and many difficulties—social and physical, could be discussed, which at an overcrowded clinic may never be discovered by the doctor. The numbers attending in 1945 have been as high as 34 at one session, and to relieve the position somewhat an additional session was commenced during the year. With the end of the war, and the release from the need of providing shelter accommodation for mothers, it was possible to resume a more normal and smoother functioning of the clinics, and the decline in the mortality rate is possibly the happy result of the increase in attention which mothers are able to have at these clinics. Table E.I. Completed cases 547 Uncompleted cases 343 Non-pregnant 13 Removals from district 16 (New cases : 719. Brought forward from 1944, 200) 919 Table E.II. Details of Completed Cases. Primipara (1st Pregnancy) Multipara (2nd or Subsequent Pregnancy) Delivered at home Admitted to Hospital or Nursing Home Primipara Multipara Primipara Multipara Normal cases 169 278 37 147 132 131 Abnormal cases 48 52 4 13 44 39 Of the cases dealt with, therefore, 38 per cent, were primiparae (against 42 per cent, in 1944), and of these 81 per cent, (against 23 per cent, in 1944) were confined in hospital, while 51 per cent, (against 32 per cent.) of the multiparae were also confined in hospital. Table XI in Appendix gives the chief abnormalities found during the year. 11 Child Welfare Clinics. The attendances at the Child Welfare Clinics during 1945 are shown in Table XII in Appendix. The total number of attendances at the Infant Welfare and Toddlers' Clinics during 1945 was 14,070, as compared with 11,013 for 1944- The figures for attendances at the Infant Welfare Clinics and Toddlers' Clinics show a large increase. This is very satisfactory, although it has meant overcrowding during many of the sessions, especially in the southern part of the Borough. It is likely that part of this increase was due to the return from evacuation of a number of mothers with their young children. Also, as noted previously, the further sub-division of the districts and the alteration in the methods of visiting, whereby the health visitors are in constant contact with whole families, is increasing the friendliness and good will of the mothers for the health visitors and the clinics. Approximately 80% of all infants born in Southall during 1945 were brought for consultation at least once. In addition to this, the children attending the nurseries were examined medically there. These children would in many cases have been brought to the clinics for consultation if medical advice had not been available in the nurseries. Pre-School Medical Inspection (Toddlers' Clinics). Toddlers' Clinics are held fortnighdy 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. An increase is to be noted in the number of children found with enlarged tonsils. Difficulty in obtaining treatment for children requiring removal of tonsils has been increasing. The waiting lists at the Hillingdon County Hospital are extremely long, and children have had to wait as much as one year for this treatment to be carried out. Enlargement of tonsils and adenoids is more likely to occur in children suffering from frequent colds and it seems possible that the inadequacy of shoes which parents can purchase for their young children, the shortage of coal for heating homes, and the unsuitability of much of the clothing sold for babies may have contributed to the increase here noted. 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 Hillingdon County Hospital. Orthopaedic conditions North Road School Clinic. Ophthalmic „ North Road School Clinic. 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. 12 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 help of the Voluntary Workers Association with various duties at the Council's clinics continued during 1945. The help given by the members so generously entails considerable sacrifice of their time and assists greatly to maintain the smooth running of busy clinics. It is seldom that a call made, even at very short notice, to the Voluntary Workers Association for help is unanswered, and the Health Department staff appreciates this very much. 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. The attendances during the year are tabulated below :— Infants. Mothers. First visits 38 9 Re-attendances 646 18 Health Progaganda. At clinics, in the homes, in the nurseries, in the hospital, and in the schools 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 are displayed on the Council's posterboards and in clinics and libraries. Mothercraft sessions are held at both clinics where mothers are given talks on the principles of health, hygiene, infant feeding, etc., and instruction as to making of infant garments and the cooking of food for young children. The scheme whereby infants at one year receive a greeting card with a reminder that anti-diphtheria immunisation should now be undertaken, was continued during 1945. Health Week. In September, 1945, an intensive week of propaganda for positive health was held in the Borough. At the Maypole Institute there were sessions held twice daily when prominent speakers on various matters relating to public health and hygiene gave talks and invited discussion. Films on health topics were shown twice daily and demonstrations of Margaret Morris health and remedial exercises were given by members of the Margaret Morris Movement. Certain youth organisations in the town gave demonstrations of physical training, first aid and home nursing. Several medical manufacturing companies co-operated by purchasing stalls for display of their products at the Maypole Institute during Health Week and a noteworthy exhibit was the first public showing of the manufacture of penicillin. 13 During the Week and subsequently health talks were giveu in various schools, and clinics and nurseries were thrown open for public inspection. Literature covering a wide range of subjects was distributed free. The attendance at the beginning of the week was somewhat low, but towards the end of the week, public interest increased considerably and figures of attendances for the last two days were extremely satisfactory. The amount of interest shown by schools and various organisations for a considerable time after the Health Week was a noteworthy result of the publicity campaign. 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 8 6 4 9 5 32 February — 6 6 4 7 23 March 1 6 8 6 5 26 April 3 1 2 4 4 14 May 1 6 3 8 2 20 June 5 4 6 8 3 26 July 5 2 5 5 3 20 August 4 3 1 4 5 17 September 1 3 4 7 4 19 October i 4 5 3 13 November 2 2 3 1 3 11 December 5 5 3 7 4 * 24 Totals 36 48 5° 66 45 245 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) 29 Number of deletions during the year 1945 Nil Number of additional applications re registration during the year 1945 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. 14 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 1945 — — 59 4 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 number of mothers using these services for themselves and their children increased greatly in 1945. The number of attendances— 1,153 to 709— an increase of 64%, and this is a very satisfactory figure, showing that mothers are coming more and more to realise the importance of the examination and care of their own teeth at a time, as during pregnancy, when there is a greater risk of permanent damage being caused by the drain of calcium from the system, and also to realise that the care of temporary teeth is quite as important as, if not more important than, the condition of permanent teeth of young children. (For statistics of dental treatment see Appendix, Table XXI. The figures show a grand total of 1,153 attendances, compared with 709 for 1944.) Wartime Day Nurseries. The four wartime day nurseries continued to care for the children of working mothers and certain mothers in distressed home circumstances. There was all through the year a considerable waiting list for places in these nurseries. The day nurseries continue to prove of excellent value as a place for the satisfactory up-bringing of young children from the tiniest age (babies from two weeks old have been admitted to these nurseries), for the education of toddlers, for training in manners and behaviour, for the training of young girls in the care and management of children, and as the means of constant health propaganda, from the Public Health staff to mothers and also fathers. It is noteworthy that while childish infections are not escaped by the children attending the Southall nurseries, the spread of these in the nurseries themselves is limited, and that in our experience the risk of contracting infectious disease by a child attending a day nursery is no greater than in ordinary home life. During the year, three members of the day nursery staff obtained the diploma of the National Society of Children's Nurseries. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. There was a condiderable increase in the number of cases of measles notified during the year. The epidemic occurred during the first months of the year, and was rather unexpected, as there had been a high number of cases of measles occurring in the early part of 1944. Outbreaks of this nature usually show a bi-annual occurrence. 15 The character of the disease was again mild, as it had been in the 1944 outbreak. There were no fatal cases. In the early part of the summer there were a number of cases of dysentery. Immediate investigation was made into all possible food sources which might be expected to cause this type of infection, but nothing conclusive was found and the outbreak did not assume epidemic proportions. No cases were notified after September. The incidence of diphtheria was slightly raised from 15 notified in 1944 to 31 in 1945, but 11 of these cases were found in hospital to be cases other than diphtheria, and only one of these had previously been immunised against 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. Under the scheme for the provision of insulin for necessitous cases not covered by other schemes, 17 people were supplied during 1945, either free or at part cost. Vaccination. The total number of successful vaccination certificates received during the year was 185, and the number of certificates of exemption issued was 221. 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 becomes smaller each year. In 1945 it was 22% vaccinated to 78% unvaccinated. It seems difficult to combat lethargy of parents in this matter, but in the course of health teaching, all mothers are informed of the dangers of smallpox for unvaccinated infants. 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 148 Covers 117 Beds 266 Eiderdowns 52 Blankets 544 Pillows 452 Bolsters 93 Sheets . 237 Books 90 Miscellaneous 30 Scabies clinic : Bags of clothing 110 Total 2,139 The following articles were destroyed : 21 mattresses, 11 bolsters, 6 pillows, 2 sheets, and 189 articles of clothing. Cancer. It will be seen by the table of causes of death (page 26) that in 1945, 83 cases (39 males and 44 females) died from cancer. (See Appendix, Tables XXIII and XXIV.) There was again in 1945 an increase in the number of deaths from cancer, although not to the high level it reached in the years preceding 1944. During that year the statistics showed a marked and satisfactory dimunition in the number of deaths from cancer. 16 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) Regulations, 1917. There were no cases of smallpox in Southall during 1945, but 15 persons who had been in contact with smallpox in other countries and who were returning either as soldiers or civilians were notified to the health department under the Public Health (Smallpox) Regulations, 1917. All these persons were kept under observation until the period of the incubation of the disease was over. Scarlet Fever (Scarlatina). The number of notifications received during the year was 104, as compared with 115 for the previous year. Of these 104 were removed to the Isolation Hospital. Diphtheria. Thirty-one cases of diphtheria were notified to the health department and admitted to the Isolation Hospital during 1945. Eleven were not confirmed as diphtheria and the total therefore was 20 positive cases, the majority of which were carriers. All cases were mild in character, except one. There were no deaths from diphtheria, and complications occurred only in four cases, i.e., cardiac irregularity in three, and pHatal paralysis in one. This case was discharged cured. Diphtheria Prevention. There was an improvement in the number of children brought for immunisation against diphtheria in 1945, and it is assumed that the continuous propaganda amongst clinic mothers and in the homes and schools has obtained this improvement. The proportion of children at the age of one year who are brought for immunisation to the total estimated number in the district is not yet quite satisfactory. The proportion of new cases attending for immunisation was 884, and was 75% up on the 1944 figure. 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 104 Total attendances made 3,524 Average attendance per session 34 Highest attendance at a session 80 Lowest attendance at a session 8 During 1945 the number of new cases was 884 Ophthalmia Neonatorum. No cases of ophthalmia neonatorum were notified in 1945. One case under treatment at the end of 1944 recovered completely during 1945. Acute Poliomyelitis. Two cases were 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. 17 Infectious Disease Visits. During the year, the Health Visitors paid 1,347 visits with reference to cases of infectious disease. 167 swabs were taken. The total number of children examined by the Health Visitors in the schools was 1,776. Uncleanliness and Verminous Conditions in Schoolchildren. Number of children on roll at 31st December, 1945 6,259 Total number of examinations of children in the schools by the school nurses 19,335 Number of individual children found unclean 948 Number of children cleansed under arrangements made by the Local Education Authority 501 From these figures it will be noted that there was a high number of children found to be suffering from uncleanliness or verminous condition. The increase over 1944 is 948 to 477—approximately 50%. While this looks to be a very unsatisfactory figure, it is possibly due to a more thorough inspection and discovery of early cases of infestation as a result of the increased co-operation throughout the service as a result of the amalgamation of the public health and school medical work. This should be justified by the 1946 figures. The discovery of early cases in school is of the utmost importance in the prevention of the spread of infestation by vermin, and mothers are given precise instructions as to the methods of dealing with lightly infested cases in a thorough manner. A contributory cause of this figure was found to be the return of cases from evacuation with severe infestation both with vermin and scabies. These children had been examined before departure from Southall and had then been in a clean condition. 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 74. Other Forms of Tuberculosis. The number of new cases notified during the year was 15. Of the total notifications 36 were notified from Institutions (Sanatoria —, County Council Hospitals, 18, General Hospitals 18). Deaths from Tuberculosis. Tuberculosis of the respiratory system, 24 ; other forms, 7. For details of new cases notified and deaths in 1945, 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. 18 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. REPORT ON THE BOROUGH ISOLATION HOSPITAL. During the year 174 patients were admitted to the Isolation Hospital, as compared with 184 in 1944. Of these, 104 were sent in as scarlatina, 31 as diphtheria, 21 as measles, 6 as impetigo and scabies, 1 as whooping cough, 1 as gingivitis, 2 as dysentery, 5 as mumps, 2 as chicken-pox, and 1 as rubella. Of the cases sent in as scarlatina, 8 were unconfirmed and were diagnosed as suffering from other diseases. Similarly, of the cases sent in as diphtheria or suspected diphtheria, 9 were unconfirmed. (Tables No. XXX and XXXI show the figures for the year and for each month, respectively.) Scarlatina. Of the 104 cases notified as scarlatina, 96 were finally diagnosed, and the following table shows the incidence in age groups of the 96 cases which were nursed in the hospital:— Table K. Age (years) 0-5 5-15 15-25 25-35 35 + Number 16 67 9 3 1 Two minor operations were performed for incision of abscesses of upper arm and cervical. One case of scarlatina developed mumps 25 days after admission—no secondary case occurred. One case was admitted suffering from bronchitis in addition, and 2 cases were found to be suffering from nephritis also. Complications of the cases of scarlatina were :— Rhinitis 3 Blepharitis 3 Secondary attacks 2 Otitis Media 3 Septic spots or boils 3 Adenitis 3 Septic finger 2 Albuminuria 1 Cardiac irregularity, etc. 18 Peritonsillar Abscess 1 Herpes of mouth 1 Diphtheria. Thirty-one cases notified as diphtheria were admitted to the hospital. 20 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 2 14 4 2 — 19 The clinical types in which the diagnosis was substantiated were as follows :— Tonsillar (Faucial) 17 Naso-pharyngeal 1 “Bacteriological” 3 Nasal 1 The complications recorded were as follows :— Cardiac irregularity 3 Palatal paralysis 1 Other Diseases. Nineteen cases admitted as scarlatina or diphtheria were subsequently diagnosed as suffering from other diseases. These were as follows :— Diseases notified as scarlatina : *Measles, 1 ; puerperal rash, 1 ; babies admitted with mothers, 2. Diseases notified as diphtheria : Tonsilitis, 7 ; Vincents angina, 0, streptococcal throats, 2 ; tonsillitis and bronchitis, 1 ; laryngitis, 1 ; urticaria and intertrigo, 1 ; wool rash, 1 ; food rash, 1 ; seborrhoea, 1. * Included in Measles Return. Stay in Hospital. The average stay in hospital was as follows :— Scarlatina : All cases (96) 31.2 days. Patients remaining over 56 days (1) 67.0 „ Patients remaining under 56 days (95) 30.9 „ Note : Carried forward from 1944 : 14 patients 349 „ Diphtheria : All cases (20) 49.5 „ Patients remaining over 56 days (7) 61.5 „ Patients remaining under 56 days (13) 43.1 „ Note : Carried forward from 1944 : 1 patient 12 „ Measles : (22). Patients remaining over 56 days (1) 87 .0 „ Patients remaining under 56 days (21) 23.0 „ Note : Carried forward from 1944 : 4 patients 45.0 „ Other diseases : All cases (36) 22.1 „ Patients remaining under 56 days — „ Note : Carried forward from 1944 : 3 patients 19 „ 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 2 1 Total number of days off duty 109 15 Casual conditions :— Rheumatism 33 days — Otitis media — 15 days Injury to toe 76 days — 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 : 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 7,378. 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 vear :— (a) Number of Council houses (1) found to be infested 8 (2) disinfested during the year 8 (b) Number of other houses (1) found to be infested 28 (2) disinfested during the year 28. Total : 36 Canal Boats. Visits were paid to the canal and 9 boats were inspected. The condition of both boats and occupants was satisfactory, but advice was tendered on up-to-date disinfestation arrangements. 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. Fire incidents occurred at both premises, resulting in reconstruction in part in one case and a new factory site for the second registration. Housing. Three hundred and six investigations revealed 41 cases of overcrowding (Housing Act, 1936). Other cases of overcrowding were given individual attention and special recommendations for medical reasons. Records and a work plan were ready at the end of 1945 for the commencement of a complete overcrowding survey. For statistics see Table XXXIV in the Appendix. 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. 21 INSPECTION AND SUPERVISION OF FOOD. Milk. Licences. The following licences under the Milk (Special Designations) Order, 1936, were granted during 1945 :— for the sale of Tuberculin Test Pasteurised — for the sale of Tuberculin Tested milk 8 for the sale of Accredited milk — for the sale of Pasteurised milk 12 for Pasteurisation 1 Supplementary Licences 3 a total of 24 licences being in force at the end of the year. Sampling. Fifty-nine 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. Food Sampling. The chemical or bacteriological analyses of 144 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 1945 are not available. Food Inspection. Inspections are made of the carcases of slaughtered animals at St. Bernard's Hospital (L.C.C.) Slaughterhouse and pig clubs, 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 154,677 29,533 10,285 6,761 125,144 96,228 3,130 25,786 Raw 75»967 23.527 5.007 6.365 52,440 8.997 5.971 37,472 Totals 230,644 53,060 15,292 13,126 177,584 105,225 9,101 63,258 RATS AND MICE (DESTRUCTION) ACT, 1919. Infestation Order, 1943. The Southall Borough Council continues to act as statutory authority for rats and mice destruction in accordance with the Infestation Order, 1943. 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. A survey of sewer infestation was commenced in 1945. 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 Council Branch Centre ditto Second and fourth Wednesday 10 a.m. 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, 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 Ultra.Violet Light Clinics Manor House, Branch Centre Artificial Sunlight Tues. and Fri. 10 a.m. Wed. and Fri. 2 p.m. The Council 24 EXTRACTS FROM VITAL STATISTICS. Table II. Total Male Female Comparative figures for 1944 Live Births—Legitimate 750 392 358 859 Illegitimate 60 29 31 55 Stillbirths—Legitimate 16 10 6 21 Illegitimate 6 3 3 Deaths 462 231 231 443 Birthrate (live and stillbirths) per 1,000 of estimated population 16.68 19.09 Stillbirth rate per 1,000 total (live and still) births 26.42 23.53 Crude death rate per 1,000 of the estimated population 9.26 9.04 Deaths from Puerperal Causes (Headings 29 and 30 of the Registrar. General's Short List): Deaths. Rate per 1,000 total (live and still) births. No. 29. Puerperal sepsis . . 0.00 No. 30. Other puerperal causes — — Total . — Death rate of infants under 1 year of age :— All infants per 1,000 live births 30.8 459 Legitimate infants per 1,000 legitimate live births 29.3 41.9 Illegitimate infants per 1,000 illegitimate live births 50.0 109.1 Deaths from cancer (all ages) 83 69 Deaths from measles (all ages) 1 — Deaths from whooping cough (all ages) — 1 Deaths from diarrhoea, etc. (under 2 years of age) 4 4 « 25 Causes of Deaths, 1945. Table III. Male. Female. Total 1945. Total 1944. 1. Typhoid fever, etc. — — — — 2. Cerebro.spinal fever — — — 1 3. Scarlet fever — — — — 4. Whooping cough — — — 1 5. Diphtheria — — — — 6. Tuberculosis—Respiratory 13 11 24 18 7. Other tuberculosis 5 2 7 2 8. Syphilitic diseases 5 2 7 2 9. Influenza — — — 3 10. Measles 1 — 1 — 11. Ac. poliomyelitis and polioencephalitis — — — 1 12. Ac. inf. encephalitis — — — — 13/16. Cancer (all forms) 39 44 83 69 17. Diabetes — 4 4 3 18. Intra.cran. vasc, lesions 19 23 42 43 19. Heart disease 70 61 131 98 20. Other circulatory diseases 5 15 20 17 21. Bronchitis 11 9 20 24 22. Pneumonia (all forms) 9 20 29 25 23. Other respiratory diseases 5 — 5 10 24. Ulcer of stomach or duodenum 1 — 1 6 25. Diarrhoea, etc. (under 2 years) 3 1 4 4 26. Appendicitis — 2 2 2 27. Other digestive diseases 4 3 7 12 28. Nephritis 5 2 7 10 29. Puerperal sepsis — — — — 30. Other maternal causes — — — — 31. Premature birth 4 1 5 12 32. Congenital malformations, etc. 7 5 12 18 33. Suicide — — — 3 34. Road traffic accidents 2 — 2 1 35. Other violence 4 5 9 21 36. All other causes 19 21 40 37 Total Deaths 231 231 462 443 Deaths in Wards. Table IV. Ward Male Female Total Waxlow Manor 25 26 51 Northcote 38 21 59 Hambrough 46 47 93 Dormers Wells 35 29 64 Glebe 49 63 112 Norwood Green 37 46 83 Total 231 231 462 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 1945. (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 Rate per 1,000 Civilian Population Births:— Live 16.1 19.1 19.2 15.7 16.24 Still 0.46 0.58 0.53 0.40 0.44 Deaths :— All Causes 11.4 13.5 12.3 13.8 9.26 Typhoid & Paratyphoid fevers 0.00 0.00 0.00 0.00 0.00 Smallpox - - - - - Measles 0.02 0.02 0.02 0.01 0.02 Scarlet fever 0.00 0.00 0.00 0.00 0.00 Whooping cough 0.02 0.02 0.01 0.02 0.00 Diphtheria 0.02 0.02 0.02 0.01 0.00 Influenza 0.08 0.07 0.07 0.07 0.00 Notifications:— Smallpox 0.00 0.00 - 0.00 - Scarlet fever 1.89 2.02 2.03 1.57 0.21 Diphtheria 0.46 0.52 0.56 0.31 0.06 Typhoid fever 0.01 0.01 0.01 0.01 0.01 Erysipelas 0.25 0.28 0.24 0.31 0.01 Pneumonia 0.87 1.03 0.72 0.78 0.09 Measles 11.67 10.81 11.19 9.03 10.02 Cerebro-spinal fever 0.05 0.05 0.05 0.06 0.01 Whooping cough 1.64 1.65 1.47 1.25 0.03 Rate per 1,000 Live Births Deaths under 1 year of age 46 54 43 53 30 Deaths from Diarrhoea and Enteritis under 2 years of age 5.6 8 5 7.6 4.9 Rate per 1,000 Live Births Notifications:— Puerperal fever 9.93 12.65 881 3.60 3.60 Puerperal pyrexia 15.87 MATERNAL MORTALITY (England and Wales). Abortion with Sepsis Abortion without Sepsis Puerperal Infections Other 0.25 0.01 0.24 1.22 Abortion—Mortality per Million Women aged 15.45 (England and Wales). With Sepsis Without Sepsis 18 6 27 Monthly Registration of Births. The monthly registration of births classified as to Wards is given in the following table. 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 9-12 months Total deaths under 1 year Bronchitis, Pneumonia, etc. 1 - 1 - 2 - - - 1 3 Congenital Malformations, etc. 7 1 - 1 9 1 - - - 10 Gastro-enteritis, Diarrhœa, etc. - - - - 1 - 2 1 4 Prematurity 6 - - - 6 - - - - 6 Accidental (Suffocation) — - - - — 1 — - - 1 Miscellaneous - - - - - - 1 - - 1 14 1 1 1 17 3 1 2 2 25 TABLE VI. Waxlow Manor Northcote Hambrough Dormers Wells Glebe Norwood Green Total January 3 3 3 1 7 5 22 February 7 8 11 5 13 6 50 March 7 9 11 11 7 8 53 April 1 2 2 2 7 2 16 May 6 5 1 2 5 2 21 June 5 8 4 3 12 2 34 July 7 2 6 1 8 4 28 August 5 4 2 3 9 6 29 September 7 6 5 1 6 4 29 October 2 2 3 3 6 2 18 November 2 1 4 3 2 2 14 December 6 3 1 3 8 4 25 58 53 53 38 90 47 339 Live Births. Legitimate, 750. Infant Deaths. Legitimate, 22. Illegitimate, 60. Illegitimate, 3. Table VIII. Summary of Health Visiting Work for the Year 1945. Visits to infants— First visits 853 Re-visit 2,757 Visits to children— First visits 337 Re-visits 4,710 Visits to expectant mothers 881 Visits for infectious disease 1,347 Visits to schools 53* Child Life Protection visits 206 Miscellaneous visits 841 Removals 213 No access 2,034 Re adoptions 135 Total 14,367 *At these visits a total of 1,776 children were examined. 28 Table IX. (1) Number of foster parents on register— (a) At the beginning of the year 40 (b) At the end of the year 49 (2) Number of foster parents receiving foster children— (a) At the beginning of the year 23 (b) At the end of the year 21 (3) Number of children on the register— (a) At the beginning of the year 28 (b) At the end of the year 25 (4) Number of children received by foster parents during the year 12 (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 4 (c) Adopted 1 (d) Returned to parents 9 (e) Removed at request of the medical officer of health — (/) Evacuated with foster mother — (g) Died during the year — (h) On whom inquests were held — (6) Total number of visits made during the year 219 (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 25 (b) Total number of children in respect of whom notice was given under Sec. 7 (3) during the year 25 (c) (1) Number of children under supervision at end of year 5 (2) Number who died Nil (3) Number on whom inquests held Nil (d) Proceedings taken during year Nil Table X. Ante-Natal Clinic Attendances. First visits Re-visits Average number of re-visits per patient Total number of births in the District (Live & Still) Percentage of new cases to total births (Live & Still) 1938 531 2157 406 856 62.03 1939 506 2109 453 824 61.42 1940 433 2036 5-70 732 59.16 1941 549 2358 433 713 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 1945 719 2815 391 832 86.42 Of the 3,534 total attendances, 2,066 occurred at the Manor House Centre and 1,646 at the Branch Centre. 29 Table XI. Ante-Natal—Abnormalities Found. (a) Abnormalities of the foetus— (i) twins 5 (ii) abortions 11 (iii) stillbirths 6 (iv) other conditions 40 (b) Abnormalities of the mother— (i) unsatisfactory measurements 5 (ii) post partum haemorrhage 6 (iii) ante partum haemorrhage 3 (iv) albuminuria — (v) high blood pressure (exceeding 140 systolic or 90 diastolic other than on the first attendance) 15 (vi) other conditions 60 Neo-Natal Mortality (before the seventh day) — Table XII. Manor House— Seen by medical officer : Infants 2,223 Children at ordinary clinics 802 Children at toddlers' clinics 283 Weighing only : Infants 3,173 Children 370 New cases (included in above): Infants 322 Children 39 Branch Centre— Seen by medical officer : Infants 3,499 Children at ordinary clinics 993 Children at toddlers' clinics 268 Weighing only : Infants 2,091 Children 368 New cases (included in above): Infants 324 Children 81 Total attendances 14,070 The total attendances at the clinics during the past six years have been as follows :— 1940 12,033 1943 12,852 1941 11,109 1944 11,013 1942 13,346 1945 14,070 30 Table XIII. Attendances of New Cases to Number of Live Births : (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 1945 646 810 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 60 74 134 2 years 62 59 121 3 years 58 65 123 4 years 50 29 79 Total Routine 230 227 457 Other inspections 53 41 94 Total 283 268 55i Table XV. Number of Individual Children found at Routine Medical Inspection to require Treatment (excluding Dental Disease) : Manor House Branch Centre Total 18 months 9 20 29 2 years 26 1 27 3 years 13 19 32 4 years 13 10 23 Total 61 5° iii 31 Table XVI. Number requiring Dental Treatment : Manor House Branch Centre Total 18 months — — — 2 years — — — 3 years 2 7 9 4 years 6 8 14 Total 8 15 23 Table XVII. Nutrition. Manor House Branch Centre Total A B C D 18 months A 51 45 96 36 2 — B 9 27 C 2 D — — 2 years A 46 35 81 39 1 — B 16 23 C — 1 D — — 3 years A 33 35 68 52 3 — B 22 30 C 3 — D — — 4 years A 41 21 62 15 2 — B 8 7 C 1 1 D — — Total 230 227 307 142 8 — 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. 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 1. Ringworm - - - 2. Scabies - - - 3. Impetigo - - - 4. Other diseases (non-tubercular) - - - Total 1-4 - - - Eye 5. Blepharitis - — — 6. Conjunctivitis 1 - 1 7. Keratitis and opacities - - - 8. Other conditions (excl. defective vision and squint) 2 — 2 Total 5-8 - - - 9. Defective vision — — — 10. Squint 4 8 12 Ear 11. Defective hearing - 1 1 12. Otitis media 1 — 1 13. Other ear diseases 2 - 2 Nose and Throat 14. Chronic tonsils and/or adenoids 20 10 34 15. Other conditions 3 - 3 16. Enlarged cervical glands (non-tubercular) 2 - 2 17. Defective speech — - — Heart and Circulation 18. Organic heart disease - - - 19. Functional heart disease 1 - 1 20. Anaemia 5 - 5 Lungs 21. Bronchitis 3 - 3 22. Other non-tubercular diseases - 23. Pulmonary tuberculosis - - - Tuberculosis 24. Glands - - - 25. Bones and joints - - — Nervous systerh 26. Chorea - - - 27. Other conditions 2 - 2 Deformities 28. Rickets deformities - - - 29. Genu valgum 18 months 1 3 4 2 years 11 1 18 3 years 2 1 3 4 years 2 — 2 30. Other forms 2 — 2 31. Other defects and diseases 6 20 26 32. Dental diseases 18 months - - - 2 years - - - 3 years 2 7 9 4 years 6 8 14 33 Table XIX. Notifications from Midwives. Medical Help, Mothers and Children 101 Laying-out dead body 2 Liability to be a source of infection 3 Death of child 6 Stillbirths 4 Artificial feeding 11 The reasons for sending 98 notifications for medical help were as follows :— Table XX. During pregnancy 12 For miscarriage 3 During labour 48 During puerperium 10 Infant conditions 25 Table XXL Dental Inspection and Treatment. Expectant and Nursing Mothers :— Number sent to the dentist for inspection 124 Number inspected 124 Number for whom treatment was completed 108 Number of completed dentures 64 Number of fillings 210 Number of local anaesthetics 44 Number of general anaesthetics 105 Total number of attendances and re-attendances 1,019 Children under five years of age:— Number sent for inspection 121 Number inspected 121 Number for whom treatment was completed 66 Number of fillings 43 Number of local anaesthetics 1 Number of general anaesthetics 44 Total number of attendances and re-attendances to dentist 134 These figures show a total number of 1,153 attendances compared with 709 in 1944, 648 in 1943, and 659 in 1942. 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 1945 810 185 221 22 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 30 52 49,550 1.05 1937 42 28 70 51,560 1.35 1938 27 3° 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 1945 39 44 83 49,880 1.88 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 4 8 12 13 1 Female - - - 2 6 12 18 6 Total - - 1 6 14 24 31 7 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 1 2 2 3 - 7 - - - - - - 15 2 - Scarlet fever 1 5 4 4 7 61 13 8 3 - - - 106 102 — Diphtheria 1 2 1 3 1 7 5 8 3 - - - 31 3i - Measles 39 49 79 73 68 164 20 5 1 - 2 - 500 6 1 Puerperal pyrexia - - - - - 1 2 - - - 3 3* - Erysipelas - - - - - - - 2 1 - 2 1 6 3* - Pneumonia 3 3 2 3 - 9 2 4 4 5 9 2 46 25 29 Ophthalmia neonatorum — - - - - - - - - — — — - Cerebro-spinal fever, &c. 1 1 - - - 1 1 1 - - — - 5 5* - Dysentery 1 2 1 2 - 7 8 5 5 1 8 8 48 21 - Paratyphoid — — — — — — 1 — — — — — 1 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 106 41 22 11 14 10 8 104 - Diphtheria 3i 6 5 2 3 8 7 31 - Puerperal pyrexia 3 - - 1 - i 1 3* — Pneumonia 46 12 7 6 8 5 8 25 29 Ophthalmia neonatorum — - - - - - - - - Tuberculosis (all forms) 89 14 14 15 14 18 14 - 31 Erysipelas 6 2 1 1 - 2 - 3* - Measles 500 86 65 104 88 82 75 6 1 Whooping cough 15 8 3 - 1 - 3 2 - Cerebro-spinal fever, &c. 5 1 1 1 i 1 — 5* — Totals 781 170 118 141 129 127 116 179 61 *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 Beaconsfield Road 10 - County School - - Clifton Road 1 1 Dormers Wells 2 3 Featherstone Road 1 3 Western Road 2 1 North Road 4 - St. Anselms 2 - Tudor Road 7 2 Lady Margaret Road 35 2 Other Schools 3 1 67 13 Table XXVIII. Age Periods New Cases Deaths Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary Male Female Male Female Male Female Male Female 0-1 — 1 — — — — — — 1-5 1 - 3 - - - - - 5-10 1 i — — — — - — 10-15 - 2 1 - - - 2 1 15-25 8 9 2 1 - 4 2 — 25-35 7 11 1 3 — 2 1 i 35-45 7 9 2 — 2 3 — — 45-65 12 3 - 1 8 1 — — 65+ 2 — — 1 1 3 - — Totals 38 36 9 6 11 13 5 2 Of the 31 deaths, 28—or 9286 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 3 1 — Clerical work 5 4 — 1 Domestic duties 1 17 - 3 Factory hands 10 8 4 1 No occupation 2 — 3 1 Various 15 4 1 - Totals 38 36 9 6 37 Table XXX. Admissions and Discharges—Isolation Hospital. Remaining on 31.12.44 Admitted during year as Subsequently diagnosed as Discharged recovered Died Transferred Remaining on 31-12-45 Scarlatina 14 104 96 103 - - 6 Diphtheria 1 31 22 17 - - 4 Measles 4 21 22 25 1 - - Whooping Cough - 1 1 1 - - - Rubella - 1 1 1 - - - Chickenpox - 2 2 2 - - - Gingivitis - 1 1 1 - - - Mumps - 5 5 5 - - - Scabies and Impetigo 3 6 6 7 - - 2 Dysentery - 2 2 2 - - - Others - - 18 17 - - 1 38 Table XXXI. Monthly Admissions and Discharges—Isolation Hospital. Number admitted Final diagnosis Number discharged Scarlet Fever Diphtheria Measles Rubella Chickenpox Mumps Scabies and Impetigo Dysentery Others Scarlet Fever Diphtheria Measles Rubella Chickenpox Mumps Scabies and Impetigo Dysentery Others January 3 2 5 - 1 1 - - 2 6 1 4 - - - 1 - - February 4 2 3 1 — — — — 2 5 — 6 - 1 1 — - — March 4 2 4 — 1 1 1 1 3 2 1 3 1 1 1 — — 2 April 6 3 6 — — 3 1 — 3 9 1 6 — — 3 — — 2 May 8 — — — — — — — 1 7 2 2 - - - - 1 1 June 15 — 1 - - — 1 — 1 8 2 — — — — 1 — - July 15 2 — — — — — — 1 15 1 — — — — 1 — 1 August 10 1 1 - - - 1 - 2 11 2 - - - - 1 - - September 8 1 I — — — — 1 — 13 1 3 — — — 1 — - October 13 2 1 — — — — — 3 9 2 — — — — 1 1 1 November 5 4 - — — — — — 1 14 2 — — — — — — 6 December 5 3 - - — — 2 — 1 4 2 1 — — — 1 — 5 96 22 22 1 2 5 6 2 20 103 17 25 1 2 5 7 2 19 Table XXXII. Houses, Public Health Act, 1936 4,976 Houses, Housing Act, 1936 95 Overcrowding 187 Disinfestation 306 War Damage 14 Vans and Sheds — Shops Acts 8 Food Shops 552 Fried Fish 3 Cafes, etc. 56 Factories (Mechanical) 46 Factories (Non-Mechanical) 2 Outworkers 1 Food Factories 495 Smoke r Bakehouses 16 Dairies 18 Water Sampling 7 Milk Sampling 57 Other Foods Sampling 72 Schools 4 Stables 32 Accumulations 26 Slaughterhouses 9 Rats and Mice 321 Food Poisoning 3 Petrol 71 7,378 Table XXXIII. Nuisances caused by the keeping of animals 16 Accumulation of refuse, etc. 43 Offensive smells 22 Vermin 76 Choked drains 232 Dampness 60 Defective roofs, gutters, etc. 85 Defective sanitary fittings 150 Rats and mice 22 Miscellaneous 55 Other defective conditions of houses 233 Overcrowding 89 Air-raid shelters 3 War-damaged houses 29 Smoke 7 Food 130 1,252 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) 1,288 (b) Number of inspections made for the purpose 5,564 (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 505 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 389 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 :— (а) By owners — (b) By local authority in default of owners — (1b) Proceedings under Public Health Acts :— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 315 (2) Number of dwelling-houses in which defects were remedied after service of formal notices :— (a) By owners 222 (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 1 (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) (1) Number of dwellings overcrowded at the end of the year 57 known (2) Number of families dwelling therein 103 (3) Number of persons dwelling therein 473 (b) Number of new cases of overcrowding reported during the year 41 (c) (1) Number of cases of overcrowding relieved during the year 11 (2) Number of persons concerned in such cases 96 (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 41 INDEX. subject page Adoptions 29 Ambulance Service 9 Ante-natal clinics 11, 29, 31 Anti-toxin provision 16 Area of Borough 6 Bed bugs, eradication of 21 Births 7,28 Birth Control clinic 11 Birth rate7,27 Blindness, prevention of 18 Canal boats 21 Cancer 16, 35 Carbide 21 Celluloid and Cinematograph Films Act 21 Child life protection 10, 29 Child welfare clinics 12 Clinics 8, 24, 29, 30, 31 Complaints 39 Consultant aid 10 Council—Members of 3 Day Nurseries 15 Deaths 6, 26, 35 Death rates 6, 27 Dental treatment 15,34 Difficult labour consultant 10 Diphtheria 17, 19 Disinfection 16 Food inspection 22 Food sampling 22 Foster children 29 General provision of Health Services 8 Grants of milk 14 Health propaganda 13 Health visiting 9, 28 Health Week 13 Homeless children, institutional provision for 10 Houses, inhabited, number of 6 Housing 21,40,41 Illegitimate children, institutional provision for 10 Infant mortality 7 Infectious disease control 15, 36, 37 Infectious disease, visits to 18 Isolation Hospital 19, 38 Laboratory work 8, 20 Maternal morbidity and mortality 8, 27 subject page Maternity and nursing homes 14 Members of the Council 3 Members of the Public Health Committee 3 Milk 22 Midwives 14 Midwives' notifications 34 Milk grants 14 Moral welfare 10 Mortuary 21 Ophthalmia 17 Parks and open spaces 6 Petroleum 21 Poliomyelitis 17 Poor Law relief 9 Population 6 Post-natal clinic 11 Premature infants 7 Pre-school medical inspection 12, 31, 32, 33 Public Health Committee—Members 3 Public Health Department—Staff 5 Rateable value 6 Rats and mice 22 Remedial exercises 13 Sanitary inspections 21, 39 Scabies clinic 8 Scarlet fever 17, 19 School children, verminous 18 Schools, infectious disease in 37 Shops Acts 21 Sick hospital staff 20 Smallpox 17 Social conditions of Borough 6 Staff—Public Health Department 5 Statistics 6, 25, 27 Toddlers' clinics 12, 31, 32, 33 Treatment centres 8,24 Tuberculosis 18,37 Ultra-violet light clinics 10 Unmarried mothers, institutional provision for 10 Vaccination 16, 35 Venereal diseases 19 Verminous school children 18 Visits by Sanitary Inspectors 39 Vital statistics 6, 25, 27 Voluntary workers 13 Water supply 21 42