AC 439 (1) SOUTHALL SouT 14 BOROUGH OF SOUTHALL ANNUAL REPORT OF THE Medical Officer of Health for the Year 1946 E. GRUNDY, Medical Officer of Health King and Etchings, ltd., printers, southall BOROUGH OF SOUTHALL ANNUAL REPORT OF THE Medical Officer of Health for the Year 1946 E. GRUNDY, Medical Officer of Health THE COUNCIL OF THE BOROUGH OF SOUTHALL, 1946 Members of the Public Health Committee (which also functions as a Maternity and Child Welfare Committee) are denoted by an asterisk. HIS WORSHIP THE MAYOR * ALDERMAN F. E. GARDNER, J.P. Deputy Mayor : *Councillor F. J. Marks, J.P. Aldermen : *Amos, Mrs. F. S. Hamblin, E. B. Hutchings, C. Neighbour, D. C. *Smith, F. G. (Chairman of the Public Health Committee) *Braine, E. W. H. *Collins, Miss M. Dane, A. T. *Douglas, H. C. Dormer, J. G. *Hopkins, W. H. Councillors : Jennings, F. H. *Lewis, J. F. Lake, H. G. *Lowe, J. Love, P. J. Luckett, F. H. *Lye, A. E. *Robinson, G. T. *Syrett, C. R. *Tooke, Mrs. M. M. 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 50th Annual Report on the health and sanitary circumstances of the Borough for the year 1946. The health of the population continues to be good. The birth rate maintained its regular increase, excepting 1945, and is comparatively high at 20.51. The death rate showed a slight decrease, 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 33.9 in 1946, 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 maintained in the control of the Public Health Department by agreement between the Southall Borough Council and the Middlesex County Council. This entailed continued adaptation 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, 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. The ambulance continued 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. Of the four day nurseries established during the war period, it was necessary to close one, this being in requisitioned premises. 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. 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, E. GRUNDY, Medical Officer of Health. Manor House, Southall. 4 HEALTH DEPARTMENT STAFF for the year 1946 Medical Officer of Health : Ernest Grundy, M.D., B.S.(Lond.), M.R.C.S., L.R.C.P., D.P.H.(Eng.). Assistant Medical Officer : Margaret A. Glass, B.Sc., M.B., Ch.B., D.P.H. Deputy Medical Officers : Elizabeth G. Stuart, M.B., Ch.B. (Resigned 31.12.46.) F. M. Forsyth, M.B., Ch.B. (Appointed 13.6.46. Resigned 31.12.46.) Sanitary Inspection Staff: Senior Sanitary Inspector : R. W. McDonald, Cert. S.I.B., Cert. M. & F., M.S.I.A. Deputy Senior Sanitary Inspector : L. Mair, Cert. S.I.B., Cert. M. & F., M.S.I.A. (Appointed 1.10.46.) Sanitary Inspectors : F. C. Hills, Cert. S.I.B., Cert. M. & F. H. Gatehouse, Cert. S.I.B., Cert. M. & F., M.S.I.A. W. Bowles, Cert. S.I.B., Cert. M. & F., M.S.I.A. (Appointed 1.10.46.) Genera! Assistant : N. V. Saunders. Health Visiting Staff : Miss G. M. Leverett, S.R.N., S.C.M., H.V., Cert. R.S.I. (Senior Health Visitor and Child Life Protection Officer.) Miss E. Gibson, S.R.N., S.C.M., Cert. R.S.I. Miss F. Keynes, S.R.N., S.C.M., H.V., Cert. R.S.I. Miss M. G. Sawkins, S.R.N., C.M.B. Miss F. E. Woodhouse, S.R.N., S.C.M., H.V. Cert. Mrs. I. F. Dykes, S.R.N., S.C.M., H.V. Cert. Miss D. Hull, S.R.N., S.C.M., H.V. Cert. (Appointed 4.3.46.) 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. 5 Clerks, Shorthand- Typists : Miss P. Ashton. Mrs. H. Hurl. (Resigned 9.11.46.) Miss N. Ketteridge. (Resigned 31.8.46.) Mrs. B. Pollard. Miss J. Greenhill. (Appointed 18.11.46.) Mrs. K. Jones. Mrs. E. Richards. T. Buchanan. A. East. (Appointed 31.8.46.) Miss P. Mepham. 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. 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) 54,440 Number of inhabited houses according to Rate Book 14,719 Rateable value £423,147 Sum produced by a penny rate £15650 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. 6 DEATHS AND DEATH RATE Whole District Total deaths, 488. (Males, 240 ; Females, 248.) Crude Death Rate, 8 96. For extracts from vital statistics and causes of death, see Appendix, Tables II and III. A fall in the death rate, which was 8 96, as against 9 26 in 1945, is to be observed. An analysis of the deaths shows that the causes are mainly deaths from cancer and heart and other circulatory diseases. The decrease in the deaths from tuberculosis from 31 in 1945 to 30 in 1946 is satisfactory, but no inference can be drawn from such slight change. A slight fall in the death rate from heart disease and other circulatory diseases is possibly a manifestation of the cessation 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 225 (males 103 and females 122). 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 263 in number (males 137 and females 126). The total number of deaths therefore belonging to the district was 488. The deaths of non-Southall residents in the St. Bernard's Hospital (not included in the above figures) numbered 133 (males 36 and females 97). 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 1945 are given in brackets). The total number of births notified to the Health Department under the Public Health Act, 1936, was 1,229 (922)- The total number of registered births in the district (under the Births and Deaths Registration Act—included in the notified births above) was 4°8 (339). The total number of live births belonging to the district whether occurring within or outside the district was 1,090 (810). The illegitimate five births were 56 (60). There were 27 stillbirths (22), and these were legitimate, with two exceptions. Last year, for the first year since 1941, there was no increase in the birth rate in Southall, but it increased in 1946 to 20 51 which is very satisfactory. The corresponding rate for the whole country in 1946 was 19-1. 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 1946 are to be found in Appendix, Table XI. Total Confinements (live births and still births), 1,117. No. born in Hillingdon County Hospital 492 or 44% No. born in London voluntary hospitals 74 or 7% No. born in nursing homes or other hospitals 335 or 30% No. confined in their homes by midwives or doctors 216 or 19% Infant Mortality. The total number of deaths under one year of age was 37. The rate per 1,000 live births was 33.9. The corresponding rate for England and Wales was 43, for London 44, and for the 148 small towns 37 per 1,000. The infant mortality rate of 33 9 is of the greatest importance. This rate, which has been decreasing steadily since 1938, maintained a satisfactory position. While the corresponding rate for England and Wales has remained stationary, such a drop was not to 7 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 1946 which compares with some of the best world rates. For details of causes of death of infants in the year, see Appendix, Table VII. Premature Infants. Seventy-two infants were born prematurely during the year of whom 60 survived at the end of one month. 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. Maternal Morbidity and Mortality. During the year 8 cases of puerperal pyrexia were notified, but no maternal death and no deaths associated with abortion. Seven of the cases occurred in institutions. 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 1946 the total number of visits made by the nurses was 9,807. 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 1946 was 300 over the 1945 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 (including work done for the Isolation Hospital). Table A Positive Negative Swabs for diphtheria 87 422 Sputa for tubercle 18 66 Faeces 8 31 Other 15 30 128 549 8 Scabies Clinic. The total number of attendances at the clinic for treatment of scabies and other skin conditions during 1946 was 3,978. Details of the cases were as follows :— Scabies First Visits 384, Re-attendances 1,147, Total 1,531. Other skin conditions „ ,,210 „ 1,208 „ 1,418. Verminous heads „ „ 542 „ 359 „ 901. Attendances at the cleansing station increased during 1946. The total number— 3,978—compares with a total number of 3,946 in 1945. 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 routine inspection for cleanliness in schools is 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 1946 the ambulance vehicles were stationed at Salisbury Road Civil Defence Depot, and were manned by specially appointed driver-attendants. All users of the civil ambulance service are expected to produce a medical certificate to justify the free use of the ambulance. Details of the work of this service are as follows :— Table B Ordinary cases removed to hospital or home 4,956 Accidents 514 Total 5470 Miles travelled in the period 51,927 Poor Law Medical Relief. The Relieving Officer issued 403 Medical Orders during 1946. Some of these cases also received outdoor relief or institutional treatment. MATERNITY AND CHILD WELFARE Health Visiting. Arrangements for health visiting which were instituted in the middle of 1946, because of the transfer of school medical duties to the Public Health Department, were continued during the year. In order to obtain a complete sequence of visiting throughout the child's life, it is desirable that the districts are so divided that each health visitor is responsible for visiting expectant mothers, infants and school children in designated areas, and that they, as far as possible, conduct clinics to which the various members of these families attend, and therefore the Borough is divided into eight districts and one health visitor allotted to each area. Each health visitor is 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 1946, 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. The " Flying Squad " of the County Council for assistance in cases of difficult labour is available to medical practitioners practising in Southall. During the year the squad was called in once. 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, 8 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 1946 was 56 to 1,034—5-4%. Ultra-violet Light Clinics. Four sessions a week for treatment by ultra-violet light were held during 1946— 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 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. Table C Number of sessions held : 115. Number of attendances :— First Visits Re-visits Mothers 9 34 Infants 220 2,102 10 Post-natal and Birth Control Clinic. Table D Number of sessions held : 24. Number of attendances :— Post Natal Birth Control First Visits 92 66 Re-attendances 70 194 Ante-Natal Clinics. The number of new patients seen at the ante-natal clinics during the year was 940, and the total number of attendances was 4,861 (2,614 at the Manor House and 2,247 at the Branch Centre). 811 cases were completed during the year, and the attendances in respect of these were as follows of Cases One attendance 90 Two attendances 57 Three attendances 60 Four attendances 82 Five attendances 84 Six or more attendances 438 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 1946 have been as high as 32 at one session, and to relieve the position somewhat, the additional session commenced last year was continued. Table E.I Completed cases 811 Uncompleted cases 246 Non-pregnant 21 Removals from district 55 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 297 373 90 185 207 188 Abnormal cases 62 79 6 16 56 63 Of the cases dealt with, therefore, 44 per cent, were primiparae (against 38 per cent, in 1945), and of these 72 per cent, (against 81 per cent, in 1945) were confined in hospital, while 55 per cent, (against 51 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 1946 are shown in Table XII in Appendix. The total number of attendances at the Infant Welfare and Toddlers' Clinics during 1946 was 13,897, as compared with 14,070 for 1945. Approximately 70% of all infants born in Southall during 1946 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 fortnightly at each centre. The total attendances at these clinics were 737, 342 at the Manor House and 395 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. 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. 12 Voluntary Workers. The help given by the Voluntary Workers Association in various duties at the Council's clinics continued during 1946. The assistance given by the members so generously entails considerable sacrifice of their time and assists greatly in maintaining 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.y 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 58 6 Re-attendances 770 28 Health Propaganda. 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 1946. 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.) 13 The monthly bookings for each district are included below :— Table F Districts No. 1 No. 2 No. 3 No. 4 No. 5 Totals January 1 7 2 6 6 22 February 1 4 — 6 2 13 March 4 7 9 8 7 35 April 3 4 5 5 6 23 May 5 6 5 11 4 3i June 4 9 1 8 8 30 July 4 10 5 2 5 26 August 3 - 6 6 8 23 September 1 5 4 5 7 22 October 8 8 6 8 6 36 November 2 9 6 5 5 27 December 4 7 5 7 6 29 Totals 40 76 54 77 70 317 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 1946 Nil Number of additional applications re registration during the year 1946 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, are 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 38 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 1946 — — 31 7 14 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 attendances—1,068—is satisfactory, 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 1,068 attendances, compared with 1,153 for1945-) Wartime Day Nurseries. The three 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. One nursery, in requisitioned premises, was closed during the year. 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, two 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 considerable increase in the number of cases of whooping cough, and four deaths due to this disease are more than normal. 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 greatly decreased from 31 notified in 1945 to 15 in 1946, and all these cases made a satisfactory recovery. 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 1946, either free or at part cost. 15 Vaccination. The total number of successful vaccination certificates received during the year was 265, and the number of certificates of exemption issued was 270. Table XXII in Appendix gives details of the percentage of children successfully vaccinated during the last eleven years. The proportion of vaccinated to unvaccinated infants becomes smaller each year. In 1946 it was 24% vaccinated to 76% 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 97 Covers 61 Beds 183 Eiderdowns 32 Blankets 292 Pillows 295 Bolsters 65 Sheets 140 Books 70 Miscellaneous 36 Scabies Clinic : Bags of clothing 85 Total 1,356 The following articles were destroyed : 10 mattresses, 2 bolsters, 1 pillow and 37 articles of clothing. Cancer. It will be seen by the table of causes of death (page 26) that in 1946, 94 cases (40 males and 54 females) died from cancer. (See Appendix, Tables XXIII and XXIV.) There was again in 1946 an increase in the number of deaths from cancer, although not to the high level it reached in the years preceding 1945. During that year the statistics showed a marked and satisfactory dimunition in the number of deaths from cancer. 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 1946, but 9 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 67, as compared with 104 for the previous year. Of these, 59 were removed to the Isolation Hospital. 16 Diphtheria. Twenty-five cases of diphtheria were notified to the health department and admitted to the Isolation Hospital during 1946. Eleven were not confirmed as diphtheria and the total therefore was 14 positive cases, the majority of which were carriers. All cases were mild in character, there were no deaths from diphtheria, and complications occurred only in three cases, i.e., cardiac irregularity in two, and palatal 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 1946, 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 new cases attending for immunisation was 974 and was 11% up on the 1945 figure. Diphtheria immunisation is carried out on Monday afternoons at the Branch Health Centre, and on Thursday afternoons at the Featherstone Road Clinic. Table J Number of sessions held 101 Total attendances made 4,218 Average attendance per session 41 Highest attendance at a session 79 Lowest attendance at a session 9 During 1946 the number of new cases was 974 Ophthalmia Neonatorum. Three cases of ophthalmia neonatorum were notified in 1946 and all recovered during the year. Acute Poliomyelitis. No 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. Infectious Disease Visits. During the year, the Health Visitors paid 526 visits with reference to cases of infectious disease. 80 swabs were taken. The total number of children examined by the Health Visitors in the schools was 489. Uncleanliness and Verminous Conditions in Schoolchildren. Number of children on roll at 31st December, 1946 6,885 Total number of examinations of children in the schools by the school nurses 26,873 Number of individual children found unclean 1,155 Number of children cleansed under arrangements made by the Local Education Authority 426 17 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 1945 is 1,156 to 948—nearly 25%. 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. 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. 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 82. Other Forms of Tuberculosis. The number of new cases notified during the year was 16. Of the total notifications 27 were notified from Institutions (Sanatoria 2, County Council Hospitals 23, General Hospitals 2). Deaths from Tuberculosis. Tuberculosis of the respiratory system, 24 ; other forms, 3. For details of new cases notified and deaths in 1946, see Appendix, Table XXVIII, and the occupation of new cases, see Appendix, Table XXIX. Public Health (Prevention of Tuberculosis) Regulations, 1925. Public Health Act, 1936, Section 172. Action under these powers was not necessary during the year. Venereal Diseases. The Middlesex County Council is the authority under the Public Health (Venereal Disease) Regulations, for the treatment of Venereal Disease in the County. REPORT ON THE BOROUGH ISOLATION HOSPITAL During the year 109 patients were admitted to the Isolation Hospital, as compared with 174 in 1945. Of these, 59 were sent in as scarlatina, 25 as diphtheria, 2 as measles, 6 as impetigo and scabies, 9 as whooping cough, 1 as tonsillitis, 1 as jaundice, 1 as enteric, 1 as mumps, 1 as chicken-pox, and 3 as rubella. Of the cases sent in as scarlatina, 1 was unconfirmed and was diagnosed as suffering from another disease. Similarly, of the cases sent in as diphtheria or suspected diphtheria, 11 were unconfirmed. (Tables No. XXX and XXXI show the figures for the year and for each month, respectively.) 18 Scarlatina. Of the 59 cases notified as scarlatina, 58 were finally diagnosed, and the following table shows the incidence in age groups of the 58 cases which were nursed in the hospital:— Table K Age (years) ... 0-5 5-15 15-25 25-35 35 + Number 14 37 7 1 — There was one return case. One minor operation was performed for incision of cervical abscess. One case was found to be suffering from dermatitis. Anti-scarlet fever serum was administered to all patients. Complications of the cases of scarlatina were :— Bronchitis 2 Otitis Media 1 Secondary rashes 1 Adenitis 1 Septic finger and toes 4 Cervical Abscess 1 Cardiac irregularity, etc 5 Diphtheria. Twenty-five cases notified as diphtheria were admitted to the hospital. Fourteen 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 5 3 2 2 The clinical types in which the diagnosis was substantiated were as follows :— Tonsillar (Faucial) 6 Naso-pharyngeal 1 " Bacteriological" 7 The complications recorded were as follows :— Cardiac irregularity 2 Palatal paralysis 1 There were 3 persistent carriers. Tonsillectomy was performed on 2 of these cases. Other Diseases. Twelve cases admitted as scarlatina or diphtheria were subsequently diagnosed as suffering from other diseases. These were as follows :— Disease notified as scarlatina : Tonsillitis. Diseases notified as diphtheria: Tonsillitis, 5; Vincents agina, 2; streptococcal throat, 1; tonsillitis, bronchitis and laryngitis, 1; scarlet fever, 1; baby with mother, 1. 19 Stay in Hospital. The average stay in hospital was as follows :— Scarlatina : All cases (59) 30.9 days Patients remaining over 56 days (1) 57 „ Patients remaining under 56 days (58) 30.4 „ Note : Carried forward from 1945 : 6 patients 66 „ Remaining on 31.12.46 : 5 patients 81 „ Diphtheria : All cases (14) 55 „ Patients remaining over 56 days (6) 105 „ Patients remaining under 56 days (8) 14.1 ,, Note : Carried forward from 1945 : 4 patients 69 „ Remaining on 31.12.46 : 2 patients 29 „ Whooping Cough : (9) 34.1 „ Patients remaining over 56 days (2) 77.1 „ Patients remaining under 56 days (7) 21.7 „ Note : Carried forward from 1945 : None — „ Remaining on 31.12.46 : None — „ Scabies : All cases (6) 31.1 „ Patients remaining on 31.12.46 : None — „ Other diseases : All cases (21) 12. 2 „ Patients remaining on 31.12.46 : None — „ 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 4 3 Total number of days off duty 109 88 Casual conditions :— Rheumatism 16 days — Chill — 20 days Nervous debility — 40 days Enteritis 27 — Pyelitis 59 — Influenza 7 28 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 : 4 samples were taken during the year and found to be satisfactory. 20 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 10,379. Table XXXII shows an analysis of the number and nature of such inspections, and Table XXXIII the number of complaints received during the year. Eradication of Bed Bugs. Table N Statistics for the year :— (а) Number of Council houses (1) found to be infested 9 (2) disinfested during the year 9 (б) Number of other houses (1) found to be infested 27 (2) disinfested during the year 27 Total : 36 Canal Boats. Visits were paid to the canal and 11 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 mortuary, situated in Havelock Road, provides adequate accommodation for the Borough. Five bodies were deposited in the mortuary during the year. Petroleum and Carbide. During the year 56 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 damage repair work was carried out at one factory. A new factory on a new site was built after destruction of the old premises by fire. Housing. One thousand and twenty-four investigations revealed 104 cases of overcrowding (Housing Act, 1936). Other cases of overcrowding were given individual attention and special recommendations for medical reasons. Work was commenced on an overcrowding survey, but was not completed by the end of the year. For statistics see Table XXXIV in the Appendix. Administration of the Shops Acts. Standards were maintained, and war-time deficiencies in natural fighting were made good. The continued co-operation with shopkeepers rendered closing hours supervision of small account. 21 Milk. INSPECTION AND SUPERVISION OF FOOD Licences. The following licences under the Milk (Special Designations) Order, 1936, were granted during 1946 :— for the sale of Tuberculin Test Pasteurised 1 for the sale of Tuberculin Tested milk 10 for the sale of Accredited milk — for the sale of Pasteurised milk 13 for Pasteurisation 1 Supplementary Licences 3 a total of 28 licences being in force at the end of the year. Sampling. Eighty-eight samples of milk, designated and undesignated, were sent during the year for bacterial count. The examinauons 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 117 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 1946 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.) Stock (lbs.) Production (lbs.) Consumption (lbs.) Total (lbs.) Animal Feeding (lbs.) ByeProducts (lbs.) Destruction (lbs.) Canned 100,082 30,593 889 27,731 1,973 69,489 48,233 695 20,561 Raw 36,641 28,206 — 281 27,925 8,435 844 2,894 4,697 Totals 136,723 58,799 889 28,012 29,898 77,924 49,077 3,589 25,258 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. Initial deratisation of sewers was completed during the year. Factories employ their own deratisation agents. Individual infestations were checked by the District Sanitary Inspectors. Work remained in progress on certain open spaces. 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. Thursday 2 p.m. The Council Branch Centre Medical Supervision Tuesday 10 a.m. Friday 10 a.m. First and third Wednesday at 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 Monday at 10 a.m. The Council M. and C.W. Dental Clinic North Road School Featherstone Road School Dental Inspection and Treatment of Expectant and nursing mothers and children under 5 years Wednesday 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 10 a.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 and North 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 1945 Live Births—Legitimate 1034 538 496 750 Illegitimate 56 32 24 60 Stillbirths—Legitimate 25 12 13 22 Illegitimate 2 - 2 Deaths 488 240 248 462 Birth rate (live and stillbirths) per 1,000 of estimated population 20.51 16.88 Stillbirth rate per 1,000 total (live and still) births 24.18 26.42 Crude death rate per 1,000 of the estimated population 8.96 9.26 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 — — 0.00 No. 30. Other puerperal causes — — Total — — Death rate of infants under 1 year of age:— All infants per 1,000 live births 33.94 30.8 Legitimate infants per 1,000 legitimate live births 30.94 29.3 Illegitimate infants per 1,000 illegitimate live births 88.30 50.0 Deaths from cancer (all ages) 94 83 Deaths from measles (all ages) — I Deaths from whooping cough (all ages) 4 — Deaths from diarrhoea, etc. (under 2 years of age) 3 4 25 Causes of Deaths, 1946. Table III Male. Female. Total 1946. Total 1945. 1. Typhoid fever, etc — 1 1 — 2. Cerebrospinal fever 1 — 1 — 3. Scarlet fever — — — — 4. Whooping cough 3 1 4 1 5. Diphtheria — — — — 6. Tuberculosis—Respiratory 14 10 24 24 7. Other tuberculosis — 3 3 7 8. Syphilitic diseases 2 2 4 7 9. Influenza 1 3 4 — 10. Measles — — — 1 11. Ac. poliomyelitis and polioencephalitis — — — — 12. Ac. inf. encephalitis — — — — 13/16. Cancer (all forms) 40 54 94 83 17. Diabetes 3 4 7 4 18. Intra-cran. vase. lesions 14 21 35 42 19. Heart disease 58 53 111 131 20. Other circulatory diseases 13 22 35 20 21. Bronchitis 12 18 30 30 22. Pneumonia (all forms) 10 7 17 29 23. Other respiratory diseases 3 1 4 5 24. Ulcer of stomach or duodenum 5 1 6 1 25. Diarrhœa, etc. (under 2 years) 2 1 3 4 26. Appendicitis 3 — 3 2 27. Other digestive diseases 5 8 13 7 28. Nephritis 6 2 8 7 29. Puerperal sepsis — — — — 30. Other maternal causes — — — — 31. Premature birth 7 1 8 5 32. Congenital malformations, etc. 9 7 16 12 33. Suicide 1 3 4 — 34. Road traffic accidents 2 — 2 2 35. Other violence 7 8 15 9 36. All other causes 19 17 36 40 Total Deaths 240 248 488 462 Deaths in Wards. Table IV Ward Male Female Total Waxlow Manor 32 36 68 Northcote 26 34 60 Hambrough 49 40 89 Dormers Wells 29 36 65 Glebe 53 60 113 Norwood Green 51 42 93 Total 240 248 488 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 1946. (England and Wales, London, 126 Great Towns and 148 Smaller Towns.) (Provisional Figures based on Weekly and Quarterly Returns) England and Wales 126 County Boroughs and Great Towns including London 148 Smaller Towns (Resident Populations 25,000 to 50,000 at 1931 Census) London Administrative County Southall Rates per 1,000 Civilian Population Births: Live 191 22.2 21.3 21.5 20.02 Still 0.53 0.67 0.59 0.54 0.05 Deaths:— All Causes 11.5 12.7 11.7 12.7 8.96 Typhoid & Paratyphoid fevers 0.00 0.00 0.00 0.00 0.00 Smallpox — — — — — Measles 0.00 0.01 0.00 0.01 0.00 Scarlet fever 0.00 0.00 0.00 0.00 0.00 Whooping cough 0.02 0.02 0.02 0.02 0.07 Diphtheria 0.01 0.01 0.01 0.01 0.00 Influenza 0.15 0.13 0.14 0.12 0.07 Notifications:— Smallpox 0.00 0.00 — 0.00 — Scarlet fever 1.38 1.51 1.33 1.42 1.23 Diphtheria 0.28 0.32 0.31 0.24 0.27 Typhoid fever 0.01 0.01 0.01 0.01 0.01 Erysipelas 0.22 0.45 0.22 0.27 0.02 Pneumonia 0.39 1.02 0.74 0.75 0.79 Measles 3.92 4.73 3.70 7.35 0.03 Cerebro-spinal fever 0.05 0.05 0.04 0.06 0.07 Whooping cough 2.28 2.48 2.05 2.22 2.24 Rates per 1,000 Live Births Deaths under 1 year of age 43 46 37 41 33 Deaths from Diarrhoea and Enteritis under 2 years of age 4.4 6.1 2.8 4.2 2.7 Rates per 1,000 Total Births (i.e. Live and Still) Notifications:— Puerperal fever 8.50 10.35 7.63 1.62 7.1 Puerperal pyrexia 9.68 MATERNAL MORTALITY (England and Wales). Abortion with Sepsis Abortion without Sepsis Puerperal Infections Other 013 0.06 0.18 1.06 Abortion—Mortality per Million Women aged 15-45 (England and Wales). With Sepsis Without Sepsis 11 5 *Including Puerperal Fever 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 2 6 2 5 8 7 30 February 1 7 1 3 6 3 21 March 8 4 3 2 10 8 35 April 8 1 5 i 7 10 32 May 2 5 4 8 6 7 32 June 11 4 1 3 12 6 37 July 4 4 7 4 12 6 37 August 8 5 4 3 10 4 34 September 3 8 7 2 11 12 43 October 5 5 10 3 4 5 32 November 8 2 5 4 5 10 34 December 3 6 8 10 9 5 4i 63 57 57 48 100 83 408 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 1 — 3 1 2 3 — 9 Congenital Malformations, etc. 11 1 — — 12 1 1 2 — 16 Gastro-enteritis, Diarrhœa, etc. — — — — 2 — 1 — — 3 Prematurity 8 — — — 8 — — — — 8 Accidental (Suffocation) — — — — — 1 — — — 1 20 3 2 — 25 3 4 5 — 37 Live Births. Legitimate 1,034 Illegitimate 56 Infant Deaths. Legitimate 32 Illegitimate 5 Table VIII Summary of Health Visiting Work for the Year 1946 Visits to infants— First visits 1,019 Re-visits 3,449 Visits to children— First visits 147 Re-visits 4,987 Visits to expectant mothers 1,598 Visits for infectious disease 468 Visits to schools 58* Child Life Protection visits 163 Miscellaneous visits 893 Removals 226 No access 2,105 Re adoptions 108 Total 15,221 *At these visits 489 children were examined. 28 Table IX (1) Number of foster parents on register— (a) At the beginning of the year 49 (b) At the end of the year 46 (2) Number of foster parents receiving foster children— (a) At the beginning of the year 21 (b) At the end of the year 14 (3) Number of children on the register— (a) At the beginning of the year 25 (b) At the end of the year 15 (4) Number of children received by foster parents during the year 14 (5) Number of foster children— (a) Reached the age of 9 during the year 2 (b) Removed during the year to different foster parents or to children's societies 3 (c) Adopted 1 (d) Returned to parents 4 (e) Removed at request of the medical officer of health — (f) Evacuated with foster mother — (g) Died during the year — (h) On whom inquests were held — (6) Total number of visits made during the year 235 (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 12 (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 2 (2) Number who died 1 (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) 1939 506 2109 453 824 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 1945 719 2815 3.91 832 86.42 1946 940 3921 4.16 1117 83.43 Of the 4,861 total attendances, 2,614 occurred at the Manor House Centre and 2,247 at the Branch Centre. 29 Table XI Ante-Natal—Abnormalities Found (a) Abnormalities of the foetus— (i) twins 2 (ii) abortions 20 (iii) stillbirths 12 (iv) congenital deformities 5 (v) faulty presentation 9 (vi) prematurity 32 (vii) other conditions 8 (b) Abnormalities of the mother— (i) unsatisfactory measurements 17 (ii) post partum haemorrhage 2 (iii) ante partum haemorrhage 5 (iv) high blood pressure (exceeding 140 systolic or 90 diastolic other than on the first attendance) 46 (v) disproportion or displacement of foetus 65 (vi) pyelitis 30 (vii) other conditions 11 Neo-Natal Deaths (before the seventh day) (included in above) 5 3° Table XII Attendances at Infant Clinics Manor House— Seen by Medical Officer : Infants 2,634 Children at ordinary clinics 629 Children at toddlers' clinics 363 Weighing only: Infants 3,690 Children 481 New cases (included in above): Infants 376 Children 30 Branch Centre— Seen by Medical Officer: Infants 2,869 Children at ordinary clinics 691 Children at toddlers' clinics 350 Weighing only: Infants 1,896 Children 294 New cases (included in above): Infants 387 Children 33 Total attendances 13,953 The total attendances at the clinics during the past six years have been as follows:— 1941 11,109 1944 11,013 1942 I3,346 1945 14,070 1943 12,852 1946 13,953 Table XIII Attendances of New Cases to Number of Live Births : (1) (2) (3) New Infant Cases Total live births Percentage of (1) to (2)* 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 1946 826 1090 75 * 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 62 92 154 2 years 85 96 181 3 years 66 78 144 4 years 65 61 126 Total Routine 278 327 605 Other inspections 64 68 132 Total 342 395 737 Table XV Number of Individual Children found at Routine Medical Inspection to require Treatment (excluding Dental Disease) : Manor House Branch Centre Total 18 months 7 3 10 2 years 23 4 27 3 years 29 6 35 4 years 37 14 51 Total 96 27 123 31 Table XVI Number requiring Dental Treatment : Manor House Branch Centre Total 18 months — — — 2 years 2 — 2 3 years 4 4 8 4 years 17 8 25 Total 23 12 35 Table XVII Nutrition Manor House Branch Centre Total A B C D 18 months A 43 72 115 36 3 — B 16 20 C 3 — D — — 2 years A 63 73 136 36 9 — B 17 19 C 5 4 D — — 3 years A 41 56 97 40 7 — B 25 15 C — 7 D — — 4 years A 45 43 88 37 1 — B 20 17 C — 1 D — — Total 278 327 436 149 20 — 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 Skirt 1. Ringworm - - - 2. Scabies - 1 1 3. Impetigo 1 - 1 4. Other diseases (non-tubercular) 2 2 4 Total 1-4 3 3 6 Eye 5. Blepharitis - - - 6. Conjunctivitis - - - 7. Keratitis and opacities - - - 8. Other conditions (excl. defective vision and squint) - 2 2 Total 5-8 - 2 2 9. Defective vision - - - 10. Squint 1 - 1 Ear 11. Defective hearing - - - 12. Otitis media 1 - 1 13. Other ear diseases - - - Nose and Throat 14. Chronic tonsils and/or adenoids 36 17 53 15. Other conditions 5 5 16. Enlarged cervical glands (non-tubercular) 1 - 1 17. Defective speech - 1 1 Heart and Circulation 18. Organic heart disease 2 1 3 19. Functional heart disease 2 - 2 20. Anaemia - - - Lungs 21. Bronchitis - - - 22. Other non-tubercular diseases 1 - 1 23. Pulmonary tuberculosis - - - Tuberculosis 24. Glands - - - 25. Bones and joints 1 - 1 Nervous system 26. Chorea - - - 27. Other conditions - - - Deformities 28. Rickets deformities 1 1 2 29. Genu valgum 18 months 1 2 3 2 years 9 1 10 3 years 7 1 8 4 years 5 - 5 30. Other forms 2 2 31. Other defects and diseases 14 11 25 32. Dental diseases 18 months - 2 years 2 - 2 3 years 4 4 8 4 years 17 8 25 33 Table XIX Notification from Midwives Laying-out dead body 2 Liability to be a source of infection 9 Death of child 5 Stillbirths 5 Artificial feeding 5 The reasons for sending 133 notifications for medical help were as follows:— Table XX During pregnancy 13 For miscarriage 5 During labour 71 During puerperium 18 Infant conditions 26 Table XXI Dental Inspection and Treatment Expectant and Nursing Mothers:— Number sent to the dentist for inspection 229 Number inspected 185 Number for whom treatment was completed 128 Number of completed dentures 81 Number of fillings 247 Number of local anaesthetics 68 Number of general anaesthetics 84 Total number of attendances and re-attendances 800 Children under five years of age:— Number sent for inspection 97 Number inspected 95 Number for whom treatment was completed 100 Number of fillings 139 Number of local anaesthetics — Number of general anaesthetics 57 Total number of attendances and re-attendances to dentist 268 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 38.6 1945 810 185 221 22 1946 1090 265 270 24 Table XXIII Deaths from Cancer Year Male Female Total Estimated population Rate per 1,000 population 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.l8 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 1946 40 54 94 54,440 1.64 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 - - - 3 11 14 11 1 Female - - 1 10 7 18 11 7 Total - - 1 13 18 32 22 8 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 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 17 19 20 16 35 3 1 - - - - 122 4 Scarlet fever - 3 3 3 4 23 21 8 2 - - - 67 - Diphtheria - - - - - 2 2 3 - 2 - - 14 - Measles 1 6 4 1 4 2 2 1 - - - - 21 - Puerperal pyrexia - - - - - 1 - 5 - - 8 - Erysipelas - v - - - - - 1 - 2 6 2 11 - Pneumonia 1 2 - 1 1 6 2 2 6 7 14 1 43 17 Ophthalmia neonatorum 3 - - - - - - - - - - - 3 - Cerebro-spinal fever, &c. - - - - - - 1 - - - - - 4 1 Dysentery - - - - - - - - 3 5 7 4 20 - 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 Total deaths Scarlet fever 67 19 8 9 15 14 2 _ Diphtheria 14 2 2 — 3 — 7 — Puerperal pyrexia 8 2 1 1 1 2 1 — Pneumonia 43 10 6 4 11 6 6 17 Ophthalmia neonatorum 3 1 — — 1 — 1 — Tuberculosis (all forms) 98 12 23 19 10 22 12 34 Erysipelas 11 — 2 5 2 1 1 — Measles 121 7 2 2 6 1 3 — Whooping cough 22 40 9 15 30 12 16 — Cerebro-spinal fever, &c. 4 1 1 1 1 — — 1 Totals 391 94 54 56 80 58 49 52 36 Cases of infectious diseases occurred during the year among schoolchildren as follows:— Table XXVII School Scarlet Fever Diphtheria Beaconsfield Road 2 _ County School _ _ Clifton Road 1 1 Dormers Wells 4 _ Featherstone Road 7 — Western Road... 3 1 North Road 2 1 St. Anselms 3 _ Tudor Road 2 1 Lady Margaret Road 8 _ Other Schools 4 1 36 5 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 — 1 — — _ — 5-10 1 1 i _ _ _ _ _ 10-15 2 3 i i _ i _ 1 15-25 13 13 1 5 2 3 — 1 25-35 5 14 — 2 3 4 _ _ 35-45 9 10 11 — 6 — — — 45-65 5 4 2 — 3 2 — — 65+ — 1 — — — — — — Totals 35 47 6 10 14 10 — 3 Of the 27 deaths, all 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 8 — — — Schoolchildren 2 4 3 1 Clerical work 1 4 1 1 Domestic duties — 22 — 2 Factory hands 6 5 1 — No occupation 6 2 — 2 Various 12 10 1 4 Totals 35 47 6 10 37 Table XXX Admissions and Discharges—Isolation Hospital Remaining on 31-12.45 Admitted during year as Subsequently diagnosed as Discharged recovered as Died Transferred Remaining on 31.12.46 Scarlatina 6 59 59 60 - - 5 Diphtheria 4 25 14 17 - - 1 Measles - 2 3 3 - - - Pneumonia and Whooping Cough - 9 9 7 2 - - Rubella - 3 2 2 - - - Chickenpox - 1 1 1 - - - Jaundice - 1 1 1 - - - Mumps - 1 1 1 - - - Scabies and Impetigo 2 6 6 8 - - - Bronchitis - - 1 1 - - - Vincents Angina - - 2 2 - - - Tonsillitis, etc. - 1 9 8 - - 1 Enteric - 1 1 1 - - - Others 1 - - 1 - - - Table XXXI Monthly Admissions and Discharges—Isolation Hospital Number Admitted Final Diagnosis Number Discharged Deaths Scarlet Fever Diphtheria Measles Whooping Cough Rubella Chickenpox Mumps Scabies Tonsillitis Jaundice Enteric Vincents Bronchitis Scarlet Fever Diphtheria Measles Whooping Cough Rubella | Chickenpox Mumps Scabies Tonsillitis | Jaundice | Enteric Vincents Bronchitis Others Whooping Cough Enteric January 7 3 – – – – – – 2 – – – – 6 3 – – – – – 2 2 – – – – 1 – – Febuary 6 – – – 1 – _ – – _ _ _ _ 7 – – – – – – – – – – – – – – – March 10 – – – 1 – – – – – _ _ _ 6 2 – – 2 – 1 – 1 – – – – – – – April 8 4 2 – – –– – – – – – _ 1 7 – 2 – – – – – 1 1 – – – – – – May 3 – – – – – – – – – – – – 11 2 – – – – – – 1 – – – – – – – June 2 – – – – – – – 2 – – _ _ 3 1 – – – – – – – 1 – – – – – – July 3 6 – 1 – – – – – – – 2 _ 3 1 – – – 1 – – 1 – – 1 – – 1 – August 2 – – 1 – – – 1 – – – – – 2 7 – 1 – – – – – – – 1 – – – – September 2 – – 6 – – – 2 – – – – – 2 – – – – – – – – – – – – – 1 – October 3 – – – – – – – – – – – – 3 – _ – – – 3 1 – – – – – – – November 8 – – – – – – – – – – – _ 2 – – 2 – – – 2 – – – – – – – – December 5 1 1 1 – – – – – – – – – 8 – 1 2 – – – – – – – – – – — – 59 14 3 9 2 1 1 6 8 1 1 2 1 60 17 3 7 2 1 1 8 8 1 – 2 1 1 2 i 38 Table XXXII Houses, Public Health Act, 1936 6,654 Houses, Housing Act, 1936 98 Overcrowding 1,024 Disinfestation 365 War Damage 9 Vans and Sheds 6 Shops Acts 16 Food Shops 480 Fried Fish Shops 13 Cafes, etc 90 Factories (Mechanical) 63 Factories (Non-Mechanical) 13 Outworkers 2 Food Factories 337 Smoke 20 Bakehouses 15 Dairies 46 Water Sampling 23 Milk Sampling 89 Other Foods Sampling 52 Schools 29 Stables 15 Accumulations 26 Slaughterhouses 10 Rats and Mice 96 Building Material Permits 724 Petrol 52 Offensive Trades 7 Canal Boats 11 10,379 Table XXXIII Nuisances caused by the keeping of animals 11 Accumulation of refuse, etc. 28 Offensive smells 20 Vermin 118 Choked drains 214 Dampness 103 Defective roofs, gutters, etc. 263 Defective sanitary fittings 237 Rats and mice 3 Miscellaneous 201 Other defective conditions of houses 272 Overcrowding 176 Air-raid shelters 1 War-damaged houses 3 Smoke 18 Food 107 1,775 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) 1,543 (b) Number of inspections made for the purpose 6,752 (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 7 (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 735 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 618 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 322 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 343 (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 7 (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 96 (2) Number of families dwelling therein 161 (3) Number of persons dwelling therein 584 (b) Number of new cases of overcrowding reported during the year 104 (c) (1) Number of cases of overcrowding relieved during the year 64 (2) Number of persons concerned in such cases 460 (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 4i INDEX. Ambulance facilities 9 Ante-natal clinics 11,24,29,30 Antitoxin 15 Area of Borough 6 Assisted Services 14 Bedbugs 21 Birth Control II Births and birth rate 7, 25, 28 Canal boats 21 Cancer 16, 35 Causes of death 7, 26 Celluloid and Cinematograph Film Act 21 Child life protection 10 Clinics 8, 9, 10, 11, 24 Consultant aid 10 Deaths and death rates 7, 25 Dental treatment 15, 34 Diphtheria I7, 19 Diphtheria prevention clinic 17, 24 Disinfection 16 Food 22 Foster children 29 Health Services, General provision of 8 Health visiting 9,28 Houses—Number inhabited 6 Housing 21, 40 Infant mortality 7, 28 Infant welfare clinics 8, 11, 24, 29, 30 Inspection and Supervision of Food 22 Isolation Hospital 18, 19, 38 Laboratory facilities and work 8 Maternal morbidity and mortality 8, 27 Maternity and Child Welfare 12 Maternity and Child Welfare Committee 3 Maternity and Nursing Homes 14 Meat and other foods 22 Medical help 34 Midwives 13, 34 Milk supply 22 Milk grants 14 Mortuary 21 Moral Welfare 10 Notifiable diseases 15,36 Nursing in the Home 8 Ophthalmia neonatorum 17 Petroleum Acts 21 Physical feature of district 6 Poor Law medical relief 9 Population 6 Pre — school medical inspection 12, 31, 32, 33 Public Health Committee 3 Puerperal pyrexia 8 Rats and Mice22 Rateable value 6 Remedial exercises 13, 24 Sanitary circumstances 20 Sanitary inspection 21, 39 Scabies clinic 9, 24 Scarlet Fever 16, 18 Shops 21 Social conditions 6 Staff 5, 20 Statistics—General and Vital 6, 7, 25 Stillbirths 7, 25 Tuberculosis 8,37 Ultra-Violet Light clinic 10, 24 Unfit houses 40 Vaccination 16, 35 Venereal disease clinics, etc 18, 24 Verminous persons 9 Vital statistics 6, 7, 25,27 Voluntary help 13 Wartime nurseries 15 Water supply 20 42