???c439 (1) SOUTHALL SOUT 15 Middx BOROUGH OF SOUTHALL ANNUAL REPORT of the Medical Officer of Health for the Year 1947 MARGARET 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 1947 MARGARET A. GLASS, Medical Officer of Health THE COUNCIL OF THE BOROUGH OF SOUTHALL, 1947 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 W. H. HOPKINS, J.P. Deputy Mayor: *Councillor A. T. Dane, J.P. *Gardner, F. E. Neighbour, D. C. *Bray, W. D. cullingworth, F. A. *Douglas, H. C. Dormer, J. G. Jennings, F. H. *Lewis, J. F. Aldermen: Hamblin, E. B. *Smith, F. G. Councillors: Lawn, P. A. Love, P. J. *Lye, A. E. *Marks, F. J. (Chairman, Public Health Committee) *Robinson, G. T. Luckett, F. H. *Salmon, J. Shepherd, A. H. *Tooke, Mrs. M. M. *Ward, E. Ward, J. H. Co-opted for Maternity and Child Welfare Purposes only: Mrs. D. Bradley and Mrs. C. E. Harley To the Mayor, Aldermen and Councillors of the Borough of Southall. MR. MAYOR, LADIES AND GENTLEMEN, I have the honour to present the 51st Annual Report on the health and sanitary circumstances of the Borough for the year 1947. This is the last year in which the report is likely to be quite in the present form as, with the coming into force of the National Health Service Act, the Southall Borough Council will no longer be in control of the Maternity and Child Welfare Services in the Borough. These services will become part of, and be administered by, a larger area. The Borough's Isolation Hospital will become separated as a result of its transference to the Regional Hospital Board for administrative purposes. The health of the population continued to be good; the birth rate was 20.16; the death rate was 8.67, a decrease from 8 96 in 1946 and 9 26 in 1945. The infant mortality rate, which had been declining steadily for the previous eight years, showed a slight increase in 1947 to 388. There was a notable rise in the figures of attendances at clinics and treatment centres, attendances being particularly heavy at infant welfare clinics, especially at the Manor House. 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. 3 In the early part of 1947 there was a considerable number of measles notifications. The disease was of a little more severe type than in 1946 and several cases developed pneumonia, but there were no deaths. The Borough's Ambulance Service continued to provide free conveyance to Southall ratepayers during the year. The Cleansing Station continued to be available for the treatment of such cases as required it. Many cases of various skin conditions were treated, in addition to the normal cases of scabies and vermin infestation. The Day Nurseries continued to care for the children of women in employment, and the demand for these services was very heavy, the waiting list being greatly increased, so much so that during the year three more nurseries could have been filled had they been available. The Isolation Hospital continued to admit infectious disease cases, a noteworthy point in this connection being that only one confirmed case of diphtheria occurred in Southall during the whole of 1947. There can be no doubt that the Isolation Hospital figures, as presented to you during the years since immunisation against diphtheria commenced, seem to demonstrate that anti-diphtheria immunisation is the complete answer to the problem of the control of this disease. Although the number of children immunised against diphtheria in Southall is high it is not yet 100% and parents of young children who avoid having this simple and painless treatment provided are doing their children a very great dis-service. Work in the Sanitary Inspector's Department continued throughout the year with steady watch over the food and housing of the people, and patient investigation and eradication of nuisances. This seems to me a suitable time for a brief review of the Public Health work in Southall for the past 50 years to be made. In 1897 the population of Southall was approximately 8,000; in 50 years the little village has grown into a Borough with a population of 56,000. The birth rate that year was 32.1 per thousand, and in 1947 it was 20.16; the death rate was 11.3 per thousand, as compared with 8 67 in 1947. Deaths from infectious disease, other than tuberculosis, were .7 per thousand, and in 1947 they were .007. Infant mortality was at the rate of 1102 per thousand, and in 1947 it was 38 8. (In a population of approximately 8,000 there were 88 cases of diphtheria compared with our 1 case out of 56,000 in 1947.) It may here be noted that if the figures for the previous year, 1896, were taken, the infant mortality rate was 149.7 per thousand, and the death rate for infectious disease, other than tuberculosis, was 2 per thousand. An infant welfare centre was established at the Manor House in 1915, and a health visitor was appointed. During that year the infant mortality rate was 110.3, and it is noteworthy that there was a gradual but steady decrease in the infant mortality rate from that time onwards. The statistics shown in the following pages, when compared with the corresponding figures of the past 50 years, show that the standard of service for the care of the health and prevention of disease of its citizens given by Southall Borough Council in the past is not one to be decried, and it is to be hoped that the smoothly working services which will be transferred to other authorities will not suffer during the passage, but that the wealth of the larger authorities may be used for the benefit of your Borough's health. 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 willingly given. I am, your Worship, Ladies and Gentlemen, Your obedient servant, MARGARET A. GLASS, Manor House, Southall. Medical Officer of Health. 4 HEALTH DEPARTMENT STAFF for the year 1947 Medical Officer of Health: Ernest Grundy, M.D., B.S.(Lond.), M.R.C.S., L.R.C.P., D.P.H.(Eng.). Deputy Medical Officer: Margaret A. Glass, B.Sc., M.B., Ch.B., D.P.H. Assistant Medical Officer: E. M. Cumming, M.R.C.S., L.R.C.P., D.P.H. (Appointed 1.12.47.) 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. Sanitary Inspectors: H. Gatehouse, Cert. S.I.B., Cert. M. & F., M.S.I.A. (Resigned 28.2.47.) W. Bowles, Cert. S.I.B., Cert. M. & F., M.S.I.A. L. Pearson, Cert. S.I.B., Cert. M. & F. (Appointed 12.2.47.) E. G. Drayson, Cert. S.I.B., Cert. M. & F. (Appointed 1.8.47.) General Assistants: C. E. Knight. R. Stockley. (Returned from War Service, 7.7.47.) 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. (Resigned 20.12.47.) Miss F. Keynes, S.R.N., S.C.M., H.V., Cert. R.S.I. (Resigned 8.8.47.) 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. Miss F. Hyman, S.R.N., S.C.M., H.V. Cert. (Appointed 1.10.47.) 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. Miss J. Greenhill. Mrs. K. Jones. Mrs. E. Richards. Miss P. Mepham. Mrs. B. Pollard. (Resigned 22.11.47.) T. Buchanan. (Called up for H.M. Forces 2.7.47.) A. East. D. Champion. (Demobilised 13.10.47.) G. Eggleston. (Appointed 30.6.47.) 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 1947) 56,240 Number of inhabited houses according to Rate Book 14,133 Rateable value £429,228 Sum produced by a penny rate £1,700 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 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 108 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, 262 ; Females, 226.) Crude Death Rate, 8.67. For extracts from vital statistics and causes of death, see Appendix, Tables II and III. Deaths. The death rate, which fell in 1946, showed another decrease in 1947 to 8 67 as against 8.96 in 1946. The highest numbers of deaths were again caused by heart disease and cancer, as in the two previous years. 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 240 (males 132 and females 108). 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 130 and females 118). 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 146 (males 62 and females 84). 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 1946 are given in brackets). The total number of births notified to the Health Department under the Public Health Act, 1936, was 1,244 (1,229). The total number of registered births in the district (under the Births and Deaths Registration Act—included in the notified births above) was 471 (408). The total number of live births belonging to the district whether occurring within or outside the district was 1,108 (1,090). The illegitimate live births were 53 (56). There were 22 stillbirths (27), and these were legitimate, with two exceptions. There was very little alteration in the birth rate in 1947 when it was 20.16 as compared with 20.51 in 1946. The corresponding rate for the whole country was 20.5 so that the birth rate for Southall was very slightly lower than the rate for England and Wales. 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 1947 are to be found in Appendix, Table XI. Total Confinements (live births and still births), 1,130. No. born in Hillingdon County Hospital 435 or 38% No. born in nursing homes or other hospitals 306 or 28% No. confined in their homes by midwives or doctors 389 or 34% Infant Mortality. The total number of deaths under one year of age was 43. The rate per 1,000 live births was 38.8. The corresponding rate for England and Wales was 41, for London 37, and for the 148 small towns 36 per 1,000. The rate of 38.8 is only fairly satisfactory. There was an increase in the number of infant deaths in 1947, for the first time since 1938. The increase was from 33.9 in 1946, to 38.8 in 1947. It is agreed by most authorities that a rate of 25 infant deaths in 1,000 live births should be obtainable, and, as scientific knowledge progresses, it is hoped that this figure, to which we may aspire now, can be lowered still further. Certain causes of infant deaths, such as congenital malformations, are not sufficiently understood for them to be considered preventable at the present time, but deaths from prematurity, of which 7 there were 11 in Southall, are considered to be preventable, and every effort is made in the Public Health Service to eliminate prematurity as a cause of death. Persistent propaganda and ante-natal care has reduced deaths from prematurity, respiratory diseases and gastroenteritis, to a very low figure, compared to that of 20 years ago, but the fact that there are still a higher proportion of infants dying from these causes than from congenital defects means that the work of treatment and teaching of expectant and nursing mothers must continue and increase. Premature Infants. Seventy infants were born prematurely during the year, of whom 53 survived at the end of one month. For cases born prematurely equipment is available to be supplied to the homes, consisting of draught-proof cots, electric blankets, hot-water bottles, catheters, thermometers, etc. Arrangements have been made to obtain supplies of breast milk at short notice from the Queen Charlotte Hospital in cases where there is not sufficient mother's milk. Premature infants born in hospital are given every care in the way of warmth, special feeding, and protection from infection. Maternal Morbidity and Mortality. During the year 18 cases of puerperal pyrexia were notified, there was 1 maternal death but no deaths associated with abortion. Sixteen of the cases occurred in institutions. It will, therefore, be noted here that only two of these cases occurred in the midwives' districts. GENERAL PROVISION OF HEALTH SERVICES IN THE BOROUGH Nursing in the Home. General Nursing: The local District Nursing Association provided three nurses in the district for the home nursing of cases of ordinary sickness and accidents. During 1947 the total number of visits made by the nurses was 9,790. A certain number of these patients were referred to the Nursing Association from the Maternity and Child Welfare Clinics. The Council made a monetary grant towards the service generally, and a specific grant per visit to toddlers treated under the Maternity and Child Welfare Scheme. 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 afforded facilities to all medical men practising in the district for the examination of pathological specimens. This work was 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 2 213 Sputa for tubercle 19 6 Faeces 2 16 Other 12 81 35 316 8 Scabies Clinic. The total number of attendances at the Clinic for treatment of scabies and other skin conditions during 1947 was 1,767. Details of the cases were as follows:— Scabies First Visits 198, Re-attendances 291, Total 489 Other skin conditions „ „ 164 „ 586 „ 750 Verminous heads „ „ 327 „ 201 „ 528 Baths 222 Attendances at the Cleansing Station decreased during 1947. The total number— 1,989—compares with a total number of 3,978 in 1946. The drop in the number of persons treated for scabies or vermin infestation was extremely satisfactory, and is to be considered a genuine improvement in the incidence of these cases, as there were continuous inspections of school children in the schools at least once every term, and sometimes twice during the same term, which gives a fairly good check on adult infestation, as cases found to be affected are followed up and adult contacts persuaded to attend for cleansing. Ambulance Service. During 1947 the ambulance vehicles were stationed at Salisbury Road Civil Defence Depot, and were manned by specially appointed driver-attendants. This service was provided free by the Southall Borough Council, and was very much appreciated by the general public. During the two years that this free service was provided, the number of cases moved increased steadily. In 1947 the total number of cases removed was 5,800 compared with 5,470 in 1946. All users of the civil ambulance service were 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 4,300 Accidents 483 Other removals 860 Mutual assistance provided for other Local Authorities 157 Total 5,800 Miles travelled in the period 43,383 Poor Law Medical Relief. The Relieving Officer issued 423 Medical Orders during 1947. Some of these cases also received outdoor relief or institutional treatment. MATERNITY AND CHILD WELFARE Health Visiting. During 1947 the Southall Borough Council provided the services of eight health visitors for the purpose of home visiting and clinic attendance. The Borough was divided into eight districts, and each health visitor was responsible for one of these areas, with the duty of visiting and advising expectant mothers, mothers of young children, and studying the welfare of infants and school children. As far as possible, each visitor was allocated clinics to which the mothers and children of her own district attended so that definite contact could be kept. The schools in Southall were also divided up amongst the health visitors so that, as far as possible, each health visitor would have direct contact with the teachers of the school children of her own area. The work also included the following up of infectious diseases in her area ; the following up of defaulters from Dental and Ophthalmic Clinics, 9 and from the Cleansing Station, and she also had certain duties in connection with Special Clinics, such as the Artificial Sunlight or Anti-Diphtheria immunisation sessions. The Senior Health Visitor was responsible for child life protection, including the visiting of foster children and children to be adopted, and one health visitor had special duties in connection with moral welfare. To carry out these duties satisfactorily, it seems that at least one health visitor to a population of 5,000 is desirable. The amount of time each health visitor can give to her home visiting is limited if the number of clinics increase, or if the clinic attendances are so heavy that more health visitors are required per session, and it will be noted from Table XII that the total attendances at infant clinics during 1947 increased by 1,472 over the number in 1946. There was a corresponding increase in the number attending the School Minor Ailments Clinics which the health visitors attended as part of their duties, and there is no doubt that the employment of at least one further health visitor would be of advantage to the Borough. When the proposed new clinic is built, the number of clinic sessions there will probably justify the employment of yet another health visitor, which would still keep the total number of health visitors below what appears to be the desirable number for a borough of this size. The increase in the number of attendances at the various clinics (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. Child Life Protection. The Senior Health Visitor was specially appointed to deal with child life protection work. This work continued during 1947 and consisted 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 was required to report on and to keep under observation all persons who wished to adopt children, and children who were 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 was the duty of one member of the health visiting staff, who was designated Moral Welfare Officer, to deal with all cases of unmarried expectant mothers referred from all districts in Southall, and she endeavoured 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, 9 cases were dealt with under this scheme. The Moral Welfare Officer also assisted with the various social problems arising from cases of this nature, and every assistance possible was given to unmarried mothers who were willing to continue to look after their own children. There was a slight reduction in the number of illegitimate live births during 1947. The number was 53 as compared to 56 in 1946, and in 1947 the proportion of illegitimate live births to legitimate was 53 to 1055, i.e., 5.2%. 10 Ultra-violet Light Clinics. Four sessions per week for treatment of ultra-violet light were held during 1947—two for expectant mothers and children under five years of age attending the Manor House Clinics, and two for those attending the Branch Centre Clinic. Ultra-violet light treatment is especially necessary for young children showing early traces of rickets infection, as the amount of natural sunlight during winter months is so limited. All patients are weighed at the commencement and finishing of a course of treatment, and the majority show a distinct gain in weight, improvement in appetite and general tone. It is difficult to obtain the attendance of expectant mothers to this clinic, but special efforts will be made to bring the usefulness of this treatment to the notice of suitable cases and to emphasise the value of it both to themselves and to their expected children. Table C Number of sessions held: 115. Number of attendances:— First Visits Re-visits Mothers 1 2 Infants 158 1,596 Post-Natal and Birth Control Clinic. Table D Number of sessions held: 24. Number of attendances:— Post-Natal Birth Control First Visits 96 81 Re-attendances 106 72 Ante-Natal Clinics. The number of new patients seen at the Ante-natal Clinics during the year was 812, and the total number of attendances was 4,704 (2,898 at the Manor House and 1,806 at the Branch Centre). 786 cases were completed during the year, and the attendances in respect of these were as follows:— No. of Cases One attendance 65 Two attendances 52 Three attendances 48 Four attendances 83 Five attendances 95 Six or more attendances 443 For table of comparison of figures for last eight years, and the proportion of new cases to re-visits, see Appendix, Table X. Although there is a slight drop in the figure for attendance at the Ante-natal Clinic, i.e., 4,704 in 1947 as compared with 4,861 in 1946, this figure means that individual sessions averaged 20 5 attendances and were very often overcrowded with an attendance of 25 to 30. Further ante-natal clinic provision remains an urgent need. Table E.I Completed cases 786 Uncompleted cases 195 Non-pregnant 16 Removals from district 59 11 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 243 413 78 206 164 206 Abnormal cases 75 57 7 10 68 47 Of the cases dealt with, therefore, 40 per cent, were primiparae (against 44 per cent, in 1946), and of these 73 per cent, (against 72 per cent, in 1946) were confined in hospital, while 55 per cent, (which was the same percentage as in 1946) of the multiparae were also confined in hospital. Table XI in Appendix gives the chief abnormalities found during the year. Child Welfare Clinics. The attendances at the Child Welfare Clinics during 1947 are shown in Table XII in Appendix. The total number of attendances at the Infant Welfare and Toddlers' Clinics during 1947 was 15,453, as compared with 13,897 for 1946. It will be noted that the attendance at the Infants' and Toddlers' Clinics during 1947 increased by 1,472. Approximately 80 per cent, of all infants born in Southall in 1947 were brought for consultation at least once. Children attending Day Nurseries are medically examined at least once every month at the nursery and so were not required to attend clinics. The large figure of attendance shown here means that many infant sessions at the Manor House were extremely overcrowded, the numbers rising to as many as 110 in one afternoon session. It is impossible in these circumstances for all healthy children to be seen as frequently as would be desirable and the need for further infant welfare sessions becomes more and more urgent each year. With the numbers as heavy as these there is also bound to be a good deal of waiting to be done by the mothers attending, and it is to their credit that, in spite of these difficulties, the attendances for advice and treatment continue to be so good. Pre-School Medical Inspection (Toddlers' Clinics). Toddlers' Clinics are held fortnightly at each centre. The total attendances at these clinics were 642, 369 at the Manor House, and 273 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 was, on the whole, satisfactory. No infants were found to be in the classification D (bad), and nine only in classification C (slightly sub-normal). The defects found were mostly of a minor character and the total number of children found to be suffering from minor defects was much lower than in 1946. There were fewer children found during 1947 with defective tonsils and adenoids. The number of toddlers found to have some degree of dental decay was not reduced but formed a reasonably low percentage of the total number of children inspected. Children found at these Toddlers' Clinics with bone defects or adenoids were referred for treatment to the Remedial Exercises Clinic, and, in many cases, excellent results were obtained. The difficulty reported in 1946 of obtaining treatment for children requiring removal of tonsils increased during 1947, and it is quite usual in cases which are not considered to be emergencies to have to wait from 2 to 2½ years for operation. Efforts were made to improve the situation by referring cases for treatment to both the Hillingdon County Hospital and the King Edward Hospital, Ealing. 12 Treatment. Cases of acute illness, and of chronic illness, where indicated, were referred to their own doctors for treatment. For certain illness the following arrangements were in operation with London and local hospitals:— Defect Hospital Tonsils and adenoids Hillingdon County Hospital and King Edward Hospital, Ealing. 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. In cases where defects were discovered the health visitors kept families under observation, making enquiries to see if the treatment recommended was accepted and if it had not been obtained to help the parents, or, in some cases, to persuade them to seek a remedy for the defect. Voluntary Workers. The work done by members of the Voluntary Workers' Association at the various clinics was of great assistance to the Health Department staff and the fact that these ladies were always willing to give so generously of their time and energies has been most warmly appreciated, and it is to be hoped that their valuable services will be obtainable and even expanded under the new regime. Remedial Exercises. Two afternoon sessions of special Margaret Morris movement exercises were held each week at the Branch Health Centre, part of each session being devoted to remedial exercises for children and the other part for exercises for expectant and nursing 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 24 10 Re-attendances 208 29 Health Propaganda. At clinics, in the homes, in the nurseries, in the hospital, and in the schools there was a continual and persistent education in health matters in progress; children learnt the reasons for being clean, for having correct diet, and how to prevent disease, and parents were advised about these things and in more detail the dangers of dirty homes, unsound and badly-cooked food, housefly and vermin infestation, the importance of sleep and a regular life for young children, and so on. Health posters supplied by the Ministry of Food, Central Council for Health Education and other educative bodies were displayed on the Council's posterboards and in clinics and libraries. Mothercraft sessions were held at both clinics where mothers were 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 received a greeting card with a reminder that anti-diphtheria immunisation should now be undertaken, was continued during 1947. 13 Midwives. Arrangements in the Council's Domiciliary Midwifery Service remained unchanged and leaflets were issued describing the services provided. These were available at the Manor House and the Branch Health Centre. Midwives attended regularly at the Ante-natal clinics, where, in consultation with the doctor, any anticipated difficulties can be discussed. The year's total of midwives' bookings for 1947 was slightly increased to 331, as compared with 316 in 1946. Mothers were encouraged to arrange for home confinements in normal cases as, with the heavy attendances at the Hillingdon County Hospital, the length of stay of normal cases had to be reduced, and mothers returned home a few days after their confinements to finish their immediate post-natal period in their own homes. But the social circumstances in very many cases made it impossible even for normal cases to have their babies at home because there was not accommodation or facilities in the houses for the undertaking of safe delivery of the mothers. (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 4 10 10 7 3 34 February 3 8 7 6 3 27 March 5 9 8 9 5 36 April 7 3 3 6 5 24 May 9 8 6 5 7 35 June 5 5 4 9 7 30 July 3 5 7 5 1 21 August 4 8 10 5 4 31 September 4 3 6 8 5 26 October 3 6 6 5 5 25 November 3 6 5 5 2 21 December 3 5 5 5 3 21 Totals 53 76 77 75 50 331 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 1947 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 14 Grants of Milk. Under the Ministry of Food scheme, expectant mothers, nursing mothers, and children under five years of age were supplied with dried milk or liquid milk, free or at 2d. a pint, according to income. Babies requiring special feeding, i.e., Cow & Gate, or Ostermilk instead of National Dried Milk, were supplied through the Council's clinics. National Cod Liver Oil, Orange Juice and Vitamin Tablets were also supplied under the Ministry of Food scheme, and were obtained at the clinics during the usual clinic session hours. There were eight 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 1947 — — 6 2 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 were enabled to have dental treatment and advice, including, if necessary, the provision of dentures. The number of attendances—1,075—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 for 1945.) Day Nurseries. The three Day Nurseries continued to care for the children of working mothers and certain mothers in distressed home circumstances. The number of children on the waiting list for places in these nurseries increased very rapidly during 1947, and by the end of the year amounted to about 150. The Day Nurseries were very much appreciated by the mothers of children who were admitted, as the benefits of a day nursery stay were plain to see in both physical and mental outlook of the children. School teachers have reported that children from day nurseries, entering school for the first time, are usually better behaved and frequently of more educational knowledge than children going from their own homes direct. The opportunity for training young girls in the care and management of children and the further opportunity of training them in their responsibilities as future mothers of young children are very valuable social assets. During the year three members of the Day Nurseries' staff obtained the diploma of the National Society of Children's Nurseries. 15 PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES During 1947 there was a considerable rise in the incidence of measles. 334 cases were notified during the year. Measles is a characteristic complaint which occurs in bi-annual waves, and 1947 was the year when a larger number of notifications were likely to occur. In 1946 there were only 21 notifications of measles. The type of case was, on the whole, mild and no deaths were reported as being due to measles or any complication of measles. The number of cases of diphtheria notified was nine and of these only one was confirmed as being clinical diphtheria, this compares to 14 in 1946. There were no deaths and no complications. A considerable number of cases of dysentery occurred in St. Bernard's Hospital. . This is a disease to which patients with mental disease are particularly prone, but the epidemic in hospital was soon got under control and there was no spread outside the hospital. In 1947 there was a considerable epidemic of poliomyelitis in England. Southall was fortunate in having only three notifications with only one case of paralysis and no deaths. Provision of Antitoxin. The Council provided 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 were obtainable 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 21 people were supplied during 1947, either free or at part cost. Vaccination. The total number of successful vaccination certificates received during the year was 498, and the number of certificates of exemption issued was 520. Table XXII in Appendix gives details of the percentage of children successfully vaccinated during the last 11 years. There was an improvement during 1947 in the number of children who were successfully vaccinated. 45 per cent, of infants under one year of age were vaccinated, as compared with 24 per cent, for 1946. Propaganda for vaccination against smallpox was continued by the doctors and nursing staff. Disinfection. In cases of infectious disease, rooms, clothing, etc., were disinfected—rooms by sealing and fumigating with formalin or a formalin preparation; clothing, bedding, etc., and infected articles which could 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 102 Covers 52 Beds 196 Eiderdowns 21 Blankets 310 Pillows 263 Bolsters 70 Sheets 154 Books 49 Miscellaneous 29 Scabies Clinic: Bags of clothing 91 Total 1.337 The following articles were destroyed: 8 mattresses, 1 bolster, 1 pillow and 29 articles of clothing. 16 Cancer. It will be seen by the table of causes of death (page 28) that in 1947 83 cases (45 males and 38 females) died from cancer. (See Appendix, Tables XXIII and XXIV.) 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 1947, but 3 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 89, as compared with 67 for the previous year. Of these, 88 were removed to the Isolation Hospital. Diphtheria. Nine cases of diphtheria were notified to the Health Department and admitted to the Isolation Hospital during 1947. Of these, eight were not confirmed as diphtheria and therefore there was only one confirmed case. The other type of the case was naso-pharyngeal and there was temporary palatal paralysis which resolved during hospital stay and the case was discharged cured. Diphtheria Prevention. The total number of attendances at the Diphtheria Immunisation Clinic during 1947 were 2,246 but a number of the children who attended the Clinic came for one injection only, a booster dose to re-enforce previous immunisation. The number of children for the booster dose has steadily increased as the result of persistent propaganda by word of mouth by the doctors and health visitors, and by posters displayed at the clinics. The number of children receiving a complete course of injections during the year was 730. Diphtheria immunisation was 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 2,246 Average attendance per session 24 Highest attendance at a session 81 Lowest attendance at a session 3 During 1947 the number of new cases was 764 Numbers attending for reinforcing single injections 208 Ophthalmia Neonatorum. Four cases of ophthalmia neonatorum were notified in 1947 and all recovered during the year. 17 Acute Poliomyelitis. Three cases were notified in the Borough during the year. During 1947 there was a considerable outbreak of poliomyelitis throughout the county and a fairly high number of cases of the disease were in neighbouring boroughs, but Southall was fortunate in this year in having only three notifications. One of these cases developed a considerable degree of paralysis which was treated at Stanmore Orthopaedic Hospital. There were no deaths from this disease. 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 458 visits with reference to cases of infectious disease. 57 swabs were taken. The total number of children examined by the health visitors in the schools was 705. Uncleanliness and Verminous Conditions in School Children. Number of children on roll at 31st December, 1947 7,500 Total number of examinations of children in the schools by the school nurses 29,736 Number of individual children found unclean 785 Number of children cleansed under arrangements made by the Local Education Authority 451 The number of school children inspected for cleanliness was higher in 1947 by about 3,000 than in the previous year, and it is very satisfactory to know that the number of children found to require cleansing was 370 less than in 1946. 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 93. Other Forms of Tuberculosis. The number of new cases notified during the year was 12. Of the total notifications 46 were notified from institutions (sanatoria 4, County Council hospitals 24, general hospitals 18). Deaths from Tuberculosis. Tuberculosis of the respiratory system, 27; other forms, 3. For details of new cases notified and deaths in 1947, see Appendix, Table XXVIII, and the occupation of new cases, see Appendix, Table XXIX. 18 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. Irradiation Experiment. In January, 1947, an experiment on the control of the spread of infectious diseases amongst school children by means of irradiation of the upper air in classrooms and school halls was commenced. This experiment was to be carried out by the Medical Research Council with the authority of the Ministry of Health and with the co-operation of the Statistical Department of the School of Tropical Hygiene and the Middlesex County Council Education Department. Southall was chosen for this experiment because it was a compact urban area, fairly well separated from surrounding districts by canals and railway lines and had pairs of schools suitable for the carrying out of the experiment. It will not be possible in this report to give any results of the experiment as the Medical Research Council and the Statistical Department of the School of Tropical Hygiene wish to have a picture of the experiment over a considerable period before offering an opinion as to whether the air treatment is or is not of value. Similar experiments have been carried out in America and the results found there will be compared with the findings shown by the Southall experiment. REPORT ON THE BOROUGH ISOLATION HOSPITAL During the year 140 patients were admitted to the Isolation Hospital, as compared with 109 in 1946. Of these 96 were sent in as scarlet fever (16 being from Ealing District), 10 as diphtheria (1 from the R.A.F. Station, West Drayton), 15 as measles, 6 as whooping cough and pneumonia, and 13 as other diseases. Of the cases sent in as scarlatina 8 were unconfirmed and diagnosed as suffering from other diseases. Similarly of the cases sent in as diphtheria 9 were unconfirmed. (Tables No. XXX and XXXI show the figures for the year and for each month, respectively.) Scarlatina. Of the 96 cases notified as scarlatina, 88 were finally diagnosed, and the following table shows the incidence in age groups of the 88 cases which were nursed in the hospital:— Table K Age (years) 0-5 5-15 15-25 25-35 35 + Number 22 57 7 1 1 There was one return case. Anti-scarlet fever serum was administered to all patients. Complications of the cases of scarlatina were:— Septic finger 1 Cardiac irregularity, etc. 2 Myocarditis 1 Otitis Media 7 Adenitis 5 Rhinorrhea 3 19 Diphtheria. Ten cases notified as diphtheria were admitted to the hospital. Only one of these was confirmed as naso-pharyngeal diphtheria. The following table shows the incidence of the cases in age groups:— Table L Age (years) 0-5 5-15 15-25 25-35 35 + Number — 1 — — — Enteric. Two cases were admitted as query typhoid, one was finally diagnosed as acute urticaria complicated with synovitis and the other was diagnosed as enteritis (non-specific). Other Diseases. Eight cases admitted as scarlatina were subsequently diagnosed as suffering from other diseases. These were as follows:— Toxic Erythema 1 Urticaria 1 Measles 2 Tonsillitis 2 Thrush Tonsillitis 1 Rubella 1 Diseases Notified as Diphtheria. Vincent's Angina 3 Tonsillitis 5 Strepto-coccal Pharyngitis 1 Stay in Hospital. The average stay in hospital was as follows:— Total Average Scarlatina: All cases (88) 2,678 days 30.4 days Patients remaining over 56 days (1) 59 „ Patients remaining under 56 days (87) 2,619 „ 30.1 „ Note : Carried forward from 1946: 5 76 „ Remaining on 31.12.47: 12 146 „ Diphtheria : All cases (1) 60 „ Carried forward from 1946: 1 54 „ Remaining on 31.12.47: None — Whooping Cough and Pneumonia: All cases (6) 187 „ 31.1 „ All under 56 days. Measles and Pneumonia: All cases (17) 392 „ 23 „ Remaining over 56 days (1) 68 „ Remaining under 56 days (16) 324 „ 21.7 „ Other diseases : All cases (26) 361 „ 13.8 „ 20 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 2 Total number of days off duty 207 59 Casual conditions:— Appendicitis (not confirmed) 22 days - Chill — 59 days Pyelitis 90 — Influenza 44 — Operation 51 — 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 & 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. 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 7,534. Table XXXII shows an analysis of the number and nature of such inspections. Eradication of Bed Bugs. Table N Statistics for the year:— (a) Number of Council houses (1) found to be infested 7 Total: 25 (2) disinfested during the year 7 (b) Number of other houses (1) found to be infested 18 (2) disinfested during the year 18 Canal Boats. Visits were paid to the canal and seven 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. Nine bodies were deposited in the mortuary during the year. 21 Factories Act, 1937. The following tables give details of the work done in connection with the mechanical and non-mechanical factories and outworkers in the Borough:— Inspections Premises Number on Register Number of Inspections Written Notices Occupiers Prosecuted Non-Mechanical 11 23 Nil Nil Mechanical 185 62 14 Nil Totals ... 196 85 14 Nil Defects Found Particulars Number of cases in which defects were found Found Remedied Referred Number of cases in which Prosecutions were instituted To H.M. Inspector By H.M. Inspector Want of cleanliness — — — — — Overcrowding — — — — — Unreasonable temperature — — — — — Inadequate ventilation — — — — — Ineffective drainage of floors — — — — — Sanitary Conveniences— (a) Insufficient 2 2 — 2 — (b) Unsuitable or defective 13 13 — 13 — (c) Not separate for sexes — — — — — Other offences against the Act (not including offences relating to outwork) — — — — — Totals 15 15 — 15 — Outworkers Nature of Work Section 110 Section 111 No. of outworkers in August List required by Section 110 (1) (c) No. of Cases of Default in sending Lists to the Council No. of Prosecutions for failure to supply Lists No. of Instances of Work in Unwholesome Premises Notices served Prosecutions Wearing apparel, making, etc. 8 — — — — — Totals 8 — — — — — 22 Petroleum and Carbide. During the year 57 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 two licences in force for the purpose of stripping and making celluloid solution from cinematograph films. Housing. Two hundred and forty-three investigations revealed 73 cases of overcrowding (Housing Act, 1936). Other cases of overcrowding were given individual attention and special recommendations for medical reasons. Work became continuous on overcrowding reviews. For statistics see Table XXXIII in the Appendix. Administration of the Shops Acts. The full-scale execution of the duties under these Acts is delayed by staff shortages. That so much remedial work was done is due to the ready co-operation of local shopkeepers. INSPECTION AND SUPERVISION OF FOOD Milk. Licences. The following licences under the Milk (Special Designations) Order, 1936, were granted during 1947:— for the sale of Tuberculin Tested 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 4 Total 29 Sampling. One hundred and eight samples of milk, designated and undesignated, were sent during the year for bacterial count. The examinations are carried out at the Public Health Emergency Laboratory. Food Sampling. The chemical or bacteriological analyses of 135 food samples taken during the year were carried out by the Public Health Emergency Laboratory. The Food and Drugs (Adulteration) Act is administered by the County Council. The figures for 1947 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. 23 FOOD INSPECTIONS Table 0 Details : Total Inspected (lbs.) SOUND UNSOUND Total (lbs.) Stock (lbs.) Production (lbs.) Consumption (lbs.) Total (lbs.) Animal Feeding (lbs.) ByeProducts (lbs.) Destruction (lbs.) Canned 112,378 15,416 702 14,614 100 96,962 44,084 2,308 50,570 Raw 42,976 23,996 — 1,840 22,156 18,980 1,066 2,392 15,522 Totals 155,354 39,412 702 16,454 22,256 115,942 45,150 4,700 66,092 RATS AND MICE (DESTRUCTION) ACT, 1919 Infestation Order, 1943 Maintenance checks on sewers were carried out during the year. Factories employ their own rodent operators. Individual infestations were checked by the District Sanitary Inspectors. Work continued in progress on surface infestations. 24 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. Post-Natal and Birth Control Clinic Manor House Medical Supervision 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 26 EXTRACTS FROM VITAL STATISTICS Table II Total Male Female Comparative figures for 1946 Live Births—Legitimate 1,055 548 507 1034 Illegitimate 53 30 23 56 Stillbirths—Legitimate 20 15 5 27 Illegitimate 2 — 2 Deaths 488 262 226 488 Birth rate (live and stillbirths) per 1,000 of estimated population 20.09 20.51 Stillbirth rate per 1,000 total (live and still) births 19.46 24.18 Crude death rate per 1,000 of the estimated population 8.67 8.96 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 1 0.88 0.00 No. 30. Other puerperal causes — — Total 1 0.88 Death rate of infants under 1 year of age :— All infants per 1,000 live births 3883 33.94 Legitimate infants per 1,000 legitimate live births 38.86 30.94 Illegitimate infants per 1,000 illegitimate live births 37.73 88.30 Deaths from cancer (all ages) 83 94 Deaths from measles (all ages) — — Deaths from whooping cough (all ages) — 4 Deaths from diarrhoea, etc. (under 2 years of age) 5 3 27 Causes of Deaths, 1947. Table III Male Female Total 1947 Total 1946 1. Typhoid fever, etc. — — — 1 2. Cerebro-spinal fever — — — 1 3. Scarlet fever — — — — 4. Whooping cough — — — 4 5. Diphtheria — — — — 6. Tuberculosis—Respiratory 17 10 27 24 7. Other tuberculosis 2 1 3 3 8. Syphilitic diseases 2 — 2 4 9. Influenza 1 3 4 4 10. Measles — — — 11. Ac. poliomyelitis and polioencephalitis — — — — 12. Ac. inf. encephalitis 1 — 1 — 13/16. Cancer (all forms) 45 38 83 94 17. Diabetes — 1 1 7 18. Intra-cran. vase, lesions 14 24 38 35 19. Heart disease 72 54 126 111 20. Other circulatory diseases 7 11 18 35 21. Bronchitis 23 13 36 30 22. Pneumonia (all forms) 17 10 27 17 23. Other respiratory diseases 7 1 8 4 24. Ulcer of stomach or duodenum 3 2 5 6 25. Diarrhoea, etc. (under 2 years) – 5 5 3 26. Appendicitis 1 – 1 3 27. Other digestive diseases 5 5 10 13 28. Nephritis 6 3 9 8 29. Puerperal sepsis — 1 1 — 30. Other maternal causes — – — — 31. Premature birth 6 5 11 8 32. Congenital malformations, etc. 9 9 18 16 33. Suicide 4 2 6 4 34. Road traffic accidents 5 1 6 2 35. Other violence 6 11 17 15 36. All other causes 9 16 25 36 Total Deaths 262 226 488 488 Deaths in Wards. Table IV Ward Male Female Total Waxlow Manor 35 . 34 69 Northcote 30 23 53 Hambrough 46 40 86 Dormers Wells 36 33 69 Glebe 76 47 123 Norwood Green 39 49 88 Total 262 226 488 28 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 1947. (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 20.50 23.30 22.20 22.70 20.16 Still 0.50 0.62 0.54 0.49 0.39 Deaths :— All Causes 12.00 13.00 11.90 12.80 8.67 Typhoid & Paratyphoid fevers 0.00 0.00 0.00 0.00 0.00 Smallpox — — — — — Measles 0.01 0.02 0.02 0.01 0.00 Scarlet fever 0.00 0.00 0.00 0.00 0.00 Whooping cough 0.02 0.03 0.02 0.02 0.00 Diphtheria 0.01 0.01 0.01 0.01 0.00 Influenza 0.09 0.09 0.08 0.08 0.07 Notifications :— Smallpox 0.00 0.00 0.01 0.00 — Scarlet fever 1.37 1.54 1-37 1.31 1.58 Diphtheria 0.13 0.15 0.14 0.14 0.14 Typhoid fever 0.01 0.01 0.00 0.01 0.00 Erysipelas 0.19 0.21 0.18 0.22 0.16 Pneumonia 0.79 0.89 0.68 0.64 0.97 Measles 9.41 9.13 9.58 5.29 5.93 Cerebro-spinal fever 0.05 0.06 0.05 0.05 0.24 Whooping cough 2.22 2.41 2.02 2.80 1.28 Paratyphoid fever 0.01 0.01 0.01 0.01 0.00 Rates per 1,000 Live Births Deaths under 1 year of age 41 47 36 37 33 Deaths from Diarrhoea and Enteritis under 2 years of age 5.8 8.0 3.7 4.8 4.51 Rates per 1,000 Total Births (i.e.Live and Still Notifications :— Puerperal fever 716 899 6.27 1.21 15.9 Puerperal pyrexia *6.94 MATERNAL MORTALITY (England and Wales). Per 1,000 Live and Stillbirths. Abortion with Sepsis Abortion without Sepsis Puerperal Infections Other 0.10 0.06 0.16 0.85 Abortion—Mortality per Million Women aged 15-45 (England and Wales). With Sepsis Without Sepsis 9 5 •Including Puerperal Fever 29 Monthly Registration of Births. The monthly registration of births classified as to Wards is given in the following table. Table VI Waxlow Manor Northcote Hambrough Dormers Wells Glebe Norwood Green Total January 4 3 6 8 4 5 30 February 8 8 7 5 8 7 43 March 11 3 7 8 12 3 44 April 7 7 4 7 9 8 42 May 6 9 3 4 6 8 36 June 6 5 9 8 9 6 43 July 6 3 7 6 10 4 36 August 3 5 5 10 5 8 36 September 10 2 7 8 10 9 46 October 4 4 8 7 8 4 35 November 4 3 9 7 9 5 37 December 5 3 13 8 9 5 43 74 55 85 86 99 72 471 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. 5 3 1 - 9 1 1 1 - 12 Congenital Malformations, etc. 8 2 - - 10 2 - - 1 13 Gastro-enteritis, Diarrhoea, etc. - - - - - 2 3 1 - 6 Prematurity 8 3 - - 11 - - - - 11 Murder 1 - - - i - - - - 1 22 8 1 - 31 5 4 2 1 43 Live Births. Legitimate 1,055 Infant Deaths. Legitimate 41 Illegitimate 53 Illegitimate 2 Table VIII Summary of Health Visiting Work for the Year 1947 Visits to infants— First visits 1,081 Re-visits 3,560 Visits to children— First visits 115 Re-visits 4,425 Visits to expectant mothers 1,315 Visits for infectious disease 409 Visits to schools 49* Child Life Protection visits 140 Miscellaneous visits 812 Removals 245 No access 2,017 Re adoptions 63 Total 14,231 At these visits, 705 children were examined. 30 Table IX (1) Number of foster parents on register— (a) At the beginning of the year 20 (b) At the end of the year 14 (2) Number of foster parents receiving foster children— (a) At the beginning of the year 20 (b) At the end of the year 12 (3) Number of children on the register— (a) At the beginning of the year 16 (b) At the end of the year 15 (4) Number of children received by foster parents during the year 15 (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 3 (d) Returned to parents 13 (e) Removed at request of the Medical Officer of Health 0 (f) Evacuated with foster mother 1 (g) Died during the year 0 {h) On whom inquests were held 0 (6) Total number of visits made during the year 139 (7) Number of cases in which court proceedings were taken 0 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 (b) Total number of children in respect of whom notice was given under Sec. 7 (3) during the year 5 (c) (1) Number of children under supervision at end of year 15 (2) Number who died 0 (3) Number on whom inquests held 0 (d) Proceedings taken during year 0 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) 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 1947 819 3885 5.79 1130 71.80 Of the 4,704 total attendances, 2,898 occurred at the Manor House Centre and 1,806 at the Branch Centre. 31 Table XI Ante-Natal and Post-Natal—Abnormalities Found (a) Abnormalities of the foetus— (i) twins 5 (ii) abortions 13 (iii) stillbirths 4 (iv) congenital deformities 4 (v) faulty presentation 14 (vi) prematurity 20 (vii) other conditions 12 (b) Abnormalities of the mother— (i) unsatisfactory measurements 19 (ii) post partum haemorrhage 7 (iii) ante partum haemorrhage 3 (iv) high blood pressure (exceeding 140 systolic or 90 diastolic other than on the first attendance) 31 (v) disproportion or displacement of foetus 47 (vi) toxaemia 25 (vii) other conditions 19 Neo-Natal Deaths (before the seventh day) (included in above) 10 Table XII Attendances at Infant Clinics Manor House— Seen by Medical Officer : Infants 1,923 Children at ordinary clinics 392 Children at toddlers' clinics 369 Weighing only : Infants 4,493 Children 320 New cases (included in above): Infants 440 Children 28 Branch Centre— Seen by Medical Officer : Infants 3,238 Children at ordinary clinics 685 Children at toddlers' clinics 273 Weighing only : Infants 3,344 Children 388 New cases (included in above) : Infants 463 Children 37 Total attendances 15,425 The total attendances at the clinics during the past six years have been as follows :— 1942 13,346 1945 14,070 1943 12,852 1946 13,953 1944 11,013 1947 15,425 32 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) 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 1947 903 1108 81 * 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 61 38 99 2 years 80 84 164 3 years 73 70 143 4 years 57 69 126 Total Routine 271 261 532 Other inspections 98 12 110 Total 369 273 642 Table XV Number of Individual Children found at Routine Medical Inspection to require Treatment (excluding Dental Disease) : Manor House Branch Centre Total 18 months 10 3 13 2 years 15 11 26 3 years 15 17 32 4 years 17 16 33 Total 57 47 104 33 Table XVI Number requiring Dental Treatment : Manor House Branch Centre Total 18 months – – – 2 years 3 2 5 3 years 4 5 9 4 years 12 12 24 Total 19 19 38 Table XVII Nutrition Manor House Branch Centre Total A B C D A 9 2 11 87 1 — 18 months B 52 35 C — 1 D — — A 7 3 10 150 4 — 2 years B 72 78 C 1 3 D — — A 9 — 9 130 4 — 3 years B 63 67 C 1 3 D — — A 6 1 7 119 — — 4 years B 51 68 C — — D — — Total 271 261 37 486 9 — 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. 34 Table XVIII shows the individual defects found at medical inspection. It must be remembered that one child may show several defects, and that all defects, however slight, are recorded. Table XVIII Defects Found Manor House Branch Centre Total Skin i. Ringworm - - - 2. Scabies 2 - 2 3. Impetigo - - - 4. Other diseases (non-tubercular) 2 - 2 Total 1-4 4 - 4 Eye 5. Blepharitis - - - 6. Conjunctivitis - - - 7. Keratitis and opacities - - - 8. Other conditions (excl. defective vision and squint) - 1 1 Total 5-8 - 1 I 9. Defective vision - 1 1 10. Squint 1 1 2 Ear 11. Defective hearing - - - 12. Otitis media - 2 2 13. Other ear diseases - 3 3 Nose and Throat 14. Chronic tonsils and/or adenoids 26 5 31 15. Other conditions 3 - 3 16. Enlarged cervical glands (non-tubercular) 1 - 1 17. Defective speech - - - Heart and Circulation 18. Organic heart disease - 2 2 19. Functional heart disease - - - 20. Anaemia - 1 1 Lungs 21. Bronchitis - 1 1 22. Other non-tubercular diseases - - - 23. Pulmonary tuberculosis - - - Tuberculosis 24. Glands - - - 25. Bones and joints - - - Nervous system 26. Chorea - - - 27. Other conditions - - - Deformities 28. Rickets - 3 3 29. Genu valgum 18 months 1 1 2 2 years 5 3 8 3 years 5 3 8 4 years 4 4 8 30. Other forms 2 2 31. Other defects and diseases 11 16 27 32. Dental diseases 18 months - - - 2 years 3 3 6 3 years 4 5 9 4 years 12 11 23 35 Table XIX Notification from Midwives Laying-out dead body 2 Liability to be a source of infection 7 Death of child 4 Stillbirths 1 Artificial feeding 8 The reasons for sending 131 notifications for medical help were as follows :— Table XX During pregnancy 12 For miscarriage 5 During labour 62 During puerperium 27 Infant conditions 25 Table XXI Dental Inspection and Treatment Expectant and Nursing Mothers :— Number sent to the dentist for inspection 105 Number inspected 138 Number for whom treatment was completed 83 Number of completed dentures 60 Number of fillings 194 Number of local anaesthetics 41 Number of general anaesthetics 71 Total number of attendances and re-attendances 647 Children under five years of age :— Number sent for inspection 53 Number inspected 270 Number for whom treatment was completed 138 Number of fillings 188 Number of local anaesthetics 2 Number of general anaesthetics 63 Total number of attendances and re-attendances to dentist 428 36 Table XXII Vaccinations Year Live Births Vaccination Certificates Exemptions Percentage of vaccinations to live births 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 1946 1090 265 270 24 1947 1108 498 520 44 Table XXIII Deaths from Cancer Year Male Female Total Estimated population Rate per 1,000 population 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 30 57 52,400 0.51 1939 33 41 74 52,430 1.41 1940 28 36 64 51,670 1.23 1941 34 37 71 50,280 1.41 1942 34 38 72 50,350 1.43 1943 51 46 97 49,730 1.95 1944 37 32 69 48,970 1.41 1945 39 44 83 49,880 1.88 1946 40 54 94 54,440 1.64 1947 45 32 77 56,240 1.36 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. - - - 10 10 15 8 1 Female - 1 2 2 3 7 13 4 Total - 1 3 12 13 22 21 5 37 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 9 12 12 9 7 23 - - - - - - 72 - Scarlet fever - 3 7 8 6 37 20 7 1 - - - 88 - Diphtheria 1 1 - - - 3 - 3 - - - - 8 - Measles 14 25 47 39 55 144 2 3 2 2 1 - 334 - Puerperal pyrexia - - - - - - - 8 8 2 - - 18 - Erysipelas 1 - - 1 - - - - 1 2 2 2 9 - Pneumonia 5 2 2 3 1 9 4 1 6 5 14 3 55 27 Ophthalmia neonatorum 4 - - - - - - - - - - - 4 - Cerebro-spinal fever, &c. 3 1 1 - - 1 2 - - 2 1 1 12 1 Dysentery - - - - - - 1 9 14 36 31 91 3 Poliomyelitis - - 1 - - 2 - - - - - - 3 - 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 88 22 19 10 19 5 13 - Diphtheria 8 - 3 1 - 1 3 - Puerperal pyrexia 18 1 4 2 7 1 3 - Pneumonia 55 11 7 4 10 9 14 27 Ophthalmia neonatorum 4 1 - 2 1 - - - Tuberculosis (all forms) 105 17 22 12 25 14 15 30 Erysipelas 9 2 - 1 6 - - - Measles 334 81 35 51 34 52 81 - Whooping cough 72 30 6 8 11 8 9 - Cerebro-spinal fever, &c. 12 1 2 2 1 3 3 1 Poliomyelitis - - - - - - - - Totals 705 166 98 93 114 93 141 58 38 Cases of infectious diseases occurred during the year among schoolchildren as follows :— Table XXVII School Scarlet Fever Diphtheria Beaconsfield Road 1 1 County School - - Clifton Road 6 1 Dormers Wells 8 - Featherstone Road 4 - Western Road - - North Road 9 - St. Anselms - - Tudor Road 10 1 Lady Margaret Road 4 - Other Schools 8 - 50 3 Table XXVIII Age Periods New Cases Deaths Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary Male Female Male Female Male Female Male Female 0-1 — — — — — — — — 1-5 2 1 — — 2 — — — 5-10 1 1 2 1 — — 1 — 10-15 2 1 — 2 1 — — — 15-25 8 17 2 1 2 — — — 25-35 12 14 2 — 4 4 1 — 35-45 7 9 — — 3 2 1 — 45-65 11 5 1 1 4 4 — — 65+ 2 — — — 1 — — — Totals 45 48 7 5 17 10 3 — Of the 30 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 6 - 1 - Schoolchildren 2 2 1 3 Clerical work 4 3 - - Domestic duties - 18 - - Factory hands 7 8 2 - No occupation 13 9 3 2 Various 13 8 - - Totals 45 48 7 5 39 Table XXX Admissions and Discharges Remaining on 31.12.46 Admitted during year as Subsequently diagnosed as Discharged recovered as Died Transferred Remaining on 31.12.47 Scarlatina 5 96 88 81 - - 12 Diphtheria 1 10 1 2 - - - Measles - 15 17 17 - - - Whooping Cough and Pneumonia - 6 6 6 - - - Rubella - 2 3 3 - - - Pneumonia - 1 1 1 - - - Infectious Hepatitis - 1 1 - - - 1 Vincent's Angina - - 3 3 - - - Tonsillitis - - 8 8 - - - Erysipelas - 5 2 2 - - - Enteric - 2 - - - - - Cellulitis - 1 4 4 - - - Urticaria - - 3 3 - - - Enteritis - - 1 1 - - - Pharyngitis - - 1 - - - 1 Toxic Erythema - 1 1 1 - - - Table XXXI Monthly Admissions and Discharges Number Admitted Final Diagnosis Number Discharged Scarlet Fever Diphtheria Measles Whooping Cough and Pneumonia Rubella Pneumonia | Infectious Hepatitis Vincent's Angina Tonsillitis Erysipelas Cellulitis Urticaria Toxic Erythema Enteritis Pharyngitis Scarlet Fever Diphtheria Measles Whooping Cough and Pneumonia Rubella Pneumonia Vincent's Angina Tonsillitis Erysipelas Urticaria Cellulitis Toxic Erythema Enteritis Pharyngitis January 7 - 3 - - - - - - - 1 1 - 1 - 6 1 - - - - - - - 1 1 - 1 - February 4 1 5 3 - - - - - - 1 - - - - 4 - 4 - - - - - - - 1 - - - March 15 - 5 1 2 - - - 1 - - - - - - 7 - 6 2 2 - - 1 - - - - - - April 7 - - - - - - - 2 - - - - - - 15 1 1 2 - - 2 2 - - - - - - May 9 - 1 1 - - - - - - - - - - - 5 - 3 - - - - - - - - - - - June 4 - 1 - - 1 - - 1 - - - - - - 9 - 1 1 - 1 - 1 - - - - - - July 2 - - - - - - - 1 - - 1 - - - 5 - - - - - - 1 - - - - - - August 3 - 2 - 1 - - - - - - - - - - 1 - 2 - 1 - - - - - - - - - September 2 - - 1 - - - - 2 2 - 1 - - - 5 - - - - - - 2 2 - - - - - October 13 - - - - - - 1 - - - - - - - 3 - - 1 - - 1 - - 1 - - - - November 10 - - - - - - - 1 - 1 - 1 - - 11 - - - - - - 1 - - 1 1 - - December 12 - - - - - 1 - - - 1 - - - 1 10 - - - - - - - - 1 1 - - - 88 1 17 6 3 1 1 3 8 2 4 3 1 1 1 81 2 17 6 3 1 3 8 2 3 4 1 1 - 40 Table XXXII Houses, Public Health Act, 1936 5,188 Houses, Housing Act, 1936 10 Overcrowding 243 Disinfestation 285 War Damage 1 Shops Acts 18 Food Shops 583 Fried Fish 6 Cafes, etc. 54 Factories (Mechanical) 62 Factories (Non-Mechanical) 23 Outworkers 11 Food Factories 319 Smoke 21 Bakehouses 20 Dairies 23 Water Sampling 20 Milk Sampling 104 Other Foods Sampling 90 Schools 44 Stables 13 Accumulations 80 Hairdressers 16 Slaughterhouses 10 Rats and Mice 70 Building Material Permits 148 Petrol 65 Canal Boats 7 7,534 41 Table XXXIII 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) 1,276 (b) Number of inspections made for the purpose 5,198 (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 733 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 555 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 207 (2) Number of dwelling-houses in which defects were remedied after service of formal notices :— (a) By owners 211 (b) By local authority in default of owners — (c) Proceedings under Sections 11 and 13 of the Housing Act, 1936 :— (1) Number of dwelling-houses in respect of which Demolition Orders were made (2) Number of dwelling-houses demolished in pursuance of Demolition Orders – (d) Proceedings under Section 12 of the Housing Act, 1936 :— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement room having been rendered fit – 42 Table XXXIII—continued. 4. Housing Act, 1936—Overcrowding :— (a) (1) Number of dwellings overcrowded at the end of the year 100 (2) Number of families dwelling therein 155 (3) Number of persons dwelling therein 683 (b) Number of new cases of overcrowding reported during the year 73 (c) (1) Number of cases of overcrowding relieved during the year 76 (2) Number of persons concerned in such cases 313 (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 43 INDEX. page Adoptions 31 Ambulance facilities 9 Ante-natal clinics 11,26,31,32 Antitoxin 16 Area of Borough 6 Assisted Services 15 Bed bugs 21 Birth control 11 Births and birth rate 7, 27, 30 Canal boats 21 Cancer 17, 37 Causes of death 28 Celluloid and Cinematograph Film Act 23 Child life protection 10 Clinics 8, 9, 10, 11, 12, 26 Consultant aid 10 Day nurseries 15 Deaths and death rates 7, 27 Dental treatment 15, 34, 36 Diphtheria 17,20 Diphtheria prevention clinic 17,26 Disinfection 16 Factories Act 22 Food 23 Foster children 31 Health Services, General provision of 8 Health propaganda 13 Health visiting 9, 30 Houses—Number inhabited 6 Housing 23, 42 Infant mortality 7, 30 Infant welfare clinics 26,31,32 Infectious Diseases, Prevalence and Control of 16 Inspection and Supervision of Food 23 Irradiation Experiment 19 Isolation Hospital 19,40 Laboratory facilities and work 8,21 Maternal morbidity and mortality 8,29 Maternity and Child Welfare 9, 12 Maternity and Child Welfare Committee 3 Maternity and Nursing Homes 14 Meat and other foods 23 PAGE Medical help 36 Midwives 14,36 Milk supply 23 Milk grants 15 Mortuary 21 Moral welfare 10 Notifiable diseases 16,38 Nursing in the Home 8 Ophthalmia neonatorum 17 Petroleum Acts 23 Physical feature of district 6 Poliomyelitis 18 Poor Law medical relief 9 Population 6 Post-Natal Clinics 11 Premature Infants 8 Pre-school medical inspection12, 33, 34, 35 Public Health Committee 3 Puerperal pyrexia 8 Rats and mice 24 Rateable value 6 Remedial exercises 13, 26 Sanitary circumstances 21 Sanitary inspection 21,41 Scabies clinic 9, 26 Scarlet fever 17, 19 Shops 23 Smallpox 17 Social conditions 6 Staff 5,21 Statistics—general and vital 6, 7, 27 Stillbirths 7,27 Tuberculosis 18,39 Ultra-violet light clinic 11, 26 Uncleanliness of School Children 18 Unfit houses 42 Vaccination 16, 37 Venereal disease clinics, etc 19, 26 Verminous persons 9 Vital statistics 6, 7, 27, 29 Voluntary help 13 Water supply 21 44