AC1439(1) SOUTHALL Public Health Sout 16 BOROUGH OF SOUTHALL ANNUAL REPORT OF THE Medical Officer of Health for the Year 1948 MARGARET A. GLASS, Medical Officer of Health KING HUTCHINGS, LTD., PRINTERS, SOUTHALL BOROUGH OF SOUTHALL ANNUAL REPORT OF THE Medical Officer of Health for the Year 1948 MARGARET A. GLASS, Medical Officer of Health THE COUNCIL OF THE BOROUGH OF SOUTHALL, 1948 Members of the Public Health Committee (which also functions as a Maternity and Child Welfare Committee) are denoted by an asterisk. HIS WORSHIP THE MAYOR *COUNCILLOR A. T. DANE, J.P. Deputy Mayor: Alderman E. B. Hamblin. *Gardner, F. E. Hopkins, W. H., J.P. Bray, W. D. *Cooper, Mrs. M. *CULLINGWORTH, F. A. *Douglas, H. C. *Dormer, J. G. Jennings, F. H. Aldermen: Luckett, F. H. Neighbour, D. C. Councillors: *Lawn, P. A. Lockyer, G. F. Love, P. J. Lye, A. E. *Marks, F. J. (Chairman, Public Health Committee) *Smith, F. G. *Salmon, J. Shepherd, A. H. *Taylor, F. K. *Walker, F. C. 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 52nd Annual Report on the health and sanitary circumstances of the Borough for the year 1948. On 5th July, 1948, Middlesex County Council took over the management of the Maternity and Child Welfare Service previously administered by Southall Borough Council. This report, therefore, will contain statistics for the environmental health and sanitary circumstances of the population of the Borough for the full year, along with details of Maternity and Child Welfare work for the period 1st January, 1948, to 4th July, 1948. The Borough Isolation Hospital continued to admit cases of infectious diseases until 4th July, 1948, but all cases were not discharged from the Hospital until early August. Subsequently the North-West Metropolitan Regional Hospital Board, to whom the Hospital was transferred, converted it for the purpose of accommodating male patients suffering from tuberculosis, and cases of other infectious diseases occurring in Southall and notified subsequent to 4th July were admitted to hospitals in other areas. The health of the population continued to be good. The birth rate was 1774, a reduction from 2016 in 1947. This reduction was general throughout the country, but the birth rate of Southall was slightly lower than the general birth rate in England and Wales, which was 17.9. The death rate was 8.28. This has decreased steadily since 1945, the corresponding rate in that year being 9 26, in 1946 8 96 and 1947 8 67. The principal causes of death were again cancer and heart disease. 3 BOROUGH OF SOUTHALL WITH THE COMPLIMENTS OF THE MEDICAL OFFICER OF HEALTH PUBLIC HEALTH DEPT. MANOR HOUSE SOUTHALL The infant mortality rate of 29.1 was the lowest ever recorded in the Borough. The fall was from 38.8 in 1947, and it is noteworthy that, except for a slight increase in 1947, the infant mortality rate in Southall has declined continuously since 1939. The number of deaths from tuberculosis was 22 compared with 30 in the previous year, although the number of notifications of new patients suffering from this disease increased from 105 in 1947 to 127 in 1948. An increase in the number of cases notified, combined with a reduction in the number of deaths from this disease, may be partly due to the attendances of large numbers of the population for X-ray by the Mass Radiography Unit, and is a hopeful sign that this disease, which has been increasing in its evil effects during the last few years, is at last becoming recognised more often in the early stages when the possibility of a fatal result from the infection can more easily be averted. The clinics and treatment centres provided by the Borough Council were all working satisfactorily, and good attendances were maintained during the period ; figures for attendances at Ante-natal and Infant Welfare Clinics show a slight increase for the half-year. The services of the local midwives were used to about the same extent as during 1947. Because of the shortage of hospital beds, and by arrangement with the Health Department, normal cases confined in hospital were sent home on the 4th day to the care of the Council's midwives to alleviate the congestion in hospitals, and this extra work is not recorded in the figures of bookings or the table of completed cases, but represents many hours of visiting and care. During the period the services in connection with school medical inspection and treatment were controlled through the Health Department by agreement between Southall Borough Council and Middlesex County Council. During the first part of 1948 there was a very high number of measles notifications, and the type of illness was more severe than it had been for the previous few years. Several cases developed pneumonia and one death occurred. The use of the Ambulance Service, giving free conveyance to Southall ratepayers suffering from illness or accident, continued to increase. The demand for places in the three Day Nurseries maintained by the Council continued heavy and increasing, both for the children of working mothers and for children whose parents were in temporary difficulty such as the admission of the mother for a short period into hospital for operation or for confinement. Arrangements were also made by the Council for children to obtain places in certain of the County Council residential nurseries for temporary periods during similar emergencies. An increase in the use of the facilities for the immunisation of young children and children of school age against diphtheria and whooping cough was marked during the period, the total attendances for 6 months being 2,105 as compared with 2,246 for the full year 1947. Continued propaganda by word of mouth, and by poster and cinema publicity, must have had its effect in producing this satisfactory state of affairs. The Clinics for Artificial Sun Treatment were maintained, and there is no doubt that beneficial results were obtained by many of the children and expectant and nursing mothers who were given treatment by this method. The use of the County Council Clinics for the purpose of ophthalmic, orthopaedic and dental treatment of mothers and young children was continued, and valuable work was done especially in the conservation of the milk teeth of children under 5 years of age. The value of this treatment is very great indeed. Not only is the foundation of the structure of the permanent teeth kept secure from decay, but the fact that the teeth are retained in position until the permanent teeth are ready to erupt secures that a good shape of the arch of the mouth is retained, with subsequent benefit, not only to the appearance of the child, but in the prevention of nasal deformity and adenoids leading to chest diseases due to poor respiration. The members of the Voluntary Workers' Association of the Borough have given much of their time and energy, during the past 25 years, to assistance in the work of the Maternity and Child Welfare Service, and I should like to extend the thanks of the Health Department 4 staff, and my personal thanks, to them for all their help which, I am sure, has to no small extent contributed to the excellent record of health care for mothers and children of this Borough. The number of inspections of premises carried out by District Sanitary Inspectors increased during the year. Although all cases of overcrowding in the Borough do not necessarily come to the notice of the Department, an increased number was ascertained, either during inspections for other purposes, or by the occupants of overcrowded property coming to the Department to ask for help with their housing problems. All such cases were recorded and brought to the notice of the Housing Department and Public Health Committee—cases were kept under review and any alteration of the circumstances noted. With regard to housing defects, it is interesting to note an increase in the amount of work carried out as a result of informal action with subsequent reduction in the number of statutory notices required—this is partly due to the relaxation of legal restrictions on the repair and decoration of property, which has had a particularly beneficial effect on the state of shop premises. The presence of large food factories in the Borough necessitates continual vigilance and much visiting, and in 1948 a survey was commenced of the conditions under which food was stored, cooked and served in all the catering establishments of the Borough. Although there were no notifications of food poisoning, and although the past records of the Borough are excellent in this respect, eternal vigilance is necessary both in search for, and removal of, sources of nuisance which might become disease and death producing. The experiment on the Irradiation of Upper Air in schools, commenced in 1947 for the purpose of ascertaining whether this method would reduce infectious disease incidence in irradiated schools as compared with non-irradiated schools, continued through the year, and no doubt the fact that there was a high incidence of measles will have helped the team of investigators with figures which will make a decision on the usefulness of the irradiation more attainable. It is hoped that the results will be available for the 1949 Annual Report. The Mass Radiography Unit of Middlesex County Council visited a factory in the Borough and carried out extensive examinations of the factory employees. A few sessions were made available to the general public and an invitation was extended to them to volunteer. Many requests were received after the Unit had gone, stating that citizens of the Borough wished a further opportunity to take advantage of the scheme, and Middlesex County Council were asked to make the services of the Unit available for Southall at their earliest convenience. I should like to thank all the staff of the Health Department for their energy and enthusiasm in the cause of health, and for their loyal support. I am, Your Worship, Ladies and Gentlemen. Medical Officer of Health. Manor House, Southall. 5 HEALTH DEPARTMENT STAFF for the year 1948 Medical Officer of Health : Ernest Grundy, M.D., B.S.(London), M.R.C.S., L.R.C.P., D.P.H.(Eng.). (Resigned 3.2.48.) Deputy Medical Officer : Margaret A. Glass, B.Sc., M.B., Ch.B., D.P.H. (Appointed Medical Officer of Health 3.2.48.) Assistant Medical Officer: *E. M. Cumming, M.R.C.S., L.R.C.P., D.P.H. 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., R.S.I. Smoke Certificate. Sanitary Inspectors : W. Bowles, Cert. S.I.B., Cert. M. & F., M.S.I.A. E. G. Drayson, Cert. S.I.B., Cert. M. & F. (Resigned 25.4.48.) C. H. Sargent, Cert. S.I.B., Cert. M. & F. (Appointed 2.2.48.) F. A. K. Streeter, Cert. S.I.B., Cert. M. & F. (Appointed 11.10.48.) General Assistants : C. E. Knight. (Resigned 31.8.48.) R. Stockley. (To Government Training Scheme, April, 1948.) R. A. Dean. (Appointed 8.9.48.) 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 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 L. J. Dunn, S.R.N. (Resigned 9.10.48.) *Miss D. Hull, S.R.N., S.C.M., H.V. Cert. (Part-time only from 4.9.48.) *Miss D. E. Rolls, S.R.N., S.C.M., H.V. Cert. (Appointed 5.4.48.) *Miss O. Pope, S.R.N., S.C.M., H.V. Cert. (Appointed 22.3.48.) Miss M. E. Hyman, S.R.N., C.M.B. (Resigned 13.3.48.) Midwives: *Miss G. Robinson, S.C.M., S.R.N., S.F.N. *Mrs. A. Delahaye, S.R.N., S.C.M. *Miss M. I. Sandell, S.C.M. *Miss G. M. 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. 6 Clerks, Shorthand- Typists: *Miss P. Ashton. (Resigned 24.7.48.) Mrs. K. Jones. Mrs. E. Richards. (Resigned 6.3.48.) *Miss P. Mepham. *Miss J. Greenhill. *Miss B. Grimmer. (Appointed 5.1.48.) *Miss J. M. Lane. (Appointed 23.2.48.) Miss W. M. Stratton. (Appointed 30.8.48.) *D. Champion. *E. Stonestreet. (Returned from National Service 16.2.48.) A. East. (Called up for H.M. Forces.) B. J. Tolworthy. (Appointed 25.2.48.) K. Keegan. (Appointed 26.7.48.) Consulting Obstetrician : J. W. Rait Bell, Esq., F.R.C.S. Matron of the Isolation Hospital : fMiss E. James, S.R.N., R.F.N. Day Nurseries : *No. 2 Day Nursery. Matron: Miss M. Parberry, S.R.N. *No. 3 Day Nursery. Matron: Mrs. A. Jones, S.R.N. *No. 4 Day Nursery. Matron: Mrs. F. Kroner, S.R.N. * These officers were transferred to the Middlesex County Council on the 5th July, 1948, under the provisions of the National Health Service Act, 1946. J. W. Cronk, Chief Clerk, was retained on part-time basis to do 40% Borough Council duties and 60% County Council duties. † The Matron of the Isolation Hospital was transferred to the North-West Metropolitan Regional Hospital Board on the 5th July, 1948. 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 1948) 56,130 Number of inhabitated houses according to Rate Book 14,291 Rateable value £418,692 Sum produced by a penny rate £1,70503s .4d. 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 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. 7 BIRTH AND DEATH RATES Whole District Total deaths, 465. (Males, 250; Females, 215.) Crude Death Rate, 8 28. For extracts from vital statistics and causes of death, see Appendix, Tables I and II. Deaths. The death rate has decreased continuously since 1946. In that year it was 8.96, in 1947 8.67 and this year it has reached the record low level of 8.28. The corresponding rate for the whole country was 10.8. Heart disease and cancer were again the principal causes of death. 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 237 (males 120 and females 117). 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 228 in number (males 130 and females 98). The total number of deaths therefore belonging to the district was 465. The deaths of non-Southall residents in the St. Bernard's Hospital (not included in the above figures) numbered 104 (males 39 and females 65). For the distribution of deaths in the various Wards see Appendix, Table III, and for the comparison of general birth and death rates and rates of maternal mortality see Appendix, Table IV. Births and Birth Rate (figures for 1947 are given in brackets). The total number of births notified to the Health Department under the Public Health Act, 1936, was 1,117 (1,244). The total number of registered births in the district (under the Births and Deaths Registration Act—included in the notified births above) was 351 (471). The total number of live births belonging to the district, whether occurring within or outside the district, was 996 (1,108). The illegitimate live births were 53 (53). There were 23 stillbirths (22) and these were all legitimate. The birth rate is declining in Southall—it has fallen from 20.51 in 1946 and 20.16 in 1947 to 18.14 in 1948. It was slightly higher in 1948 than the birth rate for the whole of England and Wales, which was 17.9. The table below gives the analysis of the places of confinement of cases occurring prior to 5th July. The monthly registration of births classified in Wards is given in Appendix, Table V. Total Confinements (live births and still births), during the period 1st January to 4th July, 1948: 577. No. born in Hillingdon County Hospital 250 or 42% No. born in nursing homes or other hospitals 136 or 26% No. confined in their homes by midwives or doctors 191 or 32% Infant Mortality. The total number of deaths under 1 year of age was 29, 27 legitimate and 2 illegitimate. The rate per 1,000 live births was 29.1. The corresponding rate for England and Wales was 34, for London 31, and for the 148 small towns 32 per 1,000. There is a gratifying fall to be observed in the infant mortality rate—from 38.8 in 1947 to 29 in 1948; this is the lowest infant mortality rate ever recorded in the Borough, and it is especially satisfactory when compared with a national rate of 34. Premature Infants. Twenty-seven infants were born prematurely during the period, of whom 23 survived at the end of 1 month. For cases born prematurely equipment was available to be supplied to the homes, consisting of draught-proof cots, electric blankets, hot-water bottles, catheters, thermometers, 8 etc. Arrangements were in being to obtain supplies of breast milk at short notice from the Queen Charlotte Hospital in cases where there was not sufficient mother's milk. Maternal Morbidity. During the year 5 cases of puerperal pyrexia were notified, there were 2 maternal deaths but no deaths associated with abortion. GENERAL PROVISION OF HEALTH SERVICES IN THE BOROUGH Nursing in the Home. The local District Nursing Association provided 3 nurses in the district for the home nursing of cases of ordinary sickness and accidents. During the period the total number of visits made by the nurses was 5,165. 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 were as follows:— Ante-natal, Post-natal, Birth Control, Infant Welfare, Toddlers and Artificial Sunlight Clinics at the Manor House; Ante-natal, Infant Welfare, Toddlers, Artificial Sunlight, Immunisation, Remedial Exercise Clinics at the Branch Centre; Immunisation, School Medical and Dental Clinics at Featherstone Road Clinic; and at North Road, School Medical and Dental, Ophthalmic, Orthodontic and Physiotherapy Clinics. A report on the work in the Diphtheria Prevention Clinic is given on page 16. 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 period (excluding work done for the Isolation Hospital):— Table A Positive Negative Swabs for diphtheria 48 64 Sputa for tubercle 4 2 Fasces — 3 Other 9 16 61 85 Scabies Clinic. The total number of attendances at the Clinic for treatment of scabies and other skin conditions during 1948 was 1,858. Details of the cases were as follows:— Scabies First Visits 127. Re-attendances 304. Total 431 Other skin conditions „ ,,155. „ 675. „ 830 Verminous heads „ „ 354. „ 243. „ 597 Baths 321 Total attendances for all purposes 2,179 Total attendances for treatment 1,858 Attendances at the Cleansing Station increased during 1948. The total number of treatments—1,858—compares with a total number of 1,767 in 1947. 9 Ambulance Service. Until 4th July, a free ambulance service was provided by Southall Borough Council. The vehicles and driver-attendants were stationed at Salisbury Road Depot. During the period the total number of cases removed was 3,305 compared with a total of 5,800 for the full year 1947. These figures show that the use of the Ambulance Service was steadily increasing, as the 1947 figure was higher by 330 than that for 1946. All users of the ambulance were expected to produce a medical certificate. Details of the work are as follows:— Table B Ordinary cases removed to hospital or home 2,659 Accidents 224 Other removals (including conveyance of expectant mothers to Hillingdon Hospital Ante-natal Clinic) 356 Mutual assistance provided for other Local Authorities 66 3.305 MATERNITY AND CHILD WELFARE Health Visiting. During 1948 the Southall Borough Council provided the services of 8 health visitors for the purpose of home visiting and clinic attendance. The borough was divided into 8 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 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 1 health visitor had special duties in connection with moral welfare. Child Life Protection. The Senior Health Visitor was specially appointed to deal with child life protection work. This work continued during 1948 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 VIII, for statistics of this work. Consultant Aid in Difficult Labour. The "Flying Squad" of the County Council for assistance in cases of difficult labour was available to medical practitioners in Southall. During the year the squad was called in 5 times. Institutional Provision for Unmarried Mothers, Illegitimate Infants and Homeless Children in the District. None. 10 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 any district 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 6 cases were dealt with under this scheme. The Moral Welfare Officer also assisted with the various problems arising from cases of this nature, and every assistance was given to unmarried mothers who were willing to continue to look after their own children. The number of illegitimate live births was 53; in 1947 the corresponding number was also 53. The proportion of illegitimate live births to legitimate was 53 to 996, i.e., 5.3%. Ultra-Violet Light Clinics. Four sessions per week for treatment of ultra-violet light were held during the period— 2 for expectant mothers and children under 5 years of age attending the Manor House Clinic, and 2 for those attending the Branch Centre Clinic. The number of attendances at the Ultra-Violet Light Clinic for the period was high as compared with the full year 1947, but the figures are not quite comparable as the period of vacation is usually from May to October and therefore the last part of the year has a shorter time for attendances to be recorded. The service was a very popular one, and in the colder months the waiting lists were considerable. The provision of new lamps at the School Clinics in addition to the lamps at Manor House and Jubilee Gardens made provision for a wide extension of the service, as these were of the Centrosol type allowing for several treatments to be given simultaneously. These new lamps had not come into full use by the time of the transfer of the Service. Table C Number of sessions held: 101. Number of attendances:— First Visits Revisits Mothers 1 1 Infants 1o1 917 Post-Natal and Birth Control Clinic. Table D Number of sessions held: 12. Number of attendances:— Post-natal Birth Control First visits 54 24 Re-attendances 35 91 Ante-Natal Clinics. The number of new patients seen at the Ante-natal Clinics during the period was 376 and the total number of attendances was 2,480 (1,384 at the Manor House and 1,096 at the Branch Centre. For table of comparison of figures for the last 8 years, and the proportion of new cases to revisits, see Appendix, Table IX. 11 Table E 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 93 151 29 76 64 75 Abnormal cases. 53 41 6 6 47 35 Of the cases dealt with, therefore, 43% were primiparae (against 40% in 1947), and of these 76% (against 73% in 1947) were confined in hospital, while 67% (against 55% in 1947) of the multiparae were also confined in hospital. Child Welfare Clinics. The attendances at the Child Welfare Clinics from 1st January, 1948, to 4th July, 1949, are shown in Table X in Appendix. The total number of attendances at the Infant Welfare and Toddlers' Clinics during the period was 7,822. Approximately 85% of all infants born in Southall during the first half of 1948 were brought for consultation at least once. Children attending Day Nurseries were medically examined at least once every month at the Nursery and so were not required to attend clinics. Pre-School Medical Inspection (Toddlers' Clinics). Toddlers' Clinics were held fortnightly at each centre. The total attendances at these Clinics were 360, 216 at the Manor House and 144 at the Branch Centre. (See Appendix, Tables XII, XIII, XIV, XV and XVI.) The general physical condition of children under 5 years of age in Southall was, on the whole, satisfactory. No infants were found to be in the classification D (bad) and 2 only in classification C (slightly sub-normal). The defects found were mostly of a minor character. A fall in the number of children found to have enlarged tonsils and adenoids was apparent. 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. 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. Orthopædic 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. 12 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 mothers and nursing mothers. This clinic was 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 were treated experimentally by means of wedging of shoes and corrective exercises. If good results were being obtained, there was then no need for a specialist's advice, the services of the specialist thus being avaiiable for more serious cases. The attendances during the period 1st January to 4th July are tabulated below:— Infants Mothers First visits 14 6 Re-attendances 172 46 Health Propaganda. At clinics, in the home, 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 1 year received a greeting card with a reminder that anti-diphtheria immunisation should now be undertaken was continued during 1948. 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 were discussed. The total of midwives' bookings for the period was 157. 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 XVII and XVIII for information dealing with notifications relating to Southall received from midwives resident in Southall during the year. This 13 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 6 11 7 7 7 38 February 1 6 5 8 5 25 March 1 6 5 6 2 20 April 5 5 4 7 5 26 May 3 2 7 6 2 20 June 4 6 4 5 9 28 Totals 20 36 32 39 30 157 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 1948 Nil Number of additional applications re registration during the year 1947 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 5 years of age could be 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. Dental Treatment. By arrangement between this Council and the County Education Authority expectant and nursing mothers and children under 5 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 during the period 1st January, 1948, to 4th July, 1949— 430 expectant and nursing mothers and 213 children under 5 years of age—was satisfactory. The proportion of new cases treated increased in the instance of both mothers and children, and there was a noteworthy increase in the amount of conservative treatment carried out, i.e., fillings, and other treatments, increased at a much greater rate than treatment by extractions, and this shows, not only an improvement in the quality of the work, but a satisfactory state of mind in the mothers attending, in that they were prepared to accept, or have their children obtain, fillings or painting in an effort to save their teeth. For statistics of dental treatment see Appendix, Table XIX. 14 Day Nurseries. The 3 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 continued to increase during 1948. 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. Under the scheme for the training of nursery students to obtain the Nursery Nurses' Diploma, all the girls employed in the Day Nurseries as students were given the opportunity to attend for general educational and theoretical training at Acton Technical College, and received practical experience in the Nurseries themselves, each of the 3 Day Nurseries having been examined and scheduled as training establishments by the National Association of Day Nurseries. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES During 1948 the incidence of measles was high—825 cases were notified during the year. Measles is normally a complaint which occurs in bi-annual waves, and 1947 was the year when a larger number of notifications was to be expected, but the number occurring in 1947, although high, i.e., 334, was much less than the number of notifications for 1948. Whether this indicates some alterations in the type of infecting organism has not been ascertained as yet. It will be interesting to compare these figures with those of 1949 which may show us that the bi-annual fluctuation in incidence is no longer typical of the disease. The type of illness was more severe than during 1947, and 16 cases were admitted to the Isolation Hospital during the first part of the year with severe attacks, in 3 cases with pneumonia as a complication; 1 death took place from measles pneumonia. An increase was noticed also in the number of notifications of scarlet fever—from 88 in 1947 to 110 in 1948- The type of case, however, was very mild ; there were no deaths and no complications with lasting effects. 7 cases were notified as diphtheria, only 1 of which was subsequently diagnosed as suffering from the disease. The case was uncomplicated and discharged cured. The number of notifications of whooping cough was considerable, although the disease did not assume epidemic form. A disturbing factor here is that 25 cases occurred in children under 1 year of age. It is difficult to tell what the value of immunisation has been in the prevention of whooping cough in the area, as the number receiving treatment is still a matter of doubt. Reports are awaited of the trials of various preparations being conducted by the Medical Research Council in several parts of the country. It is obvious that if the vaccination is indeed effective, it should be carried out in children at a very early age, i.e., 6-9 months—it is very doubtful whether immunity can be produced by any injections given before the age of 6 months. In 1948 the epidemic of poliomyelitis in England, which had occurred in the latter end of 1947, was diminishing. During the early months of the year Southall had 2 notifications of cases, 1 of whom was left with a considerable amount of paralysis of the legs. No deaths occurred from poliomyelitis. Provision of Antitoxin. The Council provided antitoxin free to local practitioners for cases of diphtheria in the district. The Ministry of Health also sanctioned the supply of tetanus antitoxin by the Council to local practitioners if such should be 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, 20 people were supplied during 1948, either free or at part cost. 15 Vaccination. The total number of successful vaccination certificates during the period 1st January to 4th July was 217. Table XX in Appendix gives corresponding figures for the past 11 years. During the period the proportion of successful vaccinations compared with the total number carried out in 1947 had decreased slightly. On 5th July compulsory vaccination came to an end, to be superseded by a voluntary scheme whereby parents could have their children vaccinated at will, and Maternity and Child Welfare Centres were urged to encourage, by all means of propaganda, that parents should take advantage of the facilities available. 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 H List of premises, articles, etc., disinfected during the year:— Rooms 129 Eiderdowns 47 Beds 147 Pillows 218 Blankets 283 Sheets 155 Bolsters 35 Towels 2 Books 63 Cushions 2 Quilts 2 Rug 1 Covers 51 Articles of clothing 27 Scabies Clinic: Bags of clothing 3 The following articles were destroyed: 12 mattresses, 1 bolster, 2 pillows, 1 bag of clothing, 2 cushions, 2 sheets and 6 articles of clothing. Cancer. It will be seen by the table of causes of death (page 27) that in 1948 84 cases (48 males and 36 females) died from cancer. (See Appendix, Tables XXI and XXII.) 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. Scarlet Fever (Scarlatina). The number of notifications received during the year was 110, as compared with 88 for the previous year. Of these, 70 were removed to the Isolation Hospital. Diphtheria. Seven cases of diphtheria were notified to the Health Department, and 6 were admitted to Southall Isolation Hospital during 1948. Of these, 6 were not confirmed as diphtheria and therefore there was only 1 confirmed case. Diphtheria Prevention. The total number of attendances at the Diphtheria Immunisation Clinic during the period was 2,105, but a number of the children who attended the Clinic came for 1 injection only, a booster dose to reinforce previous immunisation. The number of children attending 16 for the booster dose 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 period was 470. Anti-diphtheria immunisation was carried out at the Branch Health Centre and at the Featherstone Road School Clinic. Table J Number of sessions held 51 Total attendances made 2,105 Average attendance per session 41 Highest attendance at a session 57 Lowest attendance at a session 7 During the period the number of new cases was 509 Numbers attending for reinforcing single injections 200 Whooping Cough Immunisation. One hundred and twenty-six completed a course of vaccination against whooping cough. Ophthalmia Neonatorum. No cases of ophthalmia neonatorum were notified during the year. Acute Poliomyelitis. Two cases were notified in the Borough during the year. One of the 2 cases was left with residual paralysis and was subsequently treated as an in-patient at Stanmore Orthopaedic Hospital, later still as an out-patient she attended for physiotherapy at the North Road Clinic, Southall. This patient made continual, if slight, progress in the acquisition of increased muscle movement during the year. 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 XXIII, XXIV and XXV. Infectious Disease Visits. During the year, the health visitors paid 548 visits with reference to cases of infectious disease, 110 swabs were taken. The total number of children examined by the health visitors in the schools was 125. Uncleanliness and Verminous Conditions in School Children. Number of children on roll at 31st December, 1948 7,465 Total number of examinations of children in schools by the school nurses 23,149 Number of individual children found unclean 400 Number of children cleansed under arrangements made by the Local Education Authority 186 Out of a total of 29,736 examined in 1947, 785 individual children were found to be unclean. The figures shown here for 1948, therefore, suggest a very great improvement in the condition of the school children. There is no doubt that the regular inspection of school children, twice in each term, carried out prior to 4th July, 1948, appears to be having a very great effect on the incidence of scabies and vermin. 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. 17 Tuberculosis. Pulmonary Tuberculosis. The number of new cases notified during the year was 113. Other Forms of Tuberculosis. The number of new cases notified during the year was 14. Of the total notifications 46 were received from institutions (County Council hospitals 26, general hospitals 20). Deaths from Tuberculosis. Tuberculosis of the respiratory system, 21; other forms, 2. For details of new cases notified and deaths in 1948, see Appendix, Table XXVI, and for the occupations of new cases see Appendix, Table XXVII. 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. Throughout 1948 the experiment on the control of the spread of infectious diseases amongst children by means of irradiation of the upper air in classrooms and school halls continued. It was decided by the Medical Research Council that an end would not be made to the experiment for a further year and that statistics of, and reports on, the results of the investigation could only be published after the whole period of work had been surveyed. It was decided that early reports might be unjustified in the light of further experience, and might influence persons connected with the experiment, such as teachers, parents, etc., in their attitude towards the scheme, and therefore vitiate the excellent records which have been made consistendy throughout the experiment. It is interesting, however, to record that, because of the large scale of the investigations carried out, new information on subjects such as the effects of ventilation, heating, etc., on the movements of bacteria in public places will become available, and our knowledge will be increased concerning the bacterial types to be found in the throats of normal children at all periods of the year, as much bacteriological examination has been done. It is hoped that the full report on the experiment will be available in time for the 1949 Annual Report. REPORT ON THE BOROUGH ISOLATION HOSPITAL During the year 1948, from 1st January to 30th June, 100 patients were admitted to the Isolation Hsopital, as compared with 140 in 1947. Of these, 76 were sent in as scarlet fever, 6 as diphtheria, 5 as measles, 8 as measles and pneumonia, and 5 as other diseases. Of these cases sent in as scarlatina 6 were unconfirmed and diagnosed as suffering from other diseases. Similarly, of the cases sent in as diphtheria 5 were unconfirmed. All cases were discharged by the end of August when the Hospital was converted by the North-West Metropolitan Regional Hospital Board into a Hospital for Tuberculosis. (Tables No. XXVIII and XXIX show the figures for the year and for each month respectively.) 18 Scarlatina. Of the 76 cases notified as scarlatina, 70 were finally diagnosed as such, and the following table shows the incidence in age groups of the cases which were nursed in the hospital:— Table K Age (years) 0-5 5-15 15-25 25-35 35 + Number 32 33 3 1 1 There were no return cases. Anti-scarlet fever serum was administered to all patients. Two minor operations were performed for incision of axillary and submaxillary abscesses. 1 case developed chicken pox 5 days after admission and 4 of the contacts later developed the disease. 1 patient developed chicken pox 12 days after admission, and 9 of the contacts contracted the disease. Complications of the cases of scarlatina were:— Septic fingers 1 Hordeolum 1 Septic toes 2 Otitis Media 6 Cardiac irregularity 8 Adenitis 1 Bronchitis 1 Rhinorrhœa 3 Abscesses 2 Secondary rash 4 Diphtheria. Six cases notified as diphtheria were admitted to the hospital. Only 1 of these was confirmed as diphtheria, nasopharyngeal type. The 5 other cases were diagnosed as tonsilitis 3, quinsy 1, pneumonia with laryngeal spasm 1. Other Diseases. Six cases admitted as scarlatina were subsequently diagnosed as suffering from other diseases. These were as follows:— Measles 2 Chicken Pox 1 Tonsilitis 3 Stay in Hospital. The average stay in hospital was as follows:— Number Total Days Average Scarlatina: All cases 76 2,219 31.7 days Patients remaining over 56 days 2 129 64 „ Patients remaining under 56 days 68 2,090 30.7 ,, Diphtheria: All cases 1 81 Measles and pneumonia : All cases 15 219 14.6 „ Other diseases : All cases 14 222 15.8 „ FOOD POISONING. There were no outbreaks of food poisoning in the Borough during 1948, and no individual cases of food poisoning were notified. 19 ESTABLISHMENTS FOR MASSAGE AND SPECIAL TREATMENT. Ten establishments were inspected for licence under this heading and all were found satisfactory for the purpose which was intended. Details are as follows:— Purpose No. of Licences Massage only Nil Chiropody only 2 Massage and Chiropody Nil Massage, Chiropody and Electrical Treatment 3 Massage and Electrical Treatment 4 Chiropody and Electrical Treatment 1 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 quantity. Sampling : 5 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 8,181. Table XXX shows an analysis of the number and nature of such inspections. Eradication of Bed Bugs. Table L Statistics for the year:— (a) Number of Council houses (1) found to be infested 34 Total: 46 (2) disinfested during the year 34 (b) Number of other houses (1) found to be infested 12 (2) disinfested during the year 12 Canal Boats. Visits were paid to the canal and 12 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. Six bodies were deposited in the mortuary during the year. 20 Factories Act, 1937. The following tables give details of the work done in connection with the mechanical and non-mechanical and outworkers in the Borough:— Inspections Premises Number on Register Number of Inspections Written Notices Occupiers Prosecuted Non-Mechanical 14 19 Nil Nil Mechanical 189 112 11 Nil Totals 203 131 11 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 1 1 - - - Ineffective drainage of floors - - - - - Sanitary Conveniences— (a) Insufficient 2 3 - 3 - (.b) Unsuitable or defective 9 9 - 2 - (c) Not separate for sexes - - - - - Other offences against the Act (not including offences relating to outwork) - - 1 - - Totals 12 13 1 5 - Outworkers Nature of Work Section110 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. 10 - - - - - Totals 10 - - - - - 21 Petroleum and Carbide. During the year 59 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 at premises of new construction. Housing. Two hundred and sixty-six investigations revealed 70 cases of overcrowding (Housing Act, 1936). Other cases of overcrowding were given individual attention and special recommendations for medical reasons. Work is continuous on overcrowding reviews. For statistics see Table XXXI in the Appendix. The 2 cases of recurrence of overcrowding were at houses lodging itinerant labourers. Administration of the Shops Acts. Concentration on food shops gave the opportunity to bring into line general provisions of the Acts. There are still arrears of routine work. INSPECTION AND SUPERVISION OF FOOD Milk. Licences. The following licences under the Milk (Special Designations) Order, 1936, were granted during 1948:— for the sale of Tuberculin Tested Pasteurised 2 for the sale of Tuberculin Tested milk 10 for the bottling of Tuberculin Tested milk 1 for the sale of Accredited milk — for the sale of Pasteurised milk 14 for Pasteurisation 1 Supplementary Licences 4 Total 32 Sampling. One hundred and sixteen samples of milk, including 32 empty bottles, 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 180 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. It is apparently not practicable for the Public Control Department of the Middlesex County Council to supply figures of this work in relation to Southall. 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 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. 22 FOOD INSPECTIONS Table M Details : Total Inspected (lbs.) Sound Unsound Total (lbs.) Stock (lbs.) Production (lbs.) Consumption (lbs.) Total (lbs.) Animal Feeding (lbs.) ByeProducts (lbs.) Destruction (lbs.) Canned 105,480 30,797 — 27,575 3,222 74,683 30,085 1,783 42,815 Raw 82,467 22,723 716 22,007 59,744 48,490 3,308 7,946 Totals 187,947 53.520 716 27,575 25,229 134,427 78,575 5,091 50,761 CATERING ESTABLISHMENTS In July, 1948, a "First Report on Catering Establishments" was presented to the Health Committee, giving the following establishments for the supply of meals and refreshments on which a full report would be forthcoming in 1949 after a complete survey:— Factories, Workshops and Canteens 51 Licensed Houses 31 Clubs and Associations 28 Cafes 25 Snack Bars 20 Schools 14 Institutions and Nursing Homes 10 Mobile Refreshment Stall 1 G.W.R. Hostel 1 Greyhound Track 1 Golf Club 1 Total number of Establishments 183 Certain preliminary findings were reported and typical difficulties quoted, likely to cause difficulty in the improvement of establishments, were:— 1. Premises established 25 years ago within restricted curtilage—no available sewer. 2. Plans for extension of old premises refused under new Town Planning provisions. This First Report has been followed by progress reports : certain Section 13, Food and Drugs Act, 1938, Statutory Notices have been complied with. Standards of cleanliness have been raised, but fundamental problems remain to be cleared up. 23 RATS AND MICE (DESTRUCTION) ACT, 1919 Infestation Order, 1943 Sewer treatments were carried out in February and October. Surface infestation were reviewed during April when it was found that action was not keeping pace with advice. On the 1st June, 1948, the Health Committee decided that disinfestation of private dwellings should be free of cost to the householder. A complete survey was made of a very large food factory, work given out to competitive tender and operations carried out with remarkable efficiency by a commercial undertaker who co-operated fully with the Public Health Department and secured excellent results in dealing with a widespread infestation. The factory has a canal dock and the Docks and Inland Waterways Executive promptly shared in the contract. Work continued throughout the year from May. Acknowledgement is gratefully made of the liaison existing between the Officers of the Infestation Branch of the Ministry of Agriculture and Fisheries and the Local Authority. Infestations Surface Sewer Total Inspections Working visits Jobs Done by Manholes—Total 657 Council Occupier Checked Baited Treated Poison 721 666 113 111 2 149 68 81 24 APPENDICES EXTRACTS FROM VITAL STATISTICS Table I Total Male Female Comparative figures for 1947 Live Births- —Legitimate 943 501 442 1055 Illegitimate 53 27 26 53 Stillbirths— Legitimate 23 12 11 20 Illegitimate — — Deaths 465 250 215 488 Birth rate (live and stillbirths) per 1,000 of estimated population 18.14 20.09 Stillbirth rate per 1,000 total (live and still) births 23.10 19.46 Crude death rate per 1,000 of the estimated population 8.28 8.67 Deaths from Puerperal Causes (Headings 29 and 30 of the RegistrarGeneral's Short List):— The Deaths. Rate per 1,000 total (live and still) births. No. 29 Puerperal sepsis 0.88 No. 30 Other puerperal causes 2 2.01 Total ... ... ... ... ... ... 2 2.01 Death rate of infants under 1 year of age:— All infants per 1,000 live births 29.12 38.83 Legitimate infants per 1,000 legitimate live births 27.57 38.86 Illegitimate infants per 1,000 illegitimate live births 2.01 37.73 Deaths from cancer (all ages) 84 83 Deaths from measles (all ages) 1 - Deaths from whooping cough (all ages) — - Deaths from diarrhoea, etc. (under 2 years of age) 4 5 26 Causes of Deaths, 1948. Table II Male Female Total 1948 Total 1947 1. Typhoid fever, etc — - — 2. Cerebro-spinal fever — — — — 3. Scarlet fever — — — — 4. Whooping cough — — — — 5. Diphtheria — — — — 6. Tuberculosis—Respiratory 13 4 17 27 7. Other tuberculosis 3 2 5 3 8. Syphilitic diseases 1 1 2 2 9. Influenza — — — 4 10. Measles — 1 1 - 11. Ac. poliomyelitis and polioencephalitis — — — — 12. Ac. inf. encephalitis — — — 1 13/16. Cancer (all forms) 48 36 84 83 17. Diabetes 1 — 1 1 18. Intra-cran. vase, lesions 20 38 58 38 19. Heart disease 56 50 106 126 20. Other circulatory diseases 10 13 23 18 21. Bronchitis 24 8 32 36 22. Pneumonia (all forms) 13 14 27 27 23. Other respiratory diseases 2 i 3 8 24. Ulcer of stomach or duodenum 4 i 5 5 25. Diarrhoea, etc. (under 2 years) 3 i 4 5 26. Appendicitis — — — 1 27. Other digestive diseases 2 2 4 10 28. Nephritis 2 2 4 9 29. Puerperal sepsis — — — 1 30. Other maternal causes — 2 2 — 31. Premature birth 4 2 6 11 32. Congenital malformations, etc 8 5 13 18 33. Suicide 3 2 5 6 34. Road traffic accidents 4 2 6 6 35. Other violence 10 12 22 17 36. All other causes 19 16 35 25 Total Deaths 250 215 465 488 Deaths in Wards. Table III Ward Male Female Total Waxlow Manor 29 24 53 Northcote 35 37 72 Hambrough 42 41 83 Dormers Wells 40 44 84 Glebe 57 31 88 Norwood Green 47 38 85 Total 250 215 465 27 Table IV 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 1948. (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 17.9 20.0 19.2 20.1 17.74 Still 0.42 0.52 0.43 0.39 0.40 Deaths: All causes 1o.8 11.6 10.7 11.6 8.28 Typhois and paratyphoid fevers o.oo o.oo o.oo o.oo o.oo Pneumonia 0.41 0.38 0.36 0.54 0.48 Smallpox — — — — Measles o.oo o.oo o.oo o.oo 0.02 Scarlet fever o.oo o.oo o.oo o.oo o.oo Whooping cough 0.02 0.02 0.02 o.o1 o.oo Diphtheria o.oo o.oo o.oo o.o1 o.oo Influenza 0.03 0.03 0.04 0.02 o.oo Tuberculosis 0.51 0.59 0.46 0.63 0.33 Acute poliomyelitis and polioencephalitis o.o1 o.o1 o.o1 o.oo o.oo Notifications: Smallpox — — — - — Scarlet fever 1.73 1.9 182 1.37 1.95 Diphtheria 0.08 o.i 0.09 o.1 0.12 Typhoid fever o.o1 o.oo o.o1 o.oo o.oo Erysipelas 0.21 0.23 0.21 0.22 o.34 Pneumonia 0.73 0.84 0.6 0.57 1.21 Measles 934 9.75 8.84 9.17 14.73 Cerebro.spinal fever 0.03 0.03 0.02 0.03 0.04 Whooping cough 3.42 3.51 3.31 3.13 3.77 Paratyphoid fever o.o1 o.o1 o.o1 o.o1 o.oo Acute poliomyelitis 0.04 0.05 0.04 0.04 0.04 Acute polioencephalitis o.oo o.oo o.oo o.oo o.oo Rates per 1,000 Live Births Deaths under 1 year of age 34 39 32 31 29 Deaths from Diarrhoea and Enteritis under 2 years of age 33 4.5 2.1 2.4 4.02 Rat es per 1,000 T otal (i.e. Live and Still) B irths Notifications: Puerperal fever 689 8.9 4.71 7.34 3.92 Puerperal pyrexia 28 MATERNAL MORTALITY (England and Wales). Per 1,000 Live and Stillbirths. Abortion with Sepsis Abortion without Sepsis Puerperal Infections Other o.11 0.05 0.13 0.73 Abortion—Mortality per Million Women aged 15-45 (England and Wales). With Sepsis Without Sepsis 9 4 Monthly Registration of Births. The monthly registration of births classified as to Wards is given in the following table:— Table V Waxlow Manor Northcote Hambrough Dormers Wells Glebe Norwood Green Total January 7 9 3 9 18 6 52 February 1 3 1 4 14 6 29 March 2 3 2 8 10 2 27 April 3 2 3 4 9 9 30 May 4 7 8 4 5 5 33 June 5 5 2 7 3 2 24 July 4 3 3 11 6 4 31 August 5 5 3 6 7 1 27 September 5 5 3 4 6 1 24 October 8 5 2 4 4 2 25 November 1 4 5 2 6 4 22 December 5 6 2 5 6 3 27 Total 50 57 37 68 94 45 351 Table VI Certified Cause of Death Under 1 week 1-2 weeks 2-3 weeks 3-4 weeks Total under 4 weeks 1-3 months 3-6 months 6-9 months 9-12 months Total deaths under 1 year Bronchitis, pneumonia, etc. - 1 1 - 2 3 - 1 2 8 Congenital malformations, etc. 6 - 1 - 7 1 - 1 - 9 Gastro-enteritis, diarrhoea, etc. - - - - 2 - 1 1 4 Prematurity 7 - - - 7 - - - - 7 Asphyxia due to misadventure 1 - - - 1 — - — — 1 Totals. 14 I 2 - 17 6 - 3 3 29 Live Births. Legitimate 943 Infant Deaths. Legitimate 27 Illegitimate 53 Illegitimate 2 29 Table VII Summary of Health Visiting Work for the First Six Months of Year 1948 Visits to infants— First visits 496 Revisits 1,603 Visits to children— First visits 36 Revisits 2,466 Visits to expectant mothers 579 Visits for infectious disease 539 *Visits to schools 9 Child Life Protection visits 111 Miscellaneous visits 404 Removals 127 No access 937 Re adoption 49 Total 7,356 * At these visits 125 children were examined. Table VIII (1) Number of foster parents on register— (a) At the beginning of the year 21 (b) At the end of the period 18 (2) Number of foster parents receiving foster children— (a) At the beginning of the year 20 (b) At the end of the period 17 (3) Number of children on the register— (a) At the beginning of the year 15 (b) At the end of the period 18 (4) Number of children received by foster parents during the year 32 (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 6 (c) Adopted 2 (d) Returned to parents l6 (e) Removed at request of the Medical Officer of Health. 1 (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 213 (7) Number of cases in which court proceedings were taken — All foster children, as soon as reasonably possible after arrival, were 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 period 12 (b) Number of children in respect of whom notice was given 12 (c) (1) Number of children under supervision at end of period 6 (2) Number who died — (3) Number on whom inquests were held — (d) Proceedings taken during the year — 30 Table IX Ante-Natal Clinic Attendances First visits Revisits Average number of revisits per patient Total number of births in the District (Live & Still) Percentage of new cases to total births (Live & Still) 1941 549 2,358 4.33 713 76.30 1942 642 2,912 4.55 826 77.71 1943 674 3,148 4.67 830 81.21 1944 710 3,184 4.48 935 76.74 1945 719 2,815 3-91 832 86.42 1946 940 3,921 4.16 1,117 83.43 1947 819 3,885 5.79 1,130 71.80 1948 (6 months) 376 2,104 4.74 - — Of the 2,480 total attendances, 1,384 occurred at the Manor House Centre and 1,096 at the Branch Centre. Table X Attendances at Infant Clinics Manor House— Seen by Medical Officer:— Infants 727 Children at ordinary clinics 262 Children at toddlers' clinics 216 Weighing only: Infants 2,546 Children 143 New cases (included in above): Infants 222 Children 8 Branch Centre— Seen by Medical Officer: Infants 1,459 Children at ordinary clinics 426 Children at toddlers' clinics 144 Weighing only: Infants 1,552 Children 347 New cases (included in above): Infants 204 Children 28 Total attendances 7,822 The total attendances at the clinics during the past 6 years have been as follows:— 1942 13,346 1946 13,953 1943 12,852 1947 15,425 1944 11,013 First half of 1948 7,822 1945 14,070 31 Table XI Attendances of New Cases to Number of Live Births : (1) (2) (3) New Infant Cases Total live births Percentage of (1) to (2) 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 1,090 75 1947 903 1,108 81 1948 (January to June) 426 589 72 Table XII Number of Inspections in Stated Groups: Manor House Branch Centre Total 18 months 48 38 86 2 years 44 50 94 3 years 27 27 54 4 years 15 36 51 Total Routine 134 151 285 Other Inspections — 1 1 Total 134 152 286 Table XIII Number of Individual Children Found at Routine Medical Inspection to Require Treatment (excluding Dental Disease); Manor House Branch Centre Total 18 months - 8 8 2 years 6 10 16 3 years 8 8 16 4 years 2 5 7 Total 16 31 47 32 Table XIV Number Requiring Dental Treatment : Manor House Branch Centre  18 months - - - 2 years 1 - 1 3 years - - - 4 years - 2 2 Total 1 2 3 Table XV Nutrition Manor House Branch Centre Total A B C D 18 months A 8 9 17 68 1 — B 39 29 C 1 — D — — 2 years A 7 9 16 78 — — B 37 41 C — — D — — 3 years A 5 - 5 48 1 — B 22 26 C - 1 D - — 4 years A 2 2 50 — — B 15 35 c - — D — — Total 134 152 40 244 2 — 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. 33 Table XVI 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 XVI Defects Found Manor House Branch Centre Total Skin 1. Ringworm — - - 2. Scabies - - - 3. Impetigo - - - 4. Other diseases (non-tubercular) 4 4 8 Total 1-4 4 4 8 Eye 5. Blepharitis - - - 6. Conjunctivitis - - - 7. Keratitis and opacities - - - 8. Other conditions (excl. defective vision and squint) - - - Total 5-8 - - - 9. Defective vision - - - 10. Squint - 2 2 Ear 11. Defective hearing - - - 12. Otitis media - - - 13. Other ear diseases - - - Nose and Throat 14. Chronic tonsils and/or adenoids 4 3 7 15. Other conditions - - 16. Enlarged cervical glands (non-tubercular) — — — 17. Defective speech - - - Heart and Circulation 18. Organic heart disease - - - 19. Functional heart disease - - - 20. Anaemia - - - Lungs 21. Bronchitis — - - 22. Other non-tubercular diseases - - - 23. Pulmonary tuberculosis - - - Tuberculosis 24. Glands - - - 25. Bones and Joints - - - Nervous system 26. Chorea - - - 27. Other conditions - - - Deformities 28. Rickets - - _ 29. Genu valgum 18 months 4 - 4 2 years 2 2 3 years — — — 4 years 1 - 1 30. Other forms - - - 31. Other defects and diseases 3 12 23 32. Dental diseases 18 months - - - 2 years 1 - 1 3 years - - - 4 years - 2 2 34 Table XVII Notifications from Midwives Laying-out dead body 1 Liability to be a source of infection 2 Death of child 2 Stillbirths 3 Artificial feeding 3 The reasons for sending 70 notifications for medical help were as follows:— Table XVIII During pregnancy 1 For miscarriage 4 During labour 41 During puerperium 5 Infant eye conditions 3 Other conditions 16 Table XIX Dental Inspection and Treatment Expectant and Nursing Mothers:— Number sent to the dentist for inspection 129 Number of new cases inspected 97 Number of new cases referred for treatment 96 Number for whom treatment was completed 62 Number of completed dentures 24 Number of extractions 181 Number of fillings 184 Number of local anaesthetics 25 Number of general anaesthetics 38 Other treatments 208 Total number of attendances and re-attendances 430 Children under 5 years of age:— Number sent for inspection 79 Number of new cases inspected 65 Number of new cases referred for treatment 62 Number for whom treatment was completed 89 Number of extractions 88 Number of fillings 16 Number of local anaesthetics 10 Number of general anaesthetics 43 Other treatments 79 Total number of attendances and re-attendances to dentist 213 35 Table XX Vaccinations Year Live Births Vaccination Certificates 1938 825 265 1939 805 278 1940 717 289 1941 713 267 1942 826 294 1943 830 316 1944 914 353 1945 810 185 1946 1,090 265 1947 1,108 498 1948 (for period 1st January.4th July) 589 217 Table XXI 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 3,370 0.62 1930 17 29 46 37,56o 1.22 1931 20 28 48 39,280 1.22 1932 22 23 45 41,530 1.08 1933 23 28 51 44,780 113 1934 22 27 49 46,693 1.04 1935 30 27 57 48,270 118 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 50,280 141 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 1948 48 36 84 56,130 1.49 The following table shows the age distribution of the cancer deaths :— Table XXII Ages at Death in Cancer Cases Age 0.15 15.30 30.40 40.50 50.60 60.70 70.80 80 + Total Male - - 1 2 6 19 15 5 48 Female . 1 1 6 7 12 8 1 36 Total . 1 2 8 13 31 23 6 84 36 The following table shows the various infectious diseases (other than tuberculosis) notified during the year and also their age incidence :— Table XXIII 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 25 31 30 28 28 62 2 2 1 1 1 - 211 - Scarlet fever 2 4 2 10 11 51 19 5 3 1 1 1 110 - Diphtheria - - - - 3 - - 3 - - 1 - 7 - Measles 32 114 100 113 115 338 5 2 3 2 1 - 825 1 Puerperal pyrexia - - - - - - - 2 2 - - 4 - Erysipelas 1 - - - - 1 1 - 1 7 5 3 19 - Pneumonia 6 4 2 4 2 9 - 8 6 12 10 6 69 27 Cerebro-spinal fever, etc. - - - - - - - 1 - - 1 - 2 - Dysentery - - - - - - - - 3 4 4 1 12 - Poliomyelitis - - - - - 1 1 - - - - - 2 - Ophthalmia neonatorum 1 - - - - - - - - - - - 1 - The number of cases of infectious diseases (including tuberculosis) notified during the year, according to their locality, are shown below :— Table XXIV Diseases Total Waxlow Manor Northcote Hamtrough Dormers Wells Glebe Norwood Green Total Deaths Scarlet fever 110 13 11 9 16 34 27 - Diphtheria 7 - 1 - 3 2 1 - Puerperal pyrexia 4 2 - 1 - 1 — - Pneumonia 69 11 10 6 7 22 13 27 Ophthalmia neonatorum 1 — 1 - - — - - Tuberculosis (all forms) 127 21 13 18 30 31 14 22 Erysipelas 19 4 3 - 7 2 3 - Measles 825 158 87 97 172 189 122 1 Whooping cough 211 28 22 34 25 60 42 - Cerebro-spinal fever,&c. 2 - — - 1 — 1 - Poliomyelitis 2 2 - - - - - - Total 1,377 239 148 165 261 341 223 50 37 Cases of infectious diseases occurred during the year among schoolchildren as follows :— Table XXV School Scarlet Fever Diphtheria Beaconsfield Road 3 - County School - - Clifton Road 11 - Dormers Wells 2 - Featherstone Road 11 - Western Road 2 - North Road 4 - St. Anselms - Tudor Road 6 - Lady Margaret Road 8 - Other Schools 1 - 48 - Table XXVI Age Periods New Cases Deaths Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary Male Female Male Female Male Female Male Female 0-1 - - - 1 - - - - 1-5 - 2 - - — 1 — — 5-10 2 4 - 1 - - - - 10-15 1 4 1 1 - - - - 15-25 18 23 3 3 3 1 - 2 25-35 9 13 - 1 4 1 - - 35-45 14 4 1 2 1 1 - - 45-65 9 7 - - 6 1 - - 65+ 3 - - - 1 1 - - Totals 56 57 5 9 15 6 - 2 Of the 2 deaths, both were of notified cases. Table XXVII The occupations of the new cases were as follows:— Occupations Pulmonary Non-Pulmonary Male Female Male Female Building and decorating trades 2 - - - Schoolchildren 3 9 2 2 Clerical work 5 4 - - Domestic duties - 19 - 3 Factory hands 5 5 _ 2 No occupation 9 9 — 2 Various 32 11 3 - Totals 56 57 5 9 38 Table XXVIII Isolation Hospital Admissions and Discharges Remaining on 31.12.47 Admitted during year as Subsequently diagnosed as Discharged recovered as Died Transferred Scarlatina 12 76 70 80 - - Diphtheria - 6 2 1 1 - Measles — 5 12 12 - - Measles and pneumonia - 8 3 2 1 - Measles and chicken pox - - 1 1 - - Infectious hepatitis 1 - — 1 — - Vincent's angina - 1 1 1 - - Tonsilitis 1 1 8 8 - — Erysipelas - 2 2 2 - - Mumps - 1 1 1 - - Quinsy - - 1 1 - - Pneumonia with laryngeal spasm - - 1 - 1 — Table XXIX Isolation Hospital Monthly Admissions and Discharges Number Admitted Final Diagnosis Number Discharged Scarlet Fever Diphtheria Measles Measles and Pneumonia Measles and Chicken Pox Mumps Vincent's Angina Tonsilitis Erysipelas Quinsy Pneumonia with Laryngeal Spasm Scarlet Fever Diphtheria Measles Measles and Pneumonia Measles and Chicken Pox Mumps Vincent's Angina Tonsilitis Erysipelas Quinsy January 13 - - - - 1 _ 1 2 1 - 12 - - - - 1 - 2 2 - February 6 - 1 - 1 - - 1 - - - 8 - 1 - - - - 3 - - March 8 - 3 2 - — — 3 — — - 9 - 1 1 1 - - 2 - - April 9 - 6 1 - — — 1 — — — 10 - 5 1 - - - 1 - - May 16 1 2 - - - - 1 - - - 8 ~ 4 - - - - - - - June 18 — — — — — 1 - - - 1 15 - 1 - - - 1 - - - July - - - - - - - - - - - 18 1 - - - - - - - - August - - - - - - - - - - - 2 - - - - - - - - - 70 1 12 3 1 1 1 7 2 1 1 82 1 12 2 1 1 1 8 2 - 39 Table XXX Houses, Public Health Act, 1936 5,109 Houses, Housing Act, 1936 53 Overcrowding 266 Disinfestation 333 War Damage 2 Vans, Sheds 24 Shops Acts 138 Food Shops 700 Fried Fish 24 Cafes, etc 261 Factories (Mechanical) 112 Factories (Non-Mechanical) 19 Outworkers 32 Food Factories 339 Smoke 43 Bakehouses 21 Dairies 85 Water Sampling 8 Milk Sampling 94 Other Foods Sampling 153 Schools 7 Stables 40 Accumulations 117 Hairdressers 1 Slaughterhouses 29 Rats and Mice 232 Petrol 97 Canal Boats 12 8,351 40 Table XXXI Statistics. HOUSING 1. Inspection of dwelling-houses during the year:— (i) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 1,213 (b) Number of inspections made for the purpose 5,162 (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 677 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 617 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 152 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 184 (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 - 41 Table XXXI—continued. (d) Proceedings under Section 12 of the Housing Act, 1936:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made - (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement room having been rendered fit - 4. Housing Act, 1936—Overcrowding:— (a) (1) Number of dwellings overcrowded at the end of the year 118 (2) Number of families dwelling therein 195 (3) Number of persons dwelling therein 839 (b) Number of new cases of overcrowding reported during the year 70 (c) (1) Number of cases of overcrowding relieved during the year 54 (2) Number of persons concerned in such cases 253 (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 2 42 INDEX. page Adoptions 30 Ambulance facilities 10 Ante-natal clinics 11, 31 Antitoxin 15 Area of Borough 7 Assisted Services 14 Bed bugs 20 Birth control 11 Births and birth rate 8, 29 Blindness, Prevention of 17 Canal boats 20 Cancer 16, 36 Carbide 22 Catering establishments 23 Causes of death 27 Celluloid and Cinematograph Film Act 22 Child life protection 10,30 Chiropody 20 Clinics9, 31 32, 34 Consultant aid 10 Day nurseries 14 Deaths and death rates 8, 27 Deaths in wards 27 Dental treatment 14, 33, 35 Diphtheria 16, 19,38 Diphtheria prevention clinic 16 Disinfection 16 Factories Act, 1937 21 Food inspection 22, 23 Food poisoning 19 Food sampling 22 Foster parents and children 30 Health Services, General provision of 9 Health propaganda 13 Health visiting 10, 30, 32 Hospital admissions 19 Houses—number inhabited 7 Housing 22, 41 Infant mortality 8, 29 Infant welfare clinics 9,31,34,38 Infectious Diseases, Prevalence and control of 15, 17, 38 Inspection and supervision of food 22 Inspection of sanitary accommodation in factories 21 Institutional provision 10 Irradiation experiment 18 Insulin 15 Isolation Hospital 18, 39 Immunisation 17 Laboratory facilities and work 9 Massage, Establishments for 20 Maternal morbidity 9, 29 Maternal mortality 29 PAGE Maternity and child welfare 10, 12 Maternity and Child Welfare Committee 3 Maternity and Nursing Homes 14 Meat and other foods 22 Medical help 35 Midwives 13, 35 Milk grants 14 Milk licences 22 Milk sampling 22 Mortuary 20 Moral welfare 11 Notifiable diseases 17, 37 Nursing in the home 9 Nutrition 33 Ophthalmia neonatorum 17 Overcrowding 42 Outworkers 21 Petroleum Acts 22 Physical feature of district 7 Poliomyelitis 17 Population 7 Post-natal clinics 11 Premature infants 8 Pre-school medical inspection 12 Propaganda—Health 13 Public Health Committee 3 Puerperal pyrexia 9 Rats and mice 24 Rateable value 7 Remedial exercises 13 Sanitary circumstances 20 Sanitary inspection 20, 40 Scabies clinic 9 Scarlet fever 16, 19, 38 Shops Acts 22 Smallpox 16 Social conditions 7 Staff 6, 7 Statistics—General and vital 7, 26 Statutory action 40 Stillbirths 8, 26, 35 Tuberculosis 18, 37, 38 Ultra-violet light clinic 11 Uncleanliness of school children 17 Unfit houses 41 Vaccination 16, 3d Venereal disease clinics, etc. 18 Verminous persons 9 Vital statistics 26, 28 Voluntary help 13 Water supply 20 Whooping cough, Prevention of 17 43