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2003a1e5-10a7-4336-81f9-1498d7a90254 | - - berculosis - - - - - - - - - - - - - - - Other - - - - - - - - - - - - - - - lous Disease - - β - β β β β - - β - β β β Meningitis (not - - - - - - - - - - - β - - β Tuberculous) - - - - - - - - - - - - - - β Convulsions - - β β β 2 β β - 2 2 β 2 β β Laryngitis - - - - - - - - - - - - - - β Bronchitis - - β 1 1 β β β 1 2 1 1 2 β β Pneumonia (all forms) - - - - - - 1 1 - 2 - 2 - 2 2 DiarrhΕa and Enteritis - - - - - 1 1 - - 2 1 |
3351e61a-dad5-40cb-9a07-c24215703a10 | 1 2 - - Gastritis - - - β - β β β - β β β β - β Syphilis - - - β β β 1 β - 1 β 1 1 β β Rickets - - β β β β - β - β β β β β β Atropyh Debility and Marasmus - - - - - 1 - - - 1 - 1 1 - - Premature Birth 3 - β - 3 1 β β β 4 β 4 1 3 2 Congenital Malformations 2 1 - - 3 - - - - 3 2 1 3 - - Injury at Birth β - β β β β β β - β β β β β - Atelectasis 4 1 β β 5 β β β - 5 1 4 5 β - Suffocation (overlaying) - - - - - - - - - - - - - - - Violence |
ff6b040a-19a0-457b-be91-428d54b4f12a | 2 β β β 2 β β β 2 2 2 β 2 β - Other causes β 1 β 1 2 β 1 β β 3 2 1 2 1 1 All causes 11 3 - 2 16 5 4 1 3 29 11 18 2 3 6 5 Nett Births in the Year: Total Births, 574; Legitimate,548; Illegitimate, 26. Nett Deaths (under 1 year): Total Deaths, 29; Legitimate Infants, 21; Illegitimate Infants, 8. Infantile Mortality Rate: Total, 51; Legitimate, 39; Illegitimate, 308, 14 Vital Statistics. |
e4f5c045-761f-4c00-a867-a061e3182b06 | There were 548 births of legitimate children during 1922, and only 21 deaths occurred amongst legitimate infants under one year of age, whereas in the case of illegitimate infants, whilst there were only 26 illegitimate births, the number of deaths of illegitimate infants numbered 8 in the year. This gives an Infantile Mortality rate amongst legitimate infants of 38 per 1,000 legitimate births contrasted with a rate amongst illegitimate infants of 308 per 1,000 illegitimate births registered. Illegitimacy increased during the years of war, and the rate of Infantile Mortality amongst these infants rose to a very high figure. Illegitimacy has since decreased, but the mortality rate remains high. The following table gives the figures for the period 1914-1922. Year. Proportion of Illegitimate Births per 1,000 Total Births Registered. |
24c5f731-06e7-4a6f-81d8-b97e83d7728b | Infantile Mortahtw Deaths of Legitimate Infants per 1,000 Legitimate Births. Deaths of Illegitimate Infants per 1,000 Illegitimate Births. 1914 50 63 83 1915 43 65 519 1916 52 48 380 1917 81 54 238 1918 86 83 132 1919 51 70 461 1920 41 56 312 1921 51 58 182 1922 45 38 308 In the ease of all illegitimate births notified, the infants are specially "follovved-up" and kept under supervision to endeavor to reduce the high death-rate amongst them. Notifiable Infectious Diseases. 15 2. NOTIFIABLE INFECTIOUS DISEASES. |
c00c8656-3493-4a2d-8a0b-2f588eff9548 | The following are the Infectious Diseases cumpulsorily notifiable in the District, and the number of cases notified during 1922 is given for each disease. Diphtheria 65 Scarlet Fever 100 Enteric Fever β Puerperal Fever 1 Erysipelas 6 Continued Fever β Relapsing Fever β Typhus Fever β Small Pox β Cholera β Plague Tuberculosis 62 Cerebro Spinal Fever β Acute Poliomyelitis β Opthalmia Neonatorum 3 Measles 590 Rubella β Encephalitis Lethargica β Acute Polioencephalitis β Malaria β Dysentery β Trench Fever Pneumonia 29 Anthrax β Table showing the Notifications of Infectious Diseases received during 1922 arranged in four-weekly periods:β Four weekly period ending Diphtheria. Scarlet Fever. Pneumonia. |
0ccfba8f-421c-44dd-b728-ab1d2b0d0e03 | Erysipelas Ophthalmia Neonatorum. Measles. Pulmonary Tuberculosis. Non-pulmonary Tuberculosis. Puerperal Fever January 28 6 16 4 1 β 42 3 β β February 28 8 13 2 β 114 9 1 β March 25 2 13 3 β 1 239 6 1 β April 22 7 5 3 β β 87 4 3 β May 20 15 12 4 2 β 48 5 1 β June 17 2 10 1 β β 16 6 β β July 15 5 4 1 β 1 5 2 3 1 August 12 6 7 2 β β 23 7 β β September 9 2 3 1 β β 3 1 1 β October 7 1 6 3 β |
3aadae11-af1d-4fe9-9f70-ec3958383dac | 1 3 2 β β November 4 5 6 3 β β 5 4 β β December 2 2 4 2 3 β β 1 β β December 31 4 1 β β β 5 2 β Totals 65 100 29 6 3 590 52 10 1 16 Notifiable Infectious Diseases. Table showing the distribution in age-groups of the cases notified during 1922, the number of cases removed to hospital, and the total numbers of deaths in the District from these diseases. Diseases. Total Cases Notified. Ages, in years. Parish. Removed to Hospital. total Deaths of Residents. Β§ Under 1 year. 1 to 2. 2 to 3. 3 to 4. 4 to 5. 5 to 10. 10 to 15 15 to 20 20 to 25. |
96bb3cd4-1832-4a7e-8f75-d0b5bbfa3c20 | 25 to 35 35 to 45. 45 to 65. 65 and over. Barnes Mortlake. Diphtheria 65 β β 3 2 2 25 17 8 3 2 2 1 β 23 42 61 3 Scarlet Fever 100 β 3 2 2 3 39 29 10 6 4 1 1 β 44 56 85 4 Puerperal Fever 1 β β β β β β β β β β 1 β β β 1 β 1 Pneumonia 29 2 2 β β β 5 2 β 1 2 5 9 1 5 24 β 25 Erysipelas 6 β β β β β 1 1 β 1 1 1 1 β 2 4 1 1 Opthalmia Neonatorum 3 3 β β β |
4a27fb9e-ad59-4ee4-ba70-c56dd002ba64 | β β β β β β β β 1 β 2 β Measles 590 13 57 37 29 37 367 40 7 1 2 β β β 193 397 β 2 Tuberculosis: (a) Pulmonary M. 24 β β β β β 2 2 β 2 7 6 5 β 12 12 β 14 F. 28 β β β β β 1 β 4 4 9 7 1 1 10 18 β 13 Total 52 β β β β β 3 3 4 6 16 13 6 1 22 30 23β‘ 27 (b) Non- Pulmonary M. 3 β β β β β 1 2 β β β β β β 2 1 β 1 F. |
caea163c-51d8-4519-be14-ec6e8c8be692 | 7 β β β β β 3 β 1 1 2 β β β 2 5 β 2 Total 10 β β β β β 4 2 1 1 2 β β β 4 6 β 3 All Diseases ... 856 18 62 42 33 42 444 94 30 19 29 23 18 2 294 562 171 96 β‘ 23 Pulmonary Tuberculosis patients were removed to Institutionsβ14 to Sanatoriums and 9 to Barnes Isolation Hospital. Β§ The deaths recorded in this column are the total corrected number of deaths assignable to the District; in the case of Pneumonia and Tuberculosis the deaths recorded are not necessarily deaths of persons recorded as notified during the year. Notifiable Infectious Diseases. |
d25a098e-75ac-4e67-aa01-2aebf39abff0 | 17 For purposes of comparison of the incidence of notifiable diseases occurring in the District, a Table is given below of the cases notified during 1922 and during the previous 10 years. Year. 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 Diphtheria 56 67 56 41 34 28 29 42 103 90 65 Scarlet Fever 109 95 153 137 94 37 32 88 69 108 100 Enteric Fever 2 1 2 3 2 6 β β 3 1 β Puerperal Fever 1 β β 6 1 β 3 2 4 β 1 Erysipelas 12 16 11 12 8 8 2 13 13 6 6 Continued Fever β β β β β β β β β β β Relapsing |
2a18551a-b02b-4d48-bf7b-1c693b2bc39e | Fever β β β β β β β β β β β Typhus Fever β β β β β β β β β β β Small-pox β β β β β β β β β β β Cholera β β β β β β β β β β β Plague β β β β β β β β β β β Tuberculosis, P. 106 74 66 60 55 54 58 44 35 52 52 β Non-P. β 28 22 9 β 14 17 12 6 4 10 Cerebrospinal Fever β β β β 3 4 2 2 β β β Poliomyelitis 1 2 β 4 3 β 1 β β β β Ophthalmia Neonatorum (Not Notifiable) 2 2 1 3 2 3 3 1 3 Measles and Rubella (Not Notifiable) 429 743 620 159 |
07ba3e6f-b8ec-4b05-b3c8-fe27b8343360 | 570 44 590 Encephalitis Lethargica (Not Notifiable) 2 1 5 β Polio encephalitis β β β β β β β Malaria β β β 18 12 β β Dysentry β β β 1 1 β β Trench Fever β β β 3 1 β β Pneumonia β β β 67 35 34 29 Anthrax β β β β β β β 18 Notifiable Infectious Diseases. DIPHTHERIA. The usually severe epidemic of Diphtheria which commenced in this district in the autumn of 1921, and which was associated with and followed on the appearance, in epidemic form, of Diphtheria in the County of London, was declining at the end of that year. Through January and February of 1922 the epidemic continued to decline, and in March there was very little Diphtheria in the District. |
5daf0769-e15e-46ab-9aa9-b9c4840471f8 | An outbreak of limited proportions occurred during April and May, but from then onwards until the end of the year the number of cases occurring were comparatively few. The number of cases notified during the year was 65, of which 61, or 94 per cent. of the cases, were removed to Hospital; only 4 cases were treated at home. Every case where it was considered isolation and treatment could not be effectively carried out at home was removed to Hospital. The incidence rate (cases per 1,000 of population) was 1.90, compared with 1.37 for England and Wales, and 3 38 for London. Had the incidence rate in Barnes corresponded to that in London, there would have occurred in the District 115 cases, and an incidence-rate in the District corresponding to that of England and Wales would have given only 48 cases. |
4806d5fa-0fa2-4131-9f7d-02f4635ae997 | Three deaths occurred, representing a mortality rate per 100 cases of 4.61, compared with a rate of 8.00 per cent. for England and Wales, and 7.44 per cent. for London. Of three fatal cases one died 3 days after admission from acute toxæmia; in the other two cases death was due to heart failure associated with diphtheritic paralysis. In a large proportion of the case? admitted to Hospital the disease was of a severe type. The majority of the severer cases were sent into Hospital at the beginning of the illness, and a fatal issue was avoided by the early administration of Antitoxin ; a small number of cases unfortunately still come into Hospital rather late in the course of the disease, and even where a fatal termination is avoided in these cases the illness is liable to be far more serious and more protracted than it otherwise would be. |
04b0c77f-5035-4bb1-9095-223d92eb4d2a | To enable an early diagnosis to be arrived at and to secure prompt administration of antitoxic serum, Notifiable Infectious Diseases. 19 logical outfits are supplied, and inoculated swabs from suspected cases are examined bacteriologically by the Public Health Department for Medical Practitioners free of charge, and diphtheria antitoxin is supplied to Medical Practitioners on request. Every case notified is carefully investigated by an Officer of the Health Department, and the effective preventive measures outlined in my Annual Report for 1921 (page 23) have been continued throughout the past year. The 65 cases of Diphtheria notified came from 62 separate families; in 59 of these families only one case occurred in each family. In the other three families there were two cases in each family; in each of these instances the second case had contracted the disease before the removal of the first case to Hospital. |
3b40c72a-380d-4137-af6e-29aa2ccf74fa | In no instance did another occupant of the house become infected after removal of the patient to Hospital and subsequent disinfection of the premises had been carried out, and in no instance did a second case occur subsequent to a patient's return home after discharge from Hospital. Table showing thenumberof notifications of Diphtheria received during 1923, the number of cases removed to Hospital and the number of cases treated at home, arranged in four-weekly periods:β Four-weekly period ending: Number of cases notified. Number of cases removed to Hospital. |
1ae58541-a623-49dd-a5c2-4d3c5451db5a | Number of cases treated at home January 28 6 6 β February 25 8 7 1 March 25 2 2 β April 23 7 7 β May 20 15 14 1 June 17 2 2 β July 15 5 3 2 August 12 6 6 β September 9 2 2 β October 7 1 1 β November 4 5 5 β December 2 2 2 β December 31 4 4 β Total 65 61 4 20 Notifiable Infectious Diseases. Table showing the number of cases of Diphthera notified and the incidence rate (cases per 1,000 of population), the number of cases and the percentage of cases removed to Hospital, and the number of deaths and the mortality-rate per 100 cases during the past 10 years:β Year. Number of Cases Notified. Number of cases removed to hospital Number of Deaths. |
8662c89d-da01-4dec-b204-389f02d1cb69 | Incidence Kate. Cases per 1,000 of Population. Percentage Removed to Hospital. lity Rate per 100 cases. |
c80d75fa-8bd1-4147-8dbd-de067839cbf1 | 1913 67 43 2 2.01 64 % 3.00 1914 56 40 β 1.61 71 0.00 1915 41 32 1 1.22 78 2.44 1916 34 25 1 1.06 74 2.94 1917 28 27 1 0.86 96 3.57 1918 29 28 3 0.89 97 10.34 1919 42 38 4 1.27 90 9.52 1920 103 56 7 3.07 54 6.80 1921 90 77 1 2.88 84 1.10 1922 65 61 3 1.90 94 4.61 SCARLET FEVER. |
2ffbccda-7d1b-4901-a9f4-c64e98f66612 | Scarlet Fever was epidemic in the District at the commencement of the year 1922. The severe epidemic which had occurred in the last quarter of 1921 was then on the decline, and the number of fresh cases continued to decrease through the first four months of the year; there was a slight increase in prevalence of the disease in May and June, and from then throughout the rest of the year the cases notified markedly decreased in number. The number of cases notified during the year was 100, nearly three-quarters occurring during the first half of the year; 85 per cent. of the cases were removed to Hospital In 15 of the cases the home circumstances were such that effective isolation could be carried out at the patients' homes, and these cases were not removed. The incidence-rate (cases per 1,000 of the population) was 2.93βthat for England and Wales being 2.85 and for London 3.81. |
7e703e18-a17a-480f-b399-d02a3032048f | Four deaths occurred, representing a mortality-rate per Notifiable Infectious Diseases. 21 100 cases of 4 00, compared with a rate of 1.40 per cent. for England and Wales and of 1.74 per cent. for London. A larger proportion than usual of the cases admitted were suffering from the disease in a severe form; in several of these the disease was of the toxic type, complicated by unusually early and severe nephritis, and to this circumstance the high percentage mortality is to be attributed. Of the four fatal cases two died from acute toxæmia on the second day after admission, one from acute nephritis with suppression of urine on the sixth day after admission, and in the fourth case death was due to uraemic convulsions on the third day after admission. The 100 cases notified came from 90 families. In 83 families one case only of the disease occurred in each family. |
256d2ef2-dc06-426e-839e-86665ffdf3a0 | In 5 families two cases of the disease occurred in each (in each of these families the second case had become infected from the first case before the latter's removal to Hospital). In one instance, where two families occupied separate floors in one house, investigations following the notification of a case of scarlet-fever led to the discovery of six other casesβeach of these children had suffered from the disease in a mild form, no medical advice had been sought, and the cases had remained undiagnosed, and were found on examination to be disquamating; all were removed to Hospital. There was no "return case" of Scarlet Fever during the year. The preventive measures taken have been of the same character as those carried out during 1921, details regarding these will be found on reference to my Annual Report for that year (page 23). 22 Notifiable Infectious Diseases. |
031a3ecb-25ba-4690-a17c-35ee02323419 | Table showing the number of Notifications of Scarlet Fever received during 1922, the number of cases removed to Hospital, and the number of cases treated at home arranged in four-weekly periods:β Four weekly period ending Number of cases notified. Number of cases removed to Hospital Number of cases, treated at home. |
3b405875-d38d-4b90-b316-ee027ab93620 | January 28 16 13 3 February 25 13 11 2 March 25 13 13 β April 22 5 3 2 May 20 12 9 3 June 17 10 6 4 July 15 4 4 β August 13 7 7 β September 9 3 3 β October 7 6 6 β November 4 6 5 1 December 2 4 4 β December 31 1 1 β Totals 100 85 15 Table showing the number of cases of Scarlet Fever notified and the incidence-rate (cases per 1,000 of population), the number of cases and percentage of cases removed to Hospital, and the number of deaths and mortality rate per 100 cases during the past 10 years:β Year. Number of Cases Notified. No. of Cases removed to Hospital. Number of Deaths. |
a58e867f-578b-45d1-8026-f004a9d5b8d5 | Incidence Rate Cases per 1,000 of Population. Percentage removed to Hospital. Mortality Pate per 100 Cases. |
bea33a24-bfb1-4bb0-9d3a-365dba0d849f | 1913 95 82 β 2.85 86 0.00 1914 153 119 β 4.40 78 0.00 1915 137 111 3 4.09 81 2.19 1916 94 81 2 2.94 86 2.13 1917 37 35 β 1.12 95 0.00 1918 32 25 1 0.99 78 3.13 1919 88 63 β 2.65 72 0.00 1920 69 57 1 2.02 83 1.45 1921 108 83 1 3.18 77 0.92 1922 100 85 4 2.93 85 4.00 Notifiable Infectious Diseases. 23 ENTERIC FEVER. |
a0d76f3e-9dd5-4953-abe2-56fdaf2eae4e | No case of Enteric Fever occurred in the District during 1922. The comparative freedom of the District from Enteric Fever is significant and is undoubtedly due to the safety of the water supply and to the almost universal adoption throughout the District of a water carriage system of sewage disposal. Cases occurring in the District are generally contracted outside the District, often in less sanitary areas, and the disease, once imported, does not gain a foothold. The cases notified during the previous 5 years were 6, 0, 0, 3 and 1 respectively. Comparative figures are:βIncidence Rate (cases per 1,000 of population)βBarnes, 0.00; London, 0.06; England and Wales, 0.06. Mortality Rate per 100 casesβBarnes, 00 per cent.; London, 16.6 per cent; England and Wales, 18.0 per cent. SMALL-POX. |
adcae27a-4e03-4aff-81ee-cd89b841861c | No case of Small-pox occurred in this District. During the year 962 cases were notified in England and Wales, and the disease was present in the Country throughout the year. An outbreak occurred in the County of London in September, and cases continued to arise in London, and in some of the surrounding Sanitary Districts, until the end of the year; in all 62 cases were notified in London, and 20 of these cases proved fatal. In view of the occurrence of cases of Small-pox in neighbouring Sanitary Areas, special preventive measures were taken in the District. The public were informed by posters and handbills of the importance of protecting themselves and their children by vaccination, or re-vaccination; contacts coming into the area were kept closely under observation, and as Chicken-pox was prevalent at this time, cases of the disease which were not being medically attended, were visited to ensure that a mild case of modified Small-pox should not escape detection by being mistaken for one of Chicken pox. |
5ea2b0b6-0f04-44f3-bcda-2ab65f92f9d7 | 24 Notifiable Infectious Diseases. Vaccination. The following return as to Vaccination during 1922, has been supplied to me by the Vaccination Officer for the District:β Births 524 Certificates of successful Vaccination 528 Certificates of exemption (statutory declarations) 157 Certificates of Insusceptibility 1 Removals from District 20 Postponements (health of Child) β Certificates of Insusceptibility from Public Vaccinator β Certificates of infectious disease or condition of house β MEASLES. Measles was made compulsorily notifiable throughout England and Wales in January, 1916, but ceased to be notifiable on January 1st, 1920. The disease however has remained a notifiable one in this District by reason of the City of Leeds, &c. (Measles and German Measles) Regulations, 1920. |
6df29c9f-5f12-4639-880b-c42047b307ff | An outbreak of Measles occurred at the commencement of the year, rapidly assuming epidemic proportions. During January 42 cases were notified, during February 114 cases, and during March the number notified reached the high figure of 239 The number of cases then rapidly decreased, 87, 48 and 16 cases respectively being notified during the next three months. The total cases notified during the year was 590, 40 only of these occurring during the last six months. The age-distribution of the cases is interesting and important. Of the 590 notified cases 173 ware infants under 5 years of age, 277 cases were children of 5 to 7 years of ageβthe age of attendance at the Infants' Schools, 109 were of 8 to 10 years of age, that is in attendance at the Junior Mixed Schools, and only 21 cases occurred amongst children of 11 to 14 years of age in attendance at the Central Schools. Eleven cases only were over school age. |
c205abf8-dec8-4098-b4ca-d3f1c3d5cba4 | The attack rate of measles is usually highest in the third, fourth and fifth years of life, whilst the death rate caused by the Notifiable Infectious Diseases. 25 disease is highest in the first and second years of life. After the age of five years the death rate caused by it is relatively very small. It is therefore of the utmost importance to adopt special measures aimed at ensuring increased safety for children under five so as to postpone attacks of measles to a later age when it is less fatal, or to avoid attacks by specially protecting young children until they have attained a less susceptible age. The cases were mainly, fortunately, mild in type; the two deaths which occurred were deaths of infants between 1 and 2 years of age. It was found necessary to close one Infants' School and the Day Nursery for a short period to prevent the spread of the disease. |
b8f1ed78-a367-4911-87d6-58fb13cbb05c | The number of cases notified in each of the previous 5 years was in 1917, 743 cases; 1918, 620 cases; 1919, 159 cases; in 1920, 570 cases; and in 1921, 44 cases respectively. Two deaths occurred, corresponding to a death-rate of 0.06 per 1,000 of the population, contrasted with 0.35 for London, and 0.15 for England and Wales. The important steps, apart from precautionary measures to limit as far as possible the spread of the disease, are to endeavour to persuade the parents to obtain medical treatment in all cases and, by instructions to the parents, to secure for the patient the care in nursing which is so important in avoiding the serious complications of the disease. These are the steps, amongst others, taken by the Health Visitors in their work of "following up" the cases notified, and this work had most beneficial results. |
07998e71-efe4-484c-b53a-70bc9de68d73 | Notification is obligatory upon the parent unless the case has been already notified by a Medical Practitioner in attendance. Unfortunately in many cases a doctor is not called in, and, in a certain proportion of these, the parent fails to notify the case to the Medical Officer of Health. It is on this account that the arrangement whereby Head Teachers are required to notify to the Medical Officer of Health and to the School Medical Officer the names and addresses of all children absent from School and believed to be suffering from, or contacts of, a case of infectious disease, are of the utmost importance. It is only by this means that the majority of unnotified cases can be brought to the notice 26 Notifiable Infectious Diseases. of the Medical Officer of Health. Whilst the majority of Head Teachers, I am pleased to say, act with promptitude in reporting the cases, some of them fail to appreciate their responsibilities in these matters. |
ccbb44e6-0963-4b43-8544-c2792c04288d | A school cannot be expected to be other than a potent agent in the spread of infectious disease unless there is this co-operation between Head Teachers and the Public Health Department. PNEUMONIA. The number of cases notified in 1921 was 29, contrasted with 67, 35 and 34 respectively in 1919, 1920 and 1921. Priorto 1919 the disease was not notifiable. Cases notified from the homes of families in poor circumstances are visited by the Health Visitors, and where the conditions are such that a case cannot receive appropriate nursing and treatment at home, the patient is removed to the Isolation Hospital for treatment, providing there is accommodation at the time. PUERPERAL FEVER. One case of Puerperal Fever was notified during the year, and the case proved fatal. The notifications for each of the preceding 5 years numbered 0, 3, 2, 4 and 0 respectively. |
1941ab64-0f09-4587-becf-9b49e29cd322 | ERYSIPELAS. Six cases only of Erysipelas were notified, and 1 death occurred from this disease. The number of notifications for each of the previous 5 years being 8, 2, 13, 13 and 6 respectively. OPHTHALMIA NEONATORUM. Three cases of Ophthalmia Neonatorum were notified, contrasted with 3, 3, 2, 3 and 1 respectively in the previous 5 years. Two of the cases were treated in Hospital, and, fortunately, no impairment of vision resulted in either of the cases notified. Ophthalmia Neonatorum is an inflammation of the eyes of newly-born infants, the eyes becoming infected at the time of birth or subsequently by conveyance of infection from the hands of the mother or nurse. The disease is to be regarded with the utmost Notifiable Infectious Diseases. 27 gravity as it results only too often in partial loss of sight or complete blindness. |
59a8255d-677e-41d0-bbbe-b32579648cbe | Ophthalmia Neonatorum is the cause of the blindness of over 40 per cent. of the inmates of our Institutions for the Blind. In consequence of its importance the disease was made notifiable by doctors and midwives in 1914. I am convinced that a certain proportion of these cases are not notified in accordance with the requirements of the Public Health (Ophthalmia Neonatorum) Regulations, 1914, and in the event of any such cases of non-compliance with the Regulations coming to light I shall advise the Council to institute proceedings against the person failing to notify. TUBERCULOSIS. During the year 52 cases of Pulmonary Tuberculosis and 10 cases of Non-pulmonary Tuberculosis were notified, representing an incidence-rate (cases per 1,000 of population) of 1.53 for Pulmonary Tuberculosis and of 182 for all forms of the disease. |
783a57d8-c28a-4971-97a8-d17a3fd0c002 | The number of notifications from this disease during the previous 10 years is shown in the table on page 17. The number of deaths assignable to this district, after correction for transferable deaths, from Tuberculosis was 30 (27 being due to the pulmonary form of the disease and 3 to the non-pulmonary form), representing a death-rate of 0.85 per thousand of population for all forms of Tuberculosis, and of 0.77 per 1,000 of population for Pulmonary Tuberculosis. Notification of Tuberculosis. Of the 30 deaths from Tuberculosis assignable to this District during 1922, in 7 of them the case had not been notified as one of Tuberculosis during the patient's lifetime, giving a ratio of nonnotified tuberculosis deaths to total tuberculosis deaths of 23 per cent. |
9fe780f0-c8f5-4b73-b96a-d19e45179006 | Of the 7 non-notified deaths 5 were "Inward Transfers," these deaths from tuberculosis having occurred outside the District; inquiries from the Medical Officer of Health of the districts in which the deaths took place showed that the cases had not been notified in those districts. Two of the non-notified deaths were those of residents whose death actually took place in the District. 28 Notifiable Infectious Diseases. Preventive Work in relation to Tuberculosis carried out by the Council. (1) Home Visiting.βThe home of every patient notified is visited by a Health Visitor with the object of giving instructions and advice as to prevention, and of inquiring into the home conditions. Sanitary defects discovered are reported to the Health Department for remedy. The homes of 71 tuberculosis patients were thus visited during the year, and 254 re-visits were made, making a total of 325 home visits by the Health Visitors in connection with patients suffering from tuberculosis. |
3caa24e2-858a-43ed-bee5-a4fe9ec8f06f | (2) Sputum outfits are supplied for the patient's use if required. (3) Disinfectants are supplied from the Public Health Department. (4) Disinfection at the home is carried out after death, or on a patient's admission to an institution, and on such other occasions as are necessary. (5) To assist in the early diagnosis of cases, specimens of sputum are examined bacteriologically at the Council's laboratory free of charge. There were 163 specimens of sputum examined during the year. TreatmentβDispensary and Institutional. The Surrey County Council is the Local Authority responsible for the treatment (institutional, dispensary, and domiciliary) of all tuberculosis cases within the Urban District, and statistical returns as to the work carried out are furnished to the County Medical Officer, and will be published in his Annual Report. |
b5246ef0-197d-4f5e-8874-ef75eb3c712e | Close co-operation between the Medical Officer of Health and the Tuberculosis Officer has been laid stress upon by the Ministry of Health as being essential, and the Ministry suggested that the Tuberculosis Officer should, for the purpose of Tuberculosis Notifiable Infectious Diseases. 29 Regulations, act as an Officer of the Sanitary Authority under the direction of the Medical Officer of Health. Being Medical Officer of Health and Tuberculosis Officer for the District, the advantages of the Ministry's suggestions are obtained. Two Health Visitors carry out, amongst other duties, the work of Tuberculosis Nurses. By arrangement with the Surrey County Council, a Tuberculosis Dispensary is provided in the Isolation Hospital Grounds, and advanced cases, from the County area, as well as from the Urban District, are admitted to a special Tuberculosis Block at the Hospital. Tuberculosis patients in this District are also sent away to other Sanatoriums under the County Scheme. Tuberculosis Dispensary. |
dc537048-ceb7-4968-b24f-ac7b4cd369ad | Patients attend under the following circumstances:β (1) Cases attending for examination for the purpose of diagnosis. (2) Contacts attending for examination and observation. (3) Doubtful cases attending for re-examination and further observation until a diagnosis is made. (4) Patients suffering from tuberculosis who are under medical treatment by their own doctor, and who attend periodically for supervision. (5) Patients who are tuberculous, and who, being unable to afford medical treatment, attend for treatment at the Dispensary. During the year 165 patients attended at the Dispensary. Of these patients, 78 were patients who had attended the Dispensary previously and 87 were new cases. Of the 87 patients attending for the first time, 24 were found to be suffering from tuberculosis, 28 were considered not to be tuberculous, and 35 were recommended to attend for re-examination and further observation, as the diagnosis was not definite at the time of their first attendance. |
abefaa97-6c33-4592-80dc-3cc6a56f64b6 | The total number of attendances made by patients during the year was 513. 30 Notifiable Infectious Diseases. The number of patients recommended from the Dispensary for institutional treatment was 23; 9 being admitted to a Hospital for advanced cases and 14 sent away to Sanatoriums. Tuberculosis BlockβIsolation Hospital. The cases under treatment during 1922 as in-patients are summarised in the subjoined table:β Male. Female Total Casts. Resident in Barnes. Resident. |
3cf5d225-a5d7-4ef2-997b-5790d91eef65 | Total cases under treatment during 1922 21 20 41 10 31 Patients under treatment on January 1st, 1922 2 2 4 l 3 Patients admitted during the year 19 18 37 9 28 Patients discharged 9 14 23 6 17 Transferred to sanatorium 2 1 3 1 2 Returned home 7 13 20 5 15 Patients died 7 2 9 3 6 Patients still under treatment, December 31, 1922 5 4 9 1 8 The majority of patients admitted to the Hospital are suffering from pulmonary tuberculosis in an advanced stage of the disease. The reason for admission in many of the cases is to provide proper treatment and nursing when this cannot be obtained at the patient's home, and, frequently, the object of admission is to prevent infection of other members of the patient's family when the patient cannot be provided with adequate isolation at home. |
02b8916a-d72b-4d77-aabd-a606c294965b | Of the 41 cases under treatment during the year, 10 were residents from the Barnes Urban District, and 31 were admitted from other Sanitary Areas in Surrey. Three of the patients so far improved under treatment as to admit of their transference to a Sanatorium. Non-Notifiable Infectious Diseases. 31 Twenty patients were discharged to their home (7 of these were much improved in health, in 6 the disease was stationary, and in 7 the disease was further advanced). Nine patients died in Hospital, a high mortality consequent on the type of case admitted. Patients sent to Sanatoriums. The number of patients from the Barnes Urban District admitted to Sanatoriums during the year was 14; 13 were cases of pulmonary tuberculosis, and 1 was a case of the non-pulmonary form of the disease. OTHER NOTIFIABLE DISEASES. No notifiable diseases other than those above referred to were notified during the year. 3. |
b5d7d5e0-dd74-4ae4-a378-bc52c48408d5 | NON-NOTIFIABLE INFECTIOUS DISEASES AND OTHER CAUSES OF SICKNESS. There have during the year been no cases under this heading of sickness and invalidity which have been specially noteworthy in the District, with the exception of whooping-cough and influenza. WHOOPING COUGH. Whooping-cough was prevalent during the first four months of the year, its incidence falling mainly on infants and very young children. All cases reported were followed up by the Health Visitors, and exclusion from School of the patient and contacts effected. To obtain information of the existence of whooping-cough, the disease being non-notifiable, the Medical Officer of Health has to depend largely on the co-operation of Head Teachers in reporting cases, or suspected cases, of the disease amongst scholars. Effective measures for preventing or limiting the spread of this disease cannot be taken unless Head Teachers promptly report all cases as they occur in their schools. |
ffbfaf5d-bca4-4d98-89a1-986568ebf556 | There were 4 deaths from this disease representing a deathrate of 0.12 per 1,000 of population, contrasted with a death-rate of 0.25 for London and 0.16 for England and Wales 32 Maternity and Child Welfare. INFLUENZA. Influenza was again prevalent in this District in 1922, and was of a severe type in a large proportion of cases. The serious complications were in the main pulmonary. A stock of influenza vaccine was kept at the Health Department available for Medical Practitioners wishing to use it. Deaths of Barnes residents from influenza numbered 15, representing a death-rate of 0.44 per 1000 of population, the death-rate of 0.57 for London and 0 54 for England and Wales. POOR LAW MEDICAL RELIEF. |
885500f7-8e3e-4056-a356-da0720b406a2 | The following is a summary regarding Poor Law Relief for persons in this District during the year 1922:β (1) The number of orders issued for Medical Attendance 177 (2) The number of orders issued for sion to the Workhouse and Infirmary 143 (3) The number of deaths which have occurred amongst Barnes and Mortlake residents in the Poor Law Institution 52 4. MATERNITY AND CHILD WELFARE. The Notification of Births Act, 1907, was adopted in Barnes in 1913. In 1917 an arrangement between the Barnes Urban District Council and the Surrey County Council was made, whereby the Surrey County Council became the Authority responsible for the Maternity and Child Welfare work within the Urban District, and the various services and arrangements for attending to the health of mothers and young children under the Maternity and Child Welfare Act are made by the County Council as a part of the County Scheme. |
93235ed2-5b7a-4be4-a84e-d1d2d789f953 | In practice, part of the services, namely, the Maternity and Child Welfare Clinics and the Home Visiting, are undertaken by Maternity and Child Welfare. 33 the Medical Officer of Health, as Medical Officer to the Maternity and Child Welfare Centre, and by two Health Visitors, whose duties also include other branches of public health work in the District. There is thus secured the fullest co-ordination in all spheres of preventive work. Assistance is also given at the Centre by voluntary helpers. The above infant welfare work is supervised by a local Maternity and Child Welfare Committee, consisting of members of the Barnes Urban District Council and additional co-opted members. The importance of further reducing the rate of Infantile Mortality, and of conserving the infant life of the population, make it desirable that adequate provision should be made for the welfare of both mother and child, even at the present time when strict economy in expenditure is enjoined on Local Authorities. |
81a7044e-d70e-4d15-b6c6-f8a9a6e3daef | Infant welfare work during 1922 has been very thoroughly carried out, and has undoubtedly been effective in assisting to secure the very favourable low death-rate amongst infants for the year. The work carried out is summarised below:β Home-Visiting. The homes of all newly-born infants amongst the working classes have been visited by the Health Visitors as soon as possible after birth. They were revisited as often as the circumstances of the particular cases indicated. An endeavour was made to persuade as many mothers as possible to attend at the Infant Welfare Centre, and the Health Visitors kept in touch with those infants whose mothers, for one reason or another, either could not or did not attend at the Centre. Notifications in respect of 504 births were received during the year (210 notifications from Doctors, 284 from Midwives, and 10 from parents or other persons). |
0d694c89-93d7-4260-a983-7034ede84983 | Of the 504 infants whose births were notified, 345 were visited in their homes by the Health Visitors, and 358 re-visits were made to the homes of such of those infants as appeared to require "following-up." It will be seen that 68 per cent. of the total births notified were home visited; a very satisfactory proportion. 34 Maternity and Child Welfare. Maternity and Child Welfare Centre. The Maternity and Child Welfare Clinics have been held weekly in premises, admirably suited to the work of the Clinics, at the Technical Institute, North VVorple Way, Mortlake. The work carried out at the Child Welfare Centre during 1922 has been highly satisfactory, and has proceeded on the following lines:β All infants and children attending the Clinics have been regularly weighed and kept under observation, so that any departure from normal health might be discovered at the earliest stage. |
807c968f-3ffe-4ab0-ab37-59983010e3a4 | All infants and children at their first attendance at the Clinic, and subsequently whenever appearing to be ailing or not making satisfactory progress, have been seen by the Medical Officer, and advice given to the parents. Educational work, which is essential to the proper conduct of an Infant Welfare Centre, has been both individual and collective: individual advice has been given by the Health Visitors and by the Medical Officer at consultations with mothers, and collective instruction has been given by Officers on the Staff, in the form of lectures and addresses to mothers on the care and management of their children. One of the chief aims at the Centre has been to encourage breast-feeding. Infants' foods for artificial feeding have been supplied at the Centre at cost price to mothers in cases in which continuance of breast-feeding has been found to be impossible or has already been abandoned. Infants' foods are supplied to mothers only on the recommendation of the Medical Officer. |
3736e3ad-0fc7-4fb4-b42b-16aec45a4b05 | The number of new cases, the total number of infants and young children attending at the Centre, and the total attendances made by them during the year are set out below:β Number of new cases under 1 year 130 Number of new cases, 1 to 5 years 45 Total new cases (infants and children β under 5 years) 175 Maternity and Child Welfare. Number of infants under 1 year attending 185 Number of children, 1 to 5 years attending 97 Total number (infants and young children under 5 years) attending 282 Attendances made by infants under 1 year 2188 Attendances made by children, 1 to 5 years 893 Total attendances of infants and children under 5 years 3081 Attendances made by mothers 3305 35 The average attendance per week at the Maternity and Child Welfare Centre of infants was 61 per week, and the average attendance of mothers, 65 per week. |
eae60cad-72da-4952-8e6e-4842e119fb17 | I called attention above to the fact that 63 per cent. of all births notified were home-visited. It is satisfactory to note that, as a result of these home-visits, in 40 per cent. of the infants visited the mothers were induced to bring their babies to the Child Welfare Centre. It is evident from an analysis of the above figures what a large amount of work is being done in the District under the Maternity and Child Welfare Act, work that is effective in assisting to reduce the rate of Infantile Mortality and in building up a stronger and healthier generation. Ante-natal work has not developed to any great extent: a comparatively small number of expectant mothers have attended at the Centre for consultation with the Medical Officer. It is difficult to get in touch with expectant mothers in the first instance, and the facilities afforded are not yet widely known to them. |
231263db-605c-4dc8-8e85-9017b6552607 | As so much of the mortality amongst infants occurs during the first few weeks of life, ante-natal work is of the utmost importance. Other Services provided under the Maternity and Child Welfare Act. The other services for which the County Council make provision under the Maternity and Child Welfare Act, are administered 36 Maternity and Child Welfare. as part of the general County Scheme, and are enumerated hereunder:β Maternity Hospital provision, or beds in a Hospital for complicated cases of pregnancy, or for the treatment of complications arising after parturition, whether in the mother or the infant, and for cases where the home circumstances are unsuitable for the confinement. The provision for payment for skilled medical assistance in the home in the case of necessitous women for whose confinement a doctor has been called in by a midwife. Home-helps in cases where a person is needed to look after the home during the lying-in period, whether the confinement takes place at home or in a hospital. |
80e9e564-3aec-4d07-83df-120f294eeb85 | Convalescent homes for mothers and their infants. Homes for widowed, deserted and unmarried mothers, and for illegitimate children. The County Council accept responsibility for charges incurred in the provision of the above services provided that the charges are reasonable and the parents contribute according to their means. Further reference to the above will be found in the summary of institutions, etc , available for the District given later in this report and in the Annual Report of the County Medical Officer for Surrey. Day Nursery. The Barnes and Mortlake Day Nursery, which is supported by voluntary contributions, takes care, by day, of infants and young children under the age of 5 years whose mothers go out to work. An account of the work of the Nursery will be found in the report of the Voluntary Committee who manage it. The Urban District Council make a contribution of Β£100 per annum towards the cost of this Institution. |
97775c28-7b98-44f9-8e88-bc25e7aaad92 | It is important to remember that it becomes difficult to prevent the spread of infectious diseases where numbers of very susceptible young children under 5 years of age are in frequent and close contact. The younger the children the greater is the mortality from these diseases, especially Measles or Whooping-cough: ninety Schools and School Medical Inspection. 37 per cent. of deaths from Measles and its complications occur under the age of 5 years. The attendance of an infant at a Day Nursery amongst numbers of other young children coming daily to the Nursery from separate homes, adds enormously to its opportunities for infection, and this is particularly so in times of epidemics. During the epidemic of Measles an outbreak occurred in March amongst the infants and young children attending at the Day Nursery. In all eighteen infants and young children who had been in attendance at the Day Nursery were reported to have contracted the disease. The Day Nursery was closed for a period on my advice with a view to checking the spread of the disease. |
c5496a4a-45b5-4cf6-b861-2d2b19eec7ad | In order to prevent as far as possible the spread of infectious and contagious diseases amongst children at the Day Nursery I instituted, in co-operation with the Committee of the Day Nursery, arrangements whereby inquiry would be made as to the reason for absence in the case of every child ceasing to attend at the Nursery and, in the event of infectious or contagious diesease being alleged or suspected as the cause of non-attendance, for this fact to be reported to me so that, after investigation, infectious children could be excluded from the Day Nursery and their contacts excluded from school or vice versa. By co-operation in this way exclusion can be effected at an earlier date in many cases of notifiable infectious diseases without waiting for the receipt of the formal "notification," and in the case of non-notifiable infectious diseases exclusion can be carried out on account of disease, the existence of which in the family might otherwise never be ascertained. 5. SCHOOLS AND SCHOOL MEDICAL INSPECTION. |
56079555-f188-4aab-b689-db9d097ce3d3 | There are 14 Public Elementary Schools and 19 Private Schools in the District. Both the Public Elementary and the Private Schools have been inspected by the Sanitary Inspector and, in addition, for the purpose of special investigations, by me personally. The water supply, sanitary accommodation and general sanitary conditions were, on the whole, very satisfactory. Several 38 Health Visitors. sanitary defects found were brought to the notice of the responsible person or authority for remedy. Careful investigations have been made into outbreaks of infectious diseases, and a very thorough organisation has been in practice for detecting infectious disease amongst scholars, and for ensuring, by exclusions from school, that neither convalescents from infectious diseases nor their contacts return to school before they can safely do so without risk of spreading infection to others. School closure was resorted to in the case of only one school (an Infants' Department) on account of the prevalence of Measles amongst the scholars. |
dd13e33f-19a9-4d37-bf28-b833fe6c6939 | There are approximately 3,500 children in attendance at the 14 Public Elementary Schools, and the medical inspection of these children has been carried out by me under the Surrey County Council Scheme. The general inspection of the children for defective conditions requiring parental attention has been carried out by the Health Visitors, and a summary of their work will be found included under the heading of "Health Visitors." The School Clinics (Minor Ailments, Eye and Dental Clinics) have been conducted at the new Centre at the Technical Institute, where the accommodation is excellent for the purpose. The details of the work of Medical Inspection, of the School Clinics, and of the Health Visitors' work in the Schools, are furnished to the County Medical Officer for inclusion amongst the statistical returns contained in his Annual Report. 6. HEALTH VISITORS. Two whole-time Health Visitors are employed in the District, and work under the supervision of the Medical Officer of Health. Their duties include:β 1. |
07b3a4f4-3c3f-43a3-acea-fec20a33c276 | Inspection of children in the Public Elementary Schools, 2. Attendance at (a) School Clinics; (b) Maternity and Child Welfare Clinics; (c) Tuberculosis Dispensary. Health Visitors. 39 3. Home-visiting in connection with:β Notified Births; Child Welfare in respect of children under 5 years; School children found defective, etc.; Infectious diseases, e.g., Measles, Whooping-cough, etc. Tuberculosis cases; Supervision of mentally defective children. A tabular summary of the work carried out by the Health Visitors during the year is given, together with the figures for the previous year for comparison:β School Inspection. 1921. 1922. |
f0aaface-707e-4712-acd7-a73ecd8848b1 | Schools Inspected 14 14 Visits to Schools for Inspection of Children 565 508 Inspections of Children for defects 29,187 29,401 Children excluded for verminous conditions 390 257 Home visits to defective Children School Clinics. 153 246 Attendances by Health Visitors at School Clinics 251 164 Attendances by Children at School Clinics 2,844 2,239 Notified Births. Notifications received 568 504 Visits to notified births (1st visits) 338 345 Re-visits to Infants under 1 year and to Children under 5 years 832 358 Maternity and Child Welfare. Attendances by Health Visitors at Child Welfare Centre 188 94 Attendances of Infants under 1 year 2,061 2,188 Attendances of Children 1 to 5 years 1,173 893 Attendances of Mothers 3,167 3,305 Tuberculosis Work. |
327f81e4-1ed7-4443-ac46-38f645c96f43 | Attendances by Health Visitors at the Dispensary 114 103 Home visits to Tuberculosis patients 76 325 Infectious Diseases. Home visits to cases of infectious disease 91 422 The amount of work in the District to be undertaken by Health Visitors is very large, and more than two Health Visitors are necessary to effectively carry out this work. 40 Summary of Nursing Arrangements. 7. SUMMARY OF NURSING ARRANGEMENTS, HOSPITALS AND OTHER INSTITUTIONS AVAILABLE FOR THE DISTRICT. (1) Professional Nursing in the Home. (a) General Nursing. Two District Nurses, employed by the Barnes Nursing Association and the Mortlake Nursing Association respectively, are engaged in General Nursing work in the homes of the poorer inhabitants. General Nursing work of this nature is undertaken in this District entirely by Voluntary Associations; neither the Urban District Council nor the Surrey County Council have made any arrangements in this respect. (b) For Infectious Diseases. |
53affa8c-1231-480d-a2fa-97d6741feb2c | No provision has been made for the actual nursing of cases of infectious disease in the homes of the poor. The services of the above-mentioned District Nurses are not available, as they are debarred from attendance on patients suffering from infectious diseases. Cases of Scarlet Fever, Diphtheria, or Enteric Fever are always removed to the Isolation Hospital if the circumstances are such that the patients cannot be effectively isolated and properly nursed in their homes. With regard to other infectious diseases, however, in epidemic times when accommodation in the Hospital may not be available, skilled nursing in the home is of the utmost value in lessening the mortality amongst cases of a severe type. This is applicable to cases of Measles, for instance, with severe complications, occurring in the homes of the poor ; in such cases no nursing assistance is at present available. (2) Midwives. |
4c668ac3-bfb6-4db6-bbcd-5f21c4f7eab3 | There are nine Midwives practising in the Districtβfour of these are resident within the District, and five, although resident outside the Urban District, occasionally practise in Barnes. There are no Midwives working in the District employed by or subsidised by a Public Health Authority, and I do not consider such provision is needed. Summary of Nursing Arrangements. 41 (3) Clinics, Treatment Centres, etc. Name of Clinic, etc. Address. Days of attendance. Provided by. |
bf99169f-735b-4a87-b1aa-d429264fc7ac | (a) Situated in the District: Maternity and Child Welfare Clinic Technical Institute, North Worple Way, Mortlake Thursday, 2.30 Surrey County Council School Clinicsβ Attendance Clinic β Monday, 10 β Minor Ailments Clinic β Wednesday, 2 β Eye Clinic β Monday, 2 β Dental Clinic β Tuesday, 2 β Tuberculosis Dispensary South Worple Way, Mortlake Wednesdays, 6 Friday, 10 β Day Nursery Afon House, High Street, Mortlake Daily, Monday to Saturday Vo1untarysub- scriptior (b) Situate outside District Venereal Diseases Clinics Richmond Royal Hospital Males. Tuesday and Friday, 6 Females, Tuesday & Friday, 5 Surrey County Council West London Hospital,Hammersmith Daily 5.30 β And at 21 other Hospitals in the County of London Various times as advertised β (4) Hospitals provided or Subsidised by the Urban District Council or by the Surrey County Council. |
8a0637d9-57ea-4d10-a728-81bcfbb64057 | (1) Tuberculosisβ (a) Institution situated within the District. Barnes Isolation Hospital By agreement between the Surrey County Council and the Barnes Urban District Council, a Tuberculosis Pavilion containing 12 beds, to accommodate 6 male and 6 female patients, is provided for the reception of cases from Barnes District and from the remainder of the Administrative County of Surrey. 42 Summary of Nursing Arrangements. (b) Institutions available situated outside the District. Patients suffering from tuberculosis may be sent at the cost of the Surrey County Council to the following Institutions:β Sanatoria: Cambridge Tuberculosis Colony, Papworth. Crooksbury Sanatorium, near Farnham, Surrey. Fifty beds, all reserved for Surrey patients. Croydon Borough Sanatorium. Holy Cross Sanatorium, Shottermill. King Edward VII. Sanatorium, Midhurst. Mount Vernon Hospital Sanatorium, Northwood. Preston Hall Training Colony, Aylesford, Kent. |
0c7f9338-ac17-4b5e-8920-1ee12952aa96 | Royal National Hospital, Ventnor. Royal National Sanatorium, Bournemonth. St. Catherine's Home, Sanatorium, Ventnor. Hospitals: Alexandra Hospital for Children suffering from HipDiseases. Brompton Hospital. City of London Hospital, Victoria Park. Lord Mayor Treloar's Hospital, Alton, for surgical cases only. Royal Sea Bathing Hospital, Margate, for surgical cases only. St. Peter's Home, Woking. St. Thomas's Hospital, London, for surgical cases only. St. Anthony's Hospital, Cheam, for surgical cases; also some Sanatorium beds for men. (2) Maternity. The Surrey County Council have arranged for Hospital beds for women needing special treatment during confinement to be available at the following Hospitals, all of which are situated outside the District:β Clapham Maternity Hospital. General Lying-in Hospital, York Road, Lambeth. |
30d014b9-a23a-49f3-87aa-1a99fbb10942 | Reigate and Redhill Hospital. Royal Surrey County Hospital, Guildford. Queen Charlotte's Lying-in Hospital, Marylebone. South London Hospital for Women, Clapham Common. (3) Children's Hospital. There is no Hospital situated within the District for the treatment of diseases of children. The Royal Hospital, Richmond, the Putney Hospital, and the West London Hospital, Hammersmith, are mainly resorted to for these purposes,. Summary of Nursing Arrangements. 45 but, in addition, use is made of the General and Children's Hospital situated in the County of London. An annual donation is made by the Barnes District Council to the three Hospitals first mentioned. It is frequently found to be a difficult matter to secure Hospital treatment for patients resident in this area; provision to meet this deficiency is desirable, and I consider would best be made by increased facilities for treatment at existing institutions. (4) Fever Hospital. |
ad90602c-ee4a-4271-b767-fa3f51bf40f8 | The Barnes Isolation Hospital, situated in South Worple Way, Mortlake, is provided by the Council for the treatment of cases of infectious disease, and has accommodation (on the Ministry of Health's basis) for 40 cases apportioned as follows:β 12 beds for Scarlet Fever, 14 beds for Diphtheria. 14 beds for the purpose of observation, isolation of cases of cross infection, or treatment of infectious diseases other than Scarlet Fever or Diphtheria. (5) Smallpox Hospital. Hospital accommodation for cases of Smallpox arising in this District is provided, by arrangement with the Surrey County Council, at the Smallpox Isolation Hospital at Clandon, Surrey. The removal of cases to the Hospital by ambulance is undertaken by the Surrey County Council at the cost of the Barnes District Council. (6) General Hospitals.βThere is no general hospital situated within the District. |
3a2e80cf-c941-444c-8116-64267c046fd7 | Use is made of the Richmond and Putney Hospitals, and of the General and Special Hospitals situated in the County of London. Increased facilities for both in-patient and out-patient treatment of cases of non-infectious diseases are urgently required, and, here again, as in connection with the lack of provision for the treatment of children's diseases referred to above, I am of opinion that further provision made should be by increasing the facilities for treatment at already established institutions. 44 Laboratory Work. (5) Institutional Provision for Unmarried Mothers, Illegitimate Infants and Homeless Children. This provision under the Maternity and Child Welfare Act is made by the Surrey County Council in Institutions which are outside the District. (6) Ambulance Facilities. (a) For Infectious Cases. Two horse ambulances are provided by the Council for removal of cases of infectious disease to the Isolation Hospital, one for patients suffering from tuberculosis, and one for other cases of infectious disease. |
dcccdd4b-70b1-4dca-b588-c72892c2112b | A motor ambulance in place of the last-mentioned horse-drawn ambulance would be far more efficient; it would enable patients to be more promptly removed into hospital, a very important step particularly in times of epidemic. (b) For Non-infectious and Accident Cases. The Council have provided a motor-ambulance which is primarily intended for use in case of accidents, when no charge is made. It may also be hired for residents of the District, for the conveyance of non-infectious cases to hospital, etc., upon the payment of a nominal scale of charges, according to distance. These fees may be remitted in necessitous cases. 8. LABORATORY WORK, Etc. Bacteriological examinations of swabs for the detection of diphtheria bacilli and of sputum for the presence of tubercle bacilli are undertaken at the Council's laboratory. |
fee183b9-a4e0-491a-8bba-44f94a4e4090 | Pathological outfits are provided by the Council for practitioners' use, and specimens sent by medical practitioners from patients in the district are examined free of charge. Examinations undertaken during the year amounted to 688, for diphtheria bacilli 525, for tubercle bacilli 163. Diphtheria antitoxin is supplied from the Public Health Department to Medical Practitioners applying for it for their patients resident in this district: antitoxin supplied in this way is charged for at cost price unless the patient to whom it was Public Health Staff. 45 administered is subsequently transferred to the Isolation Hospital, in which case no charge is made. A stock of Influenza Vaccine is kept in the Public Health Department, and is supplied to Medical Practitioners on request. 9. PUBLIC HEALTH STAFF. |
a921ab95-33b5-4d3b-bff8-b7d4ec12c5bb | In addition to carrying out the duties of Medical Officer of Health of the Barnes Urban District, 1 act as Medical Superintendent of the Isolation Hospital and as Tuberculosis Officer for the District, and also carry out the work of School Medical Inspection and Maternity and Child Welfare, under the Surrey County Council Scheme within the Urban District. Sanitary Inspectors. The services of Mr. T. Grylls have been retained by the Council as Consulting Sanitary Inspector. The Chief Sanitary Inspector holds the Sanitary Inspectors' Certificate of the Royal Sanitary Institute, and in addition, a Certificate as an Inspector of Meat and other Foods. The Assistant Sanitary Inspector holds the Sanitary Inspectors' Certificate of the Royal Sanitary Institute, and his duties are mainly in connection with infectious diseases. Health Visitors. |
06cb1eda-4852-473a-98e4-bc01605e1eb8 | There are two whole-time Health Visitors employed in the District: their duties include those of School Nurse and Tuberculosis Nurse, work under the Notification of Births Act, and in connection with Maternity and Child Welfare and Infectious Diseases. Both Health Visitors are trained nurses and hold the Certificate of the Central Midwives Board and the Health Visitors' Certificate of the Royal Sanitary Institute. Clerical Staff. One whole-time shorthand-typist clerk is employed in the Public Health Department. Isolation Hospital Staff. The staff consists of the Matron, one Sister, and eight trained Nurses: there are, in addition, a lodge-porter, a disinfecting officer, a boiler attendant, a gardener, and eight domestic servants included in the permanent staff. Other Staff. Rat Officer (whole time); Public Mortuary Attendant ; Superintendent and Matron of Cleansing Station (part time). |
f668b305-95cd-45f9-be8a-88d3e3d95817 | The Officers to whose salary contribution is made under the Public Health Acts or by Exchequer Grants are the Medical Officer of Health, the Chief Sanitary Inspector, and the two Health Visitors. 46 10. SANITARY ADMINISTRATION. The fallowing is an account of the work undertaken during the year by the Sanitary Department under the various Public Health Acts, Bye-laws and Regulations (including the Adoptive Measures given below), and of the action taken. Particulars furnished by the Sanitary Inspector under Article XX. of the Sanitary Officers (Outside London) Order, 1910, are included. List of Adoptive Acts, Bye-laws and Local Regulations relatingto Public Health in force in the District, with date of adoption. Adoptive Acts. Portion Adopted Date of Adoption, Infectious Diseases (Prevention) Act, 1890 The Whole Act 13th Mar., 1894 Public Health Acts (Amendment) Act, 1890 Part II. |
ec6a1ee2-1e37-4b8a-b39f-759f647dabab | 28th Sept., 1897 Part III. 11th July, 1893 Housing of the Working Classes Act, 1890 Part III. 8th Dec., 1896 Private Street Works Act, 1892 The Whole Act 8th Aug., 1893 Small Dwellings' Acquisition Act, 1899 The Whole Act 12th Dec., 1899 Public Health Acts (Amendment) Act, 1907 Part II., III., IV. 14th July, 1908 (except Sec. 66) Notifications of Births Act, 1907 The Whole Act 8th July, 1913 Byelaws Regulations, etc. |
f6a330ef-7880-43ca-951c-f732825001c7 | New Streets and Buildings Prevention of Nuisances Cleansing of Earth Closers, &c Removal of Filth through Streets Offensive Trades (Fish-Fryers) Slaughter Houses Public Mortuary Common Lodging Houses Houses Let in Lodgings Domestic Servants1 Registries Tents, Vans and Sheds Fire-escape in Factories and Workshops Dairies,Cowsheds and Milk Shops Notification of Measles, &c. Notification of Human Anthrax Statute. P.H. Act (Amend.) Act, 1890 Public Health Act, 1875 Public Health Act, 1875 P.H. Act (Amend.) Act, 1890 P.H. Act (Amend ) Act, 1907 Public Health Act, 1875 Public Health Act, 1875 Public Health Act, 1875 Housing & Town Planning Act, 1919 P.H Act (Amend.) |
f6614084-0cb8-4696-b72a-9b71d20961e1 | Act, 1907 Housing of Working Classes Act, 1885 Factory & Workshops Act, 1901 Dairies, Cowsheds, and Milk Shops Order, 1885 City of Leeds (Measles and German Measles) Regulations, 1920 Infectious Diseases (Notification) Act,1899 Date coming into Operation. 15th April, 1914 17th Dec., 1894 21st Feb., 1906 22nd Mar., 1912 28th May, 1913 17th Dec., 1894 23rd Dec., 1895 19th June, 1912 11th July, 1922 10th Aug., 1909 27th Nov., 1897 24th April, 1908 13th Oct., 1903 8th Mar., 1920 5th Mar., 1921 Sanitary Administration. |
2764ff48-7372-4079-a10f-15208e9c5480 | 47 Table showing the number and nature of the inspections made by the Sanitary Inspectors during 1922, the number of notices served in respect of defects found in the course of inspection, and the number of notices complied with:- Nature of Inspections. Number of Premises Visited. Number of Visits of Inspection and Reinspection. Action taken in respect of defective conditions. Informal Notices. Statutory Notices. Number issued. Complied with. Number issued. Complied with. Milkshops 24 50 3 3 β β Butchers' Shops 26 298 5 5 β β Fishmongers and Poulterers 16 201 β β β β Greengrocers 22 67 4 4 β β Cooked-provision shops 6 12 β β β β Restaurants 14 28 2 2 β β Fried-fish Shops 5 60 2 2 β β Slaughterhouses 1 97 |
8516ac7a-0505-4195-a74a-814343a15d27 | β β β β Bakehouses 13 28 4 4 β β Chocolate Factory 1 2 1 1 β β Factories 3 8 2 1 β β Workshops 86 86 β β β β Workplaces 14 14 β β β β Home-workers 29 34 β β β β Schools 33 33 β β β β Dwelling - houses (including houses let in lodgings):β (1) House - to - House Inspection 185 1504 134 65 33 25 (2) Inspected on complaint 254 2746 320 294 15 15 (31 Inspected in course of other work:β (a) Housing work, etc. 170 (b) For infectious Diseases 277 379 48 Sanitary Administration. Table of Defective Conditions Remedied. Drainage. |
9deb9892-0e7b-4ce1-81d0-bb4b67416932 | Drains inspected on complaint 59 β Water tests applied 46 β Smoke tests applied 19 β Cleansed or repaired 60 β relaid 16 β reconstructed 2 Inspection Chambers repaired 4 β β new provided 19 Interceptorsβcaps fixed 2 Soil Pipes renewed 1 β β new provided 5 Ventilating Shafts repaired 4 Fresh air inlets repaired or new provided 19 Rain water pipes disconnected from drains 4 Water Closets. Pans and traps provided 36 Waste water preventers repaired 27 β ,, β new provided 6 β β β Water supplied 21 Apartments repaired 82 β lighted and ventilated 10 Sinks and Baths. Repaired or newly fixed 26 Waste pipes repaired 12 β β newly fixed 1 β β trapped 2 Cesspools. Abolished 1 Urinals. Repaired or cleansed 3 Flushing apparatus provided 1 Structurally improved 1 Sanitary Administration. 49 Water Supply. |
90afd1c2-1f3c-4a10-b3f2-ae39f3f58488 | Cisterns repaired or renewed 31 Taps off main provided 7 Dustbins. Provided 102 Ashpits abolished 3 Yards. Paving repaired 65 Newly paved 42 Dampness. Roofs repaired 93 Gutters and rain water pipes repaired 51 Damp proof courses provided 31 External wall repointed 107 Floor spaces ventilated 12 Dangerous structures repaired or rebuilt ... 6 General. Food larders ventilated or new provision provided 59 Windows repaired 152 β made to open 37 Stairs repaired or handrails provided 19 Grates repaired or renewed 71 Smoky chimneys remedied 17 Washing coppers repaired 23 Walls and ceilingsβplaster repaired 205 β β stripped and redecorated 645 Verminous premises fumigated and cleansed 10 β bedding cleansed and destroyed 4 Offensive accumulations removed 20 Miscellaneous defects remedied 68 Animals improperly kept 1 Stables. |
f1ba09d3-f59f-46bf-941c-35b1a271ddf6 | Manure receptacles provided or repaired 1 Floors and yards properly paved and drained 2 50 Sanitary Administration. In Connection with Infectious Disease. Rooms disinfected 348 β stripped and cleaned 99 Lots of bedding disinfected 258 β ,, destroyed 3 The following Schools were also disinfected during the year:β Public Elementary Schools. Westflelds Infants. East Sheen Mixed and Infants. National Schools. Private Schools. Castelnau College (twice). S.W. London College (twice). Convent School, Barnes. Legal Proceedings. It became necessary to institute legal proceedings in one instance only during the year. An application was made to the magistrates for an Order for the ejectment of the tenant of a house in respect of which a Closing Order had been made by the Council. The Order for Ejectment was granted. |
4e3fe83c-89aa-4843-9a25-92756c533898 | FOOD SUPPLY AND PLACES WHERE FOOD IS STORED OR PREPARED. Milk Supply. No milk is produced in the District, the source of the whole of the milk supplied to inhabitants is from outside. It is of the utmost importance that milk, especially as it enters so largely into the dietary of young children, should be produced as pure as possible, and safeguarded subsequently from every kind of contamination and adulteration. There is no indication that the milk supplied has been below the average. Sanitary Administration. 51 With regard to adulteration, 59 formal samples of milk were taken by the County Inspector under the Sale of food and Drugs Act (the Surrey County Council being the authority responsible for the administration of the Sale of Food and Drugs Act within the District). Of these 59 samples of milk, only 2 were found to be adulterated; a prosecution followed in respect of one of these but a conviction was not secured. |
b051d53e-aba5-40af-aed4-12483e7c7f73 | With regard to contamination, much greater care is required in the storage and handling of milk. With the additional powers conferred under the Milk and Dairies (Amendment) Act, 1922, which came into operation (with the exception of Section 3) on 1st September, 1922, and under the Milk (Special Designations) Order, 1922, made under Section 3 of the Milk and Dairies (Amendment) Act, 1922, and coming into operation on 1st January, 1923, it should be possible to secure much greater freedom from contamination, both as regards contamination arising during milk production and during its distribution. Dairies, Cowsheds, and Milk-shops Reg-ulations. The number of milk-shops and milk-stores on the Register at the end of the year was 24. |
8d251b3f-9b84-4e65-bfa1-07d07f7c31af | There are also three firms registered as retailers of milk in the District, but whose premises, from which their milk is retailed, are situated outside the District. There is no cow-shed in the District. All the milk-shops and milk-stores have been kept under close supervision by the Sanitary Inspector: in instances where the conditions were found not to be satisfactory action was taken under the newly-enacted Milk and Dairies (Amendment) Act, 1922, Milk and Dairies (Amendment) Act, 1922. Action was taken under Section 2 of this Act in the case of two retail purveyors of milk. The Council being satisfied that the public health was or was likely to be endangered on account of the unsatisfactory conditions of the premises in use (and on account of want of cleanliness on the part of one of the retailers), both of these retailers were removed from the Register. 52 Sanitary Administration. Meat. |
4b1e40c0-16e3-4e84-8e1e-2a4abf00803f | The source of the great bulk of the meat sold in the District is from outside. Meat from outside the District comes in mainly from the Smithfield and Islington Markets, and such meat is inspected at the place of slaughter. In spite of inspection, diseased meat may get through, and meat may also deteriorate before it reaches the purchaser. Regular and frequent inspections of meat exposed for sale in all butcher's shops have been carried out by the Sanitary Inspector to detect diseased or unsound meat. Meat killed in the District receives efficient inspection; slaughtering takes place at one slaughter-house only, and the Sanitary Inspector inspects the carcases and viscera of all animals killed there, an arrangement being in force whereby he is notified beforehand, by the Owner, of each occasion on which slaughtering, takes place. One carcase of a heifer was found to be tuberculous; the carcase and offals were surrendered voluntarily and destroyed. |
42021ec3-7d00-48a6-8072-e6170918d8d3 | The Ministry of Health issued in March, 1922, a Memorandum on a System of Meat Inspection recommended by the Ministry, together with a Circular thereon, with the object of securing uniformity in meat inspection throughout the country. The methods recommended by the Ministry were in the main already in operation in this District, having been adopted and carried out by the Sanitary Inspector, who is a Certified Inspector of Meat, during the past two years or more. Slaughter-houses. The slaughter-house above referred tois the only licensed slaughter-house used in the District, and the Sanitary Inspector reports that it is kept in excellent condition. Visits of inspection during the year numbered 97. Other Foods and Places where Food is Prepared. In addition to the above-mentioned food premises, other places where food is sold, stored, or prepared for sale or consumption, have been periodically visited by the Sanitary Inspector. Sanitary Administration. |
62b1523f-665a-4011-bcd5-94fd5f516980 | 53 Such premises have included fishmongers, poulterers, greengrocers, restaurants and eating-houses, and cooked-provision shops (for list of unsound articles of food discovered, see below). Bakehouses. There are 13 bakehouses in the District; four of these are underground bakehouses. These premises have been inspected, and, apart from some minor defects in four instances, which have been remedied, were found by the Sanitary Inspector to be in good condition. There is also one large chocolate factory in the District; this has been inspected by the Sanitary Inspector in the course of his routine work, and conditions found satisfactory. Unsound Food. As a result of inspection, a number of articles of food in an unsound condition were detected by the Sanitary Inspector, and the following articles were surrendered voluntarily and destroyed:β Meat (tuberculous) 1 carcase of heifer and offals. FishβSkate wings 6 stone. |
cb998708-f58e-4152-8659-5d32fea003de | β Codling 6 stone. β Kippered Herrings 3 boxes. Sale of Food and Drugs Act. This Act is administered by the Surrey County Council; the County Medical Officer has supplied me with the following table, setting out the work undertaken in the District by the County Inspectors. Return of Samples Analysed during the Year ended 31st December, 1922. Articles. Analysed. Adulterated or deteriorated Prosecutions. Convictions Formal. Informal. Total. Formal. Informal. Total. Milk 59 β 59 2 β 2 1 β Spirits 12 β 12 4 β 4 4 3 Totals 71 β 71 6 β 6 5 3 54 Sanitary Administration. WATER SUPPLY. The water supply is that of the Metropolitan Water Board, and is sufficient and of good quality. |
0e55235c-60fd-4f92-a880-75919c2073d2 | The supply is constant. Almost entirely throughout the District the supply is through a storage cistern. Where this system is in use it is desirable, from a health point of view, to have a direct supply from a tap on the service pipe, available for water used for drinking purposes. In only a relatively small number of houses is this provision made. Water in cisterns not only tends to become flat and insipid, but is liable to contamination whilst in the cistern; such cisterns require to be subjected to periodical inspection, especially in poorer class property. During the year 31 cisterns were found by the Sanitary Inspector to be defective, and were remedied. In 7 instances a newdirect supply from a tap on the service pipe was provided. RIVER AND STREAM POLLUTION. No case has come to my notice of pollution of streams by effluents, solid refuse or filth. SEWAGE DISPOSAL. |
8238cbc5-7667-42dd-8df3-d3a21a356724 | The water carriage system of sewage disposal is in use throughout the whole District, with the exception of 3 earth closets and 16 cesspools in positions where connection with a sewer is difficult or impossible ; the condition of these has been found to be satisfactory. One cesspool was abolished during the year. The purification of the sewage and the maintenance of the intercepting sewers is undertaken by the Richmond Main Sewage Board. DRAINAGE, WATER CLOSETS, &c. Numerous defects in connection with water-closets and drains were discovered by the Sanitary Inspector, and remedy of the defects obtained; these will be found referred to in detail in the table of Sanitary Defects given above. 55 Sanitary Administration. PUBLIC CONVENIENCES. |
0a99a4e2-8c57-474f-8eca-3fbe6a7f709c | The public conveniences in the District (both those maintained by the Council, and the public house urinals which are entered from the street and available to the public) have been regularly inspected during the year by the Sanitary Inspectors, and defective conditions found have been remedied. The urinal at the Bridge Hotel has been structurally improved. The public conveniences maintained by the Council number 5. These 5 public conveniences are for the use of men only, and water-closet accommodation is provided in only two of them. There are no public conveniences providing accommodation for women. The number of public-house urinals entered from the street and available to the public is 12. There are conveniences, both urinals and water-closet accommodation, at 3 Railway Stations in the District; water-closet accommodation is provided at each of the Stations for both sexes. All are entered from the Station premises. |
20b83a06-d923-4328-b06e-0c7eeafed560 | I do not consider that the requirements of the District as to public conveniences are met by the above-mentioned facilities ; the public conveniences are too few in number, the water-closet accommodation especially is insufficient, and the entire absence of women's lavatories for the use of the public (except those situated at the Railway Stations, needs remedying. The subject has been given careful consideration by the Council, and it is anticipated that improved facilities will shortly be provided. SCAVENGING AND REFUSE DISPOSAL. The scavenging and the disposal of the refuse from the District is undertaken by the Surveyor's Department. Collection of house Refuse. House refuse is collected at least once a week ; during the summer months it is removed twice weekly from flat-dwellings and large establishments. All house refuse is removed to the Council's 56 Sanitary Administration. Destructor for incineration, motor-driven vehicles being very largely used in its removal. |
578e9734-d568-4773-a802-c7cbcbf6f822 | Almost entirely throughout the District movable ash-bins of galvanised iron are in use. A small number of fixed receptacles, about 10 in number, still exist in West Road, Mortlake. In compliance with notices served by the Sanitary Inspector, 102 new movable ash-bins have been provided and 3 ash-pits abolished during the year. Cleansing: and Scavenging of Streets. The scavenging and cleansing of the streets have been undertaken at frequent intervals, the frequency depending upon the character of particular localities. Those streets which are liable to greater pollution or fouling, receive more frequent attention. Mechanical sweepers are largely used, and the road sweepings are removed by motor-vehicles. Watering of the street in association with scavenging has been resorted to as far as necessary. |
f28c1e4a-de9e-4f82-a905-353e7ec542f5 | Difficulty arises in connection with passages at the rear of premises, such premises being very liable to get into an insanitary condition, and the securing of the cleansing of them not an easy matter. Such passages are much more easily kept in a sanitary condition if they are suitably paved. During the past year some of the passages have been so paved, and it is desirable they should be dealt with generally throughout the District in a similar way: they could then be easily and regularly scavenged. Disposal of Refuse. The house refuse removed is incinerated at the Council's Destructor. The refuse so removed from the Barnes Urban District aud destroyed during the year amounted to 9,691 tons. In addition to the refuse from Barnes, that from the Borough of Richmond is also destroyed at the Council's Destructor, the amount dealt with from the latter District during the year being 10,387 tons. Road sweepings from both Barnes and Richmond District are tipped ou a site adjacent to the Destructor. |
c2d5166a-e47c-4a92-965b-1433a1f72f30 | 57 Sanitary Administration. RATS AND MICE DESTRUCTION ACT, 1919. A whole-time Rat Catcher has continued to be employed by the Council during the year to assist in the work of rat destruction, under the supervision of the Sanitary Inspector. The Sanitary Inspectors make inspections in the District for the purpose of discovering rat-infested premises. The Sanitary Inspector reports that 4,956 rats' tails were brought to the Office by the Rat Catcher during the year, contrasted with 5,102 during the year 1921; poisoned bait was laid at 87 premises. 234 complaints were received of the presence of rats on premises. The Rat Catcher paid 634 visits to premises, in addition to periodical visits to such open places as Barnes and Sheen Commons, the Beverley Brook, Tow path, &c. DISINFECTION AND DISINFESTATION. |
0489aeea-962e-4e56-9a1d-b1505c79570e | The following is an account of the work carried out during the year in connection with :β (1) The disinfection and disinfestation of (a) Premises; (b) Bedding and other articles. (2) The cleansing of persons infested with vermin. The Disinfecting Station attached to the Isolation Hospital, and the Cleansing Station situated at the Council's Depot, have been used for these purposes. In premises, disinfection of rooms vacated by persons suffering from infectious disease has been by formaldehyde vapour, disinfestation of verminous premises has been by fumigation with sulphur dioxide and other means. The number of rooms disinfected after the occurrence of infectious disease was 348; and 99 rooms were stripped and cleansed on this account. Verminous premises fumigated and otherwise treated to rid them of vermin numbered 10. |
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