C4386 BAT 39 Metropolitan Borough of Battersea. ABRIDGED REPORT on the HEALTH of the BOROUGH in 1940 by G. Macdonald, M.A., M.B., D.P.H,, Medical Officer of Health. Principal Figures for 1940. Area of Borough acres 2,163 Population (Registrar-General's mid-year estimate) 108,380 Structurally separate occupied dwellings 27,580 Rateable value—£1,151,435. Sum produced by 1d. rate £4.415 Births—(live 1,794, still 47) 1,841 Live birth rate 16.55 Deaths—1,992. Death rate 18.38 Maternal deaths—3. Maternal death rate 1.77 Infant deaths—68. Infant mortality rate 41.29 68603 2 To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Battersea. Mr. Mayor, Ladies and Gentlemen, I present herewith my report upon the health and sanitary condition of the Borough during the year 1940. Following upon the advice of the Ministry of Health, the report is an abridged one as for the previous year, and is mainly confined to a statistical record. It is a matter for profound thankfulness that there has been no serious epidemic during the year and that the general health of the population after two years of war has been so good. The incidence of infectious disease has not been unduly high. The rise in the death rate is the result very largely of deaths through enemy action. The infantile mortality rate is the lowest ever recorded in the Borough. The incidence of tuberculosis and the death rate from this disease show a small rise as compared with the previous five years. A similar rise occurred during the last war. During the year the department was unfortunate in losing through enemy action the premises housing the Tuberculosis Department and the main Maternity and Child Welfare Clinic, and also a Maternity and a Child Welfare Clinic in another part of the Borough. This caused temporary dislocation of the work in those departments which was, however, quickly overcome. Many of the records, however, of the Tuberculosis Dispensary were lost. My staff has been called upon during the year to undertake many duties incidental to the war and I gratefully acknowledge my indebtedness to them for their willing and ready help in all emergencies. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, G. MACDONALD, Medical Officer of Health. January, 1942. The Secretary London School of Hygiene and Tropical Medicine. with the compliments of the medical officer of health ELECTRIC HOUSE, LAVENDER HILL, S.W. 11. 3 Vital Statistics. Population.—Ihe population of the Borough at the middle of 1940 is estimated by the Registrar-General to have been 108,380 or 23,220 less than in 1939. On this figure is based the birth-rate and the civilian death-rate. Births registered in Battersea numbered 2,489. Of these, only 1,301 were of Battersea parents, but there were 493 Battersea children born outside the Borough, and the total number of Battersea live births in 1940 was therefore 1,794 (900 males, 894 Females), giving a live birth-rate of 16.55 per 1,000 of the estimated population. Still births numbered 47—rate 25.5 per 1,000 births, live and still. ' Illegitimate births numbered 100, which included 3 among the still births. Of the 1,794 Battersea live births, 1,442 were notified to the medical Officer of Health under the Public Health (London) Act, Marriages.—1,654 marriages were registered in Battersea during 1940, giving a marriage-rate of 30.5, over 50 per cent. above the average for 1935-39. Deaths.—2,962 deaths were registered in Battersea during 1940. Of these only 1,546 were of Battersea residents, but there must be added 446 deaths of residents of the Borough registered elsewhere, giving a total of 1,992 (992 males, 1,000 females) and a death-rate of 18.38. For the 5 years 1935-39 the death-rate was 12.5 per 1,000 population, the average number of deaths per annum having been 1,779. The number in 1940 was 213 in excess of this average, while the estimate of population upon which the rate is calculated was much reduced. Deaths through enemy action and deaths ascribed to bronchitis, which numbered 200, or 106 more than the same 5 years' average, account for the increase. The causes of death, arranged under the headings or the short list used by the Registrar-General, were as follows:— 1. 2. Typhoid and paratyphoid fevers — 18. Intra cranial vascular lesions 84 3. Lerebro-spinal fever 6 19. Heart disease 586 4. Scarlet fever — 20. Other diseases of circulatory system 45 5. Whooping cough 1 6. diphtheria 8 1 21. Bronchitis 200 Tuberculosis of the respiratory system 109 22. Pneumonia 91 7. 23. Other respiratory diseases 15 8. 9. Other forms of tuberculosis 10 24. Ulcer of stomach or duodenum 32 Syphilitic diseases 16 10. influenza 16 25. Diarrhoea (under 2 years) 5 11. Measles 2 26. Appendicitis 4 33 37 Acute polio-myelitis and Polio-encephalitis 27. Other digestive diseases 12. 13. 28. Nephritis Acute infective encephalitis Lancer of buccal 1 29. Puerperal and post-abortion sepsis 2 cavity and cesoP h a g u s (m): uterus (f) 24 272 30. Other maternal causes 1 31. Premature birth 22 14. 32. Congenital malformations, birth injuries, infantile diseases 17 Lancer of stomach _ and duodenum 43 15. 16. Lancer of breast 30 33. Suicide 10 Lancer of all other sites 175 34. Road traffic accidents 20 17. 35. Other violent causes 236 Diabetes 21 36. All other causes 97 4 Infant Mortality.—There were 68 deaths of infants under twelve months of age, giving an infant mortality-rate of 41.29* per 1,000 births. This may be compared with a rate for the previous five years (1935-39) of 62.0 The deaths of illegitimate infants numbered 3, giving an illegitimate infant death rate of 31.25. Maternity and Child Welfare. The activities of the Council under this heading were continued during 1940 with only a few curtailments noted below. Temporary interference was caused when the centre at 55, Mundella Road, having been damaged two nights previously by incendiary bombs was demolished by enemy high explosive on the night of 18th September. Two months later (17th November) a portion of the Southlands building, including part of the Infant Welfare Centre, was also demolished, and it became necessary to house the centre in Southlands School adjoining, which was standing empty. Grants.—The Committee at the beginning of the year reviewed the grants which they were accustomed to pay to various bodies carrying on work ancillary to the scheme for maternity and child welfare. Each case was considered, but no reduction was made, and the grants to the Invalid Children's Aid Association and the St. Thomas's Babies Hostel were increased. Infant Welfare Centres.—717 sessions, 28,846 attendances. Ante-Natal Clinics.—227 sessions, 2,417 attendances. Mothercrajt Classes.—303 meetings, 3,107 attendances. Dental Clinic.—222 sessions, 1,976 attendances, 302 new patients. This clinic was destroyed when the Southlands Centre was bombed. Arrangements for re-establishment of the clinic were not complete at the end of the year. Toddlers' Clinics were discontinued on the outbreak of war. During 1940, 586 first attendances were made by toddlers at the Infant Welfare Clinics. Artificial Light Treatment.—112 sessions, 51 patients, 1,223 attendances. Massage Clinic.—129 sessions, 918 attendances, 45 new patients. The two last-mentioned clinics, owing to falling attendances, were closed at the end of September, and for a similar reason the gynaecological clinic, which was established in 1939, was discontinued in October. Hospitals.—675 cases were referred to hospitals, etc., from the Welfare Centres, and 2,323 visits were paid at the request of various hospitals. Milk.—In August the Government scheme for the supply of milk at cheap rates to expectant and nursing mothers and children under 5 years of age came into force throughout the country, and thereafter the Council's scheme, which had been in operation *This figure is, by direction of the Registrar-General, based on a total of 1,647 births. 5 since 1901, ceased to function except for the supply of additional Quantities of milk to those babies found, on medical examination, to require more than the official allowance of one pint daily. Throughout the whole year the quantity supplied by the Council amounted to the equivalent of 119,157 pints of liquid milk, and the recipients numbered 1,371 persons, 74.1 Per cent. of the issue being free of charge and 25.9 per cent. at reduced prices. More than 98 per cent. of these quantities were issued before the coming into force of the Government Scheme. These figures include the supply made through the Public Assistance Committee under the arrangement made with the London county Council. The cost incurred by the Council amounted to approximately £1,974. Dinners.—Women and children were still sent for dinners to rooms of the Women's League of Service at Southlands, but it is regretted that the kitchen of the Invalid Kitchens Association in Henley Street, to which selected cases had previously been sent, closed down in April. Maternal Mortality.—3 deaths (2 from puerperal sepsis and rom other puerperal causes), giving a maternal mortality rate of 1.77 per 1,000 births, live and still. Unmarried Mothers.—The usual grant of .£150 was made to the southwark Diocesan Association. 13 Battersea mothers were admitted to their Homes and stayed for 1,221 days. Home Helps.—6 cases. Cost to Council, £22 18s. l0d. A new scheme for the supply of home helps was adopted by the Committee in March. A panel of six suitable women was formed, and a scale of income drawn up for the assessment of applicants' contributions. Owing to evacuation of mothers from London, however, the scheme was very little used. St. Thomas's Babies Hostel.—Transferred to Wiltshire on the outbreak of War, and remained there during 1940, but in the summer test feeding was resumed for a few weeks in London. A Committee was formed to promote this revival of the hostel's activities, and Mrs. Alderman Bowler was appointed to represent the Council thereon. After a short period, however, the occurrence of heavy bombing caused the experiment to be abandoned. Work done.—Test feeding 48 cases, 78 attendances. In-patients 20 (8 mothers, 12 babies), total stay 1,011 days. The council decided to increase their annual grant from £200 to £400 per annum. Nursing.—The District Nurses, under contract with the council, paid 4,979 visits to 553 cases, of which 240 were patients suffering from infectious disease. The St. Margaret's Day Nursery, which was evacuated on the outbreak of war, remained at Horsham throughout 1940 and was used, in common with other evacuated nurseries, for evacuees selected by a central committee. The Council continued its financial grant. Child Life Protection.—71 foster-mothers were still on the register at the end of 1940, but only 15 of these had nursechildren (to the number of 17) in their care. The health visitors paid 480 visits to foster-mothers. 6 Infectious Diseases. The incidence of infectious disease was even lower in 1940 than in 1939. As shown in the table below, there were only 968 cases notified, about one-third of the average number during the past five years:— Diphtheria 41 (252) Erysipelas 52 (59) Scarlet fever 75 (300) Enteric fever 3 (7) Puerperal fever 8 (5) Puerperal pyrexia 9 (18) Meningococcal meningitis 29 (5) Ophthalmia neonatorum 20 (23) Polio-myelitis, etc. 1 (5) Malaria — (1) Dysentery — (7) Pneumonia (acute primary) 172 (206) Pneumonia (acute influenzal) 39 (44) Whooping cough 62 (607 Measles 280 (1042) Tuberculosis (all forms) 177 (219) 968 (2800) for the purposes of comparison, the average number of cases notified in the five years, 1935-1939, is inserted in brackets. Schick Clinic.—The diphtheria immunisation clinic was continued throughout the year, and attended by 247 patients (194 new). Five were found to be immune on primary test, and 104 on test after inoculation. Tuberculosis.—Beside 177 cases notified, there were otherwise reported 25, making a total of 202 new cases. The dispensary was carried on throughout the year as in normal times, but it is impossible to give the usual detailed figures of the work owing to the destruction of the dispensary and the current records by enemy action in November, 1940. Deaths from tuberculosis numbered 119, of which 10 were of the non-pulmonary form. The death-rate was 1.10 per 1,000 of the population, as compared with an average of 0.85 during the 5 years 1935-39. Extra nourishment was provided during the financial year ended 31st March, 1941, for 63 necessitous dispensary patients at a cost of approximately ,£234. Cancer.—212 deaths of Battersea residents were recorded, being at the rate of 2.51 per 1,000 population, the average rate for the preceding 5 years being 1.84 per 1,000. Sanitary Circumstances. The Inspectorial staff were to a large extent engaged on special duties in relation to bombed dwellings, displaced tenants, air-raid shelters, etc. The number of dwelling houses inspected therefore shows an increase on previous years, but in general the usual work of the department in relation to sanitation shows a marked decrease, as evidenced by the following table. Complaints received 3,357 House inspections 40, 988 Shop Act inspections 25 Factory, etc., inspections 1,343 Gipsy van inspections 38 Drains— Smoke tests 77 Water tests 423 Relaid 38 Repaired 249 Plans received 70 Water supply— New houses certified 135 Additional to tenement houses 4 Water closets provided, etc. 18 Smoke observations 28 Notices served— Intimation 2,113 Statutory— Sections 197 and 220 551 Fifth schedule, etc. 1,130 7 Persons cleansed (including 3,497 children) 4,275 Premises disinfected 1,957 Articles disinfected 33,268 Mortuary— Bodies received 592 P.M. examinations 416 Inquests 122 Legal proceedings to enforce various requirements or for the very of penalties incurred by the breach of statutory requirements were taken in 37 instances; fines were inflicted amounting to £10 17s. 6d., and costs to £17. Factories and Homework.—The number of factories in which mechanical means are used decreased by 14 to 275, and of nonmechanical factories by 24 to 178. Inspections of these premises numbered 938. The number of homeworkers decreased by 2 to Bakehouses numbered 49 at the end of the year, two being closed during the year. The number of underground bakehouses remained at 14. Four of the 49 premises do not rank as factories since only the proprietor works on the premises. 64 inspections of bakehouses were made during 1940. protection of the Food Supply.—1,200 samples (of which 450 were formally taken) were analysed by the Public Analyst. Of these 12 (5 informal) were certified to be adulterated, which gives Percentage of adulteration of 1.0. 731 of the samples were of milk, the percentage of adulteration among which was 0.7. There were 104 dairies (milk shops) registered at the end of the year. 46 licences to sell tuberculin tested milk and 63 for pasteurised milk were valid during 1940. 250 Premises (excluding street stalls) were on the register for the Manufacture, storage or sale of ice cream, and 165 for the sale Preserved foods and 65 as fish shops. Street stalls from which food was sold numbered 129. Housing. No. of new houses or tenements erected during the year 135 No. of dwelling houses inspected for housing defects (37,655 inspections) 9,476 Number of dwelling-houses found not to be in all respects reasonably fit for human habitation— (i) Dealt with under Housing Act Nil (ii) Dealt with under Public Health (London) Act 1,652 Number of defective dwelling-houses rendered fit by informal action 12 Number of dwelling-houses in respect of which Statutory Housing Act notices were served requiring repairs Nil Number of dwelling-houses which were rendered fit after service of formal notices 1 Number of dwelling-houses in respect of which Public Health Act notices were served requiring defects to be remedied (1,958 intimation notices) 1,652 8 Number of dwelling-houses in which defects were remedied after service of formal notices— (i) By owners (1,764 intimation notices complied with) 1,474 (ii) By Local Authority in default of owners 3 Number of separate tenements or underground rooms in respect of which Closing Orders were made (in 1 house) 2 Overcrowding— (a) New cases reported during the year 14 (b) Cases relieved during the year 18 (c) No. of cases on register at the end of the year 1,140 Housing accommodation provided by the London County Council for Battersea families 465 Staff. The appointment of Dr. Shirlaw (recorded in the annual report for 1939) was extended by the Council in January and July for further periods expiring in February, 1941, but the proportion of his time taken up with public health duties was reduced to onefourth instead of one-half as before. Mr. P. Bracking, Grade A Clerk, in the general office of the Health Department, entered the Royal Air Force in November. It is with regret that I have to report the following deaths among the staff of the Department:— Mr. C. A. Hackman, F.I.c., Public Analyst, on 12th December. During the first quarter of 1940 Mr. Hackman's duties were performed (owing to his absence through illness) by his partner, Mr. A. H. Mitchell Muter, f.i.c., who had been appointed public analyst for the purpose. Mr. Hackman returned to duty in April, but in October he wrote saving that his convalescence had proceeded but slowly, and that his doctor insisted that he should leave London for a time, and asking the Council to appoint his partner, Mr. J. E. Woodhead, an additional Public Analyst for the Borough. The Council did so, but Mr. Hackman's illness proved fatal before the end of the year. He had held his office since June, 1922, and was a highly esteemed and competent Public Analyst. The appointment was not filled until early in 1941. Miss M. H. Wilkie, health visitor, who came into the service of the Council when the work of the Battersea School for Mothers was taken over by the Council in 1935. Miss Wilkie was a very capable and efficient health visitor who was most popular with the mothers among whom she served. Her death in August was preceded by a painful illness of many months' duration. The vacancy was not filled. Mr. and Mrs. Clark, caretakers of the Tuberculosis Dispensary, who (with their only child) were killed in Southlands when that building was partly demolished by an enemy bomb on 17th November. Mr. T. E. Noble, laboratory technician at the Tuberculosis Dispensary, who was a victim of enemy bombing in December at his own home.