BAT 42 cu 384 Metropolitan Borough of Battersea. ABRIDGED REPORT on the HEALTH of the BOROUGH in 1943 by G. Macdonald, M.A., M.B., D.P.H,, Medical Officer of Health. 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 conditions of the Borough during the year 1943. In accordance with the instructions of the Ministry of Health, the report is an abridged one and is mainly a statistical review. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, G. MACDONALD, Medical Officer of Health. Principal Figures for 1943. Area of Borough acres 2,163 Structurally separate occupied dwellings 26,812 Rateable value—£1,077,318. Sum produced by Id. rate 4,160 Births—(live 1,631, still 36) 1,667 Deaths 1,408 Maternal deaths—Nil. Maternal death rate 0.00 Infant deaths—88. Infant mortality rate 53.95 BATTER.SEA BOROUGH COUNCIL With the Compliments of the Medical Officer of Health. 3 Vital Statistics. Births registered in Battersea numbered 2,082. Of these, only 1,009 were of Battersea parents, but there were 622 Battersea children born outside the Borough, and the total number of Battersea live births in 1943 was therefore 1,631 (852 males, 779 females). Still births numbered 36—rate 21.60 per 1,000 births, live and still. Illegitimate births numbered 120, which included 3 among the still births. Of the 1,631 Battersea live births, 1,442 were notified to the Medical Officer of Health under the Public Health (London) Act, 1936. The birth rate for the year showed an increase of 0.013 per cent. over that of the previous year. Marriages.—810 marriages were registered in Battersea during 1943. Deaths.—2,585 deaths were registered in Battersea during 1943. Of these only 1,095 were of Battersea residents, but there must be added 313 deaths of residents of the Borough registered elsewhere, giving a total of 1,408 (716 males, 692 females), and the death rate was 5.69 per cent. higher than that for 1942. For the 5 years 1938-42 the death-rate was 15.2 per 1,000 population, the average number of deaths per annum having been 1,629. The causes of death, arranged under the headings of the short list used by the Registrar-General, were as follows: — 1. Typhoid and paratyphoid fevers 1 18. Inter-cranial vascular lesions 65 19. Heart disease 413 2. Cerebro-spinal fever 2 20. Other diseases of circulatory system 72 3. Scarlet fever — 4. Whooping cough 7 21. Bronchitis 103 5. Diphtheria 5 22. Pneumonia 85 6. Tuberculosis of the respiratory system 80 23. Other respiratory diseases 13 24. Ulcer of stomach or duodenum 14 7. Other forms of tuberculosis 9 25. Diarrhoea (under 2 years) 7 8. Syphilitic diseases 15 26. Appendicitis 2 9. Influenza 34 27. Other digestive diseases 29 10. Measles 2 28. Nephritis 20 11. Acute polio-myelitis and polio-encephalitis — 29. Puerperal and post-abortion sepsis — 12. Acute infective encephalitis 3 30. Other maternal causes — 13. Cancer of buccal cavity and oesophagus (m): uterus (f) 26 31. Premature birth 26 32. Congenital malformations, birth injuries, infantile diseases 26 14. Cancer of stomach 227 and duodenum 24 33. Suicide 2 15. Cancer of breast 33 34. Road traffic accidents 9 16 Cancer of all other sites 144 35. Other violent causes 45 17. Diabetes 7 36. All other causes 85 Infant Mortality.—There were 88 deaths of infants under twelve months of age, giving an infant mortality rate of 53.95 per 1,000 births. This may be compared with a rate for the previous five years (1938-42) of 54.65. The deaths of illegitimate infants numbered 11, giving an illegitimate infant death rate of 94.02. 4 Maternity and Child Welfare. The activities of the Council under this heading were continued during 1943 with only a few variations noted below. Grants.—No variation was made in the grants paid by the Council to various bodies carrying on work ancillary to the scheme for maternity and child welfare. Visiting.—The Health Visitors paid 9,144 home visits to children under 1 and 5,888 to children between 1 and 5. The total number of home visits for all purposes during the year paid by Health Visitors was 31,298. Infant Welfare Centres.—716 sessions, 27,181 attendances. Owing to the falling off of the attendances at the St. James Mission Welfare Centre, Nine Elms, it was decided at the end of the year to suspend the meetings of this centre until after the war. Ante-Natal Clinics.—206 sessions, 3,571 attendances. An additional ante-natal clinic was established at the Gideon Road Centre in fune. Mothercraft Classes.—243 meetings, 4,039 attendances. Dental Clinic.—Following the destruction of the Dental Clinic by enemy action, arrangements were made with the London County Council for dental treatment to be carried out at St. James's Hospital, this service commencing in March, 1941. During the year 186 mothers and 75 children were referred to the Clinic, and of these 58 mothers and 38 children had attended. Hospitals.—848 cases were referred to hospitals, etc., from the Welfare Centres, and 3,535 visits were paid at the request of various hospitals, etc. National Dried Mil^ and Vitamins.—Throughout the year, National dried milk and fruit juice and cod liver oil, supplied by the Ministry of Food, have been distributed to children and expectant mothers through the Public Health Department and the Welfare and Ante-natal Clinics. The totals issued through these sources during the year were: National Dried Milk, 10,347 packets ; Fruit Juice, 64,604 bottles ; Cod Liver Oil, 7,705 bottles and 1,154 packets of capsules. Supplementary Clothing Coupons.—Despite protests to the Ministry of Health, it was decided that supplementary clothes coupons to expectant mothers should be issued from Food Offices instead of, as hitherto, from Public Health Departments. The changeover took place in July and up to that time 1,002 books had been issued. Dinners.—Women and children were still sent for dinners to the dining rooms of the Women's League of Service at Southlands. The Invalid Kitchens Association also supplied meals during the year from a kitchen established in Balham, the dinners being delivered at the home of the patient. 5 Maternal Mortality.—It is gratifying to be able to record, for the first time, that no maternal deaths occurred throughout the year. Unmarried Mothers.—The usual grant of £150 was made to the Southwark Diocesan Association. 6 Battersea mothers were admitted to their Homes and stayed for 784 days. Home Helps.—During the year 12 cases were attended, the cost to the Council being £35. 6s. 7d. In February, the scale of payment by the Patient was revised, and this has resulted in greater use being made of this service. St. Thomas's Babies Hostel.—Alderman Mrs. Bowler was reappointed to represent the Council on a Committee of Management. Work done.—In-patients 39 (16 mothers, 23 babies), total stay 1,222 days. The annual grant of £400 per annum was continued by the Council. Nursing.—The District Nurses, under contract with the Council, paid 4,086 visits to 438 cases, of which 192 were patients suffering from infectious disease. Sunlight Clinic.—The activities of this clinic were resumed in November and 65 attendances were made during the year. The St. Margaret's Day Nursery, which was evacuated on the outbreak of war, remained at Horsham throughout 1943, and was used, in common with other evacuated nurseries, for evacuees selected by a central committee. The Council continued its financial grant. War-time Nurseries.—Three additional war-time nurseries were opened during the year—one in Albert Bridge Road in June, another in Battersea Park in August and the third on Clapham Common in September—making a total of six in all. The total accommodation in these six nurseries is 294, and the attendances during the year numbered 44,959. Child Life Protection.—29 foster-mothers were still on the register at the end of 1943, but only 19 of these had nurse-children (to the number of 21) in their care. The health visitors paid 499 visits to foster-mothers. Infectious Diseases. The following table shows the number of cases notified during Diphtheria 89 (108) Dysentery 9 (7) Erysipelas 51 (49) Pneumonia (acute primary) 173 (166) Scarlet Fever 321 (139) Pneumonia (acute influenzal) 55 (25) Enteric fever 1 (2) Whooping Cough 430 (443) Puerperal fever 2 (7) Measles 851 (928) Puerperal pyrexia 12 (15) Tuberculosis (all forms) 233 (189) Meningococcal meningitis 11 (17) Scabies 413 (—) Ophthalmia neonatorum 16 (20) Polio-myelitis, etc 1 (4) Encephalitis lethargica (-) 2670 (2119) Malaria 2 (-) [For the purposes of comparison, the average number of cases Notified annually in the five years, 1938-42, is inserted in brackets.] 6 Compared with the figures for the previous year there was a large increase in the number of cases of both scarlet fever and acute influenzal pneumonia. But there was a considerable diminution in the number of cases of measles. Scabies became notifiable as from the 1st of August. Schick Clinic.—The diphtheria immunisation clinic was continued throughout the year. The arrangement with the London County Council whereby children who had been inoculated by the School Medical Officer, attended for testing as to immunity, continued in force during the year. The clinic was attended by 2,482 patients (1,439 new and 402 who had been inoculated by school medical officers). Eight were found to be immune on primary test, and 1,561 on test after inoculation. As a result of the special campaign which aimed at securing the immunisation of all children between the ages of 1 and 5, which was completed during the year, it was found that of 5,403 children under 5 visited, it was stated that 2,301 were already immunised. Of the remainder, the parents indicated their willingness to have immunisation carried out in 2,657 cases and in only 445 instances the parents declined. While it has been found impossible to produce reliable statistics showing the effect of the campaign, the impression gained at the immunisation clinic and by the Health Visitors was that the response was poor and not commensurate with the work involved. It was most noticeable in this connection that the best propaganda was undoubtedly a broadcast talk, and the showing of a cinematograph film was also effective. The increase in the proportion of children known to have been immunised has been slow and shows that much work still remains to be done before mass-immunity of the population is assured. The estimated figures are as follows : — Age Group. June Dec. 0— 5 27.4% 29.4% 5—15 51.4% 54.9% Arrangements were also made for private practitioners to immunise children who were unable to attend the clinic and in this way 35 children were immunised. The Schick test is offered to all children who have been immunised whether by the School Medical Officers or at the Council's clinic, but the response from the School immunised children has been rather low. It was found that 96.7 % of the children tested after inoculation were Schick negative. A very stringent standard was maintained in reading the test and most of those found to be Schick positive showed by the mildness of the reaction that they had attained a considerable degree of protection against diphtheria. 7 Tuberculosis.—Beside 233 cases notified, there were otherwise reported 25, making a total of 258 new cases. The Dispensary was carried on throughout the year as in normal times. Deaths from tuberculosis numbered 89, of which 9 were of the nonpulmonary form. Death rates for all forms of tuberculosis and for the pulmonary form alone, which increased steadily from 1938 to 1941 and which dropped appreciably in 1942, have remained at substantially the same level in 1943. The death rate for the non-pulmonary forms of the disease showed a slight increase in 1943, but is still less than half that of 1941. In contrast to the trend of the death rate for the last two years, the notification rate for pulmonary tuberculosis has continued to rise both in 1942 and 1943, while the non-pulmonary notification rate remains at a fairly high level. While there is no doubt that there has been a considerable increase in the number of cases of tuberculosis in the population during the war years, the continued and increasing disparity between the rates for deaths and for notifications may be partially explained by the use of mass-radiography in the Forces and in the industrial population and by the increased attention given to the disease generally—both of which are factors leading to unusually early diagnosis and notification of the disease. There still appears to be no increase in incidence of tuberculosis among females of the industrial age group (15—34) as compared with all female notifications, while the number of notifications among children under 5 years of age has returned to more usual proportions. Tuberculosis Allowances. In recognising the principle of providing allowances for persons undergoing treatment for pulmonary tuberculosis and for their dependants, the Government has undoubtedly made a great advance in tackling the problem of tuberculosis. Even given ideal circumstances the treatment of the disease is no easy matter and when, as is usual, the economic factor obtrudes, it may become very difficult indeed and often Impossible. The provision of free treatment was, of course, of great benefit but it failed to meet the needs of a large number of patients who, being breadwinners, left their families in financial difficulties when they undertook sanatorium treatment. Now such patients can give up their work knowing that their families will not be in actual want, although in the scheme as it stands the benefits are unevenly distributed and, where there is no other breadwinner, the standard of living of the 8 family may be gravely reduced. There would also seem to be need for revision of the conditions of the scheme in cases where the patient is the main breadwinner while not being the householder. Difficulties also arise in the case of students and others who, not having given up remunerative occupation, are not covered by the conditions of the scheme although there is still need for the allowance and there is prospect of work later. There remains also the great drawback that the benefits of the scheme are restricted to those in whose case there is the prospect of a return to work. It is extraordinarily difficult to explain to these unfortunates why they are ineligible and it sometimes indeed has the anomalous effect of sending them back to work when they are quite unfit. Moreover, it is often difficult for the Tuberculosis Officer to foretell what is going to be the condition of a particular patient possibly twelve months later in a disease where prognosis is particularly difficult and which is full of surprises both favourable and unfavourable. Payments of allowances are made at the Dispensary—an arrangement which is much appreciated by the patients and which has proved to be advantageous to the dispensary staff, providing as it does an opportunity for explanation and enquiry. In effect, the scheme, although capable of improvement, has been found of great benefit and, while it has meant a considerable increase in the work of the Dispensary staff, no great difficulties have been encountered in its working, and arrangements with the Borough Treasurer for payments and with the London County Council's Assessment Officer have given every satisfaction. The administration of the scheme for the six months July to December, 1943, involved the presentation of 153 new cases and the number of cases reviewed was 237; it also necessitated 380 interviews with patients or their relatives and the sending of 565 letters. During the six months in which the scheme was in operation the Borough Treasurer disbursed £2,207. 7s. 6d. to 113 patients, in addition to which various small sums were paid out by the stewards of LC.C. institutions. Extra nourishment was provided during the financial year ended 31st March, 1944 for 28 necessitous dispensary patients at a cost of approximately £133. The number of new patients attending at the Dispensary was 958. Of these 721 were discharged as "non-tuberculous," 188 were found to be suffering from the disease and 49 were still under observation. The total number of attendances during the year was 6,452. Home visits to the number of 3,722 were paid (335 by Tuberculosis Officer and 3,387 by nursing staff). 186 patients received institutional treatment, the average length of stay being 78 days. The Handicraft Class was held on 49 occasions during the year with an average attendance of 8. Cancer.—227 deaths of Battersea residents were recorded. Sanitary Circumstances. The following table sets out in summarised form the details of the work of the department in relation to sanitation: — Complaints received 4.029 Water supply— House inspections 28,533 New houses certified Shop Act inspections 13 Additional to tenement Factory, etc., inspections 2,781 houses 2 Gipsy van inspections — Water closets provided, etc. 5 Drains- Smoke observations 25 Smoke tests 27 Notices served— Water tests 146 Intimation 2,202 Relaid 14 Statutory-— Repaired 238 Sections 197 and 220 506 Plans received 39 Fifth schedule, etc. Mortuary— 989 Persons cleansed (including 5253 children) 7,240 Bodies received 441 Premises disinfected 1,619 P.M. examinations 438 Articles disinfected 20,999 Inquests 148 Scabies and Vermin.—As from 1st August, scabies became a notifiable infectious disease. Up to the end of the year 413 cases were notified. The number of baths given to persons suffering from scabies during the year was 5,624 (1,942 adults and 3,682 children). The falling off in the number of baths from that of 1942 (8,583) is due to the fact that with the benzyl benzoate treatment which is now provided a single bath is sufficient in most cases whereas under the treatment previously available three baths were necessary. Two notices were served under the scabies order, but in no ease was it found necessary to resort to legal proceedings. The number of baths given for other verminous conditions was 1,616 (75 adults ; 1,541 children). Head Lice.—It has been the practice for many years to refer to the Personal Cleansing Station all cases of Head lice discovered by the staff during home visiting, at the Welfare Centres, or at War-Time Nurseries. 1518 children referred by the school medical service were treated for head lice. Legal proceedings to enforce various requirements or for the recovery of Penalties incurred by the breach of statutory requirements were taken in 35 instances; fines were inflicted amounting to £59 and costs to £21. Factories and Homework.—The number of factories in which Mechanical means are used decreased by 3 to 248, and of non-mechanical factories increased by 4 to 124. Inspections of these premises numbered 1958. The number of homeworkers decreased by 33 to '25. Bakehouses numbered 41 at the end of the year. The number of underground bakehouses was reduced to 10. Two of the 41 premises do not rank as factories since only the proprietor works on the premises. 140 inspections of bakehouses were made during 1943. Protection of the Food Supply.—1,200 samples (of which 604 were informally taken) were analysed by the Public Analyst. Of these 15 (6 informal) were certified to be adulterated, which gives a percentage of adulteration of 1.25. 576 of the samples were of milk, the percentage of adulteration among which was 0.87. There were 68 dairies (milk shops) registered at the end of the year. 21 licences to sell tuberculin tested milk and 32 for pasteurised milk were valid during 1943. 129 premises were on the register for the sale of preserved foods and 33 as fish shops. Street stalls from which food was sold numbered 83. Housing. Number of new houses or tenements erected during the year Nil Number of dwelling-houses inspected for housing defects 4,147 (26,570 inspections) 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 1,722 Number of defective dwelling-houses rendered fit by informal action Nil Number of dwelling-houses in respect of which Statutory Housing Act notices were served requiring repairs Nil Number of dwelling-houses in respect of which Public Health Act notices were served requiring defects to be remedied 1,722 (2,184 intimation notices) Number of dwelling-houses in which defects were remedied after service of formal notices— (i) By owners 1,711 (1,955 intimation notices complied with) (ii) By Local Authority in default of owners 4 Number of separate tenements or underground rooms in respect of which Closing Orders were made Nil %