C 4386 B AT 43 Metropolitan Borough of Battersea. ABRIDGED REPORT on the HEALTH of the BOROUGH in 1944 by G. Macdonald, M.A., M.B, D.P.H,, Medical Officer of Health. 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 1944. 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. Principle Figures for 1944. Area of Borough acres 2,163 Pulation (Registrar-General's mid-year estimate) 85,380 Structurally separate occupied dwellings 25,570 Rateable value—£1,082,040. Sum produced by 1d. rate £3,988 Births— (li ve 1,626, still 40) 1,666 Liv e birth rate 19.04 Deaths—1,510. Death rate 17.69 Maternal deaths—2. Maternal death rate 1.22 Infant deaths—81. Infant mortality rate 49.82 2 Vital Statistics. Population.-The population of the Brough at the middle of 1944 is estimated by the Registrar-General to have been 85,380. Births. Births registered in Battersea numbered 1826. Of these, only 828 were of Battersea parents, but there were 798 Battersea children born outside the Brough, and the total number of Battersea live births in 1944 was therefore 1,626 (844 males, 782 females). Live birth-rate 19.04 per 1,000, an increase of 0.75 over that of the previous year. Still births numbered 40—rate 24.01 per 1,000 births, live and still. Illegitimate births numbered 152, which included 5 among the still births. Of the 1,626 Battersea live births, 1,435 were notified to the Medical Officer of Health under the Public Health (London) Act, 1936. Marriages.—730 marriages were registered in Battersea during 1944, a marriage-rate of 17.1. Deaths. —2,422 deaths were registered in Battersea during 1944. Of these only 964 were of Battersea residents, but there must be added 546 deaths of residents of the Borough registered elsewhere, giving a total of 1,510 (799 males, 711 females), and the death rate was 17.69 per 1,000 population, an increase of 1.9 over the figure for the preceding year. This increase, however, is mainly due to deaths arising through enemy action. 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 — 2. Cerebro-spinal fever 1 3. Scarlet fever — 4. Whooping cough 5 5. Diphtheria 2 6. Tuberculosis of the respira- tory system 78 7. Other forms of tuberculosis 8 8. Syphilitic diseases 10 9. Influenza 3 10. Measles — 11. Acute polio-myelitis and polio-encephalitis — 12. Acute infective encephalitis — 18. Cancer of bucal cavity and œsophagus (m): uterus (f) 25 216 14. Cancer of stomach and duodenum 42 15. Cancer of breast 28 16. Cancer of all other sites 121 17. Diabetes 9 18. Inter-cranial vascular lesions 91 19. Heart disease 394 20. Other diseases of circulatory system 53 21. Bronchitis 116 22. Pneumonia 81 23. Other respiratory diseases 10 24. Ulcer of stomach or duodenum 22 25. Diarrhœa (under 2 years) 19 26. Appendicitis 3 27. Other digestive diseases 28 28. Nephritis 24 29. Puerperal and post-abortion sepsis 2 30. Other maternal causes — 31. Premature birth 12 32. Congenital malformations, birth injuries, infantile diseases 25 33. Suicide 5 34. Road traffic accidents 10 35. Other violent causes 194 36. All other causes 89 Infant Mortality. —There were 81 deaths of infants under twelve months of age, giving an infant mortality rate of 49.82 per 1,000 births. This may be compared with the rate for the previous year of 53.9. The deaths of illegitimate infants numbered 11, giving an illegitimate infant death rate of 74.83. 8 Maternity and Child Welfare. The activities of the Council under this heading were continued during 1944 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 8,893 home visits to children u nder 1 and 5,927 to children between 1 and 5. The total number of home visits for all purposes during the year paid by Health Visitors was 23,701. Infant Welfare Centres. —660 sessions, 18,982 attendances. Ante-Natal Clinics. —232 sessions, 3,145 attendances. Post-Natal Clinics. —The activities of the Post-Natal Clinic, which were suspended in 1941, following the damage caused by enemy action at Southlands, were resumed at the Gideon Road Cen tre in January. During the year 33 sessions were held, the attendances numbering 199. Mothercraft Classes. —239 meetings, 2,921 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 159 mothers and 51 children were referred to the Clinic, and of these 57 mothers and 31 children had attended. Hospitals.— 560 Cases were referred to hospitals, etc., from the Welfare Centres, and 4,389 visits were paid at the request of various hospitals, etc. National Dried Milk 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, 7,529 packets; Fruit Juice, 42,004 bottles; Cod Liver Oil, 4,337 bottles and 856 packets of capsules. Priority Dockets for Sheets.—In November arrangements were ma de for the issue of priority dockets to enable mothers who were being confined at home to purchase utility sheets. The maximum allowed to any one mother was three. Up to the end of the year 38 dockets were issued to 15 mothers. 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. Maternal Mortality.—2 Deaths from puerperal sepsis, giving a maternal mortality rate of 1.22 per 1,000 births, live and still. Unmarried Mothers. —The usual grant of £150 was made to the Southwark Diocesan Association. 2 Battersea mothers were admitted to their Homes and stayed for 227 days. Home Helps.—During the year 20 cases were attended, the cost to the Council being- £71 2s. 1d. St. Thomas's Babies Hostel.—Alderman Mrs. Bowler was reappointed to represent the Council on a Committee of Management. Work done.—ln-patients 25 (8 mothers, 17 babies), total stay 876 days. The annual grant of £400 per annum was continued by the Council. Nursing.—The District Nurses, under contract with the Council, paid 3,884 visits to 393 cases, of which 152 were patients suffering from infectious disease. Sunlight Clinic.—46 Sessions were held and 509 attendances were made during the year. The St. Margaret's Day Nursery, which was evacuated on the outbreak of war, remained at Horsham throughout 1944, 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.—As a result of damage sustained by enemy action, it became necessary to close the Albert Bridge Road Nursery. The accommodation in the remaining five nurseries is 235, and the total attendances during the year numbered 49,836. Child Life Protection. —3o foster-mothers were still on the register at the end of 1944, but only 14 of these had nurse-children (to the number of 16) in their care. The health visitors paid 249 visits to foster-mothers. Infectious Diseases. The following table shows the number of cases notified during 1944:— Diphtheria (82) 33 Dysentery Pneumonia 26 (6) Erysipelas 37 (49) Scarlet Fever 143 (152) (Acute influenzal) 17 (32) Enteric fever 2 (1) (Acute primary) 124 (158) Puerperal fever 1 (6) Whooping Cough (464) 407 Puerperal pyrexia 4 (13) Measles 200 (661) Meningoccal meningitis 6 (19) Tuberculosis (all forms) 184 (216) Ophthalmia neonatorum 13 (17) Scabies 774 (-)* Polio-myelitis, etc. (3) - Encephalitis lethargica (—) 5 1976 (1879) Malaria 5 (-) (For the purposes of comparison, the average number of cases notified annually in the five years, 1939-43, is inserted in brackets.) *Scabies became notifiable on 1st August, 1943. Compared with the figures for the previous year there was a large decrease in the number of cases of diphtheria, measles, scarlet fever and acute influenzal pneumonia. 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 1,468 Patients (662 new; 279 old and 527 who had been inoculated b y school medical officers). 921 were found to be immune on test a fter inoculation. 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 34.8% 36.1% 5—15 57.6% 61.5% Arrangements are in force for private practitioners to immunise children who are unable to attend the clinic, but no children were immunised in this way during the year. 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 98.2% 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. Tuberculosis. —Beside 184 cases notified, there were otherwise reported 18, making a total of 202 new cases, and a case rate of 236.6 per 100,000 population. The Dispensary was carried on throughout the year as in normal times. Deaths from tuberculosis numbered 96, of which 8 were of the non-pulmonary form. The death rates for all forms of tuberculosis was 112.4 per 100,000 population, that for the pulmonary cases being 103. These figures whilst higher than those for the preceding two years are lower than those for 1941. The death rate for the non-pulmonary cases was 9.4 per 100,000 Population which is a decrease of 0.7 from the corresponding figure for 1943. Advantage was taken of the proximity of the mass radiography unit at the end of 1943 and the beginning of 1944 to arrange for groups of workers to attend. The following table shows the results obtained: — Males Females Total Examined 1,343 1,178 2,521 Referred for large films Of these:— 63 28 91 Did not re-attend 3 5 8 No abnormality 10 6 16 Calod. and other lesions — N.F.A. 25 5 30 Referred to Gen. Practitioner: Probably T.B. 14 11 25 Probably not T.B. 7 7 - 5 4 1 Cardio-vasc. The provision of allowances for persons undergoing treatment for pulmonary tuberculosis and their dependants, details of which were outlined in the Annual Report for 1943, were continued during the year. The administration of the scheme involved the presentation of 164 new cases and the number of cases reviewed was 593; it also necessitated 717 interviews with patients or their relatives and the sending of 783 letters. The Borough Treasurer disbursed £4,410 13s. Od. to 162 patients, in addition to which various small sums were paid out by the stewards of L.C.C. institutions. Extra nourishment was provided during the financial year ended 31st March, 1945, for 12 necessitous dispensary patients at a cost of approximately £70. The number of new patients attending at the Dispensary was 794. Of these 623 were discharged as "non-tuberculous," 146 were found to be suffering from the disease and 25 were still under observation. Five cases kept under observation during previous years were also found to be suffering from the disease, making a total of 151 definite cases. The total number of attendances during the year was 6,137. Home visits to the number of 3,542 were paid (307 by Tuberculosis Officer and 3,235 by nursing staff). 145 patients received institutional treatment, the average length of stay being 153 days. The Handicraft Class was held on 50 occasions during the year with an average attendance of 6. Cancer.—216 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 3,466 Water supply— House inspections 21,119 New houses certified - Shop Act inspections 14 Additional to tenement houses 2,367 Factory, etc., inspections 1 - Water closets provided, etc. Gipsy van inspections 7 19 Smoke observations Drains Smoke tests 73 Notices served— Water tests 150 Intimation 1,463 Relaid 15 Statutory— Sections 197 and 220 Repaired 221 232 Plans received Fifth schedule, etc. 607 30 Mortuary— Persons cleansed (including 3,931 children) 5,729 Bodies received 468 Premises disinfected 992 P.M. examinations 468 Inquests Articles disinfected 18,031 68 Scabies and Vermin. —The number of baths given to persons suffering from scabies during the year was 3,839 (1,618 adults and 2,221 children). The falling off in the number of baths from that of 1943 (5,624) is partly 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. One notice was served under the Scabies Order, and it was found necessary to resort to legal proceedings. The defendant, in his absence, was fined one shilling. The number of baths given for other verminous conditions was 1,890 (180 adults; 1,710 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. 1,633 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 23 instances ; fines were inflicted amounting to £29 3s. 0d. and costs to £l5 15s. 0d. Factories and Homework.—The number of factories in which mechanical means are used decreased by 1 to 247, and of nonmechanical factories decreased by 11 to 113. Inspections of these Premises numbered 1,770. The number of homeworkers decreased by 53 to 72. Bakehouses numbered 40 at the end of the year, 10 of which a re underground bakehouses. One of the 40 premises does not r ank as a factory since only the proprietor works on the premises. 83 inspections of bakehouses were made during 1944. Protection of the Food Supply. —1,200 samples (of which 607 were informally taken) were analysed by the Public Analyst. Of these 20 (12 informal) were certified to be adulterated, which gives a percentage of adulteration of 1.67. 462 of the samples were of milk, the percentage of adulteration among which was 1.08. There were 63 dairies (milk shops) registered at the end of the year. 22 licences to sell tuberculin tested milk and 33 for pasteurised milk were valid during 1944. 126 premises were on the register for the sale of preserved foods and 33 as fish shops. Street stalls from which food was sold numbered 85. Housing. Number of new houses or tenements erected during the year Nil Number of dwelling-houses inspected for housing defects 5,278 (19,563 inspections) Number of dwelling-houses found not to be in all respects reasonably fit for human habitation— Nil (i) Dealt with under Housing Act 1,390 (ii) Dealt with under Public Health (London) Act Number of defective dwelling-houses rendered fit by informal action Ni l 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 1,390 (1,621 intimation notices) Number of dwelling-houses in which defects were remedied after service of formal notices — 1,291 (i) By owners (1,447 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 9 (18 rooms)