C4386 BAT 44 Metropolitan Borough of Battersea. ABRIDGED REPORT on the HEALTH of the BOROUGH in 1945 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 1945. 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 1945. Area of Borough acres 2,163 PoPulation (Registrar-General's mid-year estimate) 90,420 Structurally separate occupied dwellings 26,993 Rateable va1ue—£1,059,750. Sum produced by id. rate £4,106 Births— (li ve 1,593, still 38) 1,631 Live birth rate 17.62 Deaths— 1,252. Death rate 13.85 Maternal deaths—2. Maternal death rate 1.23 Infant deaths—65. Infant mortality rate 40.80 Vital Statistics. Population.—The population of the Borough at the middle of 1945 is estimated by the Registrar-General to have been 90,420. Births. —Births registered in Battersea numbered 1,830. Of these, only 880 were of Battersea parents, but there were 713 Battersea children born outside the Borough, and the total number of Battersea live births in 1945 was therefore 1,593 (817 males, 776 females). Live birth-rate 17.62 per 1,000, a decrease of 1.42 from that of the previous year. Still births numbered 38 —rate 23.3 per 1,000 births, live and still. Illegitimate births numbered 166, which included 4 among the still births. Of the 1,593 Battersea live births, 1,516 were notified to the Medical Officer of Health under the Public Health (London) Act, 1936. Marriages.—l,oB2 marriages were registered in Battersea during 1945, a marriage-rate of 23.9. Deaths.—2,o32 deaths were registered in Battersea during 1945. Of these only 630 were of Battersea residents, but there must be added 622 deaths of residents of the Borough registered elsewhere, giving a total of 1,252 (660 males, 592 females), and the death rate was 13.85 per 1,000 population, a decrease of 3.84 from the figure for the preceding year. 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 18. Inter - cranial vascular lesions 99 - 2 Cerebro-spinal fever 1 19. Heart disease 320 3. Scarlet fever 20. Other diseases of circulatory system - 54 4. Whooping cough 5 21. Bronchitis 109 5. Diphtheria - 6. Tuberculosis of the respiratory system 22. Pneumonia 46 62 23. Other respiratory diseases 5 24. Ulcer of stomach or duodenum 7 Other forms of tuberculosis 5 20 25. Diarrhoea (under 2 years) 6 8. Syphilitic diseases 9 26. Appendicitis 7 9. Influenza 7 10. Measles 27. Other digestive diseases 35 - 28. Nephritis 36 11. Acute polio-myelitis and polio-encephalitis 29. Puerperal and post-abortion sepsis - - 12. Acute infective encephalitis - 30. Other maternal causes 2 13. Cancer of bucal cavity and oesophagus (m): uterus (f) 27 31. Premature birth 23 32. Congenital malformations, birth injuries, infantile diseases 14. Cancer of stomach and duodenum 34 214 25 33. Suicide 8 22 15. Cancer of breast 34. Road traffic accidents 8 16. Cancer of all other sites 131 35. Other violent causes 52 17. Diabetes 10 36. All other causes 84 Infant Mortality.—There were 65 deaths of infants under twelve months of age, giving an infant mortality rate of 40.80 per 1,000 births. This may be compared with the rate for the previous year of 49.82. The deaths of illegitimate infants numbered 6, giving an illegitimate infant death rate of 37.04. The Infant Mortality Rate is the lowest ever recorded in the brough, and it compares favourably with that for England and Wales (46) an d the County of London (53). It is interesting to note that at the beginning of the century the corresponding rate for the borough was 160. Maternal Mortality.—2 maternal deaths, giving a maternal mortality rate of 1.23 per 1,000 births, live and still. Maternity and Child Welfare. The activities of the Council under this heading were continued during 1945 with only a few variations noted below. Grants.—No variation was made in the grants paid by the Coumcil to various bodies carrying on work ancillary to the scheme for Maternity and child welfare. Visiting.—The Health Visitors paid 8,658 home visits to children under one; 6,113 to children between 1 and 5; and 4,244 prenatal visits. The total number of home visits for all purposes during the year paid by Health Visitors was 24,285. Infant Welfare Centres.—649 sessions, 21,570 attendances. Ante-Natal Clinics. —231 sessions, 3,188 attendances. Post=Natal Clinics.—25 sessions, 226 attendances. Mothercraft Classes. —234 meetings, 3,121 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 200 mothers service commencing in March, 1941. During the year th ese and 40 children were referred to the Clinic, and of these 63 mothers and 17 children had attended. Hospitals.—544 Cases were referred to hospitals, etc., from the Welfare Centres. N a ti onal 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 trough the Public Health Department and the Welfare and Ante-natal Clinics. The totals issued through these sources during the y ear were: National Dried Milk, 6,621 packets; Fruit Juice, 33.655 bottles; Cod Liver Oil, 3,664 bottles, and 1,800 packets of capsules. Priority Dockets for Sheets.—The arrangements made for the issue of priority dockets to enable mothers who were being confined at home to P urc hase utility sheets were continued during the year. The maximum allowed to any one mother was three. 794 dockets were issued to 291 mothers during 1945. Dinners.- Women an d children were still sent for dinners to the dinning 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. Unmarried Mothers.—The usual grant of was made to the Southwark Diocesan Association. 4 Battersea mothers we re admitted to their Homes and stayed for 192 days. Home Helps.—During the year 29 cases were attended, the cost to the Council being £92 IIS. 3d. St. Thomas's Babies Hostel. —Alderman Mrs. Bowler was r e appointed to represent the Council on a Committee of Management. Work done.—In-patients 19 (6 mothers, 13 babies), total stay 711 days. The annual grant of £400 per annum was continued by the Council. Nursing.—The District Nurses, under contract with the Council paid 4,572 visits to 492 cases, of which 185 were patients suffering from infectious disease. Sunlight Clinic. —This clinic was temporarily suspended and no sessions were held during the year. The St. Margaret's Day Nursery, which was evacuated on the outbreak of war, remained at Horsham until November, 1945, a n was used, in common with other evacuated nurseries, for evacuees selected by a central committee. On return the Nursery resumed its activities at 10-12, Cambridge Road. No variation was made in the Council's financial grant. War-time Nurseries.—On the return of St. Margaret's Day Nursery, referred to above, the Council's war-time nursery,which had been established at the premises they formerly occupied' ceased to function as such. The accommodation in the remaining four nurseries is 190 and the total attendances during the year numbered 52,746. Child Life Protection.— 31 foster-mothers were on the register at the end of 1945, but only 18 of these had nurse-children (to th e number of 23) in their care. The health visitors paid 226 visits to foster-mothers. Premature Infants. —In accordance with Circuliar 20/44 of the Ministry of Health, arrangements were made for information as to the weight of infants to be given on the birth notification when such weight was less than 5½ lbs. Suitable equipment was also purchased so that it could loaned out if required. In addition, arrangements were made for the services of a paediatrician to be available at the request of general practitioners in such cases as was considered necessary. His services were not called upon during 1945. The following table sets out a record of the number of premature infants who were notified during 1945. At Home Born In Hospital No. of premature babies Total Notified 9 122 131 Nursed entirely at home 6 6 - 24 Died during first 24 hours 1 23 Survived at the end of one month 77 6 71 Infectious Diseases. The following table shows the number of cases notified during 1945:- (10) 33 (63) Dysentery 19 42 (48) DiPhtheria Erysipelas Scarlet F ever Enteric fever Puer peral fever Puerperal pyrexia Miningoccal meningitis OPhthalmia neonatorum Polio-myelitis etc. Encephalitis lethargica Malaria 197 (146) Pneumonia (Acute influenzal) 23 (28) 3 (2) (Acute primary) 85 (149) 4 (4) Whooping Cough 210 (383) 9 (10) Measles 1565 (662) (193) 5 (14) Tuberculosis (all forms) 199 Scabies 783 (892)* 19 (20) 2 (1) (-) 3206 (2627) - 8 (2) For the purposes of comparison, the average number of cases notified annuall y i n the five years, 1940-44, is inserted in brackets. *Scabies became notifiable on Ist August, 1943; equivalent annual rate. Compared with the figures for the previous year there was a increase in the number of cases of measles and scarlet fever. It is intresting to note that the case rate for diphtheria—viz., 0.36 per 1,000 population—is the lowest recorded and that for the first time no death was ascribed to this disease. Schick Clinic.—The diphtheria immunisation clinic was continued throught the year, 103 sessions being held. The average attendance was 31. The clinic was attended by 1,294 patients (987 new, 251 old, and 56 who had been inoculated elsewhere). The incre ase 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. Immunised. Population. 0-5 2054 7160 5—15 11830 7019 Arrangements are in force for private practitioners to immunise children who are una ble to attend the clinic, and two children were immunised in this way during the year. The Schick test is offered to all children who have been immunised whether at the Council's clinic or elsewhere. It was found that 96.6% the children tested after inoculation were Schick negative.A ve ry 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 considerabel degree of protection against diphtheria. Tuberculosis.—Beside 199 cases notified, there were otherwise reported II, ma king a total of 210 new cases, and a case rate of 232.2 Per 100,000 population. The Dispensa ry was carried on throughout the year as in normal times. Deaths from tuberculosis numbered 67, of which 5 were of the non-Pulmonary form. The death rates for all forms of tuberculosis was 74.1 per 100,000 population, that for the pulmonary cases being 68.6. These figures are the lowest since 1938. The death rate for the non-pulmonary cases was 5.5 per 100,000 population, which is a decrease of 3.9 from the corresponding figure for 1944. Advantage was taken of the proximity of the mass radiography unit at the end of 1945 and the beginning of 1946 to arrange for groups of workers to attend. The following table show the results obtained: — Males Females Total 2428 Examined 1339 1089 Referred for large films 60 85 25 Of these: — ... Did not re-attend 1 1 - No abnormality 6 13 7 Calcd. and other lesions— N.F.A. 28 33 5 Referred to Gen. Practitioner: Probably T.B. 29 17 12 8 Probably not T.B. 7 1 Cardo-vasc. - - - Refused further investigation 1 - 1 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 138 new cases and the number of cases reviewed was 570: it also necessitated 754 interviews with patients or their relatives and the sending of 719 letters. The Borough Treasurer disbursed £3842 12s. 6d. to 153 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, 1946, for 10 necessitous dispensary patients at a cost of approximately £81. The number of new patients attending at the Dispensary was 775. Of these 572 were discharged as "non-tuberculous," 153 were found to be suffering from the disease and 50 were still under observation. Eight cases kept under observation during previous years were also found to be suffering from the disease, making a total of 161 definite cases. The total number of attendances during the year was 6,527. Home visits to the number of 3,533 were paid (311 by Tuberculosis Officer and 3,222 by nursing staff). 130 patients received institutional treatment, the average length of stay being 133 days, The Handicraft Class was held on 48 occasions during the year with an average attendance of 6. Cancer. —214 deaths of Battersea residents were recorded. Sanitary Circumstances. The following table sets out in summarised form the details of he work of the department in relation to sanitation: — Complaints received 5289 Water New houses certified House inspections 26991 141 Shops Act inspections 8 Additional to tenement houses Factory, etc., inspections 2135 3 Gipsy van inspections Drains Water closets provided, etc. 2 Smoke tests - Smoke observations Notices 333 47 Water tests 766 Notices served— Intimation 2379 4 Relaid repaired 353 Statutory— Sections 197 and 220 284 Plans received 78 Fifth schedule, etc. 949 persons cleansed (including 3,277 children) 5162 Mortuary— Bodies received 604 924 Premises disinfected P.M. examinations 601 Articles disinfected 13818 Inquests 246 Scabies and Vermin.—The number of baths given to persons Suffering from scabies during the year was 4,036 (1,757 adults and 2,279 children). The number of baths given for other verminous conditions was 1,126 (128 adults; 998 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. a 955 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 requirement were taken in 26 instances; fines were inflicted amounting to £34 Ios. and costs to £10 17s. 6d. Factories and Homework.—The number of factories in which mechani ca l means are used increased by 6 to 253, and of nonmachanical factories decreased by 5 to 108. Inspections of these Pr e mi ses num bered 1,738. The number of homeworkers decreased by 2 3 to 49. bakehouses numbered 40 at the end of the year, 10 of which are underground bakehouses. One of the 40 premises does not rank as a factory since only-the proprietor works on the premises. 99 inspections of bakehouses were made during 1945. Rate an d Mice Destruction.—ln addition to the usual work carried out under the Rats and Mice Destruction Act maintenance treatment for rats in sewers was carried out on two occasions during the year. This treatment involved the baiting of 1,571 manholes e ach occasion. The results obtained were very satisfactory. Protection of the Food Supply.— 1,200 samples (of which 599 were informally taken) were analysed by the Public Analyst. Of these 5 (3 informal) were certified to be adulterated, which gives a Percentage of adulteration of 0.42. 469 of the samples, were of milk, the percentage of adulteration among w hich was 0.44. There were 62 dairies (milk shops) registered at the end of the year. 25 licences to sell tuberculin tested an d 34 for pasteurised milk were valid during 1945. 126 premises were on the register for the sale of preserved foods and 36 as fish shops. Street stalls from which food was sold numbered 89. The manufacture of Ice Cream was resumed during the year and 20 premises were registered for the manufacture, storage; and/or sale of this commodity. Heat Treated Milk. —At the request of the Ministry of Food the Council agreed to the taking of samples of heat treated milk at regular intervals for submission to the Public Analyst for phosphatase and methylene blue tests. The taking of samples was commenced in March and samples as under were taken with the results set out:— Satisfactory Failed Satisfactory Failed Phosphatase Methylene Blue Pasteurised 1 - 1 - Heat Treated 25 2 26 - Sterilised 20 — 20 - Housing. Number of new houses or tenements erected during the year 14 1 Number of dwelling-houses inspected for housing defects... 4,498 (22,291 inspections) Number of dwelling-houses found hot 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 2,080 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 2,080 (2,530 intimation notices) Number of dwelling-houses in which defects were remedied after service of formal notices — (i) By owners 1,515 (1,716 intimation notices complied with) (ii) By Local Authority in defualt of owners - Number of separate tenements or underground rooms in respect of which Closing Orders were made Nil Housing Accommodation. —For some eight months in the year one Sanitary Inspector was engaged exclusively on the investigation and report of applications for housing accommodation. The work, however, grew to such an extent that it became necessary to spread it out over all the sanitary inspectorial staff, and a considerble portion of their time was taken up in this work.