BAT 45 C 4386 Metropolitan Borough of Battersea. ABRIDGED REPORT on the HEALTH of the BOROUGH in 1946 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 1946. In acc ordance 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 1946. Area of Borough acr es 2,163 Population (Registrar-General's mid-year estimate) 108,610 Structurally separate occupied dwellings 26,956 Rateable value-£1,095,983. Sum produced by Id. rate £4,406 Births-(live 2,546, still 59) 2,605 Live birth rate 23.44 Deaths-1,469. Death rate 13.53 Maternal deaths-4. Maternal death rate 1.54 Infant deaths-108. Infant mortality rate 42.42 Vital Statistics. Population. —The population of the Borough at the middle of 1946 is estimated by the Registrar-General to have been 108, 610. Births. —Births registered in Battersea numbered 2,939 of these, 1,665 were of Battersea parents, but there were 881 Battersea children born outside the Borough, and the total number of Battersea live births in 1946 was therefore 2,546 (1,317 males 1,229 females). Live birth-rate 23.44 per 1,000, an increase of 5.82 over that of the previous year, and the highest since 1915. Still births numbered 59 —rate 22.65 per 1,000 births, live and still. Illegitimate births numbered 184, which included 2 among the still births. Of the 2,546 Battersea live births, 2,422 were notified to the Medical Officer of Health under the Public Health (London) A ct 1936. Marriages. —1,043 marriages were registered in Battersea during 1946, a marriage-rate of 19.2. Deaths. —2,004 deaths were registered in Battersea during 1946. Of these 848 were of Battersea residents, but there must be added 621 deaths of residents of the Borough registered els ewhere, giving a total of 1,469 (751 males, 718 females), and the death rate was 13.53 per 1,000 population, a decrease of 0.32 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 — 2. Cerebro-spinal fever 3 3. Scarlet fever — 4. Whooping cough — 5. Diphtheria 2 6. Tuberculosis of the respiratory system 83 7 Other forms of tuberculosis 9 8. Syphilitic diseases 12 9. Influenza 20 10. Measles 1 11. Acute polio-myelitis and polio-encephalitis — 12. Acute infective encephalitis — 13. Cancer of bucal cavity and oesophagus (m): uterus (f) 18 14. Cancer of stomach and duodenum 38 224 15. Cancer of breast 25 16. Cancer of all other sites 143 17. Diabetes 8 18. Inter-cranial vascular lesions 111 19. Heart disease 448 20. Other diseases of circulatory system 63 21. Bronchitis 105 22. Pneumonia 75 23. Other respiratory diseases 11 24. Ulcer of stomach or duodenum 22 25. Diarrhoea (under 2 years) 10 26. Appendicitis 3 27. Other digestive diseases 35 28. Nephritis 27 29. Puerperal and post-abortion sepsis - 30. Other maternal causes 4 31. Premature birth 29 32. Congenital malformations, birth injuries, infantile diseases 30 33. Suicide 10 34. Road traffic accidents 8 35. Other violent causes 44 36. All other causes 72 Infant Mortality.—There were 108 deaths of infants under twelve months of age, giving an infant mortality rate of 42.42 per 1,000 births. This may be compared with the rate for the previous year of 40.80. The deaths of illegitimate infants numbered 16, giving an illegitimate infant death rate of 87.91. The infant Mortality Rate compares favourably with that for England and Wales (43) and the County of London (41). It is interesting to note that at the beginning of the century the Corresponding rate for the borough was 160. Of the 108 infant deaths, twenty were under 24 hours; twenty 1 to 7 days; and sixteen 1 to 4 weeks old at the time of death. Thus 51.9 per cent. of the infant deaths took place before the child reached the age of 4 weeks. Maternal Mortality.—4 maternal deaths, giving a maternal Mortality rate of 1.54 per 1,000 births, live and still. Maternity and Child Welfare. The activities of the Council under this heading were continued during 1946 with only a few variations noted below. Grants. —Except in the case of the Southwark Diocesan Association 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 10,171 home visits to children under one; 5,970 to children between 1 and 5; and 5,583 prenatal visits. The total number of home visits for all purposes during the year paid by Health Visitors was 27,455. Infant Welfare Centres.—667 sessions, 27,316 attendances. Ante-Natal Clinics.—267 sessions, 4,928 attendances. Owing to the large increase in the attendances at the antenatal clinics an additional session was arranged to be held at Chatham Hall. This commenced on May 8th. Post-Natal Clinics. —52 sessions, 509 attendances. Cases found to require, on medical grounds, advice on birth control, were deferred by agreement to the North Kensington Women's Welfare Centre. Toddlers' Clinic.—During the war the special toddlers' clinics were discontinued, the children between 1 and 5 being seen a t the usual infant welfare centre. On January 12th, however, the separate clinics were resumed u nder a specially appointed medical officer. The clinics are held alternate weeks at five of the welfare centres, and during the year 528 children attended, the total attendances being 1,053. Mothercraft Classes.—277 meetings, 4,517 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' Hospital, this service commencing in March, 1941. During the year 303 mothers and 105 children were referred to the Clinic, and of these 98 mothers and 30 children had attended. Hospitals.—72l Cases were referred to hospitals, etc., from the welfare centres. 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, 12,866 packets; Fruit Juice, 33,140 bottles; Cod Liver Oil, 5,530 bottles, and 1,521 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 purchase utility sheets were continued during the year. The maximum allowed to any one mother was three. 2,268 dockets were issued to 811 mothers during 1946. 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 were compelled to close down during the year. Unmarried Mothers. —Instead of the usual grant of £150 being paid direct to the Southwark Diocesan Association the Council made an agreed contribution of £109 to a Central Fund out of which the Metropolitan Boroughs' Standing Joint Committee made annual grants to the various Moral Welfare Associations in London. During the year 9 Battersea mothers were admitted to the homes maintained by the Southwark Diocesan Association and stayed an aggregate of 451 days. Home Helps.—During the year 56 cases were attended, the cost to the Council being £257 14s. 5d. In addition to the home help for confinement cases, in accordance with Ministry of Health circular 110/46, domestic helps were provided in cases of old age, infirmity and/or illness. 8 applicants were provided with help of this nature. In view of the difficulties of securing sufficient help to meet the demands and to ensure adequate supervision the Council decided to appoint an organiser for the Scheme. The appointment was not, however, made by the end of the year. St. Thomas' Babies Hostel.—Alderman Mrs. Bowler was reappointed to represent the Council on a Committee of Management. Work done. —In-patients 13 (2 mothers, 11 babies), total stay 452 days. The annual grant of £400 per annum was continued by the Council. Nursing.—The District Nurses, under contract with the Council, paid 4,443 vists to 630 cases, of which 139 were patients suffering from infectious disease. Day Nurseries. —The four nurseries having accommodation for 1 90 children, continued to be utilised to capacity during the year, the attendances totalling 46,506. As from April 1st the nurseries w ere subject to grant from the Ministry instead of as hitherto the Ministry being responsible for the whole of the cost. In view of the length of the waiting list the Council laid down rules regarding priorities for admission the effect of which was that the children of those mothers who had most need on economic grounds to go into employment are to be given preference when a v acancy arises. St. Margaret's Day Nursery.—Throughout the year this nursery continued its normal activity and the attendances numbered 4,858 and an average of 13.6 children was maintained in the Guest House. Unfortunately owing to lack of staff, the Guest House had to close down in December. The Council's grant of £500 was continued. Child Life Protection.—40 foster-mothers were on the register a t the end of 1946, but only 17 of these had nurse-children (to the number of 20) in their care. The health visitors paid 236 visits to foster-mothers. It is to be regretted that two foster children died during the year. In both cases the inquests indicated that the cause of death due to natural causes and no blame attached to the foster mothers. In one case the Council guaranteed the payment to a foster Mother. The Report on the Care of Children Committee (Curtis Report) forwarded with Ministry of Health and Ministry of Education Joint circular was considered. The only part of this report applicable to the Council is that re lating to child life protection. The setting up of an "ad hoc" committee and the appointment of a special executive officer, as recommended in the report, does not seem to be a practical proposition having regard to the small number of foster children in this borough. The further suggestion of the constitution of a joint board for two or more areas will be met when the National Health Service Act comes into operation, when the administration of legislation regarding child life protection will be transferred to the London County Council. Premature Infants. —In accordance with Circular 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 be 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 1946. The following table sets out a record of the number of premature infants who were notified during 1946: — Born Total No. of premature babies At Home In Hospital Notified 135 39 96 Nursed entirely at home 28 28 - 17 Died during first 24 hours 2 15 31 Survived at the end of one month 58 89 Infectious Diseases. The following table shows the number of cases notified during 1946:— Diphtheria 29 (62) Malaria 10 (3) Erysipelas 37 (46) Dysentery 11 (14) Scarlet Fever 228 (170) Pneumonia (Acute influenzal) 31 (25) Enteric Fever (2) - (Acute primary) 78 (132) Puerperal fever 3 (3) Puerperal pyrexia Meningococcal 11 (10) Whooping Cough 341 (413) Measles 1,096 (919) Tuberculosis (all forms) 228 (197) meningitis 15 (9) Ophthalmia neonatorum Scabies 535 (712)* 17 (20) 2,673 (2,738) Polio-myelitis, etc. 3 (1) Encephalitis lethargica (-) - [For the purposes of comparison, the average number of cases notified annually in the five years, 1941-45, is inserted in brackets.] *Scabies became notifiable on 1st August, 1943; equivalent annual rate. Compared with the figures for the previous year there was a large increase in the number of cases of meningococcal meningitis, whooping cough and scarlet fever, whilst there was a considerable decrease in the number of cases of measles. It is interesting to note that the case rate for diphtheria—viz., 0.27 per 1,000 population—is the lowest recorded. Schick Clinic. —Diphtheria immunisation was continued at Southlands, and, in addition, immunisation was also carried out at St. George's Hall Welfare Centre where 51 children received the full dosage and 9 received one injection only. The clinics were attended by 2,254 patients (1,431 new; 409 old; 414 who had been inoculated elsewhere) and the total attendances numbered 5,825. 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. Immunised. Population. 8,820 0—5 2,737 5—15 7,737 13,800 Arrangements are in force for private practitioners to immunise children who were unable to attend the clinic, and 18 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 97.17% 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 a ttained a considerable degree of protection against diphtheria. Tuberculosis.—Beside 228 cases notified, there were otherwise reported 22, making a total of 250 new cases, and a case rate of 230.2 per 100,000 population. The Dispensary was carried on throughout the year as in normal times. Deaths from tuberculosis numbered 92, of which 9 were of the n on-pul m onary form. The death rate for all forms of tuberculosis was 84.7 per 100,000 population, that for the pulmonary cases being 76.42. The death rate for the non-pulmonary cases was 8.29 per 100,000 Population, which is an increase of 2.76 over the corresponding figure for 1945. 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, was continued during the year. The administration of the scheme involved the presentation of 96 new cases and the number of cases reviewed was 747; it also necessitated 779 interviews with patients or their relatives arid the sending of 733 letters. The Borough Treasurer disbursed £4,434 12s. 8d. to 122 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, 1947, for 14 necessitous dispensary patients at a cost 1 approximately £95. The number of new patients, contacts and transfer cases added to the dispensar y register during the year was 942, as compared with 775 in 1 945. Of these 716 were discharged as being nontuberculous; 38 were still under observation at the end of the year; and 188 were found to be suffering from Tuberculosis. Nine cases kept Un der observation during previous years were also found to be suffering from the disease, making a total of 197 new definite cases. The total number of attendances during the year was 7,531. home visits to the number of 4,053 were paid (272 by Tuberculosis officer and 3,781 by nursing staff ). 163 patients received institutional treatment, the average length of stay being 211 days. The Handicraft Class was held on 50 occasions during the year with an average attendance of 5.4. Cancer.— 224 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 6,991 House inspections 35,009 Shops Act inspections — Factory, etc., inspections 597 Gipsy van inspections Drains — Smoke tests 50 Water tests 1,518 Relaid 19 Repaired 383 Plans received 78 Persons cleansed (including 4,229 children) 6,051 Premises disinfected 1,180 Articles disinfected 11,244 Water supply— New houses certified 357 Additional to tenement houses 8 Water closets provided, etc. 14 Smoke observations 136 Notices served— Intimation 3,907 Statutory— Sections 197 and 220 324 Fifth schedule, etc. 1,800 Mortuary— Bodies received 735 P.M. examinations 728 Inquests 308 Scabies and Vermin.—The number of baths given to persons suffering from scabies during the year was 3,778 (1,702 adults and 2,076 children). The number of treatments given for other verminous conditions was 2,273 (120 adults; 2,153 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 Day Nurseries. 2,100 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 62 instances; fines were inflicted amounting to £37 12s. 6d. and costs to £42. Factories and Homework.—The number of factories'in which mechanical means are used increased by 1 to 254, and of nonmechanical factories remained at 108. Inspections of these premises numbered 341. The number of homeworkers increased by 12 to 61. 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. 48 inspections of bakehouses were made during 1946. Rats and 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 1,565 manholes on each occasion. The results obtained were very satisfactory. Protection of the Food Supply.—1,l99 samples (of which 600 were informally taken) were analysed by the Public Analyst. Of these 16 (7 informal) were certified to be adulterated, which gives a percentage of adulteration of 1.3. 430 of the samples were of milk, and in no case was adulteration reported. There were 62 dairies (milk shops) registered at the end of the year. 25 licences to sell tuberculin tested milk and 33 for pasteurised milk were valid during 1946. 126 premises were on the register for the sale of preserved foods and 41 as fish shops. s treet stalls from which food was sold numbered 93. By a res olution of the Council the provision of section 16 of the food and drugs act 1938 relating to ice cream (which requires that the name of the dealer should be legibly and conspicuously displayed on the stall, vehicle, etc., which which it is sold) were made applicable to all other foods, except milk. This resolution was approved by the Ministry of Health. Sixteen premises were registered for the manufacture, storage, and/or sale of ice cream, making the total on the register 35, one having been removed during the year. Draft Regulations made by the Minister of Health prescribing the, Con ditions under which ice cream can be manufactured, stored and sold, were issued during the year. They did not, however, come into force until 1947. Heat Treated Milk. —Samples of heat treated milk are taken at regular intervals for submission to the Public Analyst for phosphatase and methylene blue tests, and during the year samples as under were taken with the results set out:— Phosphatase Satisfactory Failed Methylene Blue Satisfactory Failed Pasteurised 13 12 - 1 Heat Treated 48 48 - - Sterilised 24 24 - - T.T. Pasteurised 1 - - - Mortuary.— In view of the large number of bodies of persons usually res ident in the Borough of Wandsworth received into the Mortuary, the Council for that Borough decided to make a grant of £250 towards the cost of maintaining the Mortuary. Public Conveniences.—To meet the need of increased provision of public conven i ences, negotiations were opened with the owners of certain licensed premises with the object of securing the urinals of those P rem i ses being made available to the public throughout the day. The negotiations were completed early in 1947 in respect of seven premises. Housing. Number of new houses or tenements (including prefabricated dwellings) erected during the year 357 Number of dwelling-houses inspected for housing defects 5,543 (22,818 inspections) 10 Number of dwelling-houses found not to be in all respects reasonably fit for human habitation— (i) Dealt with under Housing Act 1* (ii) Dealt with under Public Health (London) Act 3,072 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 3,072 (3,829 intimation notices) Number of dwelling-houses in which defects were remedied after service of formal notices— (i) By owners 2,408 (2,899 intimation notices complied with) (ii) By Local Authority in default of owners 2 Number of separate tenements or underground rooms in respect of which Closing Orders were made Nil [*Owing to the present conditions an undertaking was accepted from the owner of this house that it would not be used for habitation instead of its demolition, which would have affected the structure of adjoining houses.] Housing Accommodation. —A considerable portion of the time of the sanitary inspectorial staff was taken up in the investigation and report of applications for housing accommodation. Repair of unfit houses. —Serious difficulties have been experienced in securing the execution of essential repairs to dwelling houses, arising from the shortage of building labour and materials, especially the latter. The provision of new housing accommodation whether by new building or conversion and adaptation of existing buildings, is of course of paramount importance and should not be impeded by unnecessary diversion of labour and materials to other purposes. It will, however, inevitably be some considerable time before new accommodation will overcome the present acute shortage, and in the interim period existing houses must continue to provide some kind of accommodation however unsatisfactory it may be, for large numbers of families. It is therefore vitally necessary that this existing accommodation should be preserved in as good a 'state of repair as possible. In this connection it should be noted that the majority of houses in this Borough have had virtually no maintenance repairs carried out to them since the outbreak of war. This lack of maintenance is a most serious matter particularly in th e older and less well built types of house, for it is generally in these types that housing conditions are at their worst. Maintenance repairs to existing houses do not under present arrangements qualify for "W.B.A. Priority" in regard to supply of materials. During the year some attempt was made by th e 11 Ministry of Health to overcome the difficulty by instituting a system of "Certificates of essential repair." Such certificates however, only authorise the builder to acquire the stated materials "Subject to stocks being available" and W.B.A. certificates still take priority over them. The y have in many instances eased the position, but in far too man y cases the delay in obtaining materials is inordinately long e ve n for repairs of the most urgent nature, neglect of which many result in further serious deterioration of the house and danger to the he alth of the occupants. It Wou ld ease the position materially if the existing system of W.B.A. priorites could be extended to cover materials for such essential re pairs and improvements to existing occupied dwelling houses as are the subject of notices served by the local authority under the Public Health, Housing, or other Acts.