CAM 32 METROPOLITAN BROUGH OF CAMBERWELL ANNUAL (ABRIDGED) REPORT OF THE MEDICAL OFFICER OF HEALTH H. W. BARNES, M.B., B.Ch., D.P.H., for the year 1943. CAM 32 Public Health Department, Town Hall, Camberwell, S.E.5. 8th September, 1944. To His Worship the Mayor, Aldermen and Councillors, of the Metropolitan Borough of Camberwell. Mr. Mayor, Aldermen and Councillors, As in the previous war years this report does not reflect in full measure the extent of the work of the Public Health Service in 1943; it attempts nothing more than a record in statistical form of the activities of the principal services, and follows the lines of the direction of the Ministry of Health on the publication of annual reports in War-time. The health of the Borough continues to be satisfactory. The birth rate was 18.76, the death rate 16.OO per thousand of the population, and the infantile mortality rate 48 per thousand live births. There were three deaths of women from diseases or accidents associated with child birth, representing a maternal mortality rate of 1.18 per thousand total births. The number of cases of infectious disease notified was less than in the previous year, especially diphtheria; the number of cases of this disease reported was 81 as compared with 159 in 1942. In my last report I referred to the Department's activities to secure the immunisation of the greatest possible number of children against diphtheria. It is pleasing to report that the attendances at the clinics provide the best commentary on these activities, which included an advertising campaign and an intensive propaganda effort by the Health Visitors and Sanitary Inspectors to stimulate Interest of the parents in diphtheria preventive treatment. The sustained efforts of the Public Health Department over a period of years has resulted in over 70% of the school child population of Camberwell having received immunisation treatment against diphtheria. The Minister has requested that a reference should be included in this report to the steps taken to improve the general standard of cleanliness and habits of the population, and to combat infestation by head lice. Among the suggestions contained in the Ministry's Circular on this matter were that Health Visitors should give more of their attention to the children between two and five, and should concentrate largely, in their visiting, on the homes which they know to be the least satisfactory, and for the local authority to make available issues of fine tooth combs and an insecticide preparation known as Lethane Hair Oil. The Health Visitors were instructed to report on the number of children under five found to have nits or lice (a) at the Clinic sessions, (b) in their own homes, and to record particulars of early and late visit to homes where guidance was necessary in establishing the right hygienic routine in washing, in the care of the hair and. teeth, etc. The figures failed to establish a case that the problem was one of some size in Camberwell; in fact there were surprisingly few instances where the standard of cleanliness In the home fell short of a reasonable level. The limited distribution of Lethane oil and combs at the Infant Welfare Centres to the end of the year also provided proof Of the existence of a fairly satisfactory standard of cleanliness throughout the Borough. The War-time nurseries programme was completed during the year. There are now twelve Nurseries in the Borough; four for children in the 0 - 5 years group; seven for children between the ages of two and five years; and one for children in the age group eighteen months to five years. Five of these War-time Nurseries are provided in L.C.C. Rest Centres. These Nurseries provide for the admission of 395 children. Once again I wish to express my thanks to the staff of the Department for their loyal service throughout the year, and in particular for the manner in which they have accepted extra and in some cases unfamiliar duties arising from the war. I also wish to acknowledge the support and encouragement I have received from the members of the Council and the Chairmen of the Standing Committees in all matters relating to the duties of my appointment as Medical Officer of Health. I am, your obedient servant, H. W. BARNES. SUMMARY OF STATISTICS. FOR THE YEAR 1943. Area of the Borough in acres 4,480 Number of live births 2,483 Birth rate 18.76 Number of deaths 2,118 Death rate 16.00 Infantile Mortality- Deaths under 1 year 120 Infantile deaths per 1,000 births (live) 48.32 Maternal Mortality- Deaths of women from diseases or accidents associated with childbirth 3 Maternal death rate (per 1,000 total births) 1.18 Deaths from phthisis 119 Phthisis death rate 0.89 Deaths from all forms of tuberculosis 138 Tuberculosis death rate 1.04 DEATHS, CAUSES OF, AND AGES AT, DURING THE YEAR 1943. Causes of Death Sex All ages. 0- 1- 5- 15- 45- 65- All causes 80 7 106 334 554 1089 1029 8 M. 7 Typhoid and paratyphoid fevers F. 40 13 85 204 680 M. - - - - - - - F. 1 - - 1 Cerebro-spinal fever - - - - - M. - - - - - F. - - - - - - - Scarlet Fever M. - - - - - - - F. - - - - - - - Whooping Cough M. - - 3 3 - - - F. 1 4 3 - - - - Diphtheria M. - - - - - - - - F. - - - - - - 41 10 Tuberculosis of respiratory system M. 83 - 32 - - 4 F. 36 - 4 25 3 - Other forms of tuberculosis M. 9 2 1 4 1 - 1 F. 10 1 6 1 - 2 - Syphilitic diseases M. 10 - - 5 5 - - - Influenza F. 5 - - 1 4 - M. 18 - - 5 13 - - F. 4 Measles 31 - 4 23 - - M. 2 1 1 - - - - F. - - Acute Polio-myelitis and polio-encephalitis. Ac: inf: enceph: - - - - - - M. - - - - - - - F. 1 1 - - - - M. - - - - - - - F. 1 1 2 - - - - Cancer of buc: cav:& oesoph:(M) uterus (F) Cancer of stomach & Duodenum M. 4 11 - 1 6 - - F. 18 - - - - 8 10 M. 23 2 10 11 - - - F. 14 5 9 Cancer of breast - - - - M. - - - - - - - - 17 13 Cancer of all other sites F. 32 2 - - 1 51 M. 122 1 8 61 - F. - 3 31 88 - - 54 Diabetes M. 1 4 - 1 2 - - 2 Intracranial vascular lesions F. 7 - - 2 3 - M. 69 21 48 - - - - F. 103 23 80 - - - - DEATHS, CAUSES OF, AND AGES AT, DURING THE YEAR 1943. Causes of Death Sex All Ages 0 - 1 - 5- 15- 45- 65- Heart disease M. 298 - - - 15 225 58 1 F. 344 - 10 34 299 Other Dis: of circ: system - 20 M. 36 - 16 - - - - - 24 F. 27 - 3 Bronchitis - 1 3 48 M. 93 1 1 39 F. 67 1 - - 12 54 Pneumonia - M. 62 19 1 - 1 22 19 2 31 F. 52 6 3 10 Other resp: diseases - M. 13 1 - - 2 6 4 4 F. 8 - 1 3 - - Ulcer of stomach or duodenum - 3 19 11 M. 33 - - - 1 5 2 F. 8 - Diarrhoea under 2 years - - - M. 16 16 - - - - F. 12 10 2 - - Appendicitis - 2 M. 3 - - 1 - - - 1 - Other digestive diseases F. 1 - - - M. - 12 21 - 9 - - 1 13 F. 20 - 6 Nephritis - - M. 12 - 1 4 7 - - 1 8 5 F. 14 - - Puer:and post-abort:sepsis - - - M. - - - - - 1 - F. 1 - Other maternal causes - - - - - - - M. - - - F. 2 - - 2 - - - Premature birth 16 - M. 16 - - - - - - Con: Mal: birth Inj: Infant dis: Suicide F. 10 10 - - - 3 M. 21 17 - 1 - - 2 9 7 - - - F. - 11 - 2 7 2 M. - - - - Road Traffic acc: F. - - - - - 2 1 M. 7 1 1 2 - 6 2 2 2 F. - - - Other violent causes 3 6 8 M. 25 3 1 4 10 7 17 F. 37 1 - 2 16 All other causes M. 68 2 - 9 41 - 59 2 9 15 30 F. 3 - INFECTIOUS DISEASES SUMMARY OF NOTIFICATION RECEIVED. No. of cases notified. Treated in Hospital Found to be not suffering from the disease 81 81 17 Diphtheria and Croup Scarlet Fever 2 365 108 660 134 Measles - Whooping Cough 320 78 3 3 2 - Enteric Fever & Para-typhoid Pneumonia (Acute Influenzal (Acute Primary - 43 10 - 75 24 Erysipelas 35 17 - Cerebro-Spinal Meningitis 14 14 - 1 1 Polio-Myelitis - Dysentery 42 40 2 5 Ophthalmia Neonatorum 2 - 8 7 - Puerperal Fever - Puerperal Pyrexia 10 10 1,662 Totals 528 24 DISINFECTING STATION - RETURN OF WORK. Notified Infectious Diseases Other Diseases Miscellaneous A.R.P. Disinfecting and washing Scabies Vermin Total all cases 1061 Rooms disinfected 724 15 163 2265 256 46 Lots of bedding disinfected 455 74 142 1581 166 327 417 Total Visits 1115 624 606 457 366 4039 871 Number of articles disinfected by steam 15,150 „ „ „ „ „ formalin 1,564 „ „ books disinfected 212 Beds and Mattresses destroyed 101 Miscellaneous goods destroyed 188 T. C. qr. 1b. Weight of Unsound foods destroyed 10 14 2 9¼ „ „ Old and verminous furniture etc. destroyed 13 3 0 „ „ dead animals destroyed 2 3 0 CLEANSING STATION. Persons cleansed Number of attendances Scabies Vermin Males Females Males Females 768 1,209 20 8 Adults Children 1,358 3,328 3,465 392 NUMBER OF BACTERIOLOGICAL EXAMINATIONS PERFORMED 1943. Swabs for diphtheria 1,121 Sputa for tubercle 935 Milks 40 Faeces for Typhoid Group 9 „ „ sonne dysentery 265 Urine for Typhoid Group 5 Bath waters 4 Miscellaneous specimens 111 Total 2,490 VACCINATION 1943. No. of names received in birth lists 1,507 Certificates of Successful Vaccination received 631 „ „ Postponement received 3 „ „ Insusceptibility received 2 Statutory Declarations of Objection received 492 MATERNITY AND CHILD WELFARE. Infant Welfare Centres - Clinic Attendances etc. 1943. Attendances of Children (i) Under 1 year 28,733 (ii) Between 1 & 5 years 7,845 Miscellaneous attendances 2,546 Total attendances 39,124 Analysis of Doctors' Consultations 12,447 Seen by Health Visitor 24,131 Health Visitors - Record of Visits, 1943. Visits to Expectant Mothers 1,079 „ „ Post-natal Mothers 2,085 No. of Births reported in the Area 2,483 Visits to (i) Under 1 year 10,017 (ii) Between 1 and 5 years 14,028 Total 24,045 Miscellaneous Visits 2,381 32,073 Ancillary Services. In 118 instances the services of a Home Help were provided for mothers, either before, during or after confinement. 23 expectant or nursing mothers were provided with dental treatment. The District Nursing Associations paid a total of 3,771 visits to 241 approved cases under the Council's Domiciliary Nursing Scheme. A total of 84 patients benefitted under the Council's Treatment of Minor Ailments scheme. FOOD AND DRUGS. FORMAL AND INFORMAL SAMPLES SUBMITTED FOR ANALYSIS - YEAR ENDED 31.12.43. Number examined Number adulterated. etc. Percentage of adulteration. Total Formal Informal Formal Informal Total Formal Informal 464 1112 24 30 648 54 5.17 4.62 COMPOSITION OF MILK SAMPLES. 433 formal and 10 informal samples of milk were taken during the year. Nine formal samples were found not to conform with requirements. MILK ADULTERATION. Nine formal samples are reported against, eight being found to contain extraneous water and one being deficient in fat. The percentage of adulteration was 2.07. No infringements of the MERCHANDISE MARKS ACT were recorded during the year or of the various orders under the AGRICULTURAL PRODUCE (GRADING AND MARKING) ACT 1928. BACTERIOLOGICAL EXAMINATION OF MILK. Number of samples submitted for examination- Pasteurised milk 40 All wore found to comply with the standard for pasteurised milk laid down in the Milk (Special Designations) Order, 1936; in addition seven samples of pasteurised milk wore submitted to the Phosphatase test. All samples were found to be adequately pasteurised. Three samples of Tuberculin Tested Milk were submitted for the Methylene Blue test, and were found to be satisfactory. EXAMINATION OF MILK FOR THE PRESENCE OF TUBERCLE BACILLI. Five samples of raw milk were examined by moans of the animal test for the presence of tubercle bacillus, with negative results. BAKEHOUSES. The number of bakehouses on the register at the end of the year was 70 overground and 27 underground. SUMMARY OF INSPECTION. Street Markets Inspections 2,238 FOOD PLACES - Inspections: Bakehouses 198 Fish curers Premises 79 Fried Fish Shops 140 Ice cream Premises 1 Restaurants and Eating Houses 237 SANITARY INSPECTION. No. of complaints received 3,108 Inspections under Shops Act, 1934 654 „ „ Pharmacy and Poisons Act, 1933. 153 „ „ Milkshops 391 Factories Act, 1937:- No. of Inspections of Factories 42 „ „ „ „ Outworkers' Promises 8 Intimations served 2 No. of Intimations, P.H. (London) Act, 1936 2,474 „ „ Statutory Notices 566 „ „ Reinspections (all Enactments) 6,300 Total number of visits 16,155 TUBERCULOSIS. Public Health (Tuberculosis) R egulations, 1930. NEW CASES during 1943. 336 fresh cases of Tuberculosis came to the notice of the Dispensary during the year. 274 of these cases were primary notifications, 44 inward transfers, 7 posthumous notifications and 11 non-notified deaths obtained from the local Registrar's returns. The distribution of these cases in age groups distinguishing pulmonary and non-pulmonary forms is set out in the following table. Age periods Fresh Cases. Respiratory Non Respiratory Total M. F. M. F. 2 - - - 2 0 - 1 2 11 1 - 5 4 1 4 6 5 - 15 8 8 5 27 16 15 - 45 97 97 15 225 9 54 45 - 65 41 2 2 5 1 17 10 1 65 - 162 120 27 27 336 Total MORTALITY during 1943. There were 138 deaths from all forms of tuberculosis after correction for Inward and Outward Transfers, equal to a death rate of 1.04 per 1,000 of population (1.00 per 1,000 in 1942). Of these, 119 were pulmonary cases and 19 nonpulmonary cases. The age groups in which these deaths occurred appear in the sub-joined table. Age periods. Deaths. Respiratory Non Respiratory Total M. F. M. F. 0 - 1 - 1 - - 1 - 2 1 3 1 - 5 - 1 2 7 5 - 15 - 4 4 6 76 41 25 15 - 45 32 4 1 1 38 45 - 65 10 13 65 - 3 - - Total 10 138 83 36 9 The total number of cases on the Tuberculosis Register at the end of the year was 1,737 i.e., 1,421 pulmonary, 316 non-pulmonary. The ratio of non-notified deaths to the total deaths was 1 to 12.5 as compared with 1 to 4.19 in 1942. No case of wilful neglect or refusal to notify cases on the part of medical practitioners occurred. No occasion arose during 1943 for any action under the public Health (Prevention of Tuberculosis) Regulations 1925 or the Public Health Act 1936, Section 172. WORK OF THE TUBERCULOSIS DISPENSARY DURING 1943. Diagnosis Pulmonary Non-Pulmonary Total Grand Total Adults Adults Children. Children. Adults Children. M. F. M. F. M. F. M. F. M. F. M. F. A - New Cases examined during the year (excluding contacts):- (a) Definitely Tuberculous. 4 2 56 158 5 6 7 84 42 4 14 3 89 - (b) Diagnosis not completed - - - 8 3 - - 1 23 - 11 - - - - - 269 49 40 576 - - 218 (c) Non-tuberculous. - - B - Contacts examined during the year:- (a) Definitely Tuberculosis 5 3 3 2 23 35 70 22 34 4 1 1 7 (b) Diagnosis not completed 6 - - 13 - 6 30 - 5 - - - - - - - 124 248 78 66 516 (c) Non-tuberculous - - - - - C - Cases written off the Dispensary Register as:- 12 (a) Recovered 15 6 11 11 4 1 6 6 6 39 - - (b) Non-tuberculous (Including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous). - - - - - - 132 - - 355 540 113 1140 D - Number of cases on Dispensary Register on December 31st:- (a) Definitely Tuberculous 100 503 64 66 622 51 628 90 125 36 712 117 1557 (b) Diagnosis not completed - 17 6 - - - 21 9 53 - - - - 1. Number of Cases on Dispensary Register on January 1st, 1943 1,517 2. Number of cases transferred from other areas and cases returned after discharged under Head 3 in previous years. 85 3. Number of cases transferred to other areas, cases not desirous of further assistance under the Scheme and cases "lost sight of". 4. Cases written off during the year as Dead (all causes) 103 83 5. Number of attendances at the Dispensary (including contacts) 6. Number of insured persons under domicilary treatment at 31st Dec. 1943. 8,355 269 7. Number of consultations with Medical Practitioners:- 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 232 (a) Personal - (b) Other 2,151 9. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes. 6,073 10. Number of:- 770 (a) Specimens of sputum etc. examined (b) X-ray examinations made in connection with Dispensary work 2,401 11. Number of "recovered" cases restored to Dispensary Register and included in A (a) and A (b) above. 12. Number of "T.B.plus" cases on Dispensary Register at December 31st, 1943. - 444 ARTIFICIAL PNEUMOTHORAX TREATMENT. A total of 1,925 refill treatments were given to Camberwell patients as compared with 1,502 in 1942. Four patients received finson Light treatment and seven patients dental treatment. Extra diet was given to 65 patients and 55 pocket flasks were supplied. X-ray. Every new case of "contact" attending the dispensary during 1943 received X-ray examination. TUBERCULOSIS ALLOWANCES. Memo 266/T. The Government scheme of monetary payments to patients suffering from pulmonary tuberculosis, receiving approved treatment and their dependents commenced in June 1943. The operation of the scheme has worked smoothly. Particulars of the cases dealt with under the scheme during the period June December, 1943 appear in the sub-joined table. 1. Number of applications considered 178 2. Number of applications found to be eligible 144 3. Number found to be ineligible but became entitled to an allowance at a later date. 3 4. Number of applications approved and subsequently lapsed as a result of altered circumstances 54 HANDICRAFT CLASS. This class has continued to meet throughout the year. The number of classes held was 50 with an average attendance of 13 students. Although the supply of raw materials for the various crafts has been limited the students have maintained their keen interest in the class and the quality of the workmanship has continued at the same high level.