LIBRARY CHE 48 METROPOLITAN BOROUGH OF CHELSEA. A N N U A L (ABRIDGED) REP 0 R T . on the Health of the Borough during 194-5 by W. H. L. MCCARTHY, D.S.O., M.C., M.D., M.R.C.P., D.P.H., Barrister-at-Law Medical Officer of Health. 1 METROPOLITAN BOROUGH OF CHELSEA. ANNUAL (ABRIDGED) REPORT ' * of the MEDICAL OFFICER OF HEALTH. for the year 1945. To the Mayor, ALdermen and Councillors of the Metropolitan Borough of caelsea. Mr. Mayor, Ladies and Gentlemen, I have the honour to submit my Annual Report on the health and sanitary conditions of the Borough for 1945. In accordance with instructions from the Ministry of Health, the report has again been prepared in abridged form. The Registrar-General's estimate of the population of the Borough was 35,310. (30,990 in 1944). The birth rate (15.8) was higher than in 1944 (13.4). The death rate (15.2) was lower than in 1944 (18.4). The infant mortality rate was 45 per 1,000 live births as compared with 50 in 1944. The health of the population was satisfactory. There was an increase in the total incidence of notifiable infectious disease. The total number of notifications was 754, as compared with 506 in 1944. A large increase was recorded in the number of cases of measles. Diphtheria immunisation was maintained at a high level, throughout the year. The Chelsea Health Society continued to render valuable assistance in connection with Maternity and Child Welfare work. The attendances by mothers at the ante-natal clinic numbered 2,302 as compared with 1,428 in 1944. Close attention was devoted to the supervision of food supplies. I should like to thank members of the Council for the support and sympathetic consideration which they have extended to me and for their attention to the problems which it has been my duty to lay before them. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, W.H.L. McCarthy, M.D., D.P.H., Medical Officer of Health. Public Health Department, Town Hall, Chelsea, S.W.3. September, 1946. 2 METROPOLITAN BOROUGH OF CHELSEA. ANNUAL (ABRIDGED) REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1945. POPULATION Registrar-General's estimate of civilian population 35>31C LIVE BIRTHS Total M. F. Legitimate 465 237 228 Birth rate per 1,000 Illegitimate 92 51 41 estimated civilian 557 288 269 population l5.8 STILL BIRTHS 15 6 9 Rate per 1,000 total (live and still) births 26.2 DEATHS 536 264 272 Death rate per 1,000 estimated civilian population 15.2 DEATHS FROM PUERPERAL CAUSES:- Deaths Rate per 1.000 total (live and still) births. Puerperal Sepsis 1 1. 7 Other puerperal causes 3 5. 2 DEATH RATE OF INFANTS UNDER ONE YEAR OF AGE:- All infants per 1,000 live births 45 Legitimate infants per 1,000 legitimate live births 32 Illegitimate infants per 1,000 illegitimate live births 109 CLASSIFICATION OF DEATHS. The causes of death (536) were as follows j~ Cerebro-spinal fever 2 Other respiratory diseases 6 Diphtheria 1 Ulceration of stomach or Tuberculosis (respiratory) 27 duodenum 5 Other forms of tuberculosis 2 Diarrhoea (under 2 years) 2 Syphilitic disease 3 Appendicitis 4 Influenza 3 Other digestive diseases 10 Measles 3 Nephritis 11 Cancer-various sites 92 Maternal causes 4 Diabetes 1 Premature Birth 4 Intra-cranial vascular Congenital malformations, lesions 51 birth injuries,etc., 11 Heart Disease 140 Suicide 4 Other diseases of the Road Traffic Accidents 7 circulatory system 18 Other violent causes 32 Bronchitis 34 All other causes 30 Pneumonia 29 (It is noteworthy that 59 per cent of all deaths occurred in persons over 65 years of age). INFANT MORTALITY (Under 1 year of age). [ The causes of deaths (25) were as follows:- Measles 1 Diarrhoea 2 Other diseases of the Premature birth 4 circulatory system 1 3 INFANT MORTALITY (CONTINUED) Bronchitis 1 Congenital malformations .. 8 Pneumonia 4 Other violent causes 2 Other digestive diseases 1 All other causes 1 NOTIFICATION OF BIRTHS. The total number of notified Chelsea Births, including still births, from all sources was 496. Of this number, 115 were notified by midwives. PROVISION OF HEALTH SERVICES IN THE BOROUGH BACTERIOLOGICAL AND OTHER EXAMINATIONS. The total number carried out was 141 including 84 for the bacillus associated with diphtheria. " NURSING IN THE HOME. The arrangement with the Chelsea District Nursing Association to undertake the nursing of cases of illness occurring in expectant and nursing mothers and the nursing of children under 5 years of age suffering from any illness was continued throughout the year, the total number of visits being 1,432 (l6l cases). CLINICS AND TREATMENT CENTRES. The Violet Melchett Infant Welfare Centre maintains the maternity and child welfare services in the Borough. The total number of attendances at the clinics by infants under one year of age- was 3,700 and l,104 children attended between the ages of 1 and 5 years. There were 2,302 attendances by mothers at the ante-natal clinic and 51 attendances by mothers at the post-natal clinic. INVALID CHILDREN'S AND ASSOCIATION. The arrangement with the Association was continued throughout the year. The number of applications referred to them for assistance of children under 5 years of age was 29. HEALTH VISITORS. The total number of visits and re-visits made by the Health Visitors was 6-702. The number of half-day attendances and clinics was 749 and 258 Hygiene inspections were made at the Third Feather's Club. CHILD LIFE PROTECTION. 1ll visits (including 6l miscellaneous visits) were made to Foster Mothers. DENTAL TREATMENT. 133 cases attended the Dental clinic at the Violet Melchett infant Welfare Centre for the provision of preventive dental treatment for children under 5 years of age. Arrangements were also made for 54 expectant or nursing mothers to receive dental treatment at St. Stephen's Hospital. Of these 5 mothers were provided with dentures. The Borough Council made a contribution of £28.4.9. towards the cost. HOME HELPS. Twelve cases were attended by a home help - the net cost to the Council being £45.1.6d. DOMESTIC HELPS. During the year arrangements were made to extend the services of home helps and to provide Domestic Help in the homes of aged and infirm persons and for those recovering from severe illness. In the period 12/3/45 to end of year 67 applications were received, all of which obtained the required assistance. The total number of hours worked was 2,174, and approximately 43 per cent of the cost of the service was met by payments from applicants. 4 DISTRIBUTION OF VITAMINS TO EXPECTANT MOTHERS AND CHILDREN. By arrangement with the local office of the Ministry of Food, these preparations were distributed from the welfare Centre by a member of the Public Health staff. WAR-TIME NURSERIES. The total accommodation provided at the two war-time nurseries is 143. Attendances during the year numbered 29,972, INSULIN FOR DIaBETIC PATIENTS. In accordance with the Ministry of Health's Circular 2734, one applicant was supplied with insulin,free of cost. CARE OF ILLEGITIMATE CHILDREN. The Council guarantees payment to approved foster mothers willing to undertake the care and maintenance of illegitimate children. No application for this service was received during the year. The provision of furnished accommodation for unmarried mothers immediately before and after confinement continued throughout the year. One applicant utilised the accommodation provided under this scheme. CARE OF PREMATURE INFANTS. A space has been provided in the notification of birth cards for the weight at birth when this is 5½ lbs or less. During the year 15 such births were notified. A follow-up of these births showed the following results:- Born at home 5 - of which one died during the firs 24 hours and 4 survived at the end of one month. Born in hospital 10 - of which none died during the first 24 hours and 7 survived at the end of one month, SANITaRY CIRCUMSTANCES and ADMINISTRATION 11,005 visits (including re-visits) were carried out by the Sanitary Inspectors. 362 Intimation Notices, 82 Nuisance Notices under the Public Health (London) Act 1936, and 5 Notices under the Food and Drugs Act, 1938, (Section 13) were served during the year. Legal proceedings were instituted under the Public Health (London) Act, 1936, in nine instances, in respect of insanitary conditions, in every case abatement orders were obtained. DISINFECTION OR DISINFESTATION. The routine disinfection of rooms after the occurrence of infectious disease was continued and also disinfestation for vermin. At the Council's Disinfecting Station, 15,092 articles were disinfected or disinfested. SCABIES. 272 adults and 179 children were treated at the Cleansing Station. The total number of treatments was 984. Disinfection of the patients' personal clothing was carried out whilst the patients were being treated. The Woman Sanitary Inspector inspected the homes, and arranged for examination of contacts. VERMINOUS PERSONS. 25 adults and 296 children (including children attending elementary schools) were cleansed at the Disinfecting Station. 5 INFESTATION BY HEAD LICE. Special attention and advice is given by the Health Visitors at the Welfare Centre and when visiting homes. Suitable combs are available when necessary. DESTRUCTION OF RATS AND LICE. A fall-time Rodent Officer is employed by the Borough Council. The following is a summary of his work during the year Poisoning campaigns were carried out in 42 business premises and in 190 private dwellings for rats. In addition, similar campaigns were carried out in 18 business premises and 64 private dwellings for mice. Advice was given to owners or occupiers undertaking their own campaigns in 73 instances. Preliminary inspections totalled 816. Laying Pre-baits 1316. Laying Poison baits 287. Visits for the purpose of clearing all unconsumed bait 287. Laying of postbaits 287. Smoke testing of drains 37. The number of points — baited was 6,043. INSPECTION AND SUPERVISION OF FOOD. The Inspectors carried out routine inspections of premises where food is prepared, stored or sold. Unsound food surrendered was either destroyed or disposed of for purpose other than human consumption. In one instance legal action under Section 13 of the Food and Drugs Act, 1938, was taken in regard to unsatisfactory conditions existing at a retailer's premises. FOOD AND DRUGS ACT. 400 samples were submitted to the Public Analyst for analysis during the year. Of these, 194 were taken as "formal" and 206 as "informal". Twenty-five samples were reported to be adulterated. In one instance, legal proceedings were taken against a manufacturing firm, whilst warning letters were sent, either by the Borough Council or the Ministry of Food, to all other Vendors concerned. All other samples were returned as genuine. INFECTIOUS AND OTHER DISEASES. NOTIFICATIONS. The total (corrected) number of notifications received during the year (754) was made up as follows 2:- Diphtheria 8 Malaria 1 Erysipelas 9 Acute Influenzal Pneumonia 1 Scarlet fever 48 Acute Primary Pneumonia 11 Enteric fever 1 Measles 342 Puerperal fever 2 Whelping Cough 38 Puerperal Pyrexia 3 Scabies 156 Gerebro-spinal fever 2 Ophthalmia Neonatorum 3 Poliomyelitis 1 Pulmonary Tuberculosis 69 Dysentery 53 Non-Pulmonary Tuberculosis 6 DIPHTHERIA. There was one death, a male, 29 years of age. DIPHTHERIA IMI1UNIBATI0N CLINIC. 386 new cases attended. SMALLPOX AND VACCINATION. No case of smallpox was notified. Of the 162 births~registered in Chelsea during 1944, 89 were successfully vaccinated - a percentage of 54.9 (Figures for 1945 are not yet available). TUBERCULOSIS. 69 new cases of pulmonary and 6 cases of nonpulmonary tuberculosis were notified. In addition, 57 new cases came to the knowledge of the Medical Officer of Health from other sources. The total number was therefore 132 (Pulmonary - Males 57) Females 655 Non-pulmonary - Males 3, Females 7). The total 6 number of deaths from all forms of Tuberculosis was 29, the death rate being 0.8 per 1,000 of the estimated population. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS. 1930. The total number of cases of Tuberculosis in the Borough on the 31st December, 1945, was 286 (Pulmonary - Males 120, Females 130; Non-Pulmonary - Males 17, Females 19). The Tuberculosis Visitor paid 84 visits to non-pulmonary cases. TUBERCULOSIS DISPENSARY AND SPECIE CASES. New cases examined 272. Of these 79 were found to be definitely tuberculous._176 contacts also examined. The number of attendances (including contacts) was 1,481 and 2,573 visits were made by the nurses or social worker to homes of patients. The Tuberculosis Officer visited 14 patients at their homes, and 86 patients were referred to him at the dispensary by Medical Practitioners. 158 specimens of sputum were examined and 799 X-ray examinations were made in connection with the work. The total number of cases on the Dispensary Register on the 31st December 1945 was 196. CHELSEA TUBERCULOSIS CARS COMMITTEE. The Committee met 5 times and 114 cases were considered, Social Services in co-operation with voluntary societies were continued. ARTIFICIAL PNEUMO-THORAX TREATMENT. 49 patients received treatment. The total cost (£498.4.6.) was borne by the Council EXTRA NOURISHMENT. 38 cases received extra nourishment as part of their treatment. The total cost (£197,7.5.) was borne by the Council. DENTAL TREATMENT. 7 patients received dental treatment, the Borough Council making a contribution of £8.7.6. towards the cost. TUBERCULOSIS - SPECIAL ALLOWANCES. The Government's Scheme to give maintenance allowances to tuberculous persons undergoing treatment continued satisfactorily throughout the year. 64 patients received allowances classified as follows:- Maintenance allowances 43 Special allowances 13 Discretionary allowances 8 The amount disbursed was £1,441.9.2d. MINIATURE MASS RADIOGRAPHY. In the latter part of the year, arrangements were made with the London County Council for the Miniature Mass Radiography of persons living or working in the Borough. Firms with 50 or more employees were invited to participate. The total number examined was 706 (Males 268, Females 438). Of this number 6 (Males 5, Female 1) were found to be probably tuberculous.