AZ445 CHE63 METROPOLITAN BOROUGH OF CHELSEA. ANNUAL (ABRIDGED) REPORT on the Health of the Borough during 1946 by W. H. L. McC.-RTHY, D.S.O., M.C., M.D., M.R.C.P., D.P.H., Barrister-at-Law Medical Officer of Health. 1 To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Chelsea. Mr. Mayor, Ladies and Gentlemen, I have the honour to submit my Annual Report on the health and sanitary conditions of the Borough for 1946. 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 45,740 (353,10 in 1945). The birth rate (17.8) was the highest since 1920. The death rate (12.0) was lower than in 1945 (15.2). The infant mortality rate was 44 per 1,000 live births as compared with 45 in 1945. The health of the population was satisfactory. There was a decrease in the total incidence of notifiable infectious disease. The total number of notifications was 686, as compared with 754 in 1945. Diphtheria immunisation was maintained at a high level throughout the year. Maternity and Child welfare work has continued to grow in extent and usefulness. The attendances by mothers at the ante-natal clinic totalled 3,311 (~s compared with 2,302 in 1945) - a record number since the inception of this clinic. Close attention was devoted to the supervision of food supplies. I have again to express ray appreciation of the work of the staff of the Public Health Department. 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 Deprtment, Town Hall, Cuelsea, S.W.3. August, 1947. 2 METROPOLITAN BOROUGH OF CHELSEA. ANNUAL (ABRIDGED) REPORT OF THE MEDICAL OFFICER OF HEALTH. FOR THE YEAR 1946. POPULATION Registrar-General's- estimate of civilian population. 45, 740 LIVE BIRTHS. Total M. F. Birth rate per 1000 estimated civilian population 17.8 Legitimate 705 356 349 Illegitimate 1ll 58 53 816 414 402 STILL BIRTHS 19 13 6 Rate per 1,000 total (live and still) births 22.7 DEATHS 550 253 297 Death rate per 1,000 estimated civilian population 12.0 DEATHS FROM PUERPERAL CAUSES:- Deaths Rate per 1,000 total (live and still) births Puerperal Sepsis - Other puerperal causes 1 1.2 DEATH RATE OF INFANTS UNDER ONE YEAR OF AGE:- All infants per 1,000 live births 44 Legitimate infants per 1,000 legitimate live births 34 Illegitimate infants per 1,000 illegitimate live births 108 SUMMARY OF VITAL STATISTICS (1917-1946 inclusive). Year Reg.Genl's Estimate of Population. BIRTHS DEATHS DEATHS UNDER ONE YEAR. MATERNAL DEATHS. No. + Rate No. + Rate No. + "Rate No. + Rate 1937 56,510 610 10.8 796 14.1 16 59 - - 1938 56,050 574 10.2 757 13.5 46 80 3 5.1 1939 55,400 539 9.7 743 14.6 17 33 1 1.9 1940 38,700 428 11.0 851 22.0 15 40 3 7.8 1941 26,470 300 11.6 600 22.7 9 38 - - 1942 27,430 342 12.5 502 18.3 17 50 1 2.8 1943 30,330 459 15.1 554 18.3 32 70 1 2.1 1944 30,990 416 572 18.4 21 50 1 2.4 1945 35,310 557 15.8 536 15.2 25 45 4 6.9 1946 45,740 816 17.8 550 12.0 36 44 1 1.2 + Corrected figures after allowing for inward and outward transfers. 3 CLASSIFICATION OF DEATHS. The causes of deaths (550) were as follows Typhoid fever 1 Pnemonia 49 Cerebro-spinal fever 2 Omar respiratory diseases 4 Tuberculosis (respiratory) 19 Ulcer of stomach or duodenum 5 Other forms of tuberculosis 7 Diarrhoea (under 2 years) 8 Syphilitic diseases 2 Appendicitis 1 influenza 2 Other digestive diseases 13 Acute poliomyelitis 1 Nephritis 7 Acute infective encephalitis 1 Maternal causes 1 Canoer - various sites 95 Premature birth 6 Diabetes 4 Congenital malformations, birth injuries, etc. 10 Intra-cranial vascular lesions 60 Suicide 11 Heart diseases 128 Road traffic accidents 5 Other diseases of the Other violent causes 24 circulatory system 26 All other causes 34 Bronchitis 24 (It is noteworthy that 6l per cent of all deaths occurred in persons over 65 years of age). INFANT MORTALITY (under 1 year of age). The causes of deaths (36) were as follows:- Cerebre-3pinal fever 1 Otner forms of tuberculosis 1 Bronchitis 1 Pneumonia 8 Diarrhoea 8 Premature birth 6 Congenital malformations 8 Other violent causes 3 NOTIFICATION OF BIRTHS. The total number of notified Chelsea Births, including still births, from all sources was 757. Of this number, 130 were notified by midwives. PROVISION OF HEALT SERVICES IN THE BOROUGH. BACTERIOLOGICAL AND OTHER EXAMINATIONS. The total number carried out was 252 including 151 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 l,605 (164 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 under one year of age was 5,676, and 1,283 children attended between the ages of 1 and 5 years. There were 3,311 attendances by mothers at the ante-natal clinic and 50 attendances by mothers at the post-natal clinic. INVALID CHILDREN'S AID 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 30. P.T.O. - 4 - HEALTH VISITORS. The total number of visits and re-visits made by the Health Visitors was 8,245. The number of half-day attendances at clinics was 950, and 63 Hygiene Inspections were made at the Third Feathers Club. CHILD LIFE PROTECTION. At the end of the year there were 10 registered Foster Mothers caring for 12 Foster Children in the Borough. The number of visits paid by the Child Life Protection Visitor was 106 (including 6l miscellaneous visits). DENTAL TREATMENT. 126 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 41 expectant or nursing mothers to receive dental treatment at St. Stephen's Hospital. Of these, 8 mothers were provided with dentures. The Borough Council made a contribution of £27. 10. 0. towards the cost. HOME HELPS. Sixteen cases were attended by a home help - the net cost to the Council being £74. 18. 6. DOMESTIC HELPS. The arrangements to provide Domestic Help in the homes of aged and infirm persons and for those recovering from severe illness were continued throughout the year. The total number of cases attended by the Domestic Helps was 133, and the total number of hours worked was 7,835. DISTRIBUTION OF VITAMINS TO EXPECTANT MOTHER, AND CHILDREN. By arrangement with" the local office of the Ministry of Food, those preparations were distributed from the Welfare Centre by a member of the Public Health Staff. DAY NURSERIES. The Borough Council's two day nurseries continued to operate throughout the year, providing accommodation for 144 children between infancy and 5 years of age. Attendances during the year numbered 26,l80. 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 ma intenance of illegitimate children. No application for this service was received during the year. The provision of furnished accrmmodation for unmarried mothers immediately before and after confinement continued throughout the year. Three applicants utilised the accommodation provided under this scheme. CARE OF PREMATURE INFANTS. A space is provided in the notification of birth cards for the weight at birth when this is lbs or less. During the year, 92 such births were notified. A follow-up of these births showed the following results:- Born at home 4 - of which one died during the first 24 hours and 3 survived at' the end of one month. Born in hospital 88 - of which 5 died during the first 24 hours and 71 survived at the end of one month. 5 MOTHERCRAFT HOME. (Vic-let Melchett Infant Welfare Centre). During the year, the Borough Council agreed to: (a) the reservation of one bed in the Mothercraft Home for the reception of a mother and baby when discharged from a maternity ward; and (b) two beds for the reception of young children in the case of the mother's illness or other home emergency. The Council also agreed to bear the difference between the weekly charges made by the Centre and the parents' contributions in respect of approved Chelsea persons filling these places, for a period not exceeding four weeks in each case. The scheme came into operation on 1st October, 1946. By the end of the year, 5 mothers with babies had been received and 6 children admitted on account of mother's illness or other home emergency. A total expenditure of £77. 14. 0. was incurred. Of this, £14. 7. 8. was met by the parents' contributions, leaving £63. 6. 4. as the net cost to the Council. SANITARY CIRCUMSTANCES AMD ADMINISTRATION. During the year, 13,274 visits (including revisits) were carried out by the Sanitary Inspectors. 898 ntimation Notices, 149 Nuisance Notices, and 8 Notices (Section 40 - Drainage) under the Public Health (London) Act, 1936, were served. In addition, a further 5 Notices were served under section 13 of the Food & Drugs Act, 1938. Legal proceedings, in ten instances, were instituted under the Public Health (London) Act, 1936. every case abatement orders were obtained, proceedings in respect of two infringements of the London County Council (Drainage) Byelaws, and one infringement of the London County Council (Water Closet) Byelaws, resulted in the imposition of penalties. DISINFECTION OR DISINFESTATION. The routine disinfection of rooms after the occurrence or infectious disease was continued and also disinfestation for vermin. At the Council's Disinfecting Station, 17,733 articles were disinfected or disinfested. SCABLES. 279 adults and 180 children were treated at the Cleansing Station. The total number of treatments was 1,049. 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. 51 adults and 402 children (including children attending elementary schools) were cleansed at the Disinfecting Station. 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 MICE. During the year, an intensified campaign was put into force in accordance with the requirements of the Ministry of Food under Circular N.S. No. 12. To ensure the successful prosecution of the campaign, it was necessary to engage additional staff on a temporary basis, and the services of six rat catchers and one female clerk were secured. The scheme came into operation on 19th august, 1946. Prior to this date, all rodent control work had been carried out by the Council's Rodent Officer and one assistant. The following is a summary of the work carried out during the year:- P.T.O. 6 DESTRUCTION OF RATS AND MICE (continue). Poisoning Campaigns: Business Premises - Rats: 65. Mice: 35 Private Dwellings - Rats:393. Mice: 827 Advice given to owners or occupiers carrying out their own campaigns: 44 Preliminary inspections: 3,271 Pre-baits laid: 5,326 Poison baits laid: 1,105 Drains smoke-tested: ??? Unconsumed Baits cleared: 1,105 Number of Points baited: 24,2 Post-Baits laid: 1,105 In addition to the above, a treatment of the whole of the sewers throughout the Borough was carried out from2nd to 5th December (inclusive). INSPECTION AND SUPERVISION OF FOOD. Routine inspections of premises at which the preparation, storage or sale of food is carried out, were made by the Inspectors. Unsound food was either destroyed or disposed of for purposes other than human consumption. No legal proceedings, consequent upon contraventions of the Food and Drugs Act, 1938, were taken. FOOD AND DRUGS ACT. Analyses were made of 402 samples submitted to the Public Analyst. of this total, 141 were taken as "formal" and 26l as "informal". Eight samples were reported to be adulterated. All vendors concerned were the recipients of warning letters, either from the Borough Council or the Ministry of Food. All other samples were returned as genuine. INFECTIOUS AND OTHER DISEASES. NOTIFICATIONS. The total (corrected) number of notifications received during the year (686) was made up as follows:- Diphtheria 14 Dysentery 46 Erysipelas 8 Acute Primary Pneumonia 8 Scarlet Fever 80 Measles 193 Enteric Fever 1 Whooping Cough ll6 Puerperal Fever 1 Scabies 131 Puerperal Pyrexia 11 Pulmonary Tuberculosis 63 Cerebro-spinal fever 4 Non-Pulmonary Tuberculosis 4 Ophthalmia Neonatorum 4 Poliomyelitis 1 Malaria 1 DIPHTHERIA. 14 cases were notified. Of these, 10 were children, 7 of them being inmates of an Institution situated within the Borough. There were no deaths. None of the cases had completed a full course of immunisation before the onset of the disease. DIPHTHERIA IMMUNISATION. A weekly clinic was held at the Violet Melchett Infant welfare Centre throughout the year. Sessions were also carried out by the Centre at various schools in the Borough. The total number of new cases dealt with during 1946 was 640, as compared with 386 in 1945. 7 SMALLPOX AND VACCINATION. No case of smallpox was notified. Of the 216 births registered in Chelsea during 1945, 128 were successfully vaccinated - a percentage of 59•3• (Figures for 1946 are not yet available). TUBERCULOSIS. 63 new cases of pulmonary and 4 cases of nonpulmonary tuberculosis were notified. In addition, 41 new cases came to the knowledge of the Medical Officer of Health from other sources. The total number was therefore 108 (Pulmonary - Males 44, Females 54; Non-pulmonary - Males 3, Females 7). The total number of deaths from all forms of Tuberculosis was 26, the death rate being 0.57 per 1,000 of the estimated population. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1930. The total number or cases or Tuberculosis in the Borough on the 31st December, 1946, was 317 (Pulmonary - Males 130, Females 148; Non-Pulmonary Males 19, Females 20). The Tuberculosis Visitor paid 89 visits to non-dispensary cases. TUBERCULOSIS DISPENSARY AND SPECIAL CASES. New cases examined 327. Of these, 60 were found to be definitely tuberculous. 197 contacts also examined. The number of attendances (including contacts) was 1,526, and 2,687 visits were made by the nurse and social worker to homes of patients. The Tuberculosis Officer visited 17 patients at their homes, and 120 patients were referred to him at the dispensary by Medical Practitioners. 288 specimens of sputum were examined and 986 X-ray examinations were made in connection with the work. Tne total number of cases on the Dispensary register on the 31st December, 1946 was 271. CHELSEA TUBERCULOSIS CARE COMMITTEE. The Committee met 5 times and 136 cases were considered. Social Services in co-operation with voluntary societies were continued. ARTIFICIAL PNEUMO-THORAX TREATMENT. 50 patients received treatment. The total cost (£542. 6. 6.) was borne by the Council. EXTRA NOURISHMENT. 28 cases received extra nourishment as part of their treatment. The total cost (£159. 18. 3. ) was borne by the Council. DENTAL TREATMENT. 5 patients received dental treatment, the Borough Council making a contribution of £4. 0. 0. towards the cost. TUBERCULOSIS - SPECIAL ALLOWANCES. The Government's scheme to give maintenance allowances to tuberculous persons undergoing treatment was continued throughout the year. 45 patients received allowances classified as follows:- Maintenance allowances 38 Special allowances l6 Discretionary allowances 11 The amount disbursed was £1,972.1.6. s