AC 4345 CHE 64 METROPOLITAN BOROUGH OF CHELSEA. ANNUAL (ABRIDGED) REPORT on the Health of the Borough during 1947 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 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 during 1947. In accordance with instructions received from the Ministry of Health, the report has again been prepared in an abridged form. The population of the Borough was estimated by the Registrar-General to be 51,000, as compared with 45,740 in 1946. The birth rate (19.0) was the highest since 1920. The death rate (12.0) and the infant mortality rate of 44 per 1,000 live births showed no variation of the rates for 1946, The health of the population was satisfactory. There was an increase in the total incidence of notifiable infectious disease, the total number of notification being 776, as compared with 686 in 1946. Diphtheria immunisation was maintained at a high level throughout the year. Maternity and Child Welfare work has steadily increased in extent and usefulness. The attendances by expectant and nursing mothers at the ante-natal clinic totalled 2,862. Close attention was devoted tc the supervision of food supplies. I have again to express my appreciation of the work of the staff of the Public Health Department. In conclusion, I should like to thank members of the Council for the support and sympathetic consideration always extended to me, and for their attention to the problems which it has been my duty to place 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. July, 1948, P.T.O, 2 METROPOLITAN BOROUGH OF CHELSEA. ANNUAL (ABRIDGED) REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1947. POPULATION Registrar-General's estimate of civilian population 51,000 LIVE BIRTHS Total M, F. Birth rate per 1000 estimated civilian population 19.0 Legitimate 885 444 441 Illegitimate 83 40 43 968 484 484 STILL BIRTHS 16 8 8 Rate per 1,000 total (live and still) births 16.3 Deaths 611 307 304 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 - 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 43 Illegitimate infants per 1,000 illegitimate live births 60 SUMMARY OF VITAL STATISTICS (1937-1947 inclusive) Year Reg.Genl's Estimate of Population. BIRTHS. DEATHS. DEATHS UNDER ONE YEAR. Maternal DEATHS. No. Rate No. Rate No. Rate No. Ra + + + + 1937 56,510 610 10.8 796 14.1 36 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 1.8 1940 38,700 428 11.0 851 22.0 15 40 3 7.8 1941 26,470 306 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 13.4 572 18.4 21 50 1 2.4 1945 35,310 557 15.8 536 15.2 25 45 4 6.8 1946 45,740 816 17.8 550 12.0 36 44 1 1.2 1947 51,000 968 19.0 611 12.0 43 44 - - + Corrected figures after allowing for inward and outward transfers. 3 CLASSIFICATION OF DEATHS The causes of deaths (61l) were as follows:- Typhoid fever - 36 Cerebro-spinal fever 1 Other respiratory diseases 4 Whooping cough 2 Ulcer of stomach or duodenum 8 Tuberculosis (respiratory) 22 Diarrhoea (under 2 years) 10 Other forms of tuberculosis 3 Appendicitis 1 Syphilitic disease 3 Other digestive diseases 14 Influenza 8 Nephritis 13 Acute poliomyelitis 1 Maternal causes - Acute infective encephalitis - Premature birth 8 Cancer - various sites 99 Congenital malformations, birth injuries, etc. 15 Diabetes 2 Intra-cranial vascular lesions 61 Suicide 7 Road traffic accidents 11 Heart disease 175 Other violent causes 16 Other diseases of the circulatory system 38 All other causes 25 Bronchitis 28 (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 (43) were as follows:- Cerebro-spinal fever 1 Whooping cough 1 Bronchitis 1 Pneumonia 5 Diarrhoea 9 Premature birth 8 Congenital malformations 14 Other violent causes 1 Intra-cranial vascular 1 All other causes 2 NOTIFICATION OF BIRTHS. The total number of notified Chelsea Births, including still births, from all sources was 947, Of this number, 174 were notified by maidwives. PROVISION OF HEALTH SERVICES IN THE BOROUGH, BACTERIOLOGICAL AND OTHER EXAMINATIONS. The total number carried out was 194 including 126 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 1,671 (190 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 6,718, and 1,615 children attended between the ages of 1 and 5 years. There were 2,862 attendances by mothers at the ante-natal clinic and 65 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 60. P.T.O. 4 HEALTH VISITORS. The total number of visits and re-visits made by the Health Visitors was 9,714. The number of half-day attendances at clinics was 995, CHILD LIFE PROTECTION. At the end of the year there were 11 register Foster Mothers caring for 11 Foster Children in the Borough, The number of visits paid by the Child Life Protection Visitor was 258 (including 101 miscellaneous visits). DENTAL TREATMENT. 166 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 53 expectant or nursing mothers to receive dental treatment at St, Stephen's Hospital. Of these, 4 mothers were provided with dentures. The Borough Council made a contribution of £33, 3, 6. towards the cost. HOME HELPS. 28 cases were attended by a home help - the net cost to the Council being £112. 9. 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 through the year. The total number of cases attended by the Domestic Helps was 211, and the total number of hours worked was 15,473, 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. 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 31,858. INSULIN FOR DIABETIC PATIENTS. In accordance with the Ministry of Health's Circular, 2734, three applicants were 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. During the year seven foster mothers received payment in respect of this service, contributions towards the cost being recovered by the Council from the mother in each case. The provision of furnished accommodation for unmarried mothers immediately before and after confinement continued until the latter end of the year. Two applicants utilised the accommodation provided under this scheme, CARE OF BREMATURE INFANTS. A space is provided in the notification of birth cards for the weight at birth when this is 5½ lbs. or less. During the year, 108 such births were notified, A follow-up of these births showed the following resultsj- Born at home 8 - of which seven survived at the end of the month. Born in hospital 100 - of which 12 died during first 24 hours and 71 survived at the end of one month. 5 MOTHERCRAFT HOME. The Borough Council's arrangement with the Violet Melchett Infant Welfare Centre as to (a) the reservation of one bed in the Mothercraft Home for the reception of a mother and baby when discharged from a materni-ty ward; and (b) two beds for the reception of young children in the case of mother's illness or other home emergency, was continued throughout the year. Sixteen mothers with babies were received and 14 children admitted on account of mother's illness or other home emergency, A total expenditure of £272. 2. Od. was incurred. Of this, £60. 8, 9d, was met by the parents contributions, leaving £211,13, 3d. as the net cost to the Council. SANITARY CIRCUMSTANCES AND ADMINISTRATION. During the year, 14,400 visits (including re-visits) were oarried out by the Sanitary Inspectors, 706 Intimation Notices, 192 Nuisance Notices and 7 Notices (Section 40 - Drainage) under the Riblic Health (London) Act, 1936, were served. In addition a further 10 Notices were served unde Section 13 of the Food & Drugs Act, 1938, Legal proceedings, in seven instances, were instituted under the Riblic Health (London) Act, 1936, In every case abatement orders were obtained. Proceedings in respect of ten infringements of the London County Council (Drainage) Bye-laws, resulted in the imposition of penalties. 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, 11,878 articles were disinfected or disinfested. SCABIES. 94 adults and 82 children were treated at the Cleansing Station, The total number of treatments was 387. 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. 16 adults and 410 children (including children attending elementary schools) were oleansed 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. Throughout the year, a comprehensive campaign proceeded in accordance with the requirements of the Ministry of Food under Circular N.S. No,12, The Council's Rodent Officer, six temporary rodent operatives and a temporary female clerk were fully employed in connection with this work, which had been in progress since 19th August, 1946, The following is a summary of the work carried out during the year:- Poisoning Campaigns Business Premises - Rats: 123, Mice: 117. Private Dwellings - Rats: 279, Mice: 1417. Advice given to owners of occupiers carrying out their own campaigns: 11 Preliminary inspections: 14,163 Pre-baits laid: 10,818 Poison baits laid: 2,186 Drains smoke-tested: 98 Unconsumed baits cleared: 2,186 Number of Points baited: 63,981 Post-Baits laid: 2,186 P.T.O. 6 In addition to the above, treatments of the whole of the sewers throughout the Borough were carried out during the periods 2nd to 5th June, and 2nd to 5th December, WATER SUPPLY. The Metropolitan Water Board are responsible for supplies of water in this Borough. No complaints were received during the year. Analyses of Well Water were made during the year, and all proved to be satisfactory, both bactericlogically and chemically. 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 400 samples submitted to the Public Analyst. Of this total, 208 were taken as "formal", and 192 as "informal". Twenty samples were reported to be adulterated. In eight instanoes, legal proceedings were instituted, penalties being imposed in each case. All other vendors concerned with adulterated samples were the recipients of warning letters, either from the Borough Council or the Ministry of Food. The remaining samples were all reported as genuine. INFECTIOUS AND OTHER DISEASES. NOTIFICATIONS. The total (corrected) number of notifications received during the year (776) was made up as fcllowst- Diphtheria 8 Polio Encephalitis 2 Erysipelas 10 Dysentery 42 Scarlet Fever 41 Influenzal Pneumonia 6 Enteric Fever 1 Acute Primary Pneumonia 24 Puerperal Fever 1 Food Poisoning 2 Puerperal Pyrexia 3 Measles 390 Cerebro-spinal fever 1 Whooping Cough 70 Ophthalmia Neonatorum 2 Scabies 69 Poliomyelitis 16 Pulmonary Tuberculosis 78 Encephalitis Lethargica 1 Non-Pulmonary Tuberculosis 9 DIPHTHERIA. 8 cases were notified. Of these 3 were children; there were no deaths. 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 1947 was 545 as compared with 640 in 1946. POLIOMYELITIS. 16 cases of Poliomyelitis were confirmed during the year, Of these, 6 suffered no ill effects, eight have suffered disablement in varying degrees, for which they are either undergoing treatment at Orthopaedic hospitals or in special departments of general hospitals. The remaining two cases have left the Borough, and despite many enquiries no information has been obtained as to either their condition or present whereabouts. SMALLPOX AND VACCINATION. No case of smallpox was notified. Of the 1095 births registered in Chelsea during 1946, 589 were successfully vaccinated - a percentage of 53.8. (Figures for 1947 are not yet available). 7 TUBERCULOSIS. 78 new oases of pulmonary and 9 cases of nonpulmonary tuberculosis were notified. In addition, 43 new cases carr. to the knowledge of the Medical Officer of Health from other sources* The total number therefore was 130 (Pulmonary - Males 53, Females 65; Non-Pulmonary - Males 4, Females 8)* The total number of deaths from all forms of Tuberculosis was 25, the death rate being 0.5 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, 1947 was 345 (Pulmonary - Males 133, Females 167; Non-Pulmonary Males 20, Females 25). The Tuberculosis Visitor paid 162 visits to non-dispensary cases. TUBERCULOSIS DISPENSARY AND SPECIAL CASES. New cases examined 302. Of these 77 were found to be definitely tuberculous. 247 contacts also examined. The number of attendances (including contacts) was 1905 and 2,670 visits were made by the nurse and social worker to homes of patients. The Tuberculosis Officer visited 15 patients at their homes and 93 patients were referred to him at the dispensary by Medical Practitioners. 300 specimens of sputum were examined and 1,083 X-ray examinations were made in connection with the work. The total number of cases on the Dispensary Register on the 31st December, 1947 was 299. CHELSEA TUBERCULOSIS CARE COMMITTEE. The Committee met 5 times and 132 cases were considered. Social Services in co-operation with voluntary societies were continued. ARTIFICIAL PNEUMO-THORAX TREATMENT. 56 patients received treatment The total cost (£511.18,0d. ) was borne by the Council. EXTRA NOURISHMENT. 29 cases received extra nourishment as part of their treatment. The total cost (£186.17.6d. ) was borne by the Council, DENTAL TREATMENT. 5 patients received dental treatment, the Borough Council making a contribution of £9.10.0d. towards the cost. TUBERCULOSIS - SPECIAL ALLOWANCES. The Government's scheme to provide maintenance allowances to tuberculous persons undergoing treatment was continued throughout the year. Forty-four patients received allowances classified as follows:- Maintenance allowances 37 Special allowances 7 Discretionary allowances 11 The amount disbursed was £2,080.l1s.l1d.