AC 4345 CHE 65 METROPOLITAN BOROUGH OF CHELSEA ANNUAL (ABRIDGED) REPORT on the Health of the Borough during 1948 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 1948. 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 50,890, as compared with 51,000 in 1947. The birth rate was 17.4 (19.0. in 1947), whilst the death rate was 11.7 (12.0 in 1947). The infant mortality rate was 40 per 1,000 live births (44 in 1947). The health of the population was satisfactory. There was an increase in the total incidence of notifiable infectious disease, the number of notifications received being 894, as compared with 776 in 1947. This is explained by the large number of cases of Whooping Cough notified to the Department. Maternity and Child Welfare, Diphtheria Immunisation, and, in part, the administration of the Tuberculosis Service, became the responsibility of the London County Council on 5th July, 1948. Details of the work carried out prior to that date will be found in my report. Close attention was devoted to the supervision of food supplies. I have again to express my appreciation of the work of the staff of the Public Health Department. Information as to officers employed is also set out in my report. In conclusion, I should like to thank members of the Council for the support and sympathetic consideration always extended to me, and for their keen 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, 1949. - 2 - STAFF OF THE.PUBLIC HEALTH DEPARTMENT at 31st December, 1948. Medical Officer of Health; W.H.L. MCCARTHY, D.S.O.,M.C.,M.D., (Part-time) M.R.C.P. ,D.P.H., Barrister-at-law. Deputy Medical Officer of C.D.L. LYCETT, M.D. ,H.R .C.S ., L.R.C.P.D.P. Helath: Full-time Deputy Medical Officer of Health for Chelsea and Kensington, Chief Sanitary Inspector: H. HOYLAND, M.R.S.I., M.S.I.A. Deputy Chief Sanitary Inspector and Senior Housing Inspector: S.W. BARKER, M.R.S.I.,M.S.I.A. District Sanitary J. CASTLEY, M.S.I.A. Inspectors. H.F. LEACOCK, M.R.S.I., M.S.I.A A.J. WHITE, M.S.I.A., A.R.S.I. E.R. YOUNG, M.R.S.I.,M.S.I.A. Housing Inspector; I.J. LAMBE, M.S.I,A. Woman Sanitary Inspector: Miss K.G. READER, M.S.I.A. Sanitary Inspectors' F.G. RAWLINGSON Assistant: Drainage Assistant: E. BOSLEY. Clerical Staff: J. BRYANT (Chief Clerk) H.W. LUDLOW (Solitary Inspectors' Clerk L.A. POWELL (General Clerk) Mrs. M.C. KILL (General Clerk) Miss A. PALMER (Shorthand-Typist) R. LITCHFIELD (Temporary Junior Clerk) Rodent Officer: J.F. COOKE. Rodent Operative: P. DRURY (Temporary) Disinfectors: L.H. BERRY , (Chief Disinfector) R.J. WESTON. H.J. FRYER. Cleansing Station Attendant: Mrs. J.C. LOBBAN. - 3 - METROPOLITAN BOROUGH OF CHELSEA. ANNUAL (ABRIDGED) REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1948. POPULATION Registrar-General's estimate of civilian population 50,890 LIVE BIRTHS Total M. F. Birth rate per 1,000 legitimate 801 430 371 estimated civilian Illegitimate 82 38 44 population 17. 4 883 468 415 STILL BIRTHS 12 6 6 Rate per 1,000 total (live and still) births 13. 4 DEATHS 597 282 315 Death rate per 1,000 estimated civilian population 11. 7 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 40 legitimate infants per 1,000 legitimate live births 34 Illegitimate infants per 1,000 illegitimate live births 98 [SUMMARY OF VITAL STATISTICS (1938 - 1948 inclusive) Year Reg. Genl's Estimate of Population. BIRTHS DEATHS DEATHS UNDER ONE YEAR MATERNAL DEATHS. No. Rate. No. Rate No. Rate. No. Rate. + + + + 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 26,470 306 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 6.9 1946 45,740 816 17.8 550 12.0 36 44 l 1.2 1947 51,000 968 19.0 611 22 .0 43 44 - - 1948 50,890 883 17.4 597 11.7 35 40 - - Corrected figures after allowing for inward and outward transfers. CLASSIFICATION OF DEATHS. The causes of deaths (597) were as follows:- Typhoid fever Cerebro-spinal fever - Whooping cough 2 Tuberculosis (respiratory) 25 Other forms of tuberculosis 3 Syphilitic diseases 4 Influenza 3 Acute poliomyelitis 3 Acute infective encephalitis Cancer - various sites 101 Diabetes 4 Intra-cranial vascular lesions 69 Heart diseases 157 Other diseases of the circulatory system 29 Bronchitis 20 Pneumonia 32 Other respiratory diseases 8 Ulcer of stomach or duodenum 9 Diarrhoea (under 2 years) 6 Appendicitis - Other digestive diseases 13 Nephritis 12 Maternal causes - Premature birth 10 Congenital malformations, birth injuries, etc. 17 Suicide 11 Road traffic accidents 6 Other violent causes 15 All other causes 41 (It is noteworthy that 64 per cent of all deaths occurred in persons over 65 years of age). INFANT MORTALITY (under 1 year of age) The causes of deaths (35) were as follows:- Bronchitis 1 Other violent causes 2 Congenital malformations 12 Pneumonia 1 Diarrhoea 6 Premature birth 10 Other forms of tuberculosis 1 Whooping cough 2 PROVISION OF HEALTH SERVICES IN THE BOROUGH. BACTERIOLOGICAL AND OTHER EXAMINATIONS. The total number carried out was 182, including 124 for the bacillus associated with diphtheria, and 32 for haemolytic streptococci. NURSING IN THE HOME. During the period 1st January to 4th July, the long-standing arrangement whereby the Westminster and Chelsea District Nursing Association undertook 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, resulted in 1,280 visits being made in respect of 118 cases. - 5 - CLINICS AND TREATMENTS CENTRES. Maternity and child'welfare services in the Borough were maintained by the Violet Melchett Infant Welfare Centre, These services, however, came under the administration of the London County Council on 5th July, 1948, but as a matter of interest, the details of the whole year's work are, briefly, as follows:- Number of attendances at the Clinics by infants under the age of one year 7,102 Number of attendances by children between the ages of 1 and 5 years 2,400 Attendances by mothers at ante-natal clinic 2,664 Attendances by mothers at post-natal clinics 69 INVALID CHILDREN'S AID ASSOCIATION. During the year, applications referred to the Association for the assistance of children under five years of age totalled 143. HEALTH VISITORS The total number of visits and re-visits made by the Health Visitors during the year was 9, 546. The number of half-day attendances at Clinics was 1,004. CHILD LIFE PROTECTION. At 4th July, 1948, there were 9 registered foster-mothers caring for 13 foster-children in the Borough. The number of visits made in this connection by the Child Life Protection Visitor was 125 (includingmiscellaneous visits). DENTAL TREATMENT. 467 attendances were made to the Dental Clinic at the Violet Melchett Infant Welfare Centre for the provision of preventive dental treatment for children under 5 years of age, and where necessary, arrangements were made for expectant or nursing mothers to receive dental treatment at St. Stephen's Hospital, Chelsea. HOME HELPS. The Borough Council provided Home Helps in respect of 33 maternity cases during the period 1st January to 4th July, 1948. DOMESTIC HELPS. The arrangement whereby Domestic Helps were provided in the homes of aged and infirm persons, and for those recovering from severe illness continued until 4th July, 1948. The total number of cases attended was 211. DISTRIBUTION OF VITAMINS TO EXPECTANT MOTHERS AND CHILDREN. These preparations are distributed from the Violet Melchett Infant Welfare Centre by a member of the local office of the Ministry of Food. - 6 - DAY NURSERIES. The two Day Nurseries in the Borough continued to operate. By 5th July, when these services were transferred to the London County Council, 18,601 attendances had been made in respect of the 146 places provided for children between infancy and 5 years of age. INSULIN FOR DIABETIC PATIENTS. In accordance with the Ministry of Health's circular, No. 2734, three applicants were supplied with insulin free of cost. The Council guaranteed payment to approved foster mothers willing to undertake the care and maintenance of illegitimate children. Payment was made to four foster mothers in respect of this service during the period 1st January to 4th July. Contributions towards the cost were recovered from the mother in each case. 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 maternity ward; and (b) two beds for the reception of young children in the case of mother's illness or other home emergency, was continued until 4th July. During the period to that date, 10 mothers with their babies were received, and 6 children admitted on account of mother's illness or other home emergency, A total expenditure of £151.19.0. was incurred, of which £42. 7.1 was met by parents' contributions, the balance of £109.11.11. being the net cost to the Council. SANITARY CIRCUMSTANCES AND ADMINISTRATION. During the year, 16,314 visits, (including revisits) were carried out by the Sanitary Inspectors. 741 Intimation Notices, 390 Nuisance Notices and 3 Notices under Section 40 (Drainage) of the Public Health (London) Act, 1936 were served. In addition 24 Notices were served under Section 13 of the Food and Drugs Act, 1938. In twenty-two instances, legal proceedings were instituted under the Public Health (London) Act, 1936. Abatement crders were obtained in twelve cases. FACTORIES ACT, 1937 The number of factories, workshops, and w orkplaces on the register at the end of the year was 62, and 80 visits were carried out to such premises. In eleven instances it was found necessary to serve notices for defects found. A total of 40 such defects came to light, 27 of which were remedied as a result of action by the Woman Sanitary Inspector, whilst 6 were referred to H.M. Inspector of Factories for further action. - 7 - HOUSING ACT, 1936. During the year the Council deputed members of the Public Health and Housing Committees to make an examination of the housing conditions in West Chelsea. The deputed members intimated that an official investigation into the position clearly showed the existing staff of Sanitary Inspectors to be inadequate, and, in order to overtake arrears of work which had accumulated during the war years, and to prevent further deterioration in the situation, two additional Sanitary Inspectors should be appointed. This recommendation was accepted. During April, one of the Council's Sanitary Inspectors was appointed as Senior Housing Inspector, and instructed to organise and carry out a survey of a section of West Chelsea, with a view to necessary proceedings under the Housing Act to remedy unsatisfactory conditions. The same month one additional Sanitary Inspector was appointed to replace the Inspector undertaking housing duties. In September another Sanitary Inspector was appointed and allocated to housing work. 13 premises, comprising 49 separate tenements, had been inspected, and notices served under the Public Health (London) Act, 1936, and a further 10 premises, involving 60 separate lettings, inspected and notices served under Section 9 of the Housing Act, 1936, requiring the whole of the various premises to be reconditioned to the standard required by the Housing Act. Some of the works required were in hand at the end of the year. SHOPS ACT. 1934. In only two instances was it necessary to serve notices under the Shops Act, 1934. In each case the required works were carried out. DISINFECTION. The routine disinfection of rooms and articles of clothing, bedding, etc., consequent upon the occurrence of infectious disease, proceeded throughout the year. Details are as follows:- Rooms. Articles. Cancer 20 878 Chicken-pox 26 123 Diphtheria 18 124 Erysipelas 3 54 Measles 38 60 Poliomyelitis 4 6l Scabies — 1,258 Scarlet Fever 133 1,206 Tuberculosis 88 138 Typhoid Fever 4 70 Whooping Cough 13 - Totals: 347 3,972 SCABIES. 41 adults and 15 children were treated at the Council's Disinfecting Station. This entailed the carrying out of 117 treatments, during which personal clothing was also dealt with. INFESTATION BY HEAD LICE. Special attention and advice on this problem was given when occasion arose. - 8 - VERMINOUS PERSONS AND CONDITIONS. 20 adults and 280 children (including children attending elementary schools) were also cleansed at the Disinfecting Station, whilst 760 rooms and 1,599 articles were treated for verminous conditions. In addition, precautionary disinfection was carried out to 164 rooms and 3,032 articles. In 54 instances work was performed at agreed charges, which totalled £43.13.0. DESTRUCTION OF RATS AND MICE. During the early part of the year, a comprehensive campaign for the destruction of rats and mice reached completion. This work had been carried out in accordance with Ministry of Food circular N.S. No. 12, and the Council's rodent officer, six temporary rodent operatives, and a female clerical assistant were fully engaged in the furtherance of this work. At the conclusion of the campaign it was found possible to dispense with the services of five of the temporary operatives. Detail of work performed during the year are set out below. Poisoning Campaigns Rats. Mice. Business Premises: 30 17 Private Dwellings; 190 113 220 530 Advice given to owners or occupiers carrying out their own campaigns: 9 Preliminary inspections: 1,365 Pre-baits laid: Poison baits laid: 2,790 625 Unconsumed baits cleared: 825 Post-baits laid: 825 Drains smoke-tasted: 98 Number of points baited: 10,513 The whole of the sewers in the Borough were also systematically treated during the periods 31st May to 4th June and 6th to 10th December The responsibility for water supplies in the Borough is vested in the Metropolitan Water Board. Two complaints were received during the year as to the quality of water. In both instances, analyse of samples indicated they were ''pure and wholesome". In six other instances the condition of water storage tanks was found to be unsatisfactory. Necessary action to provide satisfactory supplies was taken by the Sanitary Inspectors. 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 totalling 8,320 lbs. was surrendered to the Sanitary Inspectors as unfit for human consumption. Wherever practicable, it was passed to the Ministry of Food for utilization in the preparation of animal feeding stuffs. In other instances the unsound food was destroyed. The traders concerned were provided with the necessary certificates to enable them to secure replacement stocks. FOOD AND DRUGS ACT. 1938. Analyses were made of four hundred samples submitted to the Public analyst during 1948. Of this total, 163 were taken as "formal and 237 as "informal". Twenty-three samples were reported as adulterated, and the vendors concerned were the receipients of warning letters, either from the Borough Council or the Ministry or Food. The remaining 377 samples were found to be genuine. - 9 - BURIAL OF PERSONS WITHOUT MEANS. In accordance with the provisions of Section 50 of the National Assistance Act, 1948, it became, on and from 5th July, the responsibility of local authorities to arrange for the burials (or cremations) of persons in respect of whom no other suitable arrangements can be made. By the end of the year, forty-three cases had been dealt with, detail tails of which are as follows:- Adults and children over ten years of age 22 Children between five and ten years of age 10 Still births 11 43 MORTUARY FACILITIES These are adequately provided for under an agreement between Hammersmith Borough Council and this authority, whereby the former body has made available all facilities at their Mortuary. Forty-eight applications were received for the retention or entry in the Council's list of traders entitled to sell poisons as set out in Part II of the Poisons List, Of this number, two were in respect of primary applications. INFECTIOUS AND OTHER DISEASES. NOTIFICATIONS. The total (corrected) number of notifications received during the year (894) were made up as follows:- Cerebro-spinal fever 4 Pneumonia, Acute Primary 14 Diphtheria 2 Puerperal Pyrexia 8 Dysentery 31 Scabies 35 Eryspielas 7 Scarlet Fever 66 Food Poisoning 4 Tuberculosis, Pulmonary 73 Measles 404 Tuberculosis, Ophthalmia Neonatorum 4 Non-Pulmonary 8 Paratyphoid Fever 1 typhoid Fever 1 Poliomyelitis 2 Whooping Cough 230 Two cases were notified, both being adults. 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 was 683, as compared with 545 in 1947. Two cases of Poliomyelitis were confirmed during the year. One suffered no ill effects, whilst the other is still undergoing treatment at an orthopaedic hospital. - 10 - SMALLPOX AND VACCINATION. No case of Smallpox was notified as occurring in the Borough during the year. Of the 1,588 births registered in Chelsea during 1941 1,070 were successfully vaccinated - a percentage of 67,4 (Figures for 1948 are not yet available). The National Health Service Act, 1946, came into operation on the 5th day of July, and at the same time, compulsory vaccination ceased. Where vaccination is desired, however, this can be obtained at a weekly clinic held at the Violet Melchett Infant Welfare Centre, Flood Walk, Chelsea. TUBERCULOSIS. 73 new cases of pulmonary and 8 cases of non-pulmonary tuberculosis were notified. In addition, 56 new cases came to the knowledge of the Medical Officer of Health from other sources. The total number was, therefore, 137. (Pulmonary - Males: 59. Females:65 Non-Pulmonary - Males: 3. Females: 10) The total number of deaths from all forms of Tuberculosis was 28, being a death rate of 0.5 per 1,000 of the population. The total number of cases of Tuberculosis in the Borough on the 31st December, 1946, was 375. (Pulmonary - Males: 156, Females: 18 Non-Pulmonary - Males: 13, Females: 23). TUBERCULOSIS DISPENSARY AND SPECIAL GASES. During the period 1st January to 4th July, 118 new cases were examined. Of this total, 33 were found to be definitely tubercular. 164 contacts were also examined. The number of attendances (including contacts) was 710, and 1,408 visits were made by the nurse and social worker to homes of patients. 43 patients were referred to the Tuberculosis Officer by medical practitioners. 66 specimens of sputum were examined, and 536 X-Ray examinations were made in connection with the work. CHELSEA TUBERCULOSIS CARE COMMITTEE. By the end of June, the Committee had met on three occasions and given consideration to 78 cases. Social services in co-operation with voluntary societies were continued. ARTIFICIAL PNEUMO-THORAX TREATMENT. During the period 1st January to 4th July, 42 patients had received attention, which necessitated 539 treatments. The total cost (£282.18. 6.) was borne by this authority. EXTRA NOURISHMENT. During the same period, 30 patients were in receipt of extra nourishment as part of their treatment, at a cost of £113. to this Council. The Government's scheme to provide maintenance allowances to tuberculous persons undergoing treatment continued until the 4th July. Thirty-one patients received maintenance allowances.