WES 49 C I T Y OF W iiSTMINSTER REPORT of the MEDICAL OFFICER OF HEALTH for the year 1939 ANDREW J. SHINNIE, M.D., D.P.H., (Lond.) Medical Officer of Health and Administrative Tuberculosis Officer CITY OF WESTMINSTER INTERIM REPORT of the MEDICAL OFFICER OF HEALTH for the year 1939 22r. Mayor, Liy Lord, Ladies and Gentlemen, The publication of this Annual Report has never before been so delayed. It will be understood that the outbreak of war in September, 1939, completely transformed the peace-time duties of £ health department. Not only were they transformed but multiplied many times over. Within a period of 24 hours, the normal staff, by the addition of First Aid and other personnel employed in Civil Defence services had been increased fifteen times. The administration of such a greatly extended organisation, required the transfer of senior officers from the municipal headquarters to Casualty Depots, War-time Mortuaries, etc., throughout the City. This likewise added to the duties of a depleted personnel engaged in central administration. The arrangements for evacuation and its subsequent ebb and flow have added another factor likely to dislocate the normal discharge of public health duties. Nevertheless the fundamental functions of a health department have been maintained. There has been no slackening for example in the investigation and control of infectious disease and other urgent conditions likely to prejudice health. But work of a planned nature, such as procedure under the Housing and Factory Acts e.g. scheduling of unfit houses and underground bakehouses has fallen into abeyance. The year 1939 was a healthy one so far as the City of Westminster was concerned. In the last quarter there wore considerable movements of population and so vital statistics based on existing data may not be completely reliable. For a time the child population had fallen by 60 per cent. For the whole year the infant mortality rate was 33.4 - the lowest on record - and there were no maternal deaths. The death rate was slightly increased and the birth rate lower. The general incidence of infectious disease was markedly low. The incidence and death rate from tuberculosis showed an increase. This report is required by the Ministry of Health as an Interim Report, being mainly a statistical report for future purposes and is thus submitted in skeleton fcra. An account, however, of 'lead in cider' causing a mild degree of poisoning is included as it may prove of some interest. No thanks or praise from me would be adecuate expression for the war-time work of the staff. Without their willing efforts, by night' as well as by day, the ;iir Raid Precautions Services under my control could never have functioned or become effective. I have the honour to be, Your obedient Servant, ANDREW J. SHINNIE. 2 STaTISTICS social conditions Area (acres): 2,502.7 Population (Census 1931) 129,579 Population, June 1939, (Registrar General's estimate): for Birth Rate 123,000 „ Death Rate113,300 Number of inhabited houses (Census 1931)22,536 Rateable Value, March 1940£10,950,000 (estimate) Sum represented by 1d. rate £37,800 (estimate) BIRTHS For calculation of Birth Rate For calculation of Infant Mortality Rate Live Births Total. Males. Females Live Births. Total. Males. Females legitimate 847 429 418 Legitimate 814 414 400 legitimate 144 82 62 Illegitimate 143 82 61 991 511 480 957 496 461 Births notified 1,127 Birth rate per 1,000 of the estimated resident population: 8.0 (Rate for London: 12.3; for England & Wales: 15.0) Number of stillbirths 33 Rate per 1,000 total (live and still) births: 32.2 DEATHS Net deaths 1,221 (males 625; females 596) Death rate per 1,000 of the estimated resident population: Crude: 10.7; Adjusted: 11.0 (Rate for London: 11.9; for England & Vales: 12.1) Deaths from puerperal causes Nil Deaths of infants under 1 year 32(males 20; females 12) Death rate of infants under 1 year - All infants per 1,000 live births 33.4 Legitimate infants per 1,000 legitimate live births 25.7 Illegitimate infants per 1,000 illegitimate live births 76.9 Rate for London 48.0 Deaths from measles (all ages) Nil " " Whooping cough (all ages) 4 " " diarrhoea (under 2 years)2 " " cancer 188 INFANT MORTALITY - Causes of Death: Total. Legitimate. Illegitimate Diarrhoea & enteritis 4 3 1 Vihooping cough 1 1 – Prematurity 13 6 7 Respiratory diseases 1 1 – Accidents and negligence 8 6 2 Broneho-pneumonia 2 1 1 Circulatory diseases 1 1 – Ill defined diseases 2 2 – • 32 21 11 3 Causes of Death. (at all ages) Males Females Total Influenza 7 9 16 whooping Cough 2 2 4 Diphtheria – 1 1 Cerobro Spinal Meningitis 1 1 2 Diarrhoea and Enteritis 5 2 7 Septic diseases 4 10 14 Syphilis 6 – 6 Diabetes 8 11 19 Rheumatic Fever – 3 3 Tuberculosis of lungs 52 30 83 Non-pulmonary Tuberculosis 6 8 14 Malignant growths 89 99 188 Congenital debility) Malformation etc.) 6 7 13 Old age 13 10 23 Locomotor ataxia & general paralysis 2 1 3 Diseases of nervous system 6 5 11 Valvular diseases of heart 10 9 19 Circulatory diseases 192 223 415 bronchitis 30 25 55 Broncho-pneumonia 37 32 69 Pneumonia 10 12 22 Respiratory diseases 11 6 17 Alcoholism 8 4 12 Cirrhosis of liver 3 4 7 Appendicitis 6 3 9 Digestive diseases 21 9 30 Bright's disease 27 11 38 Cystitis 13 10 23 Accidents and negligence 30 26 56 Suicide and murder 11 12 23 Other defined diseases 2 6 8 Ill defined diseases 6 5 11 625 596 1221 INFECTIOUS DISEASE Notifications. Removal to Hospital. Deaths Diphtheria 88 87 1 Erysipelas 29 21 – Scarlet Fever 104 102 – Enteric Fever 12 11 – Puerperal Fever 3 5 – Puerperal Pyrexia 18 18 – Cerobro-spinal meningitis 6 6 2 Poliomyelitis 3 3 – Ophthalmia neonatorum 9 9 – Measles 18 8 – Pneumonia 23 11 22 Malaria 1 1 – Dysentery 13 8 – Whooping cough 93 57 4 Non-notifiable diseases: Gorman measles 67 cases Chickenpox 94 " Mumps 79 " VACCINATION Persons vaccinated by Public Vaccinators; Primary 405 Secondary 25 - 4 REPORT ON SCHICK TESTING aND IMMUNISATION TREATMENT AGAINST DIPHTHERIiA, 1959. Weekly clinics for this purpose were held from the beginning of January until the middle of August, but had to be discontinued owing to the outbreak of hostilities in September. They were not started again until January, 1940. The clinics were held as usual at the Council's Maternity and Child Welfare Centres and at the Westminster Health Society's Centre. During the year 128 new casus were dealt with as compared with 223 and 254 in 1938 and 1937 respectively. New cases attended the Centres as follows:- Ebury Bridge 22 Bessborough Street 35 Marshall Street 33 Westminster Health Society. 38 128 During the first two months of the year alum precipitated toxoid was tried for immunisation in place of toxoid antitoxin mixture which had been previously used, two injections only with an interval of a month being given instead of the three weekly injections given with toxoid antitoxin mixture. The use of this prophylactic was discontinued owing to the greater difficulty of obtaining attendances after a month's interval, and the difficulty of complete reassurance of the mothers about the more marked local reaction and the noc.ule produced in the tissues as a result. Toxoid antitoxin floccules was then tried and has been continued since, proving entirely satisfactory, the reaction in the older child being less than with toxoid antitoxin mixture, and the proportion of negative reactors four to six months after three weekly injections being just as high. The preliminary Schick test was only done on older children or for some special reason in particular cases. Treatment was carried out without difficulty end with satisfactory results. The following table shows the age groups of those treated end the results of such preliminary tests as were performed:- Ages Preliminary Schick Test Positive Negative No Test Total Under 5 years - 1 77 78 5 to 10 years 1 3 40 44 Over 10 years 1 1 4 6 Totals 2 5 121 128 The one child under five years whose preliminary tost was negative had had diphtheria. Two of those between five and ten whose preliminary test was negative had had diptheria, one of them being stated to have had the disease twice. 67 cases who had previously been treated were retested during the, year; one of these was a positive reactor end was given further immunisation treatment. 5 ??? - Cost of Diptheria (native 58?. positive 8), Enteric) (negativ3 5, positive -). .£120 Bysentry (negative 2, positive -)) Tuberculosis (negative 184, positive 31) £17 TUBERCULOSIS Pulmonary: 166 new cases, including 5 transfers and 13 non-notified deaths. non-pulmonary: 26 new cases, including 1 transfer and 6 non- notified deaths. (1938 - Pulmonary 188 new cases. Non-pulmonary 41 new cases). New cases and Deaths: Age periods New Cases Deatns Pulmonary. Non-pulmonary, . Pulmonary. non-pulmonary M F M F M F M F Under 1 year – 1 – – – – – – 1 to 5 years 1 1 – 2 – – – 2 5 "10 years – 3 – 1 – – – 1 10 " 15 " 1 2 2 1 – – – – 15 " 20 " 9 4 5 3 4 3 1 3 20 "25 " 11 18 1 1 3 3 1 1 25 " 35 " 19 21 2 1 8 5 – – 35 " 45" 16 14 2 1 11 6 1 1 45 " 55 " 15 8 1 – 9 10 1 – 55 " 65 " 11 2 2 – 12 1 1 – 65 and upwards 6 3 1 – 6 2 1 – Totals 89 77 16 10 55 30 6 8 . Deaths from Tuberculosis: Pulmonary 83. Non-pulmonary 14. Death rate per 1,000 - O.85. Tuberculosis Dispensary New patients seen 267 (374). No. considered tubercular 119 (154). Patients recommended for institutional treatment: Hospitals 24 (20). Sanatoria 89 (110). Dental treatment at Council's clinic: 3 patients (6). Artificial Pneumothorax treatment: 485 refills (428). Light treatment for Lupus: 2 cases (l) . Cost £3.5.6d. (£11.2.6d). Extra nourishment granted to 67 patients (56). Cost £457 (£378.7.10d) . GENERAL PROVISION OF HEALTH SERVICES Services are generally as set out in the Report for 1938 With the declaration of war in September, they had, of course, to be modified to some extent, as a result, particularly, of evacuation and the reservation of hospital accommodation. Sanatoria accommodation has, for a time, been restricted. MATERNITY AND CHILD WELFARE ' The welfare scheme during 1939 was as set cut in the Report for 1938, except that after September there were fewer mothers and children in the City. The Council's Welfare Centres played a large part in the evacuation of expectant mothers. Midwifery and consultant services were maintained, but classes in mothercraft etc., had to be somewhat curtailed. Midwifery visits 1947 (1890). Confinements attended 111 (107)• 6 VISITS BY HEaLTR VISITORS To expectant mothers 2,577 " Children under 1 4,486 " " between 1 and 5 9,550 ANTE AND POST-NaTAL CLINICS Attendances by mothers 1,471 INFANT CLINICS Attendances 8,86l MILK SUPPLIED TO EXPECTANT MOTHERS Liquid 7,526 galls) At a cost of Dried 1,722 lbs. ) £897.8.2d. HOME NURSING Number of cases attended during year. 1,752 CONVALESCENT TREATMENT The Council contributed £67 towards the cost of treatment for 18 Westminster mothers and 51 children. HOME HELPS Supplied in 10 cases. Cost £9. INSULIN TREATMENT Two cases. Cost £41. DENTAL TREATMENT - Clinic Reports: NEW Cases Reappoint ments Extractions Fillings Other operations Anaesthetics Local. General 1938 242 1,000 1,045 146 399 9 209 1939 184 847 686 161 427 5 152 Si.NIT.aRY CIRCUMST ANCES For particulars of general services, see previous reports. AIR RAID DAMAGE - None during 1939. DRAINAGE AND SANITARY WORKS. Plans submitted 405 (743) Combined drainage orders made 15 (10) DISTRICT SaKITARY INSPECTION Inspections of Dwelling Houses 7,491 " " other premises 3,019 " " sanitary works 8,672 NUISANCES Intimation notices served 778 Statutory " " 18 7 WATER SUPPLY Metropolitan Water Board notices of withdrawal - 11. SHOPS ACT. 1934. Shops inspected 711 Inspections made 746 Notices served 2 FACTORIES AND WORKPLACES 202 defects under the Public Health Acts were found. All were remedied without legal proceedings. Visits to Outworkers' premises other than factories 56 Workrooms measured 94 Visits of enquiry re employment of:- Women 28 Outworkers 17 NUISANCE FROM PIGEONS Complaints 18. Pigeons destroyed 478. PHYSICALLY INCAPACITATED PERSONS REMOVED TO INSTITUTIONS - 27 The statutory powers to effect removal did not require to be brought into operation. DISINFECTION. Rooms 481. Articles 34,083. Articles washed 3,150. Articles destroyed 40. Books disinfected 48. Vehicles 49. Business premises 23. CLEANSING OF PERSONS (Head lice, Body lice, Scabies). Children 327- Adults 341. - Total 668. ERADICATION OF BED BUGS Premises found to be infested - Council flats 17; other houses 556. All premises disinfested. The furniture & effects of 136 families were disinfested on re-housing. TREATMENT OF BEDDING FROM CASUALTY DEPOTS, REPORT CENTRES, ETC. Articles of bedding etc., disinfected, September to December, 1939 10,788 INSPECTION aND SUPERVISION OF FOOD Samples purchased for analysis 1,806 Visits to premises 2,209 Notices served 137 Samples found to be adulterated 24 Prosecutions 11 Convictions 4 Fines £13.0.0. Costs £14.14.0. LEAD IN CIDER Information was received during the year from one of the Voluntary General Hospitals of a patient in a ward suffering from lead poisoning. The only suggestion which could be obtained as to the source of this lead was that the patient regularly consumed cider. 8 Enquiries went to show that ho frequented the same public house nightly, anc. that he was not engaged in any trade or industry likc-ly to cause lead poisoning. Samples were thereupon taken of the cider in the public house concerned, and were found on analysis to contain 1.5 parts of lead per million. The inkers of the cider were informed of the result of analysis and were requested to investigate thE matter end take early retion to stop it. Further samples of the same brand of cider taken from different sets of premises were also found to contain lead. The Ministry of Health were informed of the circumsti nces ana of the results of the analysis. Inspections of premises throughout the City were made and investigations mode of the method of handling, storing and serving of cider therein. Numerous samples of cider were taken and the results went to show that samples from one particular manufacturer contained lead in varying quantities. These results pointed to lead contamination taking place at the source, which was outside Westminster. The Medical Officer of Health for the district concerned was informed and the Ministry of Health then took over the investigations in association with this Department. Whilst these investigations were in progress, a second case came to the notice of the Medical Officer of Health in the person of a charwoman at another hospital, also suffering from lead poisoning, and who, on enquiry, turned out to be a regular consumer of cider at the same premises as the first patient. Investigations were further carried out at the original premises in Westminster, and it was discovered that barrels of cider were stored in the basement and supplies drawn through glass tubes fitted with rubber connections by means of a stainless steel beer engine fitted to the counter in the floor above. The stainless steel tubes were inserted into the barrel through the 'spigot' hole at the end of the barrels. As the end of the barrels had been treated with lead paint, it was thought possible that some of the cider had been splashed on to the paint and to have trickled back into the barrel. On this hypothesis the producers tool; proper steps to safeguard further supplies. Members of the Cider Association WEre also informed of the results cf the investigations. Results of further investigations made it evident that lead could be absorbed into the cider from lead paint. The producers at once withdrew from sale all the barrels in use with lead paint. This, however, diD not eliminate the lead content, as samples still showed .5 part of lead per million. The Ministry of Health were, however, conducting investigations at the source, and it is understood that it was established that if cider were put in barrels which had been in contact with lead paint, the lead could be absorbed into the wood of the interior of the barrel. When fresh cider was placed in these old. barrels at a later date, lead was found to be absorbed from the walls of the barrel, even though there might not be any paint on the outside of the barrel at the time. Subsequent samples taken in the City of Westminster following these investigations, were -found to be free from lead. CERTIFICATION OF FouD FOR EXPORT Certificates issued in respect of the export of articles of food. To Switzerland 20 " Ztussia 6 " Canada 1 9 ICE CRiEAM PREMISES Promises on Register at 31st December, 1939 l80 Promises registered during the year 34 Inspections made 82 PRESERVED MEAT. ETC. PREMISES Premises on Register at 31st December, 1939 121 Premises registered during the year 3 Inspections made 44 MILK (SPECIAL DESIGNATIONS) ORDER. 1936 & 1938. Licences-issued 79 REGISTRATION OF DAIRYMEN & DAIRIES Premises. Persons. On Register at 31st December, 1939 169 244 Registered during the year 11 7 Inspections made 198 Notices served 8 CORONER'S COURT & MORTUARY Bodies received 255 (199) Causes of Death:- Drowning 12(17) Street accidents 31 (16) Other accidents 29 (26) Murder 2(1) Suicide 39 (36) Natural causes 98 (63) Misadventure 24 (22) Miscellaneous causes 22 (26) Inouests held 162 (127) Post-mortem examinations 174 (177) NOTE: The figures in brackets are for the year 1938, and are inserted for the purpose of comparison.