WES 50 CITY OF WEST- MINSTER REPORT of the MEDICAL OFFICER OF HEALTH for the year 1940 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 1940 Mr. Mayor, My Lord, Ladles and Gentlemen, The Minister of Health has again required that the Annual Report of the Medical Officer of Health on the health and sanitary conditions of the City be in summarized form embodying statistics necessary for future records. In this foreword, however, it may be of interest to mention briefly some of the activities of the Department carried out in praecipe form in 1939, but transformed into grim realism in 1940. The members of the Casualty Services, whether engaged in Fixed First Aid Posts, Stretcher Parties or Mobile Aid Posts, acquitted themselves with high courage and tenacity of purpose in rendering aid to the victims of air warfare over the City. Indeed some were themselves severely wounded, whilst a few lost their lives, and among the latter one deplores the loss of W.A. Roust, Staff Officer, of St. John Ambulance Brigade and Officer in Charge of Stretcher Parties, a heroic and devoted officer. To the St. John Ambulance Brigade and the British Red Cross the City Council is deeply indebted. It is difficult to express due appreciation of the unstinted co-operation given by those bodies in recruitment, training and the detailed management of their units serving in the City Council's Casualty Services. The personnel proved themselves fully worthy-in the emergencies through which they were tested. There were many victims who did not survive and the measures originally planned for their reception had further to be extended and improvised. The Council has already recorded its appreciation of the work of the male staff of the Public Health Department, mainly the Sanitary Inspectors who unflinchingly volunteered ana faced up to a task entirely unfamiliar, naturally distasteful, but which must needs be done. There were occasions when almost the whole of the male staff were engaged in duties connected with air raid fatalities. A.R.P. Training. In this City, the Medical Officer of Health, besides undertaking First Aid Training of Civil Defence Personnel, has also within his reference general A.R.P. Training. The Officer appointed by the City Council for this purpose, and designated by the Ministry of Home Security "Training Officer", is a member of the staff of the Medical Officer of Health, and he is assisted by 6 full-time Instructors, and 1 part-time. The scheme of training is in full accordance with the Training Manuals Nos. 1 and 2, but while the special duties of each service are the care of the head of that service, the Training Officer co-ordinates the whole, when he takes complete control of exercises in Combined Training. The work of the Training Officer also extends to activities such as the training of fire-guards, personnel for public cleansing stations, demonstrations and lectures for the general public, public gas tests, etc. 2 The food industry is an important one in the City. Consequently much emergency work arose after damage to food premises. The reclamation ofnfood on the site, its conveyance to a special place for inspection and its subsequent return for sale for human consumption, disposal for the food of animals, or use for industrial purposes. It is gratifying to record that of many tons of food examined, over 80% proved in reality to be undamaged and remained fit for human consumption. During one period, four of the Inspectors were devoting full time to the examination and reclamation of food from damaged premises. Public Shelters: The Medical Officer of Health is responsible for the general hygiene in shelters and the medical supervision and nursing services for the inmates. Standards of air space, methods of ventilation, heating and lighting, and arrangements for sanitary conveniences were recommended. Four Inspectors were detailed for night inspections of these shelters throughout the City, working on a 24 hour rota. The occurrence of infectious disease among shelterers was very slight, but what is more important there was no evidence of any spread of infection. Careful observation was kept on verminous conditions among persons and their effects. Those instances which did occur were so few and so promptly dealt with that no opportunity for infestation was permitted. In conjunction with the Ministry of Health considerable and extended experiment was made of entiseptic sprays and mists to reduce the germ content of the air where many people congregated. In collaboration with the Bacteriologists of the Harvard University Medical Unit and the Ministry of Health some interesting research was begun relating to respiratory organisms among shelterers. Whatever the cause may be the fact remains that during 1940 the health of shelterers was remarkably good. The Council should take credit for anticipating the wishes of Central Authority by organising a complete medical and nursing service throughout the public shelters within its control. By a system of complete collaboration between medical practitioners, specially engaged trained nurses, the voluntary hospitals with their medical and nursing staffs, and the personnel of St.John Ambulance Brigade and British Red Cross Society, measures for the medical care of the shelterers were assured. Diphtheria Immunization: Opportunities and facilities for this most desirable form of protection were extensively provided. By arrangement with the London County Council, school children were included and also many children in shelters normally resident in other districts. The total thus protected up to date number 963- Anti-Typhoid Inoculation: Members of the public and of the Civil Defence Services, numbering 10J, requested and received protection against Typhoid infection. Re-Housing and Billeting: In the Spring of 1940, the management of the headquarters of these activities was in the hands of officers of my Department and much valuable assistance was given by the Sanitary Inspectors and Health Visitors to those rendered homeless. This work was later transferred to the City Valuer when he was appointed Re-Housing Officer. Evacuation: This activity has proceeded with varying tempo and at times assumed a pendulum movement. At one period, as high a proportion of mothers and children including unaccompanied school children 60 per cent had been moved to reception areas; at another 80 per cent of these had returned. Comments were freely circulated in 1939 about the lack of cleanliness of evacuees and accompanying skin infections. No such complaint regarding Westminster mothers or children has ever reached me from the health authorities of any reception area. The scheme of evacuation for expectant mothers for confinement has operated very well and smoothly in co-operation with the London County Council and the County Authority of the reception area. It will be 3 understood that much, additional work has been placed on the officers of the Council's Maternity and Child Welfare service through these activities as well as those of the new free and assisted milk scheme and the more recently introduced distribution of vitamin enriched accessories to diet. '* Health Conditions: The health of the City remained during 1940 remarkably good. It is difficult to assess the value of statistics in a resident population which does not for long remain static, but these are based on the figures supplied by the Registrar General; Death rate, crude 17.4 (adjusted 17.5) per 1,000. The figure in London is 17.8. Owing to evacuation, the number of births is lower than ever. The birth rate is slightly higher than in the two previous years, but in view of the fluctuations in population the difference is not significant. The Infant Mortality figure, 44.6 per thousand births, is higher than in 1939 but considerably lower than in 1938, and below the rate for London as a whole. The incidence of infectious disease was surprisingly low, even when one takes the evacuation of children into account. There were no deaths from measles, whooping cough, diphtheria, scarlet fever or enteric fever. Six out of forty-two cases of cerebro-spinal meningitis were fatal, and there were twenty two deaths from pneumonia. The death rate from tuberculosis, .83 per thousand, is above the average for the last ten years, but is the same as in 1939 when the effects of war had not had time to influence this figure. There seems some evidence that the incidence of tuberculosis has increased throughout the country since the outbreak of war. The experience of the last war would lead one to expect some increase as a result of changes affecting both nutriment and conditions of employment. Except in the very early days of the war, there has been no decrease in the facilities for the treatment of tuberculosis. I have the honour to be, Your obedient Servant, ANDREW J, SHINNIE. ■4 STATISTICS AND SOCIAL CONDITIONS Area (acres): 2,502.7 Population (Census 1951) 129,579 Population, 1940, (Registrar General's estimate:) 85,920 Number of inhabited houses (Census 1931) 22,536 Rateable value, March 1941 £10,700,000 (estimate) Sum represented by 1d rate £35,670 (estimate) BIRTHS For calculation of For calculation of Infant Birth Rate and Maternal Mortality Rates Live Births Total Males Females Live Births Total Males Females Legitimate 717 375 342 Legitimate 643 338 305 Illegitimate 121 50 71 Illegitimate 119 48 71 838 425 413 762 386 376 Births Notified 623 Birth rate per 1,000 of the estimated resident population: 9.7 (Rate for London: 13.7; for England & Wales: 14.6) Number of Stillbirths 30 Rate of Stillbirths per 1,000 total (live & still) births 34.5 DEATHS Net deaths 1502 (males 807, females 695) Death rate per 1,000 of the estimated resident population: Crude: 17.4; Adjusted: 17.5(Rate for London: 17.8; for England & Wales: 14.3) Deaths from puerperal causes 2 (2.6 per 1000 births). Deaths of infants under 1 year 34 (males 17; Females 17) Death rate of infants under 1 year:- All infants per 1,000 live births 44.f Legitimate infants per 1,000 legitimate live births 43 Illegitimate infants per 1,000 illegitimate live births. 50 Rate for London 50 Deaths from measles (all ages) Nil " " whooping cough (all ages) Nil " " diarrhoea (under 2 years) 3 " " cancer 175 INFANT MORTALITY - Causes of Death: Total Legitimate Illegitima Diarrhoea & Enteritis 3 3 Congenital malformation, Prematurity etc. 18 15 3 Respiratory diseases 1 1 Broncho-pneumonia 6 5 1 Accident 1 — 1 Kidney affections 1 1 Tubercular meningitis 1 1 Digestive diseases 1 1 Syphilis 2 1 1 34 28 6 5 Causes of Death (at all ages) Males Females Total Influenza 7 7 14 Meningitis & Convulsions 2 - 2 Cerebro Spinal Meningitis 2 4 6 Diarrhoea & Enteritis — 5 5 Septic diseases 5 5 10 Syphilis 7 3 10 Diabetes 3 9 12 Tuberculosis of Lungs 45 17 62 Non-pulmonary Tuberculosis 3 7 10 Malignant growths 88 87 175 Congenital debility Malformation etc 11 8 19 Old age Locomotor ataxia & general 8 10 18 paralysis 4 1 5 Diseases of nervous system 6 9 15 Valvular diseases of heart 3 1 4 Circulatory diseases 196 209 405 Bronchitis 65 58 123 Broncho-pneumonia 46 31 77 Pneumonia 14 8 22 Respiratory diseases 8 9 17 Alcoholism 4 2 6 Cirrhosis of liver 2 2 4 Appendicitis 5 2 7 Digestive diseases 33 23 56 Bright's disease 24 18 42 Cystitis 26 4 30 Accidents & negligence 42 32 74 Suicide & Murder 22 7 29 Other defined diseases 4 3 7 Ill defined diseases 6 3 9 Parturition — 2 2 Other violent causes 116 109 225 807 695 1502 INFECTIOUS DISEASE Notifications Removal to Hospital Deaths Diphtheria 37 35 - Erysipelas 16 12 - Scarlet Fever 42 41 - Enteric Fever 7 3 - Puerperal Fever - - - Puerperal Pyrexia - - - Cerebro Spinal Meningitis 42 41 6 Ophthalmia Neonatorum 3 2 - Measles 90 65 - Pneumonia 14 7 22 Dysentery 6 4 - Whooping Cough 7 6 - Non-notifiable diseases - removed to hospital:- German Measles 127 cases Chickenpox 10 " Mumps 6 " VACCINATION Persons vaccinated by Public Vaccinators: Primary 243 Secondary 5 6 BACTERIOLOGICAL EXAMINATION Diphtheria - negative 168, positive 6 Tuberculosis - negative 99,positive 30 TUBERCULOSIS Pulmonary: 154 new cases, including 8 transfers and 10 non-notified deaths. Non-pulmonary: 26 new cases, including 1 transfer and 2 non-notified deaths. (1939 - Pulmonary: 166 new cases. Non-pulmonary 26 new cases). New Cases and Deaths:- Age Periods New Cases Deaths Pulmonary Non-pulmonary Pulmonary Non- pulmonary M F M F • M F M F Under 1 year — — — 2 - - - 1 1 to 5 years — — 4 - - 1 1 5 " 10 " — — - 1 - - 1 10 " 15 " 1 3 1 1 - - - - 15 " 20 " 9 7 4 1 1 2 1_ 2 20 " 25 " 8 13 2 1 5 2 1 1 25 " 35 " 23 20 1 3 3 4 - - 35 " 45 " 21 9 2 1 9 1 — - 45 " 55 '' 10 3 1 — 10 3 - 1 55 " 65 " 18 2 1 — 14 3 — - 65 & upwards 6 1 — — 3 2 Totals 96 58 16 10 45 17 3 7 Deaths from Tuberculosis:- Pulmonary 62; Non-pulmonary 10 Death rate per 1,000 - 0.83. WORK OF TUBERCULOSIS DISPENSARY 1940. Throughout the year the Dispensary continued to afford to its patients all the facilities that are available in times of peace. Owing to war conditions, however, the number taking advantage of the Dispensary was considerably lower than the normal. Only 73 new cases were diagnosed as suffering from Tuberculosis, 11 of these being cases of non-pulmonary tuberculosis. This represents considerably less than half the normal number of new cases considered definitely tubercular, and other figures at the Dispensary show a corresponding decrease, most marked in the final quarter of the year when the City was subjected to severe and repeated bombing. The dearease in the Dispensary figures should therefore be considered a reflection of war-time conditions rather than an indicate of a decline in the incidence of the disease which, indeed, appears to show some increase throughout the country. The population of the City has decreased markedly as a result of the call to the colours, changes in centres of employment, and the evacuation both of families and business houses. Evacuation; in particular, has greatly reduced the number likely to attend the Tuberculosis Dispensary. Persons in poor health are likely to join in a move to the qountry, and many of the long-standing patients left the City to live with relatives or friends in quieter districts. The evacuation of school children made a marked decrease in the number of children attending, both as patients and as contacts. One case of Tuberculosis in childhood was found in the last quarter of the year. 7 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. Sanatorium accommodation has, for a time, been restricted. MATERNITY MP CHILD WELFARE The Welfare scheme during 1940 was as set out in the Report for 1938. Midwifery and consultant services were maintained, but classes in mothercraft etc., had to be somewhat curtailed. Midwifery visits 2691 (1947); Confinements attended 150 (111) VISITS BY HEALTH VISITORS To expectant mothers 1527 " children under 1 2544 11 " between 1 and 5 3426 ANTE AND POST-NATAL CLINICS A.N. P.N. No. of women attending 668 59 INFANT CLINICS Attendances 1,510 MILK SUPPLIES TO EXPECTANT MOTHERS Liquid 3743 galls) Dried 5037 lbs. ) By Food Executive Officer from inception of National Milk Scheme (15,017 Galls.(liquid) ( 291 lbs. (dried) HOME NURSING Number of cases attended during year 1705 CONVALESCENT TREATMENT The Council contributed £45 towards the cost of treatment for 12 Westminster mothers and 22 children. HOME HELPS Supplied in 7 cases. Cost £8. 15. Od. INSULIN TREATMENT One case - Cost £31. DENTAL TREATMENT - Clinic Reports New Cases Re Appoint ments Extractions Fillings Other Operations Anaesthetics Local General 1939 184 847 686 161 427 3 152 1940 217 826 816 221 418 18 176 - 8 - SANITARY CIRCUMSTANCES. For particulars of general services, see previous reports. DRAINAGE AND SANITARY WORKS Plans submitted 95 Combined Drainage Orders made 2 DISTRICT SANITARY INSPECTION Inspections of Dwelling Houses 5177 " " other premises 24o9 " " sanitary works 1198 NUISANCES Intimation Notices served ... 152 Statutory " « ... ... ... 25 WATER SUPPLY Metropolitan Water Board notices of withdrawal - 6 Deep Wells. No. of examinations made... ... 19 SHOPS aCT, 1954. Shops inspected .. 1081 Inspections made ... .. 1127 Notices served 25 FACTORIES AND WORKPLACES 110 defects under the Public Health Acts were found. All were remedied without legal proceedings. Visits to Outworkers' premises other then factories - 65 Workrooms measured . - 51 Visits of enquiry re employment of women - 26 Outworkers... - 21 NUISANCE FROM PIGEONS Complaints: 7« Pigeons destroyed: 391 PHYSICALLY INCAPACITATED PERSONS REMOVED TO INSTITUTIONS The Statutory Powers to effect removal did not require' to be brought into operation. DISINFECTION Rooms: 462; Articles: 13,129; Articles washed: 3450; Articles destroyed: 9; Books disinfected: 152; Vehicles: 37; Business premises: 18. CLEANSING OF PERSONS - (Head Lico, Body Lice, Scabies). Children: 192. Adults: 267 Total: 459* CLEANSING OF REFUGEES Refugees cleansed... ... ... 532 Articles of clothing .... ... 2673 ERADICATION OF BED BUGS Premises found to be infested - Council flats: 18 Other houses: 46. All premises disinfected. 1 TREATMENT OF BEDDING FROM CASUALTY'DEPOTS, REPORT CENTRES, etc., Articles of bedding, etc. disinfected 24,720. 9 INSPECTION AND SUPERVISION OF FOOD Samples purchased for analysis 1216 Visits to premises 1525 Notices served 96 Samples found to be adulterated 69 Prosecutions 47 Convictions 33 Fines: £112.l7.0d. Costs: £106.13.0d. AIR RAID SHELTERS(Public and Communal Domestic) Number of visits 869 ICE CREAM PREMISES Premises on Register at 31st December, 1940 182 Premises registered during the year 2 PRESERVED MEAT etc. PREMISES. Premises on Register at 31st December, 1940 124 Promises registered during the year 3 MILK (SPECIAL DESIGNATIONS) ORDER, 1936 & 1938 Licences issued 52 REGISTRATION OF DAIRYMEN & DAIRIES Premises Persons On Register at 31st December 1940 169 247 Registered during the year 11 3 Inspections made 6l Notices served 4 CORONER'S COURT & MORTUARY Bodies received 348 Causes of Death:- Drowning 6 Street accidents 44 Other accidents 40 Murder 3 Suicide 52 Natural causes 182 Misadventure 9 Miscellaneous causes 12 Inquests held 195 Post-mortem examinations 275