CITY 0F WESTMINSTER REPORT of the MEDICAL OFFICER OF HEALTH for the year 1942 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 1942 Mr. Mayor, My Lords, Ladies and Gentlemen, I beg to submit a report on the health and sanitary conditions of the City of Westminster. The form of the report is prescribed by Ministry of Health Circular No. 2769, which directs that the Annual Report of the Medical Officer of Health shall continue in abbreviated form as laid down for the previous war years. The health of the City has been well maintained. The death rate fell from 21.4 to 14.4. There were no fatal casualties from bombing. The infantile mortality rate 53.1 per 1000 births was considerably lower than last year and less than the rate for London as a whole, 60. While more babies were born, fever died. Prematurity was again the greatest contributory factor to infantile mortality. Immunization against diphtheria was actively pursued. In 1941, much of the work was carried out in public shelters, many children from other Boroughs receiving protection. In 1942, these measures were carried out at the Schools and Welfare Centres of the City; no fewer than 1373 "Westminster children were immunized almost twice the total in 1941. Tuberculosis cases showed an increase in the number notified, especially of the non-pulmonary type. There was also an increase in the pulmonary type among females. The proportion of food samples analysed and found to be adulterated was considerably less. Close co-operation with representatives of the Ministry of Food, both centrally and locally, was maintained. Routine inspections of restaurants was again instituted and it is re-assuring to find that after a lapse of two or more years only in a few instances were serious insanitary conditions found. A most encouraging sign of the vigour and well being of our people is the continuing expansion of the Maternity and Child Welfare services in response to local needs. The number of confinements at home have increased three-fold, while attendances of mothers and children at the clinics have likewise greatly exceeded those in 1941. It is now 25 years since the service was established by Statute, although voluntary pioneer work by the Westminster Health Society had, since 1903, brought the principles of healthy living into the homes of the people. Maternity and Child Welfare is more than a service, it has become woven into the life of the community. The opening of the War-Time Day Nursery at 1 Bessborough Street was referred to in last year's report. It has now been catering very successfully for almost a year for 50 children under 5 years of age. Its success is largely due to the organising ability of the Superintendent Health Visitor in charge who has undertaken these extra responsibilities so cheerfully. The City Council at the request of the Minister of Health and Labour, is taking steps to open two additional War-Time Nurseries in other parts of the City. Other activities which have come into prominence during the year have been an intensified campaign against rat infestation and improved facilities for the cleansing of persons infected with Scabies and other verminous conditions. The Council appointed an officer possessing special experience of rodent infestation, to organise measures for rat clearance in premises in the City. These measures are actively proceeding and would be more effective still if owners and occupiers ware more fully alive to their statutory obligations in regard to clearing their premises of rats. - 2 - Valuable assistance has been given at the Cleansing Station by all Civil Defence nursing personnel who undertake a rota of duty there. Owing to war conditions there has been an increase in the number of persons requiring disinfestation and the services of the nurses and auxiliaries is much appreciated. The nursing auxiliaries are also giving most useful help in the voluntary hospitals of the City. As will have been gathered from the brief outline, the work of the Department has been increasing rapidly because of the resumption of its peace-time duties, and I must take this opportunity of expressing my appreciation to all members of the staff for the additional service so cheerfully given; not only is the scope of the duties placed on the Department steadily extending, but the responsibilities of colleagues absent on military service have also to be discharged. I have the honour to be Your obedient Servant, ANDREW J. SHINNIE. August, 1945. - 3 - STATISTICS AND SOCIAL CONDITIONS Area (acres): 2,502.7 Number of inhabited houses (Census 1931) 22,536. Rateable value, March 1943 §10,011,871 (estimate) BIRTHS Live Births Total Males Females Legitimate 526 282 244 Illegitimate 132 66 66 658 348 310 Births notified 272 Birth rate per 1,000 of the estimated resident population: 10.7 (Rate for London: 14.0; for England & Wales: 15.8) Number of Stillbirths 23 Rate of Stillbirths per 1,000 (live & still) births 33.7 DEATHS Net deaths 837 (males 474; females 413) Death rate per 1,000 of the estimated resident population 14.4 (Rate for London: 13.9; for England & Wales: 11.6) Deaths from puerperal causes 2 (2.9 per 1,000 births) Deaths of infants under 1 year 35 (males 24; females 11) Death rate of infants under 1 year:- All infants per 1,000 live births 53.1 Legitimate infants per 1,000 legitimate live births. 49.4 Illegitimate infants per 1,000 illegitimate live births. 63.1 Rate for London 60 Deaths from measles (all ages)- " " whooping cough (all ages)1 " " diarrhoea (under 2 years)6 " " cancer 141 INFANT MORTALITY - Causes of Death. Total Legitimate Illegitimate Diarrhoea & Enteritis 6 4 2 Congenital malformation, Prematurity etc. 18 14 4 Respiratory diseases 1 1 - Broncho-pneumonia 6 3 3 Accident 1 1 - Bronchitis 2 2 - Whooping cough 1 1 — 35 26 9 CAUSES OF DEATH (At all ages) Males Females Total Influenza 1 2 3 Meningitis & Convulsions 1 1 2 Cerebro Spinal Meningitis 1 - 1 Diarrhoea & Enteritis 5 3 8 Septic diseases 2 2 4 Syphilis 9 4 13 Diabetes 1 6 7 Tuberculosis of Lungs 30 26 63 - 4 - GAUGES OF DEATH (At all ages) Contd. Males Females Total Non-pulmonary Tuberculosis 4 5 9 Malignant growths 71 70 141 Congenital debility) Malformation etc.) 11 8 19 Old age 4 7 11 Locomotor ataxia & general paralysis 4 - 4 Diseases of nervous system 5 3 8 Circulatory diseases 166 172 332 Bronchitis 35 16 51 Broncho-pneumonia 30 17 47 Pneumonia 11 4 15 Respiratory diseases 3 — 3 Alcoholism l — 1 Appendicitis 1 1 2 Digestive diseases 18 14 32 Bright's disease 12 10 22 CyStitis 14 - 14 Accidents & negligence 24 21 45 Suicide & Murder 6 6 12 Other defined diseases 1 8 9 Ill defined diseases 1 3 4 Parturition — 2 2 Other violent causes — 2 2 Whooping cough 1 — 1 474 413 887 INFECTIOUS DISEASE Notifications Removal to Hospital Deaths Polio-myelitis - - - Encephalitis Lethargica 1 1 — Diphtheria 38 38 — Erysipelas 16 13 - Scarlet Fever 59 56 — Enteric Fever 4 2 - Puerperal Fever 3 3 — Puerperal Pyrexia 8 7 - Cerebro Spinal Meningitis 9 9 1 Ophthalmia Neonatorum 1 1 — Measles 192 83 - Pneumonia 7 5 15 Dysentery 14 6 1 Whooping cough 31 11 1 Smallpox 1 1 - A case of modified smallpox came to light in a young woman on a visit to London from Glasgow where several cases of smallpox occurred. The patient had been vaccinated in infancy and again on the 7th July by the doctor attached to the factory where she worked in Glasgow. The patient arrived in London on the l8th July, staying in the Soho district. She woke on the 19th July with a swollen eye. and a rash appeared on the following day. On the 21st July, the girl attended the surgery of a medical practitioner in Soho, who diagnosed smallpox which was confirmed by the Medical Officer of Health the same day and removed to the London County Council's Smallpox Hospital All contacts were vaccinated. The patient subsequently recovered and returned to her home. Non-notifiable diseases - removed to hospital German Measles 8 cases Chickenpox 19 Mumps 83 ,, -5- VACCINATION Persons vaccinated by Public Vaccinators: Primary 255 Secondary 222 BACTERIOLOGICAL EXAMINATIONS Diphtheria - negative 106, positive 4 Tuberculosis - negative 92, positive 40 TUBERCULOSIS Pulmonary: 163 new cases, including 8 transfers, 10 non-notified deaths, and 5 posthumous notifications. Non-pulmonary: 29 new cases, including 1 transfer and 5 non-notified deaths• (1941 - Pulmonary: 153 new cases. Non-pulmonary: 12 new casus) 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 - - - - - - - - 1 to 5 years - 1 2 3 — 1 1 — 5 „10 „ — — 1 1 — — — — 10 „ 15 „ - - 3 1 - — __ 1 15 „ 20 „ 3 14 1 - - - 1 - 20 „ 25 „ 13 9 3 3 4 4 - 2 25 „ 35 „ 13 20 - 4 4 4 — — 35 „ 45 „ 32 11 - 1 6 9 - - 45 „ 55 „ 15 6 2 - 10 2 1 - 55 „ 65 „ 19 1 1 1 11 1 1 - 65 & upwards 5 1 - - 2 2 — 1 Totels 100 63 15 14 37 26 4 5 Deaths from Tuberculosis:- Pulmonary: 63 (37 males, 26 females) Non-pulmonary: 9(4 males, 5 females) WORK OF TUBERCULOSIS DISPENSARY,1942. The work of the Tuberculosis Dispensary has continued on the normal lines, and the facilities for treatment remain as in time of peace. There was a considerable increase In the work in 1942, due largely to the return of population, but in some measure to increased incidence of the disease. As was noted last year, there appears to be an increase in cases of the acute type with a fairly rapid course. There were 3l6 new patients in 1942 as compared with 194 in 1941, and 374 in 1938, the last complete:- pre-war year. As the population is still below its pre-war level, this suggests a proportional increase in cases and suspects. Thirty eight of the new patients were children. Of the 316 new patients, 106 were considered to be suffering from pulmonary tuberculosis and 10 from other types of the disease. The remainder showed no definite evidence of tubercular infection, but in many cases were kept under observation. MATERNITY AND CHILI} WELFARE The welfare scheme during 1942 was as set out in in the report of 1938. -6- WAR TIME LAY NURSERY A War-time Day Nursery for 90 children was opened by the Council at No. 1 Bessborough Street in October, 1942. Midwifery and consultant services were maintained. Midwifery visits: 737 (211); Confinements attended; 52(17) VISITS BY HEALTH VISITORS To expectant mothers 2375 " children under 1 3629 " " between 1 and 5 2584 ANTE AND POST-NATAL CLINICS A.N. No. of women attending 1345 INFANT CLINICS Attendances 1507 HOME NURSING Number of visits made during year 921 HOME HELPS Supplied at the cost of the Council in two cases. DENTAL TREATMENT - Clinic Reports:- New Cases Re Appointments Extrections Fillings Other Operations Anaesthetics Local General 1941 84 305 561 152 197 8 72 1942 125 579 486 329 369 26 84 DIPHTHERIA IMMUNISATION TREATMENT AND SCHICK TESTING Immunisation. Under 5 years of age 772 Over „ „ „ 83 London County Council School children (treated by City Council's Medical staff) 518 1375 Schick To sting. Under 5 years of age - negative 98 positive 11 109 London County Council School children (trested at City Council's Clinics) - negative 296 positive 11 309 SANITARY CIRCUMSTANCES For particulars of general services, see previous reports. DRAINAGE AND SANITARY WORKS Plans submitted 72 Combined Drainage Orders made Nil - 7 - DISIRICT SANITARY INSPECTION Inspections of Dwelling Houses 1364 " " other premises 2077 " " sanitary works 287 NUISANCES Intimstion notices served 581 Statutory 11 Prosecutions 5 Orders made 3 Fines: £4.0.0d. Costs: £12.12.0d. WATER SUPPLY Metropolitan Water Board notices of withdrawal. 11 Deep wells: No. of examinations made 136 SHOPS ACT. 1954 Shops inspected 1282 Inspections made1297 Notices served 42 FACTORIES AND WORKPLACES 6 defects under the Public Health Acts were found. All were remedied without legal proceedings. Visits to Outworkers' premises other than factories - 103 Workrooms measured - 33 Visits of enquiry re employment of women - l0l Outworkers - 8l RATS Rat complaints - (1941) 165; (1942) 505. Total number of rats caught by -Contractors - 2138 Rat Officer appointed - 21. 12. 42. Total number of premises visited re rat complaints - 1352 Total number of inspections - 2005 RESTAURANTS Routine inspection of restaurants had fallen into abeyance owing to pressure of other work on Civil Defence duties so an intense survey was instituted. •Total number of restaurants inspected 1237 Number of notices served 186 Legal proceedings 2 NUISANCE FROM PIGEONS Complaints: 17. Pigeons destroyed: 408 DISINFECTION Rooms: 215. Articles: 26,462. Articles washed: 9,500. Articles destroyed: 156. Books disinfected: 110. Vehicles: 16. Business- premises: 119. CLEANSING OF PERSONS - (Head lice, Body lice, Scabies) Children: 355. Adults: 774. Total: 1129 ERADICATION OF BED BUGS Premises found to be infested - 82. All were disinfected. TREATMENT OF BEDDING FROM CASUALTY DEPOTS. REPORT CENTRES. ETC. Articles of bedding, etc., disinfected 6670 - 8 - INSPECTION AND SUPERVISION OF FOOD Samples purchased for analysis - 18 L4 + 42 Pharmacy & Poisons Act Visits to premises 2831 Notices served l86 Samples found to be adulterated 51 Prosecutions 34 Convictions 23 Fines: £142.0.0d. Costs: £l71.3.Od. AIR RAID SHELTERS (public and Communal Domestic) Number of visits 3,873 ICE CREAM PREMISES Premises on Register at 31st December, 1942 132 PRESERVED MEAT ETC. PREMISES Premises on Register at 31st December, 1942 124 MILK (SPECIAL DESIGNATIONS) ORDER. 1936 & 1938 Licences issued 53 REGISTRATION OF DAIRYMEN & DAIRIES Premises Persons On Register at 31st December, 1942. 169 239 Registered during the year - 1 Inspections made 126 - Notices served 10 - CORONER'S COURT AND MORTUARY Bodies received 292 Causes of death:- Drowning 1 Street accidents 21 Other accidents 46 Murder 2 Suicide 23 Natural causes 178 Misadventure 8 Miscellaneous causes 13 Inquests held 115 Post-mortem examinations 232