WES S3 AC4 344 CITY OF WSSTTINTSR REP0RT of the year MEDICAL OFFICER OF HELTH for the year 1943 ANDREW J, SHIINIE, M.D., D.P.H., (Lond.) Medical Officer of Health and Administrative Tuberculosis officer. oOo CITY OF HESINISTER interim report OF THE MEDICAL OFFICER OF HEALTH for the year 1943 Mr. Mayor, My Lord, Ladies and Gentlemen, I beg to submit a report on the health and sanitary conditions of the City of Westminster for the year 1943. This report is tarmed an interim report within the tars of the directional circular No.10/44 of the Ministry of Health and the information contained is therefore limited in scope as was the case in the preceding reports for the war years. The absence of any serious air raids ha. naturally reawakened interest in the development of public health activities and particularly housing. I had the honour to submit several reports during the year dealing with such matters are further clearance areas and the more pressing problem of providing improved amenities in houses occupied by more than one family in order to secure where possible and practicable a measure of self contained accommodation. It is gratifying to note that the Ministry of Health is inclined to encourage this policy of adaptation where the houses lend themselves to such internal re-arrangement. By this means a number of the houses let in tenements might be worthy of adaptation and thus provide a higher standard of housing than hitherto existed in them. It will be remembered that the winter and spring of 1943 was abnormally mild; summer like to temperatures were found in January and February. This may have had a bearing on the increased incidence of infectious disease of most types. Fortunately serious or fatal cases were extraordinarily few except as regards pneumonia where there were 19 deaths compared with 15 last year. The onset of a wove of influenza towards the end of the year contributed to this. The birth rate increased but so did the number of still births. Maternal mortality increased from 2.9 to 3.8 per 1000 births. Of the five cases, three were due to septic abortion occurring in districts outside London. These three should not be regarded as deaths due to confinement. Cancer again exacted an increased- toll of victims chiefly in the higher ages. At the request of the Ministry of Health,on a representation from the Ministry of Labour, the Council took steps to provide two additional war time nurseries in other districts of the City. One of these was ready for occupation by the end of the ear in part of the praises belonging to the Westminster Trolling College in Horseferry Road. The other in Bloomfield Terrace was in process of adaptation but the work les been much impeded owing to the more urgent calls on the building trades. The accommodation for the children of women on work of National i portanee will be between 170 - l80 nursery places. The Council made a substantial grant to the enterprise of the Westminster Health Society in setting up a day nursery for five half days per week. There is no doubt that after the war part time nurseries will fulfil a very definite need. - 2 - Increased accomodation for maternity cases in hospital was arranged with Charing Croc Hospital and the existing arrangements with Westminster Hospital -ere extended. In addition the City Council took part in the Lender County Council scheme for further provision of maternity beds by having a call on four lore beds in Westminster Hospital. The question of Hone Helps and the better care of illegitimate children were the subject of inquiry by the Maternity and Child Welfare Sub-Committee. The lady members visited specially the various centres and considered the circumstances of each district. They recommended in the first instance, the employment by the Council of two whole time Horn: Helps and the Council accepted the recommendation. To far, owing to the priorities of war work, it has been possible to obtain one Home Help but her services have proved of great benefit not only to others in confinement but in other circumstances where housewives require help, such as acute illness in the family. As regards illegitimate children tribute was paid to the fruitful work of the voluntary moral welfare- organisations. As a result of the efforts of their experienced and able workers there was little in the way of a problem in Westminster There was, however, an urgent need for the re-establishment of the home for mothers and babies formerly run by one of these voluntary bodies but at present requisitioned for war purposes. Throughout the year, at the request of the Ministry of Health, advantage pas taken of the local press to inform the public about Diphtheria immunization. It is estimated that some 51% of the children up to 14 years of age arc protected against Diphtheria. A special note is made of the coming into force in August 19-3 of the payment of allowances to sufferers from pulmonary tuberculosis in order to assist their recovery and Return to work. There were 63 beneficiaries during the ear. Arrangements were made through the "London County Council for mass radiography on a voluntary basis of the staffs of large undertakings. The object is the early diagnosis of pulmonary tuberculosis among certain age groups. Among the 391 examined only 5 were r forded for treatment. Among other matters affecting the public health lay be mentioned the measures to combat rat infestation. The Council appointed an officer of special experience to deal with this matter with three whole time assistante. On the grading adopted by the Ministry of Food there mere 13 areas of major infestation in the City. Very satisfactory progress was made in clearing these areas. Proposals to extend the accomodation for the cleansing of persons affected by lie. , scabies , etc. were approved, but the work required had to give way to the needs for making good, war damage- dwellings. There was a considerable increase in disinfection owing to the calls of the service departments, while the number of persons cleansed likewise greatly ox-ceded that of the previous ear. I should like to conclude by expressing my appreciation of the kindness and consideration which I have always received from cambers of the Council and from my colleagues. My gratitude is always due to the ready assistance and interested loyalty given me by the staff of the Department. September 1944. I have the honour to be, four obedient Servant, ANDREW J. SHINNIE. 3 STATISTICS AND SOCIAL CONDITIONS Area (acres) 2,502.7 Number of inhabite d houses (Census 1931) 22,536 Rateable value, March 1944 £9,459,094 BIRTHS Live Births Total Males Females Legitimate Illegitimate 660 168 340 89 320 79 828 429 399 Births notified. ... 5 — < 5o Birth rate per 1,000 of the estimated resident population: 12.6 (Rate for London: 15-8; for England Sc Wales: 16.5) Number of Stillbirths 50 Rate of Stillbirths per 1,000 (live still) births 34.9 DEATHS Net deaths 1087 (males 599; females 488) Death rate per 1,000 of the estimated resident population 16.6 (Rate for London: 15.0; for England & Wales: 12.1) Deaths from puerperal causes 5 (5.8 per 1,000 births) Deaths of infants under 1 year 64 (males 58; females 26) Death rate of infants under 1 year:- All infants per 1,000 live births 77.2 Legitimate.infants per 1,000 legitimate live births 60.1 Illegitimate infants per 1,000 live births 113.1 Rate for London 58 Deaths from measles (all ages) " " whooping cough (all ages) " " diarrhoea (under 2 years)12 " 11 cancer 188 INFANT MORTALITY - Causes of Death. Total Legitimate Illegitimate Diarrhoea & Enteritis 12 11 1 C ongen i ta1 ma1formation Prematurity etc 24 15 9 Want of attention 4 - 4 Broncho-pneumonia 10 9 1 Accident 3 3 - Tuberculosis 3 3 - Other causes 3 3 - Syphilis 3 - 3 Murder 1 - 1 Digestive disease 1 1 - 64 45 19 - 4 - cause- of death (At ail ages) Males Females Total Influenza 12 12 24 Meningitis & Convulsions 1 — 1 Cerebro Spinal v-!eningitis — 1 1 Diarrhoea & Enteritis 5 7 12 Septic diseases 9 2 4 Syphilis 5 2 7 Diabetes 4 5 9 Tuberculosis of Lungs 51 19 70 N on-pulmonary Tuberculosis 5 0 6 Malignant growths 104 84 188 Congenital debili ty) – Malformation etc.) 16 12 28 Old age 4 8 12 Locomotor ataxia & general paralysis 5 4 9 Diseases of nervous system 2 2 4 Circulatory diseases 225 200 425 Bronchitis 20 21 41 Broncho-pneumonia 59 34 75 Pneumonia 8 11 19 Respiratory diseases 5 2 7 Alcoholism — 2 2 Appendicitis — 2 Digestive diseases 24 8 52 Bright's disease 21 15 54 Cystitis 7 5 12 Accidents & Negligence 19 12 51 Suicide & Murder 6 6 12 Other defined diseases 8 5 15 Measles — l 1 Parturition - s 5 Other violent causes 2 2 Diphtheria 1 — 1 Cirrhosis 2 – 2 599 488 1087 INFECTIOUS DISEASE /###]Eotifications Removal to Hos-ji tal Deaths Poliomyelitis 1 _ _ Diphtheria 51 50 — Erysipelas 19 12 1 Scarlet Fever 141 127 — Enteric Fever - - - Puerperal Fever 4 4 - Puerperal Pyrexia 10 10 - Cerebro Spina1 Meningitis f O 6 _ / Ophthalmia Neonatorum 6 1— 2 — Measles 528 98 1 Pneumonia 15 5 19 Dysentery 19 l^i - Whooping cough 55 16 - Malaria 1 1 - Scabies 185 - - Non-notifiable diseases - removed to hospital:- German Measles 16 cases Chicken pox 50 " Mumps 56 " - 5 - INFLUENZA The Medical Of!icer of Health noted during the early winter months the rise in the incidence of influenza amongst Westr.iinr.ter residents and initiated discussions with the local Medical War Committee, the three district nursing associations operating in the City, the British fled Cross Society, the St. John Ambulance Brigade and the Women's Voluntary Services in order to explore the possibilities of ensuring adequate Medical attention and rendering nursing assistance and domestic help in houes where there was sickness, in view of the shortage under war co editions of such assistance. The Minister of Health early in December suggested certain lines of action which might be undertaken by Local Authorities to this end. With the assistance of the associations referred to and other bodies, a scheme was formulated and put into operatic in the City whereby a central office for the receipt of request for assistance was set up at the British Red Cross Society's offices in Westminster and a rota prepared of nursing personnel of 10th the British Red Cross Society and the St. John Ambulance Brigade available to render nursing assistance in the home. The requests for medical assistance received in the central office were transmitted to the secretary of the Local Medical War Committee and the requests for nursing assistance were first referred to the District Cursing Association operating in the area, who would request any further nursing assistance from the Central Office. Any hospitals in the City requiring such nursing assistance could likewise obtain help through the Central Office. The requests for domestic help wore transmitted to the Women's Voluntary Services who provided domestic help in the home and rendered assistance with shopping, etc. Arrangements were also made with the London County Council for the use of ambulance services where necessary and for -he provision of hot meals for patients through the Londoners' Meals Services. Fortunately the number of eases requiring such assistance were few in number and up to the clos of the year one request was received for nursing assistance and four requests for domestic help, all of which wwre satisfactorily dealt with. VACCINATION Persons vaccinated by Public Vaccinator: Primary 346 Secondary 1.1 BACTERIOLOGICAL EXMINATIONS Diphtheria - negative 137, positive 3• Tuberculosis - negative 13, positive 55. TUSERCULOSIS Pulmonary: 185 new cases, including 7 transfers and 16 non-notified deaths. Kon-pul:uonary: 9 now cases, including 2 transfers and 6 non-notified deaths. (1942 - Pulmonary: 163 new cases; lion-pulmonary: 29 new cases). - 6 - TUBERCULOSIS (dontd). New Cases and Deaths Age Periods Now Cases Deaths Pulmonary Lion-pulmonary Pulmonary Non -pulmonary M. F. M. F. M. F. M. f. Under 1 year 1 – – 1 1 – 1 1 1 to 5 years 1 — — 1 — — — 5 " 10 " 2 - — — — — — — IP " 15" 0 1 1 - - — — 15 " 2P " 3 9 - — - - — 1 2P " 21 " 11 21 — 1 4 2 — — 25 " 35 " 18 20 2 - 5 5 - - 35 " 45 " 21 15 - 1 0 4 1 1 41 " 55 " 22 7 - — 11 0 1 - 55 " 65 24 4 - - 16 2 - - 65 & upwards 1 - - 1 4 - - — Totals 106 79 3 6 51 19 3 3 Deaths from Tuberculosis:- Pulmonary: 7Q (51 males; 19 females) Non-pulmonary: 6(3 males; 3 females) WORK OF TUBERCULOSIS IS DISPANSARY. 1945. The work of the Dispensary continued throughout the year and the number of patients, lower in the ear];; years of the war, has been comparable to pre-war years. Some increase is due to the higher incidence of the disease under war conditions, some to the number of patients referred by National Service Medical Boards, and of patients discharged from the Services, on account, of tuberculosis. Total attendances numbered 1645 • There were 436 new patients during the year, including 94 contacts. 110 were considered to be definite cases of pulmonary tuberculosis, though not necessarily all at an active stage of the disease. 15 cases of non-pulmonary tuberculosis were also diagnosed. There have been two new developments in tuberculosis work during the year. The scheme for detecting cases of early disease by Mass Radiography of sections of the population has been inaugurated. Owing to war time difficulties of staffing and equipment, the London County Council had to start operations with one unit only. Mass Radiograph; has, therefore, only been reasonably available to Westminster residents during certain periods. Some 900 patients have been examined, however, from volunteers obtained by circulating enquiries io some of the larger business firms' in Westminster. Fuller development of this scheme may be expected after the war. The second important development was the institution by the Government of maintenance allowances payable to persons undergoing approved treatment for tuberculosis. These are varied in amount to suit the circumstances of each case. The first weekly payment of these allowances was made at the Tuberculosis Dispensary on Juno 30th, 1943. At this initial stage payment was made in 22 cases, but this number will increase steadily for some time. Broadly speaking, the allowances are payable to persons giving up employment to undergo approved, treatment. These are either awaiting or receiving treatment or, having received Institutional - 7 - treatment, are not yet fit to resume their occupations and are receiving home treatment under Dispensary control. Where the Tuberculosis Officer certifies that the patient is eligible, a communication and in application form is i issued to hie. The patient often requires assistance in completing the form, and enquiries be patients and the verification of derails given entails a considerable volume of work. The Dispensary Secretary discusses each case with the Count;7 Council Assessment Officer, with whom lie decisions, as to eligibility and the amount to be paid. His order is communicated to the City Comptroller who makes payment to the patient or his nominee at the Dispensary each Wednesday or, in special cases, by post. Arrangements are proceeding smoothly, and the changing circumstances of each patient are kept under constant review by the Tuberculosis Officer and the Dispenser; Staff, so that allowances ere varied or stopped when necessary. MATERNITY AND CHILD WELFARE The welfare scheme during 19.3 was set out in the report of 1938. WAR TIME DAY NURSERIES. There is one war time day nursery in the City with accommodation for 50 children. Two others were nearing completion towards the close of the year. MATERNITY AND CHILD WELFARE To expectant mothers 2264 " children under 1 4087 " children between 1 and 5 5668 ANTE AND POST-NATAL CLINICS A.N. P.N. Number of women attending 1798 482 INFACT CLINICS Attendances 1916 HOME I1URGIMG Number of visit:: made during year 1887 I-IOME HELPS Supplied at the cost of the Council in four cases. DEriTAL TREATMENT - Clinic Reports New Cases Re Appointments ions Fillings Other Operations Anaesthetics Local General 1942 125 579 486 529 369 26 84 194J 146 539 498 283 283 22 96 - 8 - DIPHTHERIA IMMUNISATION TREATMENT ASD SCHICK TESTING CHILDREN IMMUNISED IN 1943 Unrlor f ive years of age 413 Over five yjv.rc; of age °s ) L.C.C.School Childrer (Immunised by City Counc.1.1. hs Medical Staff) 274 Total 712 CHILDREN SCHICK TESTeD IN I'M- Negatives Positives Under five years of age 342 21 L.C.C.School Children (Tested by City Council's Medical Staff) 200 1? Total 542 34 Total number of children Schick Tested 576 SANITARE CIRCUMSTANCES For particulars of general service, see previous reports. DRAINAGE AND SNITARYWORKS Plans submitted 110 Combined Drainage Orders made 3 DISTRICT SANITARY INSPECTION Inspections of Dwelling Houses 3002 " " other premises 4599 " " sanitary works 866 NUISANCES Intimation notices served 1024 Statutory " " 26 Productions 1 Orders made 1 Fines: NIL. Costs : £3 . 3 • 0. EATER SUPPLE Metropolitan Water Board notices of withdrawal 6 Deep wells: No. of examinations made 140 shops act, 1934 Shops inspected 938 - Inspections made 959 Notices served 64 - 9 - factories and workplace 6l defects under the Public Health Acts v;ere found. All were remedied without legal proceedings. Visits to Outworkers1 promises other than factories - 67 Workrooms measured 10 Visits of enquiry re employment of women 45 Outworkers 64 RATS Rat complaints 743 Total number of rats destroyed 10,729 Total number of promises visited re rat complaints 4,097 13 major infestations found following Survey carried out on receipt of direction of Ministry of Food. AU of these dealt with. PESTAURaI-TS Total number of restaurants inspected 2225 Number of notices served 349 Legal proceedings 1 NUISANCE FROM PIGEONS Complaints: 5- Pigeons destroyed: 525• DISINFECTION Rooms: 555- Articles: 59*782. Articles washed: 8000. Articles destroyed: 775- Books disinfected: 496. Vehicles: 84. Business premises: 10. CLEANSING OF PERSONS - (Head lice, Body lice, Scabies) . Children: 511. Adults: 767. Total: 1278 Number of treatments: 2196. INSPECTION AMD SUPERVISION OF FOOD Samples purchased for analysis - 1806 * 8 Pharmacy E: Poisons Act. Visits to premises 3^79 Notices served ... ... ... ... .... ... 411 Samples found to be adulterated 82 Prosecutions ... ... ... ... ... • • • 1£ Convictions ... ... ... ... • • • • • • 16 Fines:£101.13.Od. Costs: £38.l7.0d. AIR RAID SHELTERS (Public and Communal Domestic) Number of visits ' 985 ICE CRVL. . PREMISES Premises on Register at 31st December, 19^3 ••• 182 PRESERVED MEAT ETC. PREMISES Premises on Register at 31st December, 19^3 ••• 124 MILK (SPECIAL DESIGNATIONS) ORDER. 1936 & 1938 Licences issued 40 - 10 - REGISTRATION OF DAIRYMEN & DAIRIES Promises Persons On Register at 31st December, 1943 111 125 Registered during the year 2 13 Inspections made 57 2 — Notices served 33 - CORONER'S COURT AND MORTUARY Bodies received 370 Causes of death:- Drowning 1 Street accidents 17 Other accidents 39 Murder 3 Suicide 2 7 Natural causes 258 misadventure 6 Miscellaneous causes 19 Inquests held 1ll Post-mortem examinations 336