AC 4344 WES 54 CITY OF WESTMINISTER REPORT of the MEDICAL OFFICER OF HEALTH for the year 1944 A NDREW J. SHINNIE, M.D., D.P.H., (Lond.) Medical Officer of Health and Administrative Tuberculosis Officer My Lord, Ladies and Gentlemen, I beg to sabmit my report on the public health and sanitary conditions of the City of Westminster for the year 1944. The report is drawn up in accordance with the requirements of Circular No. 49/45 of the Ministry of Health and is therefore in the abbreviated form appropriate to war conditions having regard to preoccupation with other than public health duties and the need for economy in paper. At the time of writing (September 1945) Victory over Japan has been celebrated, the hoped for complement of that earlier day in May when Germany was overthrown. Thus in one marvellous year the Country emerges from the darkness of the six years nightmare of war. So much readjustment has to be made, so many threads have to be found and rewoven. The essential public health services mere maintained throughout the war and in some important instances had to be expanded in accordance with conditions resulting from the War. Further measures were put in hand for the care of maternity cases and the welfare of children. The risk of imported infectious disease had to be guarded against and practical measures provided for mitigating difficulties in the home arising from winter epidemics such as influenza. It must be remembered that up to the end of 1944 and after, the City remained under the threat of aerial attack. Public shelters were fully occupied and supervision of hygienic conditions in them and the attached medical and nursing services required an organisation to be maintained by day and by night. As has been stated in previous wartime reports statistics, having in mind a reduced but moving population must be accepted as only of relative value. The address on the identity card was no indication of permanent residence. Infants might be born in Westminster and moved away for an indefinite period. Others born elsewhere might be brought in. There was an almost constant flow of population. The birth rate, based on figures supplied by the Registrar General shews a slight decrease from 12.6 in 1945 to 12.5 in 1944. The general death rate was 17.1. The most common cause of death apart from air raid casualties was from circulatory diseases and next to it malignant growths indicative of the general elderly age groups of the population. The year was singularly free from outbreaks of infectious disease. There was one death from Diphtheria, none from Scarlet Fever or Whooping Cough, but seventeen from Pneumonia. There were no deaths in women from childbirth and only nine cases notified of Puerperal Fever and Puerperal Pyrexia. Infantile mortality rate was 65.5 a considerable reduction on last year. It was again heaviest among illegitimate children and among the chief causes were congenital malformation and prematurity, diarrhoea and enteritis. Arrangements for Home Helps in maternity and child welfare cases continued to work satisfactorily both during the period of the mothers confinement at home and during the course of any associated intercurrent illness of herself or the new born child. The City Council pays the whole cost of the Home Help service less contributions received from the mother. The Domestic Help scheme was formulated by the Ministry of Health in November 1944. Its purpose is to provide assistance in the home in cases of acute or chronic illness and disablement including the infirmaties of old age. The cost is borne in full by the Exchequer but the beneficiaries are expected to refund in whole or in part the wages of the domestic worker. The domestic workers of whom there are at present five are part time employees of the Council. In all cases up to the present the beneficiaries have been able to contribute the full cost of the workers wages. The amount of domestic help given varies from 2 hours to 10 hours per week the average being four. During the war the facilities provided by the Government for maternity beds in country hostels and hospitals met a very urgent need. Now that the war is over these special arrangements cannot he continued indefinitely. Interim arrangements are however taking shape to maintain these facilities for a period. Not only is there a pronounced wish on the part of a woman having her first baby to have the confinement in hospital - war conditions have made this almost an accepted custom - but many returning mothers are living with relations or in furnished rooms where conditions are not suitable for a confinement. Such governing factors may well prevail until the housing situation becomes easier. There is no question that the health of young children has been well maintained during the war. Whatever the cares and anxieties besetting adults, the children attending the Welfare Centres or Day Nurseries present a most heartening sight in health and vigour. During the year suggestions from the Ministry for the better care of illegitimate children including measures for guaranteed payment to the Foster mothers ware considered in conjunction with the Metropolitan Boroughs Standing Joint Committee. These measures are referred to in this report. The problem of prematurity, the highest contributory factor in infantile mortality has also received, attention. There were fewer newly notified cases of tuberculosis and fewer deaths. It is to be hoped that the slightly higher incidence of tuberculosis noted in the earlier war years and no doubt attributable to war conditions is now on the wane; a good deal will depend on the amount and variety of foodstuffs likely to be available to the general population in the immediate post war period. There is no doubt the scheme of money allowances to sufferers before and after institutional treatment is of material assistance in restoring working capacity. Apparatus for conducting mass miniature radiography is in short supply. The London County Council which operates this scheme for the early diagnosis of pulmonary tuberculosis in the general population was good enough, at the request of the City Council, to make special arrangements for people employed in the City. Thanks to the good will of the Governors of the Soho Hospital for Women, the apparatus was set up in the Out-patients Department of the Hospital during six weeks of the summer of 1945. When the X-Ray Unit was operating there, some 7,770 individuals were x-rayed. In concluding this report I would again express my thanks to the Members of the Council with whom I have been more immediately concerned both in measures for the public health and civil defence. To the members of the staff of the Public Health Department I again pay tribute for their constancy and steadfastness in conditions of war as well as for their invariable and ready assistance in all matters affecting the health and welfare of the citizens of Westmeinster. I have the honour to be, Your obedient Servant, ANDREW J. SEINNIE. Medical Officer of Health. September, 1945. - 1 - STATISTIC AND SOCIAL CONDITIONS Area (acres) 2,502.7 Population (Registrar General' s Estimate 1944) 64,170 Number of inhabited houses (Census 1931) 22,536 Rateable value, March 1945 £9,550,000 BIRTHS Live Births Total Males Females Legitimate 622 298 324 Illegitimate 171 102 69 793 400 393 Births notified 641 Birth rote per 1,000 of the estimated resident population: 12.3 (Rate for London: 15.0; for England & wales: 17.6) Number of Stillbirths 29 Rate of Stillbirths per 1,000 (live & still) births 35.2 DEATHS Net deaths 1101 (males 592; females 509) Death rate per 1,000 of the estimated resident population: 17.1 (Rate for London: 15.7; for England & Wales: 11.6) Deaths from puerperal causes Nil. Deaths of infants under 1 year 52 (males 31; females 21) . Death rate of infants under 1 year:- All infants per 1,000 live births 65.5 Legitimate infants per 1,000 legitimate live births 53.0 Illegitimate infants per 1,000 live births 111.1 Rate for London 61 Deaths from measles (all ages) - " " whooping cough - " " diarrhoea 11 " " cancer 173 INFANT MORTALITY - Causes of Death. Total Legitimate Illegitimate Diarrhoea & Enteritis 16 10 6 Congenital mlformation, Prematurity etc. 19 15 4 Want of attention 3 — 3 Broncho-pneumonia 8 5 3 Accident 2 1 1 Other causes 3 2 1 Syphilis 1 — 1 52 33 19 - 2 - CAUSES OF DEATH (At all ages) Males Females Total Influenza 1 2 3 Meningitis & Convulsions 1 2 3 Diarrhoea & Enteritis 11 7 18 Septic diseases 2 2 4 Syphilis 3 1 4 Diabetes 3 2 5 Tuberculosis of Lungs 35 14 49 Non-pulmonary Tuberculosis 6 6 12 Malignant growths 91 83 174 Congenital debility Malformation etc. 13 9 22 Old age 2 9 11 Locomotor ataxia & general paralysis 2 1 3 Diseases of nervous system. 1 6 7 Circulatory diseases 206 185 391 Bronchitis 32 22 54 Broncho-pneuoionia 28 19 47 Pneumonia 10 7 17 Respiratory diseases 5 2 7 Alcoholism 4 1 5 Appendicitis — 5 5 Digestive diseases 19 18 37 Bright's disease 17 6 23 Cystitis 10 2 12 Accidents & Negligence 28 22 50 Suicide & Murder 9 5 14 Other defined diseases 3 3 6 Rheumatic Fever 1 — 1 Other violent causes 48 65 113 Diphtheria — 1 1 Cirrhosis l 2 3 A bortion — 1 1 592 509 1101 INFECTIOUS DISEASE Notifications Removal to Hospital Deaths Polio-myelitis — — — Diphtheria 32 32 1 Erysipelas 17 11 — Scarlet Fever 54 46 — Enteric Fever 1 1 — Paratyphoid 2 1 — Puerperal Fever 4 4 — Puerperal Pyrexia 5 5 — Cerebro Spinal Meningitis 6 6 — Ophthalmia Neonatorum 3 3 — Measles 42 13 — Pneumonia 9 — 17 Dysentery 9 9 — Whooping cough 41 13 — Malaria 3 3 — Scabies 426 — — Corrected diagnosis: Scarlet Fever 1; Diarrhoea 3; Measles 1. - 3 - Non-notifiable diseases - removed to hospital:- German Measles — Chickenpox 10 Mumps 2 VACCINATION Persons vaccinated by Public Vaccinator: Primary 535 Secondary 116 BACTERIOLOGICAL EXAMINATIONS Diphtheria - negative 130; positive 5 Tuberculosis - negative 128; positive 66 TUBERCULOSIS Pulmonary: 170 new cases, including 9 transfers and 18 non-notified deaths. Non-pulmonary: 19 new cases, including 1 transfer and 4 non-notified deaths. (1943 - Pulmonary: 185 new cases; Non-pulmonary: 9 new cases). New Cases and Deaths Age Periods New Cases Pulmonary Non-pulmonary Deaths Pulmonary Non-pulmonary M. F. M. F. M. F. M. F. Under 1 year — — — — — — — — 1 to 5 years 1 2 1 — — — 1 1 5 " 10 " 2 — 1 1 — — — — 10 " 15 " 1 — — — — — — 2 15 " 20 " 5 3 1 1 — — 1 — 20 " 25 " 6 16 2 1 1 1 — 1 25 " 35 " 22 23 4 1 2 1 2 — 35 " 45 " 26 11 — 3 9 6 1 1 45 " 55 " 20 5 — 1 7 3 1 — 55 " 65 " 15 4 — — 12 1 — — 65 & upwards 6 2 1 1 4 2 — 1 104 66 10 9 35 14 6 6 Deaths from Tuberculosis:- Pulmonary: 49 (35 males; 14 females) Non-Pulmonary: 12 ( 6 males; 6 females) - 4 - WORK OF TUBERCULOSIS DISPENSARY, 1944 The work has been continued on the lines indicated in previous reports. During the year 372 new patients attended, 178 males and 194 females. This number included 75 persons examined as contacts. 93 of the new patients were found to be suffering from pulmonary tuberculosis, and 15 from other forms of the disease. 56 patients were recommended for sanatorium treatment, and 48 for admission to hospital. During the year 457 X-ray films were taken, and 140 specimens submitted for bacteriological examination. 763 reports were made to public authorities and 196 to medical practitioners. The total attendances at the Dispensary numbered 1546. The Ministry of Health treatment allowances have been helpful to patients who fall into the categories eligible. The average number of patients drawing allowances is from 30 to 35. There is an average of, 5 new applicants each month, while allowances stop for one reason or another in about the same proportion. MASS MINIATURE RADIOGRAPHY. By arrangement with the London County Council facilities were afforded to the employees of some of the large undertakings in Westminster to attend for examination by miniature radiography whilst the Unit was stationed at St. Luke's Hospital, Chelsea and elsewhere. Some 1202 persons were thus examined. Of these 38 were referred for further investigation. MATERNITY AND CHILD WELFARE The welfare scheme during 1944 was as set out in the report of 1938. WAR-TIME DAY NURSERIES. There are three war-time Day Nurseries in the City which are open from 7 a.m. to 7 p.m. Monday to Friday and from 7 p.m. to 1 p.m. on Saturday. (a) No.l Bessborough Street, S.W.l. opened on the 12th October, 1942 with accommodation for 50 children. (b) Westrainster Training College, Horseferry Road, S.W.l. opened on the llth April, 1944 with accommodation for 60 children. (c) 37/39 Bloomfield Terrace, S.W.l. opened on the 1st January, 1945 with accommodation for 59 children. - 5 - VISITS by HEALTH VISITORS To expectant mothers 2,173 To children under 1 3,935 To children between 1 and 5 6,204 ANTE AND POST NATAL CLINICS A.N P.N. Number of women attending l,815 456 INFANT CLINICS Attendances 2,046 NEW INFANT WELFARE CLINIC IN KNIGHTSBRIDGE AREA In order to meet the convenience of the increasing number of mothers in the Knightsbridge area, the City Council established a weekly Infant Welfare Clinic in the Kingston House Civil Defence First Aid Post. HOME NURSING The City Council has an arrangement with three District Nursing Associations for the nursing in the homes of children under five years of age suffering from various ailments and for certain conditions in adults. The City Council pay the Associations 2/6d per visit for this service. During the year the District Nurses made 955 visits under this scheme. CARE OF PREMATURE INFANTS The ministry of Health issued a circular in march 1944 on the subject of the care of premature infants and. the problem of neo-natal mortality. . The minister suggested that a weight at birth of 5½ lbs. or less should be recorded on the notification of birth cards. This was put into operation. The City Council in accordance with the minister's recommendation also appointed a paediatrician whose services are available for consultant visits in the home where premature infants are being nurtured. Other recommendations of the minister have been carrier out. There were 26 premature infants born in the City curing 1944 all of whom were born in hospital, 14 however failed to survive and died in hospital. - 6 - CARE OF ILLEGITIMATE CHILDPEN. The City Council has given consideration to this problem during the year and to certain lines of action suggested by the Ministry of Health. The City Council considered that the voluntary bodies who have been efficiently dealing with this problem for so many years should receive fuller recognition and financial assistance on an adequate scale. The problem being one concerning London as a whole the matter has also received the joint consideration of the Metropolitan Borough Councils, the London County Council and various voluntary organisations. As a result of this joint consideration it was decided that the Metropolitan Borough Councils should make additional contributions in proportion to rateable value to the voluntary organisations, to enable them to increase their staff and improve their services. Mestminster's contribution for the year 1944-45 was £972. Other measures approved.by the City Council include (a) the provision of residential nursery places for these children and, (b) homes for mothers in later stages of pregnancy and immediately after confinement. The City Council also agreed that when conditions returned to normal it would prepare a scheme of guaranteed payments to approved foster mothers who undertook the care and maintenance of illegitimate children. CHILD LIFE PROTECTION. There were 20 women on the Council's register of foster mothers at the end of the year. These foster mothers and the children in their care are regularly visited by the Council's Health Visitors. SUPPLY OF SHEETS FOR EXPECTANT -OTHERS. A Circular dated 3rd November, 1944, was received, from the Minister of Health stating that by arrangement with the Board of Trade it had been decided to issue Priority Dockets for utility sheets, on production of a medical certificate, to expectant mothers who were to be confined in their own homes. These dockets are being issued through the Maternity and Child Welfare Centres and up to the end of 1944, twelve dockets were issued to expectant mothers. supply of food accessories. By arrangement with the Ministry of Food, national dried milk, fruit juices, vitamin tablets and cod liver oil have been distributed to expectant mothers and children at the Maternity and Child Welfare Centres in the City. - 7 - HOME HELP SERVICE FOR MATERNITY CASES. The City Council during the year authorised the engagement of two whole-time Home Helps to help in the homes during confinement, etc. Mothers having such assistance contribute towards the cost according to their financial circumstances. Difficulties were experienced in securing the services of suitable women but two helpers were engaged. HEAD LICE. The Health Visitors have continued to give the subject. of personal hygiene, including the infestation by head lice, special observation and instruction both in the home and at the Centres. Cleansing facilities are available at the City Council's Cleansing Station and for expectant mothers and children at the Maternity and Child Welfare Centres. Where necessary suitable combs for use at home have been supplied. DENTAL TREATMENT - Clinic Reports. New Cases Re Appointments Extractions Fillings Other Operations Anaesthetics Local General 1943 146 539 498 283 285 22 96 1944 141 512 283 304 373 17 66 DIPHTHERIA IMMUNISATION TREATMENT AND SCHICK TESTING. Children Immunised in. 1944 Under five years of age 276 Over five years of age 9 L.C.C. School Children (Immunised by City Council's Medical Staff) 24 Children Schick Tested in 1944 309 Negatives 323 Positives 7 Total tested 330 INFLUENZA - NURSING AND DOMESTIC ASSISTANCE IN THE HOME. Mention was made in the Annual Report for last year of a scheme formulated by the City Council for providing voluntary nursing and domestic assistance in the homes of inhabitants where there was sickness due to the incidence of influenza. This scheme continued in operation throughout the year, the voluntary nursing assistance being provided by members of the British Red Cross Society and the St. John Ambulance Brigade. Non-nursing assistance being provided by members of the Women's Voluntary - 8 - Influenza - Nursing and Domestic Assistance In the Home (Contd). Services. This latter service has now been augmented by the introduction of a Domestic Help Service mentioned below. Some 15 cases were dealt with under this voluntary scheme during the year. DOMESTIC HELP SERVICE. In December 1944 a circular was received from the Ministry of Health stating that the Government were concerned with the position of persons sick or infirm who were unable to obtain domestic help of which under present conditions they were in need, many of whom most in need were unable to pay the current rates for this work. The miinistry asked Welfare Authorities, if there was such a need in their area, to undertake the organisation of a Domestic Help Service to render assistance in such cases, the Government having made a Defence Regulation giving Welfare Authorities the requisite power to do so, the Ministry undertaking to reimburse reasonable expenditure incurred by the Authorities in the matter. The City Council being satisfied that there was a need for a service of this nature, chiefly for aged and infirm persons and patients discharged from hospital, decided to provide such a service for its inhabitants. At the close of the year substantial progress had been made with the preparation of a scheme. SALUTARY CIRCUMSTANCES. For particulars of general services, see previous reports. DRAINAGE AND SANITARY WORKS. Plans submitted 86 Combined Drainage Orders made 4 DISTRICT -SANITARY INSPECTION. Inspections of Dwelling Houses 7,318 " " other premises 6,162 " " sanitary works 1,995 NUISANCES. Intimation notices served 2,018 Statutory " " 29 Prosecutions 8 Orders made 1 Fines: £3. 0. 0. Costs: £14. 14. 0. WATER SUPPLY. Metropolitan Water Board notices of withdrawal 2 Deep wells: No. of examinations made 148 The supply provided by the Metropolitan Water Board has been satisfactory (a) in quality (b) in quantity. No samples have been taken for chemical or bacteriological examination. Of the supply derived from 101 deep well bores in the City, two adverse reports have been received following chemical and bacteriological examination. In both instances the owners took steps, in consultation with their analysts and engineers to ensure a satisfactory supply. By the end of the year one was again reported as satisfactory whilst investigations were still proceeding in regard to the other. 7 SHOPS ACT,1934. Inspections made 223 Notices served 85 FACTORIES AND WORKPLACES 50 defects under the Public Health Acts were found. All were remedied without legal proceedings. Visits to Outworkers' remises other than factories 73 Workrooms measured 4 Visits of enquiry re employment of women 52 Outworkers 150 RATS Rat complaints 1,269 Total number of rats destroyed 21,067 Total number of visits to premises re rat infestation etc. 4,382 Special attention has been given to poisoning campaigns and this method has almost replaced trapping. In addition to a Rodent Officer and staff of ratcatchers, the City Council have employed a contractor to deal specifically with rat infestations on bombed sites and adjacent war damaged buildings. RESTAURANTS Total number of restaurants inspected 1,383 Number- of notices served 426 Legal proceedings 1 NUISACE FROM PIGEONS Complaints: 14 Pigeons destroyed: 687. DISINFECTION Rooms: 1,309 A rticles: 67,062 Articles washed: 9,861. Articles destroyed: 418. Books disinfected: 318 Vehicles: 37 CLEANSING OF PERSONS - (Head lice, Body lice, Scabies). Children: 564. Adults: 797 Total: 1,361 Number of treatments: 2,191 INSPECTION AND SUPERVISION OF FOOD Samples purchased for analysis 1,807 Visits to premises 3,344 Notices served 448 Samples found to be adulterated 77 Prosecutions 11 Convictions 10 Fines: £46,19.0. Costs: £48. 6. 0. - 10 - INSPECTION OF MEAT On the outbreak of war the wholesale distribution of meat from the Central Market in the Metropolis was decentralised. Various distributing depots were opened, including one in westminster. Throughout the war daily inspections by the Council's Sanitary Inspectors have been maintained and the meat passing through the Depot has been examined before despatch to retail shops. AIR RAID SHELTERS (Public and Communal Domestic) Number of visits 1523 ICE CREAM PREMISES Premises on Register at 31st December, 1944 186 PRESERVED MEAT ETC. PREMISES Premises on Register at 31st December, 1944 122 MILK (SPECIAL DESIGNATIONS) ORDER, 1936 & 1938 Licences issued 45 REGISTRATION OF DAIRYMEN & DAIRIES Premises Persons On Register at 31st December, 1944 88 59 Registered during the ye. r 1 Inspections made 94 Notices served 2 CORONER'S COURT AND MORTUARY Bodies received 300 Causes of death:- Drowning 4 Street accidents 16 Other accidents 46 Murder 1 Suicide 23 Natural Causes 188 Misadventure 2 Miscellaneous causes 20 Inquests held 116 Post-mortem ex-minations 257