METROPOLITAN BOROUGH OF FULHAM / REPORT of the MEDICAL OFFICER OF HEALTH for the year 1940 JOHN ALEXANDER SCOTT, O.B.B. ,M.D. ,M.R.C.S. ,L.R.C.P. ,D.P.H. Medical Officer of Health 77.75Ful 9565 PUBLIC HEALTH DEPARTMENT, Tom Hall, Fulham, S.W.6. December, 1941 To the Mayor, Aldermen and Councillors, of the Metropolitan Borough of Fulham. Mr. Mayor, Ladies and Gentlemen, I have the honour to submit the Annual Report on the health and sanitary conditions of the Borough for the year 1940. In accordance with the instructions of the Ministry of Health this Report is in a summarised form. I should like to call attention to the low Infant Mortality Rate, 45 per 1,000 live births as against 47 per 1,000 last year, which is again the lowest on record for the Borough. The only item in the report on which I wish to comment is the Death Rate. The population, owing to evacuation, is, of course, over 40,000 below the normal peace time figure, and the actual Death Rate in relation to that of other years clearly depends on the accuracy of the estimated population. In any case the whole of the increase can be ascribed to one group of causes. Deaths by violence from all forms are 300 more than in a normal year - the cause will be quite obvious, and is not capable of any remedy by public health methods proper. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, your obedient Servant, J. A, Scott Medical Officer of Health. GENERAL STATISTICS, AREA (acres) 1,706, Population (Census 1951 150,928 Population, mid-1940 (Registrar-General's estimate 106,650 Number of inhabited houses (Census 1931 26,245 Rateable Value, March, 1941 £l,269,109 Sum represented by a penny rate £4,645 EXTRACTS FROM VITAL STATISTICS FOR THE YEAR. LIVE BIRTHS:- Total. Males. Females, Birth rate per Legitimate 1,579 794 785 1,000 of the Illegitimate 97 55 44 mated polation 15.7 Rate for London 15.7 TOTALS 1,676 847 829 „ „ England and Wales. 14.6 STILLBIRTHS:- Rate per 1,000 total Legitimate ill) Illegitimate 5 2 1 births 26.1. TOTALS 45 27 18 Death late per 1,000 DEATHS 1,994 1,011 983 of the estimated population: Crude rate 18.7 Adjusted rate 18.1 Rate for Londonl7-5 „ „ England and Wales 14. 5 Percentage of deaths occurring in public institutions 49.19 Deaths from puerperal causes: Rate per 1.000 (live Deaths. and still)births. From sepsis 2 1.26 From other causes 1 O.65 Death rate of Infants under One Year of Ages- All infants per 1,000 live births 45 Legitimate infants per 1,000 legitimate births 47 Illegitimate infants per 1,000 illegitimate births 22 Deaths from2- Cancer (all ages)248 Meales(all ages)- Whooping Cough (all ages) 2 Diarrhoea (under two years of age) 5 5 CAUSES OF DEATH. These are classified in Table I at the end of this Report, which shows that the five commonest causes were; Heart Disease, 407 (20.41 per cent. of the total deaths), Respiratory Diseases, 316 (15.85%) Cancer 248 (12.44%), Intra Cranial lesions, 135 (6.77%) and Tuberculosis (all forms) 105 (5.26% 3 Maternal Mortality. There were three deaths resulting from pregnancy and childbirth giving a maternal mortality rate of 1.89 per 1,000 births. Infant Mortality. The. causes of death of the 70 children who died before attaining the age of one year were:- Gastro-Enteritis & Diarrhoea 4 Premature Birth, Debility & Marasmus 17 Bronchitis and Pneumonia. 12 Congenital Malformations 13 Atelectasis 3 Injury by birth. 6 Digestive diseases 3 Non-pulmonary tuberculosis 4 Whooping Cough 2 Chronic constipation. 1 Enemy action 5 The Infant Mortality Rate was 45 per 1,000 births, which is the lowest rate in the history of the Borough. Nursing in the Home. The Fulham District Nursing Association has continued to carry out this work on behalf of the Council and during the year paid 5,8l8 visits to 573 cases. Clinic and Treatment Centres The Dispensary and Ultra Violet Light Clinics were open throughout the year. The Infant Welfare Clinics at Wandsworth Bridge Road and Greyhound Road were reopened in March and April respectively. At the end of April the Parson's Green Clinic was re-opened for Antenatal sessions and Eridge house used for Infant sessions only. In November a new Clinic was opened in North Fulham at Burne Jones House, both Antenatal and Infant sessions being held. Hospitals. (a) General. The Fulham Hospital continued to function throughout the year. (b) Children. The Babies' Hospital was partially re-opened on 30th March. (c) Infectious Diseases. The Western Hospital continued to function as a Casualty Hospital and Infectious Disease Hospital, Ultra Violet Light Clinic. This Clinic re-opened at the end of 1939 and during 1940, 7,638 attendances were made. Babies' Hospital. The number of cases admitted to the hospital from its opening on 30th March until the end of the year was 55• One child died in the Hospital owing to Bronchopneumonia. Maternity and Child Welfare. The number of attendances at the Infant Welfare Centres of children under one year was 10,748 and of children aged one to five years 5671. The number of attendances at the Ante-natal clinics was 4,227. Health Visitors, The total number of visits paid by the Health Visitors was 23,495. Infant Life Protection. At the end of the year there were only 27 children on the Register, about one quarter of the usual number. 4 Maternity Home. During the year 270 cases were admitted for labour and 23 for antenatal treatment.Ther were no maternal deaths but 3 babies died within 14 days and there were 8 stillbirths. Day Nursery. The Nursery continued in its Sussex surroundings as a residential nursery. In October we were able, through the generosity of an ex-Mayoress of the Borough, to evacuate 25 young children to North Wales. Supply of Milk. The total quantity of milk supplied to mothers and young children was: Cow's milk free of cost1,731 gallons, at half cost 151 gallons; dried milk free of cost 7,0877 lbs; at half' cost 591 lbs. The approximate cost to the Borough was £815 In addition 8,841 lbs of dried milk was sold at cost price, a total amount of £736. SANITARY CIRCUMSTANCES OF THE AREA. Sanitary Inspection of the Area. The following table gives a summary of the Inspections made by the sanitary inspectors during the years- Cause of Inspection First inspections Reinspections Total inspections In consequence of complaint 1,714 6,090 7,804 " 11 infectious disease 358 99 457 House to House Inspections 29 113 142 Infirm and Dirty Tenants 65 126 191 Rent Restriction Act applications 14 - 14 TOTALS 2,180 6,428 8,608 As a result of these inspections 1,240 Intimation Notices and 304 Statutory Notices (11 under the Housing Act and 293 under the Public Health Act) were Served. The routine visiting of food premises, factories, etc., was continued, 1,745 visits being made, Drainage of Buildings. During the year 67 plans were approved by the Public Health Committee, Legal Proceedings. Twelve summonses were issued in connection with the work of the sanitary inspectors and fines and costs amounting to £6 were imposed. Rag Flock. Proceedings were instituted against an upholsterer using Rag Flock which contained 150 parts of chlorine per 100,000 parts of rag flock as against the standard of 30 parts and a fine of £5 was imposed. Smoke Abatement. During the year 5 complaints were received from mambers of the public, one observation was made and 4 notices served. pent (Restrictions) Acts. In response to applications by the tenants, 13 certificates were issued during the year. Aged. Infirm and Physically Incapacitated Persons. During the year 34 visits were paid by the woman sanitary inspector to aged persons, including 258 for the purpose of arranging evacuation. Rat Repression the year 134 complaints were received and the Rat officer in addition to attending to these complaints continued his routine visits to business premises, particularly food premises, paying 2,240visits. Rats known to be destroyed numbered 1,147.Damage to property and drains by enemy action resulted in the disturbance and subsequent destruction of many rats, the total number destroyed being double that in many previous years. Mortuary During the year 339 bodies were received into the Mortuary. Shops Act. Inspections numbered 41. Factories. The inspections ox factories numbered 500 and one notice was served. Outworkers Premises. Visits to these premises totalled 84; no notices had to be served. HOUSING. Inspections of Dwelling houses. The number of house-to-house inspections was 142(29 being first inspections). The number of intimation Notices served was 18 and the number of Statutory Notices 9. The number of inspections of houses after complaint, occurrence of infectious disease, or applications under the Rent Restriction Acts was 7820 (1714 being first inspections). The number of intimation notices served was 1,210 and the number of Statutory Notices 293. Disinfestation. During the year 150 families had their furniture treated by HCN process prior to removal to a Borough Council estate. Xhe treatment of rooms found to be infested with vermin was continued during the year, 179 such rooms being treated. INSPECTION AND SUPERVISION OF FOOD. Milk. Samples taken numbered 592 and of these ten or 1.7 per cent were found to be adulterated; Food and Drugs Act, 1938. During the year 1,000 samples of food and drugs were submitted to the Public Analyst and 15 or 1.3% were reported adulterated. The following are the comments of the Public Analyst on these adulterated samples (it is regretted that it is not possible to publish his complete report). Article Total samples examined Number Adulterated Remarks. Formal Informal. Boric ointment 7 1 1 15% & 14% deficiency in Boric Acid. Butter 105 2 - 1.6% & 2% excess water Buttered buns. 2 - 2 Spread with a mixture containing not more than 40% & 60% butter Fish paste 4 - 1 Lobster paste contained 0.08% boric acid Rolls and butter 5 1 1 Spread with margarine and not butter. Sweetened milk powder 2 1 1 65% dried separated milk with 35% sucrose. Labelled that "diluted with water was equivalent to sweetened fresh mi1k. Whisky 2 - 1 Contained .0012% iron It was not necessary to take legal action in respect of any of these samples. 6 PREVALENCE AND CONTROL OVER. INFECTIOUS AND OTHER DISEASES. Notifiable Diseases. Table 2 at the end of this Report gives particulars of the cases notified. Cases of Cerebro-spinalmeningitis numbered 41 as against 8. The number of cases of diphtheria decreased from 158 to 55 and those of Scarlet Fever from 140 to 48. There were 257 cases of Measles notified compared with 42 the previous year. Diphtheria Immunisation. The Clinic re-opened on 2nd May. Sessions numbered 33 and 170 new cases attended, a total of 728 attendances being made by both new and old cases. Cancer. The percentage of deaths from this cause was 12.44 and the death rate 2.55. The age distribution at death is shown in Table 1 at the end of this Report. Tuberculosis. The death rate from this cause was 0.98 (pulmonary 0.85 and non-pulmonary 0.15) The following is the information required by the Ministry of Health. CASES NOTIFIED AND DEATHS. Age periods years New Cases Deaths. Respiratory Non-res piratorv Respiratory Non-respiratory M F M F M F M F 0-1 - 1 - - - - 3 1 1-5 - 1 1 1 - - 2 - 5-15 3 2 4 - 1 - 1 - 15 - 25 21 24 6 4 6 8 1 2 25 - 35 30 17 3 1 16 7 1 1 55 - 45 15 11 - - 13 5 2 - 45 - 55 10 4 - - 11 1 - - 55 - 65 11 2 - 1 11 2 1 - 65 upwards 1 2 - 1 5 3 - 1 TOTALS 91 64 14 8 63 26 11 5 Dispensary. A total of 2965 attendances were made including 590 who attended for the first time during the year; 92 patients were recommended for residential treatment. Vaccination. The annual returns furnished to the Ministry of Health showed that 49.24 per cent of the children born in 1939 had been successfully vaccinated by 31st January, 1941. Disinfection. The routine disinfection of rooms after the occurrence of infectious diseases was continued as was also disinfestation for vermin. A total of 6.19 rooms were treated. At the Disinfecting Station 22,164 articles were treated. TABLE 1 - Causes of and Ages at Death during year 1940. Cause of Death All Ages 0- 1- 2- 5- 15- 25- 35- 45- 55- 65- 75- Typhoid & Paratyphoid fevers - Cerebro-spinal fever 8 1 1 1 4 1 Scarlet Fever - Whooping Cough 2 2 Diphtheria 1 1 Tuberculosis of respiratory system 89 1 14 23 18 12 13 7 1 Other forms of Tuberculosis l6 4 2 1 3 2 2 1 1 Syphilitic diseases 28 3 2 4 12 4 3 Influenza 30 1 1 3 7 7 6 5 Measles - Acute Pollo-myelitis & - Polio-encephalitis Acute infantile - Encephalitis Cancer of buccal cavity & oesophagus(M) 6 3 2 1 Cancer of uterus (F) 22 1 3 5 6 6 1 Cancer of stomach & duodenum 42 3 4 14 16 5 Cancer of breast 18 7 4 3 4 Cancer of all other sites 160 2 8 26 37 46 41 Diabetes 11 l 3 4 3 Intra-cranial vascular lesions 135 1 6 26 48 54 Heart Disease 407 l 4 3 6 20 49 127 197 Other diseases of circulates system 69 1 2 10 30 26 Bronchitis 160 2 1 2 1 7 25 47 75 Pneumonia 125 10 2 1 2 4 6 16 26 30 28 Other respiratory diseases 31 3 1 5 10 6 6 Ulcer of stomach or duodenum 29 1 2 6 7 2 6 5 Diarrhoea under 2 years 5 4 1 Appendicitis 9 1 2 2 l 3 Other digestive disorders 37 3 1 1 4 4 9 12 3 Nephritis 33 1 4 7 8 13 Puerperal & postabortion sepsis 2 1 1 Other maternal causes 1 1 Premature birth 17 17 Congenital malformations, birth injuries, &c. 28 22 1 1 2 1 1 Suicide 20 1 1 3 3 7 4 1 Road traffic accidents 14 1 2 4 5 2 Other violent causes 326 5 4 8 21 39 47 61 43 46 26 26 All other causes 113 1 1 1 2 9 5 6 15 27 46 TOTALS 1994 70 9 14 28 70 108 142 191 341 474 547 TABLE 2. INFECTIOUS DISEASES NOTIFIED DURING 1940. Notifiable Diseases. Number of cases notified Total cases removed to Hosoital Deaths D.N.C. At Ages - Years At all ages 0- 1- 2- 3- 4- 5- 10- 15- 20- 35- 45- 65- Smallpox - - - - - - - - - - - - - - - - Cholera, plague - - - - - - - - - - - - - - - - Diphtheria 63 2 2 3 6 4 15 6 11 9 4 1 - 55 1 - Erysipelas 28 - - 1 - - - - - 4 5 10 8 14 - - Scarlet Fever 48 1 2 3 14 5 10 6 3 2 1 1 - 34 - 1 Typhus Fever - - - - - - - - - - - - - - - - Enteric Fever 3 - - - - - - - - - 1 2 - 2 - - Relapsing and Continued Fever - - - - - - - - - - - - - - - - Puerperal Fever 5 - - - - - - - - 4 1 - - 2 2 - Puerperal Pyrexia 12 - - - - - - - - 12 - - - 5 - - Cerebro-Spinal Meningitis 41 4 2 5 1 1 3 2 5 7 2 7 2 36 3 1 Poliomyelitis - - - - - - - - - - - - - - - - Ophthalmia Neonatorum 5 5 - - - - - - - - - - - 3 - - Tuberculosis of Respiratory System 155 1 1 - - - 3 2 19 73 26 27 3 - 89 - Non-Pulmonary Tuberculosis 22 - - - 1 1 2 2 5 9 - l 1 - 16 - Measles 257 18 41 50 37 34 50 3 12 12 - - - 88 - - Encephalitis Lethargica - - - - - - - - - - - - - - - - Pneumonia 100 1 3 - 4 - 2 1 7 19 12 35 16 45 - - Diarrhoea 22 17 1 3 1 - - - - - - - - 22 5 - Malaria - - - - - - - - - - - - - - - - Dysentery 4 1 1 - - - - - - 2 - - - 2 - - Trench Fever - - - - - - - - - - - - - - - - Whooping Cough 17 6 5 1 3 1 1 - - - - - - 7 2 - Totals 782 56 58 66 67 46 86 22 62 153 52 84 30 315 123 2