LIBRARY Ful 31 METROPOLITAN BOROUGH OF FULHAM REPORT of the MEDICAL OFFICER OF HEALTH for the year 1939 JOHN ALEXANDER SCOTT, O.B.E,, M.D., M.R.C.S , L.R.C.P,,D,P.H. Medical Officer of Health. Public Health Department, Town Hall, Fulham, S.W.6. July, 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 1939. In accordance with the instructions of the Ministry of Health, this Report is in a summarised form, although the full statistics usually published have been prepared in draft form for recora purposes. The publication of this Report has been delayed owing to the burden thrown on the department by the organisation of the Casualty Services section of the Air Raid Precautions Scheme and the subsequent dislocation of the routine worK of the department. In September, 1939. all staff, with the exception of four who concentrated on the centralised infant welfare work, were given duties in connection with this service and although to-day much of the routine work has been restored, there are still some members who devote the whole, or a proportion, of their time to A.R.P. The staff, especially on the male side, has of course undergone change and there are now six permanent members of the staff serving with the forces. It is a pleasure to call attention to the infant mortality rate of 47, which is the lowest in the history of the Borough, I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, J.A. SCOTT, Medical Officer of Health. 2 GENERAL STATISTICS. AREA (acres) ... 1,706. Population (Census 1931) 150,928 Population, mid-1939 (Registrar-General's estimate): for Birth Rate 135,800 for Death Rate 128,600 Number of inhabited houses (Census 1931) 26,245 Rateable Value, March, 1940 £1,351,025 Sum represented by a penny rate £5,390 EXTRACTS FROM VITAL STATISTICS FOR THE YEAR. LIVE BIRTHS:- Total. Males. Females. Legitimate 1,715 885 830 Illegitimate 116 58 58 Birth rate per 1,000 of the esti- mated population, 13.5 888 Rate for London 12.3 " " England ana Wales. 15.0 TOTALS 1,831 943 STILLBIRTHS:- 26 Rate per 1,000 total (live and still) births 28.1. Legitimate 47 21 Illegitimate 6 4 2 TOTALS 53 25 28 DEATHS 1,613 808 805 12.5 12.6 11.9 Death rate per 1,000 of the estimated population: Crude rate Adjusted rate Rate for London " " England and wales. 12.1 Percentage of deaths occurring in public institutions 63.24 Deaths from puerperal causes: Rate per 1,000 (live ana still) births. Deaths. - From sepsis - From other causes 3 1.64 Death rate of Infants under One Year of Age:- All infants per 1,000 live births 47 Legitimate infants per 1,000 legitimate births 42 Illegitimate infants per 1,000 illegitimate births 133 Deaths from:- Cancer (all ages) 265 Measles (all ages) - Whooping Cough (all ages) 1 Diarrhoea (under two years of age) 20 3 Causes of Death. These are classified in Table 1 at the end of this Report which shows that the five commonest causes were: Heart Disease 459 (28.46/6 of the total deaths), Cancer 265 (16.43%), Respiratory Diseases 182 (11.28/0, Tuberculosis (all forms) 108 (6.69%), Cerebral Haemorrhage 67 (4.15% Maternal Mortality. There were three deaths resulting from pregnancy and childbirth giving a maternal mortality rate of 1.64 per 1,000 births. Infant Mortality. The causes of death of the 84 children who aiea before attaining the age of one year were:- Gastro-Enteritis & Diarrhoea 19 Premature Birth, Debility & Marasmus 24 Bronchitis ana Pneumonia 17 Congenital Malformations 5 Atelectasis 6 Injury by birth 3 Syphilis 1 Convulsions 1 Tuberculous-Broncho-Pneumonia 1 Cancer 1 Other causes 5 Ill defined or not known 1 The Infant Mortality Rate was 47 per 1,000 births, which is the lowest rate in the history of the Borough. GENERAL PROVISION OF HEALTH SERVICES. Staff. There was no material change in the staff shown in my Report for 1938 until the outbreak of the war when several permanent members were seconded for Air Raid Precaution duties and temporary staff was recruited to replace these members and also those who had to join the Armed Forces. Laboratory Facilities. The arrangements detailed in my Report for 1938 continued until the outbreak of the war when, owing to the evacuation of the Lister Institute for Preventive Medicine, arrangements were maue with Dr. Guy Bousfield of the Camberwell Research Laboratories to examine specimens when our own Laboratory was closea, During the year 3,142 specimens were examinee, at our own Dispensary, 25 by Dr. Bousfielct, and 591 by the Lister Institute. 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 6,606 visits to 589 cases. Clinic and Treatment Centres. During the first eight months of the year the clinics enumerated in my Report for 1938 were all open but on the outbreak of the war the Infant Welfare Clinics were closed and a combined clinic, open every day of the week, was established at the premises of the evacuated Day Nursery; the Diphtheria Immunisation, Dental and Sunlight clinics were closed. In December the Sunlight clinic was re-opened but the other clinics remained closed until the end of the year. The Tuberculosis Dispensary did not. close, although for a few weeks at the outbreak of the war its work was curtailed as the ground floor of the premises was used as a Depot for Stretcher Bearers. 4 Hospitals. (a) General. The Fulham Hospital continued to function throughout the year. (b) Children. The Babies' Hospital was closed at the outbreak of the war, the staff being transferred to one of the First Aid Posts. For a few weeks the premises were used as an auxiliary fire station. (c) Infectious Diseases. The Western Hospital was prepared for use as a casualty hospital and the ground floors of two blocks were handed over to the Council for conversion into a First Aid Post. Infectious cases were, however, still admitted to the Hospital when accommodation permitted. Ultra Violet Light Clinic. Until the date of its closure this clinic was attended 6,701 times.THe reasons for treatment were very similar to those given in my report for 1938. Babies' Hospital. The number of cases admitted to the hospital from Ist January until its closure was 72 and the average daily number in hospital was 10. 5, the average duration of stay being 31 days. Four children died in the Hospital (two owing to Broncho-Pneumonia, one to Enteritis and one to Gastritis). Maternity and Child Welfare. The total number of attendances at the Infant Welfare Centres of children under one year was 15,366 and of children aged one to five years 10,322. The number of attendances at the Ante-Natal clinics was 4,590. Health Visitors. The total number of visits paid by the Health Visitors was 23,686. Infant Life Protection. At the end of the year there were only 49 children on the Register, about half the usual number. One woman was prosecuted for sending in false information that a foster-child had been removed from her care. She was fined £5 as a result of the proceedings initiated following the death of the child. Maternity Home, The Home was closea on the outbreak of war, the mothers in the Home being evacuated, ana partially re-opened at the beginning of December. During the year 292 cases were admitted for labour and 92 for ante-natal treatment. There were no maternal deaths but 5 babies diea within 14 days and there were 3 stillbirths Dental Clinic. This clinic was closed in September and. up to that date attendances had been made. Day Nursery. The Nursery was evacuated on September Ist with 27 children and became a residential nursery. Between January and September 6,078 attendances were made by children. Supply of Milk. The total quantity of milk suppliea to mothers and young children was: Cow's mi Ik; free of cost 3,597 gallons, at half cost 176 gallons; dried milK free of cost 10,962 lbs., at half cost 909 lbs. The approximate cost to the Borough was £1,259. In addition, 12,991 lbs. of dried milk was sold at cost price, a total amount of £1,039. 5 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 year:- Total inspections. First inspections. Cause of Inspection. Reinspections. 2,325 In consequence of complaint 8,645 10,970 " " infectious disease 901 330 1,231 224 1,561 1,785 House to House Inspections Infirm and Dirty Tenants 105 140 245 Rent Restriction Act applications 19 - 19 3,574 10,676 TOTALS 14,250 As a result of these inspections 1,684 Intimation Notices and 328 Statutory Notices (9 under the Housing Act and 319 under the Public Health Act) were served. The routine visiting of food premises, factories, etc. was continued, 5,598 visits being made. Drainage of Buildings. During the year 165 plans were approved by the Public Health Committee. Legal Proceedings. Seven summonses were issued in connection with the work of the sanitary inspectors. In one case a fine of £2 was imposed, in two cases orders were made for the work to be done within a specified time, in two instances the case was dismissed under the Probation of Offenders Act on payment of 10s. costs in each case, and in the other two cases the work was completed before the hearing. Rag Flock. Proceedings were instituted against an upholsterer using Rag Flock which contained 184 parts of chlorine per 100,000 parts of rag flocK as against the standard of 30 parts and the case was dismissed under the Probation of Offenders Act on payment of 20s. costs. SmoKe Abatement. During the year 15 complaints were received from members of the public, 44 observations were made and two notices served. Rent (Restrictions) Acts In response to applications by the tenants, 22 certificates were issued during the year. Aged, Infirm ana Physically Incapacitates Persons. During the year 519 visits were pais by the woman sanitary inspector to aged persons, including 74 for the purpose of arranging evacuation. One application for compulsory removal to hospital was made but the order was refused by the Magistrate. Rat Repression. During the year 115 complaints were received and the Rat Officer in addition to attending to these complaints continued his routine visits to business premises, particularly food premises. It was found that in 60 cases the rats gained admission to premises through drainage defects. Rats known to be destroyed numbered 516. 6 Mortuary During the year 254 bodies were received into the Mortuary. Shops Act. Inspections numbered 205 and 8 notices were served. Factories. The inspections of factories numbered 929 and 30 notices were served mainly for the remedying of inadequate ventilation. Outworkers Premises. Visits to these premises totalled 173? no notices had to be served. Rag and Bone Dealer. A dealer was prosecuted for exchanging toys for old clothes; he was fined 5s. HOUSING. Inspections of Dwelling Houses. The number of house-to-house inspections up to August, was 1,785 (224 being first inspections). The number of intimation Notices served was 148 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 12,465 (3,550 being first inspections). The number of intimation notices served was 1,53° and the number of Statutory notices 319. Demolition and Closing Orders, Orders "were made for the demolition of two houses which were duly demolished. Orders were also made for the closing for human habitation of ten rooms. Overcrowding During the year four families obtained accommodation on London County Council estates and 30 on Borough Council estates. It was not possible to make the usual survey of overcrowded families at the end of the year so that no statistics as to the extent of such conditions are available. Disinfestation. During the year 116 families had their furniture treated by HCN process prior to removal to a Borough Council estate. The treatment of rooms found to be infested with vermin was continued during the year, 236 such rooms being treated. INSPECTION AND SUPERVISION OF FOOD. Milk. Samples taken numbered 563 and only two or 0.36 per cent, were found to be adulterated; in one case there was 3.9 P er cent, added water and in the other there was 4 per cent, fat abstracted. Food and Drugs Act, 1958. During the year 1,000 samples of food and drugs were submitted to the Public Analyst and 22 (or 2.2%) were reported to be adulterated. The following are the comments of the Public Analyst these adulterated samples (it is regretted that it is not possible to publish his complete report at the moment) Total samples Number Adulterated Article examined, "Formal, Informal. Remarks, Butter 87 1 1 16.2 & 16,8% of water. Cheese 10.3 2 44,6, 46.6, 41,7, 47.3 & 44.2% of water. Cider 4 2 - 0.7& 0.9 parts of lead per million. Jam I 12 - 1 82 parts of sulphur dioxiae per million. 7 Total samples Number Adulterated Article examined Formal Informal. Remarks. Sausages 24 1 Not lab oiled as preservea, contained 240 parts of sulphur diioxide per million. Sugar 8 1 1 Yellow crystals coloured with artificial dye and the other had been damaged by sea water. Split Peas 13 2 - 15 & 12.7% of peas attacked by maggots. Vinegar 10 5 Four were artificial vinegar and the fifth was artificial vinegar 20% deficient in acetic acid. It was not necessary to take legal action in respect of any of these samples. Pharmacy and Poisons. Seven samples were. taxen, one being reported as 20% deficient in Ammonia and the other (Disinfectant Fluid) did not bear the vendor's name and address. PREVALENCE AND CONTROL OVER INFECTIOUS AND OTHER DISEASED. Notifiable Diseases. Table 2 at the end of this Report gives particulars of the cases notified. The number of cases of diphtheria decreased from 212 to 158 and those of Scarlet Fever from 264 to 140. There were only 42 cases of Measles notified compared with 1,609 the previous year while cases of diarrhoea decreased from 72 to 25. Diphtheria Immunisation. Immunisation was carried on once a week until the end of July when work was, as usual, suspended for one month. The outbreak of the war prevented the re-opening of the clinic before the end of the year. Sessions numbered 29 and 168 new cases attended, a total of 1,359 attendances being made by both new and old cases. The following is a summary of the treatments given Under 5 Aged 5 Over 15 years of to 15 years. Total. age. years. Primary Schick: Positive 10.5 35 - 140 Negative 5 14 - 19 Inoculations APT 1st 114 40 - 154 2nd 97 36 133 Alter Positive Post Schick 3 8 - 11 Inoculations T A.F,: 1st 1 6 - 7 2nd 1 6 1 8 3rd - 1 1 2 Contd. overleaf Under 5 Aged 5 Over 15 years of to 15 years, Total age years Posterior Schick: Positive 3 8 - 11 Negative 40 147 5 192 Not reaa 5 3 - 8 Cancer, The percentage of deaths from this cause was 16,4 and the death rate 2.05- The age distribution at death is shown in Table 1 at the end of this Report. Tuberculosis. The death rate from this cause was 0.84 (pulmonary 0.77 and non-pulmonary 0.07). The following is the information required by the Ministry of Health: Age periods New Cases. Deaths. years. Respiratory Non-respiratory Respiratory Non-respiratory M.F. M. F. M. F. M. F. 0-1 - - - - 1 - - 1-5 - - - 1 - - - 1 5 -15 - 2 4 3 - - - 1 15 -25 13 40 2 7 5 9 1 2 25-35 37 23 4 7 14 12 - 1 35-45 19 11 1 6 8 4 - - 45-55 17 3 1 1 13 6 - 1 55-65 17- 2 - - 16 4 - 1 65 upwards 612 - 12 161 - 1 TOTALS 109 185 12 27 36 1 8 Di spensary. A total of 4,042 attendances were made by 1,176 patients of whom 576 attendee for the first time during the year, 184 patients were sent to residential institutions. Vaccination, The annual returns furnished to the Ministry of Health showed that 48.77 per cent, of the children born in 1933 had been successfully vaccinated by 31st January, 1940. Disinfection. The routine disinfection of rooms after the occurrence of infectious diseases was continued as was also disinfestation for vermin. A total of 675 rooms were treated. At the Disinfecting Station 14,407 articles were treated. TABLE 1. - Causes of and Ages at Death during year 1939. All Ages Cause of Death 65- 0- 1- 2- 5- 15- 25- 35- 45- 55- 75- Typhoid fever Measles Scarlet Fever Whooping Cough Diphtheria 3 1 Influenza 20 3 8 Encephalitis Lethargica Cerebro-Spinal Fever Tuberculosis of respiratory system 26 12 19 20 6 99 14 Other tuberculosis 9 3 3 Syphilis General paralysis of the Insane 6 12 265 6 17 69 78 Cancer 39 54 Diabetes 15 3 Cerebral Haemorrhage 67 12 21 29 Heart Disease 459 1 1 8 12 33 76 131 194 2 Aneurysm 14 3 Other circulatory diseases 36 86 14 33 6 Bronchitis 63 12 12 30 Pneumonia 109 14 3 3 9 28 17 30 Other respiratory diseases 10 Peptic ulcer 20 8 5 Diarrhoea 20 17 3 Appendicitis 11 Cirrhosis of liver Other liver diseases 8 Other digestive diseases 14 3 3 3 3 Acute & Chronic Nephritis 26 3 3 5 11 3 Puerperal Sepsis - Other puerperal causes 3 Congenital Debility, premature birth &c., 40 38 Senility 29 25 Suicide 18 3 3 3 Other violence 64 8 6 13 19 Other defined diseases 120 7 11 10 16 28 37 Ill-defined or not known TOTALS 1613 84 2 12 10 35 75 77 147 299 388 484 Cases Certified 1344: Inquests 103; Coroner without inquests 106. 1 1 4 5 4 4 1 1 2 2 4 2 4 2 3 4 1 1 1 1 1 1 1 1 2 2 2 1 1 1 1 1 1 4 2 1 1 1 2 4 1 4 2 2 2 4 1 1 2 2 1 2 5 1 4 4 1 6 6 1 . 1 2 1 1 2 1 4 1 1 1 1 1 1 1 1 - 1 1 2 2 4 1 1 1 1 1 1 1 - - - TABLE 2. INFECTIOUS DISEASES NOTIFIED DURING 1939. Number of cases notified Total cases removed to Hospital At Ages - Years Deaths D.N .C. Notifiable Diseases. At all ages 0- 1- 2- 3- 4- 5- 10- 15- 20- 35- 45- 65- Smallpox - - - - - - - - - - - - - - - - Cholera, Plague - - - - - - - - - - - - - - - - 158 8 Diphtheria 158 1 10 13 1 14 55 27 9 12 4 1 3 - Erysipelas 45 2 1 3 6 8 16 9 31 - - - - - - - 6 Scarlet Fever 140 6 7 15 17 67 15 6 3 131 4 - - - - Typhus Fever - - - - - - - - - - - - - - - - Enteric Fever 2 1 1 2 - - - - - - - - - - - - Relapsing and Continued Fever - - - - - - - - - - - - - - - - Puerperal Fever 4 3 1 4 - - - - - - - - - - - - Puerperal Pyrexia 22 1 17 3 1 17 - - - - - - - - - - Cerebro-Spinal Meningitis 8 1 2 2 1 1 1 8 1 - - - - - - - Poliomyelitis 1 1 1 - - - - - - - - - - - - - Ophthalmia Neonatorum 12 12 7 - - - - - - - - - - - - - Tuberculosis of Respiratory System 192 1 1 22 91 30 39 8 99 - - - - - - - Non-Pulmonary Tuberculosis 39 1 4 3 6 14 7 2 2 9 - - - - - - Measles 42 5 9 6 4 8 5 2 3 13 1 - - - - - Encephalitis Lethargica 2 - - - - - - - - - - - - - - - 128 4 8 3 10 23 20 36 10 63 109 Pneumonia 4 1 9 - 25 16 7 2 23 Diarrhoea 20 - - - - - - - - - - Malaria 7 - - - - - - - - - - - - - - - 6 1 1 1 1 6 Dysentery 1 1 - - - - - - - - Trench Fever - - - - - - - - - - - - - - - - Whooping Cough 263 38 60 25 45 44 45 4 1 - 1 - - 24 1 - 16 Totals 1087 67 82 80 85 56 174 97 488 243 73 209 57 77 30