FuL 32 M E T R 0 P O L I T A N B O R O U G H F U L H A M. REPORT of the MEDICAL OFFICER OF HEALTH for the year 1941. JOHN ALEXANDER SCOTT, O.B.E.,M.D.,M.R.C.S.,L.R.C.P.,D.P.H. Medical Officer of Health. METROPOLITAN BOROUGH. OF FULHAM PUBLIC HEALTH DEPARTMENT, Town Hall, Fulham, S.W.6. December, 1942 To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Fulham. Mr. Mayor, Ladies and Gentlemen, I have the honour to submt-the Annual Report on the health and conditions of the Borough for the year 1941. In accordance with the instructions of the Ministry of Health this report is in a summarised form and the General Statis and the birth and death the usual form. v>- - " 1 ~ I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, J. A. Scott O.B.E.,M.D. ,L.R.C.P. ,D.P.H., Medical Officer of Health EXTRACTS FROM VITAL STATISTICS FOR THE YEAR. Total. LIVE BIRTHS:- Males. Females. Legitimate 1,261 635 626 Illegitimate 101 45 56 682 1,362 680 TOTALS STILLBIRTHS:- Legitimate 32 19 13 Illegitimate 3 2 1 TOTALS 35 21 14 DEATHS 1,378 709 669 Percentage of deaths occurring in public institutions 62.91 Deaths from puerperal causes: Deaths Rate per 1,000 (Live and still) births. From sepsis 1 0.72 From other causes - - Death rate of Infants under One year of Age:- All infants per 1,000 live births 50 Legitimate infants per 1,000 legitimate births 46 Illegitimate infants per 1,000 illegitimate births. 90 Deaths from:- Cancer (all ages) 191 Measles (all ages) 2 Whooping cough (all ages) 2 Diarrhoea (under two years of age) 4 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, 370 (26.85 per cent of the total deaths), Respiratory Diseases, 192 (13.93%), Cancer 191 (13.86%), Intra Cranial lesions, 117 (8.49%) and tuberculosis (all forms) 93 (6.74%) Maternal Mortality. There was only one death resulting from pregnancy and childbirth giving a maternal mortality rate of 0.72 per 1,000 births. Infant Mortality. The causes of death of the 59 children who died before attaining the age of one year were:- Congenital Malformations 23 Premature Birth, Debility & marasmus 16 Bro. chitis and Pneumonia 11 Measles 1 Whooping cough 1 Influenza 1 Gastro-Enteritis & Diarrhoea 4 Digestive diseases 1 Violence. 1 The Infant Mortality Rate was 50 per 1,000 births. 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 5,405 visits to 464 cases. Ultra Violet Light Clinic. This Clinic was open throughout the year and 13,752 attendances were made. Babies' Hospital. The number of cases admitted to the hospital was 51. There was one death. Maternity and Child Welfare. The number of attendances at the Infant Welfare Centres of children under one year was 11,121 and of children aged one to five years 5534. The number of attendances at the Ante-natal clinics was 6,461. Health Visitors. The total number of visits paid by the Health Visitors was 24,650. Infant Life Protection. At the end of the year there were 67 children on the Register, about one half of the peace-time mumber. Maternity Home. During the year 425 cases were admitted for labour and 81 for antenatal treatment. There were no maternal deaths but there were 9 infant deaths and 3 stillbirths. Day Nursery. The Nursery continued in its Sussex surroundings as a residential nursery. In October the Fulham premises, after redecoration, were opened as a wartime day nursery for the accommodation of 40 children. 2 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:- Cause of Inspection. First inspections Reinspections Total Inspections 1,583 5,714 7,297 In consequence of complaint " " " infectious disease 844 121 965 House to House Inspections 28 26 54 Infirm and Dirty Tenants 226 76 302 Rent Restriction Act applications 21 - 21 TOTALS 2,702 5,937 8,639 As a result of these inspections 887 Intimation Notices and 216 Statutory Notices were served. The routine visiting of food premises, factories etc., was continued, 1,322 visits being made. No legal proceedings were instituted during the year. Drainage of Buildings. During the year 71 plans were approved by the Public Health Committee. Rent(Restrietions) Acts. In response-to applications by the tenants, 16 certificates were issued during the year. A ged, Infirm and Physically Incapacitated Persons. During the year 302 visits were paid by the woman sanitary inspector to aged persons. One order for compulsory removal to Hospital was obtained. Rat Repression. During the year 169 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 2290 visits. : Rats known to be destroyed numbered 1115, double that in peace-time. Mortuary. During the year 252 bodies were received into the Mortuary. Shops Act. Inspections numbered 62. Factories. The inspections of factories numbered 269 and 4 notices were served. Outworkers Premises. Visits to these, premises totalled 92 No notices had to be served. HOUSING. Inspections of Dwelling Houses. The number of house-to-house inspections was 54 (28 being first inspections). No Notices were served. The number of inspections of houses after complaint, occurrence of infectious disease, or applications under the Rent Restriction Acts was 8283 (2448 being first inspections). The number of Intimation Notices served was 879 the number of Statutory Notices 216. Disinfestation. During the year 80 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, 216 rooms being treated. 3 INSPECTION AND SUPERVISION OF FOOD. Milk. Samples taken numbered 608 and of these 7 or 1.1 per cent were found to be adulterated. Food and Drugs, Act. During the year 1,000 samples of food and drugs were submitted to the Public Analyst and 39 or 3.9 % 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. Butter 53 - Margarine (sample submitted by member of public) 1 Cereals 47 - 1 12% attacked by maggots. Coffee & Chicory Extract 5 1 - Improperly labelled. Egg substitute 11 1 3 3.45% total solids containing 1% sodium bicarbonate, 0.25% gelatine, 0.3% gum. Labelled "Perfect substitute for eggs for cooking purposes" -preparation was a coloured baking powder egg substitute. Labelled "Contents equal 4 eggs" - contained no egg powder. Essences and flavourings 9 - 4 Contained 24,000 bacteria viable@ 22º C 22,000 2,400 Rice Custard Pudding. 1 - 1 Lemon substitute contained no acid constituents. Misleading label "looks and tastes like a real egg pudding" -Preparation was an ordinary starch substitute. Saccharin & Sugar Substitutes 9 3 3 19% & 76% deficient in saccharin. Contained 16.000 bacteria viable @ 22º C. Contained only 1/6 recognised content of saccharin. Sausages 22 2 - Preservative not declared. Contained 136 pp of SO2 per million. 2 - 2 Bitter taste due to keeping infusion hot in an urn for too long a period. Tea Infusion Vinegar 11 2 2 12.5% & 4% deficient in acetic acid. Spirit vinegard labelled "Non-brewed" Glauber Salts. 3 - 3 37%, 14% & 8% deficient in water of crystallisation. Proceedings were taken in respect of (a) one sample of adulterated milk and the case was dismissed under P of 0 Act on payment of 3 guineas costs, (b) a sample of falsely described Vinegar - fined £2 & 3 guineas costs, and (c) a sample of Saccharin tablets 76% deficient in saccharin - fined £50 & 5 guineas costs. 4 PREVALENCE AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. Notifiable Diseases. Table 2 at the end of this Report gives particulars of the cases notified. The number of cases of diphtheria increased from 55 to 64 and those of searlet fever-from 48 to 68. There were 159 cases of measles notified compared with 257 the previous year. Diphtheria Immunisation. This work was intensified during the year, an additional session being opened at Burne Jones house in January, another at Greyhound Road in May and another at Wandsworth Bridge Road in August, making; a total, number of weekly sessions of four. of sessions held was 1.16 and 1498 new cases attended, a total of 5912 attendances being made by new and old cases. Cancer. The percentage of deaths from this cause was 13.86 and the death rate 2.16. The age of distribution at death is shown in Table 1 at the end of this Report. Tuberculosis. The death rate from this cause was 0.92 (pulmonary 0.8 and non-pulmonary 0.12) The following is the information required by the Ministry of Health. CASES NOTIFIED AND DEATHS. Age periods years. New Cases Deaths. Respiratory Non- respiratory Respiratory Non-respiratory M F M F M F M F 0 - 1 - - 1 - - - - - 1 - 5 - 1 1 3 1 1 2 1 5 - 15 1 5 2 1 - - 1 1 15 - 25 27 26 9 4 I ! . . 25 - 35 20 21 2 1 20 23 3 1 35 - 45 14 12 - 1 _L X X -i 45 - 55 21 6 1 2 m IT I X T 55 - 65 12 1 - - 24 5 1 1 65 upwards 5 4 - 1 66 22 - - TOTALS 100 76 16 13 51 31 7 4 Dispensary. A total of 2458 attendances were made including 554 who attended for the first time during the year; 85 patients were Vaccination. The annual returns furnished to the Ministry of Health showed that 40.29 per cent of the children born in 1940 had been successfully vaccinated by 31st January, 1942. Disinfection. The routine disinfection of rooms after the occurrence of infectious diseases was continued as was also disinfestation for vermin. At the Disinfecting Station 19,274 articles were treated. 5 TABLE 1 - Causes of and Ages at Death during year 1941. Cause of Death All Ages 0- 1- 5- 15- 45- 65 Typhoid & Paratyphoid fevers 2 2 Cerebro-spinal fever 1 ■ 1 ■ Scarlet Fever - . . Whooping Cough 2 1 1 Diphtheria 2 1 1 Tuberculosis of respiratory system 82 2 43 29 8 Other forms of Tuberculosis 11 3 2 4 2 Syphilitic diseases 16 . . 4 5 7 Influenza 14 1 1 1 3 8 Measles 2 1 1 ' Acute Poliomyelitis & Polio-encephalitis - • « . Acute Infantile Encephalitis Cancer of buccal cavity & oesophagus (M) 1 1 10 5 5 Cancer of uterus (F) 14 2 6 6 Cancer of stomach & duodenum 24 2 12 10 Cancer of Breast 20 ' 2 11 7 Cancer of all other sites 123 1 4 55 63 Diabetes 7 3 4 Intra-cranial vascular lesions 117 28 89 Heart Disease Other diseases of circulatory system 370 1 13 80 276 49 > 2 11 36 Bronchitis 96 4 3 28 61 Pneumonia Other respiratory diseases 83 7 4 11 22 39 Ulcer of stomach or duodenum 13 5 8 25 4 14 7 Diarrhoea under 2 years 4 4 : Appendicitis 3 2 1 Other digestive disorders 25 1 2 11 11 Nephritis 27 ,. . ■, 9 4 14 Puerperal & post abortion sepsis 1 1 Other maternal causes - I I Premature birth Congenital malformations, birth injuries &c., 16 16 26 23 ■ 3 Suicide 10 V 4 3 3 Road traffic accidents 16 i 1 9 6 Other violent causes 55 1 20 17 17 All other causes 111 3 2 19 22 65 TOTALS 1378 59 15 8 155 390 751 TABLE 2. INFECTIOUS DISEASES NOTIFIED DURING 1941. NUMBER OF CASES NOTIFIED Total cases removed to Hospital At Ages - Years Notifiable Diseases. At all ages 0- 1- 2- 3- 4- 5- 10- 15- 20- 35- 45- 65- Smallpox - - - - - - - - - - - - - - Cholera, Plague - - - - - - - - - - - - - - Diphtheria 64 4 4 4 6 7 10 5 10 9 3 1 1 64 Erysipelas 45 - - - 1 - 1 1 1 4 7 22 8 24 Scarlet Fever 68 - 8 2 2 4 22 8 4 11 3 3 - 56 Typhus Fever - - - - - - - - - - - - - - Enteric Fever 2 - - - - - - - 2 - - - - 2 Relapsing & Continued Fever - - - - - - - - - - - - - - Puerperal Fever 3 - - - - - - - 2 1 - - 3 - Puerperal Pyrexia 16 - - - - - - - 3 11 2 - - 11 Cerebro-Spinal Meningitis 21 - 2 1 - 1 2 1 6 6 - 2 - 21 Poliomyelitis 4 - 2 - - 2 - - - - - - 4 - Ophthalmia Neonatorum Tuberculosis of Respiratory- System 10 10 - - - - - - - - - - - 5 176 - 1 - - - 2 4 23 71 26 40 9 - Non-Pulmonary Tuberculosis 29 1 3 1 - - 2 1 5 11 1 3 1 - Measles 159 13 16 19 17 20 58 5 3 8 23 Encephalitis lethergica - - - - - - - - - - - - - - Pneumonia 89 3 2 4 2 1 5 2 4 13 7 36 10 38 Diarrhoea 9 8 - 1 - - - - - - - - - 9 Malaria - - - - - - - - - - - - - - 6 - 1 1 1 1 1 - - 1 - - - 6 Dysentery Trench Fever - - - - - - - - - - - - - - Whooping Cough 220 23 25 36 51 29 55 1 - - - - - 49 Totals 989 62 72 69 80 63 160 28 61 147 50 107 29 315