LIBRARY Ful 34 METRO POLITAN BOROUGH OF FULHAM REPORT of the MEDICAL OFFICER OF HEALTH for the year 1943 % JOHN ALEXANDER SCOTT, O.B.E. ,M.D.,M.R.C.P. ,L.R.C.P. ,D.P.H Medical Officer of Health. METROPOLITAN BOROUGH OF FULMAM Public Health Department, Town Hall, Fulhara, S.W.6. July 1944 To the Mayor, Alderman 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 of the Borough for the year 1943. In accordance with instructions, the report is in summariesed form and for reasons of security the birth rate, death rate and total population figures are not published. Several matters affecting the health of the Borough deserve brief comment. The Infant Mortality Rate. Throughout the war period this has been fifty or less per thousand children born, until the year 1945 when a sharp rise to 63 occurred. There are two main groups of causes responsible for this increase. The first has led to an increase in the deaths from diarrhoeal diseases. This phenomenon has been widespread throughout the country and no certain explanation of its occurrence can yet be given. The exigencies of war may clearly have affected the quality of the milk supply, if only by producing some delay in its distribution. On the other hand, there seems some evidence that we may be witnessing one of those obscure alterations in the relationship between host and parasite (infecting micro-organism) which leads over a period of years to the increased or decreased prevalence of certain diseases. The periodic outbreak of cerebro-spinal fever, the still longer intervals between outbreaks of encephalitis lethargica (sleeping sickness) and the great diminution in the severity of scarlet fever are illustrations of this altered relationship., to this kind of altered organic may be due the increase in infantile diarrhoea. The second cause of the increased number of infant deaths has been respiratory disease. This increase was in the main associated with the influenza and measles outbreaks. The influenza outbreak which occurred towards the end of the year and which, after four years of war tensions and strain might have been serious, in the event proved manageable. In the borough there were during the year 62 more deaths (about 535) from influenza, bronchitis and pneumonia than had occurred in the previous year. The maternal mortality rate (2.70) was slightly lower than that for the previous year. and compared reasonably well with that both for London and for the country as a whole. It was, nevertheless, with this exception higher than for any year since 1937 In considering maternal health it is a pleasure to draw attention to the splendid use the public are making of the Council's ante-natal facilities. 1810 children were born during the year, but 1903 women made first attendances during the same calender period at the clinics. 2061 individual ante-natal patients attended the clinics during the year, some of course having first attended during 1942. The total ante-natal attendances wore much the highest in the history of the borough, being 12,241 as compared with 3,059 in 1937 towards the latter end of which the Parson's Green clinic and Maternity Home was first opened. Here is proof, if proof were needed, that the public appreciate and utilise good facilities. Further proof is the fact that the twenty beds at the maternity home accommodated 475 mothers and 63 ante-natal cases. The heavy pressure on beds and space which this practical appreciation of municipal facilities has caused has given some anxiety at times to the medical and nursing staffs, but good management and possibly some good fortune have obviated any ill consequences. It is also worth noting that the -1- substantial contribution which the Council thus makes to the total amount of available institutional maternity accommodation has, despite war-time difficulties, enabled about three quarters of the births during the year to take place in hospitals. To the women affected, faced with a shortage of most peace-time conveniences and with the alarms and excursions of war, these facilities have had more thai a medical value, important as that alone would have been. The public health facilities for infants have been equally well appreciated and used. Nearly four thousand children under five, of whom more than sixteen hundred were, under one, were brought to the clinics on occasions which aggregate to over thirty-two thousand (more than in any pre-war year). The Babies' Hospital, handicapped even more than the other services, has also continued its unobtrusive and life-saving work. 68 cases were admitted of which four proved fatal. It is safe to say that without the painstaking and inspired nursing which these infants receive many more would have died. The work in this hospital is perhaps the least spectacular, but the most laborious of any undertaken by the health department staffs. The remaining preventive medicine activity to which I would briefly draw the attention of the Council is that of immunisation against diphtheria. This began in 1934 but during the last three years received more concentrated attention. At the present time, more than 60% of the children under five and about 75$ of children of school age are immunised. From 1900 to 1934 the highest number of cases of diphtheria notified yearly was 644 (1901) and the lowest 271 (1915) On the average in every ten days in the year, nine notifications of diphtheria were received. For the years 1940 onwards, the annual notifications have been 63, 64, 55 43 (almost one a week) and the annual deaths for the same four years were 1, 2, 3 and 2 respectively. The causal relationship between the immunisation campaign and the altered incidence of the disease seems beyond question. It would be striking at any time but in the intermittently crowded conditions which accompany life in an urban community liable to aerial bombardment, conditions which predispose to the easy spread of droplet borne infection such as diphtheria, it is even more striking. It would not be fitting to conclude this brief note on a few of the more interesting aspects of the health of the borough without expressing my grateful thanks for the loyal support of an enthusiastic staff and for the sympa the tic understanding invariably accorded by my Chairman and their Committees. Both have worked under difficulties. To certain sections of the staff, particularly the Sanitary Inspectors, those difficulties have meant an inevitable slowing down of their work, but they have invariably been met by everyone, Committee and staff alike, with tolerance, good humour and ingenuity. I have the honour to be, Mr. Ladies and Gentlemen, Your obedient Servant, J, A. Scott O.B.E.,M.D.,M.R.C.S.,L.R.C.P.,D.P.H., Medical Officer of Health. 2 EXTRACT FROM STATISTICS FOR THE YEAR. Total. Males. Females. LIVE BIRTHS:- Legitimate 1,659 842 817 Illegitimate 159 73 86 TOTALS 1,818 915 903 STILLBIRTHS:- Legitimate 33 18 15 Illegitimate 1 - 1 TOTALS 34 18 16 DEATHS 1,510 713 797 Percentage of deaths occurring in public institutions. 62.05 Rate per 1,000 (Live and still) births. Deaths from puerperal causes: Deaths From sepsis 3 1.62 From ether causes 2 1.08 Death rate of Infants under One year of A ges:- All infants per 1,000 live births 63 Legitimate infants per 1,000 legitimate birth 60 Illegitimate infants per 1,000 illegitimate births 88 Cancer (all ages) 207 Measles (all ages) 2 Whooping cough (all ages) 3 Diarrhoea (under two years of age) 26 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 582 (25.29% of the total Respiratory Diseases 226(14.97%) Cancer 207 (13.71%) Intra cranial lesions 117 (7.75%) ; Tuberculosis (all forms) 93 (6.16%) Maternal Mortality. There were 5 deaths resulting from pregnancy and childbirth giving a maternal mortality rate of 2.71 per 1,000 births. Infant Mortality. The causes of death of the 114 children who died before attaining the age of one year were:- Mecsles 2 Tuberculosis 1 Meningitis (not tuberculous) 2 Bronchitis & pneumonia 26 Influenza 1 Gastro-enteritis 25 Injury by birth 8 Congenital ma1formatins 24 Premature birth 22 Other causes 3 114 The Infant Mortality Rate was per 1,000 births. 3 Deaths from:- Nuraing 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 6001 visits to 582 cases. Ultra Violet Light This was open throughout the year and 16,490 attendances were made. Babies' Hospital. The number of cases admitted to the Hospital was 68. There were 4 deaths. Maternity and Child Welfare. The number of attendances at the Infant Welfare Centres of children under one year was 23,864 and of children aged one to five years 8795, The number of attendances at the Ante-natal clinics was 12,241. Health Visitors. The total number of visits paid by the Health Visitors was 25,402. Infant Life Protection. At the end of the year there were 63 children on the Register, about one half of the peace time number. Maternity Home. During the year 4/5 cases were admitted for labour and 63 for antenatal treatment. There was one maternal death, 7 infant deaths and 3 stillbirths. Dental Clinic. The total number of attendances to this clinic was 2,698 Day Nurseries. Two more nurseries were opened during the year; the Bramber in July and the St. Dunstan's in September. Both are of the "hutted" type and accommodate 54 children. Between them the six nurseries in the borough accommodate 288 children although attendances have never reached this figure owing to the occurrence of the usual epidemics. At the end of the year there were 122 children on the waiting list for admission and two more "hutted" nurseries to accommodate 72 children each were under construction. 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 Re- Ins pections Total Inspections In consequence of complaint ” infectious disease House to House Inspections Infirm and Dirty Tenants RENT (Restriction) Acts application 2,582 1,883 3 38 26 9,717 12,299 108 1,991 5 8 66 28 19 45 TOTALS 4,532 9,877 14,409 As a result of these inspections 1758 Intimation Notices and 461 Statutory Notices were served. The routine visiting of food premises, factories etc., was continued, 2,648 visits being made. Legal proceedings were instituted during the year in sixteen instances. Drainage of Buildings. During the- year 53 plans were approved by the Public Health Committee. Certificates of Essentiality. Special inspections in connection with applications for these Certificates numbered 2676. 4 Rent(Restrictions) Acts. In response to applications by the 22 certificates were issued during the year. Aged, Infirm and Physically Incapacitated Persons. During the year 66 visits were paid by the woman sanitary inspector to aged persons. Rat Repression. During the year 1943, 2542 visits were made and poison laid in 35& sewers; 1134 rats are known to have been destroyed. During July: a special inspection was made of all factory and food premises and advice given regarding rat infestation. In November participation in the scheme for poisoning the rats in sewers, sponsored by the Ministry of Food was begun. INSPECTION AND SUPERVISION OF FOOD Food and Drugs net. During the year 1,000 samples of food and drugs were submitted to the Public Analyst and 63 or 6.3% 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 Butter Cereals Cereal powder Total samples examined 74 43 23 Number adulterated Formal Informal 1 2 2 - 3 4 Remarks. (i) 2% excess water (ii) Contains 10% marg- (iii) do arine. Weevils found. Semolina (i)7.9% passed through 40 mesh sieve. (ii) Peach flavoured dessert powder, wheat powder & gum, 70% starch.only (iii) Semolina, contained Cocoons of weevils. (iv) Semolina, 99% passed through 40 mesh sieve (v) do. 60% do. (vi & vii) Custard powder substitute,contained 60% starch only. Chocolate spread 9.84% dry, fat free cocoa only, insufficient flavour. 2 1 - Coffee and Chicory extract (i) Benzoic acid 350 PP million preservative not declared. 6 1 2 (ii) Fermenting, Benzoic acid absent; preservative not declared. 18 (iii) Fermenting. - Cordials 8 (i-iv) absence of sugar (v) Total Solids 0.87% not a winter warmer, useless for colds. (vi) 88% deficient in lime (vii) Contained only 0.68% total solids. (viii) 25,% deficient in sugar. 5 Total samples examined Number adulterated Article Remarks. Cake & Pudding mixture Essence & flavourings Jams & preserves. Legumes Lemonade powder Margarine Milk Milk powder Mince tart Sausages & sausage meat Spices and condiments Suet 18 6 16 21 5 22 490 2 1 19 17 1 Formal Informal 2 2 2 - 3 1 - 2 1 1 - 1 1 1 3 1 2 1 1 - - 3 - - -6- (i) Contained only 0.28% available carbon dioxide. (ii-iv) Misleading label (i) Dilute garlic oil solution (ii) No onion present (iii) Contained a mould growth (i)37% deficient in stawberries (ii)25% deficient in raspberries (iii) 7.5% deficient in strawberries (i.) Lentils contained rat dirt, beans, peas and general dirt. (ii, iii) contained mould and maggot. (iv) split peas too mouldy for human consumption. (i, ii) contained sodium acid phosphate (iii) contained only 2.38% tartaric acid. Contained 16.6% water (i) 7.8% added water (ii) 2% added water (iii) Contained particals of coagulated milk. Rancid before evaporation Filled with spiced bread paste (i) Contained 51 parts of sulphur dioxide per million. (ii) Contained 173 PP million sulphur dioxide. (iii) Blackpudding,75% deficient in blood & 100% deficient in added fat. Relish contained 11% acetic acid deficient in fruit and spices. Fat rancid. Article Total samples examined Number adulterated Formal Informal Remarks. Saccharine Vinegar Non-brewed vinegar Lime water Rheumatism tablets Sulphur and orange tablets lodine 24 1 1 Half strength tablets labelled standard strength. 5 1 - Consisted of nonbrewed vinegar. 9 2 - (i) 29% deficient in acetic acid. (ii) 8.5% do. 2 1 - Contained no sugar, preserved with SO 2 1 - 1 Misleading label, contravenes the Pharmacy & Medicines Act. 4 1 1 No orange flavour & deficient in citric acid. 2 - 2 (i) Contained 4.15% iodine. (ii) 3.2% deficient in iodine. 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 decreased from 55 to 45 those of scarlet fever increased from 208 to 4-25. There were 1028 cases of measles notified compared with 845 the previous year. Diphtheria Immunisation. The number of sessions held was 174 and 1991 new cases attended, a total of 11,318 attendances being made by new and old cases. By the end of the year 11,743 children had been immunised since the beginning of the campaign in 1934. Cancer. The percentage of deaths from this cause was 13.7. 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 0.95 (pulmonary 0.86 and non-pulmonary 6.07) The following is the information required by the Ministry of Health. CASES NOTIFIED AND DEATHS Age periods Years. New cases. Old cases Respiratory Non-Respiratory Respiratory Non-respiratory M M F M. F M F F 0-1 - - 1 - - - - - 3 1-5 2 - - 2 - - - 8 5 5-15 - - 1 - 5 - 19 33 6 1 15-25 4 7 10 1 25-35 35 27 2 5 7 10 - - 35-45 29 1 8 - 11 11 - - 45-55 15 5 2 3 11 1 - - 1 3 1 55-65 18 3 11 1 - 5 65 upwards 5 2 - - 4 - - 1 TOTALS 128 81 22 21 51 35 6 Dispensary. A total of 4,070 attendances were made including 715 patients who attended for the first time during the year; 156 patients were recommended for residential treatment. Vaccination. The annual return furnished to the Ministry of Health showed that per cent of the children born in 1942 had been successfully vaccinated by 31st January 1944. Disinfection. The routine disinfection of rooms after the occurrence of infectious diseases was continued and 19,148 articles were treated at the Disinfecting Station. Foot Clinic. On 2nd April, 1943, the Council assumed responsibility for the Foot formerly run by a voluntary body and, it was established at the Greyhound Road Clinic. During the peroid several by this report the Clinic has been opened on two sessions per week and 652 treatments given. Mortuary. During the year 197 bodies were received into the Mortuary. Shops Act. Inspections numbered 46. Factories. The inspections of factories numbered 269.No notices were served. Outworkers Premises. Visits to these premises totalled 53.No notices had to be served. HOUSING. Inspection of Dwelling Houses. The number of house-to-house inspections was 8(3 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 14,355 (4,491 being first inspections). The number of Intimation Notices served was 1,758 and the number of Statutory Notices 451. Disinfestation. During the year 44 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, 251 rooms being treated. TABLE 1. Causes of and Ages at Death during year 1943 All Ages 1- 2- 1 5- 25- 35- 45- 55- 65- 75 0- 5- Cause of Death Typhoid & Paratyphoid fevers - - - - - - - - - - - - Cerebro-spinal fever 4 2 - - 2 - - - - - - - Scarlet Fever 1 - - - 1 - - - - - - - Whooping Cough 3 - - 2 1 - - - - - - - Diphtheria 2 - - 1 1 - - - - - - - Tuberculosis of respiratory system Other forms of Tuberculosis 86 - 17 19 12 8 1 - - - 12 17 7 1 1 1 2 - - - 2 - - - Syphilitic diseases 8 - - - - - - 1 - 5 - 2 - 2 2 8 14 Influenza 41 1 - 1 2 11 - - - - - - - Measles 2 2 - - - - Acute Poliomyelitis 1 - - 1 - - - - - - - - Acute Infantile Encephalitis 2 - 1 - - - 1 - - - - - Cancer of buccal cavity & oesophagus (M) - 6 - - - 1 3 2 - - - - Cancer of uterus (F) - - 4 1 15 - - - - 3 7 - Cancer of stomach & duodenum - 1 28 - 4 8 7 8 - - - - Cancer of Breast 27 - - - 2 5 3 7 9 1 - - Cancer of all other sites 131 - - - - 3 4 18 2 3 62 21 - 2 Diabetes 16 - - - 3 - 1 2 3 5 - Intra-cranial vascular lesions - 1 - - 9 37 40 117 - - - 30 Heart Disease 382 - - 1 9 8 23 102 186 - 53 - - 1 - 7 Other diseases of circulatory system 2 5 34 - 5 14 - - Bronchitis 7 - - - 5 8 14 27 37 98 - - 110 19 - 1 14 22 24 19 Pneumonia 4 - 1 6 - Other respiratory diseaseses 18 - - 2 - 1 1 1 5 4 4 Ulcer of stomach or duodenum - - - 1 1 - 2 4 4 1 13. - Diarrhoea under 2 years 26 25 1 - - - - - - - - - 1 1 Appendicitis 7 - - 1 - - 2 2 - - Other digestive disorders 37 - 1 - 1 4 4 6 11 10 - - Nephritis 43 - - - 2 4 5 10 9 13 - - Puerperal & post abortion sepsis - - - - - - - 3 - 3 - - Other maternal causes 2 - - - 2 - - - - - - - Premature birth 22 22 - - - - - - - - - - Congenital malformations, birth injuries &c., 2 - 2 2 32 1 1 - - 40 - - Suicide 13 - - 1 4 1 4 - 3 - - - Road traffic accidents 5 - - - - 1 - 1 1 1 1 - Other violent causes 52 2 3 1 14 3 2 3 2 11 11 - 21 All other causes 108 1 - 4 - 6 5 6 20 45 - 9 13 43 56 77 131 258 367 435 TOTALS 1510 114 7 Cases Certified 1277; Inquests 69; Coroner without inquests 163; Uncertified 1. TABLE 2. INFECTIOUS DISEASES NOTIFIED DURING 1943. Notifiable Diseases Number of cases notified Total cases removed to Hospoital Deaths D.N.C. At Ages - Years At all ages 0- 1- 2- 3- 4- 5- 10- 15- 20- 35- 45- 65 Smallpox - - - - - - - - - - - - - — m — Cholera, Plague - - - - - - - - - - - - - Diphtheria 3 4 5 7 - 2 17 43 4 5 12 2 1 - 43 - Erysipelas 52 - - 1 1 1 2 7 8 22 10 21 - 1 - - Scarlet Fever 4 31 36 43 176 302 1 3 425 16 76 16 20 5 2 - Typhus Fever - - - - - - - - - - - - - - - - Paratyphoid 1 - - - - 1 1 - - - - - - - - Relapsing & continued fever - - - - - - - - - - - - - - - Puerperal Fever 4 - - - - - 4 - 4 3 - - - - - - Puerperal Pyrexia - - - - 1 - - - - - 28 3 - - 18 32 Cerebro-Spinal Meningitis 7 1 2 - - - - - 1 2 - 7 1 - - - 1 Poliomyelitis Ophthalmia - - - - - - - - - - - - - - - Neonatorum Tuberculosis of Respiratory 1 1 - - - - - - - - - - - - - - 93 7 System 209 - - 2 - 2 3 21 40 41 - 86 - - Non-Pulmonary Tuberculosis - - 7 6 9 - - 7 - - 43 3 - 12 1 5 Measles 1028 53 137 407 18 11 3 122 116 152 8 - 1 145 2 2 Encaphalitis Lethargica 1 1 - - - - - - 1 - - - - - - - 7 Pneumonia 82 3 3 1 5 - 8 3 5 8 13 26 8 110 - Diarrhoea (under 5 years) 62 1 26 47 5 - - - - 6 - 54 - 3 - - Malaria 1 - - - - - 1 - - - - - - - - - Whooping cough 343 41 61 52 46 1 3 3 44 92 5 1 - - 73 - Dysentery 44 6 1 7 3 3 1 9 3 5 2 36 - 1 4 - Scabies (notifiable since 1.8.43 4 10 6 8 39 91 - 6 6 43 29 - 40 30 - 312 I fa I L 2690 161 232 235 230 265 747 144 105 285 116 137 33 713 241 27