LIBRARY Ful 35 METROPOLITAN BOROUGH OF FULHAM REPORT of the MEDICAL OFFICER OF HEALTH for the year 1944 P.L.T. BENNETT, M.C., M.R.C.S., L.R.C.P., T.D.D., D.P.H., Medical Officer of Health. METROPOLITAN BOROUGH OF FULHAM Public Health Department, Town Hall, Fulham, S.W.6. September, 1945. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Fulham. Mr. Mayor, Ladies and Gentlemen, I have the honour to present the Annual Report on the Health of the Borough for the year 1944 on behalf of Dr. J.A. Scott under whose direction the work of the Health Department was carried out. Dr. Scott left Fulham early in January, 1945, after having served the Council as Medical Officer of Health since 1935• His tenure of office coincided with a very strenuous period, both in the history of the Borough of Fulham and that of the nation for following the threatening aspect of international relations in 1938 the storm burst in 1939; and at the time of Dr. Scott's departure to take up the office of a Principal Medical Officer under the London County Council early in this year the war was still in progress. During his term of office many important local developments in health activities took place - chiefly in the direction of housing and clearance, the opening of the Borough Maternity Home, the inception of a part-time Foot Clinic and the further expansion of the Child Welfare Services. The staff of the Department will remember, with much appreciation, many acts of kindness and consideration which Dr. Scott was always willing to render to those in need. Another member of the staff who will be much missed is Mr. A.T. Hurford, the Chief Clerk and Vaccination Officer, who retired in December after 40 years' honourable service in the Department. Mr. Hurford has seen the Department grow from very small beginnings and has taken his full share in the development of the many activities now carried on. During the year under review the calls of Civil Defence made many heavy demands upon the staff of the department - particularly during the blitz period early in the year and the long spell of flying bomb activity which commenced in June. It was therefore inevitable that the normal work should suffer to some extent by delay or the temporary suspension of activity: and in this connection I have to record with much regret that the Fulham Babies' Hospital in Broomhouse Road was badly damaged and put out of action by a flying bomb explosion in its vicinity at the end of July. Fortunately no casualties occurred amongst the inmates or staff of the hospital. At the present time the building is being repaired and when it is possible to re-open will fill a much needed gap .in the services of the Borough Council. Tuberculosis - Memorandum 266T. The allowance scheme (first started in June, 1943) has been carried on throughout the year and it is now possible to make some kind of estimate of its value. Under the scheme, for the benefit of those who may not be familiar with its essentials, I would state briefly that monetary allowances are provided for certain cases who have to stop working (on doctor's advice) in order to undergo treatment for the disease, and in whom there is a reasonable chance of eventual restoration to good working capacity by the treatment. It will EXTRACTS FROM VITAL STATISTICS FOR THE YEAR. POPULATION, estimated, 1944 95,090 Rate per 1,000 of Population. LIVE BIRTHS: Total Males Females Legitimate 1587 758 829 16.7 Illegitimate 175 95 80 1.8 1762 853 909 18.5 STILLBIRTHS: Legitimate 34 17 17 0.36 Illegilimate 8 6 2 0.08 42 23 19 0.44 1578 778 800 16.6 DEATHS: Percentage of deaths in public institutions 52 Deaths from puerperal causes: From sepsis. From other causes. 2 Number of deaths. - Rate per 1,000 (Live and Still) births. - 1.11 Death Rate of Infants Under One Year of Age: All Infants per 1,000 live births 43 Legitimate infants per 1,000 legitimate births 40 Illegitimate infants per 1,000 illegitimate births 63 Deaths from: Cancer (all ages) 210 Measles (all ages) Whooping Cough (all ages) - 5 Diarrhoea (under two years of age) 14 CLASSIFICATION OF CAUSES OF DEATH: The Registrar-General classifies the 1,578 deaths as follows: Cerebro-spinal fever 2; Whopping Cough 5; Tuberculosis of respiratory system 75; Other forms of tuberculosis 4; Syphilitic disease 15; Influenza 9; Poliomyelitis 1; Acute encephalitis lethargica 2; Cancer of (a) buccal cavity 11; (b) uterus 13; (c) stomach and duodenum 35; (d) breast 24; other sites 127; Diabetes 7; Intracranial lesions 112; Heart Diseases 381; Other diseases of circulatory system 45; Bronchitis 86; Pneumonia 79; Other respiratory diseases 13; Ulcer of stomach or duodenum2l; Diarrhoe (under 2 yrs.) 14; Appendicitis 4; Other digestive diseases 29; Nephritis 43; Other Maternal causes2; Premature birth 15; Congenital malformations etc. 21; Suicide 10; Road traffic accidents 10; Other violent causes 269; All other causes 94. It will be seen that five causes accounted for 60 per cent of the total deaths, namely Heart diseases, Cancer, Respiratory diseases, intra-cranial lesions and Tuberculosis (all forms) therefore be seen that some difficulty may arise in the interpretation of the second provision, as the possibility of a large number of cases, more or less of chronic type, might have to be excluded as well as thos of non-pulmonary disease (which is specified in the memorandum). The Tuberculosis Officer has to give the medical "verdict" and in Fulham cases have always been dealt with in as lenient a manner as possible, whilst still carrying out the intention of the memorandum and-actually no real difficulty appears to have been experienced. In assessing the value of this allowance scheme after about 18 months of its operation the opinion may be expressed that not only are the allowances on the meagre side in comparison with Public Assistance, but that the scheme should be considerably widened to include all cases. As a wartime measure it is undoubtedly a big step in the right direction and no doubt full consideration on the lines indicated above will be given to the betterment of the scheme in post war reconstruction. Miniature Mass Radiography. A further new development of preventive medicine was inaugurated early in 1944, when the London County Council miniture mass radiography unit carried out the first periodic survey at St. Luke's Hospital (Chelsea) Centre. This was within easy distance of the Borough of Fulham and a total of sixteen hundred ana seventy-six individuals employed in the area were dealt with at the centre. From this unit (and from other centres operating elsewhere towards the end of the year) thirty cases were sent to the Tuberculosis Officer for further investigation and a total of one hundred attendances were made at the Dispensary, nine cases eventually being notified as suffering from tuberculosis. In accordance with instructions this Report is prepared on the lines of that for 1943 and is therefore in an abbreviated form, though some restrictions relating to vital statistics which were previously imposed have now been lifted. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, P.L.T. BENNETT M.C., M.R.C.S., L.R.C.P., T.D.D., D.P.H. Medical Officer of Health. INFANTILE DEATHS. There were 75 deaths of infants under the age of One year the causes being as follows: Whooping Cough 4; Bronchitis 3; Pneumonia 11; Diarrhoea 11; Other digestive diseases 2; Premature birth 15; Congenital malformations etc. 16; other violent causes 8; all other causes 5. The Infant Mortality Rate was 43 per 1,000 live births. GENERAL PROVISION OF HEALTH SERVICES. 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 3,912 visits to 446 cases. Ultra Violet Light Clinic. This Clinic was open throughout the year and 13,042 attendances were made, and in addition 370 massage, 965 radiant heat and 504 infra-red treatments were given. Maternity and Child Welfare Centres. The four Centres at Parson's Green, Greyhound Road, Wandsworth Bridge Road and Burne Jones House were open throughout the year, the number of weekly sessions at 31st December being for antenatal 13; postnatal 2; infant 14. The attendances of children under one year of age totalled 16,695 and of children aged one to five years 6,261. The number of attendances at the antenatal clinics was 10,395. Home Visiting. The total number of visits paid by the Health Visitors was 22,945. Infant Life Protection. At the end of the year there were 44 children in the care of 33 foster-mothers. Dental Clinic. Attendances at this clinic which is open for at least one session per week, extra sessions/arranged according to the need, totalled 2,488. Maternity Home. During the year 322 women were admitted for labour and 59 for antenatal treatment. There were no maternal deaths and only one infant death, due to prematurity. At the request of the Ministry of Health the Home was closed at the end of August and the staff and equipment transferred to Rotherham for the opening of an emergency home. The arrangement was cancelled in a few weeks and the Home re-opened on Ist October. Additional Maternity Accommodation. Under the L.C.C. scheme four beds were allotted to this Borough in Queen Charlotte's Hospital from July and by the end of the year 34 women had been admitted. Babies' Hospital. Prior to its compulsory closing (see Preface) 28 babies had been admitted. There was one death. Day Nurseries. At the end of the year there were six nurseries open in the Borough, the Munster Nursery of the "hutted" type with accommodation for 72 children having been opened in July and the staff and children from Eridge House transferred there. The latter Nursery was temporarily closed owing to the distance between the Nursery and the Air Raid Shelter. Between them the six nurseries provided accommodation for 315 children. The construction of another nursery for 72 children was nearing completion when the building sustained damage from enemy action and eventually the site was handed over to the Ministry of Works. Supply of sheets for expectant mothers. The arrangements outlined in Ministry of Health Circular 154/44 were adopted and by the end of the year 67 dockets had been issued through the Maternity and Child Welfare Centres. SANITARY CIRCUMSTANCES OF THE AREA. Sanitary Inspection. The following table gives a summary of the inspections made by the sanitary inspectors during the year: Cause of Inspection First Inspections Re- Inspections Total Inspections Complaint 2,555 5,654 8,209 Infectious Disease 914 49 963 Infirm and Dirty Tenants 71 8 79 Rent Restrictions Act applications 2.1 5 26 TOTALS 3,561 5,716 9,277 As a result of these inspections 1,329 Intimation Notices and 321 Statutory Notices were served. In addition to the inspections shown above the inspectors paid 539 visits in connection with the repair of drains and 704 in connection with other repairs, caused by enemy action. Factories &c., The visiting of food premises, factories etc. was continued 2,059 visits being made. Legal proceedings were instituted in 8 instances for non-compliance with Statutory Notices. Drainage of Buildings. During the year 25 plans were approved by the Public Health Committee. Rent Restrictions Acts. In response to applications by tenants 14 certificates were issued during the year. Aged. Infirm and Physically incapacitated persons. During the year 79 visits were paid by the woman sanitary inspector to aged persons and in one instance a notice was served regarding the condition of the premises. No applications for compulsory removal were made. Rat repression. During the year 2,447 visits were made and 958 rats are known to have been destroyed as the result of action taken by the Rat Officer. In connection-with the Government's publicity campaign 445 visits were paid to premises reported as infested. Other inspections. The Inspectors also paid visits in connection with billets for homeless persons 199; air raid shelters 93; evacuation 216; public conveniences 101; application for re-housing 51; certificates of essentiality. 100. Disinfestation. Number of rooms disinfested was 242 and 17 families had their furniture treated by HCN process prior to removal to a Borough Council estate. In addition public air raid shelters were treated on 113 occasions. Scabies. Treatment for Scabies was arranged for 226 men, 479 women and 220 children. All cases were followed up to ensure that contacts received appropriate treatment. Other conditions. Treatment was given for 10 men, 95 women and girls and 53 children who were suffering from Pediculi capitis. Close contact with the hairdressers in the borough is maintained and many of the girls and women had been referred by them. Supervision of Food. During the year 1,000 samples of food and drugs were submitted to the Public Analyst and 65 or 6.5 per cent were reported adulterated. None of these adulterated samples call for any special comment. PREVALENCE AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. Notifiable diseases. The number of notifications received, after correction, were: Diphtheria 19; Scarlet Fever 253;Erysipelas 47; Typhoid 1; Puerperal 7; Puerperal Pyrexia 14; Corebro-Spinal Meningitis 8; Ophthalmia Neonatorum 4; Tuberculosis of Respiratory system 182; Non-Pulmonary Tuberculosis 32; cheasles 213; Pneumonia 75; Diarrhoea (under 2 yrs of age; 45; Malaria 2; Whooping Cough 209; Dysentery 37 ; Scabies 462; Food poisoning 1. The number of cases of Diphtheria decreased by 24 compared with the previous year, of Scarlet Fever by 172, measles by 815, Diarrhoea by 7. and Whooping Cough by 134. Smallpox. Contacts of cases of smallpox numbering 23 were kept under observation during the year but no cases occurred in the borough. Diphtheria Immunisation, The number of sessions held was 112 and 843 new cases attended, a total of 4,876 attendances being made. By the end of the year 12,644 children had been immunised since the beginning of the campaign in 1934. Cancer. The percentage of deaths from this cause was 13.3 a slight reduction compared with last year. Tuberculosis. The death rate from this cause was 0.83 (pulmonary 0.79 and non-pulmomary 0.04). During the year 182 notifications of pulmonary and 32 of non-pulmonary were received. At the Dispensary 3,530 attendances were made including 651 cases who attended for the first time: 111 were referred for institutional treatment. Comments on Mass Radiography and on the Allowances Scheme are included in the pr eface to this report. Vaccination. The annual return furnished to the Ministry of Health showed that 60.8 per cent of the children born in 1943 had been successfully vaccinated by 31st January, 1945. Disinfection. The routine disinfection of premises after the occurrence of infectious disease was continued and 18,396 articles were treated at the Disinfecting Station. Foot Clinic. This clinic was open for four sessions per week and the demand for the facilities provided was very constant, in fact it had been found necessary to establish a waiting list extending for several weeks in order to cope with the number of applicants. A total of 1083 treatments was given during the year. Mortuary. During the year 223 bodies were received into the Mortuary (apart from those due to enemy action) and 172 Post-Montems were carried out.