LIBRARY Ful 37 METROPOLITAN BOROUGH OF FULHAM REPORT of the MEDICAL OFFICER OF HEALTH for the year 1946 P.L.T. BENNETT, M.C.j 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, 1947. 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 1946 which has been generally satisfactory - as can be seen from the statistical records in the report. The report on the instruction of the Ministry of Health, follows the abbreviated, form that has been submitted during the past few years. The Registrar General's estimate shows that the population of the borough is slowly coming back to the pre-war figure, no doubt due in a large measure to the return of previous residents from the country and other areas after war-time evacuation, and to the increased birth rate which this year reached 21.4 per 1,000 of the population; the highest rate since 1921. The mid-year population is shown to total 116,870, an increase of 17,080 over the previous year's figure. I should like also to draw attention to the Infantile Mortality rate of 39 P e r 1,000 live births, which is three lower than last year, and the lowest rate on record for the Borough of Fulham. The year under review has been a quiet one from the point of view of infectious disease, and the main difficulties appear to be concerned with housing dilapidations and repair of insanitary conditions due to extreme shortages in materials of many kinds, labour etc. Many of the houses in Fulham were, even before the war, getting worn out, and enemy activity during the bombing periods has increased the defects, which are becoming more and more apparent. Owing to all these adverse factors the operation of the Housing and Public Health Acts has been very difficult to carry out to the proper extent; particularly one could mention overcrowding, and in addition the lack of accommodation has made it a very trying time for young married people endeavouring to find homes. The housing survey of the borough has been steadily proceeded with, and a careful record made of various areas which, at a future date, could be scheduled for action under Sections 3 5 of the Housing Act. It is impossible to foretell at the present time when this is likely to be commenced, but the aim should be to deal with these areas as an urgent priority scheme, due regard being given to the necessary displacements of population and re—housing of same. The establishment of the Foot Clinic in Fulham Road on a full-time basis has had the greatest success, so much so that I feel that the time is ripe to extend the service even further, and if possible to organise branch clinics on a part-time basis for the convenience of residents in remoter parts of the borough who find some difficulty in getting to the one central establishment. Some changes have occurred in the medical staff during the past year - Dr. Shanna Wright, Dr. Dowds and Dr, Harrison having all resigned from service in the Maternity and Child Welfare Department at the Maternity Home a various periods of service; and Dr. Hay has been appointed as permanent Resident Medical Officer at the Home, whilst Dr. Price was appointed Deputy Medical Officer of Health and Tuberculosis Officer in December. My thanks are due to the Chairman and Members of the Public Health and Maternity and Child Welfare Committees for their help and support during the year, and I would like to put on record my great appreciation of the work of the various sections of my staff in the Town Kail and elsewhere, in particular to Dr. Barrett, Mr. Robey (Senior Sanitary Inspector) and Mr. Trendell (Chief Clerk) for so ably carrying on the work during my long absence on sick leave during the latter part of the year. I nave 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. EXTRACTS FROM VITAL STATISTICS FOR THE YEAR POPULATION, estimated, 1946 116,870 LIVE BIRTHS: Rate per 1,000 of Population Total Males Females Legitimate Illegitimate 2289 219 1200 103 1089 116 19.7 1.8 1303 1205 21.5 2508 STILLBIRTHS: Legitimate 54 37 17 0.46 Illegitimate 6 1 5 0.05 60 38 22 0.51 DEATHS: 1515 757 758 12.9 Percentage of deaths in public institutions 58 Deaths from puerperal causes: From sepsis. From other causes. Number of deaths - 3 Rate per 1,000 (Live and Still) births - 1.2 Death Rate of Infants Under One Year of Age: All Infants per 1,000 live births 39 Legitimate infants per 1,000 legitimate births 37 Illegitimate infants per 1,000 illegitimate births 68 Deaths from: Cancer (all ages) 263 Measles (all ages) - Whooping Cough (all ages) 1 Diarrhoea (under two years of age) 9 CLASSIFICATION OF CAUSES OF DEATH: 1515 deaths as follows ;- Cerebro Spinal Fever 3; Whooping Cough 1; Diphtheria 4; Tuberculosis of respiratory system 79; Other forms of tuberculosis 12; Syphilitic disease 16; Influenza 13; Poliomyelitis 1; Acute Infectious Encephalitis 1; Cancer of (a) buccal cavity 12; (b) uterus 13; (c) stomach and duodenum 37; (d) breast 36; other sites 165; Diabetes 10; Intracranial lesions 116; Heart Diseases 390; Other diseases of circulatory system 44° Bronchitis 98; Pneumonia 97; Other respiratory diseases 16; Ulcer of stomach or duodenum 32; Diarrhoea (under 2 yrs.) 8; Appendici-tis 5; Other digestive diseases 34; Nephritis 42; Other Maternal causes 3; Premature birth 17; Congenital malformations etc. 47; Suicide 10; Road traffic accidents 11; Other violent causes 43; All other causes 99. -1- INFANTILE DEATHS. There were 100 deaths of infants under the age of one year the causes being as follows: Congenital malformations 21; Prematurity 17; Atelectasis 15; Pneumonia 15; Suffocation 9; Diarrhoea 8- haemorrhage (cerebral pulmonary, following operation) 3; nephritis 2; erythroblastosis Foetalis 2; Pulmonary tuberculosis 1; Convulsions 1; Injury at birth 1; Influenza 1; Marasmus 1; Infective hepatitis .1; Pyaemia 1; Found dead (? stillborn) 1. The Infant Mortality rate was 39 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 6,406 visits to 682 cases. Ultra Violet Light Clinic. This Clinic was open throughout the year-and 17,001 attendances were made, and in addition 464 massage, 1782 radiant heat and 537 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 51st December being for antenatal 13; postnatal 2; infant 15. The attendances of children under one year of age totalled 28,650, and of children aged one to five years 9,236. The number of attendances at the antenatal clinics was 23,365. Home Visiting. The total number of visits paid by the Health Visitors was 23,301. Infant Life Protection. At the end of the year there were 50 children in the care of 36 foster-mothers. Dental Clinic. This Clinic averaged 2 sessions per week, and 5,084 attendances were made by 857 cases. Maternity Home. During the year 495 women were admitted for labour and 75 for antenatal treatment. There were no maternal deaths, but 5 infant deaths, due to prematurity. Additional Maternity Accommodation. Under the L.C.C. scheme four beds were allotted to this Borough in Queen Charlotte's Hospital and during the year 8l women had been admitted. Babies' Hospital. The Babies' Hospital was re-opened in April after repair following war damage, and 20 children were admitted during the period April to December. Day Nurseries. In April 1946 the Council decided to hand over the three prefabricated buildings to the County Council for use as Nursery Schools, and to retain the other four Wartime Day Nurseries so that the accommodation available was reduced to 185 places. At no time during the year was the waiting list very small, and towards the end of the year the M. & C.w. Committee reviewed the circumstances of all parents with children in the Nurseries, and gave three month's notice to those who did not seem in such urgent need of accommodation, as those on the waiting list. Supply of sheets for expectant mothers. The arrangements made in 1944 for the issue of priority dockets to expectant mothers continued in operation, and during the year 1497 dockets "were issued. SANITARY CIRCUMSTANCES OF THE AREA Sanitary Inspection. The following table gives a summary of the inspections made by the sanitary inspectors during the years: First Inspections Re- Inspections Total Inspections Cause of Inspection Complaint 5244 13,661 18,905 1276 46 1,320 Infectious Disease Infirm and Dirty Tenants 24 5 - 29 Rent Restrictions Act applications 20 20 TOTALS 6,564 13,712 20,274 As a result of these inspections 3,870 Intimation Notices and 1,598 Statutory Notices were served. In addition to the inspections shown above, 673 drains were tested, 4,106 inspected, and 63 visits paid in connection with War Damage to drains. Factories &c. The visiting of food premises, factories etc. was continued 1,391 visits being made. Legal proceedings were instituted in 40 instances for non-compliance with Statutory Notices. Drain age of Buildings. During the year plans were approved by the Public Health Committee. Rent Restrictions Acts. In response to applications by tenants 39' Certificates were issued during the year. Aged, Infirm and Physically incapacitated persons. During the year 29 visits were paid by the woman sanitary inspector to aged and infirm persons and to dirty tenants. Rodent Repression. On October 1st, 1946 the number of rodent operatives was increased to three, and inspection and treatment of the borough on the Ministry of Food "block control 1, system was inaugurated. By the end of the year 2,457 premises had been inspected, and 98 found to be infested. The number of complaints by householders of rat infestation increased from 366 in 1945 to 407, probably due to the heavy rains in the latter part of the year driving the rats out of the drains and sewers. Disinfestation. The number of rooms disinfested was 346, and bedding from 9 premises was treated prior to removal to Borough Council flats. Scabies. Treatment for Scabies was arranged for 222 men, 352 women and 196 children. All cases were followed up to ensure that contacts received appropriate treatment. other condi tions . Treatment was given for 4 men, and 57 women, girls and 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 3.3 P er cent were reported as 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,- (showing the previous year's figures in brackets) were: Diphtheria 39 (51; Scarlet Fever 157 (238); Erysipelas 31 (3l); Puerperal Fever 8 (8); Puerperal Pyrexia 14 (17); Cerebro-Spinal Meningitis 11 (8); Ophthalmia Neonatorum 4 (14); Tuberculosis of Respiratory system 241 (209) ; Non-Pulmonary Tuberculosis 22 (22); Measles 814 (1,153); Pneumonia 53 (70); Diarrhoea (under 2 yrs. of age) 33 (68); Whooping Cough 227 (l60); Dysentery 13 (75); Scabies 312 (450); Food Poisoning 5 (-); Encephalitis Lethargica 1 (-); Poliomyelitis 3 (-); Malaria 2 (-); Paratyphoid "B" 1 (-). Smallpox. Contacts of cases of smallpox numbering 20 were kept under observation during the year but no case occurred in the borough. Diphtheria Immunisation. The number of sessions held was 120, and 2505 new cases attended, a total of 10,379 attendances being made. By the end of the year 13,549 children had been immunised since the beginning of the campaign in 1934. Cancer. The percentage of deaths from this cause was 17.4, a slight increase compared with last year. Tuberculosis. The death rate from this cause was 0.77 (pulmonary 0.67, and non-pulmonary 0.10). During the year 241 notifications of pulmonary and 22 of non-pulmonary were received. At the Dispensary 4,585 attendances wore made including 957 cases who attended for the first time; 133 were referred for institutional treatment. Vaccination. The annual return furnished to the Ministry of Health showed that 64.9 per cent of the children born in 1945 had been successfully vaccinated by 31st January, 1947. Disinfection. 284 rooms were disinfected after infectious disease, and 2,258 articles were treated. 7,774 dressing gowns and blankets from the Maternity Home and Day Nurseries were sterilised. Owing to difficulty in arranging for the necessary laundry work to be carried out for the Maternity Home and Day Nurseries, extra staff were engaged and as from September all linen, towels, etc. were laundered at the Disinfecting Station. Foot Clinic. This clinic has been open for 11 sessions per week, and reached the total of 3,136 attendances. _ 4 -