LIBRARY Ful 38 METROPOLITAN BOROUGH OF FULHAM REPORT of the MEDICAL OFFICER OF HEALTH for the year 1947 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, 1948. 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 1947. On the instructions of the Ministry of Health this report is again in an abbreviated form. According to the Registrar General's estimate, the midyear population of the borough was 122,280, which shows an increase of 5410 over the estimated mid-year figure for the previous year. The birth rate of 21.58 per 1,000 of the population is very slightly increased, but the infantile mortality rate, 32.9 per 1,000 live births, shows a very considerable drop from that of the figure for 1947, which was 39 Per 1,000 population, and is again the lowest rate on record for the borough. Statistical records indicate that the health of the borough is maintained at a very satisfactory standard, and the year has been a quiet one from the infectious disease standpoint, although Fulham has experienced an outbreak of Poliomyelitis in common with the rest of the country. The epidemic has been by far the largest ever experienced in Great Britain, although outbreaks of this disease have been common and widespread in North America, Scandinavia and Australasia; whilst during the recent war years there have been outbreaks in the islands of Malta, St. Helena and Mauritius. The outbreak in Fulham, which commenced in June, rose to its maximum severity in August and September, and subsided during the following two months, was responsible for 27. notifications (4 being fatal); but I feel that we have come off comparatively lightly compared with some other areas in the country and in London. There have been numerous theories put forward to account for the epidemic of Poliomyelitis, but the fact remains that in spite of extensive research and case investigation, no definite evidence has been deduced to show why the disease was so much more prevalent in England in 1947 than ever before, or how infection was spread. The Public Health Department in close co-operation with that of the Borough Surveyor and the Baths' Superintendent, has carried out all sanitary and hygienic precautions which were considered at all likely to have a bearing on the prevention of infection of Poliomyelitis, but unfortunately it is impossible to ascertain if they were effective. As in the previous year many difficulties were encountered in dealing with housing dilapidations and repairs of insanitary defects. Delays were generally due to shortage of labour and materials, or in some cases to difficulty in arriving at decisions as to what was due to war damage or normal deterioration; and a very large burden of work has fallen on the Sanitary Inspectors in their endeavour to keep work in hand and properly carried out, especially as there has been considerable difficulty in maintaining a full staff. Close touch has been kept with the Housing Department of the borough, many urgent cases being referred to the Director of Housing & Public Buildings for priority consideration, and I should like to express my appreciation to him for much help in this connection from him and his staff. The Maternity & Child Welfare services have had a busy year, and more than upheld their high record of efficiency. Special attention has been given to illegitimate children and constant supervision maintained over foster mothers. Diphtheria immunisation progress has been well maintained although the statistical returns are less than in 1947. There are two factors which may largely account for this (a) a special arrangement in the previous year to hold an additional 18 sessions for school children and (b) there were in 1946 over twice the number of notifications of cases of diphtheria in the borough, - and experience has invariably been that applications for immunisation are much more numerous in a locality after the occurrence of a case. The death rate from Tuberculosis, 0.58 again shows a decrease - the figure for the previous year being 0.77. There has been continued difficulty in getting admission to sanatorium, the delay being due without doubt to the scarcity of available beds, owing to the shortage of domestic and nursing staff in the institutions. Various changes in the medical staff of the Maternity & Child Welfare Department have occurred during the year, Drs. Dowds, Brodigan, Wood and Clarke having acted for various periods; and Dr. Michael Elyan was appointed on the permanent staff and commenced - 2 - duty during the summer. I would like to express my appreciation ?nd thanks to the Mayor, Chairman and Members of the Public Health & Maternity & Child Welfare Committees for their consideration and support during the year, and to the members of my staff for their loyal and efficient service at all times. 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. EXTRACTS FROM VITAL STATISTICS FOR THE YEAR 1947 POPULATION, estimated, 1947 122,280 LIVE BIRTHS: Rate per 1,000 of Population Total Males Females 20.11 Legitimate 2459 1274 1185 93 87 1.47 Illegitimate 180 2639 1367 1272 21.58 STILLBIRTHS: 1 Legitimate 47 24 23 0.38 Illegitimate 4 3 1 0.03 51 27 24 0.42 1491 770 721 12.19 DEATHS: Percentage of deaths in public institutions 59 Deaths from puerperal causes: From sepsis From other causes Number of deaths 1 - Rate per 1,000 (Live and Still) births 0.37 - Death Rate of Infants Under One Year of Age: All Infants per 1,000 live births 32.9 Legitimate infants per 1,000 legitimate births 32.5 Illegitimate infants per 1,000 illegitimate births 38.9 Deaths from: Career (all ages) 252 Measles (all ages) - Whooping Cough (all ages) 4 12 Diarrhoea (under two years of age) CLASSIFICATION OF CAUSES OF DEATH; 1491 deaths as follows:- Cerebro Spinal Fever 1; Whooping Cough 4; Tuberculosis of respiratory system 60; other forms of tuberculosis 11; Syphilitic disease 18; Influenza 13; Poliomyelitis 4; Acute Infectious Encephalitis 1; Cancer of (a) buccal cavity 11; (b) uterus 12; (c) stomach and duodenum 41; (d) breast 29; other sites 159; diabetes 9; Intracranial lesions 137; Heart Diseases 393; Other diseases of circulatory system 57; Bronchitis 114; Pneumonia 112; Other respiratory diseases 18; Ulcer of stomach or duodenum 27; Diarrhoea (under 2 yrs.) 12; Appendicitis 4; Other digestive diseases 28; Nephritis 31; Premature birth 17; Congenital malformations etc. 32; Puerperal and post abortive sepsis 1; Suicide 8; Road traffic accidents 12; Other violent causes 32; All other cause's 83. INFANTILE DEATHS. There were 87 deaths of infants under the age of one year the causes being as follows:- Congenital malformations 26; Prematurity 17; Pneumonia 17; Diarrhoea 12; Asphyxia 4; Whooping Cough 2; Acute Infective Encephalitis 1; Influenza 1; Cerebro-spinal fever 1; Bronchitis 1; Other respiratory diseases 1; Meningitis 1; Otitis Media 1; Infective hepatitis 1; Marasmus 1. The Infant Mortality rate was 32.9 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 9,001 visits to 1,141 cases. Ultra Violet Light Clinic. This Clinic was open throughout the year and 12,981 attendances were made, and in addition 379 massage, 1710 radiant heat and 219 infra-red treatments were given. Maternity and Child Welfare Centres. The four Centres at Barson'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 15. The attendances of children under one year of age totalled 33,704, and of children aged one to five years 8,896. The number of attendances at the antenatal clinics was 18,343. Home Visiting. The total number of visits paid by the Health Visitors was 28,807. Infant Life Protection. At the end of the year there were 60 children in the care of 42 foster-mothers. Premature Infants. During the year 41 premature births have been notified, of which 25 were born in hospital, and 16 at home. There have been 4 deaths. Denta1 Clinic. This Clinic averaged 2 sessions per week, and 2,181 attendances were made by 776 cases. Maternity Home. During the year 631 women were admitted for labour and 98 for antenatal treatment. There were no maternal deaths, but 5 infant deaths, due to prematurity. There were 7 still-births (5 macerated). Additional Maternity Accommodation. Under the L.C.C. scheme eight beds were allotted to this Borough in Queen Charlotte's Hospital, and during the year 96 women had been admitted. Babies Hospital. Owing to staffing and other difficulties the Babies Hospital has been used temporarily as a Day Nursery for Babies under the age of 2 years. Accommodation was provided for 18 infants. Day Nurseries. In addition to the Babies' Hospital four Day Nurseries were maintained during the year. Accommodation was provided for 185 children, and there was constantly a long waiting list for vacancies. A review of the circumstances of all parents with children in the Nurseries was carried out in October with a view to the removal of those cases where it was considered that the need was not sufficiently great to make it essential that the mother should work. This action was designed to provide accommodation for the priority cases on the waiting lists. 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 954 dockets were issued. Home/Domestic Help Service. At Home and Domestic Help Organiser was appointed in April 1947, md by the end of the year the Service was firmly established, nearly 20,000 hours having been worked in the patients' homes. - 3 - 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 Complaint First Inspections Re- Inspections Total Inspections Complaint 22,622 6,404 16,218 Infectious Disease 596 25 621 Infirm and Dirty Tenants 24 24 - Rent Restrictions Act applications 37 37 - 16,243 7,061 23,304 TOTALS As a result of these inspections 4,551 Intimation Notices and 1,928 Statutory Notices were served. In addition to the inspections shown above, 617 drains were tested, 3,800 inspected, and 49 visits paid in connection with War Damage to drains. Factories &c. The visiting of food premises, factories etc. was continued 1,995 visits being made. Legal proceedings were instituted in 130 instances for noncompliance with Statutory Notices. Drainage of Buildings. During the year 100 plans were approved by the Public Health Committee. Rent Restrictions Act. In response to applications by tenants 37 certificates were issued during the year. Aged. Infirm and Physically incapaci tated persons. During the year 24 visits were paid by the woman sanitary inspector to aged and infirm persons and to dirty tenants. Rodent Control. Block Control of the Borough was continued during 1947 in accordance with the recommendations of the Ministry of Agriculture & Fisheries. In October the number of operatives was increased to 6, and quite a number of business premises were treated at the request of the occupiers. The number of complaints received was 495 compared with 487 during 1946. Disinfestation. The number of rooms disinfested was 849, and bedding from 12 premises was treated prior to removal to Borough Council flats. Scabies. Treatment for Scabies was arranged for 132 men, 277 women and 173 children. All cases were followed up to ensure that contacts received appropriate treatment. Other conditions. Treatment was given for 3 men, and 54 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 (457 milk) and drugs were submitted to the Public Analyst, and 37 or 3.7 per cent were reported as adulterated. None of these adulterated samples call for any special comment. Samples of milk taken for bacteriological examination. Tuberculin Tested Milk (Certified) 1 Tuberculin Tested Milk (Pasteurized) 8 Tuberculin Tested Milk 12 Pasteurized Milk 167 Sterilized 9 197 Total Ice Cream. 68 samples examined. Water Supply. The Metropolitan Water Board are the responsible authority for supplies of water in this Borough. No complaints have been received during the year. No well waters are used for drinking or culinary purposes. 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 17 (39); Scarlet Fever 93 (157); Erysipelas 23 (31); Puerperal Fever 1 (8); Puerperal Pyrexia 10 (14); Cerebro- Spinal Meningitis 6 (11)j Ophthalmia Neonatorum 8 (4); Tuberculosis of Respiratory system 226 (241); Non-Pulmonary Tuberculosis 33 (22); Measles 631 (814); Pneumonia 75 (53); Diarrhoea (under 2 yrs. of age) 41 (33); Whooping Cough 236 (227); Dysentery 1 (13); Scabies 160 (312); Food Poisoning 7 (5); Encephalitis LethargIca - (l); Poliomyelitis 27 (3); Malaria - (2); Paratyphoid "B" - (1); Polioencephalitis 8 (-). Smallpox. Contacts of cases of smallpox numbering 55 were keptunder observation during the year, but no cases occurred in the borough. Diphtheria Immunisation. The number of sessions held was 102 and 1,615 new cases attended, a total of 6,896 attendances being made. By the end of the year 15,032 children had been immunised since the beginning of the campaign in 1934. Cancer. The percentage of deaths from this cause was 16.9, a slight decrease compared with last year. Tuberculosis. The death rate from this cause was 0.58 (pulmonary 0.49, and non-pulmonary 0.09). During the year 226 notifications of pulmonary and 33 of non-pulmonary were received. At the Dispensary 4,758 attendances were made including 987 cases who attended for the first time; 113 were referred for institutional treatment. 4,064 patients were interviewed by the Almoner, and in 785 cases extra nourishment was provided. The Tuberculosis Officer (Dr. Price) has submitted the following notes on the Treatment Allowances and Care Association work:- The Tuberculosis Treatment Allowances were restricted during this year to those who appear likely to recover and who had given up work to undertake treatment. Many patients were, therefore, forced to apply for relief from the Social Welare Department. The only increase in the scale of allowance was that for coal, and the allowances were quite inadequate to meet the increased cost of living. The consequent hardship must have had a deleterious effect on those patients dependent on Tuberculosis Treatment Allowances. Bacteriological & other examinations carried out during the year. Examination for Tubercle Bacilli. Sputum 1162 (Positive 211, Negative 951) Urine 4 (Positive 2, Negative 2) Other examinations. Diphtheria 367 Enteric Fever 6 Gonococci 7 Urine Tests 180 Miscellaneous 56 Vaccination. The annual return furnished to the Ministry of Health showed that 53.2 per cent of the children born in 1946 had been successfully vaccinated by 31st January 1948. Disinfection and Laundry Services. 273 rooms were disinfected after cases of Infectious Disease and 1784 articles were stoved. 6590 dressing gowns from the Maternity Home were sterilized. The volume of laundry work undertaken at the Disinfecting Station for the Maternity Home, Day Nurseries, etc., showed a sharp increase and 43,367 articles were laundered during the year. This total included 14,566 sheets, 22,858 towels, and 2,232 overalls. Foot Clinic. This Clinic has been open for 11 sessions per week, and 3,630 attendances were made.