LIBRARY GRE 38 METROPOLITAN BOROUGH OF GREENWICH ABRIDGED REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1940. F. R. WALDRON, M.D., D.P.H., Health Department, Town Hall, Greenwich, S.E.10. September, 1941. To the Mayor, Aldermen and Councillors of the Metropolitan Boroughof Greenwich. Mr. Mayor, Ladies and Gentlemen, I have the honour to submit my report for the year 1940. In accordance with the instructions of the Ministry of Health, it again presents in an abridged form a summary of the work performed by the various sections of the department. The fact that the incidence of infectious diseases has been extremely low is a matter for gratification, especially in view of the adverse circumstances during the latter part of the year. The birth rate (15.7 per 1,000) was somewhat above that for London as whole, and the death rate (17,5 per 1,000) considerably higher than usual, due to the inclusion in the figure, of deaths through enemy action. The infantile mortality rate was 56 per 1,000 births. The Registrar General's estimate of the population, namely 74,280 is a decrease of 20,510. In view of the fact that the population must be regarded as fluctuating during the year, it is difficult to present conclusive statistics. The work of the District Sanitary Inspectors was necessarily restricted, and towards the end of the year was mainly concentrated on the many problems arising from war damage. Notwithstanding the many difficulties, the routine sampling of food and drugs has been carried out systematically, and every effort has been made to maintain a high standard as regards sanitary circumstances generally. Up to September, the Antenatal and Infant Welfare Centres functioned normally, though on a restricted basis, because of the evacuation of mothers and children. The Maternity Home, being still closed, the 'Home Helps' scheme was utilised on an increasing scale. Throughout the year, the volume of work entailed in Air Raid Precautions, markedly increased. In July, a Welfare Centre, which had been used as a Stretcher Party Depot, was again put into service, and the Unit was re-housed in new quarters. By September, the various aspects of the casualty services were consolidated, and reorganised. Owing to the calling up of personnel, and necessary continued recruitment, training had to be maintained in order to keep the services up to the desired state of efficiency. I should like to take the opportunity of again expressing my warm appreciation of the very efficient manner in which the members of my staff have carried out their onerous and responsible duties. Finally, I desire to thank the Chairman and members of the Public Health and Maternity Committee for the consideration shown to me during the past year. I have the honour to be, Your obedient Servant, F.R. WALDRON STATISTICS As in the previous year local statistics in regard to Births & Deaths are affected, chiefly owing to considerable Proportions of the population being evacuated to reception areas. It should be recorded also that non-civilian deaths i.e. all males serving in H.M. Forces are not now included. POPULATION (Registrar General's. Estimate) 74,280 LIVE BIRTHS Total Males Females Legitimate 1134 568 566 Illegitimate 34 21 13 BIRTH RATE per 1,000 estimated civilian population 15.76 " " " (England & Wales) 14.6 "(London) 13.7 STILLBIRTHS Legitimate Total Males Females Legitimate 16 8 8 Illegitimate 2 2 - Rate per 1,000 total (live and still) births 15.2 DEATHS Total Males Females 1273 687 586 Death rate, per 1,000 civilian population:- Crude Adjusted 17.18 17.52 " " " " " " (Engla nd & Wales) 14.3 " " " " (London) 17.8 DEATHS FROM PUERPERAL CAUSES Puerperal Sepsis 1 Other Puerperal Causes 0 1 Rate per 1,000 total (live and still) births .89 DEATHS OF INFANTS UNDER ONE YEAR. All infants per 1,000 births 56 (Rate for London) 50 Legitimate Infanta per 1,000 legitimate births 54 Illegitimate infants per 1,000 illegitimate births 117 DEATHS Deaths from Cancer (all ages) 140 " " Measles ( " " ) - " " Whooping Cough ( " " ) - "Diarrhoea (under 2 years) 3 PROVISION OF HEALTH SERVICES IN THE BOROUGH Notification of Births The total number of births notified in the Borough was 1350. Of these 531 were transferred to other Authorities. Particulars were received o.f 2i 4 births which took place in other areas, thus pivin/? a net figure of 1093. Home Nursing such cases needing special nursing are referred to the ranyar mission and the queen nursing association. Health Visitors Visits Revisits Total Infants under 1 year 1187 3548 4735 Children 1-5 years 304 5534 5838 Re Infectious Diseases 149 42 191 Miscellaneous 1445 914 2359 Despite the difficulties encountered in maintaining the Maternity and Child If are Services in the Borough luring war time conditions, it is gratifying to be able to record that 9 Infant Consultations and 4 Ant e-NcalSessions were held weekly. Much additional work wasundertaken by the Health Visitors in connection with the evacuation of expectant mothers to reception areas and n lso in connection with vhe introduction of the National Milk Scheme. The following is a brief summary of the work carried out during the year h Infant Welfare Centre Attendances Babies 8919 Children 1-5 years 8643 17562 New Cases - Babies 811 Children 1-5 years 581 1392 Medical Consultations 7927 Ante-Natal & Post-Natal Clinics. No. of New Cases - Ante-Natal 676 No. of New Cases - Post-Natal 67 No. of Attendances 2717 Artificial Sunlight Treatment 626 No. of New Cases No. of Treatments given 8658 No, of Patients at 31st. December 1940 100 Child Life Protection The number of Foster-Mothers on the Register at the end of the year was 30, but only 11 were actually receiving children. The number of children on the Register was 25. Periodical visits were made by the Health Visitors who act as Child Protection Visitors. Home Helps In connection with the Council's Maternity & Child Welfare Scheme, Home Helps were provided at a net cost to the Council of £103.14.11d. Foot Clinics Despite curtailed sessions during the winter months, the attendances have been well up to the average, the number being 3745 Supply of Milk to Mothers & Children The total amount supplied during the year was:- Pkts. Dried Milk (a) distributed free 13903 " " (b) sold at full or reduced prices 12444 Liquid Milk (a) and (b) gallons National Milk Scheme About the middle of the year the National Milk Scheme was introduced by the Ministry of Food and provided for fresh milk to be available for mothers and young children either free, or at half price if the income scale exceeded a certain standard. Provision was made for dried milk to be available for babies up to the age of one year where such was advised on medical grounds. The Scheme naturally ran on somewhat similar lines to the Council's own Maternity and Child Welfare organisation, and for this reason the administration thereof was referred to the Department, the Medical Officer of Health being provisionally appointed Milk Officer. Some 3,000 applications were receivedin respect of the first quarter. The work considerable demands upon both the clerical staff in carrying out the necessary clerical work the Health Visitors in connection with verifying particulars a nd authorising supplies. Towards the end of the year, arrangements wore made for the National Milk Scheme to be transferred to the Food Control Department, co-operation with the Welfare Centres continuing in respect of distribution of dried milk etc. Convalescent Treatment Owing to war conditions, a number of the coastal Convalescent Homes were closed down and where possible were re-opened in safer areas. No. of Children for whom Convalescent Treatment was arranged 30 Average duration of stay 6 weeks Bacteriological Examinations The undermentioned specimens were submitted to the Seamen's Hospital Laboratory for bacteriological investigation, the results being:- I Positive Negative Total 12 275 287 Diphtheria Tuberculosis 60 274 334 1 8 9 Typhoid Miscellaneous 4 5 9 Dental Clinic M.& C.W. T.B. Total 10 46 No. of Sessions 36 " " New Cases 143 12 155 " " Attendances 347 26 373 " Extractions 461 45 506 SANITARY CIRCUMSTANCES OF THE AREA. During the period from September to the end of the year, much of the District Inspectors' time was devoted to inspection of premises consequent upon damage by enemy action. Close co-operation was made with the Administrative Department set up by the Council, necessitating numerous reports and certificates in connection with First Aid Repairs, Billeting, Storing of Furniture etc. Summary of Work Performed:- Houses Inspected (War damage) 4090 do (Complaints, Nuisances) 974 do (Infectious disease) 118 do (Overcrowding ) 99 No. of re-inspections 5190 Factories Workshops inspected 246 Shop Premises (Shops Act 1934) 73 Premises (Pharmacy & Poisons Act) 32 No. of Intimation Notices served 901 No. of Statutory Notices served 165 Disinfection. No. of Rooms Disinfected 613 " " Beds " 245 " Mattresses " 457 " " Blankets " 3734 " " Quilts " 363 " " Sheets " 453 " " Miscellaneous articles disinfected 2026 " " " " destroyed 403 Verminous Conditions. No. of attendances at Cleansing Stations:- Adults 38 Children 554 Disinfestation. No. of applications received 317 " rooms treated 831 " " " re-treated. 23 " " Shelters treated 11 " " Gallons Vermicine used 309 HOUSING. As stated in last year's Report, action taken under the Housing Act has fallen into abeyance. Despite the restriction on building operations, the following houses were completed and occupied during the year:- L.C.C. (Houses & Flats):- 158 Kidbrooke Housing Estate 57 Thames Street (Rockfield House) Commerell Street (Dyson House) 72 do (Cliffe House) 14 301 G.B.C. Flats (East Mascalls) 26 Private Enterprise 15 342 INSPECTION AND SUPERVISION OF FOOD MILK The number of Dairy Premises on the Register is 60 and there are 182 Purveyors of Milk now registered. No. of Inspections ... 199 ICE CREAM PREMISES No. on Register 148 No. of Inspections 159 PRESERVED FOOD PREMISES No. on Register 136 No. of Inspections 107 MILK (SPECIAL DESIGNATIONS) ORDERS 1936/38 Licences granted to sell "Pasteurised" milk 25 " " "Tuberculin Tested" milk 8 Supplementary Licences granted 2 INSPECTION OF FOOD PREMISES During the year 3,797 visits were made. As a result of advice given 79 improvements to premises were carried out. Numerous visits were made at premises damaged by enemy action with a view to arranging for the salvage of foods at such premises. IMPORTED FOOD SURRENDERED Total Amount - 2 tons 15 cwt. 1 qr. 2 lbs. BACTERIOLOGICAL EXAMINATIONS 29 samples of milk, including 22 from local hospitals and schools were submitted. With one exception all were found to comply with the standards required. EXAMINATION FOR PRESENCE OF T. B. One sample of milk was examined for presence of tuberclebacilli and was found to be free from infection." FOOD & DRUGS ACT 1938 During the year 415 samples were submitted to the Public Analyst for analysis Of these 158 were "formal" and 257 "informal". The chief article sampled was milk, 11 out of 111 samples were adulterated. PREVALENCE & CONTROL OVER INFECTIOUS DISEASE The total number of infectious diseases was 501 which is easily the lowest on record. Even allowing for the fact that a large proportion of the child population have been evacuated to evacuation areas, it is still difficult to understand the low incidence generally, having regard to the abnormal conditions under which families were living during the latter half of the year. The notifications received were as under:- DISEASE UNDER 1 Yr. 1 - 5 Years 5 Yrs. & UPWARDS TOTAL No. ADMITTED TO HOSPITAL Diphtheria 1 20 24 45 45 Dysentery 1 1 - - - - 19 19 Erysipelas - 1 18 45 64 11 60 Scarlet Fever Enteric Fever - 7 9 9 2 - 1 1 1 Puerperal Fever - 11 Puerperal Pyrexia 11 11 - - Cerebro-Spinal Fever 2 18 23 23 8 3 62 44 114 37 Measles 5 22 4 Whooping Cough 2 15 8 Diarrhoea 12 4 16 - Ophtalmia Neonatorum 3 3 2 - - 95 95 66 Tuberculosis, Pulmonary - - 7 Non-Pulmonary 9 9 - - 5 5 59 69 27 Pneumonia, Acute Primary or Acute Influenzal 501 311 TOTALS 34 130 337 VACCINATION Of the 1,755 births registered during the year 1939, 696 were successfully vaccinated (39.6 per cent) TUBERCULOSIS New Cases and Mortality. Age Periods Years 0 - 1 New Cases Deaths Respiratory Non-Respiratory Respiratory Non-Respiratory M F M F M F M F 1-5 1 1 1 5-15 3 1 2 5 11 3 15 - 25 21 24 2 2 1 25 - 35 19 12 2 3 3 9 1 1 35 - 45 11 7 j L 1 11 1 45 - 55 11 1 2 2 1 2 1 55 - 65 6 4 1 9 4 6 1 65 & Upwards 5 4 TOTALS 76 49 7 10 37 28 4 Death Rate from Tuberculosis (all forms) 0 . 97 per 1,000 " " (Pulmonary) 0.87 " " " " (Non Pulmonary) 0.10 TUBERCULOSIS DISPENSARY The number of definite cases of tuberculosis on the Dispensary Register at the end of the year:- Pulmonary Non-Pulmonary Total Adults (Males (Females 221 32 253 190 34 224 50 Children (Males (Females 18 6 32 9 15 542 GRAND TOTAL 1,692 Number of Patients Attendances " " Visits by Tuberculosis Health Visitors 2,128 " " Sputum Examinations 257 441 " " X-Ray