GRE 40 METROPOLITAN BOROUGH OF GREENWICH ABRIDGED REPORT of the ACTING MEDICAL OFFICER OF HEALTH for the Year 1942. CHARLES PORTER M.D., B.Sc., M.R.C.P. (Ed.) Of the Middle Temple, Barrister-at-Law. Health Department. Town Hall, Greenwich, S.E. 10. June 1943. To the Mayor, Aldermen & Councillors of the Metropolitan Borough of Greenwich. Mr, Mayor, Ladies & Gentlemen, This Report covers the year 1942 and is like several of its predecessors, in accordance with instructions of the Ministry of Health, an abridged one. Since it deals with a period before I began to act and while Dr. Waldron, who entered upon Military Service in January 1943, was still in charge of the Public health Department, the report is perhaps even more abridged than that for 1941. The showing of the Borough for the year 1942 from the Health point of view is eminently satisfactory. The Birth Rate at 18.75 per 1000 is only a little short of the high figure 18.92 attained in the year 1925. The Death Rate, 13.7 per 1000 is lower than that for the previous year by 3 per 1000; while the Infantile Mortality and Maternal Mortality Rates of 32 and 0.86 respectively are again low and very much below the rates for England and Wales. For the third successive year notifications of Infectious Disease were well below the mean. The slight increase in the case of Diphtheria was to some extent countered by an increase in the number of children immunized against the Disease. Scabies gave rise to some anxiety. Owing to increase of Scabies generally throughout the country, in which the Borough shared,, additional powers have been given to Local Authorities in the Scabies Order 1941 to combat the disease. Apart from other steps taken locally, provision for treatment additional to that at Tunnel Avenue was made by utilising the Gas Cleansing Station attached to the Seamen's Hospital. Here all adult male persons are examined and treated. A trained nurse has also been engaged to assist at the Centre and follow up cases. The fact that a great deal of work was done in connection with the provision of War -Time Nurseries calls for mention and it may be noted that in May as a temporary expedient, arrangements were made at four of the Council's First Aid Posts to receive a limited number of children until the proper facilities were available. By the end of the year W ar-Time Nurseries were fully functioning near the Deptford boundary, at East Greenwich and at Blackheath. I feel sure that it would he the wish of Dr. Waldron that reference should be made to the valuable services rendered by the staff of the Department and tribute paid to them on account of the work they did and the loyalty they displayed. He would also I know, like to express gratitude to the Chairman and Members of the Public Health, Maternity and Child Welfare Committee and to Colleagues in other Departments of the Council's service. It gives me great pleasure to do this and to add words of thanks on my own behalf. I am, Mr. Mayor, Ladies & Gentlemen, Your Obedient Servant, Charles Porter. STATISTICS, Year 1942. Statistics for the year 1942 are again presented in an abridged form. During the war period deaths of males and females serving in H.M. Forces are excluded from civilian records. POPULATION. (not available for publication) LIVE BIRTHS. Total. Males. Females. Legitimate 1083 579 504 Illegitimate 49 22 27 BIRTH RATE per 1,000 estimated civilian population - 18.75 STILLBIRTHS. Total. Males. Females. Legitimate. 26 1 17 1 9 - Illegitimate. Rate per 1,000 total (live and still) births - 23.3 DEATHS. Total. Males. Females. 391 827 436 Death rate per 1,000 civilian population - Crude 13.7 DEATHS FROM PUERPERAL CAUSES. Puerperal Sepsis Other Puerperal causes 0 1 1 Rate per 1,000 total (live and still) births - 0.86 DEATHS OF INFANTS UNDER ONE YEAR. All infants per 1,000 births 32 Legitimate infants per 1,000 legitimate births. 29 Illegitimate " " " illegitimate births. 102 DEATHS. Deaths from Cancer (all ages) 133 " " Measles ( " " ) 2 " " Wh.Cough ( " " ) - " " Diarrhoea (under 2 years) 1 PROVISION OF HEALTH SERVICES IN THE BOROUGH. Notification of Births. The total number of births notified in the Borough was 1122. Of these 425 were transferred to other Authorities. Particulars were received of 383 births which took place in other areas, thus giving a net figure of 1080. Home Nursing. Such cases needing special nursing are referred to the Ranyard Mission and the Queens Nursing Association. Health Visitors. The following is a brief summary of the work carried out during the year:- Visits Revisits Total 1201 2461 3662 Infants under 1 year Children 1-5 years 221 5036 5257 Re Infectious Diseases. 1016 328 1344 Ante-Natal Cases. 1110 497 1607 Miscellaneous 914 483 1397 Infant Welfare Centre. Attendances - Babies 13,368 Children 1-5 years 7,942 21,310 New Cases - Babies 1,004 Children 1-5 years 476 1,480 Medical Consultations 7,203 Ante-Natal and Post Natal Clinics. No. of New Cases - Ante-Natal 901 No. of New Cases - Post-Natal 140 No. of attendances 4,237 Artificial Sunlight Treatment. No. of New Cases 703 No. of treatments given 12,483 No. of Patients at 31st December 1942 233 Child Life Protection. The number of Foster-Mothers on the Register at the end of the year was 12, but only 3 were actually receiving children. The number of children on the Register was 9. 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, 39 Home Helps were provided at a net cost to the Council of £166, FOOT CLINICS. Owing to the increased demand additional sessions were held but it is still difficult to cope with the number requiring treatment. The number of attendances were 4,853 as compared with 3,542 for the previous year. SUPPLY OF MILK TO MOTHERS AND CHILDREN. The total amount of dried milk supplied during the year was:- Under M. & C.W. Scheme. Under Nat. Milk Scheme. (a) Distributed free 4756 pkts. 1641 pkts. (b) Sold at full or reduced price s 14108 " 2089 " ??? Information kindly supplied by Food Executive Officer. SUPPLY OF VITAMINS TO EXPECTANT MOTHERS AND CHILDREN. By arrangement with the local Ministry of Food Office, Fruit Juices are distributed at the Welfare Centres. During the year certain fruit juices were made available for expectant mothers. CLOTHING COUPONS FOR EXPECTANT MOTHERS. The arrangements made with the Board of Trade to supply special coupons to enable expectant mothers to buy materials for baby clothing continue to be in force. A total of 69,370 coupons were issued to 1243 expectant mothers during the year. CONVALESCENT TREATMENT. Comparatively few cases were recommended for convalescence by the Medical Officer in charge of clinics. Difficulty is still experienced in finding suitable convalescent homes. BACTERIOLOGICAL EXAMINATIONS. The undermentioned specimens were submitted to the Seamen's Hospital Laboratory for bacteriological investigation, the results being:- Positive. Negative. Total. 29 374 403 Diphtheria Tuberculosis 39 177 216 Typhoid 1 3 4 Miscellaneous. 6 12 18 DENTAL CLINIC. M. & C.W. T.B. Total. No. of Sessions 49 (a) 49 No. of New Cases 252 261 9 No. of attendances 393 20 413 No. of extractions 671 9 680 (a) included under M. & C.W. WARTIME NURSERIES. Representations were received from the Ministry of Labour and National Service and the Ministry of Health stating it was desirable to set up Day Nursery facilities in order to assist women who were desirous of undertaking war work but were prevented from doing so owing to family ties. As a temporary arrangement four of the First Aid Posts functioning under the Civil Defence Scheme were utilised for this purpose, a dozen children being accommodated at each Post. A fee of l/- is charged for each child per day. After protracted negotiation as to suitable sites and many difficulties encountered in obtaining necessary staff the following permanent Day Nurseries were established:- 1. Rachael McMillan Nursery School, Deptford Church Street, S.E. 8. Opened 20th July 1942. Accommodation for 40 children under 2 years and 65 between the ages of 2 and 5 years. 2. Conley Street, East Greenwich, S.E. 10. Opened 30th September, 1942, accommodation for 10 under 2 years and 30 between the ages of 2 and 5 years. 3. 154 Shooters Hill Road, S.E. 3. (late Blackheath and Charlton Cottage Hospital) opened 21st December 1942 accommodation for 48 children from 2 to 5 years of age. SANITARY CIRCUMSTANCES OF THE AREA. From springtime onwards many complaints were received regarding nuisances caused by mosquitoes breeding in static water tanks. In all cases where it was found necessary the tanks were emptied, thoroughly scoured out and treated with special oils and insecticides. In addition to the many duties arising out of war time conditions disinfestation is undertaken at premises requisitioned by the Council for storage of furniture from bombed houses. Disinfestation has also been carried out at the various Public Air Raid Shelters and Warden Posts in the Borough. The following brief summaries serve to show the work carried out by the Sanitary Inspectors and Disinfecting Staff during the year:- Summary of Work Performed. Houses inspected (war damage) 1419 " " (complaints, nuisances) 1625 " " (Infectious Disease). 255 " " (Overcrowding) 41 No. of re-inspections 10890 Factories and other Premises inspected 205 Shop Premises (Shops Act, 1934) 73 Investigations (Rats and Mice) 560 No. of Intimation Notices served 1363 No. of Statutory Notices served 181 Disinfection. No. of Rooms Disinfected 1536 No. of Beds " 486 No. of Mattresses " 1303 No. of Pillows " 2602 No. of Blankets " 5797 No. of Quilts " 1102 No. of Sheets " 1058 No. of Miscellaneous articles disinfected 1736 No. of " " destroyed 298 Verminous Conditions. No. of persons treated at Cleansing Stations:- Vermin. Scabies. Adults 30 1224 Children under school age - 402 Schoolchildren 469 1621 No. of home visits by Nurse 501 No. " " reviaits " 312 Disinfestation. No. of applications received. 357 No. of rooms treated 892 No. of rooms re-treated 74 No. of shelters treated 15 No. of Gallons Vermicine used 312 Rat Repression. No. of complaints received 218 No. of premises inspected 255 No. of premises found to be infested 238 General Observations. Shortage suitable building material has led to the erection of unsatisfactory hen houses. Ferrets have been employed usefully in destroying many rats. Baiting and trapping have proved successful also in many cases. Shortage of suitable building material has led to the erection of unsatisfactory hen houses. Ferrets have been employed usefully in destroying many rats. Baiting and trapping have proved successful also in many cases. HOUSING The following houses were completed and occupied during the year:- By Private Enterprise 25 Kidbrooke (L.C.C.) Housing Estate 2 27 INSPECTION AND SUPERVISION OF FOOD. MILK. The number of Daily Premises on the Register is 33 and there are 82 Purveyors of Milk now registered. No, of Inspections 173 ICE CREAM PREMISES. No. on Register 98 No. of Inspections 57 An Order made under the Emergency Powers (Defence) Act came into force on the 1st October 1942 and prohibits the manufacture and sale of Ice Cream. PRESERVED FOOD PREMISES. No. on Register 109 No. of Inspections 166 MILK (SPEC I AL DESIGNATIONS) ORDERS 1936/1941. Licences granted to sell "Pasteurised" Milk 24 " " " " Tuberculin Tested" Milk 8 Supplementary Licences granted 3 INSPECTION OF FOOD PREMISES. During the year 3710 visits were made. As a result of notices served or advice given 44 improvements to premises were carried out. Special attention was again given to premises with a view to salvaging war damaged food stocks. FOOD DECONTAMINATION. The work of training volunteers with special knowledge of handling food in the event of food being contaminated by war gases was continued during the year. Premises have been acquired and full arrangements made to provide against any such contingency. IMPORTED FOOD SURRENDERED. (Wharves and Warehouses). Total amount - 11 tons. 12 cwt. 3 qrs. 20 1bs. UNSOUND FOOD SURRENDERED. (Shops and Meat Distributing Depot). UNSOUND FOOD SURRENDERED. (Shops and Meat Distributing Depot). Total amount - 10 tons. 1 cwt. 1 qr. 10 1bs. FOOD & DRUGS ACT. 1938. During the year 428 samples were submitted to the Public Analyst for analysis. Of these 85 were "formal" and 343 "informal". The chief article sampled was Milk, 5 out of 82 samples were adulterated. FOOD POISONING. There were only 3 cases of suspected food poisoning notified during the year. Routine investigations were carried out in each instance. PREVALENCE AND CONTROL OVER INFECTIOUS DISEASE. Excluding notifications received for Tuberculosis the total number notified during 1942 was 1319 as compared with 753 for the previous year. The usual biennial epidemic of Measles was responsible for approximately one half of the notifications. Scarlet Fever shewed an increase of 106, whilst "Whooping Cough and Diphtheria rose from 184 and 50 to 235 and 72 respectively. DISEASE Diphtheria Dysentery Erysipelas Scarlet Fever Enteric Fever Continued Fever Puerperal Fever Puerperal Pyrexia Cerebro-Spinal Fever Malaria Measles Whooping Cough Diarrhoea Ophthalmia Neonatorum Pneumonia, Acute Primary or Acute Influenzal TOTAL DIPHTHERIA IMMUNISATION. UNDER 1 YR. 1-5 YRS. 2 - - 1 - - - - 2 - 31 23 21 6 4 90 5 YRS & UPWARDS 20 6 1 51 1 - - - 2 - 267 131 6 - 10 495 50 16 31 107 2 1 5 8 11 3 352 81 - - 67 734 TOTAL 72 22 32 159 3 1 5 8 15 3 650 235 27 6 81 1319 NO. ADMITTED TO HOSPITAL. 72 22 14 146 3 1 5 7 15 3 37 32 24 4 53 438 During the year 957 children were immunised under the Council's Scheme and 940 by the School Medical Officer, making a total of 1897 cases completed as compared with 1160 cases for the previous year. Of this total 385 were given Post-Schick tests. Following the national appeal for more children to be immunised the existing Scheme has now been extended so that it will be possible for parents to have their children immunised by their own Doctor. VACCINATION. Of the 576 births registered during the year 1941, 225 were successfully vaccinated (39.0 per cent). TUBERCULOSIS NEW CASES AND MORTALITY. Age Periods Years. Deaths. New Cases Respiratory M F Non-Respiratory M F Respiratory M F Non-Respiratory M F 0-1 I I I ( i I I I ! i 1 t I | I 2 ; I ! i 1 ■' s ■U. 1 2 1-5 1 ! ! I I 1 5-15 3 7 1 2 2 1 28 ! 2 15-25 16 1 ! I I I I | ! I I 1 I 1 5 8 26 7 9 6 9 j 4 15 3 25-35 1 5 8 35-45 21 3 16 45-55 4 4 55-65 1 7 65 & Upwards 8 2 1 1 1 TOTALS 62 10 21 3 3 102 8 37 Death Rate from Tuberculosis (all forms) 1.05 per 1,000 " " " " (Pulmonary) 0.95 per 1,000 " " " " (Non-Pulmonary) 0.09 per 1,000 TUBERCULOSIS DISPENSARY. The number of definite cases of Tuberculosis on the Dispensary Register at the end of the year:- Non-Pulmonary Total Pulmonary 225 Adults Males Females 199 26 173 24 197 Children Males 19 19 38 Females 13 15 28 GRAND TOTAL 488 Number of Patients Attendances 1804 " " Visits by Tuberculosis Health Visitors 2734 " " Sputum Examinations 216 " " X-Rays 512