LIBRARY GRE 41 METROPOLITAN BOROUGH OF GREENWICH ABRIDGED REPORT of the ACTinG MEDICAL OFFICER 0F HEALTH For the Year 1943. 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. 31st July 1944. To the Mayor, Aldermen & Councillors of the metropolitan Borough of Greenwich. Mr. Mayor, Ladies & Gentlemen, The slight delay in issuing the abridged report on the health of the Borough in 1943 is due to events arising in the course of the current year which led to considerable interference with routine Public Health duties, including preparation of this summary. Except that the prevalence of certain of the infectious diseases was, unaccountably, greater than in 1942, the year's showing was satisfactory. The birth-rate - 18.94 - was higher than the high 1925 rate of 18.92. The death-rate was lower than that for 1942, and there was a nil rate for maternal mortality. The increase in the infant mortality rate to 42 per 1,000 births was traceable to an increase in ??? and respiratory affections. Part of the increase in infectious disease notifications was due to the inclusion of scabies in the list. The norsase in the number of cases to be dealt with necessitated an increase in the number of Cleansing Clinics at the Seamen's Hospital. Considerable progress was made in the direction of increasing the amount of accommodation in the War-time Nurseries, discussions and work centring mainly around extensions to Conley treet and Blackheath & Charlton Nurseries, and new provision at Pound Park Road and Canberra Road. Another direction in which progress was made was in the provision of Welfare Centres at Rochester Way and Bardsley Lane, to serve areas regarded as inadequately covered. Steps also were taken to improve and extend dental clinic provision in order to meet the increasing demand for attention on the part of expectant and nursing mothers. It gives me great pleasure to record how very much I have appreciated the kindness I have received from the Chairman, ViceChairman, and Members of the Public Health, Maternity and Child • Welfare Committee, and the readiness shown to consider favourable and further any suggestions out forward. The Department was short-handed throughout the year, but the members of the Staff have done most excellent work and given me much more than full support. I offer them gratitude and very sincere thanks . I am, Mr. Mayor, Ladies & Gentlemen, Your Obedient Servent, Charles Porter. Acting Medical Officer of Health. STATISTICS. Year 1943. Statistics for the year 1943 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 1126 608 518 Illegitimate 61 29 32 BIRTH RATE Per 1,000 estimated civilian population - 18.94 STILLBIRTHS Total Males Females Legitimate 24 11 13 Illegitimate 1 - 1 Rate per 1,000 total (live and still) births - 20.6 DEATHS. Total Males Females 885 462 423 Death rate per 1,000 civilian copulation - Crude 14.12 DEATHS FROM PUERPERAL CAUSES - Nil. DEATHS OF inFANTS UNDER ONE YEAR All infants per 1,000 births 42 Legitimate infants per 1,000 legitimate births 42 Illegitimate „ „ „ illegitimate 32 DEATHS Deaths from Cancer (all ages) 127 „ „ Mea3les ( „ „ ) - „ „ Whooping Cough („ „) 1 „ „ Diarrhoea (under 2 years) 6 PROVISION OF HEALTH SERVICES in THE BOROUGH Notification of Births. The total number of births notified in the Borough was 1161. Of these 444 were transferred to other Authorities. Particulars were received of 222 births which took place in other areas, thus giving a net figure of 939. 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 infants under one year 1175 2836 4 011 Children 1-5 years 159 5770 5929 Re infectious Diseases 1305 214 1519 Ante-Natal Cases 980 349 1329 Miscellaneous 1182 547 1529 infant Welfare Centre. in spite of the fact that many mothers are occupied on war work and unable to attend the Clinics, there was an increase in the number of attendances with the result that some of the Centres were overtaxed. A proposal was therefore submitted to the Council for the establishment of a further two Centres, and by the end of the year both of these were functioning. Attendances - Babies 16,141 Children 1-5 yrs 8,609 24,750 New Cases-Babies 973 Children 1-5 yrs 478 1,451 Medical Consultations 7,918 Ante-Natal and Post Natal Clinics No. of New Cases - Ante-Nqtal 867 No. of New Cases - Post-Natal 134 No. of attendances 5,379 Artificial Sunlight Treatment No. of New Cases 705 No. of Treatments given 12,852 No. of Patients at 31st December 1943 266 Child Life Protection The number of Foster-Mothers on the Register at the end of the year was 12, but only 9 were actually receiving children. The number of children on the Register was 15, 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, 69 Home Helps were provided at a net coat to the Council of £240. Foot Clinics. The continued popularity of these clinics is shown by the increase in the number of attendances. There were 8,052 attendances during the year as compared with 4,853 for the previous year. There can be little doubt as to the vital need for clinics of this nature having regard to the large number of war workers, who necessarily, have long periods of standing at their benches. f". , Supply of Milk to Mothers and Children The total amount of dried milk supplied during the year was:- Under M. & C.W. Scheme. Under Hat. Milk chome. (a) Distributed free 3324 pkta 676 pkts (b) Sold at full or reduced prices 26478 „ 1704 „ * information kindly supplied by Food Executive Officer. Supply of Vitamins to Expectant Mothers and Children The arrangements made with the Ministry of Food continued to be in operation whereby fruit juices are distributed at the Welfare Centres. Convalescent Treatment. As stated in last year's Report, owing to the few vacancies available, only a small number of cases were seat away for periode of convalescence. Bacteriological Examinations. The undermentioned specimens were submitted to the Seamen's Hospital Laboratory for bacteriological investigation, the results being:- Positive Negative Total Diphtheria 32 535 567 Tubereculosis 101 277 378 Typhoid - 2 2 Miscellaneous 1 29 30 Dental Clinic. m.& C.W T.B. Total No. of Sessions 51 ??? 51 No. of New Cases 225 12 237 No. of attendances 437 19 456 No. of extractions 649 14 663 (a) included under M. & C.W. Rat Repression No. of cornelaints received 347 No. of premises inspected 612 No. of premises found to be infested 470 War-time Nurseries. The three war-time nurseries continued to function throughout the year. The Attendances suffered at times owing to outbreaks of infectious diseases and illness hut applications for admittance are still fairly considerable. Arrangements are in hand for the extension of two of the nurseries. in addition, the Council has consider tenders for the erection of a hutted building- in Pound Park Road, Charlton. SANITATION CIRCUMSTANCES OF THE AREA. The following brief summaries serve to show the work out by the inspectors and ??? ??? during the year:- Summary of Work Performed. Houses inspected (war damage) 1110 (complaint nuisance 3) 1981 „ „ (infectious Disease) 584 (Overcrowding) 16 No. of re-inspections 16545 Factories and other ??? inspected 427 Shop Premises (Shops Act, 1934) 12 Investigations (Rats and ice) 629 No. of Intimation Notices served 1519 No. of statutory Notices served 351 Disinfection. No. of Rooms disinfected 1198 No. of Beds 517 No. of Mattresses „ 9ll No. of Pillows „ 1696 No. of Blankets „ 4471 No. of Built „ 772 No. of Sheets „ 942 No. of Miscellaneous articles disinfected 2611 No. of destroyed 336 Verminous Conditions. No. of persons treated at Cleansing Stations:- Vermin Scabious Adults 4 2109 Children under school age - 1182 Schoolchildren 1065 No. of home visits by Purse - 2546 1054 No. „ revisits - 1427 Disinfestation. No. of applications received 427 do. of rooms treated 1121 No. of rooms re-treated 19 No. of shelters treated 22 No. of Gallons Vermicine used 223 INSPECTION AND SUPERVISION OF FOOD. MILK. The number of Dairy Premises on Register is 33 and there are 80, Purveyors of Milk registered. N0. of Inspections 299 PRESERVED FOOD PREMISES. No. on Register 114 No. of Inspections 288 MILK (SPECIAL DESIGNATIONS) ORDERS 1936/1941. Licences granted to sell "Pasteurised" Milk 25 „ „ „ „ "Tuberculin Tested" Tested Milk 8 Supplementary Licences granted 3 INSPECTION OF FOOD PREMISES During the year 4546 visits were made. As a result of notices served or advice given 149 improvements to premises were carried out. Special attention was again given to premises with a view to salvaging war damaged food stocks. FOOD DECONTAMINATION. Progress has been made in the recruitment of this service and lectures have been given to key-men employed at wharves where food is stored. Eighty men of the Borough Engineers Decontamination Squads have been given a short course in food decontamination with a view to the co-operation in an emergency. Further assistance has been assured where large stores are affected by the training of a large number of employees registered by the London Dock Labour Pool whose services are available to all Riparian Local Authorities. Squads intended to deal with the decontamination of retail shops are fully equipped and have a depot at Rectory Field, Blackheath. IMPORTED FOOD SURRENDERED (Wharves and Warehouses). Total amount - 4983 lbs. UNSOUND FOOD SURRENDERED (Shops and Meat Distributing Depots) Total amount - 30228 lbs. In accordance with the usual practice, the majority of rejected food is used for animal feeding stuffs. FOOD & DRUGS, ACT, 1938. Daring the year 478 sample were submitted to the Public Analyst for analysis Of these 109 were "formal" and 369 "informal". The chief article sampled was Milk, 3 out of 116 samples were adulterated. FOOD POISONING. There was only one case of suspected food poisoning notified during the year. From investigations it appealed the patient was taken ill at 5 a.m. on the 24th June after partaking of an evening meal consisting of Veal and Hample, new potatoes and tomatoes He was admitted to Hospital on the 25th June. Unfortunately the case was not notified by the hospital authorities until the 30th June when the patient was discharged, apparently recovered. REVALENCE AND CONTROL OVER IN SECTIONS DISEASE. The total number of infectious diseases notified, excluding T.B. was 2,184 as compared with 1319 for the previous year. Scabies which was added to the list of Infectious diseases notifiable. on the 1st August was responsible for 263. Measles was prevalent duringt the second quarter of the year, no less than 643 case? being reported. / The following tables shows the age period of cases notified:- DISEASE UNDER 1 Yr. 1-5 Yrs. 5 Yrs & UPWARDS TOTAL NO. ADMITTED TO HOSPITAL Diphtheria 4 25 62 91 91 Dysentery - 4 5 9 9 Srysipelas - 2 22 24 18 Scarlet Fever 4 100 199 303 281 Enteric Fever - - - - - Puerperal Pever - - 2 2 2 Puerperal Pyrexia - - 4 4 - Cerebro-Soinal Fever - 1 1 2 2 Measles 57 437 480 974 81 Whooping Cough 36 164 76 276 27 Diarrhœa 11 14 - 25 16 Ophthalmia Neonatorum 2 - - 2 1 Malaria - - 2 3 2 Scabies 10 35 218 265 - Pneumonia, Acute Primary - or- Acute Influenzal 7 25 175 207 140 TOTALS Diphtheria Tmmunisation. During the year 899 children were immunised under the Council' scheme and by the school Medical Officer, making a total of 1765 cases completed as compared with 1897 for the previous year; of this number 829 were under 5 years of age and 936 between the ages of 5-14. 929 cases were given post-schick tests. It is regretted that increased Propaganda, there still appears to be a certain amount of reluctance on the art of parents to take advantage of this scheme. This is reflected in the lower number- immunised during the Year. TUBERCULOSIS. I am indebted to Dr. Macdonald, Acting Tuberculosis Officer, for the following report on the work of the dispensary and in relation to this disease generally:- "Notlfications during 1943 numbered 155, of which 128 were cases of pulmonary tuberculosis and 27 of non-pulmonary tuberculosis. In the same period 54 died from pulmonary tuberculosis and 6 from non-pulmonary tuberculosis. NEW CASES AND MORTALITY. AGE PERIODS YEARS. NEW CASES DEATHS Respiratory. Non-respiratory. Inspiratory. Non-Respiratory M F M F M F M F 0-1 - - - - - - - - 1-5 1 - 2 - - - 1 - 5-15 4 2 3 2 - 1 - 1 L5 - 25 19 26 4 7 6 7 - - 35 - 35 18 14 1 1 5 6 - - 55 - 45 19 5 - - 9 3 - 1 15 - 55 15 2 1 3 6 1 - 1 55 - 65 10 1 - 1 6 1 - 1 55 and upwards 2 - - 2 2 1 - 1 TOTALS 78 50 11 16 34 20 1 5 TUBERCULOSIS DISPENSARY. 608 new cases were examined. Of these 117 were suffering from Pulmonary Tuberculosis and 26 from Non-pulmonary Tuberculosis. The remainder were diagnosed as not suffering from tuberculosis In any form. Of the 608 new cases it is interesting to know that 91 were referred by the various Medical Boards, an Indication of the care that is now being taken in the selection of recruits for the Services. At the close of the year the number of definite cases of tuberculosis on the Dispensary Register was as follows Adults. Children. M F. M F. Pulmonary 225 181 22 13 Non-pulmonary 24 28 20 16 No. of attendances by patients 1495 " " visits by Tuberculosis Health Visitors 2395 " " Sputum examinations 289 (of which 97 were positive) " X—rays 668 The Dental Clinic is held as usual. 12 patients made 21 attendances- Artificial Pneumothorax. The number of patients undergoing pneumothorax therapy is increasing and during the year 509 refills were given by the Tuberculosis Officer at St. Alfeges Hospital. By arrangement with the Hospital, patients who are working and cannot attend the afternoon clinic are treated by the Hospital staff. Grants of extra nourishment (milk) were made in 14 cases at a cost of £52. to patients not in receipt of the Social Welfare Assistance or Maintenance Allowance. The closest co-operation is maintained with the Social Welfare Officers who have dealt very generously with patients referred to them by the Dispensary. The Care Committee met on 4 occasions during the year, but as in previous years, emergency matters were dealt with by the Chairman and Tuberculosis Officer, and reported later to the Committee. The Chairman pays a weekly visit to the Dispensary for this purpose. The Committee were keenly interested and very helpful in re-starting the Christmas Seals Campaign which owing to war conditions had been allowed to lapse for 5 years. A sum of £32. 12.6, was realised by the sale of seals during December 1943. A detailed statement of matters affecting the Handicraft and Christmas as Seals Funds is presented to the Committee at the end of the financial year, but briefly it may be stated that these funds are used to purchase material for the Handicraft Class, to assist needy patients by paying fares to enable their relatives to visit them it sanatoria, to purchase clothing etc. Handicraft Class. Owing to War Damage in 1940, the Handicraft Hut could" not" be" used, but in August this year the Class was restarted with 14 members. Unfortunately, owing to the illness of the teacher (Mrs.. Clark) and the difficulty in obtaining material, it had to be abandoned after a few meetings. Several of the member" however are carrying on at home. Arrangements are in hand for the class to commence again in the Autumn. Tuberculosis Allowances. In June 1943, a Government scheme was introduced to provide maintenance allowances for certain patients and their dependents. The scheme applies only to patients suffering from pulmonary tuberculosis who may be expected to return to work within a reasonable period. The Tuberculosis Officer decides whether a patient is eligible from a medical point of view, and an Assessing Officer from the London County Council decides from the financial side. The Assessing Officer visits the Disoensary every week to assess all new cases and renew old ones where necessary. Details of payments to be made are sent to the Borough Treasurer each week, and the clerk at the Dispensary makes the necessary payments to those authorised to receive them, The first payment was made on July 1st 1943. During this six months 94 patients received allowances. The amount paid during this period was £2297. 11. 0." Vaccination. The Annual Return respecting the vaccination of children whose births were registered in Greenwich during the year ended 31st December 1942 shows that of the 937 births of registered 445 wore successfully vaccinated (47.5 per cent). In consequence of war-tine evacuation schemes it was ascertained that 294 children wore actually born outside the Borough, returning to Greenwich aft or their mothers' confinements of this number, 200 were successfully vaccinated. Taking these figures into consideration, it will be seen that 5.4 per cent were successfully vaccinated during this period. HOUSING Owing to war-time conditions, no official action has been taken under the Housing Act 1036. Apart from routine inspections carried out by the Sanitary Inspectors arising out of complaints, nuisances etc. a certain amount of time was devoted, to inspections following first aid repairs to houses damaged by enemy action.