LIBRARY GRE 42 METROPOLITAN BOROUGH OF GREENWICH ABRIDGED REPORT OF THE ACTING MEDICAL OFFICER OF HEALTH FOR THE YEAR 1944. CHARLES PORTER M.D.,B.Sc.,M.R.C.P.(Ed.) Of the Middle Temple, Barrister-at-Law. Public Health Department Town Hall, S.E.10. July 1945. Mr. Mayor, Ladies and Gentlemen, In accordance with the instructions of the Minister of Health, the report on the health of the Borough in 1944 is a summary only. In the main it reveals that from the health point of view, in spite of the real hardships so many of the population were called upon to endure, in the matter of housing in particular, conditions were rather more than satisfactory. One rate which showed an increase was that of Infant Mortality,, which went up from 42 to 52 per 1,000 births. The chief contributors to the increase were the respiratory diseases, for the occurrence of which, in a number of cases, unsatisfactory housing accommodation as well as climate was responsible. The birth-rate at 18.98 was slightly in excess of that (18.94) for 1943. The situation in relation to the Infectious Diseases was more favourable than in 1943, none of those cases classed as "commoner" showing any marked prevalence. Scabies cases were still numerous, and the call on the services provided at the Cleansing Station continued to be heavy. During the year the additional Maternity and Child Welfare facilities provided at the new Centres in Rochester Way and at the Coroner's Court in Bardsley Lane were widely used and greatly appreciated. Here, as at other Centres, arrangements were made for carrying on a Foot Clinic under the direction of the full-time Chiropodist, who was appointed during the year, and has been given every encouragement to develop this most useful branch of the Welfare work of the Council. At the three War-time Nurseries alterations and additions which had been in hand at the end of 1943 were completed during 1944, and as a result it became possible to give better service to the children of the many mothers engaged in munitions and other work of National importance. Once more I wish to express my great appreciation of the kindness and encouragement I have received from the Chairman, ViceChairman, and Members of the Public Health, Maternity and Child Welfare Committee. With real pleasure and gratitude I record that on all occasions ready and favourable consideration was given to any suggestions put forward, and every facility offered to put into operation and further any accepted as suitable for adoption. The shortness of staff referred to in previous War-time reports continued. To those who remain I offer most sincere thanks for the support they have given and congratulations on the excellent results obtained so largely on account of their efforts. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, CHARLES PORTER. Acting Modical Officer of Health. STATISTICS - Year 1944. Statistics for the year 1944 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 61800 LIVE BIRTHS Total Males Females Legitimate 1108 564 544 Illegitimate 62 30 32 BIRTH RATE Per 1,000 estimated Civilian population - 18.98 STILLBIRTHS Total Males Females Legitimate 21 7 14 Illegitimate 1 1 - Rate per 1,000 total (live and still) births - 10.8 DEATHS Total Males Females 980 542 438 Death rate per 1,000 Civilian population - (Crude) 15.90 DEATHS FROM PUERPERAL CAUSES Puerperal Sepsis 0 1 Other maternal causes Rate per total births (live and still) 0.83 DEATHS OF INFANTS UNDER ONE YEAR All infants per 1,000 births 52 Legitimate infants per 1,000 legitimate births 51 Illegitimate 11 illegitimate 80 DEATHS Deaths from Cancer (all ages) 125 .. " " Measles ( " " ) .. - " " 11 Whooping Cough (all ages) 1 .. " " Diarrhoea (under 2 years) 9 .. NOTIFICATION OF BIRTHS The total number of births notified in the Borough was 1102; of these 483 were transferred to other Authorities. Particulars were received of 286 births which took place in other areas, thus giving a net figure of 905. PROVISION OF HEALTH SERVICES IN THE BOROUGH Home Nursing, Cases needing special nursing are referred to the Ranyard Mission and the Queen's District Nursing Association. Health Visitors. The following is a brief summary of the work carried out during the year:- Visits. Revisits. Total. 1152 2649 3801 Infants under 1 year 115 4430 4545 Children 1-5 years 583 54 637 Re Infectious Diseases 946 406 1352 Ante-Natal Cases 993 1550 Miscellaneous 557 Infant Welfare Centres. In order to provide for the needs of the West Greenwich district the Council were able to make arrangements to take over the old County Court premises at Bardsley Lane, and a weekly clinic has functioned throughout the year commencing from February 24th. Several of the Centres suffered damage as a result of enemy action, but only in one instance (Charlton House) was it necessary to close the Centre permanently. Owing to these causes and the consequent disruption of the Services the attendances generally were less than in previous years. Attendances - Babies 11,115 Children 1-5 years 6,658 17,773 New Gases - Babies 867 Children 1-5 years 324 1,191 Medical Consultations 6,533 Ante-Natal and Post-Natal Clinics. No. of New Cases - Ante-Natal 931 No. of New Cases - Post-Natal 113 No. of Attendances 5,064 Artificial Sunlight Treatment. No. of New Cases 799 12,580 No. of treatments given No. of patients at 31st December 1944 254 Child Life Protection. The number of Foster-Mothers on the Register at the end of the year was 10, but only 6 were actually receiving children. The number of children on the register was 10. Periodical visits were made by the Health Visitors who act as Child Protection Visitors. Care of Premature Infants. In March 1944 the Ministry of Health issued Circular 20/44 which dealt with the care of premature infants and the problem of neo-natal mortality. The suggestion that where the weight at birth is 5½ lb. or less a note to that effect should be recorded on the birth card, has been put into operation. Out of 28 premature births notified, only in 8 cases did the confinement take place at home, and in no instance was a call made for extra equipment. The service of a Home Help was provided in 1 case. Detailed information relating to the cases notified is set out hereunder:- Born at home: Nursed entirely at home 2 Died during the first 24 hours 1 Died subsequently 1 Survived at the end of one month 4 Born In hospital: Died during the first 24 hours 5 Died subsequently 1 Survived at the end of one month 14 Care of Illegitimate Children. Towards the end of the year the Council agreed to participate in a scheme formulated by the Metropolitan Borough Councils, which provides for the co-operation with and the reinforcing of the work of existing voluntary moral welfare associations. A further proposal provides for the services of Poster-mothers to undertake the care of children up to five years of age not on the school roll. Home Helps. The Council's Home Help Scheme provides for the services of one full-time woman and a panel of women available to perform the duties when called upon. Generally speaking, there has been a shortage of women of a suitable type, one reason being the attraction of higher wages paid to factory workers. In spite of this, however, the scheme has worked satisfactorily, and has been greatly appreciated. Home Helps were provided in 56 cases. The total payments received towards the cost of such provision was £66. Foot Clinics. The attendances at the Centres continue to show a marked increase. The total number of treatments was 10,253, as compared with 8,052 for the previous year. The average number of cases dealt with each day was 35. The smooth running of the Clinics was somewhat disturbed during the months of June, July and August, owing to the flying-bomb attacks, and for this reason it was found necessary to transfer the Charlton House Clinic, owing to extensive damage, to another Centre. Supply of Milk to Mothers and Children. The total amount of dried milk supplied during the year was:- Under M.& C.W. Scheme. Under National Milk Scheme. (a) Distributed free 1785 pkts. 618 pkts. (b) Sold at full or reduced prices 21690 3588 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 and cod-liver oil are distributed at the Welfare Centres. Supply of Sheets for Expectant Mothers. Towards the end of the year, under a scheme introduced by the Ministry of Health, expectant mothers who are being confined in their own homes were enabled to purchase Utility sheets on Priority Dockets, issued by the local Health Departments, provided the midwife engaged certifies that the applicant is genuinely in need of additional sheets. Eleven such dockets were issued during December. All midwives employed in the Borough were notified as to the operation of the Scheme. Convalescent Treatment. As stated in last year's Report, owing to the few vacancies available, only a small number of cases were sent away for periods 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 15 351 366 Tuberculosis 153 360 513 Typhoid 3 3 - Miscellaneous 1 17 18 Dental Clinic. Dental treatment has been carried out for many years at the maze hill centre, which is chiefly used as a tuberculosis dispense in view of the fact that the majority if the persons requiring to provide a new centre at 105, shooters hiĺ road.this centre has now been provided with up-to-date equipment and apparatus at a cost of ₤330. 4, Dental Clinic (cont'd). The Dental Surgeon, Mr. G. F.Ferris, L.D.S., R.C,S.(Eng)., submits the following return as to work carried out during the year:- M.& C.W. T.B. Total. No.of sessions (a) 48 48 No.of new cases 131 11 142 No.of attendances 418 40 458 No.of extractions 481 452 29 47 1 48 No. of gas cases No.of dentures supplied 2 40 38 (a) included under M.& C.W. War-time Nurseries. Despite many difficulties a new Nursery was opened at Pound Park, Charlton, on the Ist May. The Nursery provides accommodation for 26 children under 2 years, and 24 between the ages of 2 and 5 years. Consequent upon the Government Evacuation Scheme which resulted in reduced attendances generally, it was decided on the request of the Ministry of Health to close the Deptford Church Street Nursery at the end of August. Arrangements were made for a portion of the staff to be transferred to a Res_idential Nursery in a reception area. SANITARY CIRCUMSTANCES OP THE AREA. 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) 14,582 " '' (complaints, nuisances) 2,179 " " (infectious diseases) 177 " " (overcrowding) 23 No.of re-inspections 10,978 Factories and other premises inspected 206 Shop Premises (Shops Act, 1934) 3 Investigations (Rats and Mice) 356 No.of Intimation Notices served 1,058 No.of Statutory Notices served 196 Disinfection No.of rooms disinfected 866 201 No.of beds " No.of mattresses " 889 No. of pillows " 1,204 No. of blankets " 4,925 No. of quilts " 370 No. of sheets " 458 No. of miscellaneous articles disinfected 1,386 No.of " " destroyed 250 Verminous Conditions. The procedure adopted to improve the general standard of cleanliness and habits, and to combat infestation by lice, etc., has continued on the lines indicated in Circular 2831. In addition to the five Health Visitors, whose duty in the six Welfare Centres and in the homes of the people includes general Instruction, two women (one a qualified Sanitary Inspector) are employed In work of this nature. Actual cleansings and disinfestations are carried out at two Stations: in the main, school-children are dealt with ar blackwall Lane, East Greenwich, under arrangements (usual in Metropolitan Boroughs) with the London County Council and in co-operation with the members of their School Nurses Staff. The second Station,at the Seamen's Hospital, provided accommodation for men, women, and young children p chiefly for Scabies treatment, but also for dealing, In the case of the latter, with other verminous conditions. Owing tc the child evacuation scheme, there was a marked falling off in the number of attendances. It can be safely assumed that the eradication of vermin in the Borough is carried out by the most modern methods and in accordance with Memo 230.A/MED.1943. No, of persons treated at Cleansing Stations:- Vermin. Scabies. Adults 55 2,825 Children under sohcol age 9 1,065 School-children 883 1,857 No.of home visits by Nurse 845 - No.of " revisits 621 - Rat Repression. Rat Infestation in Greenwich can be classified as mainly "Minor infestations" and arise chiefly through the keeping of chickens and rabbits„ It is possible that the source of most of the Infestations is defective drains, and disturbances caused through the bomb raids. These defects are not always easily traceable and entail much investigation. At the moment a part-time Rat-catcher is engaged at the rate of 3/- per hour as often as his services are required. Where infestations occur in chicken-runs or beneath sheds, dogs and ferrets are used. In other cases trapping and poisoning are resorted to. No.of complaints received 216 No.of premises found to be infested 264 No.of premises inspected 349 No. of premises re-visited 525 In accordance with the directions of the Infestation Order, 1943, special attention is given by the Engineer's Department to the baiting and inspection of the Council's sewers. The following figures show the result of such action:- December, 1943.1944. No.of manholes baited 765 583 Estimated member of rats killed;, as per Ministry of Food's mothod of calculation 4587 1785 6 Disinfestation. No. applications received 336 No. of rooms sprayed 1008 No. of roomS re-sprayed 57 No. of shelters re-sprayed 60 No. of gallons Vermicine used 361 Water Supply. T he whole of the Borough is supplied with water by the Metropolitan Water ? and apart from temporary interruption in certain areas due to enemy action, no complaints were received as to service or the purity of such supply. INSPECTION AND SUPERVISION OF FOOD. Inspection of Food. The Inspection of shops, stores, and factories, where food supplies are processed or otherwise handled, has always been unremittingly performed to ensure the highest available standard of hygiene. Notwithstanding the limits imposed upon these establishments by the shortage of labour and materials and war conditions generally, the inspectors have suceeded In securing that a relatively high degree of cleanliness Is maintained. In addition to Civil Defensce activities, 3,149 visits to food premises were made, and 74 improvements and structural repairs carried out. Milk. The ass—urance of a safe milk supply has been an important object of the year's activities, and this has largely been attained. Apart from Tuberculin Tested Milk, it is not possible to purchase raw milk as from the cow. Pasteurisation and other authorised forms of heat-treated milk have almost completed the line of defence against milk-borne disease in this Borough. Milk purveyors on the register number 71. Milk (Special Designations) Orders 1936/41. The following licences were granted during the year:- Licences granted to sell Pasteurised Milk 19 " " " " Tuberculin Tested Milk 7 Supplementary Licences granted 19 Preserved Food Premises. The Food & Drugs Act, 1938, provides for the registration of premises where the preservation of food is carried out, whether bysalting, smoking or even cooking. Such premises and their products are under the constant supervision of the food Inspectors. Number on Register 109 Food Decontamination. The service formed to combat the danger of food contaminated by poison gas has been maintained. The Food Decontamination Squads are based at the Rectory Field, Blackheath, where additional equipment has been supplied on the advice of the Ministry of Food. 7 Imported. Food Surrendered (Wharves and Warehouses ). Large quantities of essential foods, imported on behalf of the Ministry of food, have been landed and stored at the several wharves and warehouses situated on the riparian limits of the Borough. During the year, 146 visits were made by the food Inspectors, and the closest co-operation maintained with the officials of the Ministry of food. Their efforts, coupled with the assistance of the firms concerned, have not only ensured a safe food supply, but have done much to prevent wastage in a time of scarcity. The following foodstuffs were certified unfit for human consumption, and where possible, were released for non-edible refining purposes Moat and Meat Offals 300 lbs. Canned Meat 165 lbs. Fruit Pulp 2681 lbs. Biscuits 165 lbs. Unsound. Food Surrendered (Shops and Meat Depot). Shops. At the last stage of distribution, food is inspected at the shops. In 1944 the weight of unsound food rejected as a result of this service was 5,988 lbs. A further 1,680 lbs. of flour was so damaged as to be unfit for food when a fire occurred in a bakehouse. Meat Distributing Depot. Under the authority of the Ministry of food the supplies of meat consumed in the Metropolitan Boroughs of Greenwich, Woolwich, and Deptford, are handled at the depot of the London Wholesale Meat Salesmen's Association, Ltd., situated in Greenwich. Here the sorting, allocation and distribution takes place. The meat supplies reaching this depot have been examined at the point of slaughter, but experience has proved the desirability of a final inspection before distribution. Routine visits made by the Pood Inspectors during the year resulted in intercepting 3,700 lbs. of unsound meat and offals which otherwise might have been distributed. War Damage to food. Structural damage to buildings caused by enemy action during the past year involved a number of food shops and stores; in consequence, food was damaged and destroyed. In all, 1,186 visits were made to war-damaged premises. The amount of food rejected was : - At shops, etc. 32 tons 17 cwt. 41 lbs. At wharves 500 tons It may be claimed that as a result of prompt action in sorting and salvaging operations, losses were greatly reduced, and a substantial portion was disposed of through the Ministry of food, Salvage Division. Food & DrugS Act. 1938. During the year, 477 samples were submitted to the Public Analyst for analysis. Of these 115 were "formal" and 362 "informal". The number of samples reported as adulterated or not otherwise up to standard wa3 28, equivalent to 5.9% of the total samples examined. Food poisoning. There were three cases of suspected food poisoning notified during the year. The usual routine investigations were made regarding the possible source of infection; in two of the cases there was no evidence as to a definite source of food poisoning and the patients quickly recovered. In the remaining case, an elderly man engaged on War-damage repairs, the illness was of a more serious nature and he eventually died in hospital, the cause being returned as Acute Enteritis, B. Aertryche. As often occurs in cases of this nature, the patient delayed seeking medical advice, with the result that a week elapsed before the Department could pursue any enquiries,. It was known, however, that the last meal deceased had partaken before the illness occurred, was at a wayside cafe. No further cases of illness were reported, and it may be assumed that the cause could in no way be connected with the cafe. PREVALENCE AND CONTROL OVER INFECTIOUS DISEASE. The total number of infectious diseases notified, excluding Tuberculosis, was 1,268 as compared with 2,184 for the previous year. Scabies, which was added to the list of infectious diseases notifiable on the Ist August, 1943, was responsible for 405. The following table shows the age period of cases notified:- Disease. Under 1 year. 1-5 years. 5 yrs. & upwards. Total. No.admit ted to Hp. Diphtheria 40 59 59 19 - 8 7 Dysohtery - 2 6 14 10 Erysipelas - 1 15 93 119 Scarlet Fever 36 129 - Puerperal Fever 9 9 9 - - 4 4 3 Puerperal Pyrexia - - 1 7 Cerebro-spinal Fever 4 2 7 174 330 34 Measles 16 140 29 Whooping Cough 23 75 56 154 25 23 Diarrhoea 17 8 - 3 2 Ophthalmia Neonatorum 3 - - 346 48 405 - Scabies 11 120 74 Pneumonia, Acute Primary or Acute Influenzal 2 19 99 376 TOTALS 76 1268 350 842 Diphtheria Immunisation. Facilities for diphtheria immunisation are available in the Borough either by arrangement with the Seamen's Hospital or through local Medical Practitioners. In addition, inoculations are carried out at the London County Council Schools by the School Medical Officer. Toxoid Antitoxin Floccules is the antigen given at the Seamen's Hospital and three inoculations are considered necessary, whilst under the London County Council and local Medical Practitioners' schemes, two only of Alum Precipitated Toxoid are required. Diphtheria Immunisation (cont'd). During the year. 338 children were immunised at Seamen's Hospital; 51 by local Medical Practitioners; 271 by School Medical Officers; and 9 were reported by other local authorities - thus making a total of 669 cases completed,, as compared with 1,765 for the previous year. 383 cases were under 5 years of age, and 286 cases were between the ages of 5 and 15. 361 cases were given Post-Schick tests. The large evacuation of school children and the intensified attacks by fly-bombs seriously interfered with the general working of the schemes. TÜBERCULOSIS 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:- "Not if I cat ions during 1944 numbered 155, of which 135 were cases of pulmonary tuberculosis ana 20 of non-pulmonary tuberculosis. In the same period 42 died suffering from pulmonary tuberculosis and 7 from non-pulmonary tuberculosis. NEW CASES AND MORTALITY. NEW CASES. DEATHS. AGE PERIODS YEARS. Respiratory. M F Non-Respiratory. M F Reapiratory. M F Non-Respiratory. M F 0 - 1 - - 1 - - - 1 - 4 2 - 1 - 5 3 1 - - - 5 - 15 10 1 1 1 4 - - 2 15 26 2 15 - 25 3 3 - 1 5 25 - 35 18 13 5 - 6 - - 2 5 35 - 45 14 4 4 - - - - 2 45 - 55 9 - - 5 2 - - 55 - 65 9 6 - - 1 1 - 2 65 and upwardS 5 4 - 1 - - - - TOTALS 84 51 4 16 27 15 5 2 577 new cases were examined, of these 113 were suffering from Pulmonary Tuberculosis and 16 from Non-Pulmonary Tuberculosis; the remainder were diagnosed as not suffering from Tuberculosis in any form. Of the 577 new cases it Is interesting to know that 56 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. Tuberculosis (cont'd) At the close of the year the number of definite cases of Tuberculosis on the Dispensary register was as follows:- Adults. Children. Pulmonary 258 205 32 11 Non-pulmonary 26 39 17 22 No. of attendances by patients 2238 No. of visits by Tuberculosis Health Visitors 2513 No. of Sputum examinations 460 of which 150 were positive. No. of X-rays 644 The Dental Clinic was held as usual, and 11 patients made 40 attendances. Artificial Pneumothorax. 425 refills were given by the Tuberculosis Officer at St. Alfege's 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 Committee met on two 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 in the Christmas Seals Campaign, and a sum of £37. 0. 3d. was realised by the sale of seals during December 1944, A detailed statement of matters affecting the Handicraft and Christmas Seals Funds is presented to the Committee at the end of the financial year, but, briefly, it may be stated that these funds were used to purchase materials for the Handicraft Class, to assist needy patients by paying fares to enable their relatives to visit them at sanatoria, to purchasing clothing, etc. Handicraft Class. Owing to enemy action in the form of rockets, etc., together with the difficulty in obtaining a teacher, the Handicraft Class was, unfortunately, unable to function. In place of the class, however, many members were encouraged to carry on work at home, chiefly in the form of leather work, and certificates were given by the Tuberculosis Officer to about; 20 patients to obtain the necessary leather. Tuberculosis Allowances. This scheme, as described in the report of last year, has been continued on the same lines. During the year, 122 patients received allowances. The amount paid during this period was £3,256." MINIATURE MASS RADIOGRAPHY. In the early part of the year the London County Council offered facilities for Miniature Mass Radiography to those employed in the Borough, units being located at Plumstead Baths, S.E.18, and at the South-Eastern Hospital, S.E.14. The numbers were limited to 2,000, and as a result of communicating with large employers of labour in the Borough, a total of 1,319 persons attended. Of the men examined, 44 out of 886 were referred for large films, 5 only being classified as probably T.B. This gives the very low percentage of .5. With regard to the women, of whom there were 433, the probable T.B. figure was again 5, giving a percentage of slightly over 1, again a favourable figure. As far as possible, those presenting themselves for examination were limited to the younger age groups, although no names were deleted on the question of age. The local firms welcomed the scheme, and in several instances could have provided a considerably greater number of their employees than their allocation. Where required on grounds of expediency, County Council ambulancos were placed at the disposal of the firms, which enabled their employees to attend the nearest Centre and return to duty in not more than about an hour. The only cost involved to the Council was the expenses associated with the use of these ambulances, which were charged up on a mileage basis,