Borough of Heston and Isleworth ANNUAL REPORT of the Medical Officer of Health 1943 Public Health Department, 92, Bath Road, HOUNSLOW. To the Mayor, Aldermen and Councillors of the Borough of Heston and Isleworth. Ladies and Gentlemen, I beg to submit my Annual Report for the year 1943. A separate report has already been submitted on the School Medical Service. As in recent years the Report consists largely of a tabulated summary. The upward trend of the birth rate which appeared last year has been maintained and the present rate is the highest recorded since 1933. The number of illegitimate births has increased and in 1943 reached a total of 90 as compared with 59 in 1942. Fortunately in the majority of cases the mother and her child remain with her family or find accommodation with relatives or friends. In other cases the child can be adopted or placed with a suitable foster mother. There remain, however, a few cases where satisfactory arrangements cannot be made before the mother and her baby are due to leave hospital and at present there is need for additional residential accommodation for such cases. Special difficulties arise where the mother is a married woman. The Health Visitors give special attention to this matter and endeavour, before the birth of the child, if possible, to assist the mother in regard to arrangements for the confinement arid for the care of the child, etc. The death rate remains almost stationary, but is slightly higher than that of the previous two years. This rate is based on the civilian population which, at the present time, contains relatively higher proportions of the young and old, among whom the natural risks of death are high. In 1943 the percentage of the total deaths occurring in persons aged 65 years and over was 50,2 as compared with 52.0 in 1942. The chief causes of deathwere heart disease (241), cancer (164), cerebral haemorrhage (101), pneumonia (68) and bronchitis (67). The steady increase in the infant mortality rate which was recorded during the previous four years has been interrupted. The rate for 1943 is 46.8 as compared with 72.1 in 1942. The percentage of the total infant deaths occurring in children under 4 weeks of age was 49 as compared with 58 in 1942. The number and causes of infant deaths in 1942 and 194-3 are shown in the following table Cause of Death. No. of Deaths. 1942. 1943. Measles 1 1 Whooping Cough 3 - Tuberculosis 2 - Otitis Media 5 1 Bronchitis 2 1 Pneumonia 15 10 Gastro-enteritis 28 22 Prematurity 20 18 Congenital Malformation 10 16 Birth Injury 5 - Accident 1 1 Other Causes 11 3 103 73 1. it will be seen that infections still play a prominent part in infant deaths. In theory all such deaths are preventable and in actual practice most can be prevented. The great difficulty is to find out when and how the breakdown in practice has occurred and this is specially so in cases of gastro-enteritis. This disease continues to give rise to anxiety by reason of its increased incidence and high mortality. The maternal mortality rate of 0.62 is the lowest recorded since 1930 when the present method of calculation was introduced. The still-birth rate per 1000 total births was 26 as compared with 32 in 1942 and 35 in 1941. Scarlet fever was more prevalent that in 1942, but continued to be of a mild type and caused no death. Since 1940 the admission of cases of scarlet fever to hospital has been restricted and has been determined by (1) the severity of the disease, (2) the home-nursing and isolation facilities and (3) the employment of another member of the household in the preparing or distribution of food for public consumption. Scarlet fever is due to a throat infection by haemolytic streptococci, but these same streptococci may give rise to a similar sore throat with no rash. There is no justification for isolating in hospital only streptococcal sore throats associated with a rash and Ignoring those with no rash as this will not protect the community. Further, the complications of scarlet fever are almost wholly due to cross-infection, which seldom occurs if the- patient is nursed at home. Objection is sometimes raised to the inconvenience arising from nursing cases of scarlet fever at home, but the welfare of the patient must be the first consideration. The following table shows that the restriction of admission to hospital has not resulted in a greater spread of the disease:- 1936-39 1940-43 No. of cases in private households 886 651 No. of above removed to hospital 765 213 % of above removed to hospital 86 33 No. of adult home contacts 2,179 1,535 No. of adult home contacts per case (average) 2.5 2.4 No. of child home contacts 1,012 686 No. of child home contacts per case (average) 1.2 1.1 No. of cases of scarlet fever among adult contacts 1 3 No. of cases of scarlet fever among: child contacts 83 44 % of cases of scarlet fever among child contacts 8.2 6.4 No. of households with 2 cases 61 26 No. of households with 3 cases 7 9 No. of households with 4 cases 1 2 No. of households with 5 cases 1 - Where more than one case occurred in a household consideration of the dates of onset of the second or subsequent cases showed that in th majority infection had occurred previous to the diagnosis of the first case. In other words, if the casecan be isolated at home there is no advantage to the community in removing it to hospital. All persons suffering from tonsillitis should be considered Infectious and should remain in isolation at home until the attack hrs subsided. In regard to diphtheria only 5 cases occurred and this is the lowest incidence in the 48 years for which records are available. Also for the first time, no deaths from diphtheria are recorded. At the end of the year 37.97 per cent, of the population under 5 years of age and 77.1^ per cent, of the population between 5 and 15 years were immunised. There is no doubt that this low incidence and mortality are due largely to the campaign of immunisation against diphtheria, which has been in operation here since 1930. It is to be hoped that parents will not grow negligent in protecting their children against diphtheria as the disease can be controlled only by maintaining a high proportion of immunised perrons in the population. 2. The increase in .tuberculosis incidence and mortality which appeared in 1940 has not been maintained and the notifications and deaths were less than in 1942 and 1941. The prevalence of scabies continued, but as compared with 1942 a larger proportion of those affected completed treatment and fewer cases relapsed. Greater advantage is being taken of the facilities provided for treatment and treatment is being sought at an earlier stage in the disease than was the case in 1942. Attention has also been given to the problem of infestation by head-lice. Regular examinations of school children are carried out, but no such scheme is applied to the rest of the population. Medical Officers and health visitors utilise the opportunities provided by clinics and home-visits to press the importance of personal cleanliness especially in families where the school records indicate the need for such advocacy. Contact has been maintained with factory nurses and assistance and advice given to combat infestation by head-lice. Here, gross infestation has been encountered, in adolescent and adult women more frequently than in children under school age. The provision of wartime day nurseries was extended by the opening of Blenheim House Nurrery with accommodation for 50 children on the 9th August, 1943, and Heston Nursery, with the same accommodation, on the 15th November, 1^43. Nursery accommodation is now available for 189 children and there is always a waiting list of applicants for admission. The nurseries have been free of serious illness or epidemic among the children. Shortage of and illness among domestic and nursing staff have placed a heavy strain on this service and there are no indications that further staff will be readily available. Dr. Roberts analysed the records of N^ntly House for a period of 80 .veeks from its opening and found that the average attendance of the children was 75 per cent., that of the 9G children who left 39 per cent, had been in attendance for less that six weeks and that only 3 of the original entrants were still in the nursery at the end of the period. Throughout the year full use has been made of the infant welfare, ante-natal clinics and dental clinics, and the total attendances at each shows an increase on 1942. Strenuous efforts have been made to extend our home-help service. The demand for the serv'ce has increased, but the shortage of suitable women for employment on this work and the uncertainty of the dates on which they will be needed make the administration of this service peculiarly difficult. The quantity of dried milk and vitamin preparations issued at clinics continues to increase. An increase is also recorded in the number of meals supplied, at school canteens and municipal restaurants. For a considerable pert of 1943 the municipal domiciliary midwifery service was severely handicapped by reason of illness among the midwives. To provide the off-duty recommended in. the report of the Midwives Salaries Committee and to meet any increased demand resulting from the rise in the birth rate the staff of municipal midwives has been increased from eight to ten. Of the 1,600 live and still births among residents of the Borough 580 occurred in private houses. The distribution of confinements during the last six years is shown below Year Total confinements Domiciliary confinements in Borough Nursing Home & Hospital confinements in Borough Confinements outside Borough No. % W.M.H. N.H. Total i % No. % 1938 1484 611 41.2 516 84 600 40.4 273 18.4 1939 1566 650 41.5 479 114 593 37.9 323 20.6 1940 1368 633 46.3 425 70 495 36.2 240 17.5 1941 1261 573 45.4 323 94 417 33.1 271 21.5 1942 1447 597 41.2 542 135 677 46.8 173 12.0 1943 1600 580 36.3 476 189 665 41.6 355 22.1 3. It will be seen that, up to the present, the increased demand for midwifery facilities is being met by sources other than the local domiciliary midwifery service. The difficulties of obtaining domestic help or the assistance of friends and relatives has no doubt influenced women to be confined elsewhere than in their own homes. The demand for foster mothers to care for young children has increased. Pew new foster mothers are available to meet this demand and careful watch has been maintained to see that overcrowding of foster homes in relation to staff or cubic space is avoided. The water supply of the Borough is adequate and constant and apart from a few isolated cottages every house has a supply direct from the mains. The Sanitary Inspectors continue to give attention to food supplies and environmental conditions. Shortage of labour and materials continues to restrict the repair and maintenance of dwelling houses and some deterioration is occurring. At the end of the year 36 houses on which 6 Demolition Orders have been made, were still occupied. The quantity of unsound food mentioned in this report refers only to such food as was disposed of under the supervision of the Sanitary Inspectors. At the request of the N. A. A.F.I. and the Military Authorities inspections of bulk stores have been carried out but any food which was condemned was dealt with by the Salvage Department of the Ministry of Food. I think it may be said that, in regard to the general health of the inhabitants and the volume of work carried out by the Health Department, 1943 has been a good year. I am particularly indebted to my staff for their loyal and generous assistance. I desire to express my thanks to the Chairmen and Members of the Committees for their support and consideration and to my colleagues in other Departments for their ready co-operation. I remain, Your obedient servant, a. ANDERSON. Medical Officer of Health. 4. general statistics. 1943. 1942. Population (Registrar-General's estimate). 95,080 95,600 Number of inhabited houses (rate books). 27,630 27,521 Number of houses erected during year. - - Rateable value of Borough. £941,785 £929,681 Sum represented by a penny rate. £3,825 £3,676 Live Births - legitimate - male 748 679 - female, 721 662 illegitimate - male. 47 27 - female. 43 32 Birth rate per 1,000 population. 16.3 14.64 Birth rate per 1,000 population (England and Wales). 16.5 15.8 Still Births - legitimate - male, 17 22 - female, 18 23 - illegitimate- male, 3 1 - female. 3 1 Still Birth Rate per 1,000 (live and still) births, 25.6 32.48 Deaths - male, 514 516 - female, 490 454 Death Rate per 1,000 population, 10.6 10.2 Death Rate per 1,000 population (England and Wales). 12.1 11.6 Infant Mortality Rate. 46.3 72.1 Infant Mortality Rate (England and Wales) 49 49 Maternal Mortality Rate. 0.62 2.76 Maternal Mortality Rate (England ard Wales), 2.29 2.01 Out-relief disbursed to Heston and isleworth residents, £15,916 £13,908 GENERAL PROVIS10N OF HEALTH SERVICES. 1943. 1942. Laboratory facilities - specimens examined. 551 583 District Nursing - visits paid. 36,125 32,519 Ambulance Service - journeys re accident. 649 535 " " sickness. 1,710 1,156 Insulin - No, of vials dispensed. 670 - 5. GENERAL PROVISION OF HEALTH SERVICES. (Continued). 1943. 1942. Infant Welfare Centres - no. of sessions. 561 557 - attendances., (a) under 1 year. 20,438 17,274 (b) 1-5 years. 10,278 10,500 (c) all ages. 30,716 27,774 Ante-natal and Post-natal Clinics. Routine clinics - sessions. 257 259 - attendances.5089 4,847 Consultant clinics - sessions. 51 49 - attendances. 619 648 Total attendances. 5708 5,495 Artificial Sunlight Clinic - children treated 67 45 Orthopaedic Treatment - children treated. 38 24 Refraction Clinic - ohildren examined. 48 45 Minor Ailments Clinic - children treated. 39 30 Speech Clinic - children treated. 2 3 Midwives - number notifying intention to practice. 46 49 - cases attended as midwife. 479 520 - cases attented as maternity nurse. 412 313 - percentage of cases where medical aid summoned. 38 37 - fees paid to medical practitioners, £239 £238 Municipal Domiciliary Midwife Service. No. of municipal midwives. 10 8 No. of cases booked - as midwife. 518 544 - as maternity nurse. 92 104 No. of cases completed - as midwife. 458 480 - as maternity nurse. 105 88 No. of visits - ante-natal. 2,777 3,391 - post-natal. 9,287 9,928 Home Helps - no. of cases where home help provided. 51 46 Convalescent Homes - no. of mothers sent. - - - no. of children sent. - 2 6. GENERAL PROVISION OF HEALTH SERVICES. (Continued). 1943 1942 Health Visitors - no. employed. 12 12 - attendances at M.&C.W. clinics, etc. 1,673 1,972 - visits to mothers and children. 14,700 12,033 Child Life Protection. No. of foster children on register. 67 62 No. of visits by Health Visitors. 591 475 Dental Treatment of Mothers and Children. Total attendances of mothers and children. 2,618 2,554 No. of extractions - mothers. 2,069 1,732 - children. 310 384 No. of fillings - mothers. 402 470 - children. 135 262 No. of dentures supplied to mothers. 241 211 Milk and Other Foods Supplied Free or at Reduced Cost. Dried milk (lbs.). 532 1,314 National Dried Milk (lbs.). 1622 4,135 Virol (lbs.). 11 10½ Groats (tins). 4 82 Cod liver oil (4 oz.). 3 17 Cod liver oil emulsion (8 oz.). 23 61 Cod liver oil and malt (lbs.). 1 36 Lactagol (tins). 59 272 Bemax (tins). 109 283 Adexolin (§ oz.). 22 186 Adexolin Capsules. Cartons of 14. 11 - Cod liver oil & malt with iron (lbs.). 36 122 Kalzana (tablets). 910 3,330 Celin (pkts. containing 30 tablets). 6 - Receipts from sales at cost price. £3,051 £2,279 Vitamin preparations distributed under Ministry of Food Scheme. Orange juice (bottles). 116,991 25,985 Black currant puree (tins). - 11,496 Black currant juice (bottles). - 1,920 7. GENERAL PROVISION OF HEALTH SERVICES. (Continued). 1943. 1942. Cod liver oil (bottles). 15,251 12,767 Cod liver oil tablets, (packets). 2,526 - Municipal Restaurants. 3 2 Meals supplied at municipal restaurants. 263,809 225,916 " " " school canteens. 901,391 714,070 Nursing Homes. No. registered at end of year, - nursing homes. 1 1 - maternity homes. 1 1 - nursing and maternity homes. 1 1 Superannuation Acts. No. of employees examined. 6 15 Wartime Day Nurseries. No. of nurseries provided. 4 2 Accommodation for children (0 - 5yrs.). 189 90 Average daily attendance. 120 71 Scabies Clinics. Nio. of persons called for examination. 798 1,317 No. of above who attended. 518 623 Total no. of persons who attended. 1,566 1,539 No. of persons found to be suffering from scabies. 1,030 1,049 No. of persons who completed treatment, (a) under school age. 100 121 (b) school children. 536 555 (c) over school age. 338 316 NO. of persona who did not complete treatment. 56 57 No. of persons in whom scabies recurred. 39 105 SANITARY CIRCUMSTANCES OF THE AREA. There was no significant change in the sanitary ciroumstances of the area as compared with 1942. A summary of the work of the inspectors in regard to general sanitation is given be low:- 1943. 1942. Visits and re-visits re complaint or remedy of nuisances. 15,974 9,699 Inspections of piggeries. 41 9 8. SANITARY CIRCUMSTANCES OF THE AREA. (Continued). 1945. 1942. Inspections of stables. 197 29 Inspections of urinals. 11 10 Visits re infectious disease. 1,289 1,072 Smoke observations. 23 7 Inspections re offensive trades. 53 17 Inspections of tents, vans and sheds. 86 66 Inspections of common lodging houses. - 4 (Hone within the Borough in 1945) Inspections of shops r3 sanitary arrangements. - 2 Inspections of factories, workplaces, etc. 1,342 325 Houses disinfested. 32 56 Inspections of canal boats. 31 21 HOUSING. 1943. 1942. No. of new houses erected - by private enterprise. - by local authority. No. of houses inspected for housing defects. 300 308 No. of houses found unfit for human habitation. 9 2 No. of houses rendered fit by informal action. 266 273 No. of houses rendered fit by formal action. 46 14 No, of houses demolished in pursuance of Demolition Orders. 9 - No. of houses rendered fit in pursuance of undertaking. - - No. of houses in respect of which Demolition Orders were made. - 1 NOo of houses where undertaking not to re-let accepted. 9 1 No. of underground rooms closed. No. of houses known to be overcrowded at end of year. 74 74 No. of new cases of overcrowding found during year. 8 16 No. of cases of overcrowding relieved during year. 8 6 No. of houses demolished voluntarily. INSPECTION AND SUPERVISION OF FOOD. 1943. 1942. Inspections of dairies, etc. 214 161 Inspections of ice cream premises. 5 30 9. INSPECTION AND SUPERVISION OP FOOD. ( Cbntt&U«d) 1943. 1942. Inspections of bakehouses. 196 52 Inspections of slaughterhouses. 3 4 Inspections of premises where food is sold or manufactured. - meat. 824 293 - fish. 225 101 - provisions. 1,161 414 - greengrocery and fruit. 665 149 - hawkers. 160 4 - food preparation. 912 110 - other foods. 114 253 Unsound food seized or surrendered (lbs.) 3,603 7,462 Unsound tinned food seized or surrendered (tins). 5,757 5,855 PREVALENCE OP INFECTIOUS AND OTHER DISEASES. 1943. 1942. Cases Notified. Deaths. Cases Notified. Deaths. Smallpox. - - - - Scerlet fever. 280 - 190 - Diphtheria. 5 - 11 1 Erysipelas. 21 - 16 - Pneuronia. 116 63 72 61 Cerebro-spinal fever. - 1 12 1 Epidemic encephalitis. - 1 - - Poliomyelitis and polioencephalitis. - - - - Typhoid fever. 1 - 4 - Paratyphoid fever. - - 1 - Dysentery. - - 2 - Tuberculosis. 203 49 200 70 Ophthalmia Neonatorum. - - 3 - Puerperal pyrexia. 105 1 58 - Measles. 636 1 1,085 2 Whooping Cough. 134 1 243 4 Non-notifiable Infectious Diseases. 1943. 1942. German Measles. 45 18 10. Non-notifiable Infectious Diseases. (Continued). 1945. 1942. Chicken Pox. 401 673 Mumps. 139 1,032 Disinfection - no. rooms disinfected. 305 255 Hospital Treatment of Infectious Diseases. Total cases treated in hospitals. 348 248 Diphtheria Immunisation. No. of attendances at clinics. 15,886 16,098 No. given certificates after immunising. 2,461 2,089 No. submitted to primary Schick test. 2,070 2,986 - Schick positive. 1,889 2,751 - Schick negative. 163 235 No. of cases of diphtheria in immunised persons. No. of deaths from dijiitheria in immunised persons. TABLE OF CAUSES OF DEATHS DURING 1945. (According to figures furnished by the Registrar General). Causes of Death. Civil Residents all ages. Male. Female. All causes 514 490 1 Typhoid and paratyphoid fever - - 2 Cerebro-spinal fever 1 - 5 Scarlet Fever - - 4 Whooping cough - 1 5 Diphtheria — — 6 Tuberculosis of respiratory system 23 19 7 Other forms of tuberculosis 5 2 8 Syphilitic diseases 9 7 9 Influenza 7 9 10 Measles 1 — 11 Acute polio-myelitis and polio-encephalitis - - 12 Acute infectious encephalitis - 1 13m Cancer of buccal cavity and oesophagus 9 - 13f Cancer of uterus - 13 14 Cancer of stomach and duodenum 12 16 15 Cancer of breast - 15 16 Cancer of all other sites 56 45 17 Diabetes 2 9 18 Intro-cranial vascular lesions 45 54 19 Heart disease 125 108 20 Other diseases of circulatory system 17 19 21 Bronchitis 58 50 22 Pneumonia 57 26 25 Other respiratory diseases 7 6 24 Ulceration of stomach or duodenum 15 5 25 Diarrhoea under 2 years 15 7 26 Appendicitis 2 3 27 Other digestive diseases 8 11 28 Nephritis 7 15 29 Puerperal and post-abortive sepsis - 1 30 Other maternal causes - - TABLE OF CAUSES OF DEATHS DURING 1943. (Continued). Causes of Death. Civil Residents, all ages. 31 Premature birth 11 7 32 Cong, malformations, birth injury etc. 12 5 33 Suicide 4 3 34 Road Traffic Accidents 2 2 35 Other violent causes 7 13 36 All other causes 39 40 12