LEW 33 The Metropolitan Borough of Lewisham ANNUAL (ABRIGED) REPORT On the Health of the Borough for the Year ended 31st DECEMBER - 1 9 4 5 Public Health Department, Lewisham Town Hall, Catford, S.E.6. Public Health Department, Lewisham Town Hall, Catford, S.E.6. 7th October, 1946. To: The Mayor, Aldermen and Councillors of the Metropolitan Borough of Lewisham. Mr. Mayor, Ladies and Gentlemen, The Annual Report for 1945 is presented again in the abridged form required by the Ministry of Health since 1939, and is chiefly a compilation of statistical information. During the year under review Dr. John W. Miller, the Medical Officer of Health, became increasingly ill so that he was granted indefinite leave of absence, but early in 1946 we learned with the greatest regret that he had decided to resign. After the strenuous and trying years of war, that very materially contributed to his breakdown, we wish him a quiet and restful retirement with the knowledge that he is much missed and remembered with real affection by all who knew him. It should be borne in mind that in consequence of war-time conditions the vital statistics contained in this report relate to the civilian population only and deaths of males and females serving in H.M. Forces are excluded. The restriction imposed during the war (on grounds of national security) as to the publication of population and other figures has now been removed and it is therefore possible to give information previously witheld. A summary of the statistics for the past eight years is of interest and is given on page 4. The Registrar General's estimate of the population at 171,280 shows a considerable increase on the previous year but is still much below the 1931 Census figure of 219,953. The Birth Rate for the year of 17.7, although lower than the previous year, is well above the mean. The Death Rate of 12.1 is below the average of the past eight years. It is satisfactory to record that the Infant Mortality Rate at 34 continues to fall and compares favourably with the figures of 46 for England and Wales and 53 for the Administrative County of London. The communicable diseases, with few exceptions, showed a decline as compared with 1944, both as regards incidence and the number of deaths. Towards the end of the year it was decided to have a special Diphtheria Immunisation Campaign in the Borough during the Spring. As a result of this the percentage of children immunised in the Borough was raised from 46% to 68%. In October 1945 the new X-ray Department was opened at the Tuberculosis Dispensary and a full-time radiologist appointed. Since that date this new department has been able to deal with the full requirements of the Borough in respect of X-ray examinations. I wish to express my appreciation of the support and help I have received from the Council and staff. I am, Mr. Mayor, Aldermen and Councillors, Your obedient servant, ELLA G. F. MACKENZIE, Deputy Medical Officer of Health. - 2 - SECTION "A" - VITAL STATISTICS AREA POPULATION The area of the Borough is 7,015 acres. Census 1931 219,953. The Registrar-General's estimate of the resident civilian population for the year 1945 was 171,280. RATEABLE VALUE £1,786,956. Estimated Product of a Penny Rate £6,200. BIRTHS Number of Live Births 3,030. MALES FEMALES TOTALS Legitimate Births 1439 1371 2810 Illegitimate Births 119 101 220 Totals 1558 1472 3030 Birth Rate per Thousand of the Estimated Population - 17.7. " " England and Wales. - 16.1. " " London, Administrative County - 15.7. STILL-BIRTHS The total number of still-births allocated to the Borough during the year was 56. This represents a Still-birth rate per thousand live and still-births of 18.1. DEATHS The total number of Deaths belonging to the Borough registered during the year 1945 was 2068, consisting of 1052 Males and 1016 Females, giving a Death Rate per thousand of the estimated Population of 12.1 INFANT MORTALITY RATE Number of Infant Deaths 102 (a) Legitimate 88 (b) Illegitimate 14 1. All Infants per thousand Births. Rate 34. 2. Legitimate Infants per thousand Legitimate Births " 31.3. 3. Illegitimate Infants per thousand Illegitimate Births " 63.6. - 3 - Section "A" (Continued) MATERNAL DEATHS Number of Maternal Deaths 6 (a) Puerperal Sepsis 0 (b) Other Maternal Causes. 6 Maternal Mortality Rate (per thousand total live and still Births) 1.9 OTHER DEATHS Number of deaths from Measles (all ages) 0 " " " " Whooping Cough 3 " " " " Diarrhoea (under 2 years) 25 " " " " Tuberculosis 138 " " " " Cancer 390 " " " " Heart Diseases. 586 Comparative Statistics for the Year 1945 Birth Rate (per 1,000 Civilian Population Death Rate (per 1,000 Civilian Population) Infant Mortality Rate (per 1,000 live Births) Live Births Still Births Lewisham 17.7 0.32 12.1 34 England and Wales. *16.1 *0.46 *11.4 46 London, Administrative County. 15.7 0.40 13.8 53 *Rates per 1,000 total population. - 4 - Section "A" (Continued) General Summary of Vital Statistics for the years 1938 to 1945 Year Estimated Population Births Deaths Deaths under One Year Deaths from Pulmonary Tuberculosis Number Rate Number Rate Number Rate Number Rate 1938 229,000 3188 13.9 2403 10.5 151 47 153 0.61 1939 220,300 3135 13.6 2356 10.8 129 42 140 0.63 1940 192,540 2833 14.7 2898 15.8 119 45 129 0.67 1941 148,150 2068 13.9 2128 14.3 54 34 137 0.92 1942 161,800 2732 16.8 1955 12.0 103 37 118 0.73 1943 168,530 3151 18.7 2359 13.9 134 42 128 0.76 1944 163,320 3046 18.6 2416 14.8 123 40 129 0.79 1945 171,280 3030 17.7 2068 12.1 102 34 122 0.71 SUMMARY OF STATISTICS AS TO TUBERCULOSIS FOR THE YEARS 1935 to 1945 (1) Year (2) Population (3) No. of new Cases Notified (All Forms) (4) Deaths (5) Death Rate from Pulmonary Tuberculosis per thousand population. All Forms Respiratory 1935 223,000 347 147 131 0.58 1936 224,000 379 157 141 0.62 1937 226,000 413 147 134 0.59 1938 229,000 330 175 153 0.61 1939 220,300 301 159 140 0.63 1940 192,540 262 149 129 0.67 1941 148,150 315 156 137 0.92 1942 161,800 354 131 118 0.73 1943 168,530 403 150 128 0.76 1944 163,320 390 146 129 0.79 1945 171,280 371 138 122 0.71 NoteThe 1944 death rate from Pulmonary Tuberculosis for the County of London was 0.84. - 5 - Section "A" (Continued) CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE DURING THE YEAR 1945 The following Table shows the causes of and ages at death during the calendar year 1945:- Code Number CAUSES OF DEATH Nett Deaths at the subjoined Ages of "Residents" whether occurring within or without the Borough. All Ages Under 1 year 1 and under 5 5 and under 15 15 and under 45 45 and under 65 65 and over Totals, All Causes 2068 102 22 10 190 583 1161 1 Typhoid & Paratyphoid Fevers • • • . . . . 2 Cerebro-spinal Fever 1 1 • • . • • 3 Scarlet Fever • . • • . • • 4 Whooping Cough 3 2 1 . . • • 5 Diphtheria 1 • 1 • . • • . 6 Tuberculosis of Respiratory System 122 . . 1 68 43 10 7 Other forms of Tuberculosis 16 • 6 • 10 • • 8 Syphilitic Diseases 17 1 . . 4 6 6 9 Influenza 11 • • . 2 4 5 10 Measles • • • • • • • 11 Acute Polio-Myelitis and Polio-Encephalitis 1 • . . 1 • • 12 Acute Infectious Encephalitis . • • . • • . 13 Cancer, Buccal Cavity & Oesophagus (M), Uterus (F) 30 . • • • 15 15 14 Cancer, Stomach & Duodenum 56 • • • 3 24 29 15 Cancer, Breast 42 . • • 5 28 9 16 Cancer, all other sites 262 • • 1 13 117 131 17 Diabetes 11 • • • • 2 9 18 Intra-Cranial Vascular Lesions 189 • • • 3 50 136 19 Heart Diseases 586 • • • 14 109 463 20 Other Circulatory Diseases 51 • . • . 2 10 39 21 Bronchitis 153 2 • • 2 51 98 22 Pneumonia 76 15 5 • 4 21 31 23 Other Respiratory Diseases 16 . • • 5 5 6 24 Ulcer, Stomach & Duodenum 28 • • • 4 10 14 25 Diarrhoea (Under 2 years) 25 24 1 . . • . 26 Appendicitis 3 • 1 1 1 . . 27 Other Digestive Diseases 46 3 3 1 4 11 24 28 Nephritis 35 . . • 4 9 22 29 Puerperal & Post Abortiye Sepsis • • • • • • • 30 Other Maternal Causes 6 . . . 6 . . 31 Premature Birth 16 16 . • • • • 32 Congenital Malformations, Birth Injury, infantile Diseases. 33 30 . 1 . 1 . 33 Suicide 8 . . . 2 4 2 34 Road Traffic Accidents 15 . . 1 3 5 6 35 Other Violent Accidents 75 5 1 2 17 24 26 36 All other causes 134 3 3 2 12 34 80 It will be seen that Cancer and Heart Diseases between them accounted for nearly half (976) of the total of 2068 Deaths in the Borough - 6 - SECTION "B" - GENERAL PROVISION OF HEALTH SERVICES NOTIFICATION OF BIRTHS The total number of births notified in the year was 1927. Of this number 24 were still births. 3030 live births and 56 still births were registered as belonging to the Borough. PROFESSIONAL NURSING IN THE HOME The number of visits paid to cases by nurses from Nursing Associations at the Council's expense was 4,401 at a cost of £476. 2s. 2d. HEALTH VISITING The following is a brief summary of the visits made by the Health Visitors during the year:- TOTAL VISITS To Expectant Mothers 2,145 To Children under 1 year 9,372 To Children 1 to 5 years 15,699 INFANT WELFARE CENTRES. The number of attendances at the fourteen Maternity and Child Welfare Centres was as follows:- Infant Welfare Centres Babies 2,578 Children 1 to 5 years 5,167 ANTE-NATAL AND POST-NATAL CLINICS Number of women who attended 2,900 CHILD LIFE PROTECTION A second Health Visitor was appointed during the year as a Child Life Protection Officer. The number of Foster Mothers on the Register at the end of the year was 71 and the number of children on the Register was 92. SuMmary of Visits made by the Child Life Protection Officers Primary visits to Foster Mothers 38 " " " Foster Children 45 Re-visits to Foster Mothers 740 " " " Foster Children1280 Number of illegitimate children at end of year 272 - 7 - Section "B" (Continued) HOME HELPS AND DOMESTIC HELPS The Council's Scheme for the provision of Home Helps for mothers during confinement, which has been in operation since 1930, was continued on a larger scale and was provided to 545 cases, fifteen whole-time and sixty-nine part-time workers were employed. Early in the year, in accordance with Ministry of Health Circular No. 179/44, the Council approved an extension of the Home Help Scheme, in order to provide a service of Domestic Helps for the homes of sick, aged and infirm persons who are unable to obtain help of which, under existing conditions, they are peculiarly in need. Considerable difficulty was experienced in obtaining a sufficient number of women suitable for this work, in addition to the requirements of the Home Help Scheme for lying-in cases, but the necessary assistance was granted to 137 cases. CARE OF PREMATURE INFANTS. In compliance with Ministry of Health Circular No. 20/44 arrangements were made for the weight of each newly born child to be entered on the Birth Notification in order that early contact could be made between the Health Visitor and the mothers of premature babies born at home. SUPPLY OF SHEETS FOR EXPECTANT MOTHERS In accordance with the Ministry of Health Circular 154/44, and by arrangement with the Board of Trade, Priority Dockets were issued to enable expectant mothers who were to be confined in their own homes to purchase Sheets. These Dockets were in freat demand and during the year 2,780 were issued at the Maternity and Child Welfare Centre. SUPPLY OF NATIONAL MILK AND VITAMIN SUPPLEMENTS. These were supplied to expectant mothers and children under five years of age at all the Welfare Centres and Clinics in the Borough throughout the year. DENTAL TREATMENT. Dental Treatment for expectant and nursing mothers and children under five years of age was continued to be carried out by arrangements made with the London County Council at their Minor Ailment Treatment Centres and also at local Hospitals. Dentures were supplied to 86 cases. PROVISION OF INSULIN The number of persons suffering from Diabetes who received Insulin supplied under the Council's Scheme during the year was 18. - 8 - Section "B" (Continued) WAR-TIME DAY NURSERIES The Council's Honor Oak Estate Day Nursery which had been housed since 1942 in the L.C.C. school premises was vacated on 30th November, 1945, and as far as possible children were transferred to another Nursery. This course was necessary as the premises were required by the L.C.C. for use as a Nursery School, as formerly, in consequence of the evacuated schools returned to London. The remaining four Nurseries in the Borough continued to function and the following Table shows the average daily attendances each month during 1945. Month Catford Ladywell Forest Hill Downham Honor Oak Approved places-40 Approved places-88 Approved places-65 Approved places-56 Approved places-60 Average Attendances Average Attendances Average Attendances Average Attendances Average Attendances January 32.2 52.8 28.4 24.2 25.4 February 35.0 58.7 33.7 29.8 30.9 March 33.6 69.2 39.2 32.2 32.4 April 36.1 69.7 46.6 48.4 40.2 May 38.0 80.7 57.5 54.1 48.3 June 40.0 79.6 67.0 55.1 60.0 July 40.7 88.2 60.7 55.6 60.5 August 38.9 87.8 58.1 60.7 64.5 September 39.1 94.4 54.7 57.7 68.1 October 40.6 89.1 64.2 65.3 75.6 November 40.6 88.0 58.8 60.7 61.4 December 39.1 81.3 50.3 50.5 Closed CONVALESCENCE FOR CHILDREN UNDER FIVE Invalid Children's Aid Association The arrangements with the Invalid Children's Aid Association for the provision of convalescent treatment for children under five was continued throughout the year and 25 children benefited from such treatment during the year. - 9 - Section "B" (Continued) LABORATORY FACT LITIES The bacteriological work of the Council is carried out under contract by St. John's Hospital, Lewisham. Routine examinations of throat and nasal swabs, sputum and blood specimens, etc., were submitted, and the following is a brief summary of the work undertaken Positive Negative Total Diphtheria 16 676 692 Tuberculosis 158 796 954 Typhoid • 4 4 Miscellaneous 4 3 7 Totals 178 1,479 1,657 VACCINATION The Annual Return made by the Vaccination Officer to the Registrar General respecting the vaccination of children whose births were registered in the Borough during the year ended 31st December 1944 shows that of the 1953 births so registered 955 or 48.9 per cent were successfully vaccinated. PUBLIC MORTUARY AND CORONER'S COURT. The number of bodies taken to the Council's Public Mortuary during the year was 339. Inquests were held in 122 cases. These figures do not include deaths due to war operations, for which separate provision was made. RODENT CONTROL This was maintained by the Council's Rodent Officer and his assistant in conjunction with the sewer operatives. TUBERCULOSIS DISPENSARY SERVICE. The total number of persons examined at the Council's Tuberculosis Dispensary was 5.680. Of this number 1,895 were new cases and 558 were contacts. The number of definite cases of Tuberculosis on the Dispensary Register at the beginning of the year was 1.772 and 1,886 at the end of the year. The Council's Tuberculosis Health Visitors paid 2,880 visits to the homes of patients during the year. Tuberculosis Allowances. The scheme for the payment of allowances to persons suffering from pulmonary tuberculosis who have to give up remunerative employment to undergo treatment continued during the year 1945, as well as the supply of extra nourishment. - 10 - SECTION "C" - SANITARY CIRCUMSTANCES OP TEE AREA The following Table shows a summary of the Inspections, etcetera, carried out by the Sanitary Inspectors during the year Cause of Inspection TOTALS Complaints 2791 Infectious Disease 1938 War Damage 2629 Notice from Builders 243 Re Building Licences 358 Rats and Mice and other Pests 272 Re Landlord and Tenant Act Certificates 243 Re Rent Act Certificates 36 Re Water Certificates 62 Re Pharmacy and Poisons Acts 3 Re Housing 548 Slaughterhouses 2 Factories, Workshops and Outworkers 1847 Miscellaneous 367 Re-Inspections 4758 Statutory Notices Served 275 Intimation Notices Served 1910 TOTAL 18,282 - 11 - SECTION "D" - HOUSING In November, 1945, the Council adopted a "Points" Soheme for the allocation of housing accommodation to families inadequately housed, in order to provide a fair means of distinguishing the most urgent cases. All applications for accommodation were referred by the Housing Controller to the Public Health Department for the award of "points" in relation to medical factors, overcrowding and insanitary conditions. SECTION "E" - INSPECTION AND SUPERVISION OF FOOD MILK SUPPLY Analysis of Milk During the year under review 103 samples of Milk were submitted by the Council's Inspectors to the Public Analyst for examinations and none of these samples were certified as adulterated or below standard. The average composition of these samples of Milk is set out in the following Table:- Period Average Composition of Samples examined. Legal Standard. Percentage Milk Fat Percentage of Solids not fat Percentage of Water Percentage of Milk Fat Percentage of Solids not fat First Quarter 3.54 8.76 87.70 3.0 8.5 Second Quarter 3.35 8.85 87.80 Third Quarter 3.59 8.71 87.70 Fourth Quarter 3.73 8.83 87.44 Average 3.55 8.78 87.66 Bacteriological Examinations of Milk. 145 Samples of heat-treated Milk were submitted to the Laboratory for Bacteriological Examination, the results of which were satisfactory. - 12 - Section "E" (Continued) MILK SHOPS AMD DAIRIES Number of Dairy Premises on the Register at the end of the year 106 Number of Purveyors of Milk on the Register 187 MILK (SPECIAL DESIGNATIONS) REGULATIONS Number of Licences issued for The sale of Pasteurised Milk 43 " " " Tuberculin Tested Milk 18 Supplementary Licences 14 ADULTERATION OF FOOD The total number of Samples taken during the year under the Food and Drugs Act was 1.049, of which number 109 were formal samples and 940 informal samples. After examination the Public Analyst reported that 5 of the formal samples and 8 of the informal samples were found to be adulterated or below standard. The percentage of adulteration amounted to 4.58 in the case of the formal samples and 0.85 in the informal samples, whilst it was 1.24 of all the samples submitted, compared with 0.84 per cent in the previous year. Premises where Food is Prepared or Offered for Sale. These premises were kept under observation by the Council's Food Inspectors, in addition to those registered under the provisions of the Food and Drugs Act, 1938. The work of revising the Registers deferred by the war conditions was put in hand during the year in order to bring the records up to date. Summary of Inspections made by the Food Inspectors. Cause of Inspections Number of Inspections made. Food Shops and Stalls 823 Registration of Food Premises 543 Wholesale Meat Depot 347 Shops Act 771 Ice Cream Premises 168 Dairies and Milk Purveyors 119 Fishmongers and Fish Frying Premises 70 Restaurants and Eating Houses 81 Bakehouses 60 Butchers' shops 25 Street Markets 20 - 13 - Section "E" (Continued) UNSOUND FOOD A considerable amount of Food was surrendered as unfit for human consumption, largely due to war conditions. In all, approximately 37 tons 17 cwts. of Foodstuffs were dealt with by the Council's Food Inspectors, consisting mainly of Meat at the Wholesale Meat Depot and Fruit Pulp, Fish, etc. In co-operation with the Salvage Division of the Ministry of food, in order to prevent wastage where possible, this unsound food was forwarded to the appropriate authorities for re-conditioning or animal feeding. SECTION "F" - PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES PRINCIPAL NOTIFIABLE INFECTIOUS DISEASES (Other than Tuberculosis) Number of Notified Cases (corrected for revised diagnosis) during the year 1945 with comparative figures for the previous six years. It should be borne in mind that some of the war-time figures were considerably affected by evacuation of population. Diseases Number of Cases Notified 1945 1944 1943 1942 1941 1940 1939 Cerebro-spinal Fever 3 4 8 25 31 30 11 Continued and Relapsing Fever 1 • • • • • 1 Diarrhoea and Enteritis • • • • • • • Diphtheria 24 24 26 53 82 78 137 Dysentery 31 65 23 34 13 7 10 Encephalitis Lethargica (Acute) • • • • 2 • 1 Enteric or Typhoid Fever • • 1 . 2 11 7 3 Erysipelas 50 86 57 52 60 53 52 Influenza • • • • • • • Malaria . • • • • • 2 Measles 462 688 1270 858 726 119 48 Ophthalmia Neonatorum 1 4 17 4 4 7 14 Pneumonia 71 110 176 103 148 113 216 Polio-encephalitis (Acute) • * • • • • • Poliomyelitis (Acute) 5 . • 5 1 2 3 Puerperal Pyrexia 21 19 20 27 19 11 29 Scabies* 566 654 515 • • • • Scarlet Fever 197 270 683 255 98 109 330 Smallpox • 1 • • • . • Puerperal Fever 4 1 1 3 2 1 2 Whooping Cough 238 275 219 254 415 24 704 TOTALS . ... _ 1674 2201 3016 1675 1612 561 1563 *Notifiable as from 1st August, 1943. - 14 - Section "F" (Continued) DISINFECTION AND DISINFESTATION Number of Rooms Disinfected 1731 Number of articles treated at the Council's Disinfecting Station 34639 Number of Verminous Children treated at the Council's Cleansing Station 2000 Number of Verminous Adults treated 142 Number of Treatments given for Scabies at the Cleansing Station: Adults 2898 Children 3625 ASSISTANCE TO HOUSEHOLDERS IN THE EVENT OF AN EPIDEMIC A comprehensive scheme was prepared in accordance with Ministry of Health Circular 196/45 for the provision of medical and nursing care and also domestic help to householders if an epidemic such as Influenza occurred. Fortunately circumstances did not arise to require the scheme to be put into operation. TUBERCULOSIS The number of new cases notified during the year 1945 and the number of deaths (together with comparative figures for the previous year) were as follows:- NEW CASES NOTIFIED DEATHS 1944 1945 1944 1945 Pulmonary 320 307 129 122 Non-pulmonary 70 64 17 16 TOTALS 390 371 146 138 The age distribution of the New Cases of Tuberculosis notified and the Deaths from Tuberculosis during the year are shown in the following table:- - 15 - Section "F" (Continued) Age Periods NEW CASES NOTIFIED DEATHS Pulmonary Non-Pulmonary TOTALS Pulmonary Non-Pulmonary TOTALS M F M F M F M F 0 - . . . . . • • • • • 1 - 3 4 3 3 13 • • 3 3 6 5 - 1 6 4 4 15 • 1 • • 1 10 - 6 7 6 2 21 • • • • • 15 - 24 23 3 8 58 34 34 7 3 78 20 - 20 30 3 6 59 25 - 33 40 4 4 81 35 - 24 16 5 6 51 45 - 30 9 2 • 41 36 7 • • 43 55 - 17 3 • • 20 65 - 9 2 1 • 12 6 4 • • 10 TOTALS 167 140 31 33 371 76 46 10 6 138 TABLE OF CONTENTS Page Preface 1 Vital Statistics (Section "A") 2-5 General Provision of Health Services, including Maternity and Child Welfare (Section "B") 6-9 Sanitary Circumstances (Section "C") 10 Housing (Section "D") 11 Inspection and Supervision of Food (Section "E"). 11 Prevalence and Control of Infectious Diseases (Section "F") 13-15