LEW 34 LIBRARY The Metropolitan Borough of Lewishan ANNUAL (ABRIDGED) R E P O R T On the Health of the Borough for the Year ended 31 December - 1 9 4 6 - S. H. R. SMITHARD M.B.S., M.D., D.P.H. Medical Officer of Health Public Health Department Lewisham Town Hall Catford, S.E.6 To'the Mayor, Aldemen and Councillors of the Metropolitan Borough of Lewishan. Mr. Mayor, Ladies and Gentlemen, The Annual Report for 1946 is presented again in the abridged form required by the Ministry of Health since 1939 and is chiefly a compilation of statistical information. As mentioned in the last report, Dr. John W. Miller, the Medical Officer of Health, after many months of illness resigned early in-1946 and it was with the greatest regret that we heard reports of continued and increasing ill-health and finally of his death in May 1947. I was appointed by the Council in October 1946 to succeed Dr. Miller but I did not commence duties in the borough until January 1947. During the year under review the health services were therefore the responsibility of Dr. Ella G.E. MacKenzie. Deputy Medical Officer of Health, and thanks are due to her and to the staff as a whole for aid towards the satisfactory results achieved. The Registrar-General's estimate of the population in mid-year 1946 at 207,410 was 36,000 more than the estimate for the previous year and compares with the pre-war estimate in June 1939 of 231,000. The birth rate for the year at 21.7 also shows a considerable increase on the previous year (17.7) and is higher than either England and Wales as a whole or the London County area as a whole. The death rate dropped to 10.6, which is a lower figure than either the England and Tales rate or the County of London rate. The infant mortality rate remained low at 33 and in fact is one lower than in 1945. Special mention may be made of the following:- Rodent control. A large and comprehensive scheme of rodent control was started in July 1946 and was not finished by the end of the year. In fact it did not finish until the middle of April 1947 and results of the completed scheme will therefore be given in the next annual report. Housing. An increased amount of the sanitary inspectors' time was taken up on housing 'matters. This borough has many housing problems not least those following the damage and deterioration which occurred during the war-years. The sanitary inspectorate was understaffed, both in comparison with other boroughs and in the amount of work to be done, and consideration was being given at the end of the year towards increasing the number of personnel. Diphtheria immunisation. The special diphtheria immunisation campaign authorised in 1945 was carried out in the spring of 1946. A feature of the campaign was that a van, complete with medical and nursing personnel, toured the district in order to give diphtheria prophylactic injections "on the spot." During this campaign 1,162 children received two injections each and this was estimated to be 7,3 percent of the children under 5 in the borough. Due to the campaign and other factors it was estimated that the number of children under 5 completely immunised rns some 68 percent of those in the borough as against 45 percent in the previous year. Mass radiography. Examinations for mass radiography for the early diagnosis of lung disease were held in the borough from 7 October to 15 November,after some weeks of preliminary propaganda. Details of the results will be found on page 16 of this report. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, Lewisham Town Hall, E. H R. SMITHARD Catford, S.E.6. 17 September 1947 Medical Officer of Health. - 2 - SECTION “A“ - VITAL STATISTICS AREA The area of the Borough is 7015 acres. POPULATION Census 1931 219,953. The Registrar-General's estimate of the resident civilian population mid year 1946 was 207,410. RAIABLE VALUE £1,716,701 Estimated product of a penny rate £6,200. BIRTHS No. of live births 4491 Males Females Totals Legitimate 2155 2088 4243 Iliedtimate 130 118 248 2285 2206 4491 Birth rats per 1000 of the estimated population 21.7 Birth rate for England and Wales 19.1 V Birth rats, London Administrative County 21.5 STILL-BIRTHS The total number of still-births allocated to the Borough during the year was 97. This represents a still-birth rate per thousand live and stillbirths of 21.l. DEATHS The total number of deaths belonging to the borough registered during the year 1946 was 2208, consisting of 1094 males and 1114 females, giving a death rate per thousand of the estimated population of 10.6 as compared with a rate of 11.5 for England and Wales and 12.7 for the Administrative County of London. INFANT MORTALITY No. of infant deaths 148 Legitimate 136 Illegitimate 12 1• ALL infants per thousand live births Rate 33.0 2. Lesitimate infnts per thousand live legitimate births Rate 32.5 3. Illegitimate infants per thousand live mate births Rate 48.4 MATERNAL DEATHS No. of maternal deaths 5. (a) Puerperal sepsis - (b) Other maternal causes 5 Maternal mortality rate per thousand total live and still births 1.1 - 3 - OTHER DEATHS No. of deaths from MEALES (all ages) - " " " WHOOPING-COUGH 2 " " " DIARRHOEA (under 2 yrs)4 " " " TUBERCULOSIS 126 " " " CANGER 346 " " " HEART .DISEASES 675 Comparative Statistics for the Year 1946 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 Lewishan 21.7 0.47 10.6 33 England & Tales *19.1 *0.53 11.5 43 London, Administrative County 21.5 0.54 12.7 41 *Rates per thousand total population. General Summary of Vital Statistics for the years 1938 - 1946 Year Estimated Population Births Deaths Deaths under one year Deaths from pulmonary. tuberculosis. Number Rate Number Rate Number Rate Number Rate 1938 229,000 1 3188 13.9 2403 10.5 151 47 153 0.61 1939 220,300 1 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 42 123 0.76 1944 163,320 3046 18.6 2416 14.8 123 40 129 0.79 1945 171,280 3030 17.7 2068 l2.1 102 34 122 0.71 1946 207,410 4491 21.7 2208 10.6 148 33 110 0.53 - 4 - Summary of Statistics as to Tuberculosis for the years 1935 - 1946 Year Population No. of new cases notified. (all forms) Deaths 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 148,150 315 156 138 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 1946 207,410 467 126 110 0.53 Note:- The 1946 death rats from pulnonary tuberculosis for the County of London was 0.62. - 5- Section "A" (continued) Causes of death at differant periods of life during tho year 1946 The following table, shows the causes of and ages at death during the calendar year 1946:- Code No. CAUSES OF DEATE 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 land under 45 45 and under 65 65 and over Totals, all causes 2208 148 16 15 208 562 1259 1 Typhoid'& paratynhoid fevers - - - - - - - 2 Cerepro-Spinal fever 2 1 1 - - - - 3 Scarlet fever - - - - - - - 4 Whooping Cough 2 2 - - _ - - 5 Diphtheria 3 - 1 - 1 1 - 6 Tuberculosis of resp.system 110 1 1 - 65 37 6 7 Other forms of tuberculosis 16 3 3 4 6 - - 8 Syphilitic diseases 22 1 - - 1 12 8 9 Influenza 18 - 1 - 3 7 7 10 Measles - - - - - - - 11 Acute poliomyelitis and polioencephalitis - - - - - - 12 Acute infectious encephalitis 1 - - - - 1 - 13 Cancer, buccal cavity & oesophagus (M), uteru's (F) 34 *- - - 3 14 17 14 Cancer, stonach &duodenum 56 - - - 2 19 35 15 Cancer, breast 41 - - - 3 15 23 16 Cancer, all other sites 215 - 2 11 83 119 17 Diabetes 11 - - - 1 2 8 18 Intra-cranial vascular lesions 212 - - - 4 49 159 19 Heart diseases 675 - - 1 23 130 521 20 Other circulatory diseases 66 - - - 3 12 51 21 Bronchitis 127 3 - 1 3 43 77 22 Pneumonia 97 15 3 1 9 22 47 23 Other respiratory diseases 25 - - - 1 10 14 24 Ulcer, stomach & duodenum 29 - - - 2 17 10 25 Diarrhoea (under 2 years) 4 4 - - - - - 26 ADpendicitis 3 - - - - 2 1 27 Other digestive diseases 42 - l - 7 15 19 28 Nephritis 36 - - 1 8 15 12 29 Puerperal & post-abortive ' sepsis - - - - - - - 30 Other maternal causes 5 - - - 5 - - 31 Premature birth 60 60 - - - - - 32 Congenital malfodrmations, birth injury, infantile diseases 51 45 2 = 1 3 -' 33 Suicide 12 - - - - 3 - 34 Road traffic accidents 15 - - 1 1 5 9 35 Other violent causes 55 8 2 4 7 7 27 36 All other causes 163 5 1 - 30 38 89 - 6- Section "B" - GENRAL. L PROVISION OF HEALTH SERVICES Notification of births The total number of births notified in the year was 4,427, Of this number 83 were stillbirths. 4,401 live births and 97 stillbirths were resistered as belonging to the. borough. Professional nursing in the hone The number of visits paid to cases by nurses from Nursing Associations at the Council's expense was 4,690, at a cost of £508.1.3. Health-visiting The following is a brief summary of the visits made by the health visitors during the year:- Total visits' To expectant mothers 2,844 To children under 1 year 9,765 To children 1 - 5 years 14,397 Infant Welfare Centres The nunber of attendances at the 14 Maternity and. Child Welfare Centres was as follows:- Babies 3,406 Children 1-5 years of age 5,766 Ante nata 1_ and post natal clinics No, of women who attended: ante natal clinics 4,116. " " " post natal clinics 508. Total number of attendances 18,512. Child Life Protection The number of Foster Mothers on the register at the end of the year was 57. 88 children ware received during the year and there were 72 on the register at the end of the year. Summary of Visits paid by the Child Life Protection Officers Primary visits to foster mothers 88 " " foster children 88 Re-visits to foster mothers 2181 " " foster children 2181 Number of illegitimate children at end of year 371 - 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 1S30 was continued on a larger scale ana was provided to 688 cases. In a. further 358 cases domestic help was provided for sick, aged and infirm-persons. 43 whole-time and 161 part-tine workers were employed. ' CARE OF PREMATURE INPUTS In compliance with ministry of Health Circular No. 20/44, it is arranged that the weight of each newly born child is entered on the birth notification in order that early contact can be made between the health visitor and the mothers of premature babies born at home. SUPPLY of SHEETS FOR EXPECTANT MOTHERS In accordance with 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 great demand and during the year 5,955 were issued at the laternity and Child Welfare Centre. SUPPLY OF NATIONAL MILK AND VITAMIN SUPPLMENTS These were supplied to expectant mothers and children under. 5 years of age at all tne 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 continued to be carried out under arrangements made with the London County Council at their minor ailment treatment centres and also at local hospitals. Dentures were supplied to 106 cases. PROVISION OF INSULIN The number of persons suffering from diabetes mho received insulin supplied under the Council's scheme during the year was 21. - 8 - Section "B" Continued LABORATORY FACILITIES 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 10 898 908 Tuberculosis 199 1014 1213 Typhoid - 4 4 Miscellaneous 1 35 36 Totals 210 1951 2161 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 1945 shews that of the 2088 births so registered 1113 or 53,3 percent were successfully vaccinated. PUBLIC MORTUARY AND CORONER'S COURT The number of bodies taken to the Council's Public Mortuary during the year was 440. Of this number 210 were received from hospitals. Inquests were held in 131 cases. RODENT CONTROL At the instigation of the Ministry of Food a special rodent control scheme for the Borough was . inaugurated on 5 July 1946. 8 investigators and 12 operatives were engaged. From the start of the scheme until the end of the year 53,861 visits were made, which included 228 visits to business premises. Treatments were given at 2558 premises and it is estimated that 13,500 rats were killed. In addition gassing and baiting of thetrivers Pool, Quaggy and Ravensbourne was carried out ana an estimated 1512 rats destroyed. 85 business premises were treated, on request, at the owners' expense and 75 owners preferred to carry out treatments themselves. TUBERCULOSIS DISPENSARY SERVICE The total number of persons examined at the Council's Tuberculosis Dispensary was 7996. Of this number 3229 were new cases and 1148 were contacts. The number of definite cases of tuberculosis on the dispensary register at the beginning of the year was 1,886 ana 1,942 at the end of the year. The Council's tuberculosis health visitors paid 3671 visits to the homes of patients during the year. - 9 - TUBERCULOSIS. ALLOVANCES The scheme for the payment of allowances to persons suffering from pulmonary tuberculosis, who have to give up remunerative employment bo undergo treatment, continued during the year 1946, as well as the supply of extra nourishment Number of maintenance allowances granted 296 " " discretionary 45 " " 45 " " special " " 36 WAR-TIME DAY NURSERIES The following Table shews the average daily attendances.each month during 1946. The fall in September attendances at Downham was due to the transfer of children aged 3-5 to the L.C.C. nursery. Month Catford Ladywell Forest Hill. Downham approved places - 40 approved Places - 88 approved places - 65 approved places - 60 average attendances average aittendances average attendances average attendances January 36 80 47 56 February 40 88 56 58 March 37 76 59 62 April 42 84 61 51 May 48 95 71 61 June 42 88 55 59 July 44 84 55 59 August 47 88 67 57 September 32 72 49 22 October 51 91 74 44 November 48 85 71 47 December 46 93 70 40 Average for Year 43 85 61 51 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 32 children benefited from such treatment. — 10 - SECTION "C" - SANTARY CIRCUMSTANCES OF TIE AREA The following table shows a summary of the inspections etc. carried out by the sanitary and food inspectors during the year:- Cause of Inspection Totals On complaint 4822 Infectious disease 1748 Notice from builder 692 Smoke observation 1 War damage complaint 613 Water certificate 306 Vermin, rats and mice 164 Rent act certificates 159 Landlord and tenant act certificates 46 Building licences 684 Rehousing cases 4452 Housing act (overcrowding) 556 Factories and workshops 212 Butchers 359 Registered food premises 702 Bakehouses 107 Fishmongers 184 Provision merchants 579 Greengrocers 95 Wholesale meat depot 62 Restaurants and eating houses 260 Dairies 63 Milk purveyors 73 Ice cream premises 225 Other food premises 229 Pharmacy ana poisons act 113 Shops Act 471 Miscellaneous 898 Market s 45 Slaughterhouses 10 Legal proceedings 23 Remspo'ctions 5451 Intimation notices served 3253 Statutory notices served 635 Number of factories on register ati31.12.46 960 Number of outworkers on register at 31.12.46 400 - 11 - SECTION "D" - HOUSING In November, 1945, the Council adopted a "Points" scheme for the allocation of housing accomodation to families inadequately housed, in order to provide a fair deans 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. During the year 3729 visits were paid by the sanitary inspectors under this heading. SECTION "5" - INSPECTION ANT- SUPERVISION OF FOOD MILK SUPPLY Analysis of milk During the year under review, 118 samples oi milk were submitted by the Council's inspectors to the Public Analyst for examinations and none of these samples was certified as adulterated or below standard. The average composition of the samples is set out in the following Table:- Period Average composition of samples examined Percentage of milk fat solids not fat water First quarter 3.47 8.71 87.82 Second quarter 3.30 8.71 87.99 Third quarter c.46 8.72 87.82 Fourth quarter 3.72 8.84 87.44 Average for Year 3.49 8.74 87.77 The legal standard is 3.0 percent milk fat and 8.5 percent solids not fat. Bacteriological examinations of milk 185 samples of heat-treated milk were submitted to the laboratory for bacteriological examination, and of these 181 satisfied the prescribed tests. 3 samples which were just below the required standard were re-sampled satisfactorily and th vendors warned about the previous samples. Legal proceedings were instituted against the vendor of the remaining sample, who was fined £10 with £1.1.0. costs for selling raw milk as heat-treated. - 12 - Section "E" Continued MILK SHOPS AND DAIRIES Number of dairy premises on the Register at the end of the year 75 Number of purveyors of milk on the Register 116 (SPECIAL DESIGNATIONS) REGULATIONS Number of licences issued for The sale of pasteurised milk (Dealer's) 35 " " " (Bottling)1 " tuberculin tested milk (Dealer's) 11 Supplementary 14 ADULTERATIION OF FOOD The total number of samples taken during the year under the Food and Drugs Act was 930, of which number 50 were formal samples and 880 informal samples. After examination the public analyst reported that 3 of the formal samples and 5 of the informal samples were found to be adulterated or below standard. The percentage of adulteration amounted to 6.0 in the case of the formal samples and 0.57 in the informal samples, whilst it was 0.86 of all the samples submitted, compared with 1.24 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 and put in hand during 1945 in order to bring the records up to date, was continued. UNSOUND FOOD A considerable amount of food was surrendered as unfit for human consumption. 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. This is exactly the same total weight as was dealt with in 1945. 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. - 13 - 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 1946 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 1946 1945 1944 1943 1942 1941 1940 Cerebro-spinal fever 11 3 4 8 25 31 30 Continued & relapsing fever - 1 - - - - - Diarrhoea and enteritis - - - - - - - Diphtheria 8 24 24 26 53 82 78 Dysentery 57 31 65 23 34 13 7 Encephalitis lethargica (aiute) 1 - - — - - - Enteric or typhoid fever 2 - - 1 2 11 7 Frysipelan 34 50 86 57 52 60 53 Hydrophobia 1 - - - - - - - Influenza - - - - - - - malaria 15 - - - - - - measles 1307 462 688 1270 858 726 119 Ophthalmia neonatorum 4 1 4 17 4 4 7 Pneumonia 108 71 110 176 l03 148 113 Polioencephalitis .(acute) - - — — - - - Poliomyelitis (acute) - 5 - - 5 1 2 Puerperal pyrexia 31 21 19 20 27 19 11 Scabies 348 566 654 515 — * * Scarlet fever 155 197 270 683 255 98 109 Smallpox - - 1 - - — - Puerperal fever 1 4 1 1 3 2 1 Whooping-cough 291 238 275 219 254 415 24 TOTALS 2374 1674 2201 30.16 1675 1612 561 * Notifiable as from 1 August 1943 DISINFECTION AND DISINFESTATION Number ,of room's disinfected 1345 Number of articles treated at the Council's disinfecting station.^..34904 Number of verminous children treated at the Council's cleansing station 2372 Number of verminous adults treated 83 Number of treatments given for at the cleansing station: adults 1940 children 1936 - 14- SECTION Continued TUBERCULOSIS The number of new cases notified during the year 1946 and the number of deaths (together with comparative figures for the previous year) were as follows:- NEW CASES NOTIFIED DEATHS 1945 1946 1945 1946 Pulmonary 307 401 122 110 Non-pulmonary 64 66 16 16 TOTALS 371 467 138 126 The age distribution of the new cases of tuberculosis notified and the deaths from tuberculosis during the year are shewn in the following table:- Age periods NEW CASES NOTIFIED DEATHS Pulmonarv NonPulmonary Totals Pulmonarv NonPulmonany Totals M F M F M F M F M F M F 0 - 1 1 - 2 - 1 - 1 2 2 2 1 - 9 5 5 4 14 9 1 - 1 2 2 2 5 - 5 6 4 4 9 10 - - 2 1 2 1 10 - 10 6 6 6 16 12 - - - 1 - 1 15 - 19 24 6 5 25 29 3 2 2 2 5 4 20 - 44 55 2 3 46 58 3 5 1 1 4 6 25 - 53 64 5 6 58 70 11 20 - - 11 20 35 - 25 13 2 1 27 14 16 5 - - 16 5 45 - 23 8 1 1 24- 9 14 6 - - 14 6 55 - 20 3 1 1 21 4 13 4 - - 13 4 65 - 5 2 1 , 1 7 3 5 1 _ 5 1 TOTALS 215 186 34 32 249 218 67 43 7 9 74 52 X-RAY DEP^RTmENT The X-ray apparatus was installed in 1945, and consists of a large 4 valve set by Deans of Croydon with two X-ray tubes and facilities for tomograph - the latter being a device for taking special films to display doubtful tuberculous cavities. During 1946, the total number of X-rays taken was 6,142. Of these 1407 were taken in the first quarter, 1439 in the second quarter. 1596 in the third quarter and 1700 in the last quarter of the year, showing a progressive increase in the scope of the work. These were mostly chest films either as a diagnostic measure in new cases or as a follow-up of established cases of tuberculosis.' - 15 - MASS MINIATURE RADIOGRAPHY An X-ray unit visited the borough for a period of six weeks during October and November, with the following results:- Males Females Total Persons, resident or working in the borough, x-rayed 2953 5062 8015 Total persons x-rayed 3234 5332 8566 Number of cases of tuberculosis found 35 45 80 It is pointed out that this unit had no official connection with the Council's tuberculosis dispensary. TABLE OF CONTENTS Page Preface 2 Vital statistics (section "A") 3 - 6 General provision of health services, including maternity and child welfare (section "B") 7-10 Sanitary circumstances (section "C") 11 Housing (section !'D") 12 Inspection and supervision of food (section "E") 12 - 13 Prevalence of and control over infectious and other diseases (section "F") 14-16 - 16 -