PAD 41 metropolitan borough of paddington abridged interim annual report of the medical officer of health for the year 1941 POPULATION. The estimated civilian population for 1941 shows a decrease over that for 1940, but in accordance with instructions no figures are given. LIVE BIRTHS Total Males Females Birth-rate per 1,000 estimated civilian population, 1941 15.67 Legitimate Illegitimate 990 227 500 128 490 99 Totals 1217 628 589 STILLBIRTHS 44 24 20 Rate per 1,000 (live & still) births 35 DEATHS 1418 665 755 Death Rate per 1,000 estimated civilian population 18.26 DEATHS FROM PUERPERAL CAUSES Rate per 1,000 (live & still) births Puerperal Sepsis Other Puerperal Causes Total 2 2 4 1.81 1.81 5.62 DEATHS OF INFANTS UNDER 1 YEAR OF AGE 64 Death Rates of infants under 1 year of age:- All infants per 1,000 live births 60 Legitimate infants per 1,000 legitimate live births 47 Illegitimate infants per 1,000 illegitimate live births 75 DEATHS FROM TUBERCULOSIS Pulmonary (all ages) 85 Other forms (all ages) 12 Death Rate from Pulmonary Tuberculosis per 1,000 of the estimated civilian population 1.09 Tuberculosis Death Rate (all forms) 1.25 - 2 - classification of deaths. all causes All Ages Under 1 year of age M f Total M f Total 665 753 1418 37 27 64 Typhoid & paratyphoid fevers 1 1 – – – Cerebro-spinal fever 3 3 6 1 — 1 Scarlet fever – – — — — - Whooping cough 2 3 5 1 2 3 Diphtheria 2 2 4 — — – Pulmonary tuberculosis 52 33 85 — — — Other tuberculous diseases 7 5 12 — — — Syphilitic diseases 7 1 8 - - - Influenza 7 4 11 — 1 1 Measles 2 — 2 — — — Acute polio-myelitis and polio-encephalitis – – – – – – Acute infectious encephalitis 2 1 3 - — - Cancer of buccal cavity and oesophagus 8 – 8 – – – Cancer of uterus - 15 15 — — - Cancer of stomach and duodenum 10 6 16 — — - Cancer of breast — 24 24 — – — Cancer of all other sites 55 73 126 — – - Diabetes 5 7 12 - - - Intra-cranial vascular lesions 29 69 98 — — - Heart disease 152 182 334 — - - Other circulatory diseases 21 27 48 - - - Bronchitis 63 44 107 3 3 6 Pneumonia 42 51 93 6 6 12 Other respiratory diseases 7 7 14 — - - Ulcer of stomach or duodenum 9 6 15 — — - Diarrhoea (under 2 years) 3 - 3 3 - 3 Appendicitis 3 1 4 - - - Other digestive diseases 18 19 37 — 1 1 Nephritis 8 14 22 — — - Puerperal sepsis - 2 2 - - - Other maternal causes — 2 2 — — - Premature birth 12 5 17 12 5 17 Congenital malformation, birth injury, infantile disease 8 9 17 8 5 13 Suicide 8 9 17 — — - Road traffic accidents 7 3 10 — — - Other violent causes 67 76 143 2 2 4 All other causes - 47 50 97 1 2 3 - 5 - NOTIFICATION OF INFECTIOUS DISEASES Disease Total Cases Notified Cases Admitted to Hospital Total Deaths Acute Encephalitis lethargica 1 1 – " Influenzal pneumonia 8 3 1 « primary pneumonia 68 53 5 « Polio-encephalitis — – – " Polio-myelitis 3 3 — " Rheumatism 6 — Cerebro-spinal fever 19 17 3 Continued fever 1 1 — Diphtheria 58 58 4 Dysentery 12 11 1 Erysipelas 29 18 1 Food poisoning or suspected food poisoning 4 2 – Infective enteritis or summer diarrhoea 15 12 1 Measles 301 71 2 Ophthalmia neonatorum 6 5 — Puerperal fever 6 6 — Puerperal pyrexia 25 - Scarlet fever 61 53 — Smallpox - – - Typhoid or enteric fever 9 7 1 Whooping Cough 170 45 5 DIPHTHERIA IMMUNISATION. During the year 1,278 children mere fully inoculated, including 747 "schools" cases. Twenty-three cases attended the Clinic at St. Mary's Hospital, and 13 of these were fully inoculated. VACCINATION. The latest return available is for the year 1940. This shows that of the 1,695 children whose births were registered during that year, 40-9 per cent, were successfully vaccinated, and 11.6 per cent. were exempted on production of statutory declarations of conscientious objection. Insusceptibility, removals, deaths, not traced etc., account for the remaining 47.5 Per cent. tuberculosis Notification Register. New cases notified comprised 184 of pulmonary tuberculosis and 26 of non-pulmonary tuberculosis The number of cases on the register at the end of the year was 729, as compared with 851 cases at the end of the year 1940. Particulars of the deaths from this disease are shown on page 1 of this Report. Dispensary Treatment. Particulars of the York carried out at the two voluntary Dispensaries in the Borough are shown in the following table:- - 4 - Paddington Tuberculosis Dispensary St. Mary's Hospital Tuberculosis Dispensary No. of patients examined for 1st time (excluding contacts) 451 150 No. of above found tuberculous 115 46 No. of contacts examined 97 23 No. of contacts found tuberculous 1 – No. of attendances at Dispensary 2904 1718 No. of visits by Tuberculosis Officers 280 55 No. of visits by Tuberculosis Nurses 2713 1608 No. of cases on Dispensary Register at end of year 435 260 MEDICINAL BATHS & DISINFECTING STATION Owing to the Disinfecting Station of the Kensington Borough Council being put temporarily out of action during November, 1940, and to representations from the Minister of Health that local authorities should consider the adequacy of their arrangements for dealing with a possible increase in the number of verminous persons requiring treatment, the Council decided to set up their own Medicinal Baths and Disinfecting Station. The Minister of Health having stated that considerable expenditure should not be incurred on such a project during the war, the scheme had necessarily to be of an economical and improvised nature. For the Medicinal Baths, two cubicles on each side of the Kensal Road Slipper Baths were utilised, and two attendants were engaged. Although this arrangement had obvious drawbacks, it has worked more satisfactorily than was expected. These baths were opened on the 26th April 1941, and have since coped with ever increasing demands. They are now working almost to their full capacity, and should the increase in the number of persons requiring treatment persist, it may become necessary to extend the baths by taking over more cubicles, and engaging additional staff. For the Disinfecting Station, the disused mortuary attached to the Kensal Road Baths was adapted. The necessary apparatus was ordered but the Ministry of Health subsequently offered the loan of a bed disinfector; this offer was accepted, the purchase of special plant being abandoned; The apparatus has worked very satisfactorily since being installed, but its design is such that the Station cannot have a "clean" and a "dirty" side. This is a serious short-coming, acceptable only as a var-time measure. The willingness of the driver of the disinfecting van to undertake disinfection work, and the assistance given by two of the First Ail Post personnel during occasional absences of the regular attendants has made it possible, up to the present, to avoid increasing the staff. Valuable help has also been given by the Baths Superintendent and his staff in getting the scheme under way. The agreement with Kensington Borough Council for disinfection work and treatment of verminous persons was terminated on the 31st July, In addition to the advantage of having Medicinal Baths and a Disinfecting Station in the Borough, there will most likely be a decrease in annual expenditure on this service in the future, in spite of the considerable increase of work owing to war conditions. - 5 - The number of verminous persons who received treatment at the Medicinal Baths up to the end of the year was 485, comprising 146 males and 339 females (adults and children other than school children), and 110 persons received treatment at the Kensington Medicinal Baths from the beginning of the year up to the end of April. The weight of bedding etc. disinfected during the year was as follows:- By Kensington Borough Council until the termination of the agreement 7 tons At the Councils Disinfecting Station 16½ tons In addition about 4 tons of bedding etc. in use by the Civil Defence Services of the Borough received treatment at the new Disinfecting Station. The number of rooms disinfected after the occurrence of infectious disease was 224. cleansing of verminous rooms. Notices under Section 123 of the Public Health (London) Act, 1936, were served with respect to 2 premises, the verminous rooms concerned being 3? which were satisfactorily dealt with. Many premises, however, were dealt with without recourse to the service of notices, and the owners of 21 premises took advantage of the arrangement whereby the Council spray verminous rooms at a charge of 7s. 6d. a room. Forty-three rooms vvere so dealt with. bacteriological work. The number of examinations made was 303, which included 174 for diphtheria, and 110 for tuberculosis. Eight of the former and 9 of the latter were positive. rent and mortgage interest (restrictions) acts. One certificate was issued under the provisions of these acts. bakehouses. At the end of the year the number of level bakehouses was 12, land of underground 26. Inspections numbered 6l, being considerably fewer than the number recorded for the previous year. shops acts. First inspections numbered 7, and reinspections 879. No exemption certificates were applied for, and no legal proceedings were hecessary. work of the district inspectors. Owing to calls on the inspectorial staff for duties in connection with Air Raid Precautions, only three Sanitary Inspectors were available for the greater part of the year for dealing with complaints and carrying out routine inspection of premises. The particulars given below include inspections of tenement houses, which lave not been recorded separately. Number of complaints received 759 Number of first inspections 1047 Number of reinspections 5123 Legal proceedings were instituted in 15 instances for offences under the Public Health (London) Act, 1936 or for contraventions of "he Bye-laws. - 6 - FOOD SUPERVISION. Five hundred samples were taken during the year, of which 5 (1.0 per cent.) were found to be adulterated. Two hundred and fiftyfive of these samples were of milk, ana 3 (1.17 per cent.) were found to be noz genuine. proceedings taken under the Food and Drugs Act, 1938, are given. below:- Offence Result of summons Milk sample l6.336 deficient in fat. Dismissed under Probation of Offenders Act on payment of £1. 1s. 0d. costs. Exposing for sale sausage rolls which were unfit for human consumption. - do - Failing to observe cleanliness in a room in which food intended for human consumption was prepared for sale. Fined £10. * 1 Using as a sleeping place a room in which food was deposited for sale. Fined £5. Being in possession of meat intended for, but unfit for, human consumption. Summons heard in conjunction with other charges preferred by the Ministry of Food against this and other defendants, resulting in £100 fines, and £25 costs. The diseased and unsound food surrendered by tradesmen and dealers for destruction was as follous:- Meat, poultry, rabbits, fish, vegetables 16½ tons (approx.) Eggs 3,331 Provisions in tins and jars 237 tins and jars. The following food stuffs, damaged by enemy action, were also , surrendered:- Meat, poultry, fish, vegetables, etc. 1 ton, 33 lbs. Eggs 636 Provisions in tins and jars 600 tins and jars. No slaughtering of animals took place in the Borough during the year. Three hundred and thirty-two inspections of the l8o dairies and milkshops were-made, and 4,015 inspections of food purveyors' premises, which number approximately 1,000. Licences issued under the Milk (Special Designations) Orders numbered 68 (53 in respect of "Pasteurised" and 15 in respect of "Tuberculin Tested" milk). No samples of milk under these designations were taken during the year. PHARMACY AND POISONS ACT, 1935. At the close of the year the Register of persons entitled to sell poisons in Part II of the Poisons List contained 88 entries. - 7 - MATERNITY & CHILD WELFARE Following on the decision to re-open the Westbourne Day Nursery as a War-Time Nursery at the original premises in Great Western Road it became necessary to recall the Matron from the evacuated Nursery at Ascot to supervise the arrangements, and Miss D. K. Newington, Health Visitor, took over duty at Ascot in her stead on the 22nd September, which post she still occupied at the end of the year. Miss M. M. Bathgate, Health Visitor, was seconded for duty with the Ministry of Health as from the 1st July for the duration of the War. The services of certain of the remaining Health Visitors continued to "be utilised as required in connection with Civil Defence, in addition to their normal duties. Home visiting work during the year is summarised in the appended table:- First visits to children under 1 year of age 885 Revisits 5841 4726 Visits to children between, the ages of 1 and 5 years 65 37 First visits to expectant mothers 725 Revisits 675 1598 i Other visits - Sickness (including Puerperal Fever, Puerperal Pyrexia, Ophthalmia Neonatorum and Infantile Diarrhoea) 75 Miscellaneous (including ineffective calls) 5241 5516 infant Consultations:- 310 sessions, 15,444 attendances by 2050 children. Rate- and Post-Natal Clinics:- 105 sessions, 1254 attendances by 559 expectant or recently confined mothers. Dental Treatment:- 14 nursing or expectant mothers received treatment under arrangements made with Mr. F. H. Brinckley Tofts, L.D.S., R.C.S. (Eng.) Home Helps:- Provided in 45 cases. fraternity Beds.- The agreement with St. Mary's Hospital became due for reconsideration and it was decided to enter into a new arrangement as from the 1st August, 1941, for the reservation of four beds at a charge of 10s. 6d. per day per bod, but otherwise on the basis of the general provisions of the existing agreement. This arrangement will operate for the duration of the main hostilities of the War and for six months afterwards. During the year 98 women were delivered in the lard. There were 2 stillbirths, and no deaths within 10 days of birth; 2 cases of puerperal pyrexia were notified. Extra Nourishment.- The first full year's working of the National Milk Scheme is reflected in the fall in the number of cases dealt with under the Council's scheme, which continues to operate in necessitous cases where grants in excess of the Government standard are needed on medical grounds, ana for the provision of ancillary - 5 - foods, medicines, etc. 250 new applications were received, of 'which 206 were granted. Approximate cost - £156. 10s. 0d. National Milk Scheme. - The quantities authorised under the scheme during the year are set out below Liquid Milk (pints) Milk (packets)/ Free @ 2d. per pint Free @ 2d. per pkt. 3,056 6,955 114 145 vitamin Products. - The Government Scheme for the provision of Vitamin products came into operation on the 8th December, 1941, and provides for the free supply, for the time being, of Cod Liver Oil and Fruit Juices to all children under 2 years of age. The following issues were made up to the end of the year:- Cod Liver Oil (6 oz. bottles) 654 Black Currant Syrup 13½ oz. bottles) 251 Black Currant Puree (8½ oz. bottles) 1028 Convalescence. - One mother with her baby was sent to a convalescent home, and grants were made in 8 instances towards the cost of children convalesced by the Invalid Children's Aid Association. Child Life Protection. - 271 visits and inspections were made. At the close of the year the register contained the names of 19 persons who had charge of 50 children. Residential Nurseries. - The three Day Nurseries, viz:- The Queen's Park Day Nursery, The Paddinnton Day Nursery, and The Westbourne Day Nursery, were evacuated on the outbreak of War. The two former are managed by voluntary bodies and the latter was established by the Council. The Executive Committee of the Queen's Park Day Nursery, having regard to the difficulties of administration occasioned by evacuation, decided to terminate their responsibility and the Nursery was accordingly taken over by the Bedfordshire Council after the 3lst August, 1941. The arrangement by which financial responsibility for the Westbourne Day Nursery is undertaken by the Berkshire County Council whilst the nursery remains in their area, in consideration of a fixed payment of £l846 per annum, was continued. War-time Nurseries. - Consideration was given during the year to the need for nursery accommodation in the Borough, and it v.as decided to establish War-time Nurseries at the original premises of the Westbourne Day Nursery in Great Western Road and the Queen's Park Day Nursery, Lancefield Street. The former, which came into use on the 24th November, will eventually provide accommodation for over 50 children (50 under 2 years of age and 20 between 2 and 5 years). The latter was opened on the 19th November and although formal approval by the Ministry of Health has not been received continues to function for about 20 children between 2 and 5 years of age. Babies are not admitted. Charges were fixed at ls.0d. per whole day, and 8d. for Saturdays. - 9 - Details of attendances are given below:- Westbourne Queen's Park Full days. Saturdays. Full days. Saturdays. Days open 26 4 29 5 Attendances 448 46 281 21 Average attendance 17-2 11.5 9.7 4.2 proposals for the establishment of additional nurseries were under consideration at the end of the year. housing. Following the execution of approved works one basement premises was made fit for human habitation, and the closing order determined. Of persons living in premises the subject of clearance or closing orders made prior to the year under review, 6 were rehoused on London County Council Estates, and 79 secured accommodation of a private nature through their own efforts. The absence of enemy activity over London during the greater part of the year enabled a brief survey to be undertaken of the working-class dwellings on the Register of Overcrowding. A member of the staff had not previously been available for this v.ork since the commencement of the War. Of the 672 cases of overcrowding on the Register at the end of 1940:- 571 were found to have been abated by removal; and a further 107 by a natural reduction in the size of the family, or on obtaining additional accommodation; 45 were found to be temporarily abated in consequence of members of the family having been evacuated or serving with H.M.Forces; 99 were still overcrowded; and 52 could not be investigated as no one could be found to answer inquiries. Nine new cases of overcrowding were discovered during the year. Two of the overcrowded families were provided with accommodation on London County^Council Estates. During the year the Associated Fumigators, Limited, under an ' agreement with the Council, removed and treated the furniture, etc., of 34 families with hydrogen cyanide gas. The cost of the work was £94. M.D., M.R.C.P.(London),D.P.H.(Cambridge). Barrister-at-Law. Medical Officer of Health. 5th August, 1942. SS.