Sou 52 Metropolitan Borough of Southwark. Interim Report of the Medical Officer of Health. Relative to the work of the Health Services Department during the year. 1941. W. Stott. M.3., B.S., D.P.H. Medical Officer of Health. Health Services Department, Walworth Road, S.E.17. Health Services Department, Walworth Road, S.E.17. November, 1942. To His Worship the Mayor, Aldermen and Councillors Mr. Mayor, Ladies and Gentlemen, I have pleasure in submitting herewith my report concerning the health of the Borough during the year 1941. As in former years this report is in abridged form including only such vital statistics and other items of interest affecting the Health Department as suggested by the Minister of Health in a circular to Local Authorities. During the year the health of the population has been good, and has been maintained at a very satisfactory standard although so many restrictions in the mode of living have necessitated many alterations in family life, There has been no serious outbreak of infectious disease during the year, but the Government drew attention to the necessity for Local Authorities to be prepared for an almost immediate out-break of typhus fever. After a number of meetings with Medical Authorities I prepared a comprehensive scheme for controlling and dealing with this disease had it arisen. Fortunately no cases were reported, although the control measures which I have mentioned, are ready to be put into action at a moment's notice. The risk of an out-break of disease calls attention to a matter which I should like particularly to emphasize; the Ministry of Labour and National Service in its unceasing drive to draft men into the Services or industry are continually calling upon Local Authorities to make still greater contributions from their own staffs. Whilst I agree that many of the executive posts, which do not require specialized knowledge can be undertaken by women in a Public Health Department, there are many situations which require an extensive knowledge of procedure and precedent. The knowledge gained during a number of years by the permanent officers cannot be acquired by temporary staff even given some months previous training. The depletion of the official staff has now reached such a state that to make a further reduction would be to imperil the working of the department, and thus endanger public health itself. The Maternity and Child Welfare Department has continued to function throughout the year, and it has been noticed that the number of women and children attending clinics has increased consequent upon their return from Reception Areas. The Ministry of Labour and National Service drew attention during the year to the necessity for opening War-Time Nurseries, and as a result negotiations have proceeded, and a new Nursery was opened early in 1942. The supervision of foodstuffs called for special attention; as a result of action taken by the Department, the import of prepared meat from Eire was banned by the Ministry of Food. The work of the Tuberculosis Dispensary has been on rather a heavier scale than formerly, due in a large measure to cases referred to the Borough by Army Medical Boards. I am, Mr. Mayor, Ladies and Gentlemen, Yours obediently, W.STOTT. Medical Officer of Health. 1 Vital Statistics - 1941. Estimated civilian population-69,740 For Birth Rate For Infant Mortality & Maternal Mortality Rates. M F Total M F Total Live 3irths. Legitimate 534 503 1037 381 325 706 Illegitimate 30 40 70 30 38 68 564 543 1107 411 363 774 Live Birth Rate 15.9 Still-Births M F Total M F Total Legitimate 24 13 37 20 12 32 Illegitimate 1 1 2 1 1 2 25 14 39 21 13 34 Still-birth Rate 34.0 Deaths. M F Total 1 068 848 1916 Death Rate 27.5 Maternal Deaths. Deaths Rate per 1000 (Live & Still-births) From Puerperal Sepsis 3 3.71 Other Puerperal Causes 1 1.24 Infant Deaths (Under 1 year) Death Rate All infants-per 1000 live births 80 Legitimate infants-per 1000 live legit. births 82 Illegitimate infants-per 1000 live illegit. births 59 Deaths from:- Measles (all ages) 1 Cancer (all ages) 176 Whooping Cough (all ages) 5 Diarrhoea (under 2 yrs. of age) 9 Classification of Deaths. The causes of death (1068 males and 848 females) were as follows:Typhoid and paratyphoid 2: Cerebro-spinal fever 1: Whooping cough 5: Diptheria 4: Tuberculosis of the respiratory system 96: Other Tuberculous diseases 20: Syphilitic diseases 30: Influenza 12: Measles 1: Acute infective Encephalitis 2: Cancer 176: Diabetes 14: Cerebral Haemmorrhage etc. 82: Heart Disease 460: Other Circulatory Diseases 44: Bronchitis 141: pneumonia 137: Other respiratory diseases 10: Peptic Ulcer 24: Diarrhoea 9: Appendicitis 1: Other digestive diseases 26: Nephritis 45: Puerperal Sepsis 3: Other maternal causes 1: Premature Births 14: Congenital malformations and birth injuries 13: Suicide 10: Road traffic accidents 19: Other violent causes 424: All other causes 90: Total deaths at all ages 1916. 2 Age Groups Under 1 1-4 5-14 15-44 45-64 65 and upwards Total Males: Females: 34 28 14 21 18 15 179 143 359 206 464 435 1068 848 62 35 33 322 565 899 1916 infant Mortality. The total number of deaths of infants under one year of age was 62, the causes of death being as follows:- Whooping cough 4: Tuberculosis of the respiratory system 1: Other Tuberculous diseases 5; Influenza 1: Bronchitis 3: Pneumonia 10: Diarrhoea 9: Other digestive diseases 1: Premature births 14: Congenital Malformation and birth injuries 12: Other violent causes 1: All other causes 1. Maternal Mortality. Three deaths were attributed to Puerperal sepsis and one to other Puerperal causes. Mortality rate 4.9. Maternity and Child Welfare. Home Nursing. 682 visits to sick children at home were made under arrangements with the local Nursing Associations. Home Visiting. The Health Visitors made 26,511 visits to homes of expectant mothers, infants and toddlers. Welfare Centre Attendance. Expectant Mothers (seen by Doctor) 3,095 Post Natal 662 Infants under one year 8,201 Children one to five years 5,899 The Assistant Medical Officers examined 7,264 children during the year. Child Life Protection. There were 4 children and 4 foster-mothers on the register at the end of the year, all of whom were regularly visited. Home Helps. 7 Home Helps were provided for home confinements. 3 Municipa1 Nurseries. In addition to the Council's Nursery at "Whitnorth" Shalford, Surrey which is maintained under the jurisdiction of the Surrey County Council and which has accommodation for 40 Southwark Children, it was found necessary to negotiate for a further Residential nursery in the county and representations were made to the Ministry of Health with the result that on January 1st, 1942, a new Residential Nursery at Tilford, Surrey with accommodation for 40 children was started. This nursery is also maintained by Surrey County Council by arrangement with this Authority. During the year the Ministry of Labour and National Service indicated that it was necessary for a War-time Nursery to be opened in Southwark to accommodate children of women war-workers. The Crossways Central Mission whose own nursery was evacuated at the out-break of war expressed a wish to re-open their Nursery in New Kent Road. The Ministry of Health sanctioned this proposal on condition that the Nursery was controlled and managed by the Local Authority. Adaptations are now in progress and equipment has been received from the Ministry or Health's Central Store and it is expected that the Crossway's Wartime Nursery will be opened early in the new year. This Nursery will have accommodation for 45 children. Women's Country Holiday Fund. 4 women and 5 children were sent for convalescence under this scheme. Solarium-Health Services Department. 68 children under 5 years of age were treated in the Solarium at the request of the Council's Medical Officers, a total of 767 attendances being made. Convalescent Treatment. 75 children were sent away by arrangement with the Invalid Children's Aid Association. Extra Nourishment. 140 dinners were provided to children, necessitous expectant and nursing mothers. Dental Clinic. Treatment was provided for Maternity and Child Welfare patients. There were 115 patients who received 325 treatments, examinations etc. Vaccination. The total number of certificates of success of vaccination received during the year was 329. Sanitary Circumstances of the Area. The Sanitary Inspectors have supervised the sanitary conditions of their districts including the inspections of lodging houses, factories and workshops. In addition the air raid shelters in the Borough were frequently inspected and reported on. After bombing had occurred during air raids the Inspectors immediately prepared the War Damage Report which necessitated some thousands of visits being made. 4 Total number of inspections 2,486 Total number of re-inspections 5,809 Total inspections (factories & workshops) 207 Visits in connection with air raid shelters 4,630 Visits in connection with war damage 3,909 x 17,041 x Additional to War Damage Reports Number of sanitary defects found and remedied 4,676 Number of Intimation Notices served 758 Number of Statutory Notices served 139 Public Health(London) Act 1956-Section 224 One person was removed to an institution upon an Order of the Court. Public Health (London) Act 1956-Section 95 One certificate in regard to water supply was granted in respect to 67 flats. Common Lodging Houses. The inspection of these premises was carried out at frequent intervals, and nuisances were abated in several instances. The London County Council Annual Census was not undertaken. Smoke Abatement. Although the special Recommendation of the Ministry of Home Security in regard to the emission of smoke resulted in discontinuation of the observations, very few complaints of smoke nuisance were received and these were found to be capable of adjustment. Shops Act, 1954. Several inspections were made under the Act, but action in respect thereto is somewhat limited as a result of war restrictions. Factories. Inspection of factories etc. has been maintained as far as possible; some have required the installation of additional lavatory and water-closet accommodation for the use of augmented staffs whilst in some cases temporary accommodation of this character has been sanctioned purely as an emergency measure. Rats and Mice. In accordance with instructions of the Ministry of Food, a District Sanitary Inspector was appointed Rodent Officer to give special attention to food premises, wharves etc., where rat infestation was likely. He is able to give supervision to any troublesome cases met with by the Sanitary Inspector's Assistant besides which he provides the monthly return required by the Ministry of Food. This arrangement has been found to work very satisfactorily. I am able to report that, despite many cases of damage to sewers and drains, the rat menace has not assumed the proportions that one might have anticipated due to the fact that immediate attention Is always given in these cases. 5 Summary of investigations and inspections made during the year 1941. Inspections-By Inspector 505 By Rat Officer 453 Re-inspections-By Inspoctor 1,185 By Rat Officer 1,746 Premises where rats were found 157 Action Taken. Poison Baits laid by Rat Officer 23,013 Wire Traps set ,, ,, 213 Break-Back Traps set ,, ,, 1,110 Premises freed from Rats 100 Probable source:- Rat runs and holes 150 Defective Drains 78 No. of Notices served 8 Housing. The situation with regard to housing is now fairly stabilized. Some belated cases of war damage are discovered and dealt with from time to time and reconditioned properties are becoming available in increasing numbers. Inspection and Supervision of Food. Inspection has been maintained as necessary. Owing to the conditions prevailing some uncrupulous persons attempted to benefit at the expense of, and risk to, the community at large by importing meat from Eire of a very unsatisfactory character. Two persons were successfully prosecuted and the commodity in question was banned from importation by the Government upon the Councils' representation. The total quantity of food destroyed after inspection amounted to some 237 tons, a very small fraction of the parcels examined amounting to approximately 0.6%. The percentage of food examined, which has been rendered unedible by reason of enemy action did not amount to one half of one per cent. Public Health (Imported Food) Regulations, and Public Health (Preservatives in Food) Regulations. Duties under these Regulations although somewhat limited have been carried out as necessary, samples for examination being taken as required and submitted to the Public Analyst. Mortuary and Coroner's Court. Post-mortems conducted-without inquest 312 Post-mortems conducted-with inquest 114 Inquests held, Post-mortems conducted else- where 51 Bodies brought in for convenience 2 479 Verminous Persons. During the year there has been a total attendance of 9,154 persons for bathing and treatment. Of this number 3,802 were treatments given to children In accordance 6 with the Council's Agreement with the London County Council. 5,352 treatments and baths were given to persons sent from various Common Lodging Houses, Hospitals and Local Practitioners. The increase in the number of treatments given to adults is due to the gradual increase of Scabies among all classes of the public. The decrease in the verminous cases can be attributed to the demolition by Air Raid of several Common Lodging Houses which formerly constituted the main supply of verminous persons. Owing to the steady return of many of the formerly evacuated school children the figures for the verminous cases show a slight increase. SCABIES. 1st Qtr. 2nd Qtr. 3rd Qtr. 4th Qtr. Men 384 315 327 445 Women 490 434 566 768 Children 404 374 513 779 Total 1,278 1,123 1,406 1,992 Whole yr.1,471 2,258 2,070 5,799 VERMINOUS. 1st Qtr. 2nd Qtr. 3rd Qtr. 4th Qtr. 441 345 342 243 74 92 41 45 382 401 437 512 897 838 820 800 Whole yr,1,371 252 1,732 3,355 As a result of the steady increase in Scabies the existing bathing accommodation was found to be inadequate and a scheme for the provision of a new Men's Bathing and Treatment Centre was submitted and the necessary alteration and addition is now in hand. Verminous Premises. There has been a considerable drop in the figures relative to disinfestation of houses counterbalanced to some extent by the treatment of A.R.P. Public Shelters, Control Posts and Depots. Fumigation by sulphur owing to the effects of blast has been very limited and in most cases the use of liquid fumigants has been the only possible method. During the year 872 verminous rooms and their contents were treated by the disinfecting staff. Council Houses found Infested Nil Council Houses disinfested Nil Other premises found to be infested 472 Other premises disinfested 472 7 Verminous Bedding Disinfested. Articles Disinfested Destroyed Beds 299 47 Palliasses 1,883 47 Bolsters & Pillows 2,594 56 Cushions 297 - Blankets 11,166 3 Sheets 854 4 Quilts 794 5 Articles of clothing etc. 66,517 262 84,404 424 In addition 53 cwts of bedding, household effects etc. were also destroyed. 24 pairs of boots and 44 steel helmets were treated with formalin. Pis infection. The total number of disinfections of rooms during the year by the Council's disinfecting staff was 331. Of this number 289 rooms were disinfected after the occurrence of the ordinary notifiable infectious diseases, and 42 after cases of phthisis. 872 verminous rooms were sulphured and otherwise cleansed by the Council's staff during the year. Articles. Disinfected Destroyed Beds 84 4 Palliasses 125 3 Bolsters 30 Pillows 338 7 Cushions 74 ! Blankets 432 Sheets 197 Quilts 246 5 Articles of Clothing, etc. 790 2 Books 34 Total: 2,350 21 In addition, 1,100 lbs. of bristles were disinfected. 20 cwt. of household effects were destroyed. 8 Legal Proceedings:- Public Health Acta etc. Defendant Cause of Proceedings Result C. Wilson-Sears, Montague Close, S.E.I. Having in his possesion food, to wit, Eire pressed meat, intended for, but unfit for, human consumption. Fined £50 & 15 guineas costs. W. & D. Harvest, Depositing unsound food (Eire King William St. Hse.pressed meat) at New Hibernia Arthur Street,E.C.4.Cold Stores. Fined £30 & 20 guineas costs. Food & Drugs and Other Acts. Name and address of Defendant. Sample Offence or Result of Analysis Result of Proceedings English Orchard Co Ltd 4 Rockingham Street Raspberry Jam Selling Raspberry Jam 73% deficient in raspberries. Fined £5 and £5.5s. costs. English Orchard Co Ltd 4 Rockingham Street Rasberry Jam Selling Raspberry Jam 30 parts per million S02 in excess. Fined £1 and £3.3s. costs. F. W. Woolworth & Co. 1 New Bond Street,W.l. Milk Selling milk with added water to the extent of 22% Fined £10 and £10.10s.Costs. Benjamin Jeffers, 15 Fleming Road Whisky Selling whisky 43 degrees under proof. Fined £15 and £5.5s. costs. Butler, Secretary, Westminster Wine Co. 18 Sussex St. S.W.I. Whisky Selling whisky 43 degrees under proof. Dismissed POA £5.5s. Costs. James C. Cox, 26 Otto Street. Milk Selling milk with added water to the extent of 9% Fined 10s and £l.ls. costs. Henry Evans, 24 Burge Street. Milk : Selling milk with added water to the extent of 8.5% Adjourned sine die. Marks & Spencer Ltd. 82 Baker Street, W.l. Lemonade Powder Selling Lemonade Powder not of the nature, substance or quality damanded. Withdrawn on pleading warranty. Johnston & Son(London Ltd. 36,37,38 St. Botolph Lane,E.C.3 Liquid Eg Substitute . Liquid Egg Substitute" label attached falsely described said article. Withdrawn on pleading warranty. Francis Martin Samuel Winand, 67 Murray Rd.Wimbledon "Teafusa" "Teafusa" with label attached calculated to mislead. Fined £10 & £5.5s. costs. Palorit Ltd. (G. F. Biro & Co. ), 83 Scrubbs Lane N.W.10 Liquid Eg Substitute. "Liquid Egg Substitute" label attached falsely described said article. Olgo Biro, 2 Oakwood Avanue, Beckenham, Kent 'Liquid Egg Substitute. Liquid Egg Substitute" label attached falsely described said article. M. Saper Ltd. Argall Avenue, Lea Bridge Factory Est Leyton, E.10. Lemonade Powder. Selling lemonade powder not of nature, substance or quality demanded. Fined £10 & £7.7s. costs. 9 Food and Drugs Acts. No. of formal samples taken 1145 No. ,, ,, ,, adulterated 24 No. of informal samples taken 1093 No. ,, ,, ,, adulterated 22 No. of water samples(wells and bombed sites) 31 Analysis of Samples. No. of samplesexamined No. adulterated. Formal Informal .. . Total. Formal Informal Total Milk and Milk Products 5 00 34 534 15 - 15 Oils, Pats, etc. 73 19 92 - - 1 Canned and Potted Poods 26 141 167 - 7 7 Meat and Meat products. 51 106 157 - - - Fruits, Canned, Bottled and Preserved. - 19 19 - - - Preserves, Jams, Jellies, etc. 30 25 55 1 - 1 Cereals, and Cereal Preparations 65 134 199 1 1 2 Bread, Flour and Confectionery 76 140 216 - 2 2 Wines, Spirits and Beverages 2 29 31 2 5 7 Condiments, Spices, Sauces, etc. 72 137 209 - - - Drugs, and Medical preparations 3 85 88 1 2 3 Miscellaneous 247 224 471 4 4 8 Total. 1145 1093 2238 24 1 22 46 Percentage of adulterated samples for the year-2.06. Milksellers. Retailers & Wholesalers in Borough 227 Retailers & Wholesalers elsewhere 134 1262 Visits were made to dairy premises. Milk (Special Designations) Order. Principal Licenses 75 Supplementary Licenses 20 10 Infectious Diseases. The notifications of infectious diseases received during the year numbered 1157 (excluding Tuberculosis) as follows Scarlet fever 127: Diphtheria 102: Enteric Fever 2: Paratyphoid Fever 1: Puerperal Fever 3: Puerperal pyrexia 2: Cerebro-spinal fever 22: Measles 478: Whooping cough 257: Dysentory 7: Epidemic Diarrhoea 1: Acute primary and influenzal pneumonia 110: Ophthalmia neonatorum 1: Erysipelas 44. 24 deaths due to infectious disease were recorded:Diphtheria 4: Enteric Fever 2: Cerebro-spinal fever 1: measles 1: Whooping cough 5: Pneumonia 11. Diphtheria Immunisation:- Immunisation against diphtheria was carried out in the Council's Diphtheria Immunisation Clinic and by general practitioners in accordance with the Council's Scheme for Doctors. Owing to the large number of children accommodated in the large air raid shelters in the Borough it was considered desirable to provide immunisation facilities in an easily accessible hall and some 55 children and 16 adults were given innoculations. To ensure the efficiency of the innoculations carried out in London County Council Schools by the County Council's School Medical Officers arrangements were made for the Post Schnick Testing of a number of children. The number proving Schick-positive proved to be under 1% and these were referred back for further injections. Pneumonia. The treatment of pneumonia by the drug "M & B 693" provided by the Council in necessitous cases has been continued throughout the year. An examination of the results achieved has provided some interesting facts. In the period under review the total number of cases treated was 19, of which 8 were males and 11 females. 3 of the patients were children under one year of age, the average age being 7 months. 6 patients were over one and under 10 years of age, the average age being 7 years, whilst 10 adults, average age 59 also received treatment. The types of pneumonia dealt with were various, 2 being acute Primary; 3 Broncho; 8 Influenza; 5 Lobar and one undefined. Of the patients treated, 2 of the adults subsequently died, but in one of these instances, the secondary cause of death was cerebral haemorrhage. The average number of days Pyrexia was 4, whilst the temperature fell in 12 cases by crisis and 6 by lysis, whilst in one instance no information is given in the reports of General Practitioners attending patients. It was shown that the Doctors were of the opinion that in 10 instances, the duration of the illness was considerably short, whilst in 6 cases the Doctors reported that they were of the opinion that the illness had been considerably shortened and severity lessened. Complications arising from the use of M. & B. 693 were few, only in 4 cases was slight sickness reported after administration. One patient, a man of 74, complained of dryness of the mouth and refused further treatment, but he ultimately recovered. Severe vomiting occurred In one case and this was due to the parent disregarding the Doctor's instructions and giving the patient, a child of 4 years, an egg; the vomiting which persisted for half a day, subsided later. It would appear from all these reports that the administration of M & B 693 has been most satisfactory and obviously justifies the continuance of the Council's scheme for the supply of M & B 693 in necessitous cases where the patients are unable to afford the cost of this treatment. 11 Tuberculosis. 231 notifications of tuberculosis were received of which 203 were in respect of pulmonary cases and 28 non-pulmonary. According to the return supplied by the Registrar General the number of deaths from tuberculosis was 116. 'PS pulmonary and 20 non-pulmonary) Treatment of Tuberculosis. DIAGNOSIS PULMONARY NON-PULMONARY total . grand total Adults C'rn Adults C'rn Adults C'rn M f M F M F M f M f M F A. New cases examined during the year(excluding contacts) (a) Definitely tuberculous. 51 42 4 4 3 1 2 1 54 43 ! 6 5 108 (b) Diagnosis not completed. 54 25 2 4 - 2 1 - 54 27 3 4 88 (c). Non-tuberculouas. 133.. 24 1 3 1 - - 1 134 94 1 4 233 . , . > B. Contacts examined during the year:- (a) Definitely tuberculous. 4 4 1 - 1 - - - 5 4 1 - 10 (b) Diagnosis not completed. 10 3 1 - - - - - 10 3 1 - 14 (c) Non-tuberculous. 30 52 34 29 - - - - 30 52 34 29 145 C. Cases written off the Dispensary Register as:- (a) Recovered. 1 - - - - — 1 1 1 - 1 1 3 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous.) 163 148 35 32 1 - - 1 164 148 35 33 380 d. No. of cases on Dispensary Register on December 31st. (a) Definitely tuberculous. 380 248 47 45 23 25 9 1 403 273 56 46 778 (b) Diagnosis not completed. 64 28 3 4 - 2 1 - 64 30 4 4 102 1. Number of cases on Dispensary Register on January 1st. 880 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years. 34 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases "lost sight of" 112 \ 4. Cases written off during the year as dead. (All causes) 57 5. Number of attendances at the Dispensary (including contacts) 3 3,354 6. No. of Insured persons under Domiciliary Treatment on December 31st. 16 7. Number of consultations with Medical Practitioners:- (a) Personal. (b) Others 41 412 8. No. of wisits by Tuberculosa Officers to homes (including personal consultations) 19 9. Number of visits by nurses or Health Visitors to homes for Dispensary purposes. 1,696 10. No. of (a) specimens of Sputum etc. examined (b) X ray examinations made in connection with Dispensary work 538 1,287 11. Number of' "recovered cases" restored to dispensary register and included in A (a) and A (b) above. 1 12. No. of "T. B. plus" cases on Dispensary Register on December 31st. 357