LIBRARY AC4379 Sou57 METROPOLITAN BOROUGH OF SOUTHWARK ANNUAL (Abridged) REPORT of the MEDICAL OFFICER OF HEALTH. Relative to the work of the Health Services Department during the year 1 9 4 7. Health Services Department, Walworth Road, S.E.17. W. Stott, M.B., B.S., D.P.H. BOROUGH OF SOUTHWARK Public Health Department, Municipal Offices, Larcom Street. S.E.17. To His Worship the Mayor, Aldermen and Councillors, Sir, Ladies and Gentlemen, I beg to submit my Annual Report on the health of the Borough for the year 1947. BIRTHS: There were 2,434 births registered in the Borough, giving a birth rate of 26.4 per thousand of the population, the highest that has been recorded for many years. Ten years ago the birth rate was 14 per thousand. The infant mortality rate, that is the deaths per thousand births was 39 as compared with 57 ton years ago. This infant mortality rate is the lowest recorded. The chief causes of infant deaths were:- Congenital malformations and birth injuries 26 Prematurity 21 Pneumonia 20 It is satisfactory to record that diarrhoea, which was the chief cause of infant mortality ten years ago, is now almost negligible but preventable conditions, such as pneumonia and prematurity, still claim far too many infant lives. In giving birth to those infants, four mothers, unfortunately, lost their lives but there were no deaths from puerperal sepsis, which is a tribute to the high degree of efficiency of the maternity service. These figures indicate the degree of efficiency of the Council's scheme of Child Welfare and Maternity Services, and also the London County Council Midwifery Service, and there is no doubt that the results obtained are very satisfactory. The babies which attend at the Welfare Centres each day are bonnier and healthier than ever, and the same can bo said for the majority of the mothers. This is no time, however, for self-satisfaction and complacency as there are still many preventable conditions to bo tackled which, as already indicated, cause far too many infant deaths. WELFARE CENTRES, ETC: The work at the Welfare Centres has become very heavy, As the figures indicate, the attendances are greater than anything experienced pre-war. The day nurseries are always full and, happily, all has boon well with them during the year, As a result of the inability to find other nursery accommodation, the Council decided to commence a play centre at Sutherland House, whore mothers doing part time work could leave their children for 3 or 4 hours a day. The demand for this typo of play centre has increased considerably and already the numbers seeking admission far exceed the capacity. The demand for the Home Help Service has increased considerably and the Council are contemplating appointing an Organiser as the work entailed has now got beyond the capacity of the Almoner's department. Apart altogether from maternity cases and mothers requiring assistance, the Home Help Service is doing useful work for the old folk. With the help of this Service on many occasions I have boon able to avoid having old people removed to institutions, thus depriving thorn of their freedom. DEATHS; The general death rate of 15 per thousand is high but is to bo expected when the percentage of old people to the young is disproportionately high. Of the total deaths of 1436 there were no less than 342 deaths occurring in persons over 65 years of ago, and as one could predict with an ago distribution of this character, the chief causes were heart and lung diseases and cancer. The death rate from Tuberculosis, which is one of the chief causes of death in the younger citizens, is certainly higher than pre-war but the figure has remained more or loss stationary since the war. INFECTIOUS DISEASES: As the tables of infectious diseases in the report indicate, the number of infectious diseases which occurred in the Borough during the year wore not unduly largo and would have boon quite low but for an outbreak of measles and whooping cough. There were, however, 13 more cases of diphtheria than in the previous year. Of the total of 40 confirmed cases the majority occurred in children of the 5 year ago group, and many of them had boon immunised in infancy. This shows;that it is highly essential for children, who have boon immunised in infancy, to receive a further protective inoculation against diphtheria before attending school. When this protective "booster" dose, as it is called, has been given there is very little likelihood of a child contracting the disease. There were no deaths from diphtheria. It is interesting to not, whilst on the subject of diphtheria, that whilst one this year. is com plaiting of 40 cases as being abnormal and unnecessary, ten years ago I made the remark that 350 cases of diphtheria, which occurred in 1938, was not an abnormal number. Since this time, as the Council realises, much propaganda and work has been done in the Borough on the immunisation of children and it is our endeavour to persuade 100% of the births to receive those inoculations. The year was noteworthy, so far as infectious diseases are concerned, for an outbreak of infantile paralysis, or to give it its proper name, poliomyelitis. The disease became general throughout the country and we were hampered in our investigations, and also in any stops of prevention, by the fact that wo were unaware of how the disease was spread or how it arose. There were 26 cases all told in the Borough, which was one of the lowest in London, in spite of the fact that no special precautionary measures were taken. The chief precautionary stop which I took was to have all contacts visited daily and on the first occurrence of any illness whatever such contacts were advised to remain at homo from work and to call in a doctor. There were no deaths from this disease. STAFF: The department and its efficiency was severely hit as a result of the loss of a number of Sanitary Inspectors during the year and with the comings and goings of others. At one time the Inspectorial staff of the department was reduced to three district Inspectors. In several districts work was commenced by an Inspector and his Notices served, shortly after which ho left, thus rendering the Notices valueless, the work having to be recommenced by another Inspector. This happened in several districts on three occasions, thus entailing very long delays in having any work executed and complaints remedied. The Council found extreme difficulty in replacing lost Sanitary Inspectors owing to the general shortage of Inspectors, but chiefly, I think, owing to housing difficulties in the Metropolis. I am, Sir, Ladies and Gentlemen, Yours obediently, W. STOTT. Estimated Civil Population - 92,070. Live Births. Males. Females. Totals Legitimate. 1188 1064 2252 Illegitimate. 106 76 182 1294 1140 2^34 Live Birth Rates- 26.4 per thousand population. Still Births . Legitimate. 36 27 63 Illegitimate 1 1 2 37 28 65 Still Birth Rate:- 26.1 per thousand total Births. Deaths. Death Rate:- 15.6 per thousand population. Rate per thousand Live and Still Births Maternal Deaths. Number. From Puerperal Sepsis Nil 0.00 Other Puerperal Causes. 4 1.60 Infant Death3 (Under one year) . Doath Rate. All Infants - per thousand live births. 39 Legitimate infants - per thousand live legitimate births. 38 Illegitimate infants - per thousand illegitimate births. 60 Deaths from: Cancer (all ages). 211 Whooping Cough (all ages) 3 Diarrhoea (under 2 years of age) 11 Classification of Deaths. The causes of death (814 males and 622 females) were as follows:- Cerebro-spinal fever 3 Whooping Cough 3 Diphtheria 1 Tuberculosis of the Respiratory System 83 Other Tuberculous Diseases 11 Syphilitic Diseases 16 Influenza 14 Cancer 211 Diabetes 3 Intra-Cranial Vascular Lesions 114 Heart Disease 360 Other Circulatory Diseases 60 Bronchitis 162 Pneumonia 101 Other Respiratory Diseases 20 Peptic Ulcer 18 Diarrhoea 11 Appendicitis 4 Other disgestive diseases 30 Nephritis 26 -1- -2- Other maternal causes 4 Premature births 21 Congenital malformations and birth injuries 30 Suicide 12 Road Traffic Accidents 10 Other violent causes 34 All other causes 74 Total Deaths at all ages 1436 AGE GROUPS. Under 1 1 to 4 5 to 14 15 to 44 45 to 64 65 and over Total. Males 51 7 5 72 225 454 814 Females 45 5 2 64 118 388 622 96 12 7 136 343 842 1436 Infant Mortality. The total number of deaths of infants under one year of age was ninety six, the causes of death being as follows:- Cerebro-spinal fever 2 Whooping Cough 3 Tuberculosis of the respiratory system 1 Other forms of tuberculosis 1 Bronchitis 2 Pneumonia 20 Diarrhoea 10 Other digestive diseases 1 Premature births 21 Congenital malformations and birth injuries 26 Other violent causes 6 All other causes 3 Total deaths under one year of age 96 Maternal Mortality. The deaths of four women duo to causes other than puerperal sepsis were recorded during the year, -2- -3- MATERNITY" & CHILD WELFARE CENTRES. Showing the attendance at the Several Centres and visits paid to the homes of Mothers and Children by Health Visitors. TABLE VILLA STREET MANOR PLACE (to 11/2/47) HEALTH SERVICES DEPT. HALL (to 20/1/47) SUTHERLAND HOUSE From 23/1/47 LAMBETH ROAD POCOCK STREET CROSSWAY GUY'S TOTAL Number of Births notified during the year 506 576 562 160 371 161 159 2495 Number of individual children attending the Centres during the year. 705 959 918 252 662 335 411 4242 Number of Sessions held during the year. 137 175 101 68 101 51 101 734 Number of children 1-5 age group attending during the year. 319 492 511 145 355 202 248 2272 Number of new cases attending the Centres during the year:- (1) Expectant Mothers (Ante-Natal Clinics) 337 236 202 - 350 - 593 1718 (2) Post Natal Cases (including Ante-Natal Clinics) 225 335 177 — 20 - 395 1152 (3) Infants under 1 year. 410 451 446 117 342 160 187 2113 (4) Seen by Doctor 410 451 446 117 342 160 187 2113 (5) Children 1 to 5 years. 41 63 36 19 26 22 38 245 (§) Seen by Doctor. 41 63 36 19 26 22 38 245 Method of Feeding (a) Bottle 84 110 90 18 27 21 22 372 (b) Breast 244 256 282 53 108 85 130 1158 (c) Breast & Bottle 36 24 28 12 69 6 18 193 (d) Ordinary diet 87 124 82 53 164 70 55 635 Total number of attendances during the year:- (1) Expectant Mothers (Ante-Natal Clinics) seen by Doctor 1257 893 741 - 1425 - 5093 9409 (2) Post Natal Cases (including Ante-Natal Clinics) 225 350 206 - 20 - 395 1196 (3) Infants under 1 year. 5144 7601 6700 1878 3960 187 5 2660 30818 (4) Children 1-5 years. 968 1692 1117 416 784 745 1126 6848 Average number of attendances (Infants under 1) 44.8 43.4 66,3 27.6 39.2 36.8 26.3 - " " " " (Children 1 - 5 ) 7.1 9.7 11.0 6.1 10.8 14.6 11.1 - (5) Infants seen by Doctor during the year. 1766 1455 1155 389 1677 681 949 8072 (6) Children 1 to 5 seen by Doctor during the year 203 392 268 123 350 351 556 2143 (7)Number of weighings recorded (children) 7017 9116 7216 2302 4378 2608 3554 36191 Total number of first visits paid by Health Visitors to home of:- (1) Expectant Mothers 265 358 386 237 193 431 306 2206 (2) Infants under 1 year 506 576 562 160 371 161 159 2495 Total number of re-visits paid by Health Visitors to home of:- (1) Expectant Mothers 30 245 244 149 151 258 251 1323 (2) Infants under 1 year. 8032 2047 2162 920 2703 929 914 11707 (3) Children 1 to 5 years. 2396 1431 2641 1118 2387 2100 2029 14102 -3- -4- NOTIFICATION OF BIRTHS Mothers Confined Live Births Still Births Total BORN AT HOME AND ATTENDED BY Midwives 888 878 20 898 Private doctors 7 7 7 BORN AT HOSPITALS In the Borough 369 362 12 375 Outside the Borough 1193 1185 31 1215 2457 2432 63 2495 Included In the above were 38 cases of twins. HOME NURSING. During the year, the nursing of sick children and home confinement cases and infectious disease was undertaken by the Catholic Nursing Association, Southwark, Newington and Walworth District Nursing Association and Ranyard Nurses. The numbers of visits made by these associations were as follows:- Catholic Nursing Association. 1117 Southwark, Newington and Walworth District Nursing Association 1276 Ranyard Nurses 142 Total Visits 2535 PREMATURE INFANTS. The number of premature babies notified during 1947 was as follows:- Born in Residing in Southwark Southwark Born at Home 64 64 Born in Guy's Hospital 38 9 Born in Hospitals outside the Borough 73 Totals 102 146 BORN AT HOME Died during first 24 hours 1 1 Died within 28 days 4 4 Survived at the end of first 28 days. 59 59 BORN IN HOSPITAL Died during first 24 hours 5 8 Died within 28 days 5 6 Survived at the end of first 28 days 28 68 102 146 BORN AT HOME Nursed entirely at home 59 59 HOME HELPS. There were two full-time and eleven part-time Home Helps on the register, and 49 cases were helped during the year under review. WOMEN'S COUNTRY HOLIDAY FUND. 35 Mothers and 37 children were sent for convalescent treatment under this scheme. -9- DAY NURSERIES. There are three Day Nurseries under the control of the Council in the Borough, and the following is a summary of the average daily attendances during the year:- Jan. Feb. Mar .Apl. May. Jun .Jul .Aug .Sep .Oct. Nov. Dec Bishop's House. 62 53 64 63 58 63 57 56 57 62 64 66 Crossways. 29 34 32 33 33 28 34 32 33 41 40 31 3t. George's. 46 30 41 48 42 32 32 32 32 41 24 29 SOLARIUM - HEALTH SERVICES DEPARTMENT. During the year, 500 children under the age of five years received treatment in the Solarium at the request of the Council's Medical Officers. The total number of attendances was 2,487. EXTRA NOURISHMENT. The Invalid Kitchens of London, under arrangements made with the Council, supplied 687 dinners to children, necessitous, expectant and nursing mothers, upon the recommendations of the Council's Medical Officers. DENTAL CLINIC . Expectant & Nursing Mothers, Pre-School Children. Total. Attendances at Clinics. 1097 710 1807 New Patients. 174 170 344 Teeth Extracted. 346 45 391 Zinc Oxide Dressings. 114 173 287 Fillings in Tooth. 137 132 269 Upper Dentures Fitted. 24 - 24 Lower 13 - 13 Scalings. 46 - 46 Polishing. 8 - 8 Local Anaesthesia. 190 4 198 General 3 81 84 VACCINATION. The total number of certificates and copies of certificates of successful primary vaccinations received during the year was:- Northern Division. 834 Southern Division. 1069 Total. 1903 CHILD LIFE PROTECTION. In 1947, nine names of Foster Mothers were on the register of Foster Mothers, At the end of the year, there were Nine Foster Mothers and nine Foster Children. The health of the children was good, except for occasional minor ailments. 195 visits were paid to Foster Mothers and to the Schools which some of the older children attend. -5- -6- SANITARY CIRCUMSTANCES OF THE AREA. Summary of work carried out under the Public Health and Factory Acts during the year:- Inspections upon complaints being received. 4,994 Miscellaneous inspections. 1,454 Inspection of Year Damaged Properties. 47 Inspections of Factories. 572 Visits to Outworkers. 292 Re-housing visits. 392 Inspections of Common Lodging Houses. 19 Re-visits. 8,635 Intimation Notices served. 3,020 Statutory Notices served. 552 Defects found and remedied. 7,138 PUBLIC HEALTH ACT, 1936 - SECTION 95. Certificates as to habitability were issued in respect of 80 newly erected premises. RENT RESTRICTIONS ACTS. 100 certificates were issued during the year under the above-mentioned Acts. INSPECTION AND SUPERVISION OF FOOD PREMISES. Food supplies in the Borough have received close attention during the year, and their inspection has been carried out thoroughly. Regular inspections have been made of the large quantities of food received at the river-side wharves in the Borough with a view to ascertaining its fitness for human consumption 423 visits were made to wharves in the Borough during the year. 923 visits were made to food premises, including factories, eating houses and ice cream promises during the year. 350 tons, 5 cwts. and 23¾ lbs of food wore found to be unfit for human consumption as a result of inspections, and instructions given for its disposal. MORTUARY AND CORONER'S COURT. The following is a statement of the work of the Mortuary land Coroner's Court during the ear 1947:- post-mortems without inquest. 924 " " with " 297 Inquests with Post-mortems elsewhere. 71 Bodies brought in for convenience. 1 TOTAL. 1,293 COMMON LODGING HOUSES. The four women's and two men's Common Lodging Houses in the Borough are fully occupied nightly, and receive periodic supervision by the Sanitary Inspectors# With the exception of a few minor defects, which are dealt with immediately, there has been nothing of importance to report during the year. The Keepers are very co-operative and conduct the Common Lodging Houses in a satisfactory manner. -6- -7- PUBLIC HEALTH (LONDON) ACT, 1956 - LEGAL PROCEEDINGS. DEFENDANT. OFFENCE. RESULT OF PROCEEDINGS. Messrs. Briant & Son, Nuisance at Adjourned' sine die - Defendant ordered to pay 10, Kennington Park Place, S.E.ll. 15, Sharsted Street. £1.1.0 costs. Messrs. C. Benabo & Sons, Nuisance at Summons withdrawn - work done. St. Stephen's Parade, S.W.1. 32, Westcott Road. Defendant ordered to pay £1.1.0. costs. Messrs. C. Benabo & Sons, Nuisance at Order made for work to be carried out within St. Stephen's Parade, S.W.1. 124, Trafalgar Street. 28 days. Defendant ordered to pay £1.1.0. costs. Nuisances at Mr.E.G.Powell, 6, 8 & 52, Alpha Work done. Summons withdrawn on payment of £3.3.0. 64, Surrey Square. Square. costs. Mr.H.A.Burnet, Nuisance at Summons withdrawn - no costs allowed. 54, queen's Road, S.E.15. 112, Olney Road. Messrs. C. Benabo & Sons, Nuisance at Order made for work to be carried out in 14 days - St. Stephen's Parade, S.W.l. 122, Lorrimore Road. defendant ordered to pay £1.1.0. costs. Messrs.C.Farren & Sons, Nuisance at Summons adjourned' sine did - work in hand. 2a, Edridge Road, Croydon. 7, Tamerton Street. Messrs. Sinclair & Rossiter, Ltd., Nuisance at Work arranged to be done - summons adjourned' sine die. "The House Beyond", Farnham Common, 9, Royal Terrace. Bucks. Rebecca Benabo, trading as Nuisance at Work completed at time of hearing - summons withdrawn. Charles Benabo & Son, 12, Royal Terrace. 3, St. Stephen's Parade, S.W.l. -do- Nuisance at Abatement Order issued requiring the necessary 104, Royal Road. work to be completed in 28 days. Defendant ordered to pay £2.2.0. costs. -8- DEFENDANT. OFFENCE. RESULT OF PROCEEDINGS. Messrs. Brewer & Pratt, Nuisance at Work completed at tine of hearing. 18, Ravens bourne Park, 60, Alberta Street. Case adjourned 'sine die' on payment of S.W.6. £1.1.0. costs. Messrs. Briant & Son, 11, Newington Crescent. Work commenced at time of hearing. 10, Kennington Park Place, Case adjourned 'sine die' on payment of S.E.11. £1.1.0. costs. Mr.E.Honig, Non-compliance with an Defendant stated he had surrendered his 27, All eyn Park, Abatement Order made on interest in the property. Case adjourned West Dulwich, S.E.21. 10th. October, 1946, for 'sine die'. failing to abate a nuisance at 208, Olney Road, S.E. Messrs. Stimson & Sons, Nuisance at 11, Kennington Summons withdrawn. Magistrate expressed 24/8, Walworth Road, Park Gardens. himself to be in "some difficulty" regarding S.E.17. the correct period to be inserted in a Nuisance Order were he to make one. Rebecca Benabo, trading as Non-compliance with an Work completed at time of hearing. Case Charles Bonabo & Son. • Abatement Order made on dismissed under Probation of Offenders Act, 3, St. Stophen's Parade, S.W.1. 9th. January, 1947, in 1907, on payment of £3.3.0. costs. respect of failure to abate a nuisance at 124, Trafalgar Street. V -8- FACTORIES ACT. 1937. 572 inspections of Factories were made during the year. The number of factories on the register increased slightly and the standard was found to be quite good generally, and much work was achieved by co-operation with the managements. Most of the defects found were in respect of the sanitary accommodation provided, and this necessitated the supervision of a large amount of drainage work. Verbal notice was given in some minor cases where conditions did not comply with the provisions of the Act, and in others written notice was served. 68 Notices wore served during the year. OUTWORKERS . Regular inspections of the homes of outworkers were made during the year and in most cases conditions were found to bo very satisfactory. 292 visits were paid and it was not found necessary to serve any notices or to institute any prosecutions for work in unwholesome premises. Once again, considerable difficulty was experienced in gaining access to some of the homes, but this generally was overcome. Firms co-operated well, and no instances were found of omission to supply lists of outworkers. One or two new firms have been sending lists to the Council during the year, and several firms have ceased to employ outworkers. RODENT CONTROL REPORT FROM JANUARY 5TH. 1947 - January 3rd, 1948. Domestic. Business. Visits - Rodent Officer. 246 254 " - Investigators. 9948 1976 " - Operatives. 4886 1749 Drains Tested. 290 51 " Defective. 66 15 " Repaired 47 6 Opened for examination. 32 3 Other preventive works. - - Reported infestations. 1324 306 Premises cleared. 1282 308 Additional to above. Business Premises. Poison Baits Laid. 6,126 Bodies recovered. 543 Domestic Premises. Poison baits laid. 5,090 Bodies Recovered. 192 Maintenance Treatments Nos. 5 and 6 of Sewers. June - July and November - December. -9- -10- TREATMENT AND BATHING CENTRE, KING JAMES STREET The returns for the year under review show a marked decrease in the number of treatments given for Scabies; 8664 in 1946 to 4906 in 1948. The method of treatment has been maintained without alteration, but since the end of December 1947 the Medical Officer of Health has discontinued the examination of patients resident in Lambeth, after the second treatment. He has made 606 examinations of patients and held 41 sessions, and continues to examine all Southwark cases until their discharge as cured. Verminous treatments show an increase as regards patients who are resident in Lambeth and a slight decrease as regards those resident in Southwark. 3314 in 1946 to 3780 in 1947, The number of male cases from Lambeth being affected by those sent from the Embankment Fellowship, 59 Belevedere Road, a philanthropic centre for the rehabilitation of old soldiers. MALES. Rov/ton Houses 109 Salvation Army Hostel 117 Southwark Casuals 9 Marshal so a Road Common Lodging House 16 Embankment Fellowship 174 Union Jack Club 1 Factories end Private residents 32 458 WOMEN & CHILDREN UNDER SCHOOL AGE. 219 New Kent Road 23 83 Blackfriars Road Common Lodging House 23 78 Camberwell Road Common Lodging House 14 Cecil House Hostel 6 Elizabeth Baxter Hostel 4 Factories and Private residents 284 354 INFECTIOUS DISEASE. This shows an increase in the incidence of the more common infections. During the year we have had a number of Poliomyelitis Cases, and the revisiting of the contacts of these cases entails a great deal of work. DISINFESTATION OF VERMINOUS ROOHS. This has increased slightly but the increase is largely in connection with the Council's requisitioned houses, m&ny of which though showing evidence of previous infestation, fall to givo evidence of live bugs. we are still using the standard 5% D.D.T. Insecticide and as far as we can judge with satisfactory results, with one exception, it has proved poor in the eradication of cockroaches. In consequence a change to Gammexane was made in July with satisfactory results, in connection with cockroaches. The worst cases we have to deal with are invariably those of old people living alone and without friends or relatives to care for them. EDUCATIONAL. Facilities have been given to various Training Centres for Public Health Students and in this connection 17 demonstrations were arranged and were attended by 178 students. —10- TREATMENT OF SCABIES MEN WOMEN TOTAL Lambeth Cases 224 425 649 " Treatments 510 895 1405 Southwark Gases 191 402 593 " Treatments 453 1038 1491 L.C.C. School Children 2010 TREATMENT OF VERMINOUS PERSONS Lambeth Cases 183 108 291 " Treatments 188 122 310 Southwark Cases 270 209 479 " Treatments 270 212 482 L.C.C. School Children 2988 TREATMENT OF VERMINOUS BEDDING & CLOTHING Beds. Pall. Bolsters Pillows Cushions Blankets Sheets Quilts 110 280 46 281 49 546 98 140 Pieces. 36,193. TREATMENT OF VERMINOUS ROOMS . D.D,T. Spray 1,369 VERMINOUS EFFECTS DESTROYED. Beds Pall.Bolsters Pi1lows Cushions Blankets Sheots Quilts 42 48 22 60 2 12 7 4 Pieces 310 VERMINOUS EFFECTS DESTROYED - Household Goods 3 tons 2 cwts. TREATMENT OF INFECTIOUS BEDDING CLOTHING . Beds Pall. Bolsters Pillows Cushions Blankets Sheets Quilts 32 151 21 339 16 521 112 91 Pieces 225 ROOMS DISINFECTED AFTER INFECTIOUS DISEASE - 261 PUBLIC LIBRARY BOOKS DISINFECTED AND RETURNED- 250 HOSPITAL WARDS DISINFECTED - 8 ROOMS DISINFECTED BY REQUEST, INCLUDING T .3, CANCER DEATHS, MEASLES, CHICKEN POX - 58 INFECTIOUS DISEASE ENQUIRIES Scarlet Fever 236. Diphtheria 76. Erysipelas 33. Dysentery 14. Cerebro-spinal meningitis 9. Poliomyelitis 34. Malaria 2. Total - 404 Notified Cases. NUMBER OF SCARLET FEVER CASES KEPT AT HOME, SPECIAL INVESTIGATIONS AND REPORT - 156 CONTROL OF CONTACTS, NUMBER OF VISITS MADE. Smallpox 16. Poliomyelitis 134. -11- -19- SCABIES ORDER 1941-1943. Visits made by Sister Kingsmill - 208 Formal Notices served - 17 POOD & DRUGS ACT, 1938 - ANALYSIS OF SAMPLES Samples Formal Examined Informal Adulterated Formal Informal Milk 236 21 1 - Condsensed Milk - 12 - - Dried Milk 1 3 - - Graded Milk - 30 - - Butter 34 20 - - Cheese 5 6 - - Margarine 12 18 - - Lard 20 15 - - Tea 25 5 1 2 Coffee 13 4 - - Coffee Mixture & Essences 12 10 - - Cocoa 18 20 - - Sugar 18 5 - - Meat & Meat Products 25 79 3 8 Canned & potted Foods 26 101 - - Fruit & Vegetables (canned) etc . 53 85 - - Preserves, Jollies, Jams etc. 79 43 1 1 Cereals & Cereal preparations 69 65 3 6 Bread, Flour & Confectionery 82 133 2 4 Wines, Spirits & Beverages 15 111 7 13 Condiments, Spices, Sauces etc. 120 190 4 4 Drugs & Med. Preparations 18 71 1 5 Miscellaneous 3amples 20 84 - 1 Total 901 1131 21 44 FOOD & DRUGS ACT 1958 - LEGAL PROCEEDINGS . DEFENDANT CAUSE OF PROCEEDINGS RESULT Tyne Brand Products Selling Horse Radish Fined £10 and Ltd., Salad Dressing 88 per £5.5.0d. Costs. Fish Quay, cent deficient in oil. North Shields. William John Selling Gin 40 degrees Fined £10. Hartwell, under proof. "Albert Arms" Public House, 1 Gladstone Street. William Robert do. Dismissed under Hartwell, Probation of 47 Kimberley Road, Offenders Act Stockwell. S.W. on payment of £1.1.0d. Costs. Mrs.Ada G. Nelson, Selling Rum 42 degrees Fined £10. "Castle" Public under proof. House, 205 Old Kent Road. -12- DEFENDANT CAUSE OF PROCEEDINGS RESULT Robert H. Coe, Soiling Whisky 49 degrees pined £5. "Beehive" Public under proof. House, 21 Bartholomew Street. Thomas Gardner, Selling Rum 47.5 degrees Dismissed under "Prince Regent" under proof. Probation of Public House, Offenders Act 40 Dawes Street. on payment of £10.10/- costs. Gerry's Ltd., Selling Beef Sausages Fined £5 and 188 Old Kent Road. 300per cent deficient £2.2/- costs. in meat. J. & J. Stanley Ltd, Selling White Pepper Dismissed under 160 Gt.Suffolk St. containing not less Probation of than 75 per cent wheat Offenders Act flour. on payment of £2.2/- costs. William Compton, Selling White pepper pined 35/- and 148 Dawes Street. containing not less than £3.3/- costs. 50 per cent wheat flour. Frederick G.Eaton, Selling Vinegar 8 per Fined £2 and 60 Lilford Road, cent deficient in Acetic £1.11.6d. costs. Camberwell. Acid. Henry J. Noakes, Selling Beef Sausages Dismissed under 77 Harper Road. 26 per cent deficient Probation of in meat. Offenders Act on payment of £3. 3/—* costs . Seven cautionary letters were sent in respect of other non-genuine samples. BAKEHOUSES. There are 40 Bakehouses in use in Southwark, of which 15 are underground Bakehouses. During the year one underground Bakehouse,214 Manor Place, was closed. MILK (SPECIAL DESIGNATIONS) REGULATIONS, 1936-1943. Dealers' Licences were granted authorising the use of the special designation "Pasteurised" in 26 oases, and Dealers' Licences authorising the use of the special designation "Tuberculin Tested" Milk were granted in 10 cases 8 Supplementary Licences In respect of "Pasteurised" Milk and 6 in respect of "Tuberculin Tested" Milk were granted to dealers selling from premises outside the Borough, the principal licences having been issued by the appropriate Licensing authority in each case. During the year, 30 samples of graded milks were taken and submitted to the Public Analyst for bacteriological examination and chemical analysis. Also 28 samples of milk supplied to local schools were examined by the Public Analyst. 13 At the close of the year, there were 184 registered retailers and wholesalers in the Borough, whilst the number of retailers and wholesalers purveying milk in the Borough from Registered premises elsewhere was 43. PUBLIC HEALTH (CONDENSED MILK) REGULATIONS, 1983 and 19247. 10 samples of Condensed Milk were purchased under the above Regulations for analysis. They were all certified by the Public Analyst to comply with the said regulations. ICE CREAM SAMPLES . 66 samples of Ice Cream were taken from factories, shops and street barrows during the year, and submitted to the Public Analyst for examination. FOOD & DRUGS ACT. 1958 - SECTION 34. There was one new registration of premises for the business of a wholesale dealer in margarine (189 Newington Butts, S.E.ll.) . PHARMACY & POISONS ACT, 1933. During the year 89 visits were paid to the various premises listed by the Council for the sale of part II Poisons under the above Act. There are 61 names of persons on the Council's List of Sellers of Part II poisons. HOUSING ACT, 1956 - SECTION II. The following premises were represented for demolition during the year under review:- 25, 24, 25 Dodson Street - Undertaking not to be used for human habitation. 12 Boddy's Bridge. - Closed. Undertaking not to be used for human habitation. 14 " " - Demolition Order made, but quashed on appeal to County Court. Premises to be made fit. 16 Marshall Gardens - Demolition Order made; quashed on appeal to County Court. Judge accepted owner's specification of work to be carried out. (The owners have since decided to demolish the premises) . 52 Arnott Street - Undertaking not to re-let for human habitation until premises have been made fit.- Since made fitness. 9 Colombo Street - Closed. Undertaking not to re-let for human habitation. 11 Ripley Street - Order Made. Appeal lodged to County Court but adjourned with liberty to either side to restore the appeal and costs reserved. Owners to carry outwork as per schedule plus additional work required by M.O.H. 41 " - Order made. Premises vacated but not demolished. HOUSING ACT, 1936 - SECT: ON 12. Underground rooms were represented for Closing Orders as follows:- 12 Princess Street. Rooms empty. 156 Blackfriars Road. Closing Order made. -15- RE-HOUSING. Extensive war damage, the suspension of Housing Act operations and the restriction on all but essential house repairs have combined to produce an acute shortage of houses which could be deemed to be in all respects fit for human habitation, and this shortage has been reflected in the number of housing applications referred to the department by the London County Council, the Council's Housing Manager and other authorities on grounds of overcrowding, health and insanitary conditions. The number of investigations undertaken by the department was 1,263, and where sanitary defects were found to exist every effort was made to secure some amelioration of the conditions under which the applicants wore living, notwithstanding the fact that for the greater part of the year the department was handicapped by having only flinty per cent of the authorised establishment of sanitary inspectors. In dealing with health cases, regard was had to the necessary for ensuring that the limited amount of accomodation likely to be available was allocated to those families having the greatest need, but nevertheless, in 149 cases, 101 for tuberculosis and 48 for other medical reasons, It was considered that relief could best be afforded by the removal of the families to other premises, and accordingly recommendations for preferential re-housing were forwarded to the London County Council. 49 families were re-housed by the London County Council on medical grounds, of which 33 were by reason of tuberculosis in the family, whilst the corresponding figures for Borough Council re-housing were 19 and 6 respectively. OVERCROWDING. It is not yet possible to give accurate figures regarding the extent of overcrowding in the Borough owing to the many fluctuations in the population which took place during the war years. At the end of 1938 the records showed 2,461 premises, occupied by 2,461 families consisting of 14,126 persons, to be overcrowded, and in 1943 circular letters were sent to occupiers of all overcrowded premises remaining on the register as a result of which it was found that many of the families had vacated the premises or that the overcrowding had been temporarily abated by evacuation and other causes. Since the end of the War, it has boon possible to re-commence the keeping of the overcrowding register and,after adjustments relating to abatements and new overcrowded promises coming to the knowledge of the department had been made to the residue of the 1938 figures, it was found that at the end of 1946 the number of overcrowded promises was 877, and that these were occupied by 976 families consisting of 4,996 persons. During 1947, 266 new cases of overcrowding were reported and 142 premises wore removed from the register, leaving a total of 1,001 overcrowded premises, 1,158 families and 5,662 persons. It will be observed from the figures quoted that overcrowding ha3 now taken a somewhat different trend, for, whereas in 1938 each of the overcrowded premises was occupied by one family, forty per cent of the overcrowded dwellings found during 1947 were occupied -15- -16- by more than one family. In determining whether a house occupied by two or more families was overcrowded the aggregate population was taken and if the permitted number for the premises was not exceeded, no overcrowding was deemed to exist, but it will be appreciated that although this was a necessary method of assessing the priority for rehousing, it ignores the fact that many houses although not overcrowded on this standard are occupied in such a manner as to constitute a grave social evil. The present housing shortage makes striot enforcement of the overcrowding provisions impossible, but during the year under review the Council considered that in two instances the circumstances were such that statutory action should bo taken. In the first case, a family having illegally overcrowded a dwelling refused several offers of alternative accommodation, and a notice served on the occupier requiring the abatement of the overcrowding was not complied with. Subsequently, the occupier was summonsed for causing the premises to bo overcrowded,and at Tower Bridge Magistrate's Court on the 26th. June, the offence was found to bo proved, but sentence was deferred for three months after which it would be considered in the light of the action taken by the defendant to abate the overcrowding during that period. Prior to the expiration of the three months a further offer of accommodation was made to the defendant which was accepted and the Council then obtained permission to withdraw the summons. In the second case it was found that an eightroomed house having a permitted number of sixteen persons was being used as an hostel or boarding house, and a statement completed by the occupier showed the number of persons sleeping in the premises to bo twentyeight. A notice to abate the overcrowding was served and complied with; no further action was necessary. During the year, 252 of the families living in overcrowded dwellings applied to the London County Council for re-housing and overcrowding certificates wore forwarded to that authority by the department. Details of the overcrowding in the Borough are given below:- Premises. Dwelling, therein. Families. Persons. Remaining on the register at the end of 1946. 877 976 4,966 Now cases reported during 1947.266 372 1,562 Totals. 1,143 1,348 6,528 Overcrowding abated 142 190 866 Remaining on register. 1,001 1,158 5,662 -16- -17- Overcrowding was abated as follows:- Premises. Dwellings therein. Families. Persons. Re-housed by London County Council. 102 141 621 " " Borough Council. 23 28 123 " " Other Boroughs. 1 1 5 " " Owners. 4 5 18 Moved Away 8 11 55 By marriages, deaths etc. 4 4 44 Total 142 190 866 INFECTIOUS DISEASES & TUBERCULOSIS . 1731 notifications of Infectious Disease were received during the year, of which 1639 were confirmed. These confirmed diagnoses showed a decrease in comparison with 1946, due chiefly to the considerable decline in Scabies, which was less than half the previous year's total. There were, however, increases in several diseases, particularly Scarlet Fever, Diphtheria, Puerperal pyrexia, Zymotic Enteritis and Whooping Cough. The most disturbing features wore the DIPHTHERIA figure of 40 as against 27 in 1946, and a further increase in WHOOPING COUGH on the abnormally high total of 1946. Live births Confirmed Diptheria No. of Diphth. "Booster" Cases Imnunisations Injections 1945 1305 38 875 1946 2903 27 1709 68 1947 2434 40 1745 34 Between 1945 and 1946 there was a very substantial increase In population and births, with a similarly high increase in the number of Diphtheria immunisations. This, with a decline in the number of confirmed Diptheria diagnoses, was a satisfactory result. Between 1946 and 1947, however, the number of immunisations was certainly exceeded, but only very slightly, whilst there was a 50 per cent decrease in the number of "booster" injections given to children on reaching school age. At the same time, it should bo noted that the increase In population was much smaller than between 1945/46; there was an appreciable fall in the birth rate; and during last year there was no specialised immunisation propaganda campaign, as in 1946. Nevertheless, a significant fact is revealed in that the highest incidence of Diptheria In 1947 occurred in children of approximately 5 years of ago when the "booster" injection is recommended. Actually, there were 23 confirmed cases of Diphtheria between 5 and 14 years of age, and as only 34 "booster" injections were given during the year, it is probable that very few of these received this necessary additional injection. Bearing in mind the sharp rise in the number of Diphtheria cases during the year, this would seem a conclusive proof of the necessity not only for continued immunisation publicity, but also particularly for the "booster" injection before commencing school. -17- -18- An epidemic of POLIOMYELITIS, severe in comparison with the usual incidence of this disease in Great Britain, occurred throughout the country during the summer. There were no deaths in Southwark, where the number of cases was amongst the lowest in the Metropolitan area. This gratifying fact is somewhat Inexplicable In view of the congested housing conditions in this borough. The most intensive Investigations and careful analyses of all salient features of each case was made, and expert medical opinion throughout the country gave continual attention to the many elusive circumstances of this disease, but the method by which it is transmitted remains largely a mystery. In Southwark (and it is believed generally in most areas) no two cases were reported in the same family. This, and the fact that although close supervision of all contacts and all possible sources of infection was maintained, no unusual precautionary measures were taken - a procedure which seems justified in view of the few cases in this borough - rather indicates that the ultimate factor in this disease is a natural immunity or susceptibility of the individual, regardless of environmental conditions or direct contact. MEASLES, although showing a decrease, is still exceptionally high. An unusually large proportion of the year's cases occurred during the last two months, following the subsidence of the Poliomyelitis outbreak, when the number of Measles cases in this Borough was the highest in London. Of the gastric disturbances often associated with Poliomyelitis, GASTRO-ENTERITIS has shown a marked increase during the year under review, both during and outside the notifiable period. It may perhaps bo of some interest to compare the data above relating to these three virus diseases. An outbreak of DYSENTERY occurred amongst children in the Day Nurseries during February. Here again, intensive investigations failed to reveal the source of infection. All patients wore immediately excluded from the Nurseries, and the utmost precautions taken to combat the complaint, which declined within a few weeks. Gases of Smallpox and Typhus occurred in various parts of the country during the year but none was reported in Southwark. There has been a further increase in the figures for TUBERCULOSIS, particularly Pulmonary cases which have risen from 241 in 1946 to 269 in 1947. The deaths from this disease, however, show very little change in the decreased figures reported in 1946. Pulmonary deaths totalled 77, against 74 in 1946, whilst Non-Pulmonary deaths wore 5, compared with 8 in the previous year. -18- -10- INFECTIOUS DISEASE NOTIFICATIONS Disease Original Cases Admitted Hospital Nos. after correction of diagnoses DEATHS Notfd. cases Un-notfd. Cases 1946 1947 Scarlet Fever 240 86 156 229 1 - Pneumonia 47 3 69 47 7 26 Diphtheria 69 69 27 40 - - Erysipelas 32 16 28 32 - - Dysentery 28 21 8 11 - - Ophthalmia Neons 9 7 10 9 - - puerperal pyrexia 14 12 8 14 - - Puerperal Fever 5 5 6 5 - - Cerebro Spinal Meningitis 10 10 8 8 - 3 Zymotic enteritis (July-Sept.) 24 15 10 22 - - Paratyphoid — - 1 - - - Malaria 5 2 7 5 - - Food Poisoning 2 2 3 1 - - Encephalitis Letharg: - - 1 - - - Scabies 198 - 405 198 - - Measles 712 124 775 705 - - Whooping Cough 293 49 232 286 3 - Enteric Fever 1 1 - 1 - - Poliomyelitis 42 41 - 26 - - TOTALS: 1731 463 1754 1639 11 29 DEATHS AGE GROUPS Disease 0-1 1-5 25-35 35-45 45-55 55-65 65-75 75 plus WHOOPING COUGH notified cases 2 1 CEREBRO SPINAL MENINGITIS Un-notf. cases 2 1 PNEUMONIA notified cases 3 4 Un-notf. cases 1 3 3 9 6 4 SCARLET FEVER \ notified cases 1 TOTALS: Total notified cases 2 2 3 4 11 Un-notf.cases 3 3 3 9 7 4 29 5 22 3 3 12 7 8 40 -19- -20— TUBERCULOSIS DISPENSARY The work of the Dispensary continues to be exceptionally heavy. The number of notified eases of Tuberculosis shows a slight increase on the previous year. Dr. Pritchard reports that the Scheme for Domiciliary treatment of Tuberculosis Patients has continued during the year and has grown. Whilst one docs not advocate or suggest that this form of treatment is bettor than a Sanatorium or Hospital, we do feel that it is of extreme value in an attempt to control the disease in view of the very long waiting period which is now necessary before admission to a Sanatorium or Hospital. An analysis of the first hundred cases shows very good results and comparable with those obtained in hospital. This work, of course, has meant a great deal of extra work for the whole of the clinical staff doctors, health visitors and clerks. The London County Council has co-operated by supplying two ambulances a week for the transport of pationt3 to and from the Clinic. Primary Notifications PULMONARY Ago groups - TOTAL TOTAL incl. DUPLICATES 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- Males 2 1 6 2 16 12 21 16 18 18 5 117 126 Females 4 4 5 21 25 15 8 2 3 87 93 TOTALS 1947 2 5 10 7 37 3 36 24 20 21 5 204 219 1946 mm* 5 8 4 25 26 44 20 14 24 8 178 196 NON- PULMONARY Males 1 2 2 2 2 2 3 1 15 16 Pemales 5 3 1 3 3 2 1 1 19 19 TOTALS 1947 6 5 3 5 5 4 4 1 1 34 36 1946 1 4 6 3 2 2 6 1 1 26 26 New Cases otherwise than by formal notifications PULMONARY Males 1 7 11 6 13 5 4 47 Females 1 2 1 5 6 1 1 1 18 TOTALS 1947 1 2 2 12 17 7 14 6 4 65 1946 1 1 1 3 11 16 14 7 5 4 63 NONPULMONARY Males 2 2 Females 1 1 2 TOTALS 1947 1 2 1 4 1946 1 1 3 1 1 7 -20- -21- TUBERCULOSIS - DK.THS 0- 1- 3- 5- 10- 15: 20- 25- 35- 45- 55- 65- 75- Notfd.TB cases died from other causes PULMONARY NOTIFIED CASES Males 1 4 10 7 8 5 1 1 (1 yr) died NonPul. TB. 1 (45 yrs) died heart failure emphysems & bronchitis Females 1 2 7 3 2 2 2 2 1 (3 yrs) died accidental injuries. 1 (20 ts) died toxaemia of pregnancy. UN-NOTIFIED CASES Males 1 2 1 5 4 2 1 Females 1 1 1 1 TOTALS 1947 1 1 4 8 9 13 15 15 9 2 (77) 4 1946 1 1 4 7 8 12 13 20 3 5 (74) 5 NON- PULMONARY NOTIFIED CASES Males Nil Females 2 2 1 UN-NOTIFIED CASES Nil TOTALS 1947 2 2 1 (5) - 1946 1 2 1 3 1 (8) - -21- 22_ RETURN RELATING TO THE YEAR OF THE DISPENSARY DURING THE YEAR ENDING 31ST. DECEMBER, 1947. DIAGNOSIS PULMONARY TOTAL GRAND TOTAL " Adults Children Adults Children Adults Children M F M F M F M F M F M F A (l) Number of definite cases of Tuberculosis on the Dispensary Register at the beginning of year 328 313 63 57 24 25 7 5 352 338 70 62 822 (2) Transfers from other Authorities during the year 24 12 1 - 1 - - 1 25 12 1 1 39 (3) Lost sight of cases returned during the year - - - - - - - - - - - - - B Number of New Cases diagnosed as tuberculosis during the year (1) Class T.B.minus 39 40 8 11 - - - - 39 40 8 11 98 (2) Class T.B.plus 53 24 1 1 - — - - 53 24 1 1 79 (3) Non-pulmonary — - - - 8 6 4 5 8 6 4 5 23 C Number of cases included in A & B written off the Dispensary Register during the year as: (l) Recovered 4 2 - - — - - — 4 2 - - 6 (2) Dead (all causes) 38 25 1 - 1 1 — — 39 26 1 - 66 (3) Removed to other Areas 31 18 3 1 2 1 1 — 33 19 4 1 57 (4) For other reasons - - - - - - - - - - - - - D Number of definite cases of tuberculosis on the Dispensary Register at the end of the year 371 344 69 67 30 29 10 11 401 373 79 78 931 1 H N 1 A. P. Refills - 3,609 X-Ray Exams - 6,594 Total Attendances - 11,364 Home visits by Health. Visitors - 3,433 REPORT BY THE ALHONER During the last year a considerable number of patients have been referred by Dr. Fritchard for allowances under the L.C.C. Tuberculosis Scheme, and those cases that do not come within the scope of this Scheme, i.e. 'patients who do not give up gainful employment to take treatment were referred to the local Social Welfare Officers. The average man or woman would not give up work if they know that they were forced to apply for relief and the allowances now made do encourage the patient to follow the treatment laid down by the Doctor. In most cases of Hardship the Dispensary arranges for the extra milk ration allowed by the Ministry of Food to be paid for by the Borough. When the patient leaves off work he is given a form on which he states particulars of his family and his normal wages, and his case is brought before the L.C.C. Assessment Officer the following Friday, when the details given are considered in full and a grant is made according to seals i.o. so much for the patient and wife and each child. If the patient has a high rent or other additional expenses which are considered reasonable, a discrtionary allowance is made in many cases. During the time that the patient is ill help is given with clothing, bedding, fares etc, through the Care Committee and arrangements are often made for the children to receive free school dinners. Pyjamas can be obtained upon production of coupons through the L.C.C. as part of the treatment before the patient is sent to a Sanatorium. Any additional needs are met through the funds of the T.B. Care Committee. When a patient is in Hospital, or a Sanatorium, and is not eligible for any allowance under the Scheme, and is not entitled to National Health Insurance benefit, a pocket money grant is made from the funds of the Care Committee. we do at all times try to meet the urgent needs of the tuberculous patients, both financially and otherwise. -25-