LIBRARY STPAN 12 METROPOLITAN BOROUGH OF SAINT PANCRAS ANNUAL REPORT (Abridged) on the HEALTH OF THE BOROUGH for the year 1943 PERCIVAL V. PRITCHARD M.D., Ch.B., M.R.C.P., F.R.F.P.S., D.P.H., Deputy Medical Officer of Health page 2 To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Saint Pancras. Sir, Ladies and Gentlemen, This is the 87th Annual Report. In accordance with the Ministry of Health's instructions it is in an abridged form dealing only with essential statistical information. It is with deep regret that the death of Dr. Radford has to be recorded. He fell fell in May 1943, was given prolonged sick leave and died in January 1944. As the Deputy I have administered the Department during his illness and since his death. The wholehearted loyalty of tne staff has enabled me to maintain an efficient service singlehanded and in face of many wartime difficulties. I very much appreciate this valuable co-operation. A brief review of the Report reveals several interesting facts. There has been a further rise in the birth rate. Unfortunately this increase was largely accounted for by a marked rise in illegitimate births. The mortality rate among these . illegitimate babies showed a welcome reduction for this year, but was still much higher than the rate for legitimate babies. There was a slight rise in the death rates at all ages including infants. There was a marked and increased use of the Maternity & Child Welfare services provided by the Authority. The attendances at the various clinics were all up for the year and the Health Visitors paid many more home visits. Additional clinics had to be organised and authorised to meet the demands of mothers and children. The accommodation for children in the War-time Nurseries was extended. It is a pleasing feature of this work to be able to state that the children coming under this scheme had a remarkably healthy record for the year and furthermore the majority seemed to derive great benefit from their attendance. The percentage of successful vaccinations among babies was the highest for a number of years. The Diphtheria Immunisation scheme continued to protect a large proportion of the young population against this serious disease page 3 The Sanitary Inspectors had a busy year with several thousand more visits and inspections to their credit than in recent years. Unfortunately there has been an increase in infestation with vermin and scabies and this has resulted in much additional work for all the outdoor staff and at the Cleansing Station. A new scheme for the control of Hat Infestation was Inaugurated, and promises to be successful. There has been for the year, a drop in the number of cases of Cerebro-spinal Meningitis, Diphtheria, Dysentery, Typhoid, Measles, Ophthalmia Neonatorum and Whooping Cough, with an increase for Food Poisoning and Scarlet Fever. Post-war planning for St. Pancras has had considerable attention and preparations are in hand to deal with the situation especially with reference to improving Housing, as soon as possible after the cessation of hostilities. I am, Sir, Ladies and Gentlemen, Your obedient Servant, Deputy Medical Officer of Health August, 1944. page 4 STATISTICS FOR THE YEAR 1941 POPULATION The estimated mid-year population shows a further increase over that of 1942 - but in accordance with instructions, no figure is quoted. LIVE BIRTHS M F Total Legitimate 804 758 1502 Illegitimate 134 140 274 938 898 1836 LIVE BIRTHS Legitimate 22 14 36 Illegitimate 8 3 11 30 17 47 DEATHS All ages - 987 855 1842 DEATHS FROM PUERPERAL CAUSES Rate per 1,000 total live & still births. Puerperal Sepsis - Nil Other puerperal causes 1 • 53 DEATH RATE OF INFANTS UNDER 1 YEAR OF AGE All infants per 1,000 live births - 71 Legitimate infants per 1,000 legitimate live births- 66 Illegitimate infants per 1,000 illegitimate live births- 99 NOTIFICATIONS OF BIRTHS The number of notifications received in respect of St, Pancras children was 1762 including 43 still-births. page 5 classification of deaths, with age distribution Causes of death Ages - Both sexes Under 1 year 1-and under 5 5 and under 15 15 and under 45 45 and under 65 65 and upwards Totals M f All causes 130 20 10 173 486 1021 987 855 1. Typhoid & paratyphoid — — — — — — — — 2. Cerebro-spinal fever 2 — — — — — 1 1 3. Scarlet fever — 1 — — — — 1 — 4. Whooping cough 1 1 — — — — 2 — 5. Diphtheria — — — 2 — 1 2 1 6. Tuberc, of resoil, system 3 2 1 53 37 15 80 31 7. Other tuberculosis 1 — 1 1 2 1 2 4 8. Syphilitic diseases 1 — — 1 10 4 12 4 9. Influenza 1 — — 6 — 15 13 14 10. Measles 1 3 — — — — 2 2 11. Ac poliomyelitis and polioencephalitis — — — 1 — — — 1 12. Ac. infectious encephalitis — — — — — — 1 — 13. Cancer - buccal cavity and Oesoph (M); Uterus (F); — — — 1 15 19 17 18 14. Cancer - stomach & duodenum — — — — 18 18 20 16 15. Cancer - breast — — — 5 10 7 — 22 16 . Cancer - all other sites 2 — — 17 62 94 109 66 17. Diabetes — — — 1 l 5 2 5 l8. Intracranial vas, lesions — — — 5 32 108 60 85 19. Heart diseases — — — 15 86 315 197 219 20. Other circulatory diseases — — — 3 19 43 34 31 21. Bronchitis 6 — — 3 42 117 97 71 22. Pneumonia 13 4 — 7 39 78 90 51 23. Other respiratory diseases — — — 4 11 10 16 9 24. Ulcer - stomach & duodenum 1 — — 4 13 12 23 7 25. Diarrhoea (under 2 years) 18 — — — — — 12 6 26. Appendicitis — — — — 2 3 4 1 27. Other digestive diseases 2 1 — 3 13 19 18 20 26. Kephritis — — — 5 15 26 21 25 29. Puerperal & post-abortive sepsis — — — — — — — — 30. Other maternal causes — — — 1 — — — 1 31. Premature birth 26 — — — — — 20 6 32. Congenital malformations, birth injury & infant diseases 30 — — 2 2 3 15 22 33. Suicide — — — 6 2 2 7 3 34. Road traffic accidents — 1 1 4 3 2 6 5 35. Other violent causes 9 4 1 16 8 22 32 28 36. All other causes 11 3 5 7 21 82 71 56 page 6 PROVISION OF HEALTH SERVICES IN THE BOROUGH Treatment Centres and Clinics Welfare Centre Expectant Mothers Children Attendances Total consultations Total attendances Consult -ations Under 1 1-5 Total St.Farcras School for Mothers (Ampthill Square) 23 172 150 2464 1306 3770 Camden Town 61 745 255 4501 268l 7182 Kentish Town 64 957 151 4517 1738 6255 North St. Pancras School for Mothers(Queens Crescent) 59 663 149 4224 1190 5414 Somers Town 15 150 151 3105 1526 5031 South Highgate - - 104 2818 1756 4574 University College Hospital 154 3611 104 673 261 534 Royal Free Hospital 147 788 | 15 5 23 28 Totals - 543 7086 1115 22,307 10,681 33,188 Artificial Light treatment - - 76 433 1826 2259 Dental Treatment Amothill Square Camden Town Sessions - 27 77 Attendances - Mothers 210 878 Children 90 141 The Borough Council also made a contribution during the year of £108, 12, 3d towards the total cost of £222, 19, 6d for Dentures supplied to nursing or expectant mothers. page Gynaecological Clinic Sessions are held weekly, and during the year there were 319 attendances, of which 137 new cases received attention. Health Visitcts The total number of visits made by Health Visitors was:- Council's U.C.Hospital Total To Expectant mothers 3,207 66 3,273 Post Natal 848 23 871 Children 19,640 665 20,305 Child Life Protection 46 1 49 Infectious diseases &c 1,573 36 1,609 Other visits 4,862 23 4,885 30,178 814 30,992 Comparable figures for 1942 were:- 25,056 772 25,828 Nursing- in the Home The following District Nursing Associations undertake the nursing of cases of illness occuring in expectant and nursing mothers, and children under 5 years of age. An annual block grant is made to each Association in respect of nursing for certain specified diseases. Block Grant Number of £ Cases Visits Hampstead 30 65 939 Metropolitan - 250 32 491 North London - 25 24 153 Invalid Childrens' Aid Association Under this scheme, assistance is rendered towards the cost of convalescence of St. Pancras children under the age of 5 years, with a maximum of 50 cases. Up to the end of March 1943 the Council were paying 30/- for each child for any one year, but beginning on 1st April of the same year, financial arrangements were varied to provide for a payment of 75% of the nett deficit outstanding after allowing for any payments by parents, up to a limit of 50 cases per annum. page 8 Supplementary Coupons for Expectant Mothers The Issue of these coupons by the "Public Health Department was continued, until 24th July of the year under review, after which date the responsibility for this work was placed with the Ministry cf Food for issue through the,Local Food Office, and 2228 expectant mothers, resident in the Borough, were supplied during with supplementary coupons. A total of 4,966 exportmothers have been issued with coupons since the scheme came in no force on 5th August, 1941. Home Helps This scheme operates with the assistance of an Annual Grant from the Council of £250 for use in maternity cases only. The total number of applications for assistance was 118, of which ll6 were for maternity and 2 for sickness. 72 cases were supplied with Home Helps, the remaining 46 applications were dealt with in various ways such as by admission to Hospital or through other arrangements made by or on behalf of the applicant. Diphtheria Immunisation The Immunisation of children Is carried out by General Practitioners; the Council's Welfare Centres; Wartime Day Nurseries, and by the London County Council Medical Officers at their day schools. During the year 2,300 children were Immunised through the various channels mentioned above and the complete number of St. Pancras children new recorded as immunised since the scheme came into operation amount to 6,972. War-time Day Nurseries There are seven Wartime Day Nurseries in St. Pancras admitting children aged 0 to 5 years, and four others admitting children 2 to 5 years accommodated at the London County Council Rest Centres. These Nurseries provide accommodation for a total of 494 children. Small-pox and Vaccination The number of births dealt with by the Vaccination Officer during1942. totalled 1,595 of which number 873 (54.7%) were successfully vaccinated. Figures for 1943 are not yet available. Comparable percentages of vaccinations for 1939, 1940 and 1941 were 41.8%; 33.4%; and 43-6% respectively. page 9 SANITARY CIRCUMSTANCES IN THE BOROUGH Work carried out by Sanitary Inspectors Visits and inspections including re-inspections, to a total of 27,662 were made by 11 of the staff. Of this figure 4,702 were made by the 2 Food Inspectors and 7,064 by the 2 Factory Inspectors. A total of 1,694 Intimation Notices including 444 by the Factory Inspectors; 507 Statutory Notices and 8 Notices under the Rent Restriction Act were served during the year. No Notices were served under the Shops Act. Under the Public Health (London) Act 1936 there were 24 prosecutions in respect of general sanitary work and 1 under the London County Council By-Laws made under the Housing Act (Section 6), Defects found under the Factories Act numbered 301, but the work required was completed in all cases without prosecution. Section 224 of the Public Health (London) Act 1936 authorises the removal to a Home or Institution of certain aged, diseased or infirm persons living under insanitary conditions. 6 persons were so dealt with. The work in connection with first-aid repairs to war damaged houses was continued in this Department with a staff of 7 technical assistants, supervised by the remaining 3 Sanitary Inspectors and the Housing Inspector who were specially seconded for this work. This staff made 22,975 visits, including 746 first visits, during the year. Infectious Diseases Notifications Acute influenzal pneumonia under 1 1 & Over Total Total deaths 1 43 44 2 Acute primary pneumonia 4 75 79 1 Anterior poliomyelitis & polioencephalitis 1 2 3 1 Cerebro-spinal meningitis 1 4 5 2 Diphtheria & membranous group 4 95 99 3 Dysentery 2 29 31 — Encephalitis lethargica — 1 1 1 Enteric or typhoid fever — 2 2 — Erysipelas r— 67 72 — Food poisoning 1 14 15 — Malaria — l l — Measles 39 993 1032 4 Ophthalmia neonatorum 12 — 12 — Puerperal fever — — 6 6 — Puerperal pyrexia — 32 32 — Scabies X 12 534 546 — Scarlatina or Scarlet fever 6 402 408 1 Smallpox — — — — Whooping cough 67 372 439 2 X from 1st August 1943 only page 10 Infectious diseases continued It was subsequently ascertained that the following notifications, which are included in the preceding table, were not regarded as cases of the disease as originally diagnosed - Under 1 Over 1 Total Cerebro-spinal meningitis 1 2 3 Diphtheria & membranous group - 1 12 13 Dysentery - - - 2 2 Measles - - 3 1 4 Scarlatina or Scarlet fever - 15 15 Whooping cough - 2 2 4 Cleansing Station The number of attendances at the Camley Street Cleansing Station show a further increase over the preceding year, the totals being as follows:- Men Women & (Children under 5) St. Pancras School children Ex. St. Pancras School children Total Vermin 688 72 1,721 552 3,033 Scabies 712 3,218 3,903 1,312 9,152 1,407 3,290 5,624 1,864 12,185 Comparable totals for 1942 - 1,847 2,562 4,328 1,312 9,959 In order to cope with the Increase of work arrangements were made with the Middlesex, Royal Free and University College Hospitals to assist in dealing with cases of scabies. Attendances made were:- Middlesex 869 Royal free 72 University College 366 Total 1,307 Scabies During 1943 certain structural alterations were carried out on the ground floor portion of the Camley Street Cleansing Station and three new bathrooms installed for male scabies cases. This infectious disease became notifiable on August 1st, and 546 cases were notified between that date and December 31st, but this gives an inadequate idea of the work involved as only the first case in the family is notifiable and frequently several members of the family were affected. The whole household is treated whenever possible whether infected or not and this has greatly reduced the number of re-infections. page 11 Disinfection and Disinfestation The number of articles dealt with or destroyed at Camley Street on account of verminous conditions and infectious diseases were:- Destroyed - 220 Disinfected or Disinfested - 12,146 of which 2,738 were A.R.P. The figures set out below show the number of Houses, Rooms, etc., dealt with after infectious diseases or following complaints of vermin:- No. of cases No. of houses No. of rooms sprayed or fumigated A. R. P. premises sprayed or fumigated Cerebro-spinal meningitis 8 8 9 — Diphtheria 91 91 77 — Dysentery 11 11 9 1 Enteric fever — — — — Erysipelas 43 48 35 — Measles 24 24 9 — Pneumonia — — — — Polio-myelitis 5 5 3 — Puerperal fever 4 4 1 — Puerperal pyrexia l 1 — — Scabies 177 168 6 — Scarlet fever 479 476 369 — Tuberculosis 120 120 113 — Vermin 460 458 554 7 Other diseases 122 122 39 — Irish Labourers 3y an arrangement with the Ministry of Health, Irish labourers temporarily recruited into the country for employment were billet ad at the Royal Veterinary College and where found necessary were cleansed and their clothing disinfested. The number so dealt with amounted to 11,704 over a period of ten months - January to October 1943. This work was all carried out as night work by Sanitary Inspectors and Disinfectors assisted by a number of A.R.P. personnel. Following October other arrangements were made by the Ministry of Health. page 12 Hat Extermination Early in 1943 the Council put into operation a scheme of the Minister of Food under the Hats and Mice Destruction Act & Infestation Order 1943; appointed a Rat Officer who was eventually trained through the medium of the Ministry of Food, and two Ratcatchers. Much of the work undertaken was of an experimental nature but some excellent results were obtained. The sewers vested in the Council were treated by the new pre — baiting method and an estimated kill of more than 7,000 rats resulted in one big drive. Business firms in the Borough were advised that the Council could assist in ridding their premises of rats; the response was satisfactory and the work is proceeding. Housing Work under the Housing Act 1936 has been at a standstill owing to the War, but as a matter of interest it should be noted that during 1943 the Council submitted to the appropriate authorities, a Post-War Development Plan followed shortly after by a First-Year Building Programme. Mortuary The number of post-mortems carried out at the Camley Street mortuary during the past five years are shown below:- 1939 - 215 1940 - 1009 1941 - 793 1942 - 712 1943 - 864 page 13 INSPECTION AND SUPERVISION OF FOOD Milk Supply Premises on the Register at the end of the year:- Dairies 148 Itinerant purveyors 67 Sealed conrainers only 218 The Inspectors made 670 visits and, 291 formal samples were taken and submitted for analysis Milk (Special Designations) Regulations 1936 to 1942 The number of licences granted during 1943 were:- Licences Supplementary licences Tuberculin tested 17 7 Accredited 1 - Pasteurised 39 11 Meat and Other Foods ( i) Public Health (Meat) Regulations 1924 Periodical visits of inspection were made as follows:- Slaughter Houses - 8 Meat Depots - - 262 Butchers' Shops & Meat Stalls - 621 Prepared Meat premises - 331 (ii) Inspection of Other premises where Food is prepared or offered for Sale The Food Inspectors have continued to keep all such premises under regular and frequent observation, 755 inspections being made for this purpose. Adulterations &c. A total of 800 Samples (396 formal and 404 informal) were sent for analysis, of which l6 formal and 11 informal were found to be adulterated. Prosecutions in 8 cases were undertaken under the Food & Drugs Act 1938. page 14 TUBERCULOSIS Tuberculosis Dispensary Number of definite cases of tuberculosis on the Dispensary Registers at the end of the year:- Pulmonary Non-Pulraonary Totals Adults Children Adults Children Adults Children M F M F M F M F M F M F 384 227 29 16 36 29 28 18 420 256 57 34 Total attendances 3,695 Visits by Tuberculosis Visitors 2,896 X-ray Examinations 764 Sputum Examinations 552 A.P. Refills 1,881 Admissions to Institutions 303 NEW CASES DEATHS Pulmonary NonPulmonary Pulmonary NonPulmonary M F M F M F M F Primary Notifications 134 94 20 15 Death Reports 13 4 0 4 Transfers 18 7 4 1 Other sources 2 1 0 0 AGES 0 3 — — 1 2 1 — 1 1 5 2 2 2 2 — — — 5 8 9 10 4 — 1 — 1 15 32 39 6 5 2 6 — 1 25 31 29 3 4 17 5 — — 35 29 15 3 — 16 7 — — 45 20 8 — 1 13 7 — — 55 28 1 — — 15 2 2 — 65 and upwards 11 2 — 3 13 2 1 TOTALS - 167 105 24 20 80 31 2 4 Notification Register on 31st December 1943:- Pulmonary 834 Non-Fulmonary 148 Comparable figures for 1942 722 126 page 15 Maintenance Allowances These allowances were introduced in July 1943. The following table shows the number of Patients assessed and the type of allowance (if any) granted from July 1st to December 1943. Standard Allowance only Standard and Discretionary Standard and Special Standard and Discretionary and Special 1 Special Allowance only Discretionary and Special only i Discretionary only Refused Allowance X TOTAL 6l 7P - - 31 1 1 29 155 X Including 5 adjourned for more information The allowances have been found to induce male married patients to accept treatment when their wives are at work but not if the wives must stay at home to care for young children. They are also effective in preventing young unmarried patients from returning to work too soon after discharge from Sanatorium provided other members of the family are at work. In the majority of other cases the allowances have not had greater effect than previously existing assistance for tuberculosis patients. Tuberculosis Care Committee More detail of the work of this Committee, which is more than ever necessary under war conditions, is omitted owing to lack of space, except for the following items:- Income from Seal Sales and other sources - £202, 13, 11d; Expenditure on Clothing, Coal, Removals, Pocket money &c., for patients - £ll6, 8.l0d; Extra nourishment (provided by the Council) cost £421, l.11d, number of patients - 73. Dental treatment (provided by Council) cost £15.11, 6d, number of patients - 3. BACTERIOLOGICAL EXAMINATIONS Positive Negative Total For Diphtheria bacilli 24 735 759 Tubercle bacilli 10 127 137 Haemolytic streptococci 1 1 2 35 863 898