LA b/S STE 45 METROPOLITAN BOROUGH OF STEPNEY. ANNUAL REPORT (Abridged) FOR THE YEAR 1940. OF THE MEDICAL OFFICER OF HEALTH AND ADMINISTRATIVE TUBERCULOSIS OFFICER F.R. O'SHIEL, L.R.C.P.I., L.M., D.P.H. TOGETHER WITH A SUMMARY OF THE REPORT OF THE PUBLIC ANALYST. form 26/Ref . . Omgial on 438/10000. Metropolitan Borough of Stepney Medical officer of Health's Report 1940 Please note the following corretions. Page 1 of Preface Death rate should be 20.0 Notifications of Tuberculosis received Total=269. (instead of 409) Page 3 of Report notifications of Tuberculosis received Total=269(unstead of 409) Public Health Department, 43, White Horse Road, Stepney, E.l. To the Mayor, Aldermen and Councillors the Metropolitan Borough of Stepney. Your Worship, Ladies and Gentlemen, An abridged report in accordance with the Ministry's suggestion is herewith submitted to you for the year 1940. The Registrar General's estimate of the population of the Borough was 136,030 but the actual resident population was probably much lower especially during the latter half of the year. Because of war conditions the population fluctuated and no accurate comparisons can be made with the figures of former years. The birth rate rose to 15.1 from Last year's rate of 12.5 The death rate increased from 12.05 in 1939 to 20.5 in 1940. The increase in the death rate was mainly due to enemy action. The death rate of infants under 1 year of age was 43.1 per thousand live births-the lowest recorded in the Borough - and last year was 53.7. Maternal mortality also has decreased from 3.35 per thousand births in 1939 to 2,39 in 1940. The incidence of infectious disease during the year was remarkably and surprisingly low-a matter for satisfaction considering the very unfavourable living conditions prevailing during the period of air raids in the latter half of the yearonly 867 notifications were received in 1940 compared with 1643 in the previous year. Scarlet fever decreased from 413 to 135, Diphtheria from 204 to 166, Pneumonia from 219 to 142, and Whooping Cough from 546 to 44. The only increases of note were Measles from 50 to 209, Cerebro-spinal Fever from 9 to 50 and Enteric Fever from 3 to 8 compered with last year. There were no cases of Smallpox. The number of notifications of Tuberculosis received during the year was 409. All the peace time health services carried on throughout the year without diminution. Many new responsibilities were placed upon the Council in connection with Civil Defence, air raid shelters and evacuation which towards the end of the year increased in urgency, and much credit must be given to the staff of the Health Department for the willingness with which they shouldered their additional burdens. These duties included shelter visiting, inspection of war damaged properties, salvage of war damaged foodstuffs, supervision of Stretcher Party Depots and First Aid Posts, training and control of several hundred Civil Defence personnel and the clerical duties connected with their wages, stores and equipment. The urgent establishment of Medical Aid Posts in -2- shelters and supervision of their staff, control of emergency mortuaries, provision and supervision of motor transport for the Casualty Services, arrangements for meals, canteens, laundry, disinfection, medical inspection etc. Rotas of the staff also undertook night duty at the Civil Defence Report and Control Centre and many other incidental duties. I desire to express my thanks to the Chairman and members of all Committees associated with the work of this Department and my gratitude to the staff for the splendid work they have put in and the cordial assistance they have given me during a very trying and difficult year. I am, Your Worship, Ladies and Gentlemen, Your obedient servant. F.R.O'SHIEL Medical Officer of Health. METROPOLITAN BOROUGH OF STEPNEY. ANNUAL (ABRIDGED) REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1940. AREA OF BOROUGH (in acres) 1902.766 POPULATION (Registrar-General's ostimate) 136,030 LIVE BIRTHS Total. M F Legitimate 2040 1009 1031 Birth rate per 1000 of the Illegitimate 104 53 51 estimated resident population 2144 1082 1082 15.7 STILL BIRTHS. 97 61 36 Rate per 1000 total (Live and Total births. 2241 1123 1118 still) births 41.2 DEATHS. 2729 1532 1197 Death rate per 1000 of the estimated resident population 20.0 DEATHS FROM PUERPERAL CAUSES. Rate per 1000 total (live and Puerperal sepsis 2 still) births 0.95 Other puerperal causes 3 1.44 5 2.39 DEATH-RATE OF INFANTS UNDER ONE YEAR OF AGS:- All infants per 1000 live births43.1 Legitimate infants per 1000 legitimate live births 40.7 Illegitimate infants per 1000 illegitimate live births 86.5 Deaths from Cancer (all ages) 292 „ „ Measles „ „ NIL „ „ Whooping Cough fall ages)NIL „ „ Diarrhoea (under 2 years of ago) 10 RATES FOR ENGLAND. WALES AND LONDON COMPARED WITH RATES FOR THE BOROUGH OF STEPNEY. England & Wales. London. Stepney. Live Births. 14.6 13.7 15.7 Deaths. 14.3 17.8 20.0 Infant Mortality. 55.0 50.0 43.1 Puerperal Causes. 2.16 (not available). 2.39 NURSING IN THE HOME. This work was continued during the year and the total number of visits was 332, being to 16 cases of measles. LABORATORY FACILITIES. Total number of Bacteriological Examinations amounted to 665 for Diphtheria Bacilli, (of these 66 were found to be positive) and 2 for Typhoid Bacilli, (neither of those was found to bo positive). TUBERCULOSIS DISPENSARIES. Number of attendances at the Dispensary. 4028 „ „ consultations with medical practitioners- Personal 284 Other 561 „ „ visits by Tuberculosis Officers to homos. 446 „ „ specimens of sputum examined 696 (of these 105 wore positive) „ „ X-ray examinations made 714 „ „ children boarded out 14 „ „ visits by Tuberculosis Health Visitors to homos. 5471 Special treatment was given to Tuberculous patients as follows:- Pheumo-thorax refills to 73 patients necessitating 663 attendances Finsen light to 3 patients necessitating 14 „ Gold injections to 1 patient necessitating 3 „ 2. Extra nourishment to Tuberculous patients. 419 Grants were made to 126 patients during the year. DENTAL CLINICS. (a) Tuberculosis: Total attendances 117 Total number of now patients 15 (b) Maternity: Total attendances 520 Total number of now patients 89 MATERNITY AND CHILD WELFARE AND HEALTH VISITING. (a) Number of Health Visitors employed: Municipal 10 Voluntary 13 Total: 23 (b) number of all health visitors visits to expectant mothers, First visits 890. Total 1705. (c) number of all health visitors visits to children under 1 year, First Visits 2520. Total 13402. (d) number of all health visitors visits to children between 1 and 5 years. Total 29337. (e) number of Infant Welfare Centres. Municipal 6 Voluntary 9 (on 31st December 6 and 6 respectively). (f) number of children at first attendance under 1 year old, 1642, between 1 and 5 years. 448. (g) number of attenders under 1 year old at end of year 1397, over 1 year old 3299. (h) number of Municipal Health Visitors. 10. (i) total number of visits made by Municipal Health Visitors during the year for all purposes, 20,105. ANTE & POST NATAL CLINICS. (a) number of clinics:- Municipal 2 Voluntary 3. (b) total number of women who attended, 3279 (including 296 Post Natal). Note: These figures include women who are not Stepney residents. SUPPLY OF MILE. Total quantity of milk supplied during the year to expectant and nursing mothers and young children was as follows:- Liquid. Dried. (a) By Council 14,311¾-gallons. 5,467 packets. x (b) Under National Milk Scheme. 64,212 „ 649 „ x The National Milk Scheme came into operation in July 1940 and took the place of the Council1s scheme. HOME HELPS were supplied in 61 cases. CHILD LIFE PROTECTION:- Number of persons who were receiving children for reward at the end of the year 1 Number of children so received 1 Number of child Protection Visitors, Health Visitors 10 " " " " " others 1 Visits made by above to Homes of Foster Mother 59 " " " " " " " Children 67 Other visits made by above in connection with Child Protection 105 Proceedings taken during the year under part XIII of the Public Health (London) Act, 1936 Sect. 259 (a) 1 SANITARY CIRCUMSTANCES OF AREA:- The following is a summary of the inspections carried out ty the 16 District Sanitary Inspectors:- 3. To houses and other promises (Complaints, Nuisances, Infectious Diseases, Restaurants, Lodging Houses, etc) 9,794 Miscellaneous Inspections 935 To Factories and other promises under Factories Act 1,336 Number of re-visits 9,430 „ „ Intimations served 4,473 „ „ Statutory Notices 950 „ „ Summonses taken out 10 „ „ Visits to Air Raid Shelters 590 „ „ Visits to Rest and Feeding Centres 37 HOUSING. The Sanitary Inspectors made £7,816 visits to houses damaged as a result of enemy action between September and the end of the year, and undertook the inspection of such houses to ascertain their habitability prior to the execution of first aid repairs or rehousing. INSPECTION AND SUPERVISION OF FOOD. Total number of inspections and re-inspections made by the four Inspectors engaged in the supervision and inspection of food amounted to 9,429. In addition 36 week-end inspections were made by the District Sanitary Inspectors of the market places of the Borough. Legal Proceedings were taken out in 15 instances. The quantity of foodstuffs destroyed during the year amounted to 379 tons under the Public Health Imported Food Regulations, and 607 tons under the Public Health (London) Act, 1936. (see also the Analyst's report NOTIFICATION OF INFECTIOUS DISEASES. (Other than Tuberculosis)867 notifications were received during the year, particulars of which are given as follows:- Scarlet Fever 135, Diphtheria 166, Enteric Fever 8, Measles 209, Puerperal Fever 6, Puerperal Pyrexia 17, Erysipelas 66, Cerebro-spinal Fever 50, Ophthalmia Neonatorum 6, Food Poisoning 8, Membranous Croup 1, Dysentory 7, Malaria 2, Pneumonia 142 and Whooping Cough 44. Total 867. NOTIFICATIONS OF TUBERCULOSIS. Pulmonary 236, Non-Pulmonary 33. Total 409. DIPHTHERIA IMMUNISATION:- Total attendances at clinics 714, number of inoculations given 439, number of Immunisation Certificates given 89, number still in course of treatment at and of year and not yet completed 182. BUG ERADICATION:- Before being housed in Council flats 126 families had their furniture and effects treated in the Council's Hydrogen Cyanide Chamber to prevent bug infestation. The furniture and effects of 2 families were similarly dealt with prior to their removal to flats owned by the Stepney Housing Trust. 2,346 inspections and re-inspections were carried out by the Inspectors on bug eradication. 181 promises and 234 rooms were fumigated and 417 promises and 874 rooms were sprayed during the year. 23 premises were inspected and disinfected prior to removal to London County Council flats. CLEANSING AND DISINFECTION:- 116 adults were cleansed during the year because of vermin. 1,159 rooms wore fumigated because of infectious disease and 503 becuase of pulmonary tuberculosis. 36,839 second-hand articles of clothing were disinfected prior to 4. export. The total number of articles disinfected by steam for all purposes was 88,679. SMALLPOX A UP VACCINATION: No cases of smallpox were notified. There were 2,466 births registered during 1939, of those 1,402 were successfully vaccinated. 1,631 Statutory declarations were received. F.R. O'SHIEL. Medical Officer of Health. S.D.25 METROPOLITAN BOROUGH OF STEPNEY. CAUSES OF ALL DEATHS DURING THE YEAR 1940. Total Deaths 2729, Mortality Rate 20.0 CAUSES OF DEATH I Totals. Under 1 year 1-5 5-15 l5-45 45-65 65 OVER. M. F. 1. Typhoid and paratyphoid - - - — - - - - 2. Cerebro-spinal Fever 2 3 - - — 3 2 - 3. Scarlet Fever. - - - - — - - - 4. Whooping Cough. - - - - - - - - 5. Diphtheria. 4 2 - 2 4 - - - 6. Tuberculosis of respiratory system. 91 39 - 1 2 65 51 11 7. Other forms of Tuberculosis 6 11 1 3 1 9 2 1 8. Syphilitic disease. 20 7 1 - - 3 12 11 9. Influenza 12 7 1 - - 3 9 6 10. Measles - - - - - - - - 11. Acute poliomyelitis and polioencephelitis. — — - - — — 12. Acute infectious encephelitis 2 - - - - 2 - - 13. Cancer of buccal cavity and oesophagus. 15 - - - - - 5 - Cancer of uterus - 15 - - 3 8 4 14. Cancer of stomach and duodenum 42 22 - - - 1 20 33 15. Cancer of breast 1 25 - - - 3 14 9 16. Cancer of all other sites 109 63 1 - - 16 72 83 17. Diabetes 9 17 - — - 2 8 16 18. Intra-cranial vascular lesions. 56 80 - - - 2 43 91 19. Heart disease 392 293 - 1 2 36 136 510 20. Other diseases of the circulatory system. 48 53 - - - 1 23 77 21. Bronchitis 148 92 4 - - 6 57 173 22. Pneumonia 87 80 15 8 - 8 40 96 23. Other respiratory diseases 22 12 — 1 - 3 13 17 24. Ulcerntion of the stomach or duodenum 20 11 - - - 3 12 16 25. Diarrhoea (under 2 yrs.) 7 3 8 2 - - - - 26. Appendicitis 4 3 - 1 3 2 1 27. Other digestive diseases. 23 29 - - - 9 21 22 28. Nephritis 22 26 - - - 10 17 21 29. Puerperal and postabortive sepsis. - 2 - - - 2 - - 30. Other maternal causes - 3 - - - 3 - - 31. Premature birth. 18 7 25 - - - - - 32. Congenital malformations birth injury, infantile disease. 15 9 20 1 1 1 1 - 33. Suicide 11 10 - - - 8 10 3 34 Road Traffic accidents 20 12 -_ - 4 7 10 10 35. Other violent causes 216 217 4 11 22 174 126 96 36. All other causes 110 44 7 - 3 19 44 79 TOTALS 1532 1197 86 35 39 405 768 1396 ? METROPOLITAN BOROUGH OF STEPNEY. P.K.C. 21.4.42. Summary of Borough Analyst's Annual Report for the year 1940. During the year, 1,381 samples were submitted to me for examination. Of these 1,313 consisted of Foods and Drugs and the remaining 68 samples were submitted by the various Borough Departments and private purchasers. Of the 1,313 samples of Foods and Drugs, 556 samples were taken formally and 38 samples or 6.8% were adulterated. Of 757 samples taken informally 56 samples or 7.4% were adulterated, making a total of 1,313 samples, of which 94 samples or 7.2% were adulterated. Of the above 1,313 samples, 1,202 consisted of foods of which 84 or 7.O% were adulterated. 10 of these samples contained permitted preservative and one sample contained preservative without declaration. Of the remaining 111 samples consisting of drugs, 10 or 9.0% were adulterated. Legal Proceedings. Offences were committed in 94 cases. These were dealt with as shown below:- Adulterated. Formal Proceedings. 23 Caution. 12 No action. 1 Informal 58 94 Fines and costs totalled £101.10.0d. ADULTERATED SAMPLES. Nature. No.examined. Formal. Informal. Prosecutions. Fines. Costs. Foods. Buttered Rolls. 198 14 31 13 £26.0.0. £25.4.0. Butter. 6 - 1 - --- --- Milk. 683 14 7 6 £2.0.0. £16.16.0. Ground Ginger. 6 1 2 - --- --- Cream Cheese. 16 4 5 4 £21.0.0. £10.10.0. Cooking fat. 2 - 1 - --- --- Lard. 6 1 1 - --- --- Vinegar. 4 - 1 - --- --- Sausage. 7 — 1 - --- --- Drugs. Ammoniated Quinine Tablets. 1 1 - - --- --- Tincture of Iodine. 13 1 3 - --- --- Saccharin Tablets. 6 - 1 _ --- --- Tartaric Acid. 3 - 1 - --- --- Zinc Ointment. 12 - 1 - --- --- Olive Oil. - - 2 - --- --- 36 58 23 £49.0.0. £52.10.0. -2- The composition of 683 milk samples including 21 adulterated samples was: Fat, 3.48%, and solids-not-fat 8.63%. 18 samples examined for the Borough of Finsbury are not included. 14 samples of milk taken from hospitals etc. averaged:Fat 3.635%, and solids-not-fat 8.71%. 5 samples of milk taken from schools averaged:Fat 3.85 and solids-not-fat 8.61%. Poor quality samples. 75 samples including 56 samples of milk were reported as of inferior grade or doubtful quality. Miscellaneous Samples. 68 miscellaneous samples were submitted for analysis. Of these samples 54 consisted of foods and of these 26 or 48.2% were unsatisfactory. D. HENVILLE. Borough Analyst.