ste 47 library METROPOLITAN BOROUGH OF STEPNEY. annual report (Abridged) FOR THE YEAR 1942 MEDICAL OFFICER OF HEALTH 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. Public Health Department, Queen Mary College, Mile End Road, London, E.1. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Stepney. Your Worship, Ladies & Gentlemen, I beg to present my report for the year 1942. it is again an abridged report in accordance with the direction of the Ministry of Health (Circular 2773). The Registrar General's estimate of the population of the Borough is not recorded. Because of war conditions it fluctuated and no accurate comparisons can be made with the figures of former years. The birth rate was 17.6 per 1,000. The death rate decreased in 1942. The death rate of infants under 1 year of age was 52.0 per thousand live births. Maternal mortality was 3.74 per thousand births. Infectious disease during the year was again low as compared with previous years. 780 notifications were received in 1942 compared with 1027 in the previous year. The notable increases and decreases compared with last year were as follows:Increases:- Scarlet Fever from 66 to 130, Puerperal Pyrexia from 4 to 9, Dysentery from 3 to 7, Food Poisoning from 3 to 6. Decreases:- Diphtheria from 120 to 47, Erysipilas from 66 to 59, Cerebro Spinal Fever from 52 to 13, Measles from 3Q2 to 250, Pneumonia 108 to 93, Whooping Cough from 214 to 158. There were no cases of Smallpox. The number of cases of Tuberculosis notified during the year was 206. All the peace-time health services carried on throughout the year. The diphtheria immunisation clinic at 35, Stepney Green continued. The attendances have increased considerably namely from 1895 in 1941 to 3775 this year. Four underground bakehouses, closed for a period of 12 months, were removed from the register leaving only 26 out of the original 69 certificated in the year 1904. The Sanitary Inspectors and certain other members of the Public Health Department still assist in manning the rota for the Casualty Services at the Civil Defence Control Centre, after office hours. This year we were fortunate in that no heavy demands were made upon the Civil Defence services nor the public air raid shelters. It was found possible to close down all the medical aid posts and points in the shelters in June except 5 of the larger ones, and in these the services of the paid staff were dispensed with and only voluntary staff retained. The arrangements for the routine visiting of public' air raid shelters by doctors were also terminated in May. In substitution, doctors are now only called to the shelters for urgent individual cases and paid per case in accordance with the Ministry's scale. In conclusion I should like once more to acknowledge the work of the staff of the Department who, although depleted, have carried on in the face of difficulties, and to accord my thanks to the Chairmen of the Committees associated with the work of this Department for their help and co-operation. I am, Your Worship, Ladies and Gentlemen, Your obedient servant, F.R. O'SHIEL. Medical Officer of Health. METRO POLITAN BOROUGH OF STEPNEY. ANNUAL (Abriged)REPORT OF OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1942 AREA OF BOROUGH (In acres) 1902. 766 POPULATION: Registrar-General's estimate for the mid-year 1942, is not available for publication, LIVE' BIRTHS. Legitimate and illegitimate. Rate per 1000 of the estimated resident. population 17.6 STILL BIRTHS. Rate per 1000 total (live and Still) births 50.2 DEATHS. M.728 F.515 Total 1243 PUERPERAL DEATHS. deaths Rate per 1000 total (live and still births) Puerperal sepsis 1 0.7 Other-puerperl causes 4 5 3.04 3.74 DEATH -RATE OF INFANTS UNDER ONE-YEAR OF AGE:- All infants per 1000 live, birth 52.0 Legitimate infants per 1000 legitimate live births 48.0 Illegitimate infants per 1000 illegitimate live births 105.8 Deaths from Cancer (all ages) 171 " " Measles - " " whooping Cough (all ages) 7 " " Diarrhoea (under 2 years of age) 9 RATES, FOR ENGLAND, WALES AND LONDON COMPARED WITH RATES FOR THE BOROUGH OF STEPNEY. England 86 Wales. London. Stepney. Live births. 15.8 14.0 17.6 Deaths. 11.6 13.9 - Infant Mortality 49.0 60.0 52.0 Puerperal causes 2.0 (not available)3.74 NURSING IN THE HOME. Facilities were provided as usual LABORATORY FACILITIES Total number of Bacteriological Examinations.was 404,401 for Diphtheria Bacilli these 11 were found to be positive and 3 for Typhoid, all of which were negative. TUBERCULOSIS DISPENSARIES Number of attendance as the Dispensary 4003 „ „ consultations with medical practitioners Personal 210 other 544 „ „ visits by Tuberculosis Officers to homes 392 „ „ specimens of Sputum examined (81 positive) 485 „ „ x-ray examinations 114 „ „ children-boarded out 11 " visits by Tuberculosis Visitors to homes 5238 Special treatment was given to Tuberculous patients as follows: Pneumo-thorax refills to 46 patients necessitating. attendances 439 Finsen light to 2 patients necessitating attendances 20 Number of patients. recommended for Sanaterium treatment 275 „ „ contacts examined 529 Extra nourishment to tuberculous patients 542 grants were made to 129 patients during the year each grant was for a period of 28 days. DENTAL. CLINIC. (a) Tuberculosis: Total attendances. 78 number of new patients 8 (b) Maternity & Child welfare Total attendances 345 number of now patients 97 maternity and child welfare and health visitor (a) Number of Health Visitors employed: - Municipal 9 Voluntary 9 18 (b) Number of all Health Visitors' visits to children mothers, first visits 1105 Total 2410 (c) Number of all Health Visitors' visits to children under 1 year, first visits 1166 Total 10696 (d) Number of all Health Visitors visits to children between 1 and 5 years Total 21964 (e) Number of Infant Welfare Centres on 31 December Municipal 6 Voluntary 5. 3. To factories, workshops and outworkers premises 2030 Number of revisits 6662 „ „ intimations served 2849 „ „ statutory notices 551 „ „ summonses taken out 2. „ „ visits to air raid shelters 809 „ „ visits to Rest and Feeding Centres nil. „ „ visits to canteens 28 A Summary of sanitary work carried out as a result of notices served is as follows:- Repairs to roofs, gutters and rain water pipes 1053 Cleansing or repairs to drains. Water Closets, Sinks, Baths and lavatory wastes 2318 Miscellaneous repairs 1892 Dampness in premises, remedied and rooms cleansed 2331 Drains tested 59, of which 20 were defective HOUSING. Number of houses inspected for housing defects to 11539 „ „ inspections made for such purposes 12756 „ „ houses not reasonably fit 2702 „ „ houses rendered fit informally 2408 „ „ houses in respect of Which notices were served 1765 „ „ houses in which defects were remedied after service of formal notice 551 OVERCROWDING. Houses in which the rooms were measured and the permitted number ascertained 32 Number of visits to the above 33 „ „ houses in which the information has been supplied to owners and occupiers 30 AGED AND INFIRM PERSONS. Six infirm persons were removed to institutions during the year under sec. 224 of the Public Health (London) Act, 1936. INSPECTION AND SUPERVISITON OF FOOD. Total number of inspections and re-inspections made by the four Inspectors engaged in the supervision and inspection of food amount to 8202. Legal Proceedings were taken cut in 31 instances. The quantity of foodstuffs destroyed during the year amounted to 461 tons of foodstuffs destroyed during the year amounted to 461 tons under the Public. Health (Imported Food) Regulations and 53 tens under the Public Health (London) Act, 1936 (see also Analyst's Report). 1422 samples of food and drugs and 44 other samples were taken and submitted for analysis. Assistance was also rendered by those Inspectors to the Food Control Committee on Food Salvage, new registrations etc. OFFENSIVE BUSINESSES. 14 Poultry Slaughter houses and 1 fur skin dresser were removed from the register not having been in use for 9 months or more. NOTIFICATION OF INFECTIOUS DISEASES. (Other than Tuberculosis) 781. notifications were received during the year, particulars of Which are given as follows:- Scarlet Fever 130, Diphtheria 47, Enteric Fever 1, Measles.250, Puerperal Fever 3, Puerperal Pyrexia 9, Erysipelas 59, Cerebro-spinal Fever 13, Opthalmia Neonatorum 3, Food Poisoning 6, Dysentery 7, Pneumonia 93, Whooping Cough 158 and Malaria 1. No notifications were received with respect to Anthrax, Encephalitis Lethargica, Poliomelitis, polio-encephalitis, Membranous Croup or Smallpox. DEATHS FROM INFECTIOUS DISEASES. Compared with last year deaths from Cerebro Spinal Fever were reduced from 8 to nil, measles from 7 to nil, Scarlet Fever nil Influenza from 16 to 8, Pneumonia from 129 to 82 (see page 6) DIPHTHERIA IMMUNISATION. Two Diphtheria Immunisation publicity campaigns were organised commencing in September, 1941 and continuing into 1943. and all local papers in accordance with the suggestions of the Ministry of Health in Circular 2627 displayed a series of illustrated advertisements, which Were supplied through the Central Council for Health Education. (f) Number of children at first attendance under 1 year old 1379 between 1 5 years 494 (g) Number of attenders under 1 year old at end of year 1167, over 1 year old 2074. (h) Total number of visits made during the year for all purposes by Health Visitors:- (a) Municipal 15968 (b) Voluntary 30783 ANTE & POST NATAL CLINICS. (a) Number of clinics:- Municipal 2, Voluntary 3. (b) Total number of women who attended. 1712 TODDLERS CLINIC. In accordance with Ministry of Health Circular 1550 27th Oct. 1936 two clinics started in 1937 but owing to small demand and poor attendances clinics are only being held when required at Spitalfields and St. Georges Centres. WAR-TIME DAY NURSERIES. Three,war-time Day Nurseries for the children of paid working mothers were opened in the Borough in 1942. Acting on the Ministry of Health's Circular 2388 of 31st May, 1941. Shadwell War-time Day Nursery at the Queen Elizabeth Hospital, Glamis Road, E.l. opened on 16th June with accommodation for 20 children under the age of two including 6 infants under two years, and 30 children between two and five years of age. Old Church Road War-time Day Nursery (in the premises which before the war was an L.C.C. Nursery School) opened on the 15th July with accommodation for 20 children under two years including 10 infants and 40 children between 2 and 5 years of age., Vallance Road School War-time Day Nursery in the premises of the Robert Montifiore L.C.C. School (which were until recently used as a Civil Defence First Aid Post) opened on 21st October with accommodation for 20 children under the age of 2 including 10 infants, and 40 children between 2 and 5 years of age. Each nursery is permitted to have a staff of twelve apart from domestic staff - viz. a matron (S.R.N.) a deputy matron 2 nursery trained nurses, 1 nursery teacher (warden) 4 untrained nursery assistants and 3 probationers. In addition there is one fully trained nursery school teacher who acts as superintendent teacher to the 3 day nurseries. All the nurseries have been affiliated to the National Society of Childrens Nurseries and are training schools for probationers. The children are looked after and fed from 7 a.m. to 7 p.m. and the other children receive nursery school training. The parents are charged 1/- per day. The working mothers were slow to take advantage of the nurseries, preferring to leave their children with relatives, but at the time of writing this report all the nurseries are full to capacity. SUPPLY OF MILK. The National Milk Scheme came into operation in July 19 40. Free. Cheap rate Number of beneficiaries 1942:- Liquid Milk 1485 3086 Dried „ 94 169 In addition the Council continue their scheme in supplying virol and oil and malt to mothers and children attending the centres. Fruit Juice and Cod Liver Oil under the Government Scheme are distributed at all Infant Welfare Centres. CHILD LIFE PROTECTION:- Number of persons who were receiving children for reward at the end of the year 2 Number of children so received 3 „ „ Child Protection Visitors, Health Visitors 9 „ „ „ „ „ Others 1 Visits made by above to Homes of Foster Mothers 21 „ „ „ „ „ Children 32 Proceedings taken during the year under part XIII of the Public Health (London) Act, 1936 Sect. 239 (a) nil. SANITARY CIRCUMSTANCES OF AREA:- The following is a summary of the inspections carried out by the nine District Sanitary Inspectors:To houses and other premises (Complaints, Nuisances, Infectious Diseases, Restaurants, Lodging Houses etc.) 7517 Miscellaneous Inspections 9955 4. The some papers also published leading articles and quotations from interviews with the Mayor. and prominent members and officers of the Council, supporting diphtheria immunisation. The Health Visitors in accordance with the Ministry's suggestion in Circular 2713 were temporarily relieved of certain duties in order to make special visits to the parents of un-immunised children. Many informative leaflets were distributed and posters displayed throughout the Borough. The result of the campaign was shown by the large increase in attendances at the diptheria immunisation clinic. Approximately 3775 attended compared with 1895 last year. 422 certificates were issued compared with 292 last year. In addition to the work done at the Borough council's clinic the L.C.C. commenced in August to immunise school children at the schools. Schools were visited by the L.C.C, school doctors for this purpose, 148 under 5 and 1062 over 5 were immunised up to December 1942 A complete list of all children in the Borough under the age of 5 years was obtained and the Health Visitors. continue to make reminder visits to those families who have not yet accepted immunisation for their children, Unfortunately there are still many children un-immunised. To wipe out diphtheritic infection it is necessary that 80% of the child population should be immunised, and moreover that this percentage should be maintained. In this country it is unlikely that the standard will be reached without compulsion. Meantime the protection of the individual child is valuable. TYPHUS FEVER ARRANGEMENTS. I common with other London Boroughs arrangements have been made to disinfest the premises and effects of typhus patients and to delouse typhus contacts. All the Sanitary Inspectors and Health Visitors and disinfectors attended special lectures of the subject. Special typhus overalls have been obtained for the use of the officers and staff engaged in this work TUBERCULOSIS NOTIFICATIONS: 206 cases of tuberculosis were notified - 180 Pulmonary and 26 non-pulmonary. TUBERCULOSIS DEATHS. There were 85 deaths: 78 being respiratory compared with 128 last year and 7 other forms compared with 17 last year. OTHER DEATHS. There were 171 deaths from Cancer compared with 203 last year, 12 road traffic accidents compared with 19 last year and 43 from other violent causes compared with 316 last year (see page 6). BUG ERADICATION: 1832 Inspections and re-inspections of premises were carried out the Inspectors on bug eradication. 399 premises, 861 rooms and 144 shelters were sprayed during the year. 12 lots of furniture were treated with Hydrogen Cyanide prior to the removal of families to other premises and 38 lots of bunks from shelters were similarly treated. 76 loads of straw were fumigated as a precaution against foot and mouth disease as required by the Ministry of Agriculture on behalf of colonial and foreign countries. CLEANSING AND DISINFECTION. 487 rooms were disinfected because of infectious disease and 101 because of pulmonary tuberculosis. 78890 articles of clothing and bedding were steam disinfected. SMALLPOX AND VACCINATION. No cases of smallpox were notified. There were 288 births registered during 1942, of these 77 were successfully vaccinated, 90 Statutory declarations wore received. In addition, 155 children who were registered outside the Borough were successfully vaccinated. The total number of children vaccinated was 232. SCABIES. During the year the existing facilities for the treatment of scabies were increased by the addition of two extra baths at Branch Road Treatment Centre. 5 The present facilities for the diagnosis and treatment of scabies in the Borough are as follows:- Branch Road. 1 M and 2 F attendants Daily sessions a.m. and 2 M and 2 F baths p.m. Doctor attends twice weekly. The London Hospital (on behalf of the Borough Council) 1 M and 1 F attendant Daily sessions a.m. 1 M and 1 F bath and p.m. Benzol Benzoate is used in most cases and otherwise Kathiolanointment. New undiagnosed patients attend the London Hospital skin clinic on Wednesday afternoons. It is hoped to establish a special scabies diagnostic clinic next year in order to facilitate the procedure of the scabies order 1941. 8 Notices (Scabies Order 1941) served for Inspection of Premises. - „ „ „ „ Medical Examination - „ „ „ „ „ Treatment. in the vast majority of eases it is found unnecessary to serve any Statutory Notices. Patients and their contacts are only too pleased to attend and are grateful for the relief they receive in the rapid alleviation and cure of their troublesome symptoms. It has not so far been found necessary to take proceedings as reluctant cases usually attend after the receipt of the first or second notice. The Health Visitors ordinarily do all visiting for scabies and following up of contacts and serve the above notices. In difficult cases and special cases the visits are made and notices served by the Sanitary Inspectors or both officers may visit together. CAUSES OF ALL DEATHS DURING THE YEAR 1942. Male 728. Female 515 Total 1243. CAUSES OF DEATHS TOTAL i Under 1 year 1-5 5-15 15-45 45-64 65 etc. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Typhoid - - - - - - - - - - - - - - Cerebro-spinal fever - - - - - - - - - - - - - - Scarlet Fever - - - - - - - - - - - - - - Whooping cough 3 4 1 - 2 3 - 1 - - - - - - Diphtheria 2 — - - 1 — 1 - - - - - - Tub. of resp. systern 65 13 - - - - 1 - 32 10 26 2 6 1 Other forms of tuberculosis 3 4 - 1 - - - - 2 1 1 2 — - Syphilitic diseases 15 5 - 2 - - - - 2 - 11 2 2 1 Influenza 5 3 1 - - - - - 1 - 1 - 2 3 Measles - - - - - - - - - - - - - - Ac. polio-ravel. & polio-enceph. - - - - - - - - - - - - - - Ac. inf. enceph. - - - - - - - - - - - - - - Career of buc. cav.& Oesoph 9 - - - - - - - 1 - 2 - 6 - of uterus - 9 - - - - - - - - - 7 - 2 of stomach & dueodenum 24 13 - - - - - - - - 9 5 15 8 of breast - 12 - - - - - - - 3 - 6 - 3 of all other sites 66 38 - - - 1 - - 4 2 29 13 33 22 Diabetes Intra-cranial Vasculer 5 12 - - - - - - 1 - - 2 4 10 lesions. 45 49 - - - - - - 1 1 9 17 35 31 Heart disease 182 116 - - - - - - 1.0 10 45 18 127 88 Other diseases of Tchp cire. system. 26 32 - - - - - - - 2 5 8 21 22 Bronchitis 54 29 - 2 - - - - 1 - 15 3 38 24 Pneumonia 45 37 4 5 - - - - 4 3 14 9 23 20 Oter res. diseases 13 4 - - - - - - - - 6 - 7 4 Under of stomach & duodenum 13 2 - - - - - - 1 - 6 1 66 11 Diarrhoea under 2 yrs. 6 3 6 3 - - - - - - - -— - - Appendicitis 2 4 - - - - - 3 - - 1 1 1 - Other digestive dis. 8 18 2 1 - - - - - 4 4 3 2 10 Nephritis 27 17 - - - - - - 1 5 11 3 15 9 Puerperal & post-abort - 1 - - - - - - - 1 - - - - sepsis - 1 - - - - - - - 1 - - - - Other maternal causes 2 4 - - - - - - - 4 - - - - Premature birth 12 10 12 10 - - - - - —- - - - - Congenital mal. birth injury, inf. disease 11 5 8 2 - 1 - - 3 1 - 1 - - Suicide 4 99 - - - - - - 1 4 2 4 1 1 Road Traffic acciderts 7 5 - - 1 - 2 1 - 1 1 2 3 1 Other violent causes 20 23 - 2 1 1 1 - 6 1 4 5 8 14 All other causes. 56 34 2 2 1 1 3 - 10 5 22 12 18 14 7 19th. Annual Report. Summary of the Borough Analyst's Quartly Report for the year 1942. 1513 samples were submitted for analysis. Of these 1455 samples consisted Of foods and drugs. The remaining 58 samples were received from Borough Departments and private purchases. Out of 682 formal samples 50 or 7.3 per cent. were adulerated and out of 773 informal samples 83 or 10.7 per cent. were adulerated making a total of 1455 samples out of which 133 or 9.1 per cent. were adulerated. Of the samples taken under the Food and Drugs Act 1129 consisted of foods and of these 91 or 8.1 per cent. were adulerated (9 samples contained an allowed amount of preservative). Of 326 drugs 42 or 12.9 per cent. were adulerated. Milk. 580 samples of milk were examined. The average composition, including 12 adulerated samples was:- Fat 3,58 percent., and solids-not-fat 8.65 per cent. Adulerated Samples (including other offences). Nature. Samples taken Adulerated etc. Prosecutions. Cautions No action Food Control Informal Formal Foods. ButteredRolls. Egg substitute 76 43 11 8 3 - - Powder. 12 3 3 3 - - - Butter. 34 - 2 2 - - - Meat Roll. 2 2 - - - - 2 Spirits. 5 - 1 1 - - - Milk. 580 1 11 5 6 - - Sausage. 25 1 - - - - - Chicken Meal. l 1 - - - - 1 Dried eggs. 3 - 2 - - - 2 Ice Cream. 15 3 3 - - - 3 Vermicelli. 2 - 1 - - - 1 Rice. 10 1 - - - - - Baking Powder. 21 2 - - - - - Drugs. Saccharin Tablets 25 12 5 1 2 - 2 Ammoniated Tino- ture of Quinine. 9 1 1 - 1 - - Paregoric Tablets 3 2 1 - 1 - - Zine Ointment. 23 2 2 - 1 1 - Grey Powder. 2 1 1 - 1 - - Talcum Powder. 5 1 2 - - 2 - Talc & Boric. 2 1 1 - - 1 - Magnesia. 4 2 2 2 - - - Calomel Ointment 1 1 - - - - - Sal Volatile. 7 1 - - - - - Anti-Gas Ointment 22 1 - - - - - Tincture of Iodine. 20 1 1 - - - - ø Reportedto the Factory. ҝ Letter sent by the Medical Officer of Health. Poor Quality Samples. 54 Samples, including 43 samples of milk were reported as of inferior grade or doubtul quality. Miscellaneous Samples. 58 samples were submitted for analysis. Of these 41 were foods of which 8 or 19.5 per cent. were unsatisfactory. D. Henville. Borough Analyst.