STE 48 METROPOLITAN BOROUGH OF STPNEY. ANNUAL REP0RT (Abridged) FOR THE YEAR 1943 OF THE MEDICAL OFFICER OF HEALTH AND ADMINISTRATIVE TUBERCULOSIS OFFICER FR0'SHIEL, L.R. C.P,I., L.M., D.P.H. TOGETHER WITH A SUMMARY OF THE REPORT OF THE PUBLIC ANALYST. P.l. Public Health Department, Queen Mary College, Mile End Road, London, E.l. To The Mayor, Aldermen and Councillors of the Metropolitan Borough of Stepney. Your Worship, Ladies & Gentlemen, I have pleasure in submitting herewith ray annual report for the year 1943, which, in accordance with the suggestions of the Ministry of Health, is an abridged report. Certain statistics relating to population are omitted for security reasons and the Registrar General's estimate of the population of the Borough is therefore not recorded. Because of war conditions no accurate comparisons can be made with the statistics of former years. The birth rate rose from 17.6 in 1942 to 18.8. The death rate was slightly higher than last year. The infantile mortality rate per 1000 live births was 53.2 compared with 52.0 last year. The maternal mortality rate decreased from 3.74 to 2.1 per thousand live and still births. One woman in the Borough died of senile myocarditis at the age of 100 years. Compared with last year there were 780 more rases of infectious disease notified, mainly Measles and Scarlet Fever. Notifications of Measles increased from 250 in 1942 to 918 this year. Scarlet Fever from 130 to 194, Pneumonia from 93 to 124, whilst Whooping Cough decreased from 158 to 142, Diphtheria from 47 to 45, Puerperal Fever and Pyrexia from 12 to 5. There was no Smallpox. There was one case of Anthrax (see page 5). 265 oases of Tuberculosis were notified during the year. One woman died from Actino-Mycosis. All health services were maintained throughout the year at almost peace-time standards. The number of children immunised against diphtheria decreased from 2964 to 2073 Scabies treatment was given to 2373 persons. The three war-time day nurseries maintained record attendances throughout-the year. Three basement bakehouses were removed from the register, having been out of action for over 12 months, leaving only 23 of the original 69 certificated in 1904. In addition to their normal duties several member of the Staff, including Sanitary Inspectors, continued to undertake Civil Defence duties at the Report and Control Centre after hours and at week-ends. Other duties include food salvage, food decontamination, gas identification officers and emergency mortuary supervision and inspection of shelters and rest and feeding centres. i should like to record my appreciation of the work of the staff of the Department and to the Chairmen of Committees who have given me their support and encouragement I offer my grateful thanks. i am, Your Worship, Ladies & Gentlemen, Your obedient servant, F.R. 0'SHIEL. Medical Officer of Health P.2. METROPOLITAN BOROUGH OF STEPNEY ANNUAL (Abridjed) REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1943. AREA OF BOROUGH (In acres)1903.766 POPULATION: Registrar-General's estimate for the raid-year 1943 is not available for publication. LIVE BIRTHS. Legitimate and illegitimate. Rate per 1000 of the estimated resident population 18.8 STILL BIRTHS. Rate per 1000 total (live and still) births 51.3 DEATHS. M 772, F 596. Total 1368. PUERPERAL DEATHS: Rate per 1000 total (live and still births). Puerperal sepsis 1) 0,7) Other puerperal causes 2) 3 1.4) 2.1 DEATH RATE OF INFANTS UNDER ONE YEAR OF AGE: All infants per 1000 live births 53.2 Legitimate infants per 1000 legitimate live births 53.4 Illegitimate infants per 1000 illegitimate live births 52.0 Deaths from Cancer (all ages) 188 " " Measles " " 5 " " Whooping Cough (all ages) 2 " ” Diarrhoea (under 2 years . . of age) 14 COMPARATIVE PATES FOR ENGLAND AND WALES, LONDON AND STEPNEY. England & Wales, London. Stepney. Live births 16.5 15.8 18.8 Deaths. 12.1 15.0 Infant Mortality 49.0 58.0 53.2 Puerperal Causes (death rate) 1.45 (not available) 2.1 NURSING IN THE HOLE. The Council's arrangements with the East London Nursing Society were continued for the nursing of cases of Measles, Pneumonia following Measles, Ophthalmia Neonatorum, Puerperal Fever, Puerperal Pyrexia and Pemphigus Neonatorum and also all complications and illnesses arising out of childbirth. P.3. LABORATORY FACILITIES. Total number of Bacteriological Examinations was 477, 470 for Diphtheria Bacilli, of these 8 were found to be positive and 7 for Dysentery, one of which was positive. TUBERCULOSIS DISPENSARIES. Number of attendances at the Dispensary. 4520 " " consultations with medical practitioners: personal: 221 other; 554 " " visits by Tuberculosis Officers to homes 349 " " specimens of sputum examined, 467 (92 positive) " " X-ray examinations (Films 1123, screening 394) 1517 " " children boarded out. 12 " " visits by Tuberculosis Visitors to homes 4839 Artificial Pneumo-thorax treatment given by Tuberculosis Officer to 35 patients, necessitating 417 refills. Artfioial Pneumo-thorax treatment was given by other hospitals to 10 patients necessitating 138 refills, was given Finsen light/to 2 patients necessitating 48 attendances. Number cf patients recommended for Sanatorium treatment 303 " " contacts examined 654 Extra nourishment to tuberculous patients, 303 grants were made to 126 patients during the year. Each grant was for a period of 28 days. A scheme,in accordance with the Ministry of Health Mem 266T for the provision of financial assistance by maintainance allowanoes for persons undergoing pulmonary tuberculosis treatment was started on the 30th June and during the year 100 patients have benefited by this financial aid. In connection with the nutrition campaign of the Ministry of Food, demonstrations were given in cookery to tuberculous patients at the Tuberculosis Dispensary. DENTAL CLINIC. (a) Tuberculosis: Total attendances 74 " number of new patients. 9 (b) Maternity & Child Welfare: Total attendances 662 " number of new patients 88 MATERNITY & CHILD WELFARE AND HEALTH VISITING. The number of Borough Council Infant Welfare Centres was increased during the year when the Borough Council took over on 1st January the 2 Jewish Voluntary Infant Welfare Centres at Berner Street, together with the 3 Health Visitors attached to them. (a) Number of Health Visitors employed: Municipal 11) ) 17 Voluntary 6) (b) Number of all Health Visitors' visits to expectant mothers, first visits. 1200 Total 2656 (c) Number of all Health Visitors' visits to children under 1 year, first visits 1289 Total 8913 (d) Number of all Health Visitors' visits to children between 1 and 5 years Total 80677 (e) Number of Infant Welfare Centres on 31st December Municipal 7, Voluntary 3, Total 10 (f) Number of children fit first attendance under 1 year old, 1322, between 1 and 5 years, 364 (g) Number of children attending under 1 year old at end of year 1070, over 1 year old 2227. Total 3297 P.4. (h) Total number of visits made during the year for all purposes by Health Visitors:- (a) Municipal 26847 (b) Voluntary 19657 post natal clinics. (a) Number of clinics:'- Municipal 2, Voluntary 3. (b) Total number of women who attended 1195. WAR TIME DAY NURSERIES. There are three War-Time Day Nurseries for the children of paid working mothers. 0-2 years 2-5 years accommodation. Shadwell. 16 (incl.6 infants) 34 50 Old Church Road. 30 ( " 10 " ) 30 60 Vallance Road. 30 ( " 10 ) 30 60 Attendances at all Nurseries have been well maintained and arrangements were made during the year for conveyance of Wapping children bo and from the Nurseries by motor ambulance. Two Hostels for Nursery Staff were opened, one at 35 Stepney Green on 3rd May and the other in Bethnal Green at the Queen;s Hospital, Hackney Rood on 30th August. Elizabeth SUPPLY OF MILK:- Milk Scheme came into operation in July 1940. Under the Scheme the Council distributed at the Infant Welfare Centres and elsewhere 18982 packets of dried milk, 8553 bottles of Cod Liver Oil and 74426 bottles of Vitamins and fruit juices, including A & D capsules. Actual "take-up" of vitamins:Cod Liver Oil - 12.4% of those eligible. Orange Juice- 43% of those elgible CHILD LIFE PROTECTION:- Number of persons who were receiving children for reward at the end of the year 2 Number of children so received 2 " Child Protection Visitors; Health Visitors 11 " " " " others 1 Visits made by above to Homes of Foster Mothers 12 " - " " " " " " Children. 10 Proceedings taken during the year under part XIII of the Public Health (London) Act; 1936, Section 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 (relating to Complaints, Nuisances, Infectious Diseases, Restaurants, Lodging Houses etc.) 6844 Miscellaneous Inspections 10789 To factories, workshops and outworkers premises 1867 Number of revisits 8655 Number of Intimations served 3148 " " Statutory Notioes 744 " Summonses taken out 5 " visits to air raid shelters 431 " " visits to Rest and Feeding Centres 14 " " visits to Canteens 279 A summary of sanitary work carried out as a result of notices served is as follows:- Repairs to roofs, gutters and rain water pipes 1556 Cleansing or repairs to drains, water-closets, sinks, baths end lavatory wastes 2456 Miscellaneous repairs. 2334 Damoness in premises remedied and room cleansed 3054 Drains tesnsn 621 ,of which 70 were defective. P.5. Rat Control Scheme. The Medical Officer of Health and all the Sanitary Inspectors attended the 2 day course of instruction in rat control at the Ministry of Food's Infestation Department. In response to a request from the Ministry of Food, an extensive scheme for the wholesale extermination of rats was conducted and large numbers of rats have been destroyed both in the Council's sewer's and special infested areas which were dealt with separately, in cooperation with the Borough Engineer. HOUSING. Number of houses inspected for housing defects 9839 " " inspections made for such purposes 11680 " " houses not reasonably fit 3111 " houses rendered fit informally 2372 " " houses in respect of which notices were served 739 " " houses in which defeats were remedied after service of formal notice 739 OVERCROWDING. Houses in which the rooms were measured and the permitted number ascertained 130 Number of visits to the above 169 " " houses in which the information has been supplied to owners and occupiers 138 AGED AND INFIRM PERSONS. Three infirm persons were removed to institutions during the year under Section 224 of the Public Health (London) Act 1936. 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 amount to 7698. Legal Proceedings were taken out in 30 instances. The quantity of foodstuffs destroyed during the year amounted to 75 tons under the Public Health (Imported Food) Regulations, find 90 tons under the Public Health (London) Act 1936 (see also Analyst's report). 1437 samples of food and drugs and 52 other samples were submitted for analysis. Assistance was also rendered by these Inspectors to the Food Control Committee on Food Salvage, new registrations etc. NOTIFICATION OF INFECTIOUS DISEASES. (Other than Tuberculosis) 1547 notifications were received during the year, particulars of which are given as follows:- Scarlet Fever 194, Diphtheria 45, Enteric Fever 1, Measles 918, Puerperal Fever 0, Puerperal Pyrexia 5, Erysipelas 49, Cerebro-Spinal Fever 13, Ophthalmia Neonatorum 3, Food Poisoning 5, Dysentery 40, Pneumonia 124, Whooping Cough 142 " Malaria 1. Anthrax 1, Encephalitis Lethargica 1, Poliomyelitis 5, Polio Encephalitis 1, Smallpox 0. DEATHS FROM INFECTIOUS DISEASES. Total 121 (last year 100), including 4 from Cerebro-spinal Fever, 5 from Measles, 0 from Scarlet Fever, 2 from Whooping Cough, 15 from Influenza, 92 from Pneumonia 2 from Diphtheria (see page8 ) ANTHRAX. 1 case of Anthrax oocurred. on the hand of a Council Dustman who had been collecting waste furs from factor.ies in the Borough. Fortunately he was at once sent to Hospital by the foreman who recognised the disease from coloured posters and sorum was early administered and a cure effected. Since then I have had illustrated warning posters exhibited in all the Council's Depots. DIPHTHERIA IMMUNISATION. The attendances at the Immunisation Clinic have incresead since last year, probably because in last year's drive most of the willing cases were immunised. . Arrangements have been made to P.6. extend immunisation facilities to the Council's Infant Welfare Centres during the coming year. In response to Circular 2838 of the Ministry of Health, a diphtheria immunisation campaign was conducted throughout the Borough. Posters were exhibited, advertisements were inserted in the nress and publicity Riven at the various cinemas in the Borough. B.C. L.C.C. Total Und 5 Ovr 5 Und 5 Ovr 5 Number of sessions held. 55 55 Number of Post Schick Testa. 956 110 - - 1066 Number of immunisation certificates given 862 99 - - 961 Number of attendances of children for Schick or immunisation 3628 280 - - 3908 Number of children who completed the full course of immunisation. 756 127 159 1031 2073 WHOOPING COUGH. In response to a demand from the mothers to have free facilities provided for the protection of their children against Whooping Cough, immunisation against Whooping Cough has been carried out since 12th November at the same premises as the Diphtheria Immunisation Clinic, viz., 35 Stepney Green, between the hourse of 2 p.m. and 4 p.m. every Friday. VENEREAL DISEASE. Propaganda against Venereal Disease was increased and conducted by lectures and films through the Central Council for Health Education. Posters were exhibited in the streets, in factories and in public lavatories. Small enamelled posters supplied by the L.C.C. were displayed in the lavatories of licenced premises throughout the Borough, with the helpful co-operation of the licenced traders. Local cinemas also showed short films, INSULIN. The Council made arrangements for the supply of insulin to certain classes of diabetic patients, limited chiefly to dependents of insured persons, widows and spinsters engaged in household duties, merchant seamen on foreign-going ships, and other patients of limited means who are not eligible through National Health Insurance, Poor Law; or School Medical Services. TUBERCULOSIS. 107 deaths, 97 being respiratory and 10 other forms. 265 notifications - 216 Pulmonary, 49 non-Pulmonary, BUG ERADICATION. 2465 inspections and re-inspections of premises were carried out by the Inspectors on bug eradication. 685 premises, 147 4 rooms and 35 shelters were sprayed during the year. 62 lots of furniture were treated with Hyrdrogen Cyanide prior to the removal of families to other premises and 5 lots of bunks from shelters were similarly treated. CLEANSING AnD DISINFECTION. 677 rooms were disinfected because of infectious disease and 89 because of pulmonary tuberculosis. 76948 articles of clothing and bedding were steam disinfected. SMALLPOX AND VACCINATION. No cases of smallpox were notified. 239 children were successfully vaccinated. 199 Statutory declarations were received. In addition, 450 children who were registered outside the Borough were successfully vaccinated. The total number of children vaccinated was 689. SCABIES. The County of London (Scabies) Regulations 1943 came into force on 1st August making Scabies a- notifiable disease. To further facilitate procedure under the Scabies Order 1941 P.7. a Diagnostic Clinic for Scabies was opened at the Council's Dispensary at Steel's Lane Devonport Street on 3rd March The Clinic is open every Wednesday afternoon and evening and two Doctors are in attendance. All patients and contacts served with Medical Examination Notices are here examined. The Council's Free Scabies Treatment Centres(opened in 1941) continue at Branch Road and the London Hospital and on 8th April. a late evening session for the treatment of workers was added at the London Hospital, on behalf of the Borough Council. All cases are followed up and visited by Health Visitors and Sanitary Inspectors. Leaflets have been widely distributed and efforts made to educate the public in the prevention of Scabies. On 13th October the Ministry of Health Film "Scabies Diagnosis Treatment" was shown by arrangement with the Central Council for Health Education to all the Medical Praotitioners in the Borough and many other interested persons. Scabies. no: of cases notified - Formally 641 No: of cases notified- Informally 1427 HEAD LICE. Ministry of Health Circular 2831. Special attention is being given to this matter by the Council's Health Visitors at the Infant Welfare Centres and when visiting the homes. Nit combs and Lethane Oil are supplied free or at cost price at the Infant Welfare Centres. Leaflets have been distributed and the Ministry of Health's film on the head louse was shown to the medical practitioners and health workers of the Borough (with trie Scabies film) on 13th October. Diagnostic Clinic (commenced) Men Women Children Total No: of sessions. - - - 79 No: of persons who attended. 484 928 517 1929 No: of persons found positive. (40%) 174 417 245 833 Total number of attendances. 502 985 587 2074 Branch Road Treatment Centre. Persons bathed and clothing disinfected. 209 473 186 858 No: of baths and treatment given. 562 1091 490 2143 London Hospital, Treatment Centre. Persons bathed ana clothing disinfected. 327 584 513 1120 L.C.C. School Treatment Centre. Pre-School children. - - 81 81 No: of baths and treatments given. - - 445 445 Statutory Action under Scabies Order 1941 NO: of Inspection of Premises nctioes served. 20 No: of Medical Examination notices served. 303 No: of Medical Treatment notices served. 3 No: of cases in Which legal proceedings were taken. NIL Verminous Persons. Branch Road Cleansing Centre. Persons bathed and clothing disinfected. 291 56 16 363 No: of baths and treatments given. 309 65 19 393 P.8. CAUSES OF ALL DEATHS DURING THE YEAR 1943. CAUSES OF DEATHS. TOTAL 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. 2 2 — 1 1 — — 1 4. — — l — Scarlet Fever. — — — — — - 4 - — — — Whooping Cough. 2 - — 2 - - — - — - Diphtheria. - 2 - - - — 2 - — — — - Tub. of Resp. system 57 4 1 - - - 1 25 26 23 - 8 4 Other forms of tub. 6 4 - - 2 2 2 1 2 1 - — - Syphilitic disease. 8 5 1 1 - - — - 1 — 3 2 3 2 Influenza. 7 8 - - - - - - 2 1 3 2 2 5 Measles. 1 4 - 2 l 2 — - - - — — - Ac. polio-myel. & polio.enceph. - - - - - - - - - - - - - - Ac. inf. enceph. - - - - - - - - - - - - - - Cancer of buc. cav. & Oesoph. 14 7 - - - - - - - - 5 4 9 3 of uterus. — - - - - - - - — — — — of stomach & dueodenum 122 16 - - - - - - - — 8 2 11 14 of breast. 1 12 - - - — - — - 3 — 6 1 3 of all other sites. 74 42 — - — — 1 5 6 34 12 34 24 Diabetes. 1 14 — - — — — - — 1 2 — 12 Intra-cranial vascular lesions. 56 47 - - - - - - - 22 IE 34 32 Heart disease. .93 161 - - - - - - - 11 38 22 153 128 Other diseases of the circ. system. 22 23 - - - - - - 1 3 7 18 15 Bronchitis. 81 47 3 1 — — — 2 — 21 1C 55 36 Pneumonia. 63 29 LI 6 l 1 — 2 2 21 L 28 16 Other resp. diseases. 18 7 2 - - - - - 1 - 9 ' r C 6 5 Ulcer of stomach and duodenum. 14 5 - - - - - - - - 11 1 2 4 Diarrhoea under 2 yrs. 7 7 7 6 — 1 — - - — — - — — Appendicitis. 3 2 - - - - 1 - 1 1 1 1 — — Other digestive diseases 17 15 1 2 - - 1 - - 2 9 - 6 5 Nephritis. 8 13 — - - - — - 2 2 3 7 3 4 Puerperal and post-abort sepsis. - 1 - - - - - - - 1 - - - - Other maternal causes. — 2 — - — — — - 2 — - — Premature birth. 6 1 6 1 - - - - - - - - - - Congenital ma. birth injury, inf. disease. 9 8 9 7 _ - 1 Suicide. 7 2 — - — — — 3 - 2 - 2 1 Road Traffic accidents. 8 2 — - l — — 1 1 3 - 3 — Other violent causes. 24 27 — 2 ll 2 3 " 6 10 5 5 9 9 All other oauses 43 39 1 2 - 3 2 6 6 9 12 25 16 All Causes. 772 596 42 317 13 10 6 66 772 334 131 413 338 TOTAL; 1368 73 20 16 ) 143 365 751 P.9. 20th annual report. SUMMARY OF BOROUGH ANALYST'S QUARTERLY REPORTS FOR THE YEAR 1943. 1,489 samples were submitted for analysis. Of these 1,437 samples consisted of food and drugs. The remaining 52 samples were received from Borough Departments and private purchasers. Out of 638 formal samples 33 or 5.2 per cent were adulterated and out Of 799 informal samples 32 or 4.0 per cent were adulterated, making a total of 1,437 samples out of which 65 or 4,5 per cent were adulterated. Of the samples taken under the Fond and Drugs Act, 1,076 consisted of foods and of these 56 or 5.2 per cent were adulterated (10 samples contained an allowed amount of preservative). Of 631.drugs 9 or 2.5 per cent were adulterated. Milk. 561 samples of milk were examined. The average composition including .14 adulterated samples was:- Fat 3.61 per cent and solids-not-fat 8,68 per cent. These samples ®f milk included 6 samples from schools, 8 samples from hospitals and 3 samples from day nurseries. ADULTERATED SAMPLES (including other offences). NATURE Samples Adulterated etc. Taken Informal Formal Prosecutive Cautions No Action Foods. Baking Powder 21 1 3 «—• 2 1 Buttered rolls. 48 14 6 5 1 — Vinegar 38 4 2 1 1 — Milk. 561 - 14 11 1 2 Caraway seeas. 1 1 — — — Spirits. 6 2 2 — — Fruit drinks. 26 1 — — — — Fish Paste. 14 1 — - — — Edible Gelatine. 6 1 3 — — 3 Ground Ginger. 11 1 - — - — Egg Sub.Powder. 1 1 - - - - Meat Roll. 1 — 11 - - 1 Drugs Tincture of Iodine. 12 2 — — — — Saccharin Tabs. 27 1 — — — — Castor Oil. 13 1 1 — 1 — Zinc Ointment. 18 1 - • - - - Gregory's Powder. 3 1 1* - - - Sodium Citrate. 6 1 - - - - * Letter sent by the Medical Officer of Health, Total fines and costs £110. 3. 0d, In addition, fines and costs were obtained in the case of a sample of Vermicelli analysed for the Food Control. Poor Quality Samples. 32 samples including 20 samples of milk were separated as of inferior grade or doubtful quality. Miscellaneous Samples. 52 samples were submitted for analysis. Of these, 43 were foods of which 14 or 32.6 per cent. were unsatisfactory. D. Henville. Borough Analyst.