5 Copies WAN78 Metropolitan Borough of Wandsworth. Annual Report of the Medical Officer of Health for the Year 1941, by F.G CALEY, M. A., M.B., B.Ch., D.P.H., together with the Report of the Public Analyst. 740 Metropolitan Borough of Wandsworth. Annual Report of the Medical Officer of Health for the Year 1941, by F. G. CALEY, M.A., M.B., B.Ch., D.P.H., together with the Report of the Public Analyst. REPORT of the Medical Officer of Health for the Year 1941. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Wandsworth. Sir, Ladies and Gentlemen, I beg to present my Annual Report on the health of the Borough for the year 1941. The Report includes an account of the Health Services administered by the Council and incorporates the Public Analyst's Report. Speaking generally, the health of the Borough during the year has been good. When compared with the previous year, there has been a large increase in the number of cases of Measles and Whooping Cough, but this has not been attended by a corresponding increase in the mortality. There has also been a considerable increase in the number of cases of Scabies which have come under treatment, and all the evidence points to the fact that the incidence of this disease is greater than it was in pre-war years. I am pleased to be able to report that the Clinics for the prevention of Diphtheria have become more popular, and the attendances at these Clinics during the year have been greater than in any previous year. The London County Council has opened Clinics for immunising children at some of their schools, and several thousand children have been immunised at these school clinics. It is to be hoped that the special campaign inaugurated by the Minister of Health to impress upon parents the importance of having their children protected against diphtheria will result in a material increase in the number of immunised children. I am, Sir, Ladies and Gentlemen, Your obedient Servant, F. G. CALEY, Medical Officer of Health. 4 STATISTICS. Population 229,610. (1940, 271,340). Census 1931, 353,100. Total live births, 2,938 (M. 1,537 ; F. 1,401). (1940, 3,662). Birth-rate, 12-79. (1940, 13-49). (Including 198 illegitimate and 84 still-births). Total deaths, 3,613 (M. 1,777; F. 1,836). (1940, 4,590). Death-rate, 15-73. (1940, crude 16-91). There were six deaths from puerperal causes-equal to a rate of 1.98 per 1,000 live and still births. Deaths of children under one year of age, 101; infantile mortality rate being 41 per 1,000 births (1940, 45) and is the lowest ever recorded. Deaths from Cancer 547 (1940, 622). Measles 3 (1940, 2). Whooping Cough 9 (1940, 1). Tuberculosis 231 (1940, 242). Tuberculosis Death Rate 1.00 (1940, .89). There was no unusual or excessive mortality during the year. STAFF. Mr. A. W. Lock, Sanitary Inspector, was released for service with a firm of shipbuilders from the 24th June to the 19th December, when he returned to his normal duties. Apart from this the full complement of Sanitary Inspectors, 20 in number, have been at work throughout the year. The staff of Health Visitors consists of 17-14 Maternity and Child Welfare, three Tuberculosis. The only change in the personnel during the year has been the retirement of Miss P. G. Moores, Health Visitor (Tuberculosis) who was superannuated in October after 26 years' service with the Council. Miss A. R. Davison was appointed to fill the vacancy. 5 Staff of Public Health Department. Mr. C. E. Gessner has been promoted from Grade " A " to Grade " B " Clerk. Miss C. Wellings, Grade " D " Clerk, died in January, 1941. All the Grade " A " Clerks, seven in number, have joined the Forces and there are now only four male members of the permanent staff of clerks, all of whom are above miliatry age, left in the Department. There are also three Grade " D " (female) clerks. 26 temporary clerks were employed in the Department at the end of the year. INFECTIVE DISEASES. There has been an increase in the amount of infective disease during the year, the number of notifiable diseases having risen from 1,649 in the previous year to 3,894. Measles and Whooping Cough are mainly responsible for this increase. There were 1,058 cases of Measles reported, compared with 230 in 1940, and 1,122 cases of Whooping Cough compared with 48. The increase in the incidence of these two diseases has not been accompanied by any appreciable rise in mortality, only 12 persons having died from the two diseases. 194 cases of Dysentery have been notified, compared with 31 in the previous year ; all except four of these occurred among the inmates of two mental hospitals in the Borough ; there were 20 deaths. Nine cases of Typhoid fever and 15 of Para-typhoid fever were notified. Two of the former died. 75 cases of Cerebro-spinal Meningitis, with nine deaths, occurred compared with 74 and nine in the previous year. There has been an increase in the cases of Scabies dealt with and 673 persons were given bathing treatment at the Council's Cleansing Station, 6 Report of the Medical Officer of Health for 1941. 839 bacteriological examinations were made at the Lister Institute and 977 specimens of sputum were examined at the Tuberculosis Dispensaries. The Council has an arrangement with various Nursing Associations in the Borough to attend patients suffering from certain infectious diseases and minor ailments. In June, 1941, it was decided to increase the fee paid for these visits from 1s. 3d. to 1s. 9d. 5,032 visits were made during the year. Treatment of Special Diseases. Two persons are receiving treatment for Diabetes and one for Pernicious Anaemia, at the Council's expense. Immunisation against Diphtheria. The Council holds two immunisation clinics which were opened in January, 1928. Since that date 7,784 children have been successfully immunised and 7,402 have been partially immunised. Addresses and times of Clinics. Municipal Buildings, Every Wednesday from Fairfield Street, 2 to 3.30 p.m. S.W. 18. Balham Infant Welfare Centre, Every Friday from 91, Bedford Hill, S.W. 12. 2 to 3.30 p.m. During 1939 and 1940 the interest shown in these Clinics appeared to be diminishing, the number of attendances having fallen from 1,134 in 1938 to 693 in 1939 and 318 in 1940. I am glad to be able to report that this tendency has been reversed during the year under review and that the number of attendances at the Council's Clinics during 1941 increased to 1,845, the largest number who have attended in any one year since they were opened 14 years ago. During the year the London County Council decided to supplement the efforts made by the Borough Council by opening Infective Diseases. 7 clinics for the immunisation of children at some of their schools in the Borough. The results have been encouraging and 4,017 children have been injected at these school Clinics. The total number attending all the Clinics during the year was, therefore, 5,862. Some years ago the Council decided to supply immunising material free of charge to general practitioners. During the year 89 children have been immunised under this arrangement. Tuberculosis. The number of new cases which came to the notice of the Department during the year was 618, compared with 522 in 1940 and 535 in 1939. 531 were pulmonary and 87 non-pulmonary tuberculosis. 231 deaths were certified as due to diseases of a tuberculous nature, the death rate being TOO. In 1940 there were 242 deaths and in 1939, 221, from this disease. The 618 new cases were added to the Notification Register and 650 who had removed, recovered or died were taken off, the number remaining on the Register at the end of the year being 2,154. The two Tuberculosis Dispensaries which are at the Municipal Buildings, Wandsworth, and 114, Gosberton Road, Balham, have operated throughout the year, and 1,294 new cases attended. Of these 310 were diagnosed as suffering from tuberculosis, 68 were suspected and 916 were non-tuberculous. Of the 1,294 new cases examined, 265 were contacts, 33 of whom were found to be suffering from tuberculosis. The number of cases remaining on the Dispensary Register at the end of 1941 was 1,502, compared with 1,449 in 1940. The total attendances at the Dispensaries was 3,272. 446 patients received institutional treatment. 2,709 attendances were made for light and other special treatment and 547 X-ray examinations were made. The number of personal consultations with doctors was 1,402. Home visits made by the Tuberculosis Officers totalled 630 and the Health Visitors made 4,812 visits. 977 specimens of sputum were examined. 8 Report of the Medical Officer of Health for 1941. Artificial pneumothorax treatment has been carried out at several hospitals by arrangement. 142 cases were treated and 2,428 refills were administered. 13 patients received dental treatment. Extra nourishment as authorised by Section 219 of the Public Health (London) Act, 1936, has been granted to 102 patients, and 104 cases who were ineligible under the scheme received extra nourishment through the Public Assistance Committee. The Tuberculosis Care Committee meets on the first Friday in every month and consists of members of the Borough Council and representatives of other bodies interested in the welfare of persons suffering from tuberculosis. The Secretary made 2,455 visits to patients during the year. The Committee controls a Fund maintained by voluntary contributions to assist patients who are ineligible for assistance from other organisations. An amount of £81 0s. lld. was expended out of this Fund during the year. A Handicraft Class is also in operation and this meets on Monday afternoons from 2.30 to 4.30. Maternity and Child Welfare. Of the 2,938 births which occurred during the year, 2,371 or 80.70 per cent. were visited by the Health Visitors. The total number of visits made by these officers for all purposes was 36,218. They also made 1,907 attendances at Infant Welfare Centres, Ante-natal Clinics, etc. There are 10 Infant Welfare Centres and nine Ante-natal Clinics in operation in the Borough. The number of attendances made by women at these Clinics was 30,922 and 2,969 respectively. Maternity and Child Welfare. 9 A Dental Clinic is held at the Municipal Buildings for expectant and nursing mothers and children under five years of age. Patients attending the Clinic are required to pay one PARTICULARS OF CLINICS. Address of Clinic. Days and Times of Sessions. Infant Welfare Clinics. Ante-Natal Clinics. Central Wandsworth: Municipal Buildings, Fairfield Street. Wednesdays at 10 a.m. 1st, 3rd and 5th Mondays at South fIEld : St. Michael's Memorial Hall, Merton Road. Fridays at 2 p.m. 1st and 3rd Fridays in every month at 10 a.m. Springfield : Congregational Church Hall, Earlsfield Road, S.W. 18. Tuesdays at 2 p.m. 2nd and 4th Tuesdays in every month at 11 a.m. Putney: St. Mary's Church Schools, Felsham Road. Tuesdays and Wednesdays at 2 p.m. 1st and 3rd Wednesdays in every month at 10 a.m. Clapham : Clapham Dispensary, 42, Clapham Manor Street. Wednesdays at 2 p.m. 1st, 2nd, 3rd and 5th Mondays in every month at 2 p.m. Balham : 91, Bedford Hill. Tuesdays and Wednesdays at 1.30 p.m. Every Friday in the month at 9.45 a.m. StreatHam : 37, Riggindale Road. Streatham Hill : Baptist Church Hall, New Park Road. Tooting : St. Peter's Church Hall, Beechcroft Road. Baptist Church Hall, Longley Road. Tuesdays at 1.30 p.m. Tuesday at 10 a.m. Tuesdays at 2 p.m. Thursdays at 2 p.m. 1st, 3rd and 4th Wednesdays in every month at 10 a.m. 2nd and 4th Mondays in every month at 2 p.m. 1st, 3rd and 4th Wednesdays in every month at 10.30 a.m. Municipal Buildings, Fairfield St., S.W. 18. Dental Clinic. Every Monday and Friday in each month at 1. 30 p.m. 10 Report of the Medical Officer of Health for 1941. shilling each time they attend. If dentures are necessary the patients are assessed on their income in accordance with a scale approved by the Council. 246 patients were seen for the first time and the number of attendances made at the Clinic by all patients was 697. 16 women were assisted by the Council towards the cost of their dentures. The Council contributed £33 lls. 6d. The Council has a scheme to assist financially women who are unable to pay for the attendance of a qualified midwife at their confinements. Four women were so assisted during the year. The Council also contributes towards the charges made by suitable women who assist in the home during confinements. Assistance was granted to 36 cases during 1941. During the year 48 families were supplied with milk under the Milk (Mothers and Children) Order, 1918. The cost to the Council was £55 14s. 5d. Grants are made to the Southwark Diocesan Association towards the maintenance of unmarried mothers in their institutions. Grants of £125 3s. 9d. have been made during the year. 19 children have been sent to Convalescent Homes, at a cost to the Council of £89 4s. 0d. 235 children under school age suffering from minor ailments were referred to the London County Council for treatment. The cost to the Borough Council was £55 14s. 0d. War Time Nurseries. A considerable number of married women who registered under the National Services Act stated they would be prepared to do work of national importance. As many of these women had young children some provision was required to be made for their care during the mothers' working hours. In May, 1941, the Ministry of Health and the President of the Board of Education issued circulars Nos. 2388 and 1553 on the subject. These circulars directed local authorities to provide war time nurseries in their area if the Ministry of Labour and National Service had come to the conclusion from the facts at Sanitary Supervision of the Borough. 11 their disposal that this provision should be made to enable the mothers of young children to take up work of national importance. The Ministry of Labour made representation to this Council that Nurseries were needed in the Wandsworth, Putney and Balham areas. As a consequence of this representation the Council, with the approval of the Ministry of Health, took the necessary steps to recondition, equip and staff Day Nurseries in Fairfield Street, Wandsworth, at 95, Lacy Road, Putney, and at 22, Old Devonshire Road, Balham, the three Nurseries which had been closed at the outbreak of war, in anticipation of re-opening them early in 1942. Sanitary Supervision of the Borough. During the year 19 Sanitary Inspectors have been available. As stated previously the number of complaints made to the Department was considerably less than in pre-war years. The Sanitary Inspectors have, however, been called upon to carry out various other duties, e.g., the inspection and supervision of the public air raid shelters in the Borough. Of the total of 42,343 inspections made for all purposes, 14,978 were made to these shelters. The total number of defects found by the Sanitary Inspectors during the visits to premises was 2,855. 400 routine visits were also made to the 171 sanitary conveniences, but it was only necessary to serve one notice. 574 complaints of the presence of rats were investigated by the Council's rat catcher who made 1,199 visits and laid 5,980 baits. 253 inspections were made to retail shops when it was found that the provisions of the Shops Act, 1934, were being observed. Mortuary and Crematorium. The Mortuary at Wandsworth was used throughout the year, and 268 bodies were received there. As Medical Referees under the Crematorium Regulations, 1930, Dr. MacDonnell and I have authorised 198 cremations which took place at the Crematorium at Putney Vale Cemetery. 12 Report of the Medical Officer of Health for 1941. Housing. Work in connection with housing has again been on a reduced scale, but 4,282 dwelling houses were inspected for defects by the Sanitary Inspectors, the total number of inspections made being 12,081. 1,648 houses were found not in all respects reasonably fit for human habitation, and of these 282 were rendered fit without the service of any notice. It was necessary to serve intimation notices under the Public Health (London) Act, 1936, in respect of 965 houses and in 410 houses the service of nuisance notices was necessary. Housing Act, 1936. No action for the clearance of insanitary areas or houses has been initiated, as the above Act is in abeyance for the duration of the war, but 16 houses in respect of which Demolition Orders were made and confirmed prior to the outbreak of war were demolished during the year. These were:- 90-110, Point Pleasant, Wandsworth—11 houses:Demolition Orders made on 19th October, 1937. 1-5, Cowpers Row, Streatham—5 houses :-Demolition Orders made on 18th January, 1938. These five houses were damaged by enemy action in April, 1941, and demolished in August and September. Eleven other houses, which I had scheduled as insanitary but on which no official action had yet been taken, were demolished by their owners in 1941. They were:— Fairview Cottage, Streatham—1 house:—had been damaged by enemy action some months prior to demolition. 1 to 5, and 11 to 15, Factory Square, Streatham-10 houses:-demolished by the owners to allow for an extension of the factory adjoining them. Overcrowding. 105 dwellings were recorded as overcrowded at the end of the year. Supervision of Food. 13 111 cases of overcrowding representing 690 persons have been abated during the year. Supervision of Food. There are four Inspectors engaged in the supervision of the food supply. The number of separate food premises is 2,485 and during 1941 they were inspected on 24,703 occasions. There are 162 registered dairies and 423 registered dairymen. The bulk of the milk sold by retail within the Borough is sent out in bottles filled in properly constructed dairies and its quality is good. 138 samples were submitted for analysis. 134 of these were genuine with an average fat content of 3.49 per cent. 65 licences for the sale of designated milks were granted during the year-34 for Tuberculin Tested Milk and 31 for Pasteurised Milk. There are four slaughterhouses in the Borough but only one is in use at present. 149 animals were inspected either before or after slaughter. During the year 44 piggeries were licensed for the duration of the war and 579 inspections of these were made. Since the outbreak of the war a Wholesale Meat Depot has been established at 666, Garratt Lane for the reception and distribution of meat slaughtered outside the Borough. This Depot is visited daily by the Food Inspectors. During these visits considerable quantities of meat were found to be unfit for human consumption. Most of this was the result of decomposition caused by delays in transportation from the places where the animals were slaughtered. After condemnation the meat was released for industrial purposes. During the year nine applications were received from persons desirous of acting as slaughtermen. 14 Report of the Medical Officer of Health for 1941. FOOD AND DRUGS ADULTERATION ACT, 1928. 1,350 samples were procured for analysis during the year— 138 samples of milk, 1,015 other foodstuffs and 197 were drugs. 17 samples were found to be adulterated. Four were samples of milk, one of butter, three of milk substitute powder, one of egg squares, one of egg powder, one of pearl barley, one of sausages, one of cream cheese, one of orange substitute and one of chocolate. 174 consignments of foodstuffs of all kinds suspected to be unsound were examined at the request of the owners. After the articles had been rendered unsaleable the owners were granted a certificate to this effect. PHARMACY AND POISONS ACT, 1933 AND PHARMACY AND MEDICINES ACT, 1941. Applications were received from 252 persons for their names to be entered on the Council's Register of sellers of poisons included in Part II. of the Poisons List. 508 inspections under these Acts were made by the Food Inspectors. FACTORIES AND WORKSHOPS. There were 1,317 factories and workshops on the Register at the end of 1941, and in addition 507 persons were receiving work to be done in their own homes. REPORT OF THE PUBLIC ANALYST. Owing to war conditions only 1,350 samples were submitted, seven being formal and 1,343 informal. All the formal samples were milk. The samples submitted for analysis consisted of 138 milk ; 1,015 other foodstuffs and 197 drugs. Four of the samples of milk were found to be adulterated. The average composition of the milk analysed during the year was:—total milk solids, 12.20, milk fat, 3.49, non-fatty solids, 8.71. Eleven samples of other foodstuffs were found to be adulterated Report of the Public A nalyst. 15 or not as described on the label, viz. :—butter contained 50 per cent. margarine ; egg squares, devoid of whole egg ; milk substitute powder which was not a milk substitute ; pearl barley which was infested with mite; egg powder, falsely described ; beef sausages contained sulphur dioxide; cream cheese contained 50 per cent. margarine fat; orange substitute, claim on label not justified; chocolate powder contained 10 per cent. powdered chalk. Samples of the following substances were analysed:- arrowroot, 12 samples ; barley, five ; bread, 28 ; butter, 28 ; cake, 33 ; cereals, 13 ; cheese, 21 ; cocoa, 35 ; coffee, 12 ; cornflour, three ; dripping and lard, 15 ; essences, 18 ; fat, one ; fish, canned or in paste form, 36 ; flour, 29 ; food powders, 77 ; ginger, seven; jam, six ; margarine, 22 ; meat products, 66 ; mustard, nine ; pepper, 12 ; pickles and sauces, 35 ; rice, 21 ; salad oil, four ; salt, eight; spice, nine ; soup, canned, 21 ; sugar, 19 ; tapioca, 13 ; tea, 18 ; vegetables, canned and dried, 56 ; vinegar, 11 ; yeast, one. The average water content of the 20 samples of butter was 15.2 per cent. ; that of the 22 samples of margarine, 14.8 percent. Three of the samples were submitted for analysis on the complaint of ratepayers, viz. :—one sample of butter, one saccharin tablets and one of liquid egg substitute. The sample of butter was the one previously mentioned found to be adulterated with 50 per cent. margarine. The other two samples were genuine. 197 samples of drugs were analysed. Two were adulterated. In conclusion I have to report that the adulteration detected during 1941 was 14.28 per cent. of the formal samples and 1.19 per cent. of the informal samples and 1.25 per cent. of all samples submitted. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, A. H. M. MUTER, F.I. C., F.C.S., Public Analyst. 325, Kennington Road, S.E. 11.