hihsary WAN 79 Metropolitan Borough of Wandsworth Annual Report of the Medical Officer of Health for the Year 1942, by F. G. CALEY, M.A., M.B., B.Ch., D.P.H., together with the Report of the Public Analyst. Metropolitan Borough of Wandsworth Annual Report of the Medical Officer of Health for the Year 1942, 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 1942. 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 1942, together with the Report of the Public Analyst. The number of births has increased by over 1,000 on the previous year, and the birth-rate has risen to 16 per 1,000 of population. The death-rate is lower and there has been no special incidence of disease. The number of children immunised against Diphtheria has again increased and additional Clinics for this Service have been opened. Five War Time Nurseries have been opened during the year to provide for the children of the increasing number of mothers who are engaged in work of national importance. Arrangements for opening a further five Nurseries are well in hand, and it is anticipated that these additional Nurseries will be ready early in the New Year. I am, Sir, Ladies and Gentlemen, Your obedient Servant, F. G. CALEY, Medical Officer of Health. 4 STATISTICS. Population 249,400. (1941, 229,610. Census 1931, 353, 100). Total live births, 4,002 (M. 2,077; F. 1,925). (1941, 2938). Illegitimate births 252. Still-births 116. Birth-rate, 16.04. (1941. 12.79). Total deaths, 3,493 (M. 1,698; F. 1,795). (1941, 3,613). Death-rate, 14.00. (1941, 15.73). There were 11 deaths from puerperal causes—equal to a rate of 2.67 per 1,000 live and still births. Deaths of children under one year of age, 177; infantile mortality rate being 44 per 1,000 births (1941, 41). Deaths from Cancer 591 (1941, 547). Measles 4 (1941, 3). Whooping Cough 7 (1941, 9). Tuberculosis 221 (1941, 231). Tuberculosis Death-rate .88 (1941, 1.co). There was no unusual or excessive mortality during the year. STAFF. The full complement of Sanitary Inspectors, 20 in number, have been at work throughout the year. There are 17 Health Visitors in the Council's Service—14 under the Maternity and Child Welfare Scheme and three under the Tuberculosis Scheme. Miss Pottinger resigned her appointment as from the 31st December, after 12 years' service with the Council. The vacancy was filled by the appointment of Miss E. A. Evans, a Health Visitor under the Sevenoaks Urban District Council. All the Grade "A" Clerks, seven in number, have joined the Forces, and there are now only four male members of the Staff of Public Health Department. 5 permanent staff of clerks, all of whom are above military age, left in the Department. There are also three Grade "D" (female) clerks. Twenty-five temporary clerks were employed in the Department at the end of the year. INFECTIVE DISEASES. There has been a decrease in the amount of infective disease during the year, the number of notifiable diseases having dropped from 3,894 in the previous year to 2,573 Measles and Whooping Cough are mainly responsible for this decrease. There were 330 cases of Measles reported, compared with 1,058 in 1941, and 657 cases of Whooping Cough compared with 1,122. 44 cases of Dysentery have been notified compared with 194 in the previous year; 30 of these occurred among the inmates of two mental hospitals in the Borough; there were three deaths. Eight cases of Typhoid Fever and one of Para-typhoid Fever were notified. Two of the former died. 22 cases of Cerebro-spinal Meningitis, with three deaths, occurred compared with 75 and nine in the previous year. 525 cases of Scabies were treated at the Council's Cleansing Station under the supervision of the trained nurse. The majority of the cases are now treated by the benzyl benzoate method. BACTERIOLOGICAL EXAMINATIONS. In accordance with a decision of the Council made in November, 1941, cultures for suspected cases of Diphtheria are now examined in the laboratory of the Tuberculosis Dispensary, the preparation of the cultures being carried out by Mr. Kitchen, the clerk and dispenser. Examinations of a special nature are performed by the Camberwell Research Laboratories During the year 1,138 Diphtheria cultures, 1,027 specimens of sputum and 29 miscellaneous cultures were examined in the Dispensary laboratory. Seven specimens of blood from suspected cases of Enteric Fever were examined by the Camberwell Research Laboratories. 6 Report of the Medical Officer of Health for 1942. DISTRICT NURSING. The Council has an arangement with the various Nursing Associations in the Borough for a nurse to attend patients suffering from certain infectious diseases and minor ailments. 7,026 visits were made during the year. TREATMENT OF SPECIAL DISEASES. Five persons are receiving treatment for Diabetes and one for Pernicious Anaemia, at the Council's expense. PREVENTION OF DIPHTHERIA. Last year I reported that there had been a large increase in the number of children brought to the two Immunisation Clinics which had been in operation since January, 1928. There has been a further material increase in the numbers during 1942, and it was decided to open further Clinics. A second weekly session for the Clinic held at the Municipal Buildings was opened on the 12th November, and new Clinics were opened in Streatham on the 29th October, in Tooting on the 17th November and in Clapham on the 8th December. The particulars of the six Clinics which were in operation at the end of the year are as follows: — Municipal Buildings, Fairfield Street Wednesdays 2 p.m. to 3.30 p.m. Thursdays 2 p.m. to 3.30 p.m. Balham Infant Welfare Centre, 91 Bedford Hill Fridays 2 p.m. to 3.30 p.m. No. 6 First Aid Post, Streatham Baths Thursdays 2 p.m. to 3.30 p.m. St. Peter's Church Hall, Beechcroft Road Tuesdays 2 p.m. to 3.30 p.m. Clapham Dispensary, 42 Clapham Manor Street Tuesdays 2 p.m to 3.30 p.m. Prevention of Diphtheria. 7. Attendances 4,209 persons attended these Clinics during the year. This compares with 1,845 in 1941 and 318 in 1940. In addition 3,063 children have attended the L.C.C. Clinics held at Schools in the Borough. The Immunising Agent The solution now used for routine immunisation is Alum Precipitated Toxoid (A.P.T.) and two injections of ½ c.c. each are given at monthly intervals. For persons over the age of 15 two injections, each of 1 c.c., of Toxoid Anti-Toxin Floccules (T.A.F.) are given. The total number of children immunised during the year was:— At the Borough Council's Clinics 4,142 At L.C.C. Clinics 3,063 Total 7,205 TUBERCULOSIS. The number of new cases which came to the notice of the Department during the year was 646 compared with 618 in 1941 and 522 in 1940. 551 were pulmonary and 95 non pulmonary tuberculosis. 221 deaths were certified as due to diseases of a tuberculous nature, the death-rate being .88 There were fewer deaths from this disease than in 1941, when 231 deaths were recorded, and in 1940 when the number was 242. The 646 new cases were added to the Notification Register and 587 who had removed, recovered or died were taken off, the number remaining on the Register at the end of the year being 2,213. The two Tuberculosis Dispensaries which are at the Municipal Buildings, Wandsworth, and 114 Gosberton Road, Balham, have operated throughout the year, and 1,628 new cases attended. Of these 330 were diagnosed as suffering from tuberculosis, 235 were suspected cases and 1,063 were nontuberculous. Of the 1,628 new cases examined, 452 wen contacts, 38 of whom were found to be suffering from tuberculosis. The number of cases remaining on the Dispensary Register at the end of 1942 was 1,597, compared with 1,502 in 1941. The total attendances at the Dispensaries was 4,425. 8 Report of the Medical Officer of Health for 1942. 590 patients received institutional treatment. 3,462 attendances were made for light and other special treatment and 1,043 X-ray examinations were made. The number of personal consultations with doctors was 1,170. Home visits made by the Tuberculosis Officers totalled 1,020, and the Health Visitors made 4,841 visits. Artificial pneumo-thorax treatment has been carried out at several hospitals by arrangement. 170 cases were treated and 2,780 refills were administered. 14 patients received dental treatment. Extra nourishment as authorised by Section 219 of the Public Health (London) Act, 1936, has been granted to 85 patients, and 64 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. During the year the Secretary of the Committee visited or interviewed 2,415 patients. The Committee controls a Fund maintained by voluntary contributions to assist patients who are ineligible for assistance from other organisations. An amount of £120 5s. 6d. 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 4,002 births which occurred during the year, 3,439 or 85.93 per cent were visited by the Health Visitors. The total number of visits made by these officers for all purposes was 39,987. In addition they attended at Clinics on 2,620 occasions. 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 46,578 and 5,948 respectively. 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 Maternity and Child Welfare. 9 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. Every Monday at 1.30 p.m. Southeield: 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. Tuesdays at 1.45 p.m. 2nd and 4th Tuesdays in every month at 10 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. Tuesdays and Wednesdays at 2 p.m. Every Monday at 2 p.m. Balham: 91, Bedford Hill. Wednesdays and Thursdays at 1.30 p.m. Every Friday at 9.45 a.m. Streatham: 37, Riggindale Road. Tuesdays at 1.30 p.m. Fridays at 2 p.m. Every Wednesday at 10 a.m. Streatham Hill: Baptist Church Hall, New Park Road. Tuesdays and Thursdays at 9.30 a.m. 2nd, 4th and 5th Mondays in each month at 2 p.m. Tooting : St. Peter's Church Hall, Beechcroft Road. Tuesdays at 1.45 p.m. Every Wednesday at 10.30 a.m. Baptist Church Hall, Longley Road. Thursdays at 1.45 p.m. Municipal Buildings, Fairfield Street. Dental Clinic. Every Monday, Tuesday and Friday at 2 p.m. 10 Report of the Medical Officer of Health for 1942. one 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. 374 patients were seen for the first time, and the number of attendances made at the Clinic by all patients was 1,046. 20 women were granted assistance towards the cost of their dentures, the Council contributing £36 14s. 5d. The Council grants financial assistance to women who are unable to pay for the attendance of a qualified midwife at their confinements. Three women received assistance during the year. Contributions are also made towards the charges made by suitable women who assist in the home during confinements Assistance was granted to 49 cases during 1942. 39 families were supplied with milk under the Milk (Mothers and Children) Order, 1918. The cost to the Counci1 was £15 gs. gd. Grants amounting to £98 8s. 1d. were made to the Southwark Diocesan Association towards the maintenance of unmarried mothers in their institutions. 21 children have been sent to Convalescent Homes at a cost to the Council of £70 14s. 6d. 344 children under school age suffering from minor ail ments were referred to the London County Council for treatment. The cost to the Borough Council for this service was £81 17s. od. In November the Under Secretary of State for the Home Office, by virtue of the power conferred on him by Section 94 (2) of the Children and Young Persons' Act, 1933, delegated to me the power of inspection of the Catholic Girls' Home, 55 South Side, Clapham Common. He appointed me, with the consent of the Council, as the authorised officer to act on his behalf. MATERNITY HOME. The Council's Maternity Home, which since the outbreak of war had been used as a First Aid Post, was re-opened for the reception of patients on the 26th August, 1942. Up to the end of the year 93 women had been admitted. Maternity and Child Welfare. 11 WAR TIME NURSERIES. In May, 1941, the Ministry of Health and the President of the Board of Education issued circulars Nos. 2388 and 1553 directing local authorities to provide War-time Nurseries in their area if the Ministry of Labour and National Service decided, from the facts at their disposal, that this provision should be made to enable the mothers of young children to take up work of national importance. In the latter part of 1941 the Minister of Labour made representations to the Council that Nurseries were needed in Wandsworth, Putney and Balham. The Council, accordingly, with the approval of the Minister of Health, took the necessary steps to recondition, equip and staff the three Day Nurseries in these districts which had been closed at the outbreak of war. The Nursery in Fairfield Street, Wandsworth, was opened at its new premises on the 12th January, and those at 95 Lacy Road, Putney, and 22 Old Devonshire Road, Balham, on the 2nd March, In addition two war-time Nurseries were opened in Mitcham Road, Tooting, on the 11th May, and at Christchurch Road, Streatham, on the 22nd November. Owing to the continued demand for nursery accommodation it was recognised that further provision would have to be made, and by the end of the year five other Nurseries were under construction, viz.: in Endlesham Road, Balham; Cresset Street and Larkhall Rise, Clapham; Sherwood Avenue, Streatham, and West Hill Road, Southfields. SANITARY SUPERVISION OF THE BOROUGH. There has been a considerable increase in the number of complaints made to the Department, and as a consequence the inspections made for the purpose of investigating complaints has increased from 11,048 in 1941 to 17,927 in 1942. The inspection and supervision of the public air raid shelters in the Borough has been continued, and 8,364 visits were made for this purpose. The total number of inspections made by the Inspectors for all purposes during the year was 38,852. 4,329 defects were found. 1,172 visits were made on account of verminous conditions of houses or bedding. 423 inspections of Sanitary Conveniences were made. 61 inspections were made to retail shops when it was found that the provisions of the Shops Act, 1934. were being observed. 12 Report of the Medical Officer of Health for 1942. 724 complaints of the presence of rats were investigated by the Council's rat catcher, who made 1,298 visits and laid baits. MORTUARY AND CREMATORIUM. The Mortuary at Wandsworth was used throughout the year, and 240 bodies were received there. As Medical Referees under the Crematorium Regulations, 1930, Dr. MacDonnell and I have authorised 225 cremations, which took place at the Crematorium at Putney Vale Cemetery HOUSING. Work in connection with housing has again been on a reduced scale, but 7,614 dwelling-houses were inspected for defects by the Sanitary Inspectors, the total number of inspections made being 20,922. 2,453 houses were found not in all respects reasonably fit for human habitation, and of these 251 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 1,728 houses, and in 465 houses the service of nuisance notices was necessary HOUSING ACT, 1936. The following four houses, on which Demolition Orders were made on the 19th October, 1937, have been demolished during the year:— 78, 80, 82 and 84 Point Pleasant. One other house which I had scheduled as insanitary, but on which no official action had yet been taken, was damaged by enemy action and has since been demolished. This was 39 Prescott Place, Clapham. OVERCROWDING. 114 dwellings were recorded as overcrowded at the end of the year. 33 cases of overcrowding, representing 227 persons, have been abated during the year. 13 SUPERVISION OF FOOD. There are four Inspectors engaged in the supervision of the food supply. The number of separate food premises is 2,288, and during 1942 they were inspected on 24,447 occasions. There are 138 registered dairies and 239 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. 349 samples were submitted for analysis. 337 of these were genuine, with an average fat content of 3.63 per cent. 57 licences for the sale of designated milks were granted during the year—27 for Tuberculin Tested Milk and 30 for Pasteurised Milk. There are three slaughterhouses in the Borough, but only one is in use at the present. 291 animals were inspected either before or after slaughter. During the year three piggeries were licenced for the duration of the war. 252 inspections of piggeries 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 11 applications were received from persons desirous of acting as slaughtermen. Food and Drugs Adulteration Act, 1928. 1,469 samples were procured for analysis during the year— 349 samples of milk, 992 other foodstuffs and 128 were drugs. 22 samples were found to be adulterated. 12 were samples of milk, two of mixed spice, one of sausages, two of table cream powder, one of Seidlitz powder, one of jelly crystals, one of egg powder, one of baking powder and one of self-raising flour. 14 Report of the Medical Officer of Health for 1942 141 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 191 persons for their names to be entered on the Council's Register of sellers of poisons included in Part II of the Poisons List. 305 inspections under these Acts were made by the Food Inspectors. FACTORIES AND WORSHOPS. There were 1,241 factories and workshops on the Register at the end of 1942, and in addition 573 persons were receiving work to be done in their own homes. REPORT OF THE PUBLIC ANALYST. Owing to war conditions only 1,469 samples were submitted, 27 being formal and 1,442 informal. All the formal samples were milk. The samples submitted for analysis consisted of 349 milk, 992 other foodstuffs and 128 drugs. Twelve of the samples of milk were found to be adulterated The average composition of the milk analysed during the year was:—Total milk solids, 12.44, fat, 3-63, non-fatty solids, 8.81. Ten samples of other foodstuffs were found to be adulterated, or not as described on the label, viz. :—Two of mixed spice containing 70 and 50 parts of lead per million; beef sausages containing 80 parts per million sulphur dioxide; two of table cream powders containing 900 parts per million sulphur dioxide and 330 parts per million of zinc; . Seidlitz powder "Extra Strong" supplied; jelly crystals excessive gritty deposit; egg powder excessive acidity; baking powder fluorine 2,900 parts per million and arsenic 4 parts per million; self-raising flour fluorine 50 parts per million. Samples of the following substances were analysed: Arrowroot, 5 samples; but tier, 87; cake, 31; cereals, 19; Report of the Public Analyst. 15 cheese, 88; cocoa, 20; coffee, 9; cornflour, 1; lard, 85; essences, 15; fish, canned or in paste form, 31; flour, 13; food powders, 40; ginger, 2; jam, 9; margarine, 88; meat products, 70; mustard, 2; pepper, 1; pickles and sauces, 24; rice, 4; salt, 6; spice, 19; soup, canned, 20; sugar, 86; tea, 86; vegetables, canned and dried, 24; yeast, 4. The average water content of the 87 samples of butter was 14.9 per cent; that of the 88 samples of margarine, 14.9 per cent. Six of the samples were submitted for analysis on the complaint of retepayers, viz.: —One sample of chocolate, one of jelly crystals, one of sweets, one of canned soup, one of buns and one of coffee extract. The sample of jelly crystals was the one previously mentioned found to contain excessive gritty deposit. The other five samples were genuine. 128 samples of drugs were analysed. One was adulterated. In conclusion I have to report that the adulteration detected during 1942 was 29.6 per cent of the formal samples and .97 per cent of the informal samples, and 1.49 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.ii.