WAN 80 Metropolitan Borough of Wandsworth Annual Report of the Medical Officer of Health for the Year 1943, 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 1943, 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 1943. 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 1943, together with the Report of the Public Analyst. The number of births shows a further increase over the previous year, and the birth rate has risen from 16.04 to 17.13 The death rate is about the same as in 1942. There has been no special incidence of disease. The number of deaths from tuberculosis has fallen from 221 to 193, and the death rate from this disease is .73 compared with .88 in 1942. The number of children immunised against diphtheria has fallen off during the year, although the attendances at the clinics arc still considerably larger than they were before the war. Owing to the fall in attendances, six of the clinics have been closed, and there are now two clinics open every week.. 333 women were admitted to the Council's Maternity Home which was open for 11 months of the year. There are now 13 War Time Nurseries in the Borough, and these have been well patronized. I am, Sir, Ladies and Gentlemen, Your obedient Servant, F. G. CALEY, Medical Officer of Health. 4 STATISTICS. Population 262,160. (1942, 249,400. Census 1931, 353,100). Total live births, 4,491. (M. 2,319; F. 2,172). (1942, 4,002). Illegitimate births 307. Still-births 101. Birth-rate 17.13. (1942, 16.04). Total deaths, 3,682. (M. 1,805; F. 1,877). (1942, 3,493). Death-rate, 14.04 (1942, 14.00). There were 10 deaths from puerperal causes—equal to a rate of 2.22 per 1,000 live and still births. Deaths of children under one year of age, 194; infantile mortality rate being 43 per 1,000 births (1942, 44). Deaths from Cancer 595 (1942, 591). Measles 2 (1942, 4). Whooping Cough 5 (1942, 7). Tuberculosis 193 (1942, 221). Tuberculosis death-rate .73 (1942, .88). There were no unusual or excessive mortality during the year. STAFF. 19 Sanitary Inspectors have been on duty throughout the year. Mr. P. P. Leacock, temporary Sanitary Inspector, resigned on the 30th July, on obtaining an oppointment as Sanitary Inspector at Dartford. There are 17 Health Visitors in the Council's service— 14 under the Maternity and Child Welfare Scheme and three under the Tuberculosis Scheme. Mis . E. E. Chesworth was engaged as a temporary Health Visitor for Maternity and Child Welfare in July. All the Grade "A" Clerks, seven in number, and one Grade "D" (female) clerk have joined the Forces. Only four male members of the permanent staff of clerks, all of whom are above military age, are left in the Department. There are also two Grade "D" (female) clerks. Twenty-four temporary clerks were employed in the Depart at the end of the year. 5 INFECTIVE DISEASES. There has been an increase in the amount of infective disease during the year, the number of notifiable diseases having risen from 2,573 in the previous year to 4,323. Scarlet fever and measles are mainly responsible for this increase. There were 2,310 cases of measles reported, compared with 330 in 1942, and 853 cases of scarlet fever compared with 363. 37 cases of dysentery have been notified compared with 44 in the previous year; 11 of these occured among patient's in Putney Hospital; there were no deaths. Four cases of typhoid fever were notified. There was one death. There were 17 cases of cerebro-spinal meningitis, with two deaths, compared with 22 and three in the previous year. The notification of scabies came into force on the 1st August. The Regulations make it compulsory for a medical practitioner to notify to the local authority any person to whom he is called, on becoming aware that such person is suffering! from scabies, unless any member of the same family shall have been notified within a period of four weeks. 562 cases of scabies had been notified up to the end of the year. 1,308 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. During the year, 1,294 diphtheria cultures and 1,193 specimens of sputum were examined in the laboratory of the Tuberculosis Dispensaries. Three specimens of blood and 21 of faeces from suspected cases of entric fever, nine cultures for streptococcus haemolyticus, four from meningococcus, and six from cases of ophthalmia were examined by the Camberwell Research Laboratories. In connection with the small outbreak of infection by streptococcus haemolyticus which occured at the Council's Maternity Home, 36 cultures were examined for this organism at the laboratory of the Lambeth Hospital. 6 DISTRICT NURSING The Council has an arrangement with the various Nursing Associations in the Borough, for a nurse to attend patients suffering from certain infectious diseases and minor ailments. 8,579 visits were made during the year. TREATMENT OF SPECIAL DISEASES. 11 persons are receiving treatment for diabetes and one for pernicious anaemia, at the Council's expense. PREVENTION OF DIPHTHERIA. There has been a reduction in the number of attendances at these Clinics as compared with 1942, when the attendances reached a record. 3,134 persons attended the Borough Council Clinics as compared with 4,209 in the previous year, and 1,845 in 1941. The number of children who attended the Clinics held at the L.C.C. Schools has fallen from 3,063 to 1,698. At the close of 1942, the Borough Council had five Clinics in operation, six sessions being held every week. Two of these were held concurrently with Infant Welfare Clinics, as it was found to be an encouragement to mothers to have their children immunised at the same time as they were brought to the Infant Welfare Clinics. During 1943, three more Clinics were opened on Infant Welfare Centre premises, and at the end of the year there were eight separate Clinics for the prevention of Diphtheria in operation throughout the Borough, a weekly session being held at each. In 1944, It was found necessary to close all but two of these Clinics, and the only two in operation in 1944 are at the Municipal Buildings, Fairfield Street—Wednesdays, 2-3.30 p.m., and Balham Infant Welfare Centre, 91 Bedford Hill—Fridays, 2-3.30 p.m. 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 giver, at monthly intervals. For persons over the age of 15, two injections, each of 1 c.c., of toxoid ante-toxin floccules (T.A.F.) are given. The total number of children immunised during the year was:— At the Borough Council's Clinics 3,115 At L.C.C. Clinics 1,698 Total 4,813 7 Vaccination. 1,672 births were notified to the Vaccination Officers during 1942. 967 children were vaccinatcd successfully, and 354 were exempted under declaration of conscientious objection. The percentage of children vaccinated to total births was 57.8 per cent. TUBERCULOSIS. The number of new cases which came to the notice of the Department during the year was 632 compared with 646 in 1942, and 618 in 1941. 553 were pulmonary, and 79 non-pulmonary tuberculosis. 193 deaths were certified as due to diseases of a tuberculous nature, the death-rate being .73. There were fewer deaths from this disease than in 1942, when 221 deaths were recorded, and in 1941, when the number was 231. The 632 new cases were added to the Notification Register, and 447 who had removed, recovered or died were taken off, the number remaining on the Register at the end of the year being 2,398. The two Tuberculosis Dispensaries which are at the Municipal Buildings, Wandsworth, and 114 Gosberton Road, Balham, have operated throughout the year, and 1,890 new cases, attended. Of these 353 were diagnosed as suffering from tuberculosis, 223 were suspected cases, and 1,314 were nontuberculous. Of the 1,890 new cases examined, 498 were contacts, 29 of whom were found to be suffering from tuberculosis. The number of cases remaining on the Dispensary Register at the end of 1943, was 1,827 compared with 1,597 in 1942, The total attendances at the Dispensaries was 5,646. 652 patients received institutional treatment. 3,903 attendances were made for light and other special treatment, and 1,321 X-ray examinations were made. The number of personal consultations with doctors was 1,202. Home visits made by the Tuberculosis Officers totalled 1,555, and the Health Visitors made 4,603 visits. Artificial pneumo-thorax treatment has been carried out at several hospitals by arrangement. 220 cases were treated and 3,525 refills were administered. Thirteen patients received dental treatment. Extra nourishment as authorised by Section 219 of the Public Health (London) Act, 1936, has been granted to 68 patients, and 63 cases who were ineligible under the scheme received extra nourishment through the Public Assistance Committee. 8 Mass Radiography. Arrangements were made for the Mass Radiography Unit to operate at one of the First Aid Posts in the Borough early in the New Year. Tuberculosis Care Committee. This Committee, which meets once a month at 3 p.m., is constituted of members of the Borough Council, representatives of authorities and organisation interested in the welfare of persons suffering from tuberculosis, and ladies and gentlemen who have a special interest in the work. Activities of the Care Committee. Details of the home conditions and financial circumstances of patients who are to receive institutional treatment are investigated. The Committee also fix the amounts patients should contribute towards the cost of dental treatment provided by the Borough Council. All persons found to be suffering from tuberculosis are interviewed by the Secretary who is able to give them advice and assistance in many directions. She also pays regular visits to patients who are being nursed at their homes, or in one 'of the London County Council's general hospitals. 2,400 patients were visited or interviewed during the year. The Committee controls a Fund, maintained by voluntary contributions, from which grants are made to patients who are ineligible for assistance from other organisations. Assistance) from the Fund is granted to relatives to enable them to visit patients undergoing treatment in institutions. Patients are also assisted with their removal expenses to better housing accommodation, and with arrears of rent and insurance payments. Clothing is supplied when required, and medical and nursing requisites are lent to those who need them. An: amount of £151 16s. 6d. was spent in this manner during the year. The Government scheme for assisting tuberculous persons who had to give up remunerative work in order to undertake treatment, came into force in July, 1943. Under this Scheme, financial assistance is only granted to patients suffering from the pulmonary forms of tuberculosis, and is limited to those who have every prospect of returning to work six months after completion of sanatorium treatment. Chronic cases are not eligible. Single men and women who are not entitled to any National Health benefit whilst undergoing treatment in an institution are eligible for pocket money up to 5/- per week. 9 Handicraft Class. The Committee maintains a Handicraft Class where patients suffering from tuberculosis are taught to make articles which they can sell. The class meets at the Wandsworth Dispensary every Monday afternoon from 2.30 to 4.30 Prior to the outbreak of war, a trained instructress conducted the class, but it has not been possible to obtain her servivces since, so the class is now conducted under the supervision of the Secretary of the Committee, with assistance from those patients who have become proficient in the work. The crafts taught include the making of articles in leather, embroidery, knitting and the making of gloves. MATERNITY AND CHILD WELFARE. Of the 4,491 births which occured during the year, 4,071 or 90.64 per cent were visited by the Health Visitors. The; total number of visits made by these officers for all purposes, was 42,464. In addition they attended at Clinics, etc., on 2,934 occasions. There are 10 Infant Welfare Centres, and nine Antenatal Clinics in operation in the Borough. The number of attendances made at these Clinics was 53,866 and 9,145 respectively. Post-natal attendances were 507. 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 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. 451 patients were seen for the first time, and the number of attendances made at the Clinic by all patients was 1,515. 104 women were granted assistance towards the cost of their dentures, the Council contributing £283 11s. Od. The Council grants financial assistance to women who are unable to pay for the attendance of a qualified midwife at their confinements. Six 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 94 cases during 1943. The Council provides a consultant to be at the service of any doctor who desires him to see one of his patients during pregnancy, at a confinement or during the lying-in period. His services were utilised on one occasion during the year. 10 10 Maternity and Child Welfare. PARTICULARS OF CLINICS. Address of Clinic. Days and Times of Sessions. Infant Welfare Clinics. Ante-Natal Clinics. Balham: 91, Bedford Hill. Wednesdays and Thursdays at 1.30 p.m. Every Friday at 9.45 a.m. Clapham: Clapham Dispensary, 42, Clapham Manor Street. Tuesdays and Wednesdays at 2 p.m. Every Monday at 2 p.m. Putney: 2, Clarendon Drive. Tuesdays and Wednesdays at 2 p m. 1st and 3rd Wednesdays in every month at 10 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. — Southfield: 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. Central Wandsworth: Municipal Buildings, Fairfield Street. Wednesdays at 10 a.m. Every Monday at 2 p.m. Dental Clinic. Municipal Buildings, Fairfield Street. Every Monday, Tuesday and Friday at 2 p.m. 11 An emergency obstetric unit is maintained by the London County Council, and is available to doctors and midwives on request. The object of the service, is to deal with acute obstetric emergencies in connection with maternity cases which could not be moved to hospital without undue risk. The unit was utilised on six occasions during the year. Grants amounting to £106 7s. 3d. were made to the Southwark Diocesan Association towards the maintenance of unmarried mothers in their institutions. Eight families were supplied with milk under the Milk (Mothers and Children) Order, 1918. The cost to the Council was £3 3. Od. The Ministry of Food Welfare (Foods) Schemes provide that all children and expectant mothers holding a green ration book, are entitled to receive one pint of liquid milk a day at 2d. a pint. They can also obtain the following vitamin foods:— cod liver oil, orange juice, and vitamin tablets. The latter are for expectant mothers only. This scheme is administered by the Ministry of Food through the local food offices. Eight children have been sent to Convalescent Homes at a cost to the Council of £25 7s. 6d. 351 children under school age suffering from minor ailments were referred to the London County Council for treatment. The cost to the Borough Council for this service was £83 15s. Od. A clinic for artificial sunlight and massage for children under five years of age when recommended by the Infant Welfare Centres and hospitals, is held at the Municipal Buildings on Tuesdays and Fridays at 2 p.m. During the year, 124 children were seen at the Clinic, and they made 1,630 attendances. Each Health Visitor has been appointed Infant Life Protection Visitor for her district, and carries out the duties relating to child life protection, under Part XIII of the Public Health (London) Act, 1936. At the end of the year there were 56 foster-mothers registered with the Council, and they had charge of 90 children. 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. During the year, 333 women were admitted. The average duration of stay in the Home was 13.97 days. One death occurred due to mitral stenosis. 12 Owing to a slight outbreak of infection by Streptococcus haemolyticus, eight cases having occurred during the months of May and June, the home was closed from 16th July to 1st August, for the purpose of carrying out thorough cleansing1 and re-decoration. Patients were re-admitted on the 2nd August. No further cases have occured since the Home was re-opened. WAR TIME NURSERIES. By the end of 1943, the Council had established 10 War Time Day Nurseries, which were authorised to accommodate 495 children. To supplement the provision made by the Borough Council, the London County Council has set up nurseries with accomodation for 86 children at three of their Rest Centres. Proposals for opening two further nurseries in Upper Richmond Road, Putney, and Summerly Street, Wandsworth, were well in hand by the end of the year. Particulars of War Time Day Nurseries. Address Authorised No. of children Date of opening 95, Lacey Road, S.W.15. 35 2.3.1942. 72, West Hill Road, S.W.18. 44 12.7.1943. Fairfield Street, S.W.18. 50 12.1.1942. 204, Mitcham Road, S.W.17. 50 11.5.1942. Sherwood Avenue, S.W.16. 50 28.6.1943. 3, Christchurch Road, S.W.2. 64 23.11.1942. 22, Old Devonshire Road, S.W.12. 40 2.3.1942. 72, Endlesham Road, S.W.12. 52 1.2.1943. 14 Cresset Street, S.W.4. 50 27.5.1943, 3/5, Larkhall Rise, S.W.4. 60 28.6.1943. 13 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, have increased from 17,927 in 1912, to 23,613 in 1943. The inspection and supervision of the public air raid shelters in the Borough, has been continued, and 4,235 visits were made for this purpose. The total number of inspections made by the Inspectors for all purposes during the year, was 41,072. 5,100 defects were found. Proceedings at the Police Court were instituted in 17 instances to enforce compliance with notices served. 765 visits were made on account of verminous conditions of houses or bedding. 398 inspections of sanitary conveniences were made. 1,024 complaints of the presence of rats were investigated by the Council's rat catcher, who made 2,315 visits and laid baits. As a normal routine, 7,603 baits were laid in sewers throughout the Borough during the year, and 4,636 baits were taken. The Director of Infestation Control, Ministry of Food, inaugurated an intensive rat campaign towards the end of the year, and requested all Metropolitan Boroughs to take concerted action, and to carry out treatment of the sewers on two occasions. This was done in December, 1943, and again in January 1944. In this Borough, 3,469 baits were laid during the first treatment resulting in the estimated destruction of 28,400 rats. On the second occasion 3,464 baits were laid, when it was estimated that 14,200 rats had been destroyed. MORTUARY AND CREMATORIUM. The Mortuary at Wandsworth was used throughout the year, and 261 bodies were received there. As Medical referees under the Crematorium Regulations, 1930, Dr. MacDonnell and I have authorised 296 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 9,084 dwelling-houses were inspected for defects by the Sanitary Inspectors, the total number of inspections made being 26,738. 2,969 houses were found not in all respects reasonably fit for human habitation, and of these, 614 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 2,341 houses, and in 5 00 houses the service of nuisance notices was necessary. 14 OVERCROWDING. 67 dwellings were recorded as overcrowded at the end of the year. 38 cases of overcrowding, representing 258 persons, have been abated during the year. SUPERVISION OF FOOD. There are four inspectors engaged in the supervision of the food supply. Tne number of separate food premises is 2,246, and during 1943 they were inspected on 23,759 occasions. There are 134 registered dairies and 141 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. 443 samples were submitted for analysis. 434 of these were genuine, with an average fat content of 3.61 per cent. 13 samples of milk were submitted for bacteriological examination and the phosphatase test. All were reported genuine and complying with the standard laid down. 70 licences for the sale of designated milks were granted during the year—35 for Tuberculin Tested Milk, 34 for Pasteurised Milk, and one for Tuberculin Tested (Pasteurised) Milk. There are three slaughterhouses in the Borough, but only one is used at the present. 268 animals were inspected cither before or after slaughter. During the year, 13 piggeries were licensed for the duration of the war. 420 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 unfi't 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, 10 applications were received from persons desirous of acting as slaughtermen. 147 consignments of foodstuffs of all kinds suspected to be unsound, were examined at the request of the owners, and afterwards released for animal feeding. The owners were granted a certificate to this effect. 15 FOOD AND DRUGS ADULTERATION ACT, 1928. 1,529 samples were procured for analysis during the year— 443 samples of milk, 979 other foodstuffs, and 107 drugs. 16 samples were found to be adulterated. Nine were samples of milk, two of sugar, and one each of cakes, sausages, haricot beans, butter and mustard. Police Court proceedings were instituted against two farmers in respect of two samples of milk wnich contained extraneous water. One case was dismissed under the Probation of First Offenders Act, on payment of £2 2s. Od. costs, and in the other case, a conviction was obtained, and a fine of £10 with £15 costs imposed. Pharmacy and Poisons Act, 1933 and Pharmacy and Medicines Act, 1941. Aplications were received from 215 persons for their names to be entered on the Council's Register of sellers of poisons included in Part II of the Poisons List. 523 inspections under these Acts were made by the Food Inspectors. FACTORIES AND WORKSHOPS. There were 1,143 factories and workshops on the Register at the end of 1943, and in addition, 537 persons were receiving work to be done in their homes. REPORT OF THE PUBLIC ANALYST. Owing to war conditions, only 1,529 samples were submitted, 29 being formal and 1,500 informal. All the formal samples were milk. The samples submitted for analysis consisted of 443 milk, 979 other foodstuffs and 107 drugs. Nine of the samples of milk were found to be adulterated. The average composition of the milk analysed during the year was:— Total milk solids, 12.46, milk fat 3.6, non-fatty solids, 8.85. Seven samples of other foodstuffs were found to be adulterated, viz.:— two sugar containing 20 and 40 per cent of Epsom salts; cakes containing rancid fat; pork sausages, deficient in meat; haricot beans containing pieces of chalk; mustard which did not contain one of the ingredients required, viz. black mustard; butter which on analysis proved wholly margarine. 16 Samples of the following substances were analysed:— arrowroot, 7 samples; butter, 102; cake, 6; cereals, 18; cheese. 101; cocoa, 13; coffee, 8; essences, 10; lard, 101; fish, canned or in paste form, 38; flour, 7; food powder, 36; ginger, 4; jam, 17; margarine, 101; meat products, 40; mustard, 8; pepper, 3; pickles and sauces, 22; rice, 15; salt. 6; spice, 16; soup, canned, 14; sugar, 103; tea, 100; vegetables, canned, 32. The average water content of the 102 samples of butter was 14.9 per cent; that of the 101 samples of margarine, 15 per cent. 17 of the samples were submitted for analysis on the complaint of ratepayers, viz.:— one sample of butter, one of cake, one of coffee extract, one of dessert powder, one of gelatine and starch powder, two of flour, one of horse-radish powder, three of milk, one of milk pudding powder, one of mustard, one of onion extract, two of sugar and one of whisky. The sample of butter on analysis proved wholly margarine, the one of cake made of rancid fat; of the three samples of milk, only one was reported against—containing "bacillus prodigiousus," which is a harmless bacterium. The one of mustard did not contain one of the ingredients required, viz. black mustard; both samples of sugar contained Epsom salts. The other 11 samples were reported genuine. In conclusion, I have to report that the adulteration detected during 1943, was 27.6 per cent of the formal samples, and 0.5 per cent of the informal samples, and 1.0 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.ii. A J. HURLEY, Ltd. GENERAL PRINTERS 119-121, CHARLMONT ROAD, TOOTING, S.W.17