AC43 88 WAN 82 Metropolitan Borough of Wandsworth Annual Report of the Medical Officer of Health for the Year 1945 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 1945 by F.G. CALEY, M.A., M.B., B.Ch., D.P.H. together with the Report of the Public Analyst. 2 REPORT of the Medical Officer of Health for the Year 1945. 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 Rorough for the year 1945, together with the Report of the Public Analyst. Although the number of births shows a further increase over the previous year, the birth rate of 16.94 is lower than in 1944 when it was 17.39, owing to the fact that the estimated population on which the rate is calculated, is higher. In spite of an increase in the population, the death rate has fallen from 1G.40 in 1944, to 1269. This is mainly accounted for by a decrease in the number of deaths from violent causes. It is also gratifying to note that the deaths from Cancer have fallen from 604 in 1944 to 537. The number of deaths from tuberculosis has fallen from 201 to 179, and the death rate from this disease is .67 compared wth .79 in 1944. There has been a large increase in the number of cases of Measles, but this has not been attended by a corresponding increase in the mortality. The number of children immunised against diphtheria has increased, and there are now eight clinics open every week. Children have received immunising injections at these clinics for whooping cough, and there is quite a demand from parents for these injections. 186 women were admitted to the Council's Maternity Home, which was re-opened at the end of February after being evacuated to Bolton in August, 1944. 12 War Time Nurseries have been open throughout the year, and there is still much demand for Nursery accommodation for children. I am, Sir, Ladies and Gentlemen, Your obedient Servant, F.G, CALEY, Medical Officer of Health. 3 STATISTICS Population 204,480. (1944, 251,510. Census 1931, 353,100). Total live births, 4,482. (M. 2,293; F. 2,189) (1944, 4,376). Illegitimate births, 371. Still-births, 90. Birth-rate, 16.94 (1944, 1739). Total deaths, 3,339. (M. 1,658; F. 1,681). (1944, 4,126) Death-rate, 12.69 (1944, 16.40). There were nine deaths from puerperal causes—equal to a rate of 1.96 per 1.000 live and still bjrths. Deaths of children under one year of age were 177, the infantile mortality rate being 39 per 1,000 births (1944, 40). Deaths from Cancer 537 (1944, 604). Measles 4 (1944, 1). Whooping Cough 3 (1944, 7). Tuberculosis 179 (1944, 201). Tuberculosis death-rate .67 (1944, .79). There was no unusual or excessive mortality during the year. STAFF. There are now 16 Health Visitors in the Council's) Maternity and Child Welfare Service and three in the Tuberculosis Service. Twenty-one temporary clerks were employed in the Department at the end of the year. Mr. F. Bray, Chief Clerk of the Department, retireid in October. He had completed 42 years' loyal and devoted service under the Council- Mr. P.C. Clark, Grade "C" Clerk, was superannuated on account of ill health after nearly 42 years' loyal service. Messrs. A.G. Patterson and C. Gessner, Grade "B" Clerks, were promoted to be Grade "C" Clerks. 4 Mr. A. E. Vickers, Senior Sanitary Inspector, was appointed Chief Sanitary Inspector as from 18th October. In May and June Messrs. A. F. Saunders and A. J. Lansley resigned their appointments as Sanitary Inspectors after 7 and 10 years' service with the Council, having obtained similar appointments in other London Boroughs. Messrs. E. Wall and J. H. Massey were appointed to fill the vacancies- INFECTIVE DISEASES There has been an increase in the amount of infective disease during the year, the number of notifiable diseases having risen from 3,913 in the previous year, to 5,474. Measles is mainly responsiblefor this increase. 2.471 cases were reported during the year, compared with 429 in 1944. 314 cases of Dysentery have been notified compared with 241 in the previous year; 74 of these occurred among patients in Springfield Mental Hospital, and 177 in Tooting Bec Hospital. There were no deaths. Five cases of typhoid fever were notified. There were no deaths. There were 10 cases of cerebro-spinal meningitis with one death, compared with 13 and two in the previous year. Five cases of polio-myelitis were notified, and there were two deaths. No case of this disease was notified in 1944. 847 cases of scabies have been notified. 1,561 cases of scabies were treated at the Council's Cleansing Station under the supervision of the two bathing attendants. The majority of the cases are now treated by the benzyl benzoate method. BACTERIOLOGICAL EXAMINATIONS. All these examinations are carried out by the Camberwell Research Laboratories. During the year 963 diphtheria cultures and 838 specimens of sputum were examined. Twenty-one cultures for dysentery, twenty-three for streptococcus hæmolyticus and fifty-two for staphylococcus aureus were also examined. 5 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. 6,133 visits were made during the year. TREATMENT OF SPECIAL DISEASES. 16 persons received treatment for diabetes and one for pernicious anæmia at the Council's expense. The cost during the year was £81. 14s. 4d. PREVENTION OF DIPHTHERIA There has been an increase in the number of attendances at these Clinics as compared with 1944. 2.827 persons attended the Borough Council Clinics as compared with 1,777 in the previous year, and 3,134 in 1943. The number of children who attended the Clinics held at the L.CC. Schools has fallen from 525 to 266. At the close of 1945, the Borough Council had seven Clinics in operation, eight sessions being held every week. The Immunising Agent. The solution now used for routine immunisation is alum precipitated toxoid (A.P.T.) and two injections of ½c.c,, each are given at monthly intervals. For persons over the age of 15, three 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 2,561 At L.C.C. Clinics 266 Total 2,827 PREVENTION OF WHOOPING COUGH. Immunisation of children against whooping cough is now carried out at the Diphtheria Immunisation Clinics, when parents wish to have it done. 6 Three injections of .5 c.c. each are given weekly for three weeks, and a fourth injection of 1 c.c. at the end of the fourth week. VACCINATION. 1811 births were notified to the Vaccination Officers during 1944. 981 children were vaccinated successfully, and 329 'were exempted under declaration of conscientious objection. The percentage of children vaccinated to total births was 54.1 per cent. TUBERCULOSIS. The number of new cases which came to the notice of the Department during the year was 588 compared with 654 in 1944 and 632 in 1943. 513 were pulmonary and 75 non-pulmonary tuberculosis. 179 deaths were certified as due to diseases of a tuberculous nature, the death-rate being .67. There were 22 fewer deaths from this disease than in 1944, when 201 deaths were recorded. In 1943 the number was 193. 588 new cases were added to the Notification Register, and 511 who had removed, recovered or died were taken off, the number remaining on the Register at the end of the year being 2,677. During the year 1,562 new cases attended. Of these 339 were diagnosed as suffering from tuberculosis, 291 were suspected cases, and 932 were non-tuberculous. Of the 1,562 new cases examined, 306 were contacts, six of whom were found to be suffering from tuberculosis. The number of cases remaining on the Dispensary Register at, the end of 1945 was 2,106 compared with 1,947 in 1944. The total attendances at the Dispensaries was 5,622. 540 patients received institutional treatment. 4,733 attendances were made for light and other special treatment, and 1,500 X-ray examinations were made. The cost to the Council was £6 10s. Od- and £562. 10s. Od, respectively. The number of personal consultations with doctors was 1,242. Home visits made by the Tuberculosis Officers totalled 2,008 and the Health Visitors made 4,121 visits. 7 Artificial pneumothorax treatment has been carried out at several hospitals by arrangement. 245 cases were treated and 4,707 refills were administered. Cost £2,291. 17s. Od. 16 patients received dental treatment. Cost £29. 15s. Od. Extra nourishment as authorised by Section 219 of the Public Health (London) Act, 1936, has been granted to 16 patients, and 108 cases who were ineligible under the scheme received extra nourishment through the Public Assistance. Committee. Cost £22.. 3s. Od. Tuberculosis Care Committee. This Committee, which meets once a month, is constituted of members of the Borough Council, representatives of authorities and organisations 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 arc interviewed by the Secretary who is able to give them advicc and assistance in many directions. She also pays regular visits to patients who are being nursed at their homes, or in on,e of the London County Council's general hospitals. 2,596 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, with arrears of rent and insurance payments, and fares to sanatoria. Clothing is supplied when required, and medical and nursing requisites are lent to those who need them. An amount of £228. 4s. 3d, 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 8 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. 812 patients received assistance under the schcme. Handicraft Class A Handicraft Class is maintained by the Care Committee where tuberculous patients who are not fit for normal work, 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. The Class is conducted under the supervision of the Secretary and an Instructress. The crafts taught include the making of articles in leather, embroidery, knitting, felt work and the making of gloves. MATERNITY AND CHILD WELFARE. Of the 4,482 births which occurred during the year, 4,081 or 91.05 per cent were visited by the Health Visitors. The total number of visits made by these officers for all purposes. was 42,653. In addition they attended at Clinics, etc., on 2,495 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 52,839 and 7,174 respectively. Post-natal attendances were 346. 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. 518 patients were seen for the first time, and the number of attendances made at the Clinic by all patients was 1,437. 51 women were granted assistance towards the cost of their dentures the Council contributing £134. 3s. Od. 9 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 Monday at 1.30 p.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, 3rd&5th Wednesdays in every month at 10 a.m. Streatham : 37, Riggindale Road. Tuesdays and Fridays at 1.30 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 and Wednesdays 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. Mondays and Fridays at 2 p.m. 1st, 3rd & 5th Fridays in every month at 9.30 a.m. Springfield : Congregational Church Hall, Earlsfield Road. Tuesdays at 1.45 p.m. 2nd.4th& 5th Thursdays in every month at 2 p.m. Central Wandsworth : Municipal Buildings, Fairfield Street. Tuesdays at 2 p m. 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. 10 The Council grants financial assistance to women who are unable to pay for the attendance of a qualified midwife at their confinements. One woman 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 75 cases during 1945. 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 confinlement or during the lying-in period. His services were not utilised during the year. 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. 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. The Scheme is administered by the Ministry of Food through the local food offices. 10 children have been sent to Convalescent Homes at a cost, to the Council of £58. 10s. Od. 209 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 £40. 12s. 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, 160 children were seen at the Clinic, and they mdde 1,549 attendances. 8 women attended the Clinic post-natally, and made 38 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 63 foster-mothers registered with the Council, but only 50 were receiving children, 89 being in their care. PREMATURE INFANTS 11 Special records are kept of all premature infants. They are visited as soon as notified and kept under observation by the Health Visitors until they are satisfied that they are making satisfactory progress. There were 124 premature births, during the year, 34 having occurred at home and 90 in hospitals. Of those born at home, 28 were nursed at home; and 27 lived through the first month! of life. Of those born in Hospitals, 21 died in the first 24 hours and 10 others during the first month ; 93 survived and are alive and well. ILLEGITIMATE CHILDREN For some years past the Council has paid grants, on a per capita basis, to the Southwark Diocesan Association towards the maintenance of unmarried mothers whose homes are in the Borough. For the three years 1942 to 1944, grants amounting to £281. 8s. 5d. were paid. In Circular 286G dated 1st October, 1943, the Minister of Health requested Welfare Authorities to give special consideration to the problems arising under war conditions in connection with illegitimate children, and suggested that the most promising line of attack would be to reinforce the work of existing voluntary moral welfare associations. The Metropolitan Boroughs' Standing Joint Committee. after investigating . the matter on behalf of the London B'oroughs, came to the conclusion that the work of the voluntary organisations was hampered by lack of funds and decided to recommend each Council to grant increased financial assistance to the Associations on the basis of rateable value. The amount apportioned to Wandsworth on this basis was £343 per annum and the Council agreed' to pay this amount from the 1st January, 1945 as annual grant to the Southwark Diocesan Association in lieu of the per capita grants previously made. MATERNITY HOME. The Council's Maternity Home, was re-opened at the end of February, having been closed since August 1944. 12 186 women were admitted in 1945. The average duration of stay in the Home was 14.11 days. 252 new cases attended the Ante-natal Clinic, and made 1,991 attendances, and 88 cases attended the Post-natal Clinic and made 88 attendances. WAR TIME NURSERIES. By the end of 1945, the Council had established 12 War Time Day Nurseries, which were authorised to accommodate 602 children. These Nurseries have been in demand during the year, and full use has been made of the accommodation available. Particulars of War Time Day Nurseries. Address Authorised No. of children Date of opening 399, Upper Richmond Road, S.W.15. 51 20.3.1944. 95, Lacy 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. 20/32, Summerley Street, S.W.18 56 30.5.1944, 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. SANITARY SUPERVISION OF THE BOROUGH. Inspections made for the purpose of investigating complaints numbered 15,813. The total number of inspections made by the Inspectors for all purposes during the year was 18,444, 4,395 defects were found. Proceedings at the Police Court were instituted during the year in respect of four premises. 82 visits were made on account of verminous conditions of houses or bedding. 218 inspections of sanitary conveniences were made. 13 1,080 complaints of the presence of rats were investigated by the Council's rat catchers who made 2,712 visits and laid baits. MORTUARY AND CREMATORIUM. The Mortuary at Wandsworth was used throughout the year, and 262 bodies were received there. As Medical Referees under the Crematorium Regulations, 1930, Dr. MacDonnell and I have authorised 391 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 8,317 dwelling-houses were inspected for defects by the Sanitary Inspectors, the total number of inspections made being 16,477. 2,728 houses were found not in all respects reasonably fit for human habitation, and of these 129 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 2,217 houses, and in 212 houses the service of nuisance notices was necessary. OVERCROWDING. 94 dwellings were recorded as overcrowded at the end of the year. 11 of the above were new cases. One case of overcrowding, representing 5 persons has been abated during the year. The smallness of this number is accounted for by all available accommodation being required for bombed-out families. SUPERVISION OF FOOD. There are four inspectors engaged in the supervision of the food supply. The number of separate food premises is 2,372, and during 1945 they were inspected on 27,125 occasions. 14 There are 127 registered dairies and 268 persons registered to sell milk from premises other than dairies. 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. 708 samples were submitted for analysis. 700 of these were genuine, with an average fat content of 3.63 per cent. 219 samples of milk were submitted for bacteriological examination, the phosphatase test and the methylene blue test. 23 of these failed to comply with the prescribed tests. 78 licences for the sale of designated milks were granted during the year—41 for Tuberculin Tested milk, 36 for Pasteurised Milk, and one for Tuberculin Tested (Pasteurised) Milk. There are four slaughterhouses in the Borough, but only one is used at present. 103 animals were inspected either before or after slaughter. There arc now 32 war-time piggeries in the Borough. 281 inspections 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, who made 792 visits during the year. During these visits, 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, six applications were received from persons desirous of acting as slaughtermen. 157 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. FOOD AND DRUGS ADULTERATION ACT, 1928. 1771 samples were procured for analysis during the year— 708 samples of milk, 929 other foodstuffs, and 134 drugs. 15 14 samples were found to be adulterated. Four were samples of milk, one of Seidlitz Powder, two of Wine ; two of Cake Mixtures; one of Sulphur Ointment ; one of Ready Made Mustard!; one of Dried Parsley; one of Dried Mixed Herbs and one of Oats. It was not necessary to take Police Court proceedings in any of the cases. Pharmacy and Poisons Act, 1933 and Pharmacy and Medicines Act, 1941. Applications were received from 277 persons for their names to be entered on the Council's Register of sellers of poisons included in Part II of the Poisons List. 609 inspections under these Acts were made by the Food Inspectors. FACTORIES AND WORKSHOPS. There were 1.27G factories and workshops on the Register at the end of 1945, and in addition, 157 persons were receiving work to be done in their homes. REPORT OF THE PUBLIC ANALYST. Owing to war conditions, only 1,771 samples were submitted, 11 being formal and 1,760 informal. All the formal samples were milk. The samples submitted for analysis consisted of 708 milk, 929 other foodstuffs and 134 drugs. Eight of the samples of milk were found to be adulterated. The average composition of the milk analysed during the year was:—■ Total milk solids, 12.41, milk fat 3-63, non-fatty solids, 8-78. Ten samples of other foodstuffs were found to be adulterated, viz :— 2 Wine, deficient in alcohol ; 2 Cake Mixtures, decomposed;'; 1 Sulphur Ointment, decomposed ; 1 Ready Made Mustard, decomposed ; 1 Dried Parsley, excess of ash ; 1 Dried Mixed Herbs, excess of ash ; 1 Oats, contained maggots ; 1 Seidlitz Powder, below B.P- standard- 16 Samples of the following substances were analysed:— arrowroot, 1 sample; butter, 76; cake, 3; cereals, 31; cheesc, 75; cocoa, 11; coffee, 12; essences, 16; fish, canned or in paste form, 45; flour, 4; food powder, 28; ginger, 3: jam, 17; lard, 75; margarine, 74; meat products, 23; mustard, 9: pepper, 2; pickles and sauces, 14; rice, 5: salt, 7 soup, canned, 23; spice, 28; sugar, 75; tea, 75; vegetables, canned, 27. The average water content of the 76 samples of butter was 15.1 per cent ; that of the 74 samples o'f margarine, 14.9 per cent. Seven of the samples were submitted for analysis on the complaints of ratepayers, viz:— three samples of wine, two of milk, one of oatmeal, and one of ready made mustard. Two of the samples of wine were found to be of poor quality, but the other five samples were up to standard. fn conclusion I have to report that the adulteration detected during 1945 was 14.3 per cent of the formal samples, 0.85 per cent of the informal samples, and 0.9 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. 4 « A. J. HURLEY. Ltd. Printers 119-121 Charlmont Road Tooting, : S.W.17 8608