AC 4388 WAN 85 Metropolitan Borough of Wandsworth Annual Report of the Medical Officer of Health for the Year 1948 by F. G. CALEY, M.A., M.B., B.Ch., D.P.H., together with the Report of the Public Analyst 1 REPORT of the Medical Officer of Health for the Year 1948. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Wandsworth. Your Worship, Ladies and Gentlemen, I beg to present my Annual Report on the Health of the Borough and on the services administered during the year 1948. Under the provisions of the National Health Service Act, 1946, the Tuberculosis, Maternity and Child Welfare, Home Nursing and Home Help Services, together with the administration of vaccination and the clinics for the prevention of diphtheria, were transferred to the control of the London County Council as from 5th July, 1948. The officers employed in operating these services have also been transferred. For the purpose of the administration of these transferred services the Boroughs of Wandsworth and Battersea have been combined to form Division 9 of the London County Council area and the headquarters of the Division have been set up in the Municipal Buildings. The health of the Borough in 1948 was good and there was no unusual or excessive mortality during the year. The population was 332,500, an increase of 2,300 over the previous year. The birth rate has fallen from 20.17 in 1947, the highest recorded for 28 years, to 16.70. The death rate has fallen from 12.35 for 1947 to 11.28. The infantile mortality, at 31 per 1,000 births, is the same as for 1947 and is the lowest ever recorded. There were two maternal deaths, equivalent to a rate of .35 per 1,000 births. 2 Although there has been an increase of 1,292 in the number of notifiable diseases, this increase is accounted for by an epidemic of measles. 2,668 cases of this disease were notified during the year, but most of the cases were mild and only three deaths occurred. Only 16 cases of diphtheria occurred and there were no deaths from this disease. I am, Your Worship. Ladies and Gentlemen, Your obedient Servant, F. Gr. CALEY, Medical Officer of Health. 3 Population, 332,500. (1947 , 330,820.) Total live births, 5,556. (M. 2,899; F. 2,657.) (1947, 6,674.) Illegitimate births, 310. Still-births, 117. Birth-rate, 16.70. (1947, 20.17.) Total deaths, 3,751. (M. 1,878; F. 1,873.) (1947, 4,087.) Death-rate, 11.28. (1947, 12.35.) There were two deaths from puerperal causes—equal to a rate of .35 per 1,000 live and still-births. Deaths of children under one year of age were 175, the infantile mortality rate being 31 per 1,000 births. (1947, 31.) Deaths from Cancer 730 (1947, 715.) Measles 3 (1947, Nil.) Whooping Cough 6 (1947, 5.) Tuberculosis 181 (1947, 217.) Tuberculosis death-rate .54 (1947, .65.) STAFF The establishment of Sanitary Inspectors at the beginning of the year was 21, but only 19 were actually employed. Mr. C. Jones and Mr. A. J. Lansley were appointed in January, completing the establishment, which, however, was raised in July to 23, creating two vacancies. The resignation of Mr. A. W. E. Porter in August created a third vacancy. The three vacancies were filled in October by the appointments of Messrs. E. C. George, F. A. Evans and E. E. Morgan, leaving the establishment complete at the end of the year. In January Mr. A. A. Rees, Grade A.P.T. III Clerk, resigned, as did Mr. A. G. Patterson, Grade A.P.T. III Clerk, in March, and Mr. J. B. Peacock, General Division Clerk, in April. 4 Mr. L. R. Craig and Mr. E. G. Harris were appointed to the Council's staff as General Division Clerks in June. On 5th July, 1948, the following members of the staff were transferred to the London County Council in accordance with the provisions of the National Health Service Act, 1946. Administrative and Clerical : Miss W. M. Godwin, Miss U. M. King, Miss B. L. Newman, Miss M. .J. Graham, Mrs. M. A. Ellwood, Miss J. A. Young, Miss M. L. Baptie, Mrs. E. Elston, Mrs. M. E. Porcher, Mr. C. E. Gessner, Mr. E. S. Regan, Mr. R. E. Parker, Mr. A. K. Gale, Mr. A. D. Briggs, Mr. C. L. Taylor, Mr. F. E. Pyne, Mr. A. Douglass, Mr. L. R. Craig. Health Visitors : Miss E E. K. Woods, Miss N. Hancocks, Miss M. Dean, Miss G. Nea'll, Miss D. M. Staniland, Miss H. M. McCarthy, Miss G. Smith, Miss K. Kenion, Miss R. Jones, Miss. M. Savage, Miss E. M. Wilkinson, Miss E. A. Evans, Miss E. E. Chesworth, Miss K. M. Evans, Miss S. Connor, Miss J. Harris, Miss C. Crump, Miss D. M. Ereeman, Mrs. O. M. Filewod, Miss M. E. Price, Mrs. M. D. Prevot, Miss A. Thompson, Miss R. M. Watling, Miss M. C. Kailey. The following members of the staff were transferred to the South West Regional Hospital Board on 5th July under the provisions of the same Act : Tuberculosis Officers : Dr. J. J. MacDonnell, Dr. L. A. S. Trott. Clerical Staff : Mr. L. L. Parrini, Miss H. G. Wright, Mrs. J. Scobell, Miss E. Giles, Miss J. Hewitt. The clerical establishment was revised in November and the Misses S. O. Spicer and M. D. Shufflebotham and Messrs. J. A. Brown, J. E. Higgs, S. Taylor, N. Lane and C. F. Nargang were placed on the permanent staff. INFECTIVE DISEASE There has been an increase in the amount of infective disease during the year, the number of notifiable diseases having risen from 3,271 in the previous year to 4,563. Measles was responsible for this increase, '2,668 cases being notified during the year, compared with 1,241 in 1947. 5 ACUTE PRIMARY AND ACUTE INFLUENZAL PNEUMONIA. These are the notifiable forms of pneumonia. There were 179 notifications of the former and 38 of the latter during 1948. CEREBRO SPINAL MENINGITIS. (Cerebro-spinal Fever, Meningococcal Meningitis, "Spotted Fever"). Eight confirmed cases were notified and two others discovered through post-mortems. There were three deaths. A number of other cases were reported but were subsequently not confirmed. In the previous year 13 confirmed cases were notified with four deaths. ANTERIOR POLIOMYELITIS AND POLIOENCEPHALITIS. There were 15 confirmed cases with six deaths, compared with 75 and four respectively in 1947. DYSENTERY. Seventy-two cases were notified or reported during the year, 30 being from institutions. Five cases were subsequently held not to be dysentery. There was one death. TYPHOID AND PARA-TYPHOID FEVER. Seven cases were notified during the year, five of which were subsequently confirmed as para-typhoid. Diagnosis was not confirmed) in the remaining two cases. There were no deaths. DIPHTHERIA. The number of cases notified was 42 but diagnosis was not confirmed in 26 instances. The actual number of cases was therefore 16. No deaths occurred. SCARLET FEVER. 452 cases were notified as compared with 343 in the previous year. The diagnosis was not confirmed in four cases. There were no deaths. 6 FOOD POISONING. Twenty-seven notifications were received during the year. SCABIES. 114 cases were notified. 379 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 Camber well Research Laboratory which in October became a Public Health Service Laboratory directed by the Medical Research Council for the Ministry of Health. During the year, 880 diphtheria cultures and 544 specimens of sputum were examined. Twenty cultures for dysentery, 110 for streptococcus haemolyticus and 20 others were also examined. TRANSFERRED SERVICES The figures given in respect of the services which, on the 5th July, 1948, came under the control of the London County Council or the Regional Hospital Board, are for the period 1st January, 1948, to 5th July, 1948, only. DISTRICT NURSING The Council had an arrangement with the various Nursing Associations in the Borough for a nurse to attend patients suffering from certain infectious diseases and minor ailments. 4,080 visits were made to July 5th. 7 TREATMENT OF SPECIAL DISEASES The supply of insulin in cases of diabetes is now obtainable under the National Health Service. In the first six months of the year 23 persons received treatment at the Council's expense. The cost was £57 1s. 10d. PREVENTION OF DIPHTHERIA 2,565 persons attended the Borough Council clinics up to July 5th at which date seven clinics were in operation, eight sessions being held each week. PREVENTION OF WHOOPING COUGH Immunisation of children against whooping cough was also carried out at the Diphtheria Clinics, when parents wished to have it done. VACCINATION 1,912 births were notified to the Vaccination Officers during the first half of the year. 1,172 children, i.e., 61.29 per cent., were vaccinated successfully. 326 were exempted under declaration of conscientious objection. TUBERCULOSIS The number of new cases which came to the notice of the Department for the half-year was 354. 324 were pulmonary and 30 non-pulmonary tuberculosis. 354 new cases were added to the Notification Register and 246 who had removed, recovered or died were taken off, the number remaining on the Register at July 5th being 3,071. During the half-year, 1,079 new cases attended. Of these 224 were diagnosed as suffering from tuberculosis, 130 were suspected cases and 725 were non-tuberculous. 8 Of the 1,079 new cases examined, 388 were contacts, 13 of whom were found to be suffering from tuberculosis. The number of new cases remaining on the Dispensary Register at July 5th was 2,310. The total attendances at Dispensaries was 3,738. 251 patients received institutional treatment. 2,273 attendances were made for special treatment, and 1,036 X-ray examinations were made. The number of personal consultations with doctors was 804. Home visits made by the Tuberculosis Officers totalled 685 and the Health Visitors made 1,670 visits. Artificial pneumo-thorax treatment had been carried out at several hospitals by arrangement. 300 cases were treated and 2,273 refills were administered. Cost £1,076 14s. 6d. MATERNITY AND CHILD WELFARE The total number of visits made by the Health Visitors up to July 5th was 27,964. Of the 2,881 births which occurred up to July 5th, 2,653 or 92.09 per cent. were visited by the Health Visitors. There were eleven Welfare Centres operating in the Borough, infant sessions being held at all these Centres and ante-natal clinics at nine of them. 37,444 attendances were made at the infant clinics and there were 5,340 attendances of expectant mothers at the ante-natal clinics. No special post-natal clinics were held, but 336 women attended the ante-natal clinics for post-natal examination and advice. A Dental Clinic was held at the Municipal Buildings for expectant and nursing mothers and children under five years of age. Up to July 5th 399 patients were seen for the first time and the number of attendances made at the Clinic by all patients was 1,172. Five women were granted assistance towards the cost of their dentures, the Council contributing £10 7s. 6d. An emergency obstetric unit is maintained by the London County Council and is available to doctors and midwives on request. 9 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 eleven occasions up to 5th July. Eleven children were sent to Convalescent Homes as a cost to the Council of £60 18s. 0d. A clinic for artificial sunlight and massage for children under five years of age, when recommended by the Infant Welfare Centres and hospitals, was held at the Muncipal Buildings on Tuesdays and Fridays. During! the period up to July 5th 140 children were seen at the Clinic and they made 2,136 attendances. Three women attended the clinic post-natally and made 18 attendances. Sunlight and massage clinics were also held at 91. Bedford Hill, Balham, and at 37, Riggindale Road, Streatham. The Health Visitors also held the appointments of Infant Life Protection Visitors for their districts and carried out the duties relating to child life protection, under Part XIII of the Public Health (London) Act, 1936. At July 5th there were 83 foster-mothers registered with the Council, but only 70 were receiving children. 86 being in their care. PREMATURE INFANTS Special records were kept of all premature infants who were visited by Health Visitors as soon as notified and kept under observation until it was clear that they were making satisfactory progress. MATERNITY HOME 188 women were admitted up to July 5th and the average duration of stay was 14 days. 191 new cases attended the Ante-natal Clinic held at the Maternity Home and made 2,251 attendances. 162 cases attended the Post-natal clinic. 10 HOME HELPS SERVICE For many years the Council had granted financial assistance to expectant mothers who arranged to have their confinements at home and had engaged suitable women to assist them, if they were found to need such assistance. In January, 1946, the scheme was extended and provision made for home helps to visit sick and infirm persons and maternity cases who did not make their own arrangements. It was not always possible to meet all the demands received as the number of women available to act as home helps was limited. 35 were employed at date of transfer of the service to the London County Council, most of them working on a part-time basis. Applicants for the service were required to pay a proportion of the cost, according to their means. The following table shows the number of cases dealt with during the half-year:— Maternity cases. Other cases. Total. No. of cases dealt with and completed 133 88 221 No. of cases commenced but not completed by 5th July, 1948 27 62 89 160 150 310 No of applications received and investigated but subsequently cancelled by patients 85 136 221 245 286 531 DAY NURSERIES The need for Day Nurseries was still acute, and only children whose parents had compassionate reasons could be placed. With the approval of the Ministry of Health, 11 Day Nurseries were operating up to the date of transfer to the County Council. 11 SANITARY SUPERVISION OF THE BOROUGH There has been a large increase in the amount of work carried out by the Sanitary Inspectors during the year, and this is mainly due to the large number of complaints received from Borough residents. Sanitary defects were found at 8,452 houses, as compared with 9,417 in 1947 and 7,595 in 1946. At 806 houses the defects were remedied without the necessity for serving a notice, but intimation notices were required in respect of the remaining 7,646 houses. 4,113 of these notices were complied with during the year without the necessity of serving nuisance notices. A further 4,133 intimation notices served in 1947 were complied with in 1948. The number of nuisance notices served during 1948 was 1,975 and 2,018 such notices were complied with, including a number served in the previous year. Proceedings at the Police Court were instituted in respect of 80 premises. The total number of visits made by the Sanitary Inspectors during the year in connection with housing and nuisances was 58,926; this figure compared with 46,138 visits in 1947, and 44,531 in 1946. Nearly all these visits were for the purpose of investigating and dealing with complaints. WATER SUPPLY The bulk of the water supply in the Borough is provided by the Metropolitan Water Board, and this has been satisfactory, both in quality and quantity. CLEARANCE OF INSANITARY HOUSES Clearance Areas. Nos. 17-27 (odd) Garratt Lane, S.W.18, were declared a Clearance Area by the Council on 27th July, 1948. 12 On 17th September, 1948, the Ministry of Health confirmed the Clearance Order made by the Council in respect of Nos. 102, 102a, 104, 104a, 106, 106a. Greyhound Lane. A Public Enquiry was held at the Municipal Buildings on 9th November. 1948, by an officer of the Ministry of Health, in connection with the North Passage Clearance Area Order of 1947. The houses affected by the Order are 7-26 (inclusive) North Passage, and evidence was given at the enquiry in support of the Order. Demolition Orders. Orders have been made for the demolition of eight houses, namely 26, 28, 30, 32, 34. 36, 38, 40, Balham New Road. An appeal has been lodged by the owner. Closing Orders. Closing Orders were made on two basement flats comprising seven rooms. They were at 2b Floss Street and 11 Wimbledon Park Road. These basements were unoccupied at the end of the year. With regard to the Closing Orders made in 1947 on the basements of Nos. 37, 39 and 41 Byrne Road, the owners submitted proposals for carrying out alterations to render these basements habitable. The proposals were approved by the Council. RAT CAMPAIGN On the 16th July, 1946, the Council decided to participate in the Ministry of Food's Private Dwellings Special Scheme, which called for the systematic treatment by pre-baiting and baiting of areas in the Borough known to be infested by rats. The Ministry contribute 50 per cent. of the cost of the scheme, provided a charge is made to the occupiers of business premises which come under treatment as part of an area, and to householders whose neglect causes infestation. During the year 1,749 complaints of the presence of rats were investigated and dealt with by the Council's rat operatives, who made 25,044 visits. 13 MORTUARY AND CREMATORIUM The Mortuary at Wandsworth was used throughout the year and 243 bodies were received there. Dr. Bertha Sharpe, Medical Officer of Division 9. London County Council, and' Dr. G. Macdonald, Medical Officer of Health, Battersea, have now been appointed Medical Referees, in addition to Dr. MacDonnell and myself, under the Crematorium Regulations, 1980. During the year we authorized 634 cremations. SUPERVISION OF FOOD There are four Inspectors engaged in the supervision of the food supply. The number of separate food premises is 2,567 and during 1848 they were inspected on 40,982 occasions. There are 110 registered dairies and 301 persons registered to sell milk. 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. 886 samples were submitted for analysis. 875 of these were genuine, with an average fat content of 3.51 per cent. 315 samples of milk were submitted for bacteriological examination, the phosphatase test, and the methylene blue test. Five of these failed to comply with the prescribed tests. 106 licences for the sale of designated milks were granted during the year—13 for Tuberculin Tested milk, 38 for Pasteurised milk and 55 for Tuberculin Tested (Pasteurised) milk. 131 samples of ice-cream were submitted for bacteriological examination, the coliform test and the methylene blue test. Five samples of artesian well water were submitted for bacteriological and chemical examination. There are three private slaughterhouses in the Borough. Two animals were inspected either before or after slaughter. 14 There are now 19 war-time piggeries in the Borough. 125 inspections were made. During the year three applications were received from persons desirous of acting as slaughtermen. 119 varieties of foodstuffs suspected to be unsound were examined at the request of the owners and afterwards released for animal feeding. The necessary certificate was granted in every case. FOOD AND DRUGS ACT, 1938 2,112 samples were procured for analysis during the year—886 samples of milk, 1,102 other foodstuffs and 124 drugs. 18 samples were found to be adulterated, 11 of milk, one each of sponge mixture, tomato juice, barley flakes, saccharin tablets, lemonade powder, fruit preserving tablets and canned fruit pudding. It was not necessary to take. Police Court proceedings in any of these cases, but proceedings under Section 3 of the above Act were taken in respect of one case of foreign matter in bread and one case of foreign matter in cake, and under Section 14 in respect of one case of storage of ice cream on unregistered premises. Pharmacy and Poisons Act, 1933. and Pharmacy and Medicines Act, 1941. Applications were received from 357 persons for their names to be entered) on the Council's Register of sellers of poisons included in Part II of the Poisons List. 703 inspections under these Acts were made by the Food Inspectors. FACTORIES AND WORKSHOPS There were 1,621 factories and workshops on the Register at the end of 1948 and, in addition, 402 persons were receiving work to be done in their homes. It was possible to make only 327 inspections owing to the large amount of housing work, and 37 notices were served in respect of nuisances found. 15 REPORT OF THE PUBLIC ANALYST During the year 2,112 samples were submitted, 2,000 being informal. The samples submitted consisted of 886 milk. 1,102 other foodstuffs and 124 drugs. Eleven samples of milk were found to be adulterated. The average composition of the milk analysed during the year was : total milk solids 12.32, milk fat 3.51, non-fatty solids 8.81. Nine samples of other foodstuffs were found to be adulterated, viz.:—sponge mixture, infested; tomato juice, labelling offence; barley flakes, incorrectly labelled ; saccharin tablets, 5 per cent, deficient in saccharin ; lemonade powder, labelling offence ; fruit preserving tablets, 13 per cent. deficient in sulphur dioxide ; canned fruit pudding, contained sand and was mouldy. Samples of-the following substances were analysed:— beverages 17 samples ; biscuits 16 ; butter 91 ; cereal preparations 48 ; cheese 64 ; coffee 16 ; fish paste 17 ; flavouring essences 16 ; ice-cream 60 ; jam and marmalade 25 ; lard and cooking fat 84 ; margarine 91 ; meat products 13 ; milk, canned, 9 ; pickles and sauces 20 ; spices and condiments 36 ; sugar 91 ; tea 91 ; vegetables, canned, 22 ; vinegar 15. The average water content of the 91 samples of butter was 15.1 per cent.; that of the 91 samples of margarine, 15 per cent. The average boric acid content of the samples of margarine was 0.19 per cent. Three samples were submitted for analysis on the complaints of ratepayers. In two cases concerning samples of mincemeat and milk the complaints were considered to be unjustified ; in the third case, a sample of canned fruit pudding was found1 to be mouldy and contained sand and the complaint was considered justified. 16 In conclusion we have to report that the adulteration detected during 1948 was 0.85 per cent. of all samples submitted. We have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient servants, A. H. MUTER, F.R.I.C., F.C.S. Public Analyst. J. E. WOODHEAD, B.Sc., F.R.I.C., Ph.C. Deputy Public Analyst. 325 Kennington Road, S.E.11. J. B. Blackmore and Co., Ltd. 85, Merton High Street, S.W.19