Metropolitan Borough of Woolwich ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR WOOLWICH 1942 BY J. MACMILLAN, D.S.O., M.C., M B., Ch.B., D.P.H. Medical Officer of Health WOOLWICH : The Kentish Independent Printing Works (T.U.) 41, Wellington Street, S.E.18 HEALTH COMMITTEE. At 31st December, 1942. The Worshipful the Mayor (Councillor E. Brown, J.P.) Councillor Mrs. E. L. Reeves (Chairman) Councillor Miss G. E. Walters, J.P. (Vice-Chairman). Councillors— J. W. Andrews Miss M. Crout, j.p. C. H. Darby Mrs. L. E. Driver A. H. Gilder, j.p. G. E. Greenwood D. B. Lister S. W. Lister J. F. Parker Mrs. K. M. Rance Rev. H. Stebbings E. G. Stevenson W. T. Walden MATERNITY AND CHILD WELFARE COMMITTEE. Comprising the Members of the Health Committee Councillor Mrs. E. L. Reeves (Chairman) Councillor Miss G. E. Walters, J.P. (Vice-Chairman). PREFACE. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Woolwich . Mr. Mayor, Ladies and Gentlemen, I have the honour to submit the Forty-second Annual Report on the health of the Metropolitan Borough of Woolwich. Owing to war-time restrictions, it is again an abridged report but the material published will, it is hoped, give a general appreciation of the work of the department and the health of the inhabitants of the Borough during the year. The restrictions on the publication of figures relating to local populations still apply and I am unable to publish the usual statistical information, but it is permissible to say that the Registrar General estimates the population to be greater than it was in 1941 : that the birth rate was the highest since 1924 ; the death rate lower than in 1941 and little higher than the mean for the five years before the war, and the infant mortality rate (34) the lowest ever recorded. The number of births was 2,036, the number of deaths under one year was 71, and the total number of deaths was 1,410. The detail of causes of death will be found in Table No. 1. The number of maternal deaths was 3. The work of the sanitary section of the Department was carried on to the usual high standard, despite the difficulties which have arisen owing to the war. Maternity and child welfare services were operating on practically a pre-war level, including the medical supervision of toddlers, which it was found possible to re-institute at the beginning of the year. The initial programme for the provision of war-time day nurseries was completed with the opening of the Eltham Nursery and provided places for 187 children. There was a further rise in the incidence of infectious disease in 1942, due to a continuance of the epidemics of measles and whooping cough and to an increase in the number of cases of scarlet fever and dysentery. There was a decrease in cerebrospinal meningitis and in enteric fever. Having regard to the rising tendency in the incidence of tuberculosis throughout the country, to which the Minister of Health called attention in 1941, it is pleasing to record that the number of cases of tuberculosis notified in Woolwich (249) was lower than in 1941: indeed, it was only one more than in 1938. The number of deaths from this disease in 1942 (102) was the lowest ever recorded. In assessing these figures regard must of course be had to the size of the population which, although greater than in 1941, was smaller than in 1938. The need for new measures in the treatment of Scabies was evident from the continued rise in this disease and a scheme of control was formulated and put into 4 effect in May. Details of the scheme are given in the body of the report under the heading Disinfection and Disinfestation. Since my last report, the following changes in the staff have taken place :— Mr. K. Morgan, Temporary Clerk, resigned his appointment on 14th February. Miss M. J. Harold, Temporary Clerk, commenced duty on 20th February (resigned, 9th May). Miss E. M. Giles, Health Visitor, resigned her appointment on 18th April. Dr. E. V. Saunders-Jacobs was seconded to the Ministry of Health as from 4th May. Dr. M. Belton, Temporary Assistant Medical Officer, commenced duty on 4th May. Miss S. Sanders, Temporary Clerk, commenced duty on 11th May. Miss M. D. Jones, Health Visitor, commenced duty on 28th May. Dr. K. Dowling, Temporary Assistant Medical Officer, commenced duty on Kith November. Miss A. G. Smith, Temporary Clerk, commenced duty on 4th December. Miss B. Loveland, Temporary Clerk, commenced duty on 4th December. Mr. J. G. Simpson, Sanitary Inspector, resigned his appointment on 28th December. At the end of the year the following members of the staff were serving with H.M. Forces : Dr. L. A. McDowell (Assistant Medical Officer) ; Mr. L. J. Allen (Grade " B " Clerk) ; Mr. J. Lewington, Mr. A. Goad, Mr. D. Buck, and Mr. R. Hillary (Grade " A " Clerks). Miss D. O'Connor, Grade " A " Clerk, was called up for national service and entered hospital as a probationer on the 28th December. In conclusion, 1 desire to thank the Chairman and members of the Health Committee and members of the Council generally, for the support and consideration given to me during the year, and I take this opportunity of expressing my appreciation of the work of the staff of the department. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, J. MACMILLAN, Medical Officer of Health, 5 TABLE No. 1. Nett Deaths during the calendar year 1942. Causes of Death. Nett Deaths at the subjoined ages of " Residents " whether occurring within or without the District. All Ages. Under 1 year. 1 and under 5 years. 5 and under 15 years. 15 and under 45 years. 45 and under 65 years. 65 years and upwards. All Causes 1,410 71 10 14 169 378 768 Typhoid and paratyphoid fevers .. .. .. .. .. .. .. Cerebrospinal fever 2 .. 1 .. .. 1 .. Scarlet fever .. .. .. .. .. .. .. Whooping cough 7 5 2 .. .. .. .. Diphtheria 2 .. 1 1 .. .. .. Tuberculosis of the respiratory system 91 .. .. 2 62 21 6 Other forms of tuberculosis 11 1 1 1 4 3 1 Syphilitic diseases 17 .. .. .. 2 5 10 Influenza 7 1 .. .. .. 2 4 Measles 2 .. 1 1 .. .. .. Acute polio-myelitis and polio-encephalitis 1 .. .. .. 1 .. .. Acute infective encephalitis .. .. .. .. .. .. .. Cancer of buccal cavity and oesophagus (M) ; uterus (F) 35 .. .. .. 1 12 22 Cancer of stomach and duodenum 43 .. .. .. 2 23 18 Cancer of breast 23 .. .. .. 2 14 7 Cancer of all other sites 144 .. .. .. 11 56 77 Diabetes 17 .. .. .. 5 3 9 Intracranial vascular lesions 129 .. .. .. 3 36 90 Heart disease 366 .. .. .. 20 74 272 Other diseases of the circulatory system 55 .. .. .. .. 9 46 Bronchitis 85 3 .. .. 5 28 49 Pneumonia 69 12 3 1 8 18 27 Other respiratory diseases 9 1 .. .. 1 4 3 Ulcer of stomach or duodenum 17 .. .. .. 3 7 7 Diarrhoea under 2 years 5 5 .. .. .. .. .. Appendicitis 2 .. .. .. 1 .. 1 Other digestive diseases 31 .. .. 2 3 8 18 Nephritis 47 .. .. .. 7 17 23 Puerperal and post-abortive sepsis .. .. .. .. .. .. .. Other maternal causes 3 .. .. .. 3 .. .. Premature birth 22 22 .. .. .. .. .. Congenital malformation, birth injury, infantile diseases 14 13 .. .. .. 1 .. Suicide 11 .. .. .. 1 7 3 Road traffic accidents 5 .. .. 2 2 .. 1 Other violent causes 34 3 1 .. 5 7 18 All other causes 104 5 .. 4 17 22 56 6 GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. Births. The number of notifications received was 982. The number of births registered in Woolwich was 1,090. After correction for inward and outward transfers the nett number of Woolwich live births was 2,036. It is known that at least 1,185 births took place in Institutions. Maternity and Child Welfare Clinics and Treatment Centres. In tabular form below are shown the arrangements in being during the year at each of the Council's maternity and child welfare clinics and treatment centres. Woolwich Central Health Centre. In use as a first aid post but child welfare and ante-natal clinics held every week. Physical medicine clinics held two whole days a week. Plumstead Health Centre In use as a first aid post but an ante-natal clinic is held every week. Child welfare clinics held in the Juvenile Section of the Plumstead Library, which adjoins this Centre. 601, Westhorne Avenue . Child welfare and ante-natal clinics held every week. Wesley Hall, Timbercroft Lane Church Hall continued to be used for child welfare clinics. New Eltham Clinics held throughout the year at the First Aid Post, Legal & General Sports Pavilion. St. Luke's Church Hall, . Westmount Road. Clinics continued to be held here. Elizabeth Street, North Woolwich. In use as a first aid post. Clinics held in St. John's Church Hall. 137, Alnwick Road, Horn Park. Ante-natal and child welfare clinics held every week. The attendances at the Maternity and Child Welfare Centres during the year were: expectant mothers, 5,152; nursing mothers, 1,192; children, 39,919. In January, toddler inspection sessions were re-instituted. The number of inspections carried out was 1,668. Artificial Sunlight Clinic. Artificial sunlight treatment was continued in the Town Hall shelter. The number of treatments given was 11,620. Health Visiting. The arrangements made for the visiting of children between the ages of one and five are described in previous Annual Reports. The number of such visits paid during 1942 was 19,497. The total number of visits paid by health visitors was 27,780. Infant Life Protection. There were 36 foster mothers on the register at the end of 1942, compared with 22 in 1941. The number of nurse children was 39. The number of visits paid by the infant life protection visitors was 306. 7 Midwifery Services. There are no whole-time midwives employed by the Council, the Domiciliary Midwifery Service in London being administered by the London County Council. Maternity beds are normally provided in the British Hospital for Mothers and Babies, the War Memorial Hospital, the Eltham Cottage Hospital, the Military Families' Hospital, St. Nicholas' Hospital, and a few in midwives' homes. At the outbreak of war the War Memorial Hospital, the Military Families' Hospital and St. Nicholas' Hospital closed their maternity wards, and as a result a greater demand was made on the British Hospital for Mothers and Babies, During 1942, 1,231 mothers were admitted to this hospital; 195 of these were admitted under the Council's scheme. No cases were admitted under the Council's scheme for ante-natal or emergency treatment. Home Helps. During the year 95 applications were considered by the Committee and 57 home helps were provided. Dental Treatment. The number of mothers and children attending the dental clinics was 393, and the number of tuberculous persons attending was 10. The total number of attendances was 1,045. Issue of Clothing Coupons to Expectant Mothers. In connection with clothes rationing, the Health Department is responsible for the issue of special coupons to expectant mothers residing in the Borough. During the year, 2,282 applications were granted, and 127,800 coupons were issued. Issue of Fruit Juices, etc. The Government scheme for the issue of fruit juices and cod liver oil for children is administered through the Maternity and Child Welfare Clinics. This resulted in considerable congestion at the Centres and at the end of the year consideration was being given to an alternative method of distribution. Supply of Milk to Necessitous Mothers and Children. The approximate cost of this service during the year was : Dried milk, £158 17s. 6d. ; fresh milk, nil; dinners, nil. War-time Nurseries. The first war-time day nursery was opened in Bloomfield Road London County Council School on the 9th February. It provided places for 40 children and was later extended to accommodate 60 children. The second nursery was established in the London County Council's Cyril Henry Treatment Centre, St. Mary's Street, Woolwich, which was erected for use as a day nursery during the last war. It now accommodates 37 children and was opened on the 18th May. The last nursery included in the Council's initial programme was opened on the 10th August. It was established in the Woolwich Borough Council Sports Pavilion, Harrow Meadow, Eltham Road, and provides places for 60 children. In addition to the Council's nurseries, the London County Council Rest Centres at Earl Rise School, Plumstead and Roper Hall, Eltham, were adapted for use as day nurseries for children betw een the ages of 2 and 5 years only. These nurseries are staffed and equipped by the London County Council but the children are admitted through the Health Department and medical supervision is provided by the Council. The provision of further nurseries was under consideration at the end of theyear. 8 All three of the Council's nurseries are affiliated to the National Society of Children's Nurseries and are training schools for probationers. The following shows in tabular form the day nurseries open in the Borough on the 31st December, and the accommodation available at each :— TABLE No. 2 Nursery Children between the ages of 1 and 2 years. Children between the ages of 2 and 5 years. London County Council School, Bloomfield Road, Plumstead. 20 40 Cyril Henry Centre, St. Mary's Street, Woolwich. 15 22 Woolwich Borough Council Sports Pavilion, Harrow Meadow, Eltham. 20 40 London County Council School, Earl Rise, Plumstead (Rest Centre). — 30 London County Council Hostel, Roper Hall, — 20 Avery Hill, Eltham (Rest Centre). 55 152 Professional Nursing in the Home. The arrangements with the six Nursing Associations for the nursing of cases of measles, ophthalmia neonatorum, zymotic enteritis, whooping cough, and poliomyelitis, in children under five, and pneumonia, puerperal fever, puerperal pyrexia, and tuberculosis were continued. The total number of visits paid by the nurses on behalf of the Council was 1,483. School Clinics. Clinics were held at the Woolwich Central Health Centre, anc) at 595, Westhorne Avenue—a Council house taken over by the London County Council when Eltham Health Centre was demolished. The number of children under 5 years of age referred to the school clinics for treatment of minor ailments during the year was 81. Ambulance Facilities. The London County Council provide an ambulance service for four main purposes, (a) removal of persons meeting with accidents or sudden illness in the streets or public places, (b) removal of maternity cases, (c) removal of sick persons, (d) removal of civil defence casualties. Clinic por Physical Medicine. This clinic was re-opened in March for two whole days a week. The number of attendances was 3,163. Foot Clinics. The first foot clinic was established with the opening of the Central Health Centre in 1939. On 1st December, 1942, a second clinic was opened in temporary accommodation at Eltham Baths, the number of treatments there during that month being 164. The total number of treatments rose from 8,945 in 1941 to 12,188 in 1942. Supply of Insulin to Persons Suffering from Diabetes. The number of patients, under the Council's scheme, who received insulin during the year was 19. 9 Tuberculosis Dispensaries. Maxey Road, Plumstead In use as a first aid post but temporary accommodation at the rear in use as a Tuberculosis Dispensary. 11, Carnecke Gardens, Eltham . Continued to be used as a Tuberculosis Dispensary during the year. The work of the dispensaries is referred to in the section dealing with infectious disease. Vaccination. There were 742 entries in the birth lists for 1941. Of these, 324 were successfully vaccinated. The total number of successful primary vaccinations during 1942 was 755, and 33 successful re-vaccinations were carried out. SANITARY ADMINISTRATION. Complaints. 2,436 complaints of nuisance were received. After investigation any necessary notices for the remedy or abatement of the defects or nuisances discovered were served. Sanitary Inspection of the Area. During the year 32,950 inspections, including re-inspections, were carried out by the sanitary inspectors. Included in this number are 2,436 primary inspections on complaint of nuisances, and 571 on account of infectious disease. The number of inspections of factories was 324. Defects were found and remedied in 38 instances. The number of intimation notices served was 1,426, and the number of statutory notices, 388. In 69 instances, where the owners did not comply with the statutory notices, the Town Clerk was asked to institute proceedings, but it was necessary to issue only five summonses as in all other cases the necessary steps were taken on receipt of a letter from the Town Clerk. Eradication of Bed Bugs. The methods adopted in Woolwich in this respect have been reported on very fully in previous reports. Cyanide was used for the disinfestation of seventeen loads of furniture and nine buildings. During 1942, 1,767 inspections were carried out and the necessary action was taken. Rats and Mice (Destruction) Act, 1919. In addition to inspections carried out specifically in connection with rat infestation, the sanitary inspectors look for signs of the presence of rats at every inspection. Thus, infestation was discovered in 400 premises, including 27 food premises. In 152 instances it was necessary to secure the repair of defective drains, 65 premises were rat proofed, and other effective measures were taken in the remainder. Infestation has not assumed any great proportions in the Borough, but constant endeavour is necessary on the part of everyone concerned to combat the menace of these rodents. Housing. The total number of dwelling houses inspected for housing defects under the Public Health or Housing Acts was 2,433, and the number found not to be in all respects reasonably fit for human habitation was 1,218. The number rendered fit in consequence of informal action by the sanitary inspectors (including the service of intimation notices) was 896. Statutory notices were served in respect of 322 houses. 10 INSPECTION AND SUPERVISION OF FOOD. Milk. The number of milk premises on the register on the 31st December was 60, and 93 inspections were made. Two pasteurisers' licences, 7 dealers' licences and 4 supplementary licences were issued under the provisions of the Milk (Special Designations) Orders, for the sale of pasteurised milk, and 14 dealers' and 3 supplementary licences were issued for the sale of tuberculin tested milk. Meat Supplies. All slaughterhouses in the Borough remained closed, but one was used occasionally under licence from the Ministry of Food. The number of animals slaughtered and inspected at this slaughterhouse during the year was 240. Premises where Food is Prepared or Offered for Sale. All such premises, including those registered under the provisions of the Public Health (London) Act, 1936, are kept under frequent observation. The number of inspections carried out during the year was 2,863. The total weight of food certified as unfit for human consumption was 10 tons 3 cwts. Very little of this food was destroyed, most of it being used for animal feeding. Sophistication of Food. During the year 826 samples were submitted to the Public Analyst for analysis. Of these, 616 were informal and 210 formal. Twenty-nine samples were reported as adulterated, only four of which were formal samples. No legal proceedings were instituted. The food and drugs examined included :— Milk, 212; condensed milk, 10; dried milk, 7; butter, 7; margarine, 7: lard, 7; arrowroot, 8; rice, sago, etc., 28; flour, 17; custard powder, pudding powder, etc., 29; baking powder, 9; biscuits, 4; dried egg and egg substitute, 23; fruit juice and fruit juice substitute, 12; dried fruit, 30; dried vegetables, 23; canned fruit and vegetables, 25; soup powder, 11; canned soup, 24; sausage, 24; cooked meats, 7; meat pie, 8; canned meat, 12; meat paste, 8; meat and vegetable extracts, 5; canned fish, 29; fish paste, 14; coffee, 14; cocoa, 9; preserves, 15; vinegar, pickles, etc., 48; condiments, 22; spices, curry powder, etc., 25: cordials, mineral waters, etc., 21; confectionery, 10; alcoholic beverages, 9; medicaments, 33; others, 20. The adulterated samples were as follows :— Formal. Lemon substitute, 1; orange substitute, 1; condiment mustard, 1; ginger wine cordial, 1. Informal. Milk, 1; canned meat stock and vegetable soup, 1: forcemeat, 1; pepper, 1; mustard, 2; mixed spice, 2; non-alcoholic beverages, 7; lemon substitute, 1; orange substitute, 1; sauce, 1; Glauber's salts, 4; bleach ointment, 1 ; pudding powder, 2. Food Poisoning. The number of notifications of food poisoning was 205, mainly due to an outbreak at Woolwich Institution. Bacteriological examinations in connection with this outbreak disclosed no evidence of the presence of bacteria of the food poisoning groups. 11 PREVALENCE AND CONTROL OF INFECTIOUS DISEASES. Notifications. The total number of notifications received was 1,931. They relate to the following diseases :— TABLE No. 3. Diphtheria 76 Malaria 7 Scarlet fever 278 Ophthalmia Neonatorum 13 Enteric fever (including Paratyphoid) 2 Dysentery 117 Cerebrospinal Meningitis 26 Puerperal fever 4 Poliomyelitis 3 Puerperal Pyrexia 13 Zymotic Enteritis 48 Erysipelas 40 Measles 723 Pneumonia 263 Whooping Cough 318 Diphtheria. The amount of anti-toxin supplied to medical practitioners during the year was 8,000 units. The number of children immunised under the Council's scheme was 2,088. In addition, 2,195 school children were immunised by medical officers of the London County Council. The percentages of the child population immunised for the two age groups 0-5 and 5-15, based on estimated populations, were 42 and 68.6 respectively. Ophthalmia Neonatorum. Thirteen cases were notified, five of whom were admitted to hospital. Nursing assistance was provided under the Council's scheme in 8 cases. Cerebrospinal Meningitis. Twenty-six cases were notified compared with 43 in 1941 and 42 in 1940. Two of these were military. All the cases were removed to hospital, and in 12 the diagnosis was not confirmed. There were 2 deaths. Typhus Fever. All the necessary arrangements were made for dealing with an outbreak of Typhus Fever should such occur. Special protective clothing was obtained for the use of the staff who would be engaged on this work and the sanitary inspectors and the disinfectors were given special training. Agreement has been reached w ith Lewisham for mutual assistance with Woolwich ; the first borough having an outbreak will deal with the Typhus cases, whilst the other borough will deal with non-typhus verminous cases. Tuberculosis. The number of persons examined for the first time at the Dispensaries was 1,129. Of these 175 were tuberculous. 280 contacts were examined, of whom 11 were tuberculous. The total number of attendances at the Woolwich and Eltham Dispensaries was 4,378. There were 767 cases on the tuberculosis register on the 31st December. 3,622 visits were made by nurses to homes of patients and 53 domiciliary visits were paid by the Tuberculosis Officer or an Assistant Medical Officer. 551 cases were referred to the Dispensaries by medical practitioners and 59 by medical boards. 607 specimens of sputum were examined, of which 94 were positive. The number of X-ray examinations made was 1,439. 73 patients received artificial pneumothorax treatment. Additional nourishment was granted in 208 instances. Ten patients received dental treatment under the Council's scheme. 284 patients were admitted to hospitals, sanatoria, or training colonies. The Tuberculosis Care Committee continued their meetings and rendered valuable assistance in various ways to the needy tuberculous and their families. 12 Laboratory Facilities. The bacteriological work of the Council is carried out at the War Memorial Hospital. In addition to the number of examinations made for the tuberculosis service, 746 specimens were examined for diagnostic purposes in the case of diphtheria, 5 in the case of enteric fever, 2 in the case of dysentery, and 17 on account of food poisoning. Disinfection and Disinfestation. The number of rooms disinfected after cases of infectious disease was 529. Seventy-six of these rooms had been occupied by tuberculous persons. On account of the presence of vermin, 566 rooms were disinfested. 59,686 articles were disinfected at the Disinfecting Station. This figure is much higher than usual, due to the increase in Scabies. Personal cleansing was continued at the temporary cleansing station in Plumstead Turkish Baths (established there when the cleansing station at White Hart Road was damaged by enemy action in 1940), and in the cleansing section of the Eltham Hill Health Centre which was opened on the 1st June. The increasing incidence of Scabies during the war has been a matter of concern and a scheme for extended facilities for its treatment and control was adopted in 1942. The scheme included diagnostic skin clinics; preliminary visits to the homes by women sanitary inspectors ; disinfestation of bedding and personal clothing ; treatment of persons at cleansing stations (family contacts to be included in those treated) ; following up after treatment and propaganda work in factories and shops. A consultant dermatologist (Dr. D. Erskine, Physician for Diseases of the Skin at Seamen's and St. John's Hospitals) was appointed, his duties being, inter alia :— To define the method of treatment and the administrative procedure to be followed ; To pay a fortnightly visit to Woolwich to inspect the scheme in being ; To see at his hospital clinic any doubtful cases sent there for diagnosis ; To see such cases under the Scabies Order, 1941, as may be referred to him and give evidence in Court if necessary. The scheme came into effect at the end of May and worked smoothly and efficiently. The method of treatment used generally requires two visits only to the cleansing station and involves absence from work only for the time taken to attend the cleansing station and receive the treatment. As was anticipated, the introduction of this scheme resulted in an increase in the number of cases of Scabies coming to the knowledge of the department. This increase, however, was more apparent than real and meant, in effect, that cases which might have remained undiscovered so far as the Department was concerned, were brought to light and induced to have the necessary treatment. The Scabies Orderv 1941, referred to above, gives power to the Medical Officer of Health to examine any person who is or has recently been accommodated in premises which he is satisfied are in a verminous condition, and to require that person, if necessary, to submit to cleansing treatment. The Order extends the existing powers with regard to verminous premises and articles. The number of school children treated at the Cleansing Stations in accordance with the terms of the agreement with the London County Council, was 2,388 ; 935 of these children were treated for scabies. In addition, 438 pre-school children were treated (411 for scabies). The cleansed was 1,775 and of these 1,703 were scabietic.