Port and Borough of King’s Lynn ANNUAL REPORT OF THE Medical Officer of Health FOR THE YEAR 1947 james w. McIntosh B.Sc. (Public Health), M.B., F.R.C.S.E. WITH WHICH IS INCLUDED THE Annual Report of the Senior Sanitary Inspector Mr. H. G. COBBOLD, m.si.a. Printed by West Norfolk Newspapers, Ltd. Digitized by the Internet Archive in 2017 with funding from Wellcome Library https://archive.org/details/b29533491 Health and Port Health Committee November, 1947. Chairman: Alderman Mrs. A. M. FISHER. Alderman J. HARWOOD CATLEUGH, o.b.e., j.p. „ J. W. RABY, j.p. Councillor E. A. ANDERSON. „ W. BAKER. „ E. M. BENEFER. „ T. W. BLOMFIELD. J. J. BONE. „ H. W. DAWSON. „ C. A. FREESTONE, m.b.e. „ O. R. JERMYN, j.p. ,, J. LEWIN, F.R.G.S., J.P. „ W. J. PANTON. „ R. A. RAYNER. „ J. SEAMAN. P. J. WEBB, j.p. Note.—Councillors Burton, Paine and C. Panton were Members of the Health and Port Health Committee to 31st October, 1947, Public Health Officers of the Authority:— All Medical Officers are part time. Some are employed by the Norfolk County Council and hold Clinics, etc., in King’s Lynn. Medical Officer to the Health and Port Health Authority and Assistant School Medical Officer (Norfolk County Council): JAMES W. McINTOSH, b.sc., (Public Health), m.b., F.R.C.S.E. Clinical Tuberculosis Officer (Norfolk County Council):— H. B. HODSON, m.d., m.r.c.p., d.p.h. Orthopaedic Surgeon (Norfolk County Council):— H. A. BRITTAIN, m.a., m.ch., f.r.c.s. Venereal Disease (Norfolk County Council):— JAMES W. McINTOSH, b.sc., (Public Health), m.b., F.R.C.S.E. Consultant Medical Officers under Midwives Act:— J. O. HARRISON, M.B., D.OBST.R.C.O.G., F.R.C.S. J. LEWIN, M.B., B.SC., F.R.C.S. Ophthalmic Surgeon:— S. T. PARKER, m.b., ch.b., l.r.c.p., f.r.c.s. Poor Law Medical Officer and Public Vaccinator:— M. CHADWICK, b.a., m.r.c.s., l.r.c.p. Veterinary Surgeon:— H. C. SWANN, m.r.c.v.s. Public Analyst:—S. GREENBURGH, ph.d., b.sc., f.r.i.c. Senior Sanitary Inspector to the Health and Port Health Authority:— H. G. COBBOLD, m.s.i.a. Additional Sanitary Inspector to the Health and Port Health Authority:— H. F. ROBINSON, m.s.i.a., a.r.san.i. Vaccination Officer:—G. H. J. CHAMBERLAIN. Health Visitors:— Miss S. M. LILLEY, s.r.n., r.s.i. Mrs. F. HOWES, s.r.n., s.c.m., r.f.n. (from 21st February —Part Time). Mrs. E. M. PEACH (Part Time). To the Chairman and Members OF THE Health and Port Health Committee of King s Lynn Public Health Department, 3, King Street, King's Lynn, June, 1948. Madam Chairman and Gentlemen, I have the honour to submit my Annual Report for the year 1947. The general health of the Borough has been good. There was no serious outbreak of Infectious Disease. A suspected case of Smallpox was removed to Hospital in the summer, but the diagnosis was not confirmed. In previous reports I have called attention to the narrow margin we are on as regards water supply. The reservoir at Leziate has barely enough water for 24 hours and we depend on the pumping machinery never breaking down for a continuous supply of water. It is certain that no major development of the town can take place until the reserve of water has been increased. Maternal Mortality. There were 550 confinements in the year with two maternal deaths. One of these was caused by Appendicitis and was not directly attributable to pregnancy. The other was caused by post partum haemorrhage. The patient was taken to Hospital and everything possible was done. Mr. J. O. Harrison wishes me to remind all doctors and midwives that there are 44 flying squad 55 facilities available and that there are cases where the patient would have a better chance if treated at home and did not undertake the journey to Hospital. He specially wishes me to say that this remark does not apply to this particular case. Including both the above cases we have now had three maternal deaths in 10 years. There have been 4,581 confinements during this period. This works out at a maternal mortality of 0.65 per 1,000 and is a little over half the maternal mortality for the whole country. Infantile Mortality. There were 21 deaths of children under one year and of these 10 were children one month of age or less, and 11 of children over one month and under one year. This is an infantile mortality rate of 39.32 per 1,000 live births, as compared with 41 per 1,000 for the whole country. Causes of death in those under one month:— 8 premature. 1 shock and asphyxia. 1 septic umbilicus. As regards the 11 children who died between one month and one year, 2 died of marasmus; 1 abnormal thymus gland; 3 bron- cho-pneumonia; 1 broncho-pneumonia and measles; 1 broncho- pneumonia and pyloric stenosis; 1 lobar-pneumonia; 1 cardiac failure and status epilepticus and 1 cardiac failure and enteritis. In the above list there are six deaths from pneumonia, two from marasmus and one from septic umbilicus. If there is to be further lowering of the infantile death rate it is in cases of this type that improvements must come. It is encouraging that there was only one death from enteritis which suggests that infant feeding is on the whole satisfactory. General Standard of Cleanliness. The School Medical Officer is, of course, responsible for the health of the school children and will no doubt report in due course. My experience is that lice and nits in the hair are becoming much less prevalent. Ringworm has almost disappeared from the town after being a great trouble during and after the war. The same remark applies to scabies which is again, fortunately, a rare disease. Illegitimate Children. There were 25 illegitimate children born during the year. They were all specially visited by the Health Visitors. The arrangements as regards Hostels, Adoption, etc., were the same as in previous years. There were no deaths amongst illegitimate children. Premature Infants. Arrangements are the same as in previous years. There were 25 premature infants, and of these 8 died. Day Nursery. It has been decided to carry on the Nursery until 5th July, 1948. It will then be taken over by the Norfolk County Council and turned into a Nursery School for children between two and five years. The average daily attendance has been 19 for those under two years and 41 for those between two and five years. Extracts from Vital Statistics (from Registrar-General) for 1947. Population .... 24,550. Male. Female. Live Legitimate 249 261 Births Illegitimate 16 8 265 269 Male. Female. Still Legitimate 11 4 Births Illegitimate — 1 11 5 • Male. Female. Deaths 163 161 Total. 510 Birth Rate per 1,000 of 24 estimated population 21.75 534 Total. 15 Rate of 29.09 per 1 1,000 total births. 16 Total. 324 Death Rate 13.19 per 1,000 of the estimated resident population. The Live Birth Rate for England and Wales was 20.5 per 1,000 total population, and for the 126 Great Towns was 23.3 per 1,000 civilian population. The Death Rate for England and Wales was 12.0 per 1,000 total population and for the 126 Great Towns was 13.0 per 1,000 civilian population. The Maternal Mortality Rate for England and Wales was 1.17 per 1,000 total births. The Infant Mortality Rate for England and Wales was 41 per 1,000 live births. GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA, —(a) Laboratory Facilities, No change. (b) Ambulance Facilities, No change. (c) Nursing in the Home. There are two district nurses. (d) Treatment Centres and Clinics. /Maternity and Child Welfare Centres. An additional Centre was opened at West Lynn during the year to cater for residents in that Area. We now have three Centres:— Orthopaedic Clinic—no change. Venereal Disease Clinic—no change. Tuberculosis Clinic—no change. (e) Hospitals. No change. (f) Home and Domestic Help Scheme. 37 Maternity cases and 13 sickness cases were covered during the year. Two whole-time and three part- time Home Helps are employed. .—(i) Midwifery and Maternity Services. Two private nursing homes in Goodwins Road take 3 and 7 cases respectively. In addition, a home in Birchwood Street is allowed to take 2 cases. Beds may, in certain circumstances, be reserved at Stow Maternity Home, by arrangement with the Norfolk County Council, and good use was made of this ser- vice during the year. The Public Assistance Institution provides 3 beds. The Borough does not provide a Maternity Home, but a Maternity block is in course of erection at the West Norfolk and King’s Lynn General Hospital. 15 women had their confinement in the West Norfolk and King’s Lynn General Hospital owing to various complications. There are 4 midwives employed by the Norfolk County Council who attend to all cases in the Borough, (ii) Institutional Provision for Mothers and Children. No change. (iii) Health Visitors. Mrs. F. Howes was appointed Part-time Health Visitor on 21st February. One Full-time Health Visitor and two Part-time Health Visitors were, therefore, working in the Borough during the year. Details of the Health Visitors’ work are appended:— To children under one year—first visits .... 560 Total visits .... .... .... .... .... 2,421 To children between 1—5 years .... .... 2,491 To expectant mothers—total visits .... .... 131 Post Natal do. .... .... 139 Number of Foster Mothers—7 Number of Foster Children—8 Number of Visits paid—88 Expectant Mothers. It was again decided not to escort mothers to Stow Maternity Home. They were advised to make their own arrangements and the system worked well. 13 mothers went to Stow; 15 to St. James’ Hospital, and 15 to the General Hospital (owing to complications in pregnancy). Infant Welfare Clinics. Sessions were held at the Infant Welfare Centres. Immunisation Clinics. 213 children were immunised against diphtheria. Ante-Natal and Post-Natal Clinics. These were held once a week. Towards the end of the year attendances showed a slight increase. There were 161 ante-natal attendances during the year. (iv) Infant Life Protection. No change. (v) Orthopaedic Treatment. No change. SANITARY CIRCUMSTANCES OF THE AREA 1. —Water. Counties Laboratories, Redwell Street, Norwich. 22nd March, 1948. Bacteriological Examination of Water. Sample collected from Reservoir on 18th March, 1948. Colonies per ml. Coliform Organisms on agar at 37°C. McConkey 2 days at 37°C. Present Absent in ml. in ml. None — 100 Remarks: A bacteriological quality of the highest standard. (Signed) W. LINCOLNE SUTTON, f.r.i.c. 2. —Rivers and Streams. No change. 3. —Public Cleansing. No change. Drainage. No change since last report. Cattle Market. No change since last report. Abattoir. No public abattoir is provided. Sanitary Inspection of the Area. The following is a summary of the work done during the year under the various Public Health and Housing Acts, viz.:— 894 Special complaints and Special visits made. 257 Informal notices and intimations served. 54 Statutory notices served. Details:— Water closet cisterns repaired and renewed .... .... 35 Drains re-laid or repaired .... .... .... .... 17 Drains cleared .... .... .... .... .... .... 40 Inspection chambers provided .... .... .... .... 4 Suitable ashbins provided .... .... .... .... 19 Dampness of walls remedied .... .... .... .... 24 Ceiling plaster repaired .... .... .... .... 35 Walls repaired .... .... .... .... .... .... 6 Miscellaneous defects .... .... .... .... .... 35 Yards concreted .... .... .... .... .... .... 3 Soil pipes provided .... .... .... .... .... 2 Pail closets abolished and new water closets and drains provided .... .... .... .... .... .... 14 Workroom cleansed and lime-washed .... .... .... 1 New water closet pedestal provided and fixed to re-place hopper and trap .... .... .... .... .... 32 Flush pipe joints repaired .... .... .... .... 8 Stair treads and risers repaired .... .... .... 2 Ventilation provided to pantry .... .... .... I W.C. roofs repaired .... .... .... .... .... 8 Rainwater pipes repaired or renewed .... .... 10 W.C. doors repaired .... .... .... .... .... 3 Stoves repaired or renewed .... .... .... .... 6 House drains connected to sewer .... .... .... 3 Chimneys repaired .... .... .... .... .... 3 Windows repaired, renewed or made to open .... 11 Sashcords renewed .... .... .... .... .... 16 Eaves gutters provided and fixed .... .... .... 19 Wallplaster repaired .... .... .... .... .... 27 Fireplaces renewed or repaired .... .... .... 4 Coppers repaired or renewed .... .... .... .... 7 New sinks provided .... .... .... .... .... 8 Roofs repaired or renewed .... .... .... .... 60 Floorboards repaired or renewed .... .... .... 22 New W.C.’s provided .... .... .... .... .... 3 Doors repaired or renewed .... .... .... .... 4 W.C. seats repaired or renewed .... .... .... 2 W.C. pans renewed .... .... .... .... .... 2 Accumulations of manure and refuse removed .... 4 Houses let in Lodgings. No change. Common Lodging Houses. The two common lodging houses were regularly visited and found to be conducted in a satisfactory manner. Meetings of Owners and Tradesmen. 141 meetings were held with regard to defective houses, drains, etc. House Drains, During the year 214 drains were tested and examined. In all cases where defects were found, notices were served on the owners concerned. 14 pail closets were abolished and new water closets provided, together with all necessary fittings, and drainage connected to the main sewer. The Corporation paid 50% of the cost in accordance with Section 47 of the Public Health Act, 1936. Rats and Mice (Destruction) Act, 1919. Two ratcatchers have been at work throughout the year with satisfactory results. Sewers, Corporation property, Almshouses, Piggeries, Docks, Ships, etc., private as well as business premises, have been regularly treated. There is no doubt the rat population in the Borough has been considerably reduced during the year. No major infestation remains. Constant treatment of the Corpor- ation refuse tips is necessary to ensure that they do not become re-infested. Eradication of Bed Bugs and Fleas. Number of house rooms disinfested (including Council and private houses) .... .... .... .... .... .... 196 Schools. No change. HOUSING. Report of Housing Manager. The number of new houses and flats completed and occupied to date is as follows:—• 50 Temporary prefabricated bungalows—Tarran type. 50 Permanent prefabricated 3 bedroom houses—Howard type. 8 Permanent prefabricated 3 bedroom parlour houses— Airey type. 12 Two bedroom flats—traditional type. 2 One bedroom flats—traditional type. 56 Three bedroom parlour type houses—traditional type. 178 Total. A large building programme is still under way, including both prefabricated and traditional type dwellings. 13 properties have been requisitioned, housing 18 families. Three schemes relating to the welfare of the tenants, particu- larly old people, have been recommended by the Housing Commit- tee and agreed by the Council. (a) Interior decoration of old age pensioners’ property in those cases where the old folk are unable to do it themselves or have no one to help in such cleansing. (b) Extension of Home Help Service (Domestic) to include those old age pensioners who are no longer able adequately to care for themselves. (c) Sale of paint and distempers to those tenants who wish to avail themselves of facilities that offer good materials together with suitable ranges of colour. Note.—The report of the Housing Manager is up to June, 1948, and not December, 1947. The following report on Housing was sent to the Chairman of the Housing Committee:— It is estimated that there are some (3,500 houses in the Borough. Roughly 1,000 of these are Council houses built between the wars, and quite another 1,000 were built during the same period by private enterprise. The remaining 4,500 are old houses built prior to 1914. Since the war some 46 traditional type houses have been built and 100 prefabricated houses erected. In order to build these traditional type Council houses and erect prefabricated houses, as much of the building labour in the town was mobilized and employed on the town’s housing estates as could be collected. As regards the older type of houses, a good many of these are more than 60 years old; they were kept in fairly good condition up to 1939, but have rapidly deteriorated since because of the lack of repairs at the proper time. The rents of the majority of these houses are, of course, controlled, and the cost of repairs has gone up to such an extent as to be out of all proportion to the rents received. It is very difficult for the landlords to keep them in repair without being financially out of pocket. If this state of affairs is allowed to go on for much longer quite a lot of this old property will become derelict. Many houses which were inspected and passed as being reasonably fit and not below the average level of working class accommodation in the Borough in 1936 are now actually falling into decay and are not reasonably fit to live in. Houses situated in Highgate, Hillington Square, Dilke Street, North End Yard, and many other places come into this category. "There are prob- ably at least 500 houses being badly neglected and many more suffering from want of attention which will become serious in another year or two. The £10 limit for repairs is very low and as prices go up becomes more and more inadequate. The appearance of some of the property suggests that the landlords have lost interest in keeping it up and are simply taking what money they can so long as the property is capable of providing some sort of accommodation and income. I have suggested that the town should buy up some of this old property before it becomes quite derelict and put it in order. If we could buy a small house for £100 and spent £100 to £200 on it, we should have a reasonable house for £300. This would cost less in money and labour than building a new house, the cost of new houses being from £1,200 to £1,500. These repaired houses would serve for at least 10 years. The annual amount required to pay, say 3% on the outlay of £200 with redemption of the capital amount at the end of 10 years, would be approxi- mately £23. 10s. Od. This represents an additional weekly increase of rental of approximately 9s. 0d., an amount within the means of the very great majority of the tenants, bearing in mind present wage levels. This could be done under Section 72 of the Housing Act, 1936. If the present policy is continued for another five years we may easily lose far more houses than we can possibly build. I have already a considerable list of houses which are decaying and need extensive repairs. We are looking round the town and noting others which will have to be added to the list. HOUSING STATISTICS. 1.—Inspection of Dwellinghouses during the year:— (1) (a) Total number of dwellinghouses inspected for housing defects (under Public Health or Housing Acts) .... .... .... .... .... 440 (b) Number of inspections made for the purpose 1,001 (2) (a) Number of dwellinghouses included under sub- head (1) above which were inspected and recorded under the Housing Consolidated Regulations, 1925 .... .... .... .... 305 (b) Number of inspections made for the purpose.... 603 .—Remedy of defects during the year without service of Formal Notices:— Number of defective dwellinghouses rendered fit in consequence of informal action by the Local Authority or their officers .... ... .... 71 3.—Action under Statutory Powers during the year:— (a) Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936: (1) Number of dwellinghouses in respect of which notices were served requiring repairs .... .... 21 (2) Number of such dwellinghouses which were rendered fit after service of formal notices: (a) By Owners .... .... .... .... .... 15 (b) By Local Authority in default of owners.... Nil. (b) Proceedings under Public Health Acts: (1) Number of dwellinghouses in respect of which notices were served requiring defects to be remedied .... .... .... .... .... 11 (2) Number of such dwellinghouses in which defects were remedied after service of formal notices: (a) By Owners .... .... .... .... .... 9 (b) By Local Authority in default of owners.... Nil. (c) Proceedings under Sections 11 & 13 of the Housing Act, 1936: (1) Number of dwellinghouses in respect of which Demolition Orders were made .... .... Nil. (2) Number of dwellinghouses demolished in pur- suance of Demolition Orders .... .... .... Nil. (d) Proceedings under Section 12 of the Housing Act, 1936: (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made .... .... .... .... .... .... Nil. (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined the tenement or room having been rendered fit .... .... .... .... .... Nil. INSPECTION AND SUPERVISION OF FOOD. Meat and other Food. No change. Special attention was paid during the year to the cleanliness of Hotel and Restaurant Kitchens. Slaughter-house. 665 visits were made to the Slaughterhouse during the year. Markets. No change. 72 visits were made to Markets during the year. Food and Drugs Act, 1938. During the year 47 samples of Food and Drugs were sub- mitted for analysis. (See Table on page 15.) Chemical and Bacteriological Examination of Food. This was carried out by S. Greenburgh, Esq., Ph.D., B.Sc., F.R.I.C., Public Analyst, Tenison Road, Cambridge. 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There were no cases of smallpox and only 2 cases of diphtheria in the Borough during the year. There were 47 cases of scarlet fever, of whom 30 were school children. 14 of the cases were removed to the Infectious Diseases Hospital. No deaths were attributed to scarlet fever. Enquiries were made with reference to all cases of Infectious Diseases notified. 567 rooms were disinfected and 1,918 articles were treated at the steam disinfector. DIPHTHERIA IMMUNISATION, Immunisation continues to be carried out at the school clinics, the Welfare Centres, and by private doctors. In 1947 193 children under 5 years of age and 20 between 5 and 15 years of age were immunised and 4 patients had re-inforcing injections. 39.38% of the children under 5 have been immunised and 80.7% of school children. There were 2 cases of diphtheria during the year. One was an adult and neither patient had been immunised. ANALYSIS OF DIPHTHERIA. FOR THE PAST TWENTY YEARS. Notifica tions. Under One. 1 to 5. 5 to 15. 15 to 25. 25 to 45. 45 to 65. Deaths. 1928 .... 221 — 25 154 28 14 — 12 1929 .... 80 — 14 51 11 3 I 8 1930 .... 86 — 16 62 3 3 2 10 1931 .... 28 — 7 12 4 3 2 4 1932 .... 19 — 4 9 3 3 — 2 1933 .... 3 — 1 2 — — — 1 1934 .... 5 — 1 3 — 1 —• 2 1935 .... 12 — 2 6 2 1 1 1 1936 .... 11 — 2 7 1 1 — 1 1937 .... 16 — 2 8 2 4 — — 1938 .... 44 — 7 31 — 2 —• — 1939 .... 15 — 2 13 — — — — 1940 .... 33 — 9 21 2 1 — 3 1941 .... 23 1 5 14 1 2 — — 1942 7 — 3 4 — —• — — 1943 .... 16 — 3 8 4 1 — 1 1944 .... 8 — 1 4 3 — — — 1945 .... 4 — 1 3 — — — 1 1946 — — — — — — — — 1947 .... 2 — — 1 — 1 — . 24 cases were admitted into the Infections Diseases Hospital during 1947, viz.:— 14 cases of scarlet fever. 1 case of tonsilitis. 2 cases of diphtheria. 2 cases of chicken pox. 1 case of glandular fever. 2 cases of measles. 1 case of gonorrhoea. 1 case of influenza. Source of Water Supply, No change. Port Sanitary Regulations, 1933. No change. CASES OF INFECTIOUS DISEASE NOTIFIED DURING 1947 Cases Notified in King’s Lynn. NOTIFIABLE DISEASE. At all ages Under 1 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 and over Hospital Deaths Scarlet Fever 47 — 6 30 7 4 — — 14 —■ Pneumonia 76 12 15 14 3 14 15 3 — 10 Whooping Cough 39 3 17 18 1 — — — — — Tuberculosis (Pulmonary) 27 — 3 3 6 8 6 1 — 3 Tuberculosis (other forms) 6 — 2 1 1 1 1 —- — — Chicken Pox 54 4 12 36 1 — — 1 2 — Scabies 21 1 3 7 6 4 — — — —• Measles 369 15 147 190 8 8 1 — 2 1 Ophthalmia Neonatorum 2 2 — — •— — — — — — Jaundice 31 — — 13 2 12 3 1 — — Meningitis .... 2 ■— — 1 1 — — — — — Malaria 1 — — — — 1 — -— — — Diphtheria 2 — — 1 — 1 — — 2 — Totals 677 37 205 314 36 53 26 6 20 14 Tuberculosis. New Cases and Mortality during 1947 CO ft +3 cS © Q ft Ph 0 CO Ph • rH A co © ft 1 1=1 O £ ft Ph o cO Sh • rH & CO © ft ft ft CO © X cO o £ © ft pH 0 +3 cO Ph • pH ft co © ft 1 a o ft ft ft Ph O +3 cO Ph • rH ft co © ft CO I—I HI CO CN CO no no no 01 no CO no no no no cc Under the National Health Service Act a whole-time Medical Officer of Health is to be appointed. This will be my last Annual Report. I am glad to be able to hand the work over with the general health of the people and the sanitary conditions of the Borough fairly satisfactory. I have to thank the Council for their constant consideration and support and all members of the Public Health Service for their loyal co-operation. I have the honour to be your obedient Servant, james w. McIntosh, Medical Officer of Health. I £ ,r \ .<• > .