FINC 25 BOROUGH OF FINCHLEY ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1944. TO THE MAYOR, ALDERMEN AND COUNCILLORS OF THE BOROUGH OF FINCHLEY. September, 1945. I have the honour to submit my Annual Report for the year 1944. It has been prepared along the lines set out in the Ministry of Health Circular 49/45 and is only a skeleton report. The Vital Statistics are, on the whole, good. The Infantile Mortality Rate is very satisfactory and is the second lowest yet recorded. The Birth Rate is slightly higher than in 1943 and is the highest for 23 years. The Death Rate, which has been steadily going up for many years, continued to do so in 1944. Apart from certain deaths directly due to the war, the increase is entirely attributable to the increasing age of the population. There are two noteworthy features in regard to infectious disease - namely - the very small number of cases of diphtheria and the fact that there were three cases of smallpox. The supervision of food and milk and water supplies has been fully maintained and everything possible has been done, under the difficult circumstances prevailing, to Improve housing and sanitary conditions in general. All members of the staff have given loyal and efficient service and have cheerfully undertaken many additional responsibilities during the year. - 2 - SOCIAL CONDITIONS. Area (in acres) 3,477 Population (estimated) on 30.6.44 59,730 Number of inhabited houses (end of 1944) 18,999 Rateable Value (1st April, 1944) £905,307 Sum represented by a penny rate £3,772 EXTRACTS PROM VITAL STATISTICS. Live Births: Total. Males. Females. Legitimate 982 509 473 Illegitimate 55 29 26 Birth rate, 17.36 per 1,000 estimated resident population. Stillbirths: Total. Males. Females. 33 14 19 Rate, 30.84 per 1,000 (live and still) births. Deaths: Total. Males. Females. 830 397 433 Rate, 13.89 per 1,000 estimated resident population. Deaths from diseases and accidents of pregnancy and childbirth: From sepsis 1 Other maternal causes 3 Death-rate of infants under one year of age: All infants per 1,000 live births 32.79 Legitimate infants per 1,000 legitimate live births 27.49 Illegitimate infants per 1,000 illegitimate live births 127.27 Deaths from Cancer (all ages) 159 Deaths from Measles (all ages) – Deaths from Whooping Cough (all ages) 5 Deaths from Diarrhoea (under 2 years of age) 5 - 3 - POPULATION. The population, as estimated by the Registrar General on the 30th June, 1944, was 59,730 which is 5,410 less than the estimate for 1938, the last normal pre-war year. This fall in the population is only apparent, as men and women in the services are not included in the 1944 estimate. THE BIRTH RATE. The number of registered live births in 1944 was 1037, two more than in 1943 and the highest number since 1920. The birth rate was 17.36 per 1,000 of the estimated population, the highest since 1921. The corresponding rate for England and Wales as a whole was 17.6. There were 55 illegitimate births - 9 more than in 1943. The excess of births over deaths was 207. STILLBIRTHS. There were 33 stillbirths, giving a rate of 30.84 per 1,000 total births - a satisfactory figure. THE DEATH RATE. There were 830 deaths in 1940 as compared with 790 in 1943. The crude or uncorrected death rate was 13.89 per 1,000 of the estimated population, the highest rate for very many years. There has been a gradual increase in the death rate in Finchley over a period of 30 years, largely due to the fact that a fall in the birthrate over a longer period has brought about a gradual increase in the average age of the population and it is in the higher ages that most deaths occur. In 1944, there were 168 more deaths than in 1938. There was an increase of 8 in persons under 45 years, 54 in persons between 45 and 65 and 106 in persons over 65 years of age. The causes of these deaths were as follows: Cancer 34 Diseases of the Heart and Circulation 45 Bronchitis, Pneumonia, etc. 28 Accidents and Violence 18 All other cases 43 – 4 – INFANTILE MORTALITY. In 1944, there were 34 deaths of Infants (6 illegitimate) under one year of age, as compared with 57 in 1943 and 48 in 1942. The infantile mortality rate was 32.79 per 1,000 live births (England and Wales, 46). Only on one occasion (1941) has the rate been lower. It was very disappointing to have to report high rates in 1942 and 1943, after the record low rate in 1941 but it is equally pleasant to be able to report such a favourable rate in 1944 after 5 years of war. In my reports for 1942 and 1943, I expressed my conviction that the high rates for these years were not due to any falling off in the health or nutrition of the expectant mother or to any hardships caused by the war. The very low rate for 1944, when conditions had in no way improved, would appear to substantiate that conviction. MATERNAL MORTALITY. There were four maternal deaths in 1944, giving a maternal mortality rate of 3.74 per 1,000 births. One death resulted from a self procured abortion and 3 from toxaemia of pregnancy. INFECTIOUS DISEASE. The following table shows the number of notifications of the principal Infectious diseases received during the past four years:– 1941. 1942. 1943. 1944. Diphtheria 38 19 9 3 Scarlet Fever 51 141 194 125 Smallpox - - - 3 Enteric Fever 6 1 1 - Cerebro-Spinal Fever 8 4 3 1 Pneumonia 51 42 60 49 Measles 647 593 364 83 Whooping Cough 376 116 78 201 - 5 - Diphtheria reached a new low level with 3 cases. Two of the cases were adults and one a baby and none of them had been immunized. There was a decline in the number of cases of Scarlet Fever over the previous two years and the disease continued to be very mild in character. Measles declined in incidence while Whooping Cough increased. A case of virulent Smallpox in a nurse was discovered in Finchley, which brought to light an outbreak associated with the Mount Vernon Hospital. The patient was unvaccinated and died. Her two sisters, who were vaccinated for the first time after the discovery of the case, developed smallpox in a modified form - one very mild and one fairly severe - and both made uneventful recoveries. Thorough disinfection was carried out, all contacts were vaccinated and kept under supervision, while some thousands in the Borough were vaccinated by the Public Vaccinators or their own doctors. No other case occurred in Finchley. IMMUNIZATION. Eight hundred and one children, mostly about one year of age were immunized during the year. TUBERCULOSIS. The following table shows the number of notifications of, and deaths from, pulmonary and non-pulmonary tuberculosis for the years 1938 to 1944 inclusive. There has been no marked increase either in notifications or in deaths. YEAR New Cases. Deaths. Pulmonary. Non-Pulmonary. Pulmonary. Non-Pulmonary. M F M F M F M F 1938 47 27 4 10 13 9 3 1 1939 34 30 6 8 16 7 2 - 1940 28 21 4 4 16 10 2 2 1941 34 38 5 7 18 15 2 1 1942 40 39 4 3 14 19 1 1 1943 41 39 7 5 14 11 3 5 1944 48 30 8 8 14 9 3 2 – 6 – BACTERIOLOGICAL WORK. The bacteriological work for the district is carried out at the Joint Isolation Hospital and, during 1944, the following specimens were dealt with:- Positive. Negative. Total. Diphtheria 2 298 300 Tuberculosis 5 35 38 Other conditions 5 34 39 377 The position in regard to scabies continued to improve there were fewer cases and, in most of them, the disease was of recent origin so that cure was more easily effected. All the cases were treated by Civil Defence Personnel at the First Aid Posts. HEAD VERMIN. Health Visiters have paid special attention to uncleanliness in children under school age, with good results. There has also been an improvement in the cleanliness of older children and those who have left school. MATERNITY AND CHILD WELFARE. There wore 19,874 attendances at the Infant Welfare Centres in 1944, as compared with 23,836 in 1943. The decrease was due to evacuation and flying bomb attacks in the second half of the year. The Centres were kept open throughout the year and the calmnest and devotion of the Staff and the Voluntary Workers did much to comfort and reassure the Mothers and Children. The Antenatal Clinic was attended by 601 expectant mothers a decrease of 198 as compared with 1943. - 7 - MATERNITY ACCOMMODATION. The situation in regard to maternity accommodation was complicated by the flying bombs and the evacuation of certain hospitals to safe areas but considerable relief was afforded by the accommodation provided by the County Council in the Bishops Avenue. The place of birth was known in 959 cases and, of these, 662 took place in hospitals and nursing homes and 297 at home. Two hundred and thirty-five cases were attended by the Council's Midwives. ACCESSORY FOODS AND VITAMIN PREPARATIONS. These substances continued to be distributed through the First Aid Posts and the Welfare Centres. Their value is beyond all doubt and it is a great pity that there are still quite a fair proportion of mothers who do not avail themselves of them. SUNLIGHT CLINIC. One hundred and forty one children and twelve mothers were referred, for various reasons, to this clinic and made 1,458 attendances. PREMATURE INFANTS. Suitable cots, bedding and warm clothing have been made available for lending to mothers who have premature babies to care for at home. The Municipal Midwives work in close association with the Health Visitors, who are ready to take over the supervision of the babies when the midwives finish attendance. As soon as notice of the date of discharge of premature and delicate babies from hospital is received, the Health Visitors call at the homes, This enables them to advise on the best arrangement of the room and the general management of the baby. They continue to visit the homes as often as they think necessary. - 8 - ILLEGITIMATE CHILDREN. Mothers of Illegitimate children are always encouraged to keep their children with them. In necessitous cases the Voluntary Associations at the Child Welfare Centres willingly provide clothes, cot a or prams. If the mother has no relative to look after her child when at work, she can obtain admission for it at one of the Day Nurseries. The Council make a grant of £25 to the Hornsey Deanery and have received much valuable assistance from this Association in finding accommodation for the unmarried mother and placing infants in safe hands when their mothers do not wish to keep them. The Council are also partners in the County Council Scheme for the care of the unmarried mother. DENTAL TREATMENT. Expectant and nursing mothers, who are in need of dental treatment, are referred by the doctor at the Centres to the Council's dentist. Complete dental treatment is available to all who require and desire it. Although operative treatment is given at a nominal cost to the patient (one shilling per treatment visit) the scheme for supplying dentures is selfsupporting. The Voluntary Association renders great assistance in that it undertakes the collection of fees for dentures on a scale which provides for a reduction in the cost of dentures to necessitous mothers. Mothers. Children. Number inspected 152 208 Number requiring treatment 152 119 Number treated 140 114 Number of attendances 687 251 Fillings 343 183 Extractions 420 153 Gas administrations 60 52 Other operations 175 30 Dentures supplied 59 – Dentures repaired 7 - - 9 - HOME HELPS. The Home Help Scheme continued to grow and, by the end of the year, it was possible to meet all legitimate demands. The Helps have done good work and many letters of appreciation have been received from mothers. DAY NURSERIES. There is accommodation for 40 children, under 3 years of age, at the Council's Nursery at the Health Centre. At the age of 3, the children are transferred to the Wartime Nursery Class at the Martin School where there are 40 places. There are three Wartime Nurseries with accommodation for 160 children. In all cases, the rolls have been full to capacity but attendances have frequently and inevitably suffered from the presence of the common infectious diseases. There is no reason to think that the Nursery Children were affected to any greater extent than outside children as, on each occasion when a nursery was in quarantine, the responsible disease was also prevalent in the Borough at large. On the other hand, it is fairly certain that the nursery population do suffer more from naso-pharyngeal conditions, with nasal discharge as the chief symptom, than the general child populat ion. The Staff were greatly tried by the flying bombs. On many days, long periods were spent in the shelters or else, with frequent alerts, there were constant processions to and from the shelters. The Staff are to be congratulated on the loyal and efficient manner in which they carried on throughout this difficult period. - 10 - FOOD. The inspection of meat and other foods still continues to occupy much of the time of the Sanitary Inspectors. During the year, it was found that meat generally was of good quality and, at the Moat Distributing Centre, which supplies the areas of Barnet, Finchley and Henden, the amount of meat and offal condemned was a very small percentage of the quantity handled. The amount of tinned and miscellaneous foods condemned was less than the previous year. The following particulars show the amount of foodstuffs condemned during the last three years:– Year. Meat and Offal. Tinned Foods. Miscellaneous. 1942 1074 lbs. 2480 tins 6617 lbs. 1943 418 lbs. 3235 tins 9451 lbs. 1944 1807 lbs. 2684 tins 4859 lbs. Two hundred and fourteen tins and packages and 395 lbs. of miscellaneous foodstuffs were condemned on account of damage by enemy action and this amount might have boon much larger but for the fact that shopkeepers had been visited earlier in the war and advised to keep foods easily damaged and subject to glass fragmentation away from windows. Wherever possible, condemned food has been used for salvage purposes. The four private slaughterhouses in the district have been licensed and used for the occasional slaughter of pigs on permit from the Ministry of Food. MILK. Dairies and milkshops have been inspected and 19 samples of designated milks have been taken and submitted for analysis and, with one exception, were satisfactery. Difficulty is still being experienced by the dairymen with regard to transport, both before delivery to the dairy from the producer and after leaving the dairy to the consumer. - 11 - WATER. Four samples of water were submitted for analysis and all proved satisfactory. HOUSING. The housing situation in the District is progressively worsening. Many new cases of overcrowding have been investigated and particulars recorded but these are not a true indication of the acute shortage of houses, as many families are inadequately or unsatisfactorily housed without being overcrowded according to the Act. Property generally is showing signs of lack of repair and maintenance after five years of war. Although many owners have been willing to execute works of repair, further damage to houses by enemy action has absorbed the available building labour and materials, and increased the difficulty of obtaining compliance with notices. The introduction of the £10.0.0 limit On building work, except by licence, has had no apparent effect in enabling the Department to obtain the services of builders to carry out work for owners upon whom notices have been served but, in general, the licences issued have been at the request of owners or builders to carry out repairs to owner occupied houses. Five hundred and sixty houses have been inspected and action taken with regard to the 1,309 defects found thereat, but the standard of fitness is necessarily lower than in pre-war days. There appears to be a steady increase in the number of old people found living in dirty and unsatisfactory conditions, often without relatives and proper care and attention. These cases are, a cause of concern to the Department and most difficult to deal with. - 12 - GENERALLY. During the year, 392 complaints of nuisances were investigated and other matters of an urgent nature dealt with, including investigation of infectious diseases, inspection of factories, supervision of drainage work and some routine inspections. A number of premises used as factories for the production of war materials are not suitable for the type of work carried on and complaints of noise have been received and dealt with and additional and separate waterclosets and washing accommodation provided. Nuisance from flies has grown steadily worse during the war years, largely due to the increase in the number of fowls, rabbits and pigs now being kept and the consequent accumulation of kitchen waste for feeding purposes and deposits of manure. THE RATS AND MICE DESTRUCTION ACT, 1919, DISINFESTATION ORDER.1943. Duties under the above were taken over from the Middlesex County Council on the 1st February, 1944. Mr. J. Yates was appointed Rodent Destruction Officer for the Borough and a fulltime Rodent Operative for Finchley and Friern Barnet was also appointed. Three hundred and forty nine complaints regarding rats and 42 regarding mice were received and dealt with, involving 174 "poisonings" and 128 "gassings". A considerable amount of work was done to render premises rat proof. There is little doubt that there are many rats in the sewers but, owing to the shortage of manpower, it was not possible to deal with them before the end of the year. A. A. TURNER. Medical Officer of Health.