LIBRARY FIN 18 THE Metropolitan Borough of Finsbury ANNUAL REPORT ON THE Public Health of Finsbury for the Year 1937 BY NICHOLAS D. DUNSCOMBE, MA., M.B., B.Chir., D.P.H.Camb., Barrister-at-Iaw MEDICAL OFFICER OF HEALTH, ADMINISTRATIVE TUBERCULOSIS OFFICER AND MATERNITY AND CHILD WELFARE OFFICER. Printed by sir Joseph causton a sons, limited. London. 1938 THE Metropolitan Borough of Finsbury ANNUAL REPORT ON THE Public Health of Finsbury for the Year 1937 by NICHOLAS D. DUNSCOMBE, M.A., M.B., B.Chir., D.P.H.Camb., Barrister-at-law MEDICAL OFFICER OF HEALTH, ADMINISTRATIVE TUBERCULOSIS OFFICER AND MATERNITY AND CHILD WELFARE OFFICER. printed by sir joseph causton & sons. limited. london. 1938 2 CONTENTS. Page Public Health Committee, 1937-38 3 Maternity and Child Welfare Committee, 1937-38 3 Introduction 5 Staff of the Department 8 Section A—Statistics and Social Conditions of the Area 10 Section B—General Provision of Public Health Services 23 Section C—Sanitary Circumstances of the Area 81 Section D—Housing 107 Section E—Inspection and Supervision of Food and Drugs 113 Section F—Prevalence and Control over Infectious and other Diseases 148 STATISTICAL TABLES. Page Page Statistical Summary 10 Maternal Mortality 66 Public Assistance 12 Medical Inspection—School Children 74-76 Population 14 Summary of Work — Sanitary Inspectors 81-83 Births and Birth Hates 15, 16 Deaths and Death Rates 18-21 Factories and Workshops 85-88 Comparative Table 22 Canal Boats 94 Maternity and Child Welfare 28 et seq. Cleansing of Persons 101 Nursing Services 34 Housing 107-112 Convalescence 36 Overcrowding 108 Foster Mothers 41 Food Seized and Surrendered 118, 119 Bacteriological Examination of Milk for Grants 50 Registered Food Premises 144 Food Sampling 144-146 Voluntary Centres 51-55 Notifiable Diseases 148, 149 Infant Mortality 56, 57, 59-61 Diphtheria 153 Midwifery Scheme 61, 62 Cancer 163 Home Helps . ... 65 Tuberculosis 164 et seq. For detailed Index see page 4. 3 METROPOLITAN BOROUGH OF FINSBURY. Public Health Committee, 1937-1938. Chairman : Alderman Dr. C. L. KATIAL, M.B., B.S., D.T.M., L.M. Vice-Chairman: Councillor Dr. H. J. KINGSLEY, M.B., B.S., M.R.C.S., L.R.C.P HIS WORSHIP THE MAYOR (Alderman C. A. Allen, J.P.). Alderman H. J. DAINTY. Alderman Mrs. E. MARTIN. Councillor W. BARRIE, M.P.S. Councillor Mrs. A. E. GIBBS. Councillor Mrs. F. E. GILBERT. Councillor Mrs. L. E. JEFFS. Councillor S. G. NUNN, J.P. Councillor Mrs. A. RAFE. Councillor Mrs. A. A. SIMMONS. Councillor Mrs. M. M. TWIGG. Maternity and Child Welfare Committee, 1937-1938. Chairman : Alderman Mrs. E. MARTIN.*f§ Vice-Chairman: Councillor Mrs. R. CURTIS.*f§ HIS WORSHIP THE MAYOR (Alderman C. A. Allen, J.P.). Alderman Dr. C. L. KATIAL, M.B., B.S., D.T.M., L.M. Councillor W. BARRIE, M.P.S. Councillor Mrs. F. E. GILBERT.* Councillor Mrs. C. GRIFFITHS.§ Councillor Mrs. L. E. JEFFS. Councillor Dr. H. J. KINGSLEY, M.B., B.S., M.R.C.S., L.R.C.P.* Councillor S. G. NUNN, J.P.*t§ Councillor Mrs. A. RAFE.f Councillor Mrs. A. A. SIMMONS.f Councillor Mrs. B. SOUTH.§ * Maternity (Management) Sub-Committee, t Day Nursery Sub-Committee. § Maternity (Assessment) Sub-Committee. The Health Visitation (Rota) Sub-Committee consists of two members of the Committee selected weekly in alphabetical rotation. INDEX. Page Aged and Infirm Persons 96, 160 Agricultural Produce (Grading & Marking) Act, 1928 123 Ambulance Facilities 24 Anthrax 160 Artificial Sunlight Treatment 31 BacteriologicalExaminations23 Bacteriological Examination of Grants Milk 50 Bakehouses 143 Beetles in Silk Warehouse 106 Birth and Birth Rates 15 BirthControl 32 Births, Deaths and Population— Comparative Table 22 Blind Children 43 Cancer 162 Canal Boats 93 Cleansing Station 100 Compulsory Removal of Persons 96, 169 Common Lodging Houses 105 Comparative Statistics 22 Convalescent Treatment 36 Coroner's Court 99 Day Nursery 32, 157 Deaths 19 Deaths and Death Rates 17 Destruction of Rats 91 Diabetes—Insulin Treatment 163 Diphtheria 152 Diphtheria Immunisation Clinic155 Diphtheria Immunisation— General Practitioners Scheme 157 Disinfection and Cleansing of Persons 100 Disinfection for Export 100 Dispensaries—Tuberculosis 169 Voluntary 26 Drainage 83 Ear Clinic 30 Factories & Workshops 83-88 Food Export 124 Food Inspection 113 Food Poisoning l25 Food Sampling 144-146 Food Storage 99 Foster Mothers 41 Grants Scheme 45 Health Visitation 37 Home Helps 64 Home Nursing 33 Hospital Treatment 34 Houses Let in Lodgings 98 Housing 107 Housing—Scheduled Areas 109 Housing Applications. 1ll Ice Cream 115 Infant Deaths 56-61 Infectious Diseases 148 Insulin Treatment 163 Inquests 20 Introduction 5 Lectures at Centres 31 Legal Proceedings 186 Licensed Houses 90 Lighting of Staircases 111 Maternal Mortality 65 Maternity & Child Welfare 26 Measles 157 Page Meat Inspection 118 Members of Committees 3 Merchandise Marks Act, 1926 122 Midwifery Service 61-65 Milk Shops and Dairies 113 Milk (Special Designations) Order, 1936 114 Mortuary 99 Municipal Clinics 26 National Society for Prevention of Cruelty to Children 42 Noise 106 Notifiable Diseases 148 Notification of Births 16 Nursing Homes 80 Offensive Trades 88 Ophthalmia Neonatorum 43 Orthopaedic Conditions 44 Outworkers 87 Overcrowding 108 Pharmacy and Poisons Act, 1933 147 Pigeon Nuisance 106 Pneumonia 160 Population 13 Population—Birth and Death Rates 15-16 Post-Graduate Course 80 Propaganda 77 Public Assistance 12 Public Baths 104 Public Cleansing 102 Public Conveniences 94 Public Vaccination 150 Pulmonary Tuberculosis 164-167 Puerperal Fever 43 Rag and Bone Dealers 89 Rag Flock 98 Rat Nuisance 91 Registration of Food Premises 143 Sanitary Circumstances 81 Scarlet Fever 151 Schools 12 School Medical Service 74 School Milk 117 Shelter 99 Shops Act, 1934 95 Slaughter-houses 142 Smallpox 150 Smoke Abatement 90 Social Conditions 11 Staff 8 & 23 Statistics 10 Stillbirths 16 Street Traders 98 Tonsils and Adenoids 35 Tuberculosis 164 Tuberculosis Care Committee 178 Tuberculosis Dispensary 169 Unemployment 13 Vaccination 150 Venereal Disease 162 Verminous Premises 96 Voluntary Associations 51 Voluntary Dispensaries 26 Weighing Centres 45 Whooping Cough 159 Winter School for Health Visitors 42 Women's Country Holidays 32 Work of the Sanitary Inspectors 81-83 X-Ray Facilities 171 5 To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Finsbury. Mr. Mayor, Ladies and Gentlemen, I have pleasure in submitting for your information my Annual Report for 1937, upon the sanitary circumstances and state of the public health generally. Another year of steady progress has been experienced. Vital Statistics.—The general death-rate was 14.6 per 1,000 population, as compared with 12.4 per 1,000 for the whole country, nd 14.0 per 1,000 in the Borough during the year 1936. The infantile mortality rate was 71 per 1,000 births, a welcome drop from that experienced in 1936, viz., 81 per 1,000 births. This latter high rate was largely due to the epidemic of measles experienced that year. The rate for London was 60 per 1,000 births. The puerperal mortality rate was 1.20 per 1,000 total (live) births and the total Maternal Mortality (including associated deaths) 2.40 per 1,000. Excluding the associated deaths the rate of 1.20 per 1,000 compares with a rate of 3.23 per 1,000 for England and Wales. The birth-rate was 13.8 per 1,000 of the population as compared with 13.3 per 1,000 for London as a whole, and 13.8 per 1,000 in the Borough in 1936. Infectious Diseases.—The number of cases of Scarlet Fever was 114, as compared with 135 last year. The number of cases of Diphtheria notified was 108, as compared with 126 in 1936. 181 persons were immunised last year either at the Municipal Clinics, or under the scheme in operation in the Borough since 1935 by medical practitioners. Housing.—The 29 flats erected in the demolished Amias Place area are now completed and occupied. Busaco Street Area.—The re-development of this area is proceeding, and at the time of writing a scheme for the erection of 234 flats of reinforced concrete construction, provided with lifts, 6 a central hot-water system, the Garchey system of refuse disposal, and other modern amenities, has been approved by the Council. Sadler Street Area.—It is also proposed to develop this area for housing purposes in the near future. Gee Street and Baker's Row Areas.—Enquiries in respect of these two areas were held last year and both were confirmed with modifications. The latter area is to be used for the erection of working-class flats. Maternity and Child Welfare.—The activities of this part of the Department's work are dealt with in detail in the body of the report. The additional Health Visitor engaged has been fully occupied with the routine home visitation. The Visitors' Districts have been revised, and now more regular visitation of the toddlers has been made possible. Minor Ailments.—The Council extended the scheme for the treatment of minor ailments by making arrangements for treatment at the School Clinics in the Borough. Midwifery Scheme.—This scheme, described in full in recent Reports, has continued to function successfully. Quarterly meetings of representatives of the Borough Council and the Hospitals concerned have been held. As a result of representations, a routine Wasserman test is now carried out on all Finsbury mothers attending the ante-natal clinics. All mothers in receipt of dinner grants now receive one capsule of a special vitamin preparation " Adexolin " daily. The scheme under the Midwives Act, 1936, for a service of domiciliary midwifery, for which the London County Council are responsible, commenced on 1st January, 1938, and will be detailed in the Report for next year. Health Centre.—The new Health Centre described in recent Reports, is now in course of erection and will be ready for occupation in the early autumn of 1938. 7 In addition to providing accommodation for the Public Health Department, it will include modern Dental, Foot and Women's Clinics, a Cleansing Station, a Tuberculosis Dispensary with the latest X-ray equipment, a Solarium, Laboratory, Disinfecting Station, and Reception House. In conclusion, I desire to thank the Chairman and Members of the Health, Maternity and Child Welfare and Housing Committees for their continued confidence and support and for the interest they have taken in the Department. I should also like to express my appreciation of the assistance and co-operation afforded to me by my fellow officials and all the members of my Staff. I have the honour to be, Your obedient servant, NICHOLAS D. DUNSCOMBE, Medical Officer of Health. June, 1938. 8 STAFF OF THE PUBLIC HEALTH DEPARTMENT at 31st December, 1937. Medical Officer of Health : Nicholas D. Dunscombe, M.A., M.B., B.Chir., D.P.H. (Camb.), Barrister-at-Law. Tuberculosis Officer and Deputy Medical Officer of Health: C. O. S. Blyth Brooke, M.R.C.S., L.R.C.P., D.P.H. Assistant Medical Officer of Health : I. E. Chandler, M.R.C.S., L.R.C.P., D.P.H. (until June, 1937). Dr. C. M. M. Culver Evans (since June, 1937). Public Analyst : J. K. Colwell, F.I.C., F.C.S. (part-time). Dental Surgeon : Dr. M. H. Wells (until March, 1937). P. R. Asplet, L.D.S. (since March, 1937). Public Vaccinators : Dr. W. H. Bell (resigned January). Dr. B. McKeown. Dr. R. E. Batson. Dr. R. K. Dadachanji. Dr. Susan A. Finch (appointed January, 1937). Vaccination Officer : P. E. Capps (part-time). Clerical Staff : E. Q. Bilham (Assistant Administration Officer). L. T. H. Mussett. T. E. Williams. J. E. McDowell. A. J. Truslove. G. Hawthorn. R. L. Cathcart (Temporary). Maternity and Child Welfare : Italian Clinic—Dr. Lomas (part-time). Clerks—Miss W. A. Freeman, Miss C. A. Blunden. Health Visitors and Superintendents : Leage Street Superintendent—Miss M. Williams (deceased Oct., 1937), Miss Fillingham, Oct., 1937 (acting). Pine Street Superintendent—Mrs. E. J. Hewlett. Health Visitors—Miss M. Fillingham, Miss J. R. Turner, Miss B. J. Scott, Miss M. Rock, Mrs. G. Hartney. Dispensers—Miss M. Willett (part-time), Miss E. E. Wightman (resigned January, 1937), Miss M. J. Shervill. Masseuse—Miss K. E. Clutton (part-time). 9 Cook-Cleaners— Leage Street: Mrs. A. Purcell and Mrs. A. Fletcher. Pine Street: Mrs. M. A. Cunningham, Mrs. A. K. Grey. Day Nursery : Matron—Miss I. V. Oakes. Nurse—Miss L. Wilkinson. Probationers—Miss M. C. Blunn (from 26th April), Miss J. Robertson, Miss F. Herbert. Cook—Mrs. L. Matthews. Cleaner—Mrs. A. L. Emmerton. Meat Inspector : T. Penman. R. S. Barber (Assistant). Sanitary Inspectors : E. A. Norman (Senior), H. Newdick, C. M. Longden, H. Clinton, R. E. Lay, A.C. Jenkins, H. Ward. Lady Sanitary Inspector—Miss F. Hall. Tuberculosis Dispensary Staff : Tuberculosis Nurse—Miss F. M. Prior. Clerk—Miss Rimel. Janitor and Cleaner.—T. E. Doncaster. Secretary of Care Committee—E. Q. Bilham. Mortuary and Disinfecting Station and Shelter : F. W. Battle (Foreman Disinfector). F. Readstone (Disinfector). J. Luke (Driver Disinfector). Mr. and Mrs. E. J. Connolly (Mortuary Attendant, Keeper of Coroner's Court and Shelter). His Majesty's Inspector of Factories for the Borough : Mr. L. D. Hooper, 324, Grays Inn Road, W.C.I. Telephone No.: Terminus 6266. 10 SECTION A. Statistics and Social Conditions of the Area. Area (in acres) 587 Registrar-General's estimate of resident population 1937 58,700 Number of inhabited houses end of 1937 (according to Rate Books) 9,019 Rateable value £1,239,431 Sum represented by a penny rate £4,800 Extracts from vital statistics of the year:— Live Births:— Total. Males. Females. Legitimate 771 373 398 Illegitimate 41 23 18 Birth Rate per 1,000 population Finsbury 13.8 London 13.3 England and Wales ... 14.9 Deaths :— Total. Males. Females. 857 439 418 Death Rate per 1,000 population Finsbury 14.6 London 12.3 England and Wales 12.4 Deaths from puerperal causes:— Rate per 1,000 total Deaths. (live) births. Puerperal sepsis 0 0.0 Other puerperal causes 1 1.23 Deaths not classed to pregnancy and childbearing but associated therewith 1 1.23 Total Maternal Mortality 2 2.46 Death Rate of infants under one year of age:— All infants per 1,000 live births Finsbury 71 London 60 England and Wales 58 Legitimate infants per 1,000 legitimate live births 70 Illegitimate infants per 1,000 illegitimate live births 98 11 Deaths from measles (all ages) 0 „ whooping cough (all ages) 6 „ diarrhoea (under 2 years of age) 11 In comparison with figures for 1936, the following matters are of interest:— Diphtheria and scarlet fever showed decreases in 1937. The number of cases of measles notified in 1937 was one-third of the number notified in 1936, when the usual biennial recrudescence of this disease occurred. The notifications of pulmonary tuberculosis were slightly more in 1937. Whooping cough in 1937 diminished by nearly one-half as compared with 1936. The number of deaths and the death-rate were higher in 1937. The infant mortality was 71 per 1,000 births. The deaths from influenza, cancer, heart disease, pneumonia, and violence other than suicide, were more in 1937. The deaths due to whooping cough, diphtheria, diabetes, bronchitis, cerebral haemorrhage and diarrhceal diseases were less in 1937. Social Conditions and Character. The Metropolitan Borough of Finsbury was formed by the Local Government Act, 1899. It succeeded and embodied the administrative Vestries of the Parishes of Clerkenwell, St. Luke Middlesex, St. Sepulchre Middlesex, The Charterhouse and Glasshouse Yard. It is bounded on the south by the City of London, on the west by the Borough of Holborn, on the north by the Boroughs of Islington and St. Pancras, and on the east by the Borough of Shoreditch. 12 It is a busy central Borough and partakes largely of the City character; in fact the City has already invaded Finsbury with its overflow of industry by way of the four main arteries, Farringdon Road, St. John Street, Aldersgate Street and the City Road. Finsbury is the smallest but one of all the Metropolitan Boroughs, the area being 587 acres, practically the whole of which is built up, there being only 11 acres of open space. Although small in area, it is estimated that the day population is approximately 200,000, this meaning that over 130,000 persons enter and leave the Borough daily. The people are employed in factories, workshops, offices and trade processes. Schools. There are 17 Elementary Schools in the Borough, both provided and non-provided, including one Central School, providing accommodation for 13,501 children (limit of enrolment). There is also a school providing accommodation for 150 deaf and partially deaf children. The numbers on the registers at the end of 1937 were 8,591, and 74 respectively. Public Assistance. The Chief Officer of Public Assistance of the London County Council has kindly given me the following details as to the number of persons resident in Finsbury who were in receipt of domiciliary relief during the last week of each quarter of 1936-7 :— Last week of quarter. Number of persons in receipt of domiciliary relief (excluding medical relief only). Number of persons in receipt of medical relief only. 1936. 1937. 1935. 1936. March 2,025 1,703 3 3 June 1,867 1,416 1 1 September 1,752 1,340 2 0 December 1,642 1,280 2 4 13 Unemployment. The following notes relating to unemployment in Finsbury have been kindly communicated to me by Mr. E. J. Fair, the Manager of the local Employment Exchange :— The steady improvement in the employment position for the Borough of Finsbury during the last few years was well maintained in 1937 as the following statement will show:— Men. Women. Boys. Girls. Total. January, 1935 1,604 379 48 19 2.050 January, 1936 1,681 436 22 24 2,063 January, 1937 1,213 355 21 36 1,615 January, 1938 1,314 253 16 6 1,639 Apart from the opportunities of employment locally, a considerable number of workpeople—men, women and juveniles—were placed with employers in other districts. The shortage of tne more skilled types of workmen has continued with the result that demands of local employers frequently have had to be met by the introduction of applicants from other districts. There is, however, a considerable number of unskilled and semiskilled workpeople for whom there can be little hope of more or less permanent employment, either locally or elsewhere, and these types account for the bulk of the live register. It is with pleasure that one is able to record that more work of an intermittent nature is now available, even for the labourer type, and comparatively few men have been wholly unemployed for any length of time. The demand for juvenile labour is still much in excess of the supply, and there is a marked tendency for young people to select jobs of work which appear to offer regular employment of a progressive nature. Many employers have been quick to realize this feature, and much has been done to improve the working 14 conditions and the prospects of advancement in factories and workshops. The position in regard to the unskilled groups is still an unsolved problem which is partly being assisted by the Ministry of Labour Training Schemes, from which a number of local applicants have benefited. Quite a number of new factories have been erected in the area recently, and these, in the main, have been acquired by local firms to meet a long overdue demand for additional workshop space, improved conditions and modern equipment. It is of interest to record that the majority of local industries have been carried on here for generations, and these activities are regarded as essentially local to the area. A number of firms which previously imported their wares are now manufacturers of the same class of goods, and this accounts for the expansion of their businesses. Population. At the Decennial Census made in April, 1931, the population of Finsbury was 69,888. The distribution by districts is given below. The population of the Borough to the middle of 1937 is estimated by the Registrar General to be 58,700, which is the figure used in compiling this report. The population has gradually diminished since the census of 1901. Estimate of Population, 1937. Estimated population 1937. Census population 1931. Census population 1921. Clerkenwell 33,448 45,777 50,322 St. Luke 19,587 23,319 24,592 St. Sepulchre 665 792 1,081 Totals 58,700 69,888 75,995 The estimate does not include the Finsbury residents detained in various London County Council Public Assistance Institutions. 15 Births and Birth Rates. These are given in the annexed table:— Year. Population in the middle of each year. Corrected Births. Corrected Births Rates. 1910 88,987 2,833 31.8 1911 87,566 2,676 30.6 1912 86,130 2,579 29.9 1913 84,679 2,494 29.4 1914 83,212 2,558 30.7 1915 76,915 2,192 28.5 1916 80,746 1,926 23.8 1917 75,813 1,572 20.7 1918 74,502 1,275 17.1 1919 78,431 1,582 20.2 1920 78,423 2,540 32.4 1921 76,619 1,973 25.7 1922 75,390 1,934 25.7 1923 74,761 1,844 24.6 1924 74,132 1,662 22.4 1925 73,503 1,754 23.9 1926 72,874 1,659 22.8 1927 72,245 1,449 20.0 1928 71.616 1,469 20.5 1929 70,987 1,373 19.3 1930 70,358 1,299 18.5 1931 70,120 1,261 18.0 1932 69,030 1,107 16.0 1933 66,640 1,010 15.1 1934 64,970 981 15.1 1935 63,100 931 14.7 1936 60,800 840 13 .8 1937 58,700 812 13.8 The rates for the various districts in 1937 were as follows:- Population. Births. Birth Rate. Clerkenwell 38,448 527 13.7 St. Luke 19,587 279 14.2 St. Sepulchre 665 6 9.0 58,700 812 13.8 16 The corresponding birth rates for the rest of the country are attached:— England and Wales 14.9 London 13.3 Finsbury 13.8 125 great towns 14.9 148 smaller towns 15.3 The number of Finsbury births reported as illegitimate was 41. The number of deaths in illegitimate children under one year was 4. The total number of stillbirths was 29. Notification of Births. The number of Finsbury births notified in 1937 was 842. Notifications were received of 15 pairs of twins. The number of births notified by parents was 13, by midwives 175, by doctors 11, by hospitals, infirmaries and nursing homes 400, and by others, chiefly medical students and midwifery students, 243. In 1937, the number of instances in which parents omitted to notify, and where there was no notification from any other source, was 10. To these a printed form was sent, drawing attention to the omission. In all cases a satisfactory explanation of the omission was given. Stillbirths. A child is stillborn when it has issued forth from its mother after the twenty-eighth week of pregnancy and has not at any time after being completely expelled from its mother breathed or shown any other signs of life. Such births are required to be registered under the Births and Deaths Registration Act, 1926, which came into force on 1st July, 1926, In 1936 the percentage was 3. 7. The stillbirths are investigated by the Assistant Medical Officer of Health. The following reasons were ascertained as the cause :— Pressure on Cord 3 Abnormal Presentation 3 Placenta Praevia 4 Foetal Injury 1 Accidental Haemorrhage 3 Failure of Placental CirculaFcetal Deformity 1 tion 2 Toxaemia 2 Maternal Syphilis 2 Eclampsia 1 Unknown 4 Abnormal Labour 3 Of these cases, one prolapsed cord was associated with breech presentation in a twin ; one death occurred in a case of toxaemia and was associated with gross fcetal injury following abnormal presentation ; one case of abnormal presentation was associated with prematurity. Of the six cases where no definite cause was ascertainable, one was associated with grave heart disease of the mother, two with maceration of the foetus (one of which was full-term and one premature), and, in the last case, although a post-mortem of the infant was held, no cause was discovered. Deaths and Death Rate. The number of Finsbury residents who died in 1937 was 857, this is equivalent to a crude death rate for the whole Borough of 17 The table below gives particulars of th; stillbirths allocated to the Borough registered last year:— Legitimate Males ... 19 Females ... ... 9 Illegitimate i Males ... ... 1 [Females ... ... — Total ... ... 29 = 3.4% of total births. 18 14.6. In order to afford an accurate means of comparing the mortality of the whole district with that of another, the crude death rate must be adjusted by means of a correction factor. This factor standardises irregularities of distribution as regards age and sex, and for the year 1937, it is given by the Registrar General as 1.09. By the use of this correction factor, the death rate for Finsbury for 1937, the " standardised " death rate, is 15.9. The death rates for previous years are given in the attached table :— Death Rates, 1912-1937. Year. The Borough. Year. The Borough. 1912 18.5 1925 14.3 1913 18.4 1926 13.7 1914 19.6 1927 14.0 1916 21.5 1928 15.1 1916 19.3 1929 160 1917 20.4 1930 131 1918 23.7 1931 14.02 1919 15.4 1932 13.4 1920 14.7 1933 12.8 1921 14.7 1934 *13.4 †l4.6 1922 16.5 1935 12.6 13.7 1923 13.5 1936 14.0 15.3 1924 14.7 1937 14.6 15.9 * Crude Death Rates. † Standardised Death Rate (see p. 17). The comparison of Finsbury with the rest of the country may be seen below :— Death Rates for 1937. England and Wales 12.4 per 1,000 London 12.3 „ Finsbury 14.6 „ 125 great towns 12.5 ,, 148 smaller towns 11.9 „ Age at Death.—There were 428 deaths of persons in Finsbury at 65 years of age and over, and of these 222 were of persons over 75 years of age. 19 Deaths, 1937. Causes of Death. All Ages. 0- 1- 2- 5- 15- 25- 35- 45- 55- 65- 76- Measles - - - - - - - - - - - - Scarlet Fever - - - - - - - - - - - - Whooping Cough 6 6 - - - - - - - - - - Diphtheria 2 — — — 2 — — — — — — - Influenza 20 1 — — — 1 — — - 4 6 8 Encephalitis Lethargica 1 - - - - - - - 1 - - - Cerebro-spinal Fever - - - - - - - - - - - - Tuberculosis of respiratory system 59 - - - - 11 10 16 10 9 2 1 Other tuberculous diseases 3 1 - - - 1 - 1 - - - - Syphilis 6 - - - - - - - - 6 - - General paralysis of the insane, tabes dorsalis 5 - - - - - - 1 3 1 - - Cancer, malignant disease 130 - - 1 - - 2 9 13 32 53 20 Diabetes 6 - - - - - - - - 2 4 - Cerebral haemorrhage, etc. 21 - - - - - - - 1 5 5 10 Heart disease 255 - - - 2 6 4 4 15 37 69 118 Aneurysm 7 - - - - - - - 2 1 3 1 Other circulatory diseases 26 1 - - - - - - 1 2 7 15 Bronchitis 31 1 - - - - - - 4 8 11 7 Pneumonia (all forms) 78 16 5 1 3 1 1 6 8 15 10 12 Other respiratory diseases 8 - 1 - - - - - - 1 3 3 Peptic Ulcer 13 - - - - - - 1 4 5 1 2 Diarrhoea, etc. 16 10 1 1 - 1 1 -_ 1 1 - - Appendicitis 5 - — - - 2 - - - 2 1 - Cirrhosis of Liver 3 - - - - - - - 1 1 1 - Other diseases of Liver, etc. 2 - - - - - - - - 2 - - Other digestive diseases 12 1 - - - - - 1 - 6 3 1 Acute and Chronic Nephritis 20 - - - - - - 1 5 3 8 3 Puerperal Sepsis - - - - - - - - - - - - Other puerperal causes 1 - - - - - - - - - - - Congenital debility, premature birth, malformation, etc. 17 17 - - - - - - - - - - Senility 9 - - - - - - - - - 1 8 Suicide 8 - - - - - 1 0 2 0 1 - Other violence 33 2 2 2 5 2 1 2 6 5 2 4 Other defined diseases 53 1 - 2 5 - 2 2 8 9 15 9 Causes ill-defined or unknown 1 1 - - - - - - - - - - All Causes 857 58 9 7 17 25 22 47 85 159 206 222 20 From the previous table it will be seen that the chief causes of death were as follows:— No. of Deaths. (a) Diseases of the heart and circulatory system 288 (b) Malignant disease 130 (c) Respiratory diseases 117 (d) Pulmonary tuberculosis 59 (e) All forms of tuberculosis 62 The following table shows the number of deaths from cancer and the death rates for the last 12 years. At the beginning of the century the death rate was 0.70 per 1,000:— Year. No. of Deaths. Death Rate. 1926 99 1.3 1927 111 1.5 1928 122 1.7 1929 108 1.5 1930 115 1.6 1931 101 1.4 1932 102 1.5 1933 105 1.6 1934 127 1.95 1935 121 1.92 1936 113 1.86 1937 130 2.2 Inquests. Inquests were held on 50 residents of the Borough last year as compared with 53 in 1936. The table below gives the findings of the inquests:— Accidental: Asphyxia 2 Blow in brawl 1 Burns 3 Cyanide poisoning 1 Falls 13 Food poisoning 2 Motor vehicle accidents 8 Scalds 2 Tramcar accident 1 21 Suicidal: Coal gas poisoning 4 Drowning 2 Hanging 1 Sulphuric acid 1 Other: Asphyxia 1 Alcoholism 1 Bronchitis 1 Cancer 1 Gastric ulcer 1 Heart disease 1 Hypersemia 1 Inattention at birth 1 Peritonitis 1 Deaths on the Road. In 1936, 9 deaths were due to the risks of the road—all were due to accidents in which motor vehicles were involved. Last year 9 deaths were due to this cause, 8 associated with motor vehicles, and 1 with a tramcar. Deaths of Persons 1-5 Years. Sixteen deaths occurred last year of persons between the ;iges of one and five years. The deaths were ascribed to the following cauncs:— 1934. 1935. 1936. 1937 Violence 12 4 0 4 Measles 11 0 12 0 Scarlet fever 2 1 1 0 Whooping cough 3 1 3 0 Diphtheria 13 1 1 0 Phthisis 4 2 0 0 Other tuberculous diseases 3 2 2 0 Heart disease 5 0 0 0 Pneumonia and bronchitis 11 6 8 6 Other diseases 11 11 6 6 Totals 75 28 33 16 Home Accidents.—Last year special leaflets on "Home and Everyday Accidents" were distributed throughout the Borough by the Municipal and Voluntary Centres and Organisations, 22 including the Public Baths. The assimilation of such knowledge should help to prevent many unnecessary accidents whether in the home or the streets. Comparative Table. The following table shows the general birth and death rates and infant mortality in each of the Metropolitan Boroughs:— Borough. Estimated Resident Population (mid-1937). Live Births Rate per 1,000 Population. Death Rate per 1,000 Population. Infantile Mortality Rate per 1,000 Live Births. Crude. Adjusted. West Districts. Paddington 138,300 13.65 13.05 12.91 66 Kensington 175,600 12.1 13.3 12.4 83 Hammersmith 126,500 15.1 12.6 13.0 68 F ulham 138,900 13.9 13.08 13.2 56 Chelsea 56,510 10.8 14.1 12.0 59 Westminster 124,300 8.2 11.5 11.8 58.7 North Districts. St. Marylebone 92,110 9.36 13.10 12.98 73 Hampstead 90,690 11.2 11.6 10.9 54 St. Pancras 181,900 13.0 12.7 13.0 62 Islington 295,400 15.25 12.9 13.02 66 Stoke Newington 50,250 14.1 12.5 12.0 37.5 Hackney 206,700 13.8 11.1 11.7 43.38 Central Districts. Holborn 34,600 8.09 11.85 12.68 79 Finsbury 58,700 13.8 14.6 15.9 71 City of London 8,980 6.1 11.2 12.4 36.3 East Districts. Shoreditch 82,240 14.86 12.47 13.72 54 Bethnal Green 94,560 13.3 12.5 14.1 54 Stepney 203,100 13.5 12.2 14.2 60.5 Poplar 136,800 15.5 12.6 14.0 61 South Districts. Southwark 147,400 14.7 13.6 14.1 64 Bermondsey 98,790 14.4 12.3 14.0 59 Lambeth 273,800 14.1 13.2 13.0 68 Battersea 143,500 14.94 12.89 12.76 70.43 Wandsworth 341,700 11.53 12.36 11.43 62 Camberwell 224,800 14.08 12.83 12.83 58 Deptford 96,580 15.1 11.8 12.3 45 Greenwich 95,990 13.88 12.03 12.27 50 Lewisham 226,000 13.9 10.8 10.9 46 Woolwich 149,400 14.2 11.1 11.7 40 23 SECTION B. General Provision of Public Health Services. Staff. The members of the Staff are indicated on page 8. Miss E. G. Wightman, Dispenser-Clerk, resigned as from 31st January, 1937. Miss Rimel, of the Borough Engineer's Department, who had formerly worked in this Department, was transferred to the Health Department, her main duties being in the Tuberculosis Dispensary. Miss M. J. Shervill was appointed to the position of Dispenser (part time) at the Maternity and Child Welfare Centres. Dr. Marie H. Wells resigned her appointment as part-time Dentist as from the end of March, and Mr. P. R. Asplet, L.D.S., was appointed in her place. Dr. W. H. Bell, Public Vaccinator for No. 2 District, resigned in January last, and Dr. Susan A. Finch, of 12, Lloyd Street, was appointed to the post. Bacteriological Examinations. Borough Laboratory.—During 1937 the scope of the Laboratory attached to the Department has been extended, and a number of bacteriological examinations of milk samples have been made which previously would have been undertaken by the Clinical Research Association. The following examinations were carried out:— No. of Throat and Nasal Swabs examined for the Diphtheria Bacillus 995 Of these, Positive results were found in 41 cases. No. of Sputums examined for Tubercle Bacilli 193 Of these, Positive results were found in 36 cases. 24 No. of Milk Samples examined:— Schools supply 35 Supplied under orders from the Council 13 Designated Pasteurised 14 General 7 69 No. of Ice Cream samples examined 15 No. of Swimming Water samples examined 7 Clinical Research Association.—No. of Samples examined : Milk:— Schools supply 10 Supplied under orders from the Council 7 Designated Pasteurised 3 Dripping 1 Turkey and Tongue Paste 1 Meat 1 Ambulance Facilities. The London County Council provides, within the administrative County, ambulances for the conveyance of patients to hospitals and /or private residences in the following circumstances:— 1. Free of Cost.— A.—(i) Persons meeting with accidents or suffering from sudden illness in the street, public places or places of employment, etc.; (ii) Persons meeting with accidents in their homes. (iii) Persons suffering from illness in their homes if a medical practitioner certifies that the case is one of life or death, and that arrangements have been made for the reception of a patient in a hospital; (iv) Parturient women, if the case is one of urgency, whether from the home, place of business or elsewhere, on the application of a qualified medical practitioner or certified midwife, provided that either a doctor or midwife accompanies the case; 25 (v) Non-urgent cases of parturition. In such cases admission to a maternity bed must previously have been arranged and a card (issued by the Council to hospitals, maternity homes, etc.) for such admission be obtained. This card must be handed to the ambulance attendant at the time of the removal, and the husband or female friend must accompany the patient. B*.—Removal of patients to the Council's General Hospitals. * No charge for the ambulance is made at the time of removal, but the patient is liable to be assessed according to his means by the appropriate Assessment Committee. C.—Removal of patients to the Council's hospitals for infectious cases. A medical certificate must be handed to the ambulance nurse, stating definitely the nature of the disease which must be one of those admissible to an infectious disease hospital (see pages 16, 17 and 40). 2. On Payment.—Ambulance and ambulance omnibuses are provided by the Council, when not required for the purposes stated above, on payment of charges as laid down from time to time by the Council for the conveyance of infectious and non-infectious patients between private houses, hospitals (other than to the Council's hospitals, etc., under the provisions of the foregoing section (1) ), nursing homes, and for examinations, consultations and treatment by specialists or at special establishments. The conveyance of private persons between addresses both of which are outside the administrative County of London, cannot be undertaken except in circumstances of unusual urgency. A pamphlet issued by the Council on the full facilities afforded by the London Ambulance Service may be obtained from the Medical Officer of Health, London Ambulance Service, County Hall, S.E.I. Ambulances are also available upon payment from the St. John Ambulance Brigade, St. John's Gate, E.C.I. The ambulance service of the Borough is very satisfactory. 26 Voluntary Dispensaries. There are three voluntary dispensaries which do extensive work in Finsbury; these are the City of London and East London Dispensary, 40, Wilson Street, E.C.2; the Royal General Dispensary, Bartholomew Close, E.C.I; the Finsbury Dispensary, Friend Street, E.C.I. For the two latter institutions I am enabled to give the following figures for 1937 by the kindness of the Secretaries. Finsbury Dispensary. No. of out-patients—Finsbury residents 8,081 No. of out-patient attendances 22,907 No. of visits to patients' homes 3,004 Royal General Dispensary. Number of new out-patients 1,288 Number of out-patients attendances 2,976 Number of visits made to patients' homes by R.M.O. 1,192 Although the Dispensary is situated within the borders of the City of London, practically all the out-patients are from the Borough of Finsbury, and all the visits to patients' homes are most certainly in the Borough of Finsbury. Maternity and Child Welfare. The activities of the two Maternity and Child Welfare Centres 24, Leage Street, and Pine Street may be summarised as follows : Pine Street. Monday, Wednesday and Friday, 10 a.m.—Engagement of Home Helps. Tuesday and Thursday, 10 a.m.—Artificial Sunlight Clinic. Tuesday and Thursday, 2 p.m.—Doctor sees mothers, children and babies; weighing of children and babies; sale of dried milk ; massage clinic. 27 Wednesday, 2 p.m.—Clinic for Italian mothers, children and babies, attended by Doctor speaking Italian; weighing of children and babies; sale of dried milk. Saturday, 10.30 a.m.—Diphtheria immunisation by appointment. Daily, 9.30 a.m.—Dried milk given to mothers receiving grants from the Council. Daily, Monday to Friday, 12 noon to 1 p.m.—Dinners to mothers and children. Leage Street. Monday, Wednesday and Friday, 2 p.m.—Doctor sees mothers children and babies; weighing of children and babies; clothing club; sale of dried milk. Tuesday and Friday, 10 a.m.—Artificial sunlight clinic. Wednesday, 10 a.m. (by appointment) and Friday, 2 p.m.— Dental clinic. Friday, 2 p.m.—Sewing Class. Daily, 9-10 a.m.—Dried milk given to mothers receiving grants from the Council. Daily, 9 a.m. to 12 noon.—Engagement of Home Helps. Daily, Monday to Friday, 12 noon to 1 p.m.—Dinners to children. Diphtheria immunisation.—By appointment. Test feeds—at both centres—as may be necessary. Women's Holiday Fund.—A Representative attends at Pine Street and at Leage Street Centres on Wednesdays from 3-4 p.m. from February to September. Mothers who would normally attend Leage Street receive their dinners at the Home of Service, King Square. 28 Attendances at the Clinics and classes in 1937 :— Leage Street. Pine Street. Mothers, individual 179 148 do. attendances 470 209 Children, 1 to 5 years, individual 720 536 do. attendances 4,522 4,611 Babies, individual 437 355 do. attendances 2,953 3,944 (The above figures do not include the service of meals.) At the various clinics numbers were allocated as follows:— Leage Street. Pine Street. Mothers (seen at Children's Clinic)— No. attended 67 87 Attendances 96 150 Leage Street. Pine Street. Children's Clinic— No. of children, 1—5 years 553 361 Attendances 3,492 2,960 No. of babies 418 336 Attendances 2,832 3,165 Dental Clinic— No. of Clinics held 64 Not held No. of nursing mothers 41 at Pine No. of attendances 130 Street. No. of expectant mothers 8 No. of attendances 23 No. of mothers of children, 1—5 year; 5 60 No. of attendances 210 No. of children 1—5 years 99 No. of attendances 193 Gas anaesthesia attendances 157 Local anaesthesia attendances 10 No. of partial or complete dentures 19 No. of dentures repaired 6 29 Home visits were paid by the Superintendents in 984 cases, to 71 expectant mothers and 913 general visits. The Health Visitors also made 690 visits to expectant mothers in connection with preparations for confinement. Clothing clubs are held at both centres for the sale of woollen and other garments at cost price, for the children of those mothers who attend the centres. Artificial Sunlight Clinic— No. of mothers 3 1 No. of attendances 11 1 No. of children, 1—5 years 68 65 No. of attendances 837 676 No. of babies 19 19 No. of attendances 121 116 * Italian Clinic— No. of mothers Not held 22 No. of attendances at Leage 56 No. of children, 1—5 years Street. 67 No. of attendances ... 535 No. of babies ... 69 No. of attendances ... 663 * (These figures are included above) Massage Clinic— No. of children Not held at 16 No. of attendances Leage Street. 299 Dinners— The numbers of dinners served at the centres were as follows :— Leage Street. Pine Street. To mothers Nil 4,468 To children 9,783 7,351 Sale and Grants of Dried, Milk— Sale of Dried Milk 1,831$ lb. 1,749 lb. Free Grants of Dried Milk 1,066 lb. 2,483 lb. 30 All serious, acute, urgent, and chronic cases were referred for treatment to general and special hospitals. In addition, a large number of minor ailments were given treatment at the Centres. Cases of tuberculosis and of suspected tuberculosis were referred to the Municipal Tuberculosis Dispensary at Whiskin Street. The Sewing Class at Leage Street Centre was continued, 221 attendances being recorded. The voluntary worker, Mrs. Mason, who had conducted this class, removed from London, and her services were no longer available. It was found possible to continue the class through an offer of voluntary aid kindly made by the late Matron of the Day Nursery, Miss M. Ditchman. Considerable assistance is given to the Assistant Medical Officer and Centre Superintendents by the Voluntary helpers who kindly attend the Centres on certain days. Their willing help is much appreciated by all concerned. Dentures.—Last year 19 mothers were supplied with dentures under the scheme previously described. In six further cases dentures were repaired. Middle Ear Disease. Arrangements have been made with the London County Council for children under five years of age suffering from ear disease to be treated at a special clinic at Popham Road, N.l. All cases are seen by an aural surgeon who prescribes the requisite treatment and admission to hospital is arranged if necessary. This clinic is a valuable one and must be the means of saving many young children from the ill effects of a neglected ear discharge. Reports on the condition of children are sent to the Medical Officer of Health on their first visit and also on discharge. These children are followed up by the Health Visitors, and any relapsed cases are referred back for further advice. Last year 5 cases were referred for treatment at this special clinic. 31 Artificial Sunlight Treatment. Artificial Sunlight treatment was given at both the Municipal Centres during 1937 for the following conditions :— Children.—Anaemia ; Debility ; Marasmus ; Skin diseases, various ; Rickets. Mothers.—Anfemia ; Debility, post-partum ; Lactational insufficiency. The Clinics were well and regularly attended, except in a few cases, where the mothers found regular attendance difficult. The various skin diseases have shown a particularly good response, notably impetigo and excoriated buttocks in infants. The results of the treatment on nursing mothers have also been very beneficial and the mothers attended most regularly. Lectures at Centres. In the course of last year a series of Lectures and Demonstrations were held at Leage Street and Pine Street on clinic days. Some of these were given by the Health and Cleanliness Council, and the Dental Board. The Gas Light & Coke Company gave demonstrations based on a week's menu for a family of five at a cost of 22s. 6d. per week. A complete meal was cooked at each demonstration and simple dietary points were given. The Milk Publicity Council gave a series of Demonstrations on Different Methods of Using Milk. On the whole, these latter demonstrations are the more appreciated as the listeners are allowed to take the puddings, etc., home. A few talks were given by the Health Visitors and the Doctor at the Centre. However, on the whole, it is found more satisfactory to talk to the mothers individually as they appear to listen and benefit most by this method of instruction. A visit was paid last year by the girls attending the Baltic Street Housewifery Centre, Golden Lane, to the Leage Street Centre. The visit was much appreciated. 32 Birth Control. There is no Municipal Women's Clinic in the Borough at which advice is given on birth control in suitable cases. The Goswell Women's Welfare Centre, 39, Spencer Street, Goswell Road, referred to last year is still in operation. The following details are given relating to the Finsbury residents who attended the Birth Control Sessions at the Centre. Number of patients 69 Number of attendances 179 Reasons for Coming :— Medical 20 Economic 32 Medical and Economic 17 Patients recommended from Medical Sources :— Mother and Child Welfare Centres, etc. 29 Private Doctors 9 Patients informed through other sources :— Other patients 18 Publicity 13 In June 1936 I reported on the subject indicating the Council's power in this matter, but consideration thereof was deferred pending the erection of the New Health Centre. The Women's Country Holiday Fund. This body continued their welcome and useful work amongst the mothers who attended at the Council's Maternity Centres, enabling many tired-out mothers to obtain a stay by the sea in comfortable surroundings, and a respite from the trying cares of a noisy and crowded home. The Council makes an annual grant to the Fund based on the expenditure incurred in sending away for holidays mothers with young babies. A grant of £46 5s. Od. was made for these services in 1937. The Day Nursery. The Municipal Day Nursery is situated in 42, Baker Street, and provides accommodation for 18 toddlers and 12 babies. In the summer a maximum of 35 are admitted, as the toddlers can then live all day in the open space provided in Granville Square. 33 The staff consists of a matron, nurse, cook-general, cleaner, and three probationers. The matron and the three probationers live and sleep in the building. The total attendances of babies and toddlers in 1937 numbered 5,701 as compared with 5,605 in 1936 and 5,194 in 1935. The charges are 9d. per head per day, or 6d. per day each for more than one child of the same family. Special cases of hardship are sympathetically considered by the Committee and last year 32 children were admitted free. The average daily attendance was 23.3 as compared with 21.9 in 1936. The Nursery was closed from 26th August to 12th September owing to measles and illness of the staff. The milk supplied to the Day Nursery is of a special grade— Tuberculin Tested. The tenancy of the Nursery was renewed for a further period of one year from the expiry of the existing lease (25th September, 1937). The Council still have under consideration the provision of up-to-date Nurseries both in the Clerkenwell and St. Luke's districts. It is hoped that provision for the former will be made in Granville Square. Nursery School Teacher. I submitted a Report last year on the provision of a Nursery School Teacher (part time), but the matter was deferred pending the erection of a new Day Nursery. Home Nursing Service. The Borough Council pays £275 a year to the Metropolitan Nursing Association for nursing Finsbury residents in their homes, maternity cases, confinements and their complications, and for the nursing of the illnesses of children and infants. The full service applies also to the home nursing of cases of measles, whooping cough, diarrhoea, pneumonia, influenza and tuberculosis. The cases are referred to the Metropolitan Nursing Association, 31, Bedford Place, Bloomsbury Square, W.C.I (Telephone No. Museum 0352), from the Public Health Department, and are invariably attended to without delay. This work has always been extremely well done. 34 The cases nursed by the Metropolitan District Nursing Association in 1937 for the Public Health and the Maternity and Child Welfare Committees were as follows :— Maternity. Public Health. Condition. Cases. Visits. Cases. Visits Tuberculosis - - 19 548 Pneumonia 5 28 19 422 Maternity conditions 30 348 — — Whooping cough 1 28 9 9 Measles and German measles 26 49 80 80 Scarlet Fever — - 1 1 Total cases 190 Total visits 1,513 1 Hospital Treatment. Infants' Hospital, Vincent Square, Westminster. The Borough Council retains three cots for use when required at the Infants' Hospital, Vincent Square. Ailing babies and children up to the age of five years are admitted at the request of the Health Department. Provision is made for the admission of the mother with the baby when this course is considered necessary. The Borough Council pay £25 per cot per annum retaining fee, and £2 per week per cot when occupied by cases sent to the Hospital by the Department. Twenty-six were admitted last year under the Scheme, for the following conditions :— Adenitis 2 Hare Lip 1 Bronchitis and Pneumonia 11 Marasmus 1 Carditis 1 Otitis Media 2 Diarrhoea and Vomiting 5 Unhealthy Tonsils 1 Feeding Adjustment 2 Arrangements have been made for the submission of a report by the hospital on each case on its discharge for home on a special form, for the guidance of the Medical Officer of the Clinic and the Health Visitors. Any recommendations for future treatment are duly noted and the parents are assisted in every way possible to carry out the treatment or methods of feeding advised. 35 Elizabeth Garrett Anderson Hospital, Euston Road. A cot has been retained at this Hospital for babies or children under five years of age at a retaining fee of £'2o per annum plus a weekly charge of 30s. per week in respect of each case actually admitted. Last year seven cases were admitted to the Hospital under the Scheme:—Bronchitis 1, Diarrhoea and vomiting 4, Otitis media 1, Prematurity 1. Other Hospitals. The Council also have arrangements with the Queen's Hospital for Children, Hackney Road, the Royal Free Hospital, the Middlesex Hospital and the University College Hospital for the admission of babies and young children. Thirty to forty shillings per week is paid for these services. Last year 12 babies and children were admitted for treatment and nursing :—Bronchitis 5, Bronchopneumonia 1, Diarrhoea and vomiting 4, Hernia 1, Otitis media 1. Arrangements were made last year for the admission of ailing, premature and marasmic babies, and mothers and babies for the , re-establishment and regulation of breast feeding, to the following Homes (i) Cromwell House, Highgate Hill. (ii) The Mothercraft Training Home, Chelsea. At the former the charges are £1 10s. per week for a mother and baby and 15s. for a baby, and the latter £2 2s. and 15s. respectively. In 1937 one case was admitted with feeding difficulties. Tonsils and Adenoids. The Borough Council has an arrangement with the Royal Free Hospital, whereby Finsbury children may be operated on for the removal of tonsils and adenoids. The patients are detained in hospital until all risk of haemorrhage is passed. The Borough Council pays the hospital lfis. Od. for each case. During 1937 the number of children referred for treatment was 69, of which number 24 were operated upon during 1937, and 14 are awaiting treatment; in 21 cases treatment was not advised. The remaining cases either refused treatment or removed before a decision was reached. All those operated on showed improvement, and many have been sent away for convalescence to complete recovery. 36 Results in practically all cases have been excellent, as in these very young children only those with marked symptoms have been operated upon. Many of those awaiting treament were being watched by the surgeon, or were waiting till the weather was more suitable for the operation. Convalescent Treatment—Babies and Children under Five years of Age. The scheme of the Council for the convalescent treatment of children under five years of age and babies provides for such treatment:— (a) At the Dedisham Convalescent Home, Slinfold, Sussex, in two beds retained by the Council. (b) At the St. Andrew's Convalescent Home, Folkestone, in one bed retained by the Council. (c) At the National Society of Day Nurseries Home, " Hurstleigh," Tunbridge Wells, in one retained bed. (d) At the Noel Home, Letchworth, and John Madock's Babies Home, Basing, in four specially retained cots. Babies are admitted up to two years of age only, at the Basing Home. These cots are kept fully occupied during the year and any extra children requiring convalescence are admitted to various convalescent homes through the Invalid Children's Aid Association under agreement with the Borough Council. Under the above arrangement 106 children completed convalescent treatment last year:— Dedisham St. Andrew's 8 Hurstleigh 7 Noel Home 15 Basing 13 I.C.A.A 54 Eleven children remained under treatment at 31st December, 1937, and two were awaiting admission. The results of convalescent treatment are given to the Committee from time to time in the monthly reports and have been uniformly good. 37 Convalescent Treatment—For Mothers after Confinement. The Council have arrangements for the convalescence of mothers after confinement. The method of referring cases to the Charity Organization Society was discontinued, and a bed was endowed at the St. Mary's Convalescent Home, Birchington, Kent. In addition, cases are sent on payment to the Mayfield Convalescent Home of the Association of Maternity and Child Welfare Centres, which is, however, only open in the summer months. The new arrangements made by the Council have been much appreciated by the mothers of Finsbury, and the table below shows the increased use made of the available beds. Convalescence completed. 1932 3 1933 3 1934 2 1935 12 1936 3 1937 25 Health Visitations. When a birth is notified, a packet is sent by post from the Public Health Department to the mother, containing, for her guidance and information, the following :— Booklets—" How to Rear a Baby." " The Truth about Vaccination." Leaflets on :— Details of the Public Vaccinators, times of attendance, etc. Particulars of the Municipal Day Nursery. Dinner grants to expectant and nursing mothers. Care after confinement. Deaths from burns and scalds—fireguards. *Milk for babies during the hot weather. ♦Summer diarrhoea. *Beware the fly ! f Whooping cough. fMeasles (two kinds), jlnfluenza. •Sent only from April to September. fSent during periods of epidemics only. When the baby is one year old, the following two leaflets aie sent to the mother:— Diphtheria Immunisation. Impetigo. 38 In addition to the above, the following leaflets are distributed by the District Health Visitors to expectant mothers :— Information as to the Municipal Midwifery Service. Special Clinics for Finsbury expectant mothers at St. Bartholomew's Hospital. Provision of Home Helps for nursing and expectant mothers. Advice to expectant mothers. A supply of these latter leaflets is also maintained at the Voluntary Centres, and at the hospitals included in the Council's Midwifery Scheme, for distribution to women attending those institutions. As far back as 1909 the Borough Council appointed two women to act as Lady Health Visitors for the Borough in conjunction with the Lady Sanitary Inspector. Their work included :— (a) The systematic visitation of infant births in the poorer parts, and the instruction of mothers in the care and upbringing of the children. (b) The supervision of the children's health and progress. (c) The improvement of home conditions, and especially of those which might react adversely on children or parents, whether these were due to faults of environment, to social conditions, or to dire poverty. Since that date great strides have been made in the Service and at the present time there are seven Health Visitors, two of whom act as Superintendents of the Pine Street and Leage Street Municipal Centres respectively. The remaining five visitors each have a district allotted to them, and are engaged mainly in the home visitation of babies, children under 5 years, and expectant mothers. Last year 708 visits were paid to expectant mothers. They also deal with the recommendations, in the first instance, of mothers and children for grants, and act as Child Protection Visitors under the Public Health (London) Act, 1936. Students of the Battersea Polytechnic, with the approval of the Council, worked in the Maternity and Child Welfare and Tuberculosis Departments last year for short periods to gain a knowledge of the work for examination purposes. 39 Number of Visits. As a routine, babies up to 1 year of age are visited once a month, and children from 1 to 5 years once a quarter, an additional Health Visitor being appointed last year to enable this to be carried out. Formerly the Health Visitors did not attend the Municipal Centres; in 1934 it was decided that one Health Visitor should be in attendance at every session. It was thought that attendance would be encouraged by this means, as a mother will often make an effort to attend a centre, if she knows she will see her Health Visitor there. The number of visits paid by the Health Visitors to babies and children under 5 years last year, was as follows — District First Births. Total Births. Total Visits to Children under 1 year. Total Visits to Children aged 1-5 years. No. 1 46 141 1,955 1,976 No. 2 44 156 1,657 2,183 No. 3 41 157 2,028 1,724 No. 4 42 180 2,169 2,393 No. 5 33 134 2,039 2,526 Totals 206 768 9,848 10,802 In 1937 the total number of Finsbury births notified was 842. In addition to the above numbers, 2,866 visits were paid to children under 5 years of age by officers of the Voluntary Associations in the Borough. The visits paid in the past five years by the Council's Health Visitors are tabulated below:— Year. No. of District Health Visitors. Visits to Children under 1 year. Visits to Children aged 1-5 years. Total Visits. 1932 4 8,691 10,630 19,321 1933 4 10,634 6,863 17,497 1934 4 10,847 5,603 16,450 1935 4 10,200 6,728 16,928 1936 5* 11,039 8,452 19,491 1937 5 9,848 10,802 20,650 *Increase of staff from Oct. 19, 1936. Much of the time of the Health Visitors is spent in making ineffectual visits, due in many cases to the mothers absence from home; in 1937, 2,345 visits were fruitless for this and other reasons. 40 Special Cases. Special cases are those in which it is often necessary for the Health Visitor to pay daily or weekly visits owing to some special condition requiring constant supervision. Details are set out below:— Nature of Cases. Districts. Total. 1 2 3 4 5 Prematurity 2 2 0 0 2 6 Respiratory 4 7 1 0 1 13 Intestinal 2 1 1 2 2 8 Marasmus 2 0 2 1 0 5 Illegitimacy 2 1 2 0 4 9 Twins 4 2 7 6 4 23 *Others 5 3 2 1 9 20 21 16 15 10 22 84 Results. Died 2 3 3 2 2 12 Still "Special" 4 1 1 2 3 11 Satisfactory 15 10 10 6 14 55 Removed 0 2 1 0 3 6 21 16 15 10 22 84 * Others Poor Progress 6 Ophthalmia 2 Underweight 3 Skin complaints 3 Neglect 2 Bad home conditions 1 Deformity 2 T.B. Contact 1 20 Fifty-five of the 84 babies dealt with as special cases recovered satisfactorily; 12 died; 11 continued under close observation; and 6 removed into other districts, to which their records were forwarded in order that supervision might be continued. All the above babies have been visited at least once a week, and some daily, by the Health Visitor, whilst the babies were on the Special Case Register. One of the great difficulties in looking after these special cases is ensuring the attendance of skilled medical help. Patients who are not eligible for the District Medical Officer say they can 41 only afford a doctor once a week, or only call him in once a week, although the baby is not fit to take to hospital, and he or she is left to the judgment of the mother. The Health Visitor finds these cases very difficult to deal with, especially when hospital treatment is either unsuitable or is refused. The local dispensaries are sometimes of considerable assistance in such cases. Birthday Cards.—In order to secure more complete medical supervision of the toddlers, arrangements have been made for the issue of special birthday cards to the toddlers on their 1st, 2nd, 3rd and 4th birthdays. The mothers are invited to bring them to the Centre on an appointed day. The response to these cards has been encouraging. A complete medical inspection is carried out and the necessary advice given. Foster Mothers. The following is a list of the persons in Finsbury who accept for reward the care of children under the provisions of the Public Health (London) Act, 1936:— Name of Foster Mother. Address. Number of children under 9 years of age in care of foster mothers on 31st Dec., 1937. Approved number of nurse children. Evans, Mrs. Harriett 5, River Street 1 1 Hall, Mrs. Hannah A. 163, Central Street 1 1 Netley, Mrs. Rose 8, Dingley Place 1 2 Nuttall, Mrs. Ethel 27, Gt. Percy Street 2 3 Tyler, Mrs. A. 20, Rahere Street 1 1 Wearing, Mrs. Ellen 73, Lever Street 1 1 Additions to the List during 1937. Attwood, Mrs. V. 28, Busaco Street .1 1 *Campbell, Mrs. May 72, Penton Street 0 1 Carter, Mrs. Agnes K 12, Coldbath Bldgs. 0 2 Edwards, Mrs. Mary 60, Lever Street 1 1 Slade, Mrs. Dorothy 27, Percy Circus 1 1 * The name of this foster mother was removed from the List upon her removal to an unknown address before the end of 1937. In addition, two foster mothers, not included above, were removed from the List during the year. The following number of Notices were received during 1937:— Reception of nurse children in Finsbury 30 Removal of nurse children from Finsbury 17 42 Visits to the addresses in Finsbury have been made by the Child Protection Visitors in order to verify the particulars stated on these notices. In cases of removal of nurse-children from Finsbury, communications have been made with the authorities concerned at the destination of the children in order to confirm the information submitted to the Public Health Department. The supervision and periodical visiting to the foster mothers in the Borough have been carried out during the year, and in one instance the Child Protection Visitor discovered that a foster mother had removed to an unknown address. There were no nurse-children in the care of this foster mother at the time of her removal and, as no information could be secured as to the destination of the foster mother, her name was deleted from the list of Finsbury foster mothers. During the year one foster mother removed to another address in Finsbury and, upon visitation, it was ascertained that the new accommodation was not suitable for the care of nurse-children, and her name was subsequently removed from the List. In one instance it was decided to increase the maximum number of children in the care of a foster mother from one to two. The total number of visits made by the Health Visitors in connection with infant life protection work during the year was 91. No legal proceedings were taken during the year. Winter School for Health Visitors. The Council were represented, at the Fifteenth Winter School for Health Visitors held at Bedford College from December 29th, 1937, to January 7th, 1938, by Mrs. Hartney and Mrs. Hewlett. The School was educational and instructive and was appreciated by the Council's representatives. National Society for the Prevention of Cruelty to Children. In cases when it is considered that certain treatment is urgently required for a baby or child and this is refused or when there is evidence of neglect in the home causing unnecessary suffering to a child, the circumstances are reported to the local inspector, and much assistance is rendered to the Department by his visits and persuasion. 43 Last year 10 cases were referred for the attention of the Inspector. Ophthalmia Neonatorum. No. of Cases notified 1937 Cases treated No. Vision unimpaired No. Vision impaired Total Blindness No. of Deaths at Home in Hospital 11 8 3 11 - - l The death was from a cause other than ophthalmia neonatorum. Two patients removed whilst under treatment. Eleven cases were notified in 1937. Each case was visited and revisited by a Health Visitor until its termination. Twenty-five visits in all were made. In no case was there impairment of vision. The London County Council reserves beds in St. Margaret's Hospital, Kentish Town, for the treatment of severe cases. In addition to the notification of true cases of Ophthalmia Neonatorum by medical men, midwives have to report cases of inflammation of the eye, and these are also kept under observation by the Health Visitors. Prevention of Blindness—Blind Persons Act 1920. The administration of the Blind Persons Act 1920 is in the hands of the London County Council. There are no blind children under 5 years of age known to the Department. Puerperal Pyrexia and Fever. Out of 842 Finsbury births notified in 1937, there were 14 cases of Puerperal Pyrexia and three cases of Puerperal Fever. The causes were as follows:— Abortion 1 Pyaemia 1 Acute Adenitis 1 Retained Products 1 Broncho-pneumonia 1 Sapraemia 1 Lobar Pneumonia 1 Septicaemia 1 Local Infection 2 Tensity of Breasts 1 Mastitis 1 Urinary Infection 1 Pyelitis 1 Unknown Origin 3 44 The statistics for puerperal fever for previous years are appended:— Years. 1912 -21 1922 -26 1927 -31 1932 1933 1934 1935 1936 1937 Total. Notifications 71 41 28 1 8 0 2 1 3 155 Deaths 33 8 7 0 0 0 0 1 0 49 The cases of puerperal fever and puerperal pyrexia are investigated by the Assistant Medical Officer of Health. Orthopaedic Conditions. Tuberculosis.—Persons suffering from orthopaedic conditions due to tuberculosis are seen at the Dispensary at Whiskin Street and receive treatment at Sanatoria under the scheme for treatment. The great majority, however, are seen in the first instance at the hospitals in the vicinity and therefore do not come under the supervision of the Tuberculosis Officer at the Dispensary until later on. Other Orthopædic Conditions.—Very few orthopædic conditions due to other causes such as congenital defects or infantile paralysis or postural causes are seen at the Welfare Centres. In the first instance the children are rather young to develop orthopaedic troubles and any serious cases such as infantile paralysis find their way direct to the many voluntary hospitals in the neighbourhood. Any cases which do conce to the Municipal Centres requiring hospital treatment are referred to St. Bartholomew's Hospital, the Royal Free Hospital, the National Orthopaedic Hospital or the Hospital for Sick Children, Great Ormond Street. Rickets.—Many cases presenting signs and symptoms of rickets, mostly of the mild variety, were seen at the Centres last year. Mild cases are dealt with at the Sunlight and Massage Clinics of the Borough Council, combined with advice as to methods of feeding and vitamin therapy. 45 Severe cases are recommended to the London County Council for admission to Queen Mary's Hospital, Carshalton, and to the Lower Southern Hospital, Dartford. Eleven babies and children under five so recommended were admitted to these institutions in 1937 for rickets and other conditions. Weighing Centres. Two municipal weighing centres in Finsbury are held at:— 24, Leage Street.—Monday, Wednesday, and Friday at 2.0 p.m. Pine Street.—Tuesday, Wednesday and Thursday at 2.0 p.m. A summary of the meetings held in 1937 is appended:— Centre. No. of Meetings. Attendances. Average Attendance. No. of Babies and Children up to 5 years. Leage Street 149 6,324 42 971 Pine Street 155 6,125 39 697 Totals 304 12,449 41 1,668 The number of new babies brought during the year was 455. Transfer of Records. When the children under the supervision of the Borough Council attain the age of 5 years, records concerning them are, so far as possible, transferred to the London County Council, so as to be available for the information of the Education Authority. Grants.—Mothers, Toddlers, and Babies. Report on Circular 1519. This Ministry of Health circular refers to the recently issued First Report of the Advisory Committee on Nutrition, and in particular to the emphasis laid therein on the nutritional value of milk. Local authorities are asked to review their arrangements under Section 251 (1) of the Public Health (London) Act, 1936, with particular reference to grants of extra nourishment to nursing and expectant mothers and children under 5 years of age. 46 The following are some of the chief points mentioned in the circular:— (i) In certain areas milk is supplied to expectant mothers only during the last two or three months of pregnancy, and the supply is limited in every case to one pint per day. (ii) In other areas milk is supplied only to children up to the age of 18 months or two years. (iii) In the interests of the health of the mothers and children it is not desirable to adopt any such limitations as above mentioned. (iv) The Scale of Income adopted by Local Authorities should be so framed as not to render it difficult for any mothers to take advantage of the arrangements made ; it is suggested that it might be found advisable for the existing scales to be reconsidered. (v) Wherever possible the Authority should provide "pasteurised" milk, and that where this is impracticable, the Medical Officer of Health should approve the source and quality of the milk supplied. (vi) It is suggested that Local Authorities should consider afresh the possibility of providing meals to mothers and youhg children. (vii) All possible steps should be taken to ensure that expectant and nursing mothers and young children receive a sufficient supply of food containing Vitamin D, the principal foods containing this being fat, fish, fish livers, egg yolk, milk and butter. This vitamin can also be provided by the regular administration of cod liver oil. The Committee will be aware that the Grants Scheme of the Finsbury Borough Council is very complete and successful. The Council make the following grants:— (1) Milk or Dinners to expectant and nursing mothers. (2) Milk or Dinners and Milk to toddlers (1-5 years). (3) Milk (wet or dried) to babies under one year of age. Expectant and Nursing Mothers. Milk.—One pint of milk a day is supplied to mothers who are unable to attend for Dinners ; this is increased to 1½ pints per day wherever necessary, and the grant is available to expectant 47 mothers during the last five months of pregnancy, or earlier on special recommendation. Dinners.—Mothers are encouraged to attend for Dinners, which are supplied free from Monday to Friday inclusive, either at the Municipal Centre at Pine Street or by arrangement at two Voluntary Organisations within the Borough. In certain cases 1 pint of milk daily in addition is given. During the week-ends 1 pint of milk and two eggs daily are supplied. Toddlers. Milk.—One pint of milk daily is supplied to toddlers between the ages of 1 and 5 years on the production of a medical certificate. Dinners and Milk.—Mothers are encouraged to bring their children for Dinners, which are supplied free from Monday to Friday inclusive, in addition to ½ pint milk daily. During the week-end they receive 1 pint of milk and 1 egg daily. Babies. Grants of wet milk or dried milk, as recommended by the doctor, are given to babies under the age of one year. The grants are given free as a rule, or at half cost, according to a scale of income drawn up by the Council. Urgent cases are dealt with immediately, emergency grants being issued for one week on the recommendation of the Health Visitors or Medical Officers pending the submission of an application. Families in receipt of Public Assistance are referred to the appropriate authority for the issue of the grant, the Borough Council issuing the grant for a week pending transference to the Public Assistance Authority. Dinners.—The dinners are given at the following Centres:— (a) Pine Street Municipal Centre.—Mothers and Toddlers. (b) Leage Street Municipal Centre.—Toddlers. (c) Home of Service, 36, King Square, E.C.1.—Mothers. (d) Women's League of Service for Motherhood, 128, Pentonville Road, N.1.—Mothers and Toddlers. (c) and (d) are Voluntary Organisations with whom the Borough Council has made arrangements for the supply of dinners recommended at an agreed rate. 48 To deal with the main points of the Circular:— (i) The Borough Council supply milk or dinners to expectant and nursing mothers during the last five months of pregnancy or earlier if recommended. Special arrangements are made for the supply of milk and eggs during the week-ends to mothers receiving dinners during the week. The usual grant of milk is one pint daily, but this is increased on special recommendation and never refused. Eggs in addition to the milk are sometimes granted to those receiving a grant of milk. (ii) Children up to the age of 5 years are given grants of milk or dinners and milk. (iii) The majority of the grants are given free and special consideration is given to every applicant when applying the scale (approved by the Ministry of Health) in order that no hardship will result. The previous difficulties of the family such as arrears of rent, illness in family, debts and periods of unemployment, are taken into account and free grants issued for a period, notwithstanding that the families' income at the time of application may be outside the scale. (iv) Designated Pasteurised Milk is not supplied, but an order is sent to the family's usual dairyman who supplies ordinary milk. In London the majority of milk has been heat treated, although it is not designated pasteurised milk. The milk supplied is tested from time to time for cleanliness, and last year 43 samples were taken for bacteriological examination; 74 per cent. of the milk could be classified as of good standard. Retailers whose samples are found to be of a low standard are removed from the list of suppliers. (v) The Borough Council provide meals as previously stated. (vi) Cod Liver Oil preparations are supplied (either free or for payment at cost price) at the Municipal Centres on the recommendation of the Medical Officer to all babies and children in attendance. "Adexolin" is given to those unable to take the oil preparations. The expectant mothers 49 being in attendance at the Ante-Natal Clinics under the Scheme, are not as a general rule given these preparations at the Municipal Welfare Centres. The preparations in use at the Centres are Cod Liver Oil, Cod Liver Oil Emulsion, Cod Liver Oil and Malt, "Roboleine" and "Adexolin" Summary. (1) The Grants Scheme of the Borough Council is very complete and every consideration is given to any special circumstances affecting the family as a whole, special additional grants are made on the recommendations of the Medical Officers. (2) The Committee should consider the advisability of providing designated "Pasteurised" milk. (3) With a view to securing a more adequate supply of Vitamin D, the grants to mothers could be revised to include a supply of Milk, Cod Liver Oil and Malt, "Adexolin," or a dried milk preparation "Colact" to those in receipt of either Dinners or Milk. A special vitamin preparation "Adexolin" in the form of one capsule per day is now given to all mothers in receipt of Dinners on the order of the Borough Council, and specially designated " Pasteurised " milk is provided for all persons receiving wet milk grants The Council gave a donation of £10 to the funds of the Home of Service in connection with the provision of meals to necessitous mothers and toddlers. } The total cost of the supply of milk (liquid or dried) in the financial year 1936-37 was £1,039 3s. 11d. and the net cost £972 11s. 9d. During the year 1937, 4,233 grants were made, an average of 353 per month; 538 families received these grants. The grants comprised 54,162 pints of milk, 3,520 lbs. of dried milk, and 59,102 dinners. 50 Bacteriological Examination of Milk for Maternity and Child Welfare Grants. During 1937 it was decided by the Council that all milk supplied to Finsbury mothers and children under orders issued by the Finsbury Borough Council should be designated "Pasteurised." This should ensure the supply of the safest milk possible. In addition to the control which is exercised over all such supplies, special attention is directed to ensure that the required standards for this particular supply are maintained and 20 samples were taken during the year for bacteriological examination. Standards.—(1) Bacterial Count. The legal maximum count allowable is 100,000 bacteria per millilitre. The count, however, only gives an approximate index of the bacterial purity and does not give any indication of the harmfulness or otherwise of the organisms. Lower counts than the legal maximum should generally prevail although at times, especially in summer, higher counts may be found without any gross contamination having taken place. Of the samples examined— 10 showed counts of below 30,000 bacteria per m.l. 6 showed counts above 30,000 but below 100,000 per m.l. *4 showed counts above 100,000 but below 500,000 per m.l. None showed counts above 500,000. * Three of these were samples of undesignated milk supplied before the decision of the Council referred to above became operative. (2) Presence of Bacillus Coli. There is no legal standard with regard to the presence of Bacillus coli in Pasteurised milk, but it is generally considered that it should not be demonstrable in 1/10 m.l. and that faulty pasteurisation or subsequent contamination has taken place when it is demonstrable in 1/100 m.l. or less. 51 Of the samples examined for the presence of this organism:— Bacillus coli were not discovered in 1/10 m.l. in 9 cases. „ „ were discovered in 1/10 m.l. but not in 1 /100 m.l. in 9 „ „ „ were discovered in 1/100 m.l. in 2 ,, Thus 90 per cent. of the milks failed to reveal the presence of B. coli in 1/100 of a cubic centimetre, as compared with 69 per cent. in 1936. This is a great improvement over last year, and a very marked advance on the results for previous years. Grants to Voluntary Associations. The conditions of payment of contributions to the Voluntary Associations include the following:— (1) That the Council is satisfied as to the efficiency of the service provided by the Association, in respect of which the contribution is payable, and that such service is being used by a reasonable number of those persons for whom it is provided. (2) That no reduction or alteration of such service is made without the consent of the Council. (3) That the service and any premises in which it is carried on are open to inspection at all reasonable times by any officer of the Council, duly authorised, and by any officer of the Ministry appointed for that purpose. All possible care is taken to foster co-operation between the activities of the Council and of the Voluntary Organisations; besides assisting these financially as indicated by the grants abovementioned the Council appoints certain of its members to represent the Council upon their Committees of Management. Representatives recently appointed (November, 1937) are as follows:— Claremont Mission Maternity Alderman Mrs. E. Martin and Centre, White Lion Street, Councillor Mrs. B. South. N.1 (Welfare Centre and Day Nursery). Women's League of Service Councillors Mrs. C. Griffiths and for Motherhood, 128, Mrs. B. South. Pentonville Road, N.1 (Welfare Centre). 52 Royal Northern Hospital, Alderman Mrs. E. Martin and Maternity Nursing Councillor Mrs. R. Curtis. Association, Myddelton Square, E.C.1 (Welfare Centre and Midwifery Service). City of London Maternity Alderman Mrs. E. Martin and Hospital, City Road, Councillor Mrs. B. South. E.C.1 (Welfare Centre and Midwifery Service). St. Bartholomew's Hospital, Aldermen Mrs. E. Martin and Smithfield, E.C.1 (Mid- Dr. C. L. Katial. wifery Service). Each voluntary centre sends a brief monthly report to the Medical Officer of Health giving statistical information as to the work carried on. The amounts of the annual contribution are as follows:— Association Amount of Grant Claremont Central Mission (Welfare Centre) £241 (Day Nursery) £391 Women's League of Service, 128, Pentonville Road (Infant Welfare Centre) £606 Maternity Nursing Association, Myddelton Square (Welfare Centre and Midwifery) £656 City of London Maternity Hospital (Welfare Centre and Midwifery) £285 The following particulars concerning Finsbury cases at voluntary institutions in the Borough have been compiled from the monthly reports that the institutions submit at the request of the Borough Council. (1) City of London Maternity Hospital. Ante-Natal Clinics Held on Mondays and Fridays at 9 a.m. to 1 p.m., Wednesdays at 1 p.m. 63 Special Cases Consultations are held on Tuesdays, Thursdays and Saturdays at 10.30 a.m. Number of meetings in 1937 307 Number of attendances by mothers 576 Post-Natal Clinics Held on Mondays and Thursdays at 2.30 p.m. to 4.30 p.m. Number of meetings held in 1937 100 Number of attendances:— Babies under 1 year of age 614 Children from 1 to 5 years 77 (2) Claremont School for Mothers. Post-Natal Clinics Held on Tuesdays at 2.30 p.m. and Fridays from 2 p.m. to 4 p.m. Number of meetings held in 1937 94 Number of Attendances:— Babies under 1 year 809 Children from 1 to 5 years 987 Sewing Class Held on Tuesdays at 2 p.m. to 4 p.m. Number of meetings held in 1937 37 Lectures Held on Mondays at 2 p.m. to 4 p.m. Number of meetings held in 1937 44 (3) Claremont Day Nursery. Open at 8 a.m. to 6 p.m. Charge, 9d. per child. 6d. each for two out of one family. Average number of Finsbury children attending per month 34 Total attendances 5,614 Some years ago it was the practice of this Nursery to close during August for administrative reasons. It was considered, however, important that a Day Nursery should be open the whole 51 year round with the exception of public holidays, and at the request of the Council the Nursery remained open during August. The Council made an additional grant to the Nursery of £19 15s. 2d. (representing the extra cost incurred). (4) Maternity Nursing Association. Ante-Natal Clinics Held on Wednesdays and Thursdays at 10 a.m. to 12 noon. Number of meetings held in 1937 104 Number of attendances 1,417 Post-Natal Clinics Held on Mondays, Tuesdays and Thursdays at 2 p.m. to 4 p.m. Number of meetings held in 1937 148 Number of attendances:— Babies 1,890 Children from 1 to 5 years 629 Dental Clinics Held on 1st Tuesday in the month from 10 a.m. to 12 noon. Number of meetings held in 1937 12 Number of attendances 34 Dinners are provided to mothers as requiied. 564 visits were paid to babies and 350 visits to expectant mothers in 1937. (5) Women's League of Service for Motherhood. Post-Natal Clinics Held on Thursdays and Fridays at 2.30 p.m. to 4.30 p.m. Number of meetings held in 1937 86 Number of attendances: — Babies 739 Children 1 255 55 Dental Clinics Held on 2nd and 4th Wednesday from 12 noon to 1.30 p.m. Number of meetings held in 1937 21 Number of attendances:— Mothers of children under 1 year 56 Mothers of older children 52 Children under 5 years 51 Sewing Class Held on Wednesdays from 2.30 p.m. to 4 p.m. Number of meetings held in 1937 35 Average attendance 16 This class is conducted by a London County Council Teacher. Lectures Held on Tuesdays from 2.30 p.m. to 3.30 p.m. Number of meetings held in 1937 33 Average attendance 28 Dinners 6,795 dinners were served to Finsbury mothers. 15,942 dinners were served to Finsbury toddlers. A knitting class is also held on Mondays at 2.30 to 4 p.m. All the facilities maintained by the Council have, at various times been communicated to the various bodies and institutions in the Borough, and cases have frequently been referred by the institutions and accepted under the Council's scheme for grants of milk and meals, admission to Infants' Hospital, and dental and other treatment. The Voluntary Associations, which are in receipt of grants from the Borough Council, are inspected yearly, and attention was also given to the work being carried on. A considerable amount of good work is done by these Associations working in some cases under difficult conditions. 56 Infant Mortality, 1937—Causes of Death. Cause of Death. 0-1 weeks. 1-2 weeks. 2-3 weeks. 3-4 weeks. Total under four weeks. 1-3 mths. 3-6 mths. 6-9 mths. 9-12 mths. Total under one year. Clerkenwell. St. Luke. St. Sepul. Prematurity 8 1 - - 9 - - - - 9 4 5 - Broncho-pneumonia - 1 - 1 4 8 1 1 15 7 8 - Intussusception - - - - - 1 - - 1 1 - - Whooping Cough - - - - - 2 1 2 1 6 6 - - Diarrhœa - - - - - - 1 - - 1 - 1 - Enteritis - - - - - 1 5 3 1 10 8 2 - Bronchitis - - - - - - 2 - - 2 2 - - Malformation 1 - - - 1 1 - - - 2 2 - - Atelectasis 3 - - - 3 - - - - 3 2 1 - Influenzal Meningitis - - - - - - - - 1 1 1 - - Asphyxia Neonatorum 1 - - - 1 - - - - 1 1 - - Miliary Tuberculosis - - - - - - - 1 - 1 - 1 - Status Lymphaticus - - - - - - - 1 - 1 1 - - Violence 1 - - - 1 - - - - 1 - 1 - Icterus Gravis Neonatorum 1 - - - 1 - - - - 1 - 1 - Hyperpyrexia - - - - - - 1 - - 1 - 1 - Lobar Pneumonia - - - - - - - 1 - 1 1 - - Inattention at Birth 1 - - - 1 - - - - 1 1 - - Total 16 1 1 - 18 8 19 9 4 58 37 21 - 57 Infant Deaths. From the previous table it will be seen that the number of infant deaths was 58 ; the infantile mortality is 71 per 1,000. In 1936 the rate was 81, the increased rate that year being almost wholly due to deaths from measles and whooping cough. In 1935 the rate was 59 per 1,000. Respiratory diseases caused 18 deaths last year as compared with 10 in 1935. Neo-natal Mortality. By Neo-natal Deaths we mean the deaths of children under 28 daysold and in 1937,18 deaths were registered under this heading, equal to a rate of 22-2 per 1,000 live births registered as compared with a rate of 17-9 in 1936. Below will be found the number of neo-natal deaths in the Borough for the last 14 years. Year. Under 7 days. 7 days and under 28 days. Rate per 1,000 live births registered. 1924 31 18 29.4 1925 18 14 18.2 1926 32 13 27.1 1927 20 12 22.1 1928 24 13 25.2 Average 5 years. 24.4 1929 26 13 28.4 1930 24 10 26.2 1931 21 9 23.8 1932 18 7 22.6 1933 17 4 20.8 24.36 1934 7 8 15.3 1935 15 5 21.5 1936 13 2 17.9 1937 16 2 22.2 It will be noted that of the 58 infants who died 16 were in their first week of life, whilst 26 were under three months, indicating that many of the deaths were due to causes operating during the period of expectant motherhood. Congenital conditions.—Congenital defects were the cause of 6 deaths last year as compared with 4 in 1933. These conditions in our present state of knowledge cannot be prevented. They are usually such states as congenital heart disease with malformation of the valves of the heart, patent ducts of the heart which should have become occluded before birth, or lungs which fail to expand. 58 Infectious Disease. Whooping cough accounted for 6 deaths as compared with 7 deaths in 1936. There were no deaths from measles. Respiratory Diseases. Diseases affecting the respiratory system are difficult to control and an epidemic of measles or whooping cough may at any time result in a high rate of infantile mortality because of the risk of broncho-pneumonia, which is so fatal in infants. Bronchitis and pneumonia accounted for 18 deaths last year as compared with 16 in 1936. Wasting Diseases. The group of wasting diseases, such as prematurity, debility and marasmus form a large proportion of the infantile deaths throughout the country and appear to be almost unpreventable. Prematurity or marasmus appeared on the death certificate in 12 cases; in 9 of these it was the only cause stated for death and in the remaining cases combined with other conditions. Gastro-enteritis as a cause of infant deaths has been declining for some,years with the advent of motor traffic and more knowledge and care on the part of the mothers in cleanly methods of artificial feeding; it still, however, ranks high in the causes of mortality. Ten deaths from gastro-enteritis were recorded last year. Summary. Prematurity, respiratory diseases, enteritis and other infections are still the heaviest contributing factors in the infant deaths recorded in the Borough. Premature infants require prolonged special attention which is most conveniently given in special cots in hospitals. Further provision for these cases is required. Happily, quadruplets and quintuplets are very rare, but the recent cases noted in the press shows clearly the success attending expert nursing in premature babies. Many mothers book too late for their confinement, or in some cases, especially the unmarried, make no provision at all. Education of the mothers and a more humane attitude to unmarried mothers by the general public would reduce much unnecessary infantile mortality. Special attention should be given at hospitals to infants possibly acutely ill; observation beds for these cases would probably prevent many deaths from bronchitis and 59 pneumonia. Many cases are sent in to hospital in a moribund condition. The question of cross-infection in infants' wards is especially important. A number of infants die from a condition other than that for which admitted to hospital. The prevention of toxaemia by the most modern methods with the co-operation of the mothers would still further reduce the infant deaths. Some mothers resent the visits of the Health Visitors and will not take the advice offered. Infant Deaths, 1911-37. The deaths of infants allocated to the various diseases since 1911 are given in the following table:— Diseases. 1911 -20. 1921 -25. 1926 -30. 1931 -35. 1936. 1937. Total. Measles 137 17 21 22 9 — 206 Diphtheria 14 9 — 1 — 24 Scarlet Fever 3 1 2 1 — — 7 Whooping Cough 87 28 32 18 4 6 175 Diarrhœa and Enteritis 469 94 53 44 18 11 689 Premature Birth 446 166 120 74 7 9 822 Congenital Defects 20 23 13 25 4 6 91 Marasmus 170 27 16 8 1 — 222 Tuberculous Meningitis 40 2 6 4 — — 52 Other Tuberculous Diseases 38 6 7 — — 1 52 Erysipelas 4 1 2 2 — — 9 Syphilis 53 9 3 — — — 65 Convulsions 71 14 7 1 2 — 95 Bronchitis 146 35 17 13 1 2 214 Pneumonia 394 147 102 62 12 16 733 Overlying 103 11 5 — — — 119 Hemorrhagic Disease of the New-born — — — 2 — — 2 Other Causes 335 91 86 47 10 7 566 Totals 2,530 681 492 324 68 58 4,153 In 1937, the infant deaths were: in Clerkenwell, 36; St. Luke's, 22; and in St. Sepulchre, 0 deaths. 60 Infant Mortality by Districts. The following table compares Finsbury with London and England and Wales generally:— England and Wales 58 London 60 Finsbury 71 125 great towns 62 148 smaller towns 55 The infant mortality rates for the period 1909 to 1937 arranged according to districts, are given in the subjoined table:— Year. The Borough. Clerkenwell. St. Luke's. St. Sepulchre. 1909 128 135 130 300 1910 121 122 120 71 1911 154 145 169 181 1912 112 110 111 210 1913 139 135 146 200 1914 118 112 131 121 1915 128 119 144 111 1916 124 127 120 62 1917 118 116 138 — 1918 110 119 95 111 1919 89 90 84 166 1920 74 70 82 105 1921 92 93 90 83 1922 82 85 75 154 1923 61 58 66 — 1924 75 72 79 159 1925 60 55 67 105 1926 66 69 62 — 1927 50 51 51 — 1928 85 91 77 — 1929 75 85 59 — 1930 63 68 51 333 1931 62 65 60 — 1932 81 82 81 — 1933 50 51 44 200 1934 51 50 53 — 1935 59 64 51 — 1936 81 81 83 — 1937 71 70 75 — 61 The figures for previous years are annexed:— Year. Corrected Births. Corrected Deaths. Infant Mortality. 1901 3 254 533 163 1902 3,191 558 174 1903 3,162 503 159 1904 3 095 522 168 1905 2,886 429 148 1906 3,012 474 157 1907 2,884 368 127 1908 2,916 400 137 1909 2,837 366 128 1910 2,813 342 121 1911 2,676 411 154 1912 2,579 290 112 1913 2,494 348 139 1914 2 558 304 118 1915 2,192 281 128 1916 1,926 240 124 1917 1,572 187 118 1918 1,275 141 110 1919 1,582 140 89 1920 2,540 188 74 1921 1,973 181 92 1922 1,934 158 82 1923 1,844 122 61 1924 1,662 125 75 1925 1,754 105 60 1926 1,659 109 66 1927 1,449 73 50 1928 1,469 125 85 1929 1,373 103 75 1930 1,299 82 63 1931 1 261 79 62 1932 1,107 90 81 1933 1,010 50 50 1934 981 50 51 1935 931 55 59 1936 840 68 81 1937 812 58 71 Midwifery Scheme. I have set out below the number of Finsbury cases attended by the three Hospitals included in the Council's Scheme, 1937. Total No. of cases. No. admitted to hospital. St. Bartholomew's Hospital 357 146 City of London Maternity Hosp 116 93 The Royal Northern Hospital 142 5 615 244 62 There being 842 Finsbury births notified last year, it is seen that over 73 per cent. of the births were conducted under the hospital service of the three hospitals. The analysis of the remaining Finsbury births in 1937 is as follows:— Voluntary Hospitals:— Inpatient. Outpatient. University College Hospital 33 15 Royal Free Hospital 17 21 Elizabeth Garrett Anderson Hospital 2 1 Queen Charlotte's Hospital 6 — Middlesex Hospital 11 — Charing Cross Hospital 2 — London Hospital 2 — St. George's Hospital 2 — Mothers' Hospital, Hackney 3 — L.C.C. Hospitals:— St. Pancras Hospital 25 — St. Mary's Hospital, Islington 15 — St. Leonard's Hospital 18 — Archway Hospital 2 — Bethnal Green Hospital 2 — Hammersmith Hospital 1 — Lambeth Hospital 1 — Mile End Hospital 1 — New End Hospital 1 — Paddington Hospital 1 — St. Mary Abbot's Hospital 2 — Sheffield Street Hospital 4 — Private Nursing Homes 5 — Private Doctors' cases — 19 Private Midwives' cases — 14 Metropolitan District Nursing Association — 1 University College Hospital.—As will be seen from the above 48 mothers were confined under the supervision of this hospital; of these 33 were admitted to hospital, and 15 were cases confined at home. The Borough Council pays to this hospital 5s. for 63 each necessitous patient confined at home and 20s. for each hospital admission; 26 cases admitted and 10 district cases were adjudged to be necessitous and were paid for at the above-mentioned rates. The following were the conditions calling for admission in the 190 cases which were charged as in-patients under the Council's Midwifery Scheme:— Maternal Causes. 1. Haemorrhage 7 2. Abnormal Labour 86 3. Primiparæ 26 4. Repeated Still-births 1 5. Toxaemia 15 6. Associated Maternal Disease 29 7. Unsatisfactory Home Conditions 16 Foetal Causes. 1. Twins 8 2. Hydramnios 1 3. Intrauterine death 1 Co-operation With Hospitals.—Requests for reports as to home conditions, etc., are received from time to time from hospital almoners in respect of Finsbury mothers who have applied for both in- and out-patient treatment for their confinements at Hospitals outside the Borough, and not included in the midwifery scheme. The Health Visitors make the necessary enquiries and reports are sent. Post-Natal Clinics. It has been stated by gynaecologists that well over 50 per cent. of the gynaecological conditions from which women suffer have their origin in child-bearing. The value of post-natal clinics can scarcely be over-estimated as a means of maintaining a healthy and alert motherhood. It is disappointing therefore that more use is not made of the post-natal clinics established under the Scheme. 64 The following attendances were made last year:— St. Bartholomew's Hospital 174 Royal Northern Hospital 63 City of London Maternity Hospital 582 Routine Wasserman Tests.—At the request of the Finsbury representatives a routine blood test is now undertaken of all Finsbury mothers attending the ante-natal clinics of the Hospitals under the Scheme. The necessary treatment required is given either at the special clinic attached to the hospitals or at neighbouring Clinics. Disinfection by Local Sanitary Authority. A midwife who has been in contact with a person suffering from puerperal fever or any other condition which may raise suspicion of infection must notify the Local Supervising Authority and unless directed otherwise must have all washable clothing boiled and send all other clothing to be disinfected by the Local Sanitary Authority. Last year, on request, the clothing of certain midwives was disinfected on 7 occasions. Midwives Act, 1936. This Act provides, inter alia, for the establishment by local supervising authorities of a salaried midwives' service. It will be noted that the London County Council, as the supervising authority, are responsible for this service, which commenced in January, 1938. Arrangements have been made for co-operation with the London County Council, and will be described in the Report for next year. Home Helps. The Council maintains a panel of home helps to attend the homes of necessitous nursing mothers in the Borough. At the end of the year there were ten persons on the panel. Two persons were appointed on the panel during the year. The names of two persons were removed from the panel following removal from Finsbury or other cause. The number of applications received last year for the services of a home help was 164; nineteen were cancelled for various reasons. 65 Below I have indicated the number of cases attended by the municipal home helps since the beginning of the scheme in 1929. Year. No. of Cases. 1929 11 1930 57 1931 118 1932 122 1933 101 1934 55 1935 98 1936 124 1937 145 Home helps are supplied both during the ante-natal and post-natal periods. Consultants for Complicated Cases. Under the Public Health (Notification of Puerperal Fever and Puerperal Pyrexia) Regulations, 1926, arrangements have been made for consultation with an obstetric consultant at the request of medical practitioners attending women in confinement. These arrangements have been extended to apply not only to cases of puerperal fever or pyrexia, but any difficult case where a practitioner asks for specialist advice. Under the midwifery scheme, these cases are dealt with by the hospitals concerned, and it is only very rarely that a case arises in the practice of general practitioners. The Council has arranged a panel of obstetric consultants for this purpose. Last year a consultant was supplied in one case. Maternal Mortality. This measures the death rate of mothers due to and associated with child-bearing. It is expressed as a number per 1,000 births, because it is assumed that each time a birth occurs the mother's life may theoretically be presumed to be in peril. 66 The following table sets forth the maternal death rates for Finsbury for the past eight years under the two headings (1) from Puerperal Sepsis, (2) from Puerperal Sepsis and other Puerperal Causes:— From Puerperal Sepsis. (Rates per 1,000 live births.) From Puerperal Sepsis and other Puerperal Causes. (Rates per 1,000 live births.) Total Puerperal Mortality. Year. Finsbury. London. England & Wales. Finsbury. London. England & Wales. 1928 1.36 1.59 1.79 3.40 3.48 4.42 1929 0.73 1.88 1.80 2.18 3.49 4.33 1930 1.54 1.93 1.92 8.47 3.21 4.40 1931 0.79 2.01 1.66 3.96 3.68 4.11 1932 o.oo 1.33 1.61 o.oo 2.90 4.21 1933 o.oo 1.69 1.83 1.98 3.54 4.51 1934 0.00 1.34 2.03 0.00 2.71 4.60 1935 1.07 1.17 1.68 1.07 2.52 4.10 1936 1.19 0.75 1.40 1.19 1.98 3.81 1937 0.00 * 0.94 1.23 * 3.11 * Not available. The term "associated with childbirth" includes causes of death which have no special connection with the puerperal state; for instance, one death in Finsbury in 1937 was due to broncho-pneumonia following severe epileptic fits, giving a total maternal mortality for Finsbury of 2.46 per 1,000. As will be seen from the above table, the Borough of Finsbury has an exceptionally good record, the maternal mortality being on the average less than that of London as a whole and England and Wales. I have set out below particulars regarding the two deaths in connection or associated with childbirth. Maternal Deaths. 1. One death was due to broncho-pneumonia following severe epileptic fits. The woman was admitted to hospital in a condition of status epilepticus, and was delivered of a premature child which survived. She had been an epileptic for 20 years, and the pregnancy was not considered to be a contributory cause. This death is included in the "associated" table. 67 2. Another death was in a woman, aged 36 years with five living children, with a history of a long labour resulting in a stillbirth in 1936. Her death was due to syncope and peritonitis following a ruptured uterus. The woman was suffering from primary uterine inertia, and, although Caesarian section was considered, it was thought safer, as she was extremely fat and a chronic bronchitic, to allow the woman to continue labour and, if necessary, apply forceps. The rupture of the uterus appeared to be spontaneous before the application of the forceps. The case was further complicated by a retained placenta, which had to be removed under an anaesthetic. The investigations made showed that the confinement was one fraught with extreme difficulties and conducted with skill by an expert consultant. Report on Circular 1622 (Ministry of Health); The following is an extract from my Report on the above, dated 14th May:— This Circular refers to the Report on Maternal Mortality recently issued by the Minister of Health. The Report has been issued as the result of special investigations which have been made during the last few years by certain Medical Officers with special experience of the question. It is pointed out that the young married woman in normal health, provided she takes the ordinary and sensible precautions which her doctor or the medical staff at the Ante-natal Clinic advise, need have no anxiety of the risk she will run in childbirth. In 1934, as a result of Circular 1433, Ministry of Health, I submitted a detailed statement showing the extent of the activities of the Council in connection with the arrangements in the Borough for Midwifery generally. It was shown that the Borough Council's arrangements were comprehensive and complete, the domiciliary midwifery being carried out by virtue of an agreement with St. Bartholomew's Hospital, the City of London Maternity Hospital, and the Royal Northern Hospital. Since 1934 68 efforts have been made with success to increase the co-operation between the Borough Council and the Hospitals. Regular quarterly meetings are held to discuss the operation of the scheme, and suggestions for improvement are often before the Committee. The attention of all Maternity and Child Welfare Authorities is specially drawn to the Recommendations in Section X of the Report, the most important of which are those designed to improve the standard of obstetrics:— 1. The establishment, under the direction of the Medical Officer of Health, of an adequate service of Obstetric Consultants:— (i) To assist medical practitioners, who undertake domiciliary midwifery, in cases of doubt or difficulty in the ante-natal period, at the time of confinement and during the puerperium. (ii) To conduct consultative ante-natal and post-natal clinics, to which patients may be referred, by general practitioners or from the routine ante-natal and post-natal clinics. (iii) To exercise clinical supervision over the in-patient treatment of the maternity patients for whom the Local Authority assumes responsibility. (iv) To supervise the treatment of patients suffering from puerperal sepsis. (v) To be responsible for the emergency domiciliary service for cases of grave obstetric abnormality in which removal to hospital is contra-indicated (e.g., certain cases of shock, eclampsia, or haemorrhage). (vi) To assist the Medical Officer of Health in the confidential investigation of the circumstances associated with each maternal death occurring in the area. 2. The Local Supervising Authority, in consultation with the local medical profession, should, in future, be empowered to take steps to ensure that the best obstetric skill is made available in all cases in which midwives are required, under the rules of the Central Midwives Board, to call in a doctor. 3. Emergency Units ("flying squads") should be provided whereby members of the staffs of maternity departments will be 69 available for the domiciliary treatment of maternity patients whose condition is too grave to justify their removal to hospital. 4. Properly constructed, adequately equipped and suitably staffed maternity accommodation (including a sufficient number of beds allocated to and reserved for ante-natal patients) should be provided to meet the needs in every area. Wherever practicable the accommodation should be provided in association with general hospitals. 5. Arrangements should be made for:— (a) Adequate domiciliary visiting by health visitors of expectant mothers with a view to encouraging them to engage an attendant for the confinement and place themselves under ante-natal supervision at an early stage of pregnancy. (b) The provision of ante-natal clinics in every district in which the number of expectant mothers justifies it. (c) The establishment of consultative ante-natal clinics to serve every area. 6. Satisfactory arrangements for the accommodation and treatment of patients suffering from puerperal sepsis and from abortion, are essential. 7. The development of post-natal services, including the establishment of clinics and arrangements for in-patient treatment is a matter of urgent necessity. 8. The education of the woman herself and of the general public should constantly be borne in mind by all concerned with maternal welfare, as the whole-hearted co-operation of mothers is essential to the success of any measure designed to reduce maternal mortality. 9. A service of home helps should, wherever practicable, be provided. 10. Arrangements should be made in every district to ensure that no expectant or nursing mother requiring extra nourishment on health ground fails to receive it for such period as may be necessary. Maternal Mortality in Finsbury. As the Committee are aware, the Metropolitan Borough of Finsbury has had an exceptionally good record in the matter of 70 maternal mortality as shown by the following table, which shows the total Puerperal Mortality per 1,000 live births for Finsbury, London, and England and Wales for the last nine years. Year. Finsbury. London. England & Wales. 1928 3.40 3.48 4.42 1929 2.18 3.49 4.33 1930 8.47 3.21 4.40 1931 3.96 3.68 4.11 1932 0.00 2.90 4.21 1933 1.98 3.54 4.51 1934 0.00 2.71 4.60 1935 1.07 2.52 4.10 1936 1.19 1.98 3.81 It will be seen that the Puerperal Mortality in the Borough has been on the average less than that of London as a whole and England and Wales. The figures above are based on those deaths in which pregnancy or childbirth was a primary cause of death ; this is popularly known as the Maternal Mortality. As has been stated, the mortality in London generally is less than that of England and Wales, and in Finsbury the even smaller mortality is no doubt due to the Midwifery Scheme of the Borough Council and the fact that the Hospital and Consultative facilities are so adequate. It should be noted that very few confinements are attended by a private practitioner or private midwife. Over 600 cases were dealt with under the Scheme, the remainder being confined in other London Voluntary Hospitals or London County Council Hospitals. A few cases were attended in the district by either University College Hospital or the Royal Free Hospital. Midwifery Scheme. The Midwifery Scheme of the Council works efficiently and well, although the Borough Council have not quite the same control as was experienced when Municipal Midwives were employed direct by the Council. 71 The Maternity Scheme of the Council provides for:— (i) Domiciliary and In-patient Confinements for all necessitous Finsbury mothers, including Consultant Services (by agreement with the three Hospitals mentioned). (ii) The provision of Home Helps. (iii) The provision of Milk or Dinners to expectant and nursing mothers. (iv) Convalescence of nursing mothers. (v) The provision of Consultant Services for general medical practitioners in cases of puerperal pyrexia or in any case of doubt or difficulty at the time of confinement, in the ante-natal period or during the puerperium. (vi) The provision of special post-natal clinics. With regard to these matters, the Committee are aware that the agreement with the three Hospitals under the Scheme does not expire until 30th September, 1939. Close co-operation is maintained with the Hospital Authorities; quarterly meetings are held at which two representatives of the Borough Council attend. Recently, as a result of representations made, the Hospitals have agreed to carry out a Routine Wasserman Test on all mothers attending the Ante-Natal Clinics. The Home Help Scheme of the Borough Council has been extended in recent years to include not only the provision of a Home Help at the time of confinement, but also during the ante-natal and post-natal periods, and to allow of the convalescence of the mother in a Convalescent Home. Convalescence.—The Council recently reserved a bed for the sole use of Finsbury mothers after confinement, in the Birchington Convalescent Home, Kent (Mothers' and Infants' Section). Extra Nourishment is given to expectant and nursing mothers Milk or Dinners as ordered by the Medical Officers. This is given during the last five months of pregnancy and earlier if necessary. Consultant Services.—These are provided by the three Hospitals under the Agreement, but for those mothers who have made arrangements with a private medical practitioner for their 72 ment, the Borough Council have formed a Panel of Obstetric Consultants to advise Practitioners in any emergency which may arise during the ante-natal period, the confinement or post-natal period. Post-natal Clinics.—Special post-natal clinics are provided by the three hospitals and any abnormality can be efficiently dealt with. Midwivts Act, 1936.—As the Committee are aware this Act provides for the institution of a salaried midwives' service by the Local Supervising Authority (the London County Council), and the position created when the London County Council Scheme is formulated cannot be accurately forecast. It will be seen, therefore, that the Maternity Services in the Borough of Finsbury are very complete at the present time. It might be appropriate to deal briefly with the recommendations made in the Report on Maternity Mortality already referred to. An adequate service of obstetric consultants has been established by the Borough Council for dealing with cases coming within the Midwifery Scheme and for general medical practitioners. The consultants are available in the ante-natal period, at the time of confinement and during the puerperium. Very few confinements are conducted by general medical practitioners in the Borough, but consultations both ante-natal and post-natal in the home (rather than at special consultative clinics) can be arranged at any time. The clinics provided by the three Hospitals are in fact consultation clinics, being staffed by obstetric specialists. Cases of puerperal sepsis arising are usually sent to the Special Unit provided at the North-Western Hospital. In-patient treatment for ordinary cases or complicated cases, is provided at St. Bartholomew's Hospital, the City of London Maternity Hospital, and the Royal Northern Hospital. Emergency Units ("Flying Squads").—The question of the provision of Emergency Units as suggested in the Report should be considered by the three Hospitals and the opinion of the Medical Committees should be sought. 73 There is probably a dearth of beds in the Hospitals allocated to and reserved for ante-natal patients. I understand at St. Bartholomew's Hospital further beds will shortly be available. The Borough Council Health Visitors now, as a routine, visit these expectant mothers who have booked for their confinement under the Scheme, and are in daily touch with expectant mothers in the course of their routine Health Visiting, and have been instructed to inform the mothers of the benefits of placing themselves under ante-natal supervision at an early stage of pregnancy. They visit, ante-natally, certain mothers who have booked for their confinements either at voluntary Hospitals or London County Council Hospitals. The accommodation for the treatment of patients suffering from puerperal sepsis appears to be adequate. The report states that the development of post-natal services, including the establishment of clinics and arrangement for in-patient treatment is a matter of urgent necessity. Post-natal Clinics are held under the Scheme, but it must be mentioned that in spite of propaganda and advice, the attendance of the mothers has been on the whole disappointing. I would suggest that when the new Health Centre is established, including as it does a Women's Clinic for women over 40, consideration be given to the possibility of holding in addition a gynaecological clinic at which post-natal patients could be seen. Education.—Continuous efforts are being made to acquaint the mothers with the facilities available to them under the Borough Council's comprehensive scheme, not only by personal talks at the Centres, but by the Health Visitors in the homes and by posters and leaflets. Extra nourishment is freely available to the mothers of the Borough who are either expectant or nursing. In view of the Midwives Act, which transfers the responsibility of a salaried midwives' service to the London County Council, and the vagueness of their present proposals, I would suggest that the detailed consideration of this Report be deferred until the Scheme under the Act is in operation. At the time of writing, arrangements are in hand for the provision of an Emergency Unit under the new Scheme passed by the Council as a result of the Act. 74 Unmarried Mothers and Babies. There is one Home in the Borough for the admission of unmarried mothers and their babies, viz., the St. Faith's Home, 2, Myddelton Square. It is controlled by the Holborn Deanery Association and is grant aided by the County Council. School Medical Service. By the courtesy of Sir Frederick Menzies, I have been able to give the following particulars of this service:— Treatment Centres for School Children.—These are under the control of the London County Council. There are two centres in the Borough, viz.:— (1) Finsbury School Treatment Centre, Spencer Street. (2) Pentonville School Treatment Centre, Cynthia Street. Statement relating to the Work at the Finsbury and Pentonville School Treatment Centres, 1037:— Finsbury Centre, 31, Spencer Street, E.C.I. Ailment. No. of cases treated. No. of attendances made. Minor Ailments 1,930 28484 Teeth 2,194 34,745 Dental inspections in the schools. No. inspected. No. found to require treatment. 6,138 4,091 Pentonville Centre, 11, Cynthia Street, Pentonville Road, N.I. Ailment. No. of cases treated. No. of attendances made. Minor Ailments 2,021 24,950 Teeth 1,509 2,673 Dental inspections in the schools. No. inspected. No. found to require treatment. 3,872 2 844 Overleaf are certain particulars relative to the routine medical inspection of the children attending the elementary schools in the Borough for the year 1937. 76 Routine Medical Inspection of Elementary School Children in Finsbury. Age Groups. Number Examined Clothing and boots. Nutrition. Cleanliness of head. Cleanliness of body. Teeth. Vision. Good Fair Poor Good Average Below Normal Bad Clean Nits Pediculi Clean Dirty Pediculi All Sound Less than 4 Decayed 4 or more Decayed 6 /6 in both Eyes 6/9 in either or both Eyes | 6/12 or worse in either or both Eyes Entrants : Boys 482 76 400 6 53 385 44 — 453 27 2 475 7 — 282 146 54 — — — Girls 452 106 346 — 42 381 29 — 429 17 6 444 8 — 258 131 63 — — — Age 7: Boys 368 67 298 3 35 292 41 — 352 15 1 359 9 — 248 102 18 268 59 39 Girls 338 73 262 3 28 290 19 1 297 39 2 331 6 1 217 102 19 244 66 26 Age 11: Boys 370 86 281 3 35 316 19 — 360 7 3 360 9 1 277 83 10 224 88 58 Girls 396 83 313 — 57 317 22 — 351 43 2 394 2 — 304 85 7 238 83 74 Age 14: Boys 544 124 417 3 114 396 34 — 531 13 — 540 4 — 377 160 7 357 92 95 Girls 498 133 364 1 110 367 21 — 445 50 3 488 10 — 338 152 8 277 115 106 Total 3,448 748 2,681 19 474 2,744 229 1 3,218 211 19 3,391 55 2 2,301 961 186 1,608 503 398 Percentage 1.7 77.8 0.6 13.7 79.6 6.7 93.3 6.1 0.6 98.3 1.6 0.1 66.7 27.9 5.4 64.1 20.0 15.9 London 55.6 44.1 0.3 16.5 77.4 6.1 97.6 2.1 0.3 99.1 0.9 0.0 70.2 26.3 3.5 67.6 19.0 13.4 76 Examination of Elementary School Children in Finsbury. Boys. Girls Number examined Entrants Age 7 Age 11 Age 14 Entrants Age 7 Age 11 4 482 368 370 544 452 338 396 498 Cases * Cases * Cases * Cases * Cases * Cases * Cases * Cases * Malnutrition 20 20 18 17 2 2 9 9 7 7 7 7 9 9 3 3 Skin disease 5 4 1 1 3 2 5 1 6 5 5 3 3 2 10 8 Defective teeth — 191 — 116 — 92 — 163 — 187 — 116 — 88 — 159 Enlarged tonsils 74 30 36 20 29 12 22 6 81 29 31 12 33 17 21 12 Adenoids 4 1 2 2 1 — 1 1 3 2 3 3 — — 1 1 Enlarged tonsils and adenoids 15 5 3 2 — — — — 9 6 3 2 — — 2 1 Other nose and throat defects — — 2 1 2 2 1 1 1 1 3 1 1 1 Enlarged glands 22 2 6 — 6 — 4 — 21 — 3 — 1 1 1 — Eye disease 15 11 10 7 7 3 4 4 30 12 4 3 10 7 1 — Vision defect — — — 27 — 50 — 69 — — 16 — 47 — 69 Otorrhœa 6 5 3 2 5 5 2 2 3 3 3 2 3 2 3 3 Other ear disease 2 2 1 — 1 Defective hearing 1 — — 2 1 — 2 1 — Speech defects 2 — 3 1 1 1 3 1 - - - - - - - - Heart defects 7 — 8 1 4 — 16 — 7 13 10 1 9 — Anœmia — — 3 2 — 3 3 3 3 4 2 Lung defects 17 5 7 3 3 — 3 — 11 3 5 4 — 2 2 Nervous defects 4 1 2 1 1 1 2 1 3 2 3 2 2 Phthisis — 1 1 - - - - - - - - - - Other T.B. disease 1 Rickets 1 — 1 4 1 - - - - - - Spinal deformities — — — — 1 1 6 5 3 2 1 1 10 8 Other deformities 1 1 — — 1 1 2 1 1 - - - - - 2 1 Other defects 6 1 10 9 20 17 6 4 11 6 4 3 14 12 9 8 Number of children noted for treatment — 248 — 168 — 151 — 242 — 237 — 143 — 154 — 231 * Defects, however slight, are included under "cases"; those severe enough to require treatment are shown under *. 77 Health Education and Propaganda. The value of health education and propaganda of a suitable kind cannot be over-estimated. Posters of an educational nature are distributed throughout the Borough regularly during the year and talks, accompanied in many cases by a film, are given from time to time at the two Municipal Centres. Health education should be continuous and not spasmodic in character; one must remember that all the work of a Public Health Department is educational in nature, and the efficient discharge of the routine duties of the department in order to remedy existing hygienic evils is indeed the soundest and best form of health education. As examples of the health education which is constantly being practised may be mentioned the instruction and advice given by the Medical Officers at the Welfare Centres, by the Health Visitors in the course of their routine visits, by the Tuberculosis Officer and the Nurse at the Tuberculosis Dispensary, and in the homes, and by the Sanitary Inspectors. Much quiet health education is thus being disseminated throughout the borough and is much more likely to have a real health value than the intermittent use of some stunt. Real and lasting good lies in the instruction and example of those, who really believe in the doctrine of healthy living, hard though it may be under certain circumstances. As an adjunct to health education, and the knowledge of facilities offered by the Department staff, pamphlets and posters are a useful accessory. Pamphlets and posters are in constant use by the Department. Sites for posters are now in use on the Public Conveniences and Open Spaces. National Health Campaign.—The Borough Council cooperated in the National Health Campaign, organised by the Ministry of Health and the Board of Education with the assistance of the Central Council for Health Education. The campaign was designed for six months as follows:— (1) October.—A campaign to encourage the use of the Health Services. 78 (2) November and December.—Maternity and Child Welfare Services. (3) January.—School Medical Services. (4) February.—Services for Adults and Adolescents, dealing with Tuberculosis, Venereal Diseases, etc. (5) March.—Physical Training and Recreation. Special Posters (16-sheet and double crown), Folders, Display Cards (for shops), Bookmarks and Posters for vehicles were distributed in the Borough last year, dealing with the first three months of the Campaign. In addition to the 16-sheet posters issued centrally, special 16-sheet " Slogan " Posters were prepared for display on adjoining sites. A Booklet issued by the London County Council entitled "Highways to Health," giving details of the County Council's services, was also distributed. Post Offices.—Last year, at the request of the Ministry of Health, special leaflets detailing the Health Services available in the Borough, were sent to all the local Post Offices for distribution to the public on request. The Council renewed the subscription of two guineas to the Central Council for Health Education. Empire Marketing Boards. The advertising board of the Empire Marketing Board in Clerkenwell Road continued in use for propaganda purposes. Special posters issued by the National Association for the Prevention of Tuberculosis, and the Central Council for Health Education, dealing with diphtheria prevention, have been displayed on this board. Two poster boards used by the Metropolitan Water Board are now at the Council's disposal. One has been fixed on the projecting wall of No. 152, Pentonville Road, an excellent site, by permission of the Penton Estate at an acknowledgment fee of 5s. per annum. Hop-picking. Special leaflets giving precautions for preventing the introduction of infectious disease in the hop-fields were distributed 79 to intending hop-pickers again last year. In addition posters were displayed throughout the Borough. The following leaflet was used last year. METROPOLITAN BOROUGH OF FINSBURY. Public Health Department. HOP PICKING. Help is asked of all those who will go hopping this year to lessen the risks of spreading infectious disease among London hop pickers. 1. You can help by preventing actual cases of infectious disease, or contacts of cases of infectious disease, from entering the hop fields. It is unlawful for any one suffering from a notifiable infectious disease to travel in a public conveyance, the penalty being a fine not exceeding £10. Apart from this there is great danger of spreading disease to other families in the hop fields. Anyone who has been in contact with infectious disease is strongly urged not to go hopping during the three weeks following contact. People who have been in contact with infectious disease and who go to the hop fields against advice are sent back by the farmers. 2. You can help by preventing cases of tuberculosis from entering the hop fields. No one suffering from consumption or tuberculosis should go hopping, as there is a grave risk to other people sleeping in the huts which are invariably overcrowded at week-ends. 3. You can help by making sure that only pickers booked by the growers go to the farms. No one should go hopping who has not actually been engaged by the farmers to pick, as the accommodation is limited. Unauthorised visitors may be turned off the farms. Overcrowding will cause great discomfort in the huts, the sanitary provision will not be adequate, and the risk of an outbreak of infectious disease will be increased. 4. Parents are strongly advised not to take infants in arms down to the hop fields. NICHOLAS D. DUNSCOMBE, M.A., M.B., B.chir., D.P.H. Medical Officer of Health. 80 Nursing Homes. There are no Nursing Homes in the Borough registered by the County Council under the Nursing Homes Registration Act, 1927 (now Part XI of the Public Health (London) Act, 1936). There are two Exempted Premises, viz., St. Barnabas Home, 14, Lloyd Square, W.C., and St. Faith's Home, 2, Myddelton Square, E.C. This latter is a home for unmarried mothers. Last year, at the request of the County Council, all the medical practitioners in the neighbourhood were asked to report to the Department or direct to the County Council any unregistered nursing homes of which they were aware. Conference—Maternity & Child Welfare. Delegates attending this Conference paid a visit to the Day Nursery, Welfare Centres and the Swimming Baths, and were greatly impressed by the activities of the Council. A special brochure was prepared for the information of the delegates. Post-Graduate Course. Your Medical Officer of Health attended the first postgraduate course for Medical Officers of Health, organised by the Society of Medical Officers of Health, at Cardiff from 28th September to 1st October. It was a great success and proved most useful and informative. 81 SECTION C. SANITARY CIRCUMSTANCES. The district work of the Sanitary Inspectors during 1937 is presented below in tabular form:— Mr. Norman Mr. Newdick Mr. Lay Mr. Jenkins Mr. Ward Mr. Longden Mr. Clinton Totals Houses damp, dirty or dilapidated, remedied 103 125 89 135 162 - - 614 Doors, windows, floors, walls, ceilings, sashcords repaired 56 112 69 50 348 - - 635 Overcrowding cases abated in other than Registered Houses 3 6 2 10 24 - - 45 Water closet defects remedied 110 92 87 79 152 — — 520 Water closets erected 37 154 146 140 55 — - 532 Urinal defects remedied 7 3 5 6 — — - 21 Urinals erected 6 5 5 9 — — - 25 Soil pipe and ventilating shaft defects remedied 6 2 4 11 9 - - 32 Soil pipe and ventilating shafts erected 14 37 34 30 20 — — 135 Yard defects remedied 38 27 44 22 53 — — 184 Waste pipe defects remedied 15 5 14 30 34 — — 98 Waste pipes erected 40 34 111 95 52 — — 332 Water cistern defects remedied — 5 3 7 6 — — 21 Accumulations of rubbish or manure removed 31 17 14 14 66 - - 142 Dung or dust receptacles repaired or renewed 40 36 29 38 53 - - 196 Drains relaid or amended 21 15 34 31 42 — — 143 Drains cleared 26 27 17 23 33 — — 126 Rain-water pipes cleared, repaired or renewed 39 7 7 7 30 - - 90 Water supply to houses reinstated 2 1 — 5 5 — — 13 Roofs and gutters repaired 70 42 56 50 91 — — 309 Area defects remedied 14 10 3 10 6 — — 43 Washhouse defects remedied 38 62 48 23 80 — — 251 Animal nuisances abated 3 — 1 3 10 — — 17 Floor space unventilated 5 — — 5 2 — — 12 Stables cleansed or repaired — — 4 1 3 — — 8 Smoke observations — 3 37 138 1 — — 179 Water supply laid on to upper storeys of house 34 18 31 35 37 - - 155 Miscellaneous nuisances abated 24 39 14 9 105 — — 191 Drains tested 40 43 15 51 95 — — 244 Bakehouses, inspections — — — — — — 179 179 Bakehouses cleansed or repaired - - - - - - 27 27 Restaurants—No. of inspections - - - - - - 726 726 Restaurants cleansed or repaired - - - - - - 38 38 Milkshops—No. of inspections - - - - - - 632 632 Milkshops cleansed or repaired - - - - - - 10 10 Public-houses cleansed or repaired 3 3 4 4 1 — 2 17 Ice cream premises—No. of inspections - - - - - - 222 222 Ice cream manufacturies cleansed or repaired - - - - - - 5 5 82 Mr. Norman Mr. Newdick Mr. Lay Mr. Jenkins Mr. Ward Mr. Longden Mr. Clinton Totals Food stalls—inspections 1,430 1,218 1,246 435 332 233 248 5,142 Butchers' shops cleansed or repaired — — — — — — 3 3 Fish purveyors' shops cleansed or repaired - - - - - - 2 2 Registered food premises—inspections - - - - - - 192 192 Registered food premises cleansed — — — — — — 19 19 Registered houses—visits of inspection 442 374 246 320 410 — — 1,792 Registered houses—overcrowding cases abated - - - 5 - - - 5 Registered houses—cleansed 75 88 59 97 104 — — 423 Registered houses—Intimation (Cleansing) Notices served 75 88 59 97 104 - - 423 Registered houses—Statutory (Cleansing) Notices served 37 16 7 17 12 - - 89 First visits (complaints, casual visits) 3,235 3,545 2,817 2,646 2,231 1,998 — 16,472 Re-visits 1,948 1,593 2,615 2,032 2,627 642 — 11,457 Intimation Notices served 312 237 273 315 366 - — 1,503 Statutory Notices served 27 30 17 47 58 - — 179 Infectious disease investigations 76 45 61 75 110 - — 367 House inspections 304 367 318 350 372 - — 1,711 House-to-house inspections 135 248 110 128 127 - — 748 Canal boats inspected — — — 91 — - — 91 Slaughterhouses—No. of inspections 110 - - - - - - 110 Verminous tenements—No. of inspections 46 59 99 125 141 - - 470 Verminous tenements cleansed by Borough Council - - - - - - - 167 Underground rooms—inspections 35 43 20 45 60 2,217 - 2,420 The number of complaints of insanitary conditions and nuisances received in the Public Health Office during the year numbered 1,248. Details of the Work of the Lady Sanitary Inspector during 1937. Visits and Re-visits :— Factories (other than out-workers' premises) 976 Workshops and workplaces (ditto) 353 Outworkers' premises (sub-contractors) 389 „ „ (domestic) 823 Complaints of vermin (L.C.C.) 175 Public health complaints 8 Public sanitary conveniences 72 2,796 Intimation Notices served 146 Statutory Notices served 2 83 Summary of Matters for which Notices were Served:— 1. Damp, dirty, verminous and dilapidated premises 72 2. Leaky roofs 11 3. Sanitary conveniences dilapidated, dirty, insufficient, not separated for sexes, unsuitable, choked 121 4. Waste pipes, rain-water pipes and gutters, choked, leaky, broken, water fittings leaky 3 5. Waterpipes and fittings defective 2 6. Dustbins absent or broken 6 7. Refuse accumulations 8 8. Smoky chimney 1 Drainage of Buildings. The sanitary inspectors supervise the drainage in connection with plans submitted to the Public Health Committee every month. This applies to alterations and additions to drains of existing buildings, and all drainage work above ground in respect of new buildings. One hundred and twenty-eight plans were deposited last year. These related to:— The provision of additional sanitary accommodation 54 Reconstruction of drainage of existing buildings 28 New buildings 39 Sanitary fittings only 7 Factories and Workshops. The number of workshops and workplaces on the register at the end of 1937 was 2,523, compared with 2,529 at the end of 1936. During the year under review, 84 entries were removed from the register owing to the closing of premises, the conversion of workshops into factories by the introduction of some form of mechanical power, or to the removal of the occupier to other places of business. 84 The number of workshops and workplaces newly registered was 78. The factories on the register at the end of 1937 numbered 2,232, compared with 2,191 at the end of 1936. The list included 4 tenement factories in which there were separate occupiers carrying on different trades or processes, and supplied with mechanical power by the owner of the premises. In the case of factories the duty of inspection is mainly carried out by H.M. Factory Inspector under the Factory and Workshop Acts 1901-1907. The duties of the Inspector attached to the Public Health Department are limited to such questions as sanitary accommodation, dustbin provision, nuisances arising from smoke, except in the case of food premises and bakehouses where the Borough Council have wider powers. In the case of workshops the Health Department deal with the above matters and in addition have other duties, including the supervision of cleanliness, ventilation, air-space and overcrowding. Co-operation is maintained with the Factory Inspector in dealing with factories and workshops in accordance with the Factory and Workshop Act 1901. The persons employed in the Factories in Finsbury are approximately:— Males, 28,006; Females, 27,369. In the workshops and workplaces:—Males; 6,087, Females, 6,461. These numbers exclude the office " hands" and clerical staffs. During the year 1,185 first visits and 632 re-visits were made by the Council's inspectors to factories and 833 first visits and 394 re-visits to workshops and workplaces. The Home Office.—21 notices of occupation were received from the Home Office during the year and 109 notices of complaint relating to the following matters:— 85 Premises dirty 4 Sanitary conveniences insanitary 8 Sanitary conveniences insufficiently ventilated 26 Water closet accommodation insufficient 2 Absence of separate accommodation for the sexes 1 Miscellaneous 75 The notices sent to the Hoir.e Office were as follows:— Abstract of the Factory and Workshop Act not affixed, or wrongly affixed 1 New occupation 1 Details of Defects and Defaults in Factories, Workshops and Workplaces, for which Notices were Served in 1937. Nuisance. Factories. Workshops. Workplaces. Total. Smoke nuisance 8 1 9 Cisterns dirty or covers broken 1 2 - 3 Dampness in walls 2 1 — 3 Drains choked 6 6 - 12 Drains leaky 5 — 1 6 Dustbins broken or absent 15 10 5 30 Guttering or rain-water pipe broken, leaking or inadequate - 2 1 3 Manhole covers broken 3 1 1 5 Open drain inlets 1 2 1 4 Refuse accumulations 14 7 1 22 Roofs leaky 13 4 — 17 Floors broken 9 10 1 20 Ceilings broken 4 5 — 9 Sanitary conveniences not separate for sexes 10 6 - 16 Sanitary conveniences defective 118 21 8 147 Sanitary conveniences dirty 86 30 4 120 Sanitary conveniences insufficient 5 1 — 6 Sanitary conveniences unsuitable 81 16 7 104 Soil pipes leaky 5 1 — 6 Staircases and landings dirty 1 16 — 17 Urinals foul 6 — — 6 Ventilation of workrooms inadequate or insufficient means of - 7 - 7 Waste material improperly stored — 1 — 1 Water closets choked 12 — — 12 Waste pipes choked or leaky 14 2 1 17 Water fittings leaky 9 2 — 11 Workshops or workplaces dirty — 38 8 46 Yard paving broken 2 2 2 6 Yard walls dirty 1 6 1 8 Total 431 200 42 673 In connection with these matters 297 intimation notices and 5 statutory notices were served. 86 The following matters are presented in the form required by the Home Office:— Inspection of Factories, Workshops and Workplaces. Premises. Inspections. Written Notices. Prosecutions Factories (including Factory Laundries) 1,817 199 Nil Workshops (including Workshop Laundries) 1,121 78 Nil Workplaces (other than Outworkers' premises) 106 20 Nil Total 3,044 297 Nil Defects Found in Factories, Workshops and Workplaces. Particulars. Found Remedied Referred to H.M. Inspector No. of Prosecutions Nuisances under Public Health Acts— Want of cleanliness 185 176 - - Want of ventilation 48 48 - - Overcrowding — — — — Want of drainage of floors 2 2 — — Other nuisances 188 179 - - Sanitary accommodation Insufficient 5 5 - - Unsuitable or Defective 230 230 - - Not separate for the sexes 15 15 — — Offences under the Factory and Workshop Acts— Illegal occupation of underground bakehouses (S. 101) - - - - Other offences (excluding offences relating to outwork which are dealt with in Part 3 of this report) — — — — Total 673 655 — — There were 16 matters outstanding at the close of the year. 87 Other Matters. Matters notified to H.M. Inspector of Factories:— Failure to affix abstract of the Factory and Workshop Act (S. 133, 1901) 1 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Acts (S. 5) notified by H.M. Inspector 109 Reports (of action taken) sent to H.M. Inspector 109 Other — Underground bakehouses (S. 101) in use at the end of the year 22 Outworkers. The number of outworkers dealt with by the Public Health Department during 1937 was as follows:— No. ot outworkers notified by firms in Finsbury 5,303 No. of outworkers notified by Local Authorities 586 Total No. notified to the Department in 1937 5,889 The number of firms employing outworkers on the Register at the end of 1937 was 337. The number of Finsbury outworkers notified to the Department during 1937 was as follows:— No. notified by Finsbury firms 751 No. notified by other Local Authorities 586 Total No. notified to the Department in 1937 1,337 Outworkers to the number of 4,552 obtaining their work from Finsbury firms, but living and working in other districts, were notified to the respective Local Authorities of their districts of residence. 88 The following analysis shows the trades followed by the Finsbury outworkers:— Finsbury Outworkers Notified During 1937. (List sent in twice yearly.) Trade. Con tractors. Homeworkers. Totals. Tailoring 149 27 176 Mantles, Gowns, Blouses 321 22 343 Coats, Costumes, Skirts 79 3 82 Pleating, Hem-stitching, Buttonhole-making 20 — 20 Uniforms 11 5 16 Furriers 104 16 120 Underwear 13 13 26 Shirts and Pyjamas 10 4 14 Neckwear 4 7 11 Woollen Goods 6 3 9 Children's Wear 1 4 5 Baby Linen 5 3 8 Millinery — 16 16 Linen and Cotton Goods 16 17 33 Needlework and Embroidery 6 13 19 Cushions 1 — 1 Coat Hangers — 47 47 Umbrellas — 14 14 Handbags — 17 17 Fancy Goods 4 15 19 Powder Puffs — 1 1 Hairnets — 6 6 Artificial Flowers — 94 94 Button and Hairpin Carding — 17 17 Box-making, etc. 4 99 103 Paper Bags — 2 2 Christmas Crackers and Stockings 1 59 60 Toy-making — 9 9 Lampshades — 1 1 Brushes 1 15 16 Fancy Stationery 2 5 7 Jewel and Plate Cases 2 3 5 Feather Sorting, Curling and Mounting — 7 7 Clock-makers and Opticians 7 — 7 Electro-platers and Silversmiths 6 - 6 Totals 773 564 1,337 Offensive Trades. At present there are the following licensed offensive trades in Finsbury:— Tripe Dressers.—Messrs. Henson, 187, Whitecross Street; Messrs. F. & W. Warman, Ltd., 5, Eagle Court. Messrs. H. P. Millicent & Co., 8, Mallow Street, fur-skin dressers, have recently discontinued operations at that address. 89 The Meat Inspector paid 400 visits to the tripe-dressing establishments, in addition to routine visits made by the District Inspectors. There are certain other firms in the Borough who deal in animal fats, bones and waste meat-cloths. In hot weather offensive effluvia arise from these premises and complaints from adjacent ratepayers and passers-by are occasionally received. Regular inspection is maintained in those premises. The licensed trades are subject to special bye-laws made by the London County Council. Rag and Bone Dealers. There are 10 premises within the Borough in which the business of rag and bone dealer is carried on. A "Rag and bone dealer" means any person selling or buying for the purpose of re-sale or otherwise dealing in rags (other than tailor's or dressmaker's cuttings), bones, rabbit skins, fat or other like articles. The premises are subject to bye-laws made by the London County Council in 1923 under Section 3 of the London County Council (General Powers) Act, 1908. Additional bye-laws were made in 1928 as follows:— 1. A person carrying on the business of a rag and bone dealer shall not sell or distribute or cause or permit to be sold or distributed any article of food or any balloon or toy:— (a) in or from any part of the premises used for or in connection with his business, or (b) in the course of his business while carried on from any cart, barrow or other vehicle or receptacle used for the collection or disposal of rags, bones, fat, rabbit skins, or other like articles, or (c) in any other way connected with his business. These premises were inspected and the inspectors paid 26 visits last year. 90 Licensed Houses. All the licensed houses in the Borough are inspected as regards sanitary accommodation from time to time, and on the transfer of licences, the Department submits a special report to the Town Clerk on these matters, so that the provision made for the use of customers can be brought to the notice of the Licensing Justices. There are 193 licensed premises in the Borough.—Public houses 127, beer houses 34, hotels and restaurants 3, off-licence houses 29; this gives one licensed premises per three acres and one to each 304 persons living in the Borough. Public Health (London) Act, 1936, Sec. 147. Regular observations are taken with regard to the emission of smoke from buildings in the Borough. There is a fair proportion of large buildings in the Borough the chimneys of which emit smoke from the boilers in connection with the business carried on therein. These include the following:—Breweries, distilleries, rubber works, printing works, tobacco factories, sweet making, general engineering, power station and hospitals. The following table shows the work under this heading during the year 1937. Number of complaints received 20 Total number of observations made 179 Number of preliminary notices served 5 Number of Statutory notices served 3 Legal proceedings 0 An instructional card for stokers giving practical suggestions for avoiding unnecessary smoke emission from hand-fired boilers has been given to firms in the Borough for the guidance of the workmen employed. Mechanical Stokers.—The advantages of mechanical stokers are a regular and constant feed, rendering the air supply a comparatively simple matter, and the absence of rushes of cold air through open doors whilst firing, and in general the result is economy of fuel with far less smoke. There are 20 buildings in which mechanical stokers are employed. 91 Rat Nuisance. Sealing and Filling Up of Disused Drains.—In connection with the Rat Nuisance special attention is paid every year to the sealing and filling up of disused drains. The sanitary inspectors whilst on their rounds keep watch for any buildings which are being demolished and should no building be erected on the site, steps are taken to have the drains effectually sealed off; when possible the drain is sealed off at the sewer end by the Borough Engineer's Department. Should a new building be erected on the site, the drains are dealt with before the premises are put in hand. Efforts are also made to secure the removal of any W.C. pans and the filling up of the drain, in the case of premises unoccupied for a long period. National Rat Week, 1st to 6th November, 1937. The methods previously pursued by the Borough Council as to National Rat Week were repeated in 1937; the activities of the Council are actively pursued throughout the whole year. Printed handbills with instructions are given out at the counters of the various municipal offices where callers are dealt with, and supplies of rat poison are liberally distributed to all Finsbury residents. The handbills invite communication with the Public Health Department, with the assurance of every assistance by the Department for ridding premises of vermin. Instructions are given as to rat-proofing of premises, and the discouragement of rats and mice by the proper storage of goods which might attract them, and the keeping of premises clear of debris and refuse harbouring the presence of vermin. The leaflets include advice in the use of traps and rat varnish, and the proper laying of rat poison. The names and addresses of firms of rat catchers of good reputation are also given on the leaflets. Posters are plentifully exhibited throughout the Borough at intervals during the year, and a monthly distribution of freshly- 92 prepared rat poison by the staff, under the direction of the Borough Engineer and Surveyor, in the sewer manholes, is regularly carried on. Every year immediately before Rat Week, the Council encloses with all rate demand notes, a special leaflet relating to the facilities offered by the Council to aid in the repression of rats, and rat repression posters are plentifully displayed, including the special poster issued by the Ministry of Agriculture and Fisheries, on hoardings, on the Council's notice boards, and on the rolling-stock of the Borough Council. The District Sanitary Inspectors carry out the duties of rat officers, giving personal attention to every complaint as to the presence of rats, and instructions and advice as to the best means of combating infestation. During the year 1937, 74 complaints of rats were received at the Public Health Department, and dealt with by the Inspectors. Two hundred and ninety-four applications were received for rat poison. The Borough Engineer and Surveyor reports as follows, as to the measures taken in his Department:— "During the first few days of every month poisoned bait is laid in the manholes of sewers throughout the Borough. This is the most practicable method of trying to reduce the number of rats which are continually breeding in the drains and sewers. The rats apparently devour a large amount of the poison with fatal results. A certain proportion of the poison is washed away during storms, and only a rough idea can be formed of its effectiveness. Dead rats are very rarely found in the sewers, and it is assumed that they are carried away in the sewage. After poison has-been laid, a few days elapse before an inspection is made. The number of cases where the poison has disappeared is noted, and the figures thus obtained continue to show that it remains untouched more often on the eastern side of the Borough than on the western. 93 Particular care is taken over the inspection during the months of November, and in 1937 the amount of poison remaining untouched was slightly in excess of the previous total. The poison was laid on the eastern district between 5th-7th November, on the western district between 1st-4th November, and inspections were made on the eastern district between 13th-19th November and on the western district between 9th-11th November. Of the 300 manholes (approximately) treated, situated in various streets and courts of the Borough, poison remaining was approximately 10 per cent. of the total amount laid. The number of rats frequenting the sewers would appear to be steadily diminishing. Much remains to be done, however, before the state of affairs can be considered satisfactory. During the course of the year many of their breeding places are destroyed when old drains, which have become unused or have been replaced, are sealed off. The replacement of old sewers or repairs to defective brickwork also help to confine the available places which rats can use. It is of interest to note that at almost any point found to be defective, rats are to be found, and in a large number of cases are responsible for the damage done. By the express desire of the Council the utmost efforts are made to assist all residents and occupiers in the Borough who have difficulty in coping with the rat nuisance by their own efforts, and every help is given by publicity, advice by leaflets, and by officers of the Public Health Department, and by the distribution of poison, to this end. Canal Boats Acts, 1877 and 1884. During the year 1937 the total number of boat inspections was 91. None carried offensive cargo. The Acts and Regulations were contravened in three instances and for these complaint notices were sent to the owners requiring abatement within a specified time. The infringements were in respect of the following:— 1. Absence of Registration Certificate (2). 2. Roof leaky in after cabin. 94 These contraventions were remedied and it was not found necessary to take legal proceedings. The following table gives statistics relating to the inspection of canal boats for the past 6 years:— Year. Boats Inspected Persons found on boats Total Registered for. Men Women Children 1933 94 142 55 49 246 348 1934 103 150 71 62 283 382 1935 98 129 66 64 259 338 1936 95 127 61 44 232 334 1937 91 109 59 64 232 311 Of the 91 Canal Boats inspected, 40 were occupied by men only, 16 by men and women and 35 by men, women and children. The number of children on the boats was 64, of which 34 were of school age and 30 were under school age. The children accompanying their parents on the boats appeared to be well cared for. No case of infectious disease was notified or discovered on the canal boats, therefore isolation of patients and detention of boats has not been necessary. The inspection of canal boats is part of the duty of the sanitary inspector whose district includes that part of the Borough in which the canal is situated. Public Conveniences. There are seven underground public conveniences in the Borough under the control of the Borough Engineer and Surveyor. They are visited regularly every month by the sanitary inspectors, the lady inspector visiting the women's side. Any special matters are brought to the notice of the Health Committee. In addition there are ten urinals. 95 HE SHOPS ACT, 1934. At the end of the year there were some 1,341 premises within the Borough to which the Act applies, distributed as follows:— Automatic machine dealers 1 Leather goods dealers 12 Bakers 41 Libraries 5 Billiard table dealers 3 Metal merchants 4 Booksellers 5 Milliners 14 Boot and shoe dealers 30 Miscellaneous and fancy goods 6 Boot repairers 12 Builders' sundriesmen 6 Musical instrument dealers 2 Butchers 54 Music sellers 2 Butchers' outfitters 3 Naturalists 2 Carpet and linoleum dealers 4 Newsagents 25 Cats' meat dealers 4 Oil and colour dealers 24 "Chain" stores 4 Opticians and clock makers 16 Chemists, druggists and herbalists 28 Pawnbrokers 5 Perfumers 1 China and glassware dealers 3 Piano dealers 3 Cleaners and laundry receiving offices 11 Post Offices 3 Printers 4 Cooked meat shops 7 Provision dealers 38 Costumiers 16 Public-houses 92 Cycles, etc. 9 Radio, gramophone and electrical goods 28 Dairies and milkshops 111 Decorators 2 Restaurants 223 Dolls' hospital 1 Second-hand dealers 5 Drapers 27 Sewing machine dealers 2 Electroplater 1 Snack bars 19 Fish sellers 7 Stationers 11 Florists 6 Surgical appliances 1 Fried fish sellers 18 Sweetshops 42 Furniture dealers 19 Sweetshops and tobacconists 30 General merchants 2 Tailors 19 Greengrocers and fruiterers 23 Theatrical costumiers 1 Grocers 44 Tin and copperware dealers 1 Hairdressers 58 Tobacconists 48 Hairdressers' sundriesmen 2 Tool merchants 2 Hatters 4 Toy dealers 5 Hosiers 12 Typewriters and cash registers 2 Ironmongers 14 Italian produce dealers 2 Umbrella dealers 2 Jewellers 7 Undertakers 1 Ladies' outfitters 2 Wearing apparel 26 Lamp manufacturers 1 Wines and spirits 11 90 All the sanitary inspectors were appointed inspectors for the purposes of the Act, each inspector dealing with the shops in his district with the exception of the sampling officer who deals with all shops where food is sold for human consumption. The summary below indicates the work carried out under the Act during the year:— No. of visits paid by the Inspectors during the year 534 No. of Notices served 24 No. of shops in which extra sanitary conveniences were provided 11 No. of shops in which means of heating were provided 2 No. of shops in which additional ventilation was provided 2 No. of exemption certificates granted 17 Public Health (London) Act, 1936.—Sec. 224. This section enables a magistrate's order to be obtained for the compulsory removal to a suitable hospital or other institution of aged and infirm persons. No application was found necessary last year. Efforts were made to get into touch with relatives, friends or other interested persons and satisfactory arrangements made for removal to a suitable institution or care at home. Aged persons known to the Department to be living alone are visited periodically to ensure that institutional treatment or care is obtained if necessary. There were, at the end of the year, 11 persons on the register kept for the purpose, to whom 56 visits were paid. Verminous Premises. Verminous Premises.—The procedure adopted for the disinfestation of verminous premises was detailed in the Report for 1934 (p. 83). 97 One hundred and thirty-two notices were served last year requiring the disinfestation of verminous premises. Below I have indicated the number of houses dealt with:— No. of Council houses found to be infested 26 No. of Council houses disinfested 26 No. of other houses found to be infested 146 No. of other houses disinfested 146 The belongings of tenants before removal to the Council's flats are inspected by the Sanitary Inspectors. Bedding is treated by steam disinfection, and other articles are sprayed with a vermicide, and the tenants instructed as to the methods to be adopted to rid, as far as possible, the articles from vermin. A special pamphlet is in use for this purpose. Tenants are encouraged to destroy all useless articles prior to removal. Use has not yet been made of hydrogen cyanide, the difficulty being the absence of a suitable site for the purpose. One fatality occurred last year as the result of the fumigation of an unoccupied semi-detached house. The Borough Council was in no way concerned with the fumigation, which was carried out by a company at the request of the representatives of an estate in the Borough. It appeared that in spite of the precautions taken, a heavy concentration of gas, hydrogen cyanide, got through the party wall into an occupied basement room. This unfortunate occurrence shows that it is very inadvisable to undertake fumigation with HCN unless adjoining premises are vacated. At the request of a private estate, arrangements were made for the steam disinfection of bedding and similar articles belonging to tenants removing from the Borough to new flats in Islington. The furniture was disinfected by a company at the request of the owner. The belongings of 108 families were dealt with. 98 Houses Let in Lodgings. At the end of the year there were 758 houses on the Register. These are regularly inspected and cleansing notices served annually in accordance with the bye-laws. No new houses were added to the Register. Apart from the annual inspection, frequent visits are paid to these premises in connection with nuisances, infectious diseases and other matters. 1,792 visits were paid last year in connection with the bye-laws. Rag Flock. The Public Health (London) Act, 1936, prohibits the sale or use, for the purpose of making any article of upholstery, cushions or bedding, of unclean flock manufactured from rags. The expression "flock manufactured from rags" is defined in the Act as flock which has been produced wholly or partly by tearing up woven or knitted or felted materials, whether old or new, but does not include flock obtained wholly in the process of scouring and finishing of newly-woven or newly-knitted or newly-felted fabrics. Wool and fibre is now being used very largely in the place of rag flock. Samples of rag flock taken from time to time have been submitted to the Public Analyst, and have been satisfactory. Street Traders. There were at the end of the year 358 persons engaged in street trading within the Borough. It was arranged during the year that all applications for licences to trade in food-stuffs should be referred to the Health Committee in order that before issuing the licence, the Health Department could investigate the places of storage to see whether they are satisfactory. When the place of storage is outside the Borough this information has been supplied by the Health Department of the Boroughs concerned. This procedure has enabled the Department to effect any improvements in the places of storage before issuing licences. 99 Accommodation for the storage of Food. London County Council (General Powers) Act, 1937, Section 65. This section extends the requirements of Section 184 of the Public Health (London) Act, 1936 (Accommodation for the Storage of Food in certain Tenement Houses) to every tenement house. Under the London Act the provision of storage accommodation for food could not be enforced in any tenement house used or occupied as such before 16th August, 1909. The Health Department has given consideration to these extended powers, and notices have been served under the Act in suitable cases. Sixteen notices were served last year for the provision of ventilated food cupboards. In all 30 such cupboards were installed. Mortuary, Coroner's Court, Shelter and Disinfecting Station. These premises are situated at Nos. 47 and 49 Northampton Road, and will be out of use for these purposes when the new Health Centre is opened. Mortuary.—The Mortuary premises are old and not ideal for the purpose ; there are no cold chambers such as are usually included in a modern mortuary and the need for such provision is obvious during hot weather. 47 bodies were received last year. Coroner's Court.—These premises have not been used for the purpose for some years. Shelter.—The Shelter provided for contacts (No. 49 Northampton Road) consists of a 9-roomed house; 5 of these rooms are occupied by the caretaker, the remainder of the upper floors being used for contacts of cases of small-pox when required, and for accommodating families during the disinfection of their premises after infectious diseases. The Holborn Metropolitan Borough has the use of the shelter, for which a sum of £37 10s. Od. per annum is paid. Last year the shelter was used on four occasions by families from Holborn. Disinfecting Station.—The Station is situated on the same premises. The disinfector is a Washington-Lyons high pressure 100 steam apparatus. Here is also kept the Morris chassis with two interchangeable bodies in connection with the work of the Station. The following table gives particulars of the disinfection work during the year 1937 :— Premises disinfected after :— Diphtheria 149 Measles 523 Vermin and Scabies 309 Scarlet Fever 142 Tuberculosis 123 By request 253 Whooping cough 124 Miscellaneous reasons 142 Bedding and mattresses were steam disinfected for the following institutions :— St. Mark's Hospital, St. Barnabas' Hospital, Royal London Ophthalmic Hospital. A total of 17,448 articles were disinfected last year. These were chiefly mattresses, pillows, bolsters, sheets, blankets, quilts and wearing apparel. Disinfection for Export.—The disinfecting station, in addition to the above, deals with a considerable amount of partly worn clothing, for forwarding agents, at a price agreed upon and prior to its exportation to foreign parts; 750,792 articles were disinfected last year under this heading and the fees charged amounted to £843. Cleansing Station. There is at present no Cleansing Station in the Borough belonging to the Council, but one is being incorporated in the new Health Centre. Arrangements for Adults.—The Borough Council have arrangements with the Borough Council of St. Pancras for the cleansing of adult cases at their Cleansing Station off the Pancras 101 Road, near the Town Hall. One shilling is paid in respect of each attendance. These arrangements are not altogether satisfactory partly owing to the fact that the Station is situated some distance from the Borough and also the times of attendances are awkward for working people. During last year 40 persons were referred to the Cleansing Station in St. Pancras for treatment. Persons Attending St. Pancras Cleansing Station for Seven Years, 1931 to 1937. Men Women Children 1931 10 4 0 1932 21 2 10 1933 22 12 2 1934 19 8 3 1935 7 11 2 1936 9 1 4 13 1937 18 17 5 Total 106 68 35 209 Of this total, 52 were sent for verminous conditions and 157 for scabies. School Children.—175 school children who were suffering from scabies were referred to the Department last year by the London County Council and the houses were visited. The necessary disinfection of the bedding and clothing was carried out by the Health Department. In addition the names of two children, stated to be in a verminous condition, were similarly forwarded to the Department and the homes visited. 102 Public Cleansing. The following particulars have been kindly supplied by the Cleansing and Markets Superintendent :— Every street in the Borough is swept daily and receives continuous attention from the orderly men who patrol the streets throughout the day. The litter is removed by covered motor containers, which perambulate the streets and collect from the orderlies. Sweeping gangs operate each night, together with a motor sweeper. The Utter at night is now also picked up by covered motor containers, horses and vans having been dispensed with. The cleansing operations are continuous throughout the week, including Sundays and Bank Holidays. Each night the market streets and the streets adjoining the City of London are washed by a washing machine with a capacity of 1,000 gallons. The debris from the street markets is cleared away nightly, and amounts roughly to 50 tons per week. The street gullies are cleared out by two gully-emptying machines : main roads, weekly ; other streets, approximately every other week. The street sweepings and silt from the gullies are conveyed by rail into the country, where the material is disposed of by controlled tipping. About 7,000 tons are disposed of annually in this manner. Over 4,325,000 gallons of water were used in street and gully cleansing. Seven hundred and twenty-five yards of shingle were used on the roads. The courts, alleys and passages in the Borough are periodically flushed. The gully-emptying machines, which are convertible into washing machines, are detailed for this work every week-day during the summer, and the frequency of the cleansing of each place ranges from eight to ten days. During the hot weather arrangements are made to accelerate the cleansing, some courts being done daily, the remainder at least once a week. Gullies in courts and alleys which are too small for the gully-emptying machine to enter are cleansed by manual labour at night. 103 List of courts for flushing:— Albion Place. Lambs Passage. Angel and Porter Court. Lambs Buildings. Arthur Passage. Lensden Place. Bayer Street. Locks Gardens. Basterfield Street. Lewins Court. Baynes Court. Macclesfield Place. Berkley Court. Masons Place. Briset Street. Medcalf Place. Blue Anchor Alley. Memel Court. Broad Arrow Court. Myddelton Passage. Bell Place. Nelson Passage. Brunswick Close (North). Nelson Place. Brunswick Close (South). Northwest Place. Chequer Alley. Northeast Place. Charlotte Place. Northampton Row. Compton Passage. Peters Lane. Chapel Place. Pickburn Place. Chequer Street. Pinks Row. Crawford Passage. Pentonville Road, 207-227. Cumberland Place. Rawstorne Place. Donegal Row. Roberts Place. Dufferin Avenue. Rose Passage. Eagle Court. Rosoman Mews. Emmens Buildings. Sally Place. Elizabeth Place. St. Johns Passage. Faulkners Alley. Shrewsbury Court. Flag Passage. Spa Cottages. Francis Court. Sidcup Place. Fryes Buildings. Union Place. Glasshouse Yard. Vineyard Gardens. Godson Street. Vineyard Walk. Goswell Terrace. Vineyard Mews. Hot Water Court. Withers Place. Howards Place. Warwick Yard. Haywards Place. Wardens Place. Ironmonger Passage. White Horse Alley. James Gardens. Wilmington Square Jerusalem Passage. Wynford Place. Kemp Place. Youngs Buildings. Killicks Cottages. There are 10 surface urinals which are flushed daily, including Sundays. 104 Removal of Refuse. The collection and disposal of house and trade refuse is performed by a private contractor. A new contract was entered into for a period of 10 years from 1st October, 1935, by which the house refuse is collected not less frequently than twice a week throughout the Borough at a cost to the Council of £27,480 per annum (less £1,000 per annum for rent of depot). The refuse is collected in receptacles and deposited in rear-loading canvascovered vans (two steps) in the streets, and thereafter conveyed by motor to Bull Stairs Wharf on the Thames for transmission to Essex for the reclamation of low-lying land. There is a daily collection of refuse in the main streets scheduled for this purpose; also on all the Council's housing estates (including Sunday). The house and trade refuse collected in 1937 amounted to 24,900 tons. In addition there were 6,088 tons of street sweepings and market garbage, and 741 tons of street gully and interceptor silt. General. Certain private streets, gullies, and interceptors are cleansed by the Council and charged to the owners. Public Baths, Wash-houses, and Swimming Pools. Under this heading there are two establishments in the Borough, viz., the Public Wash-house in Ironmonger Row, which contains 18 trough washing compartments, 5 washing machines, 3 hydro-extractors, etc., and 40 slipper baths for men and 40 for women, and the Swimming bath, Slipper baths and Wash-house Establishment at Merlin Street. The swimming pool at Merlin Street holds 120,000 gallons of water and is 100 feet long and 35 feet wide with a depth ranging from 3 feet to 7 feet 6 inches. The system of purification of the water and a full description of the Bath appeared in the Report for 1933. It is much appreciated by the inhabitants of Finsbury and is extremely well managed and supervised, and the water maintains a high state of purity ; 5 samples of the water for chemical and bacteriological examination were taken last year with satisfactory results. All reports stated that the water was very satisfactory for swimming purposes. 105 The number of persons using the swimming bath last year was 86,°44 and the slipper baths:—Merlin Street, 143,539 ; Ironmonger Row, 139,978. The number of women using the wash-tubs last year was as follows:— No. of Washers. Merlin Street Establishment 30,074 Ironmonger Row Establishment 25,248 There is also a swimming pool attached to the Northampton Institute in St. John Street, and eight samples of water analysed last year gave satisfactory results. A satisfactory system of purification has been installed. Extension of Ironmonger Row Baths. The extension of these baths mentioned in last year's report is in progress. Common Lodging Houses. There are two common lodging houses licensed in Finsbury as follows:— 57, White Lion Street, James Shuttleworth. 88, Old Street, Salvation Army. The number of visits made by the Sanitary Inspectors in 1937 was 116. The annual census of homeless persons in London was taken in the night of 21st February and arrangements were made for a census to be taken at the two common lodging houses in the Borough with the following result:— 88, Old Street: Licensed No. of Beds 348 men Beds occupied 290 „ No. known to be in receipt of public assistance nil. No. of beds paid for by charit able organisation 6 „ 57, White Lion Street : Licensed No. of Beds 92 „ Beds occupied 29 „ No. known to be in receipt of public assistance 4 „ No. of beds paid for by charitable organisations nil. 106 Nuisance from Pigeons. Public Health (London) Act, 1936, Section 121. Power is given by this section to destroy pigeons causing any nuisance, annoyance or damage, and last year the Council arranged for the destruction of those birds which were causing trouble in the vicinity of one of the elementary schools in the Borough, and the Town Hall. Altogether 215 pigeons were destroyed. Beetles in a Silk Warehouse. The aid of the Department was sought last year in connection with the infestation of the offices of a firm, engaged in the silk trade, with beetles. The office portion of the establishment only was affected, but the proprietors were anxious less they should be of a type which might infest the silk goods. The beetles were found to be the ordinary bacon beetle, Dermestes Lardarius, which attacks bacon and ham and many other dried products of an animal origin, skins, etc. It is quite a wellknown pest of silk, both in Italy and France, and in certain silk factories it has given some trouble, and it has also been fed on silk cocoons. The firm in question only dealt, however, in artificial silk, and no evidence was found that the beetle in question had been injurious to this product. Noise (London County Council (General Powers) Act, 1937. By Section 66 of this Act a noise nuisance shall be a nuisance which may be dealt with summarily under the Public Health (London) Act, 1936. It should be noted that no complaint to a court shall be effective unless it is made by not less than three persons, either householders or occupiers of premises within hearing of the noise nuisance which is the subject of the complaint. Further, in any proceedings, it is a good defence to show that the best practical means have been used to prevent or mitigate the nuisance, due regard being paid to the cost and other relevant circumstances. Six complaints of noise were received last year, but no action under the Act was taken. 107 SECTION D. Housing. Particulars of Inspections. L. Inspection of Dwelling-houses during the year :— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 2,394 (b) Number of inspections made for the purpose 2,634 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 748 (b) Number of inspections made for the purpose 915 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 0 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 1,503 2. Remedy of Defects during the year without Service of Formal Notices :— Number of defective dwelling-houses rendered fit in consequence of informal action by the local authority or their officers 38 3. Action under Statutory Powers during the year :— (a) Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936 :— (1) Number of dwelling-houses in respect of which notices were served requiring repairs 0 108 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners 0 (6) By local authority in default of owners 0 (6) Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 1,926 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 1,926 (b) By local authority in default of owners 0 (c) Proceedings under Sections 11 and 13 of the Housing Act, 1936:— (1) Number of dwelling-houses in respect of which Demolition Orders were made 0 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 0 (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 0 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit 0 4. Housing Acts—Overcrowding :— *(a) (1) Number of dwellings overcrowded at the end of the year 2,442* (2) Number of families dwelling therein 2,442* (3) Number of persons dwelling therein 12,337* * The information under this heading was ascertained within a reasonable degree of accuracy at the end of 1935, through the special survey undertaken under the Housing Act of that year ; no other figures with a greater degree of accuracy can be quoted for 1937. 109 (b) Number of new cases of overcrowding reported during the year 87 (c) (1) Number of cases of overcrowding relieved during the year 27* (2) Number of persons concerned in such cases 131* (d) Particulars of any cases in which dwelling-houses have again become overcrowded after the local authority have taken steps for the abatement of overcrowding 0 * In respect of Borough and County Council operations, so far as is ascertainable from the Council's records. Busaco Street Area.—This area comprises the following properties : Nos. 1-42 (consecutive), Busaco Street; Nos. 21-61 odd numbers), Cumming Street; Nos. 36-86 (even numbers), Southampton Street; Nos. 10-24 (even), Collier Street. The re-development of this area is proceeding. Sadler Street Area.—This area comprises the following properties : Spa Cottages, Nos. 7-19 (consecutive), Sadler Street, Nos. 2-34 (even), Lloyds Row, Nos. 2-10 (consecutive), with some houses (Nos. 1-9) in Rydon Crescent. This area when developed will provide working-class flats. Both these areas the Council decided to acquire by agreement on April 5th. Atnias Place Area.—The 29 flats erected on this area by the London County Council are now occupied. London County Council (Gee Street), Finsbury, Nos. 1, 2, 3 Clearance Orders, 1936. The enquiry in respect of these areas was held on May 31st and lasted one day. Your Medical Officer of Health gave supporting evidence. The Orders were confirmed with modifications on 5th September. Nos. 29, 31, 73, Gee Street, Nos. 37, 38, Bastwick Street, Nos. 21, 23, Central Street, were excluded. 110 London County Council (Baker's Row), Finsbury Order, 1936. London County Council (Baker's Row) Clearance Order, 1936. This area which comprises premises in the Borough of Holborn as well as in Finsbury, was referred to in the Report for last year (page 99). It is one of the worst larger areas in the Borough, and it is to be developed mainly for residential purposes (66 flats and seven lock-up shops will be provided). The enquiry with respect thereto was held on 21st June and lasted three days, and supporting evidence was given by the Medical Officer of Health. The Orders were confirmed with modifications on 26th November, 1937. Notice to County Council. Section 33 (a), Housing Act, 1936. Notice was given to the London County Council last year, in accordance with the provisions of the above section of the Housing Act, 1936, in respect of the following areas :— (а) Jay's Buildings Area, comprising Jay's Buildings, Rodney Residences, Penton Residences, Nos. 1-19 (odd), Risinghill Street, 61 & 63, Muriel Street, 32 & 34, Rodney Street. (b) Waterloo Street Area (an island site bounded by Lever Street, Waterloo Street, Galway Street, and Ironmonger Row). (c) Wynford Place Area (a site bounded by Wynford Road, Muriel Street and Cumming Street, the southern boundary of which is the extremity of Wynford Place). (d) Church Row Area (consisting of Nos. 1-6 inclusive, Church Row, and Nos. 7 & 9, Norman Street). (e) Pine Street Area (an island site bounded by Vineyard Walk, Vineyard Gardens, Northampton Road, and Pine Street). The two latter sites have now been demolished in connection with the extension of the Ironmonger Row baths and the erection of the new Health Centre respectively. Little Northampton Street Area.—The London County Council declared the Little Northampton Street Area to be a Clearance Area on 16th February. It is proposed that the area shall be dealt with by way of a Clearance Order and left in the hands of the owner to re-develop for industrial purposes. Re-housing accommodation will be provided in Islington and elsewhere in London. 111 It is hoped that a site of rather more than an acre bounded by Percival Street, Malta Street and Cyrus Street adjoining this area will be available by arrangement with the owner for the erection of working-class flats, of which approximately 78 could be provided on the site. Many of the houses are empty at the present time. Corporation Buildings were purchased from the Corporation of the City of London last year. The dwellings comprise nine separate blocks containing 181 tenements, 91 of three rooms, 89 of two rooms and one four-roomed tenement, and 23 shop premises (each comprising eight tenements). Gibson House and Gordon House, Pentonville Road, were also taken for a tenancy of three years, with an option to renew the tenancy for a like period. Underground Rooms.—The Council made Regulations last year for controlling the occupation of underground rooms. The Regulations are similar to the Model Regulations issued by the Ministry of Health. In the absence of alternative accommodation, it has not been found possible to enforce them rigidly, but steps are taken when the rooms are vacated. A number have been either reconditioned or closed voluntarily. The survey of the underground rooms has been continued, and the records of those in the Borough, including those over 7 ft. in height, are fairly complete. Individual Houses.—No. 3, Norman Street, an old, worn-out house was represented last year under the Housing Act, 1936. Lighting of Staircases of Tenement Buildings. Power is given by the Public Health (London) Act, 1936, to require the lighting of staircases of tenement buildings. Last year one notice was served in this matter, and the necessary lighting was provided. Housing Applications. 127 families last year were recommended for priority treatment by the Health Department. 112 The following summary gives particulars of the applications dealt with last year in the Town Clerk's Department:— No. of applications received for Borough Dwellings 469 No. of applications received for County Dwellings 98 No. of cases of hardship 225 No. of cases with no relative hardship 342 No. of applicants for accommodation in Finsbury removed from register: (a) Withdrawals 1 (6) Removed from recorded address 2 No. of applications transmitted on behalf of Borough Council to the London County Council with priority recommendation 127 No. of recommended applicants accommodated by L.C.C 46 No. of recommended applicants refused by L.C.C. 1 No. of direct applications to L.C.C. acceded to last year 78 No. of warning letters as to reletting sent by Health Department to landlords of premises vacated by tenants accommodated by the Borough Council or the L.C.C 31 113 SECTION E. Inspection and Supervision of Foods and Drugs Bye-laws for the Protection of Food.—The Bye-laws made by the London County Council for the protection of food, on 28th July, 1936, were confirmed by the Ministry of Health last year. They became operative on 1st January, 1937. Milkshops and Dairies. No legal proceedings were found to be necessary in respect of milk premises during the year. Applications for Registration.—Thirty-three applications for registration were considered during the year; five of them were in respect of a round only. The figures in respect of the registration of Milkshops are set out below:— No. of Purveyors of Milk on Register at end of 1936 186 No. of Purveyors removed from Register during the year 39 No. of Purveyors added to Register during the year 33 No. of Purveyors of Milk on Register at end of year 1937 180 632 visits of inspection were made and 10 notices served for cleansing and repairs to be carried out. Many improvements in the method of storage and handling of milk have been suggested, which the dairy occupiers have willingly put into operation. A large majority of milkshops in the Borough are now provided with one of the modern gas or electric refrigerators for storage purposes. The number of small purveyors of milk who do not sell milk other than in sealed bottles or other containers as delivered to them now numbers 54. 114 During the year the removal of a dairyman to adjoining premises enabled supervision, and suggestions to be made, during the conversion of the new premises into a dairy. The result is that this dairyman is now in a position to deal with milk in a way that was impossible at the premises vacated. Five dairies are now provided with means of sterilizing milk vessels and appliances by steam. In some dairies conditions do not permit the installation of a sterilizing plant. This difficulty has been overcome in two dairies, where all the milk for "bottle sales" is delivered to them already bottled by their wholesalers. Several more dairymen are negotiating for suitable steam sterilizing apparatus, and it is hoped more will be in use during the coming year. The Milk (Special Designations) Order, 1936. A full explanation of this Order was given in last year's Report (pages 110-113). By this Order the Council are authorised to grant licences to persons, other than producers, to sell milk under special designations. The following licences were granted last year :— (1) To use the designation " Tuberculin Tested " Milk 5 (2) To use the designation "Accredited" Milk 3 (3) To use the designation "Pasteurised Milk" 40 (4) Pasteurisation 1 (5) Supplementary licences to sell 7 Pasteurising Establishment.—There is one establishment in the Borough licensed for the pasteurising of milk. These premises have been under continuous supervision during the year, and a new pasteurisation apparatus has been installed. Certain improvements required to comply with the Order have been effected following a detailed report on the matter, and an interview of the proprietor by the Public Health Committee. 115 During the year 78 samples of designated pasteurised milk were procured from dealers specially licensed under the Order, for bacteriological examination. Twelve of these samples were found not to comply with the standard prescribed. In each case where an unsatisfactory result was obtained further investigations were made to trace and to eliminate as far as could be possible unsatisfactory methods in the processing and handling of the supply. This has led to various improvements being effected. Arrangements were made during the year for copies of the results of the examinations of milk supplied in other areas, but pasteurised in this Borough, and undertaken by other authorities to be furnished to this Department. This has enabled a better check to be maintained on the bacterial purity of all the milk pasteurised in the Borough. ICE-CREAM. There were 135 vendors of ice-cream on the Register at the end of the year. Two hundred and twenty-two visits of inspection were made and five notices served for cleansing and other purposes. The number of premises at which ice-cream is sold in wrapped portions of various values is now 56. This ice-cream is purchased by the retailer already wrapped by the manufacturers, and affords a very cleanly method of dealing in ice-cream. Many of the retailers in this Borough, still manufacturing their own ice-cream, have equipped themselves with electrical freezers. Compared with the old method of "ice-tub" freezing, these electrical freezers are a marked improvement. The "custard" or "cold-mix" (a method of making "custard" without having to boil the mixture) is placed into a container which is put into a totally enclosed apparatus, and without further handling is frozen into ice-cream. The working of these freezers is quite simple, and, as far as the user is concerned, there is no complicated mechanism to receive attention and the cleansing is an easy matter. 116 Fifteen samples of ice-cream were examined last year bacteriologically, and the results are summarised below :— (a) B. Coli not present in less than 1 c.c. Total bacterial count under 100,000 per c.c 4 (b) B. Coli not present in less than 1 c.c. Total bacterial count under 750,000 per c.c 1 (c) B. Coli not present in less than 1 c.c. Total bacterial count over 1,000,000 per c.c 3 (d) B. Coli not present in less than 1 /10 c.c. Total bacterial count under 1,000,000 per c.c 5 (e) B. Coli present in 1 /100 c.c. or less Total bacterial count under 1,000,000 per c.c 1 (/) B. Coli present in 1/100 c.c. or less Total bacterial count over 1,000,000 per c.c 1 When B. Coli is present in less than 1/10 c.c. some contamination from dirty utensils, receptacles or hands has almost certainly taken place. This organism should be absent altogether, but if not present in less than 1/10 c.c. it is probable that gross contamination has not occurred. It was noted that in eight specimens taken it was altogether absent. The total bacterial count is probably largely dependent on the care with which the material is kept as regards exposure to air and dust, No count over 750,000 can be regarded as at all satisfactory. There are no official standards for the cleanliness of ice-cream, and the classification given can only be used as a general guide. It is seen, however, that the bacterial purity of most of the samples taken is not satisfactory ; thus groups (a) and (b), five in all, may be regarded as generally good; those under (e) and (f) must be regarded as definitely bad. A warning was sent to those dealers whose samples proved unsatisfactory, and special visits were paid to the premises of those concerned. A special leaflet giving advice as to cleanliness, etc., has been prepared for distribution to all those dealing in this commodity. 117 Cowhouses.—There are no cowhouses in the Borough. Provision of Milk for School Children. As a result of the Scheme by the Milk Marketing Board made under Section II (i) of the Milk Act, 1934, milk was made available to the school children in the Borough (as from 1st October, 1934) at ½d. per one-third of a pint instead of a 1d. as hitherto. No milk is accepted for rebate unless the source and quality of the supply has been approved by the County Medical Officer after consultation with the Medical Officer of Health of the local sanitary district. It has been generally agreed in London that the only milk to be approved by the Metropolitan Medical Officers of Health should be pasteurised, milk sold and labelled as such. Samples of the milk delivered to the schools is taken regularly and sent for analysis to the public analyst (under the Food anc Drugs (Adulteration) Act) and the results are shown below. Schools at which Samples taken. No. of Samples. Result. Amwell Street 3 Genuine 3. Bath Street 1 „ 1. Bowling Green Lane 3 „ 3. Central Street 3 „3. Chequer Street 1 „1. Compton Street 4 „4. Hugh Myddelton 4 „4. Moreland Street 5 „5. Risinghill Street 2 „2. St. Joseph's 1 „1. St. Luke's 6 „6. St. Mark's 2 „ 2. SS. Peter and Paul 2 „ 2. Vernon Square 2 „ 2. White Lion Street 2 „ 2. Winchester Street 3 „ 3. Forty-five samples were bacteriologically examined. Of these, 34 were within the limit of 100,000 bacteria per millilitre. Thirty-one of these contained less than 50,000 per m.l., and of these 31, 17 contained less than 20,000 per m.l. 118 Of the 11 samples over standard, three contained less than 200,000 bacteria per m.l. It will be seen that all the samples except 11 complied with the requisite standard. Five samples, however, showed the presence of B. Coli in 1/10 c.c. Five samples in 1/100 c.c. and four in 1/1000 c.c. In each case of non-compliance with standard a warning letter was sent to the supplier. Meat and Other Foods. The work of meat inspection continues to be carried out by Mr. Penman, who is assisted generally by Mr. Barber. Meat Inspector's Office.—The Meat Inspector's Office was removed to No. 28, Cowcross Street, last year; an inclusive rate of £40 per annum is paid (except charges for gas and electricity). There is a considerable number of wholesale meat and offal shops and other food premises in the Borough, and the two inspectors are kept fully employed. Regular inspection of the butcher's shops and market streets is carried out by Mr. Penman. Summary of foodstuffs seized by or surrendered to the meat inspector during 1937 :— Tons. Cwts. Qrs. Lbs. Diseased Meat 53 7 2 24 Diseased Offals 13 6 1 4 Decomposed, etc., Meat 135 2 3 19 Decomposed, etc., Offals 58 8 2 7 260 5 1 26 Unsound Bacon released for Soap Boiling 30 6 2 22 Totals, 1936 290 12 0 20 Imported Mutton and Lamb (Caseous Lymphadenitis) :— Carcases of Mutton 108 Carcases of Lamb 26 Pieces of Mutton and Lamb 28 119 The annual amount of meat and offal seized and surrendered by the Meat Inspector in Finsbury from 1927 to 1937 has been as follows:— Year. Diseased Meat. Tons. Diseased Offal. Tons. Decomposed Meat. Tons. Decomposed Offal. Tons. Total. Tons. 1927 23 31 40 48 142 1928 104 40 26 29 199 1929 122 44 53 38 257 1930 70 31 57 22 180 1931 41 42 84 26 193 1932 57½ 58½ 138½ 106½ 360½ 1933 50½ 38½ 147½ 56½ 293 1934 58 25 100 66 249 1935 74 24 102 54 254 1936 61 21½ 79½ 49 211 1937 53½ 13½ 165 58½ 290½ In addition to meat and offal, large quantities of diseased and decomposed poultry, game and rabbits, unsound tinned foods, butter, cheese, eggs, fish, fruit and vegetables are annually seized by or surrendered to the Meat Inspector. Disposal of Condemned Meat. The condemned meat and offals are collected daily by the Smithfield Animal Products, Stanwell, Staines, Middlesex, and taken to their works at Court Farm, Stanwell. The site is an open one of some 34 acres, and is excellently conducted without any nuisance. Bone meal, meat meal, meat and bone meal, and tallow is manufactured from the materials transported to the works. These products are used for soaps, candles, fertilisers, and pig and poultry food. " Ticks " in Veal Chop.—On 2nd March, 1937, the Meat Inspector was handed by a firm of wholesale butchers in the Borough a few very small structures which had the appearance of congealed blood with the statement that this firm's customer, i.e., a West End hotel, had returned those to the Finsbury firm and stated that a diner had extracted those structures from the sub-cutaneous tissue of a veal chop, and complained that he had been given a veal chop containing " tick " eggs. 120 Examination of those structures under a hand glass showed that they had the appearance of haemo-lymph glands which are normal bodily tissues. This first impression was afterwards supported on microscopical examination carried out by the Clinical Research Association, Ltd. The bovine " tick," it is interesting to note, is a parasite of hot arid climates. This insect injects smaller parasites directly into the blood stream of oxen and gives rise to " Texas fever," as it is called, or " Redwater." It is not a parasite which is known in this country, and further enquiries showed that this diner was a gentleman with a good deal of experience of Eastern countries, where this disease is quite prevalent. The Meat Inspector observed during the year that certain imported frozen lamb's livers packed in tin pails were of a vivid red colour. A scraping from the surface of one of these coloured livers was submitted for analysis. The Public Analyst reports that this red colouring matter consists of an organic dye known as eosin. Eosin is not prohibited by the Preservative Regulations, and it is permitted both in France and the United States of America as a food colouring. The appearance of such coloured livers is by no means pleasing to many people. The object of colouring foodstuffs is normally that of endeavouring to present a more pleasing appearance to the buyer. Here it is probable that because the surface livers in these pails are apt to become discoloured through exposure in the refrigerating chambers, the colouring is added as a further coating. Macaroni affected with Weevils.—A complaint was made that some macaroni bought in a shop in the Borough showed, when placed into water, that it was infected with reddish structures which appeared to be worms or insects. When placed into water and allowed to stand, it was found that several minute weevils made their appearance on the surface of the water. They were specimens of the grain weevil, Balandra granaria, which were no doubt contained in the flour from which the macaroni was manufactured. 121 The wholesalers were communicated with, and stated that it was their practice, when such infestation was recognised, to turn over their stocks for pig food. Arrangements were made for the destruction of two boxes of 56 lbs. and one lot of 30 lbs. which remained on the retailer's premises. English New-laid Eggs.—A complaint was made last year that foreign eggs were being sold as English new-laid eggs in one of the market streets of the Borough. Investigations were made and it was found that the bulk of the eggs on sale were imported Lithuanian eggs and stamped as such, as required. A small quantity were unstamped and English eggs. It appears that the stallholder had been utilising old cardboard cartons branded " English New-laid Eggs " as stock boxes for displaying the eggs on sale. There was no intention to represent the Lithuanian as English new-laid eggs as they were clearly branded and easily visible to any purchaser, although displayed in the cartons. To avoid any confusion, instructions were given to obliterate the " English New-laid Eggs " on the cartons. The term " new laid " is one which is much misused. Formerly when the Sale of Food Order, 1921, was in force the term " new laid " implied an English egg, but now the term has come to be applied to almost any kind of egg, and what constitutes a new-laid egg has never been defined by law. Unsound Dates.—Information was received from the Medical Officer of Health, Port of London, that 34 boxes of dates had been detained as unfit for human consumption at the South-West India Docks. The dates were consigned to an address in the Borough and on arrival, notice of which had been given, the Inspector visited the premises and arranged for their disposal by the firm for purposes other than human consumption. They were sent to the firm's farm in the country and used for pig's food. 122 Rubber in Liquorice Allsorts—A bag of liquorice allsorts was brought to the Department last year and attention drawn to the presence therein of a rubber cutting which resembled to a remarkable degree at first sight a piece of liquorice such as is found in these sweets. It was ascertained that the consignment of sweets had been obtained from a reputable firm, and arrangements were made for their return to the wholesaler's factory, where they were sorted out and freed from any foreign matter. The rubber appeared to have been introduced from a machine on which the sweets were cut, and steps were taken to prevent the recurrence. Merchandise Marks Act, 1926. Orders in Council under this Act make the exposure for or act of sale illegal in the case of specified imported food unless the food is marked with an " Indication of origin " which may be the name of the country of origin or the word " Empire " or " Foreign " as the case may be. The following is a list of Orders which have been made under this Act:— The Merchandise Marks (Imported Goods) No. 3 Order, 1928 ... Honey, Fresh Apples. The Merchandise Marks (Imported Goods) No. 5 Order, 1928 Currants, Sultanas, Raisins, Eggs in shell, Dried Eggs, Oat Products. The Merchandise Marks (Imported Goods) No. 4 Order, 1929 Raw Tomatoes. The Merchandise Marks (Imported Goods) No. 5 Order, 1930 Malt Products. The Merchandise Marks (Imported Goods) No. 8 Order, 1931 Salmon and Trout. The Merchandise Marks (Imported Goods) No. 1 Order, 1932 Butter. The Merchandise Marks (Imported Goods) No. 3 Order, 1934 Bacon and Ham. The Merchandise Marks (Imported Goods) No. 5 Order, 1934 Dead Poultry. 123 The Merchandise Marks (Imported Goods) No. 6 Order, 1934 Maize Starch (including Maize starch cornflour). The Merchandise Marks (Imported Goods) No. 7 Order, 1934, and Amendment Order, 1936 Chilled Beef, Frozen Mutton, Frozen Lamb, Frozen Pork, Boneless Beef, Boneless Veal, Salted Beef, Salted Pork, Edible Offals, and Frozen Beef and Veal. The Merchandise Marks (Imported Goods) No. 4 Order, 1935 Prepacked Salt. Agricultural Produce (Grading and Marking) Acts 1928 and 1931. These Acts and Orders made thereunder specify grades under which various specified agricultural and horticultural produce sold under those grades shall be a guarantee that the respective foodstuffs are the produce of England and Wales and comply with certain standards. The following is a list of the products as to which Regulations were in force on 31st December, 1935 :— Date of Regulations. Produce. 1929 Potatoes. 1930 Strawberries; Cherries. 1931 Beef. 1932 Cider. 1933 Gooseberries; Loganberries; Raspberries; Red Currants; Cheshire Cheese; Pears. 1934 Cauliflowers and Broccoli; Asparagus; Leeks; Radishes; Red Beet; Cabbage Greens and Cabbages; Spring Onions; Carrots; Horse-radish; Kidney and Runner Beans; Forced Rhubarb; Dressed Poultry; Celery; Apples; Pears; Jam; Canned Fruits; Honey; Natural Rhubarb; Stilton Cheese. 124 1935 Creamery Butter; Globe Artichokes; Jerusalem Artichokes; Broad Beans; Purple Sprouting Broccoli; Red Cabbage; Savoy Cabbage; Witloof Chicory; Scotch Kale ; Mustard and Cress; Green Peas; Sage; Table Swedes; Thyme; Celery; Endive; Batavian Endive; Cabbage Lettuce; Cos Lettuce; Marrows; Mint; Parsley; Seakale; Spinach; Brussels Sprouts; Table Turnips; Perry; Canned Fruits (Amendment); Bottled Fruits; Bottled Vegetables; Caerphilly Cheese; Apples; Dressed Poultry; Cheddar Cheese; Glasshousegrown Tomatoes and Cucumbers; Blackcurrants; Hot-house grapes. 1936 Cream Cheese; Malt Extract and Malt Flour; Eggs- 1937 Eggs (Amendment Regns.) ; Derby Cheese ; Plums; Wheat Flour and Wheat Flakes; Fruit Products; Lancashire Cheese; Canned Vegetables; Wensleydale Cheese; Leicester Cheese. Certification of Articles of Food for Export. The Medical Officer of Health has been nominated by the Ministry of Health for the purposes of certifying foods and food products exported to foreign parts. Dr. C. O. S. Blyth Brooke, Tuberculosis Officer and Deputy Medical Officer of Health, with the approval of the Ministry of Health, has been designated to act as Certifying Officer in connection with the export of meat food products to the United States of America and Canada during the absence of the Medical Officer of Health. These products are usually Bovril, sides of bacon, or meat essence. The number of certificates issued in 1937 was 347. Most of these were for Australia. A few were issued for the United States, Canada, France, Italy, Finland, the Philippine Islands, Morocco, Chechoslovakia, Jersey, Demerara, and Denmark. 125 Food Poisoning. Food poisoning has been notifiable since 12th July, 1932, under the London County Council (General Powers) Act, 1932. Since October it is notifiable under the Public Health (London) Act, 1936, Section 182. During the year 101 cases were notified. 1. Outbreak due to B. enteritidis Gaertner. The following is an account of an outbreak of food poisoning due to the infection of gammon, corned beef and breakfast sausage with one of the members of the Salmonella group of food poisoning organisms, viz., B. enteritidis Gaertner. It was impossible to prove with any certainty the precise path of infection. The B. enteritidis Gaertner was isolated from four of the staff of the shop concerned, 23 of those attacked, and from the suspected food on the retailer's premises. Persons Affected.—132 persons (in 70 households) were affected by the outbreak, 82 of whom resided in the Metropolitan Borough of Finsbury, 40 in the Metropolitan Borough of St. Pancras, eight in Islington, one in Bethnal Green, and one in Holborn. Nineteen persons were admitted to hospital, either general hospitals or London County Council hospitals. Their ages ranged from 5 years to 79 years. Eleven children under 15 years of age were notified. A number of persons were ascertained to have partaken of the suspected food without ill effects. Deaths.—Three deaths were recorded, two being in Finsbury and one in St. Pancras—a blind man of 73 years, and two women of 54 and 43 years of age respectively. The B. enteritidis Gaertner was isolated from the stools in each case, but in one the partaking of the suspected food could not be proved. Symptoms and Incubation Period.—The symptoms were of the usual type, viz., gastro-intestinal irritation and inflammation of various degrees of severity; nausea, vomiting, diarrhoea and abdominal pain were prominent symptoms. Vomiting in some cases was delayed for several hours, and fever in some cases was high and in others moderate. Some of those attacked had only mild symptoms, and medical attention was not sought. The incubation period ranged from 7-38 hours, 12-24 hours being the most common. The long incubation period in most 126 cases suggested that the symptoms were due, not to a toxic infection, but to living organisms. During the outbreak, 33 cases of suspected food poisoning in 27 households were notified, the practitioners in the neighbourhood having been warned of the outbreak. On enquiry, however, these cases were found to have no connection with the outbreak under investigation or with one another. Some appeared to be ordinary gastric upsets occurring in susceptible persons, but in one instance the B. aertrycke was isolated from the stools. In ordinary times many of these cases would never have been brought to the notice of the Health Department. At the beginning of the outbreak it was found that the sufferers, including four St. Pancras cases, had all obtained ham (on Saturday, 21st August, or Monday, 23rd August) from a provision shop in the Metropolitan Borough of Finsbury, and attention was immediately directed thereto. Detailed investigations and enquiries were made. Premises.—The shop, a grocer's and provision store, consisted of a ground floor front room (converted into a shop), communicating directly with the ground floor back room (shop parlour) and a back basement. In the back room there was a gas stove used for cooking light meals for the staff; this room could also be approached from a door in the passage. The only water supply for the use of the shop was by means of a tap in the yard ; there was no sink in the house. The water closet was situated in the ground floor back passage, and was used by the occupants of the top floors. A water supply was provided on the landing for the use of the tenants upstairs. The back basement was entirely separated from the front basement, the side door being closed, and was approached from the shop by means of a trap door and wooden stairs. It was used for storage purposes—eggs, tinned goods, cheese, tea chests and the like, no unwrapped food being kept in this part of the shop. A portion of the back yard was used for the storage of old tins and boxes connected with the business. The front basement room was occupied in conjunction with rooms on the upper floors, the access to which was by means of a separate front door. No undue presence of flies was noted on the premises. 127 Staff.—The staff of the shop consisted of Mr. A., who owns the business, his son Mr. A. Junior, and an errand boy B. Mr. A. had occupied and carried on business from this shop as a grocer and provision merchant since 1923, and had been cooking gammons since that year. Mr. A., his son and the errand boy resided outside the Borough. Mr. A.'s family consisted of himself, his wife, Mr. A. Junior, a son living away from home, and a daughter living at home, but working elsewhere in London. Mrs. A. and the daughter did not work in the shop. Mr. A. and the son handled the food in the shop, and the possibility of the errand boy doing so could not be excluded, although his ordinary duties were delivering, sweeping the shop and helping to serve occasionally if there was a rush of business. Mr. A. had been working continuously at the shop until Saturday, 31st July, when he went on holiday for a fortnight with his daughter, staying with his sister in Wales. He returned on 16th August. During this time Mrs. A. was at the shop from 11.30 a.m. until 5 p.m. to prepare light meals for her son and the errand boy, who worked in the shop during Mr. A.'s absence. Mrs. A. took very little part in the business during this time. The errand boy was at work in the shop until noon on Saturday, 21st August, when he went on holiday for a week. Mr. A., his family and the errand boy were stated to be in perfect health, and no history of any illness or suspicious passing indisposition could be elicited. The staff were stated to be very particular in their habits. No history of any illness was obtained from Mr. A. during his absence on holiday or in his sister's household in Wales. The tenants (two families) on the upper floors took no part in the business, but occasionally might get supplies from the shop, approaching it by means of the side door in the passage into the shop parlour. One family (man and wife and daughter 9 years of age) occupied the front basement and the first floor rooms, and the other (man and wife and son 11 years of age) the second floor rooms ; the top floor rooms were unoccupied. No history of any suspicious illness was obtained from these families. 128 Rats and Mice.—It was stated by Mr. A. that no trouble had been experienced with rats or mice, two cats having access to the shop and back basement. No rats had ever been seen, and no mice for the last four years. No poison had been kept on the premises since that time, when some was used for mice. No droppings of these animals could be found. The tenant of the front basement stated that she got two cats six months ago as she had been troubled with mice, but since then she had never seen any mice. Suspected Food.—As ham was under suspicion, it was ascertained that Mr. A. had had delivered to his shop two gammons on 12th August, and two on 16th August, from a firm in the East End of London. The Health Department concerned was immediately informed with a view to ascertaining possible contamination at the wholesalers. The gammons were of Danish origin, being imported " green " by the wholesalers and smoked by them, and cooked by Mr. A. on his premises on Friday, 20th August, and on sale in the shop as from Saturday, 21st August. The bacon in the shop was also obtained from the same wholesalers. The cooking of the gammons was carried out in the back basement room, which has a stone floor with no drainage and walls of unsurfaced brick. The area is small, being the length of the window, and the room was badly lighted, the ceiling, which consisted of unsealed floor joists, being slightly above the yard level. It was covered with cobwebs. Gas was provided for artificial lighting. The room was found to be full of crates of tinned goods, tea chests and such articles, no unwrapped food being found. Shelves were fixed on some of the walls. The copper used for cooking the gammons was made of enamelled iron, heated by gas and placed close to the wall; a wooden cover was provided. It would be impossible under these conditions to keep the basement in a satisfactory condition for the preparation of food. All the cooking was carried out by Mr. A. himself, gammons being the only articles dealt with. Mr. A.'s premises were not registered as required by the London County Council (General Powers) Act, 1932 (now by the Public Health (London) Act, 1936). 129 The gammons, as they arrived from the wholesaler, were hung up in the shop for at least two days to harden, and when required for cooking were taken down from their hooks to the basement room, placed in the copper, covered with cold water, the gas ring under the copper lighted, and the water brought to the boil; the gas was then regulated so as to keep the hams on the simmer, which was continued for twelve hours. The gas was then turned out and the hams allowed to remain in the water in the copper with the lid on until cold, when they were removed from the copper and taken immediately into the shop, two being placed in the refrigerator under the counter, one on a small marble shelf at the back of the counter, and the remaining one skinned and sales commenced from it. No ham is skinned until just before it is required for sale. Mr. A.'s ham sales average four per week, but occasionally six are disposed of, and on a few occasions eight. The gammons in question were hanging in the shop, two from 12th August and two from 16th August until 20th August, when they were cooked as described above ; they remained in the copper with the lid on on the night of 20th August until the next mornings when one was put on sale. Mr. A. stated that it was his regular custom to taste the ham after cooking to test the quality. All the four cooked gammons had been sold when the shop was first visited, with the exception of the remains of one weighing approximately 5 lbs., which was being sold at the time. This appeared perfectly good, and none of those attacked had noticed anything wrong with the food when eaten. Four uncooked gammons were also hanging up in the shop, two of which were delivered on 18th August and two on 23rd August. The remains of this cooked gammon were taken off sale at once and a sample taken for bacteriological examination ; a sample was also taken from the exterior of one of the four uncooked gammons, which were also obtained from the same wholesaler. Mr. A. was instructed to cease boiling hams on his premises. Permission was given to sell a tinned ham, which was on his premises, and which he kept for emergency use. Two had been obtained from the same wholesaler on 9th August, one having been sold soon after delivery. 130 Notifications of suspected food poisoning from other practitioners were received during the day, and other suspicious cases who had not consulted a medical practitioner were found by the Sampling Officer in the houses of notified cases; a history of having eaten ham from the same source was obtained. No portions of the suspected food actually consumed by the sufferers were available for examination, except a piece of ham in one St. Pancras case which was submitted for examination. The report stated that no organism of the food-poisoning group was isolated, and no other abnormal coliform organisms isolated. On culture there was a very marked growth of staphhylococci, 10 per cent, of which were S. aureus, and 90 per cent. S. albus. A growth of non-haemolytic streptococci mitis was obtained. It is known, however, that such food may be contaminated in one part and not in another, and this would explain the fact that a number of persons in affected households were not taken ill, although they had partaken of the suspected food. The next day, 25th August, 25 further Finsbury and one St. Pancras cases were notified, and the Ministry of Health informed of the circumstances of the outbreak. The death of one case residing in St. Pancras was reported. It was found that certain cases had only consumed corned beef from the same source, and no ham. The cooked gammon (taken from sale the previous day) and the uncooked gammon were reported as being infected with the B. enteritidis Gaertner. The uncooked gammon was accordingly taken from the shop. It appeared at this time that the knife used for cutting the cooked gammon had contaminated the corned beef, it being admitted that when a customer bought ham and corned beef the same knife might easily be used for the latter, and accordingly the knives in use were thoroughly washed in hot soap and water and soda as well as the counter and scales, and a slice taken from all articles of unwrapped food, such as corned beef, butter, breakfast sausage, cheese, and destroyed. The counter, scales and all washable parts were cleansed with soap and hot soda water. Samples of the remaining three uncooked gammons were taken and a piece from the interior of the first uncooked gammon, and of corned beef and breakfast sausage. 131 Specimens of feces of two patients were collected, and Mr. A. and his son were instructed to collect specimens of their stools in special containers provided to exclude the possibility of carrier infection. 26th August.—Thirteen further Finsbury and 15 St. Pancras cases were notified on this date. One case residing in Holborn was found by the Inspector. This person, a woman of 55 years, had taken a ham sandwich in the home of one of the Finsbury cases. In view of the gravity of the outbreak, all medical practitioners were notified. The death of a Finsbury case in hospital was reported. During the outbreak St. Pancras reported further cases arising from the same source. The results of the samples taken the previous day were as follows:— (a) Three uncooked gammons ... Negative so far. (b) Breakfast sausage Negative so far. (c) Corned beef S1. positive B. enteritidis Gaert- ner. (d) Two patients Positive B. enteritidis Gaertner. (e) Interior of uncooked gammon Negative so far. At this time it was considered that the cooke'd gammon had either been derived from a diseased animal or had been infected from some outside animal source, such as rats or mice, or contaminated meal used for dressing purposes. The corned beef on sale which had been cut was immediately taken off sale, together with 2 lbs. of cheese and 6 ozs. of breakfast sausage and destroyed. It will be noted that at this stage the same organisms had been isolated from the gammons, corned beef and two patients. Later on in the outbreak the same organism was isolated from several patients who had been admitted to hospital. All the knives used in the business, together with the coats worn by Mr. A. and his son, towels, etc., were taken to the Disinfecting Station, sterilised and returned to the shop the next day. The counter, scales and all washable parts of the shop were thoroughly washed with hot lysol solution. 132 The following specimens were submitted for bacteriological examination :— (a) Faeces—Mr. A. and Mr. A Junior. (b) Tin of corned beef opened and on sale (25th August, 1937). (c) A piece of corned beef taken from an unopened tin by the Food Inspector. (d) Breakfast sausage. On sale 26th August, 1937. (e) Butter (unwrapped). On sale 26th August, 1937. (/) Cheese (unwrapped). On sale 26th August, 1937. On this day I was informed that there had been no sale of corned beef, ham or breakfast sausage. A telephone message was received during the day that a woman of 32 years of age, living in Bethnal Green, was suffering from food poisoning, the suspected food being corned beef obtained from Mr. A. in Finsbury. Later (30th August, 1937) it was reported that B. enteritidis Gaertner had been isolated from this person's stools. 21th August.—Thirteen Finsbury and four St. Pancras cases were notified on this date, and news was received from Islington that eight cases of food poisoning in that Borough had been notified, the suspected food in each case being ham or corned beef from Mr. A. in Finsbury. The results of the bacteriological examinations received were as follows :— (a) Three uncooked gammons Positive, B. enteritidis Gaertner. (b) Corned beef (taken on 25th August, 1937) Positive, B. enteritidis Gaertner. (c) Breakfast sausage (taken on 25th August, 1937) Posirive, B. enteritidis Gaertner. (d) Interior of uncooked gammon Negative. (e) Tin of corned beef opened and on sale 25th August, 1937 Negative so far. (/) Corned beef taken from an unopened tin Negative so far. (g) Breakfast sausage (on sale 26th August, 1937) Negative so far. (h) Butter and cheese Negative so far. (t) Faeces—Mr. A. Positive, B. enteritidis Gaertner. (j) Faeces—Mr. A. Junior Negative so far. 133 It should be noted that for the first time the breakfast sausage was found to be infected, and that a piece taken from the interior of a positive gammon was definitely negative. This would appear to have indicated a surface contamination of the gammon. It was now apparent that the shop was heavily infected, and Mr. A. appeared to be a carrier, although no history of any illness in the family had been obtained in spite of close questioning. Immediate action was imperative, and the Deputy Town Clerk (in the absence of the Town Clerk) was consulted as to the legal position. Public Health (London) Act, 1936, Section 204.—By this section a person who knows himself to be suffering from a dangerous infectious disease shall not engage in any occupation connected with food, or carry on any trade or business in such a manner as to be likely to spread the disease, and if he should do so, he shall be liable to a fine not exceeding £10. Public Health (Infectious Diseases) Regulations, 1927.—By these regulations power is given to prohibit a carrier of enteric lever or dysentery infection from engaging in the preparation or handling of food or drink for human consumption. London County Council By-Laws for the Protection of Food.— By these By-Laws the occupier of any premises shall take such steps as may be reasonably necessary to prevent risk of contamination of food on the premises. Penalties are provided for offenders. It appeared that Section 204 would not apply to an apparent carrier of a food poisoning organism, and that there was great doubt whether the Public Health (Infectious Diseases) Regulations, 1927, applied in view of the definition of Dysentery in Article 1. It was considered that the By-Laws of the London County Council might be applied in this particular case. No power existed to close the shop. Mr. A. was accordingly instructed to cease forthwith handling any food in the shop until further instructions, and a warning letter was sent by the Deputy Town Clerk to his home address the same day, pointing out that if he should engage in any way in the handling or sale of food to the public he might be liable to 134 certain prescribed penalties, and that if he did so engage the Council would immediately take action under the relevant statutes. Three negative examinations at intervals of two days would be required before he would be allowed to handle food in the shop. Mr. A. returned home and Mr. A. Junior and Mrs. A. were interviewed, and the following action taken :— (i) The white coats worn by the staff, knives and other utensils liable to be contaminated were removed to the Disinfecting Station and sterilised. (ii) The following food was removed from the shop : the three uncooked gammons, 34 lbs. of bacon, 6 lbs. of breakfast sausage, 14 lbs. of unwrapped cheese, a cooked tinned ham (permission to put on sale having been given on 24th inst.), 12 lbs. of corned beef, 6 lbs. of block butter, 10 lbs. of lard, which had been packed in the shop, and 4 lbs. of candied peel. These were considered to be the goods most liable to have been contaminated either by the hands or knives. (iii) The counters, shelves were thoroughly washed down with hot, strong lysol solution. Mr. A. Junior was instructed not to open any tins of corned beef, or sell any more ham, corned beef or unwrapped articles of food, such as butter, cheese and breakfast sausage. The gravity of the situation was explained to the family and instructions given for the collection of samples of faeces from Mr. A., Mr. A. Junior and Mrs. A., who had elected to help her son in carrying on the business during her husband's absence. 28th August.—Six further Finsbury and one St. Pancras cases were notified on this day arising from sales on either Monday, Tuesday or Wednesday, 23rd, 24th and 25th August respectively. The results of the bacteriological examinations received were :— (a) Tin of corned beef opened and on sale 25th August, 1937 Positive, B. enteritidis Gaertner. (b) Corned beef taken from an unopened tin Negative (c) Breakfast sausage on sale, 26th August, 1937 Positive, B. enteritidis Gaertner. (d) Butter and cheese Negative. (e) Mr. A. Junior Negative. 135 Samples of the faeces of Mr. A., Mr. A. Junior and Mrs. A. were submitted for bacteriological examination. The errand boy was expected to return to the shop on Monday, 30th August, but instructions were given that he was not to return until sanctioned, and arrangements were made for a specimen of his faeces to be collected and given to the Sampling Officer on 30th August. 29th August.—Thirteen further Finsbury notifications were received on Sunday, 29th August. It was ascertained that in all the symptoms had arisen from food eaten from Mr. A.'s shop and obtained either on Saturday, 21st August, Monday, 23rd August, Tuesday, 24th August, or Wednesday, 25th August. Some had no medical attendant. 30th August.—Nine further Finsbury and 12 St. Pancras cases were notified, but none were found to have been infected after Wednesday, 25th August. The death in hospital of a second Finsbury resident was reported, the stools and vomit containing B. enteritidis Gaertner. This person resided in the house of one of the sufferers as a lodger, and was stated not to have any of the ham, which had only been given to the landlady's husband, who was affected. The following results of the bacteriological examinations were received:— (i) Mr. A. Junior Positive, B. enteritidis Gaertner. (ii) Mr. A. (2nd specimen) Positive, B. enteritidis Gaertner. (iii) Mrs. A Negative. The specimen of faeces from the errand boy was submitted for bacteriological examination. Mr. A. Junior was immediately instructed to cease handling the food, and no sales were effected after 11.30 a.m., when Mr. A. Junior was found to be a carrier. Action taken:— (i) The following goods were removed from the shop as being possibly contaminated, viz., all biscuits in tins which had been opened and loose goods such as currants, sultanas, mixed fruit, shredded suet, nutmegs, sugar in packets, which had been packed in the shop, custard powder, icing sugar, desiccated cocoanut, etc. In fact, nothing not requiring boiling, and no unwrapped foods were left in the shop. 130 (ii) Disinfection of the premises, and sterilisation of all knives, coats, towels, etc., was carried out as previously. (iii) Only pre-wrapped goods were to be sold. It was suggested to Mr. A. Junior that it might be advisable in the interests of the shop for it to be closed temporarily, but this suggestion was not acted upon. He was told that he would not take any further part in the handling of food in the shop until three negative examinations of his faeces at intervals of two days had been obtained. He suggested that his mother could come down the next day, and the errand boy after the result of the bacteriological examination was known, and that his sister could come in the evening after she had finished her ordinary work at 5.30 p.m. As Mrs. A. had a negative result, the preliminary result of the errand boy would be known by 11 a.m., and there was no evidence of the girl being infected, this course was assented to. Arrangements were made for the collection of a second specimen of faeces from Mrs. A. and Miss A. It should be noted that on this date the first definite suggestion as to closing the shop was made. Mr. A. and family up till this time had agreed to all the action which I had taken in dealing with the outbreak, and has assisted in every possible way. (iv) A letter in similar terms as that to Mr. A. was sent by the Deputy Town Clerk to Mr. A. Junior. He was informed that three negative examinations would be required in his case as well. 31s/ August.—No cases connected with the outbreak were reported on this day. The shop had been opened at 9.30 a.m. and Mrs. A. only was in attendance in the shop; a few sales of pre-wrapped articles had taken place. The second specimen of faeces from Mrs. A. and Miss A. (1st sample) were sent for bacteriological examination. The following result of the bacteriological examination of the faeces of the errand boy was received: Positive, B. enteritidis Gaertner. Mrs. A. was at once instructed not to allow the errand boy to enter the shop, and the information was sent to the Acting 137 Medical Officer of Health of Holbom, where the boy resided. A warning letter was sent by the Deputy Town Clerk to the errand boy. Mrs. A. was informed that the boy would not be allowed to return until three negative results had been obtained, as in the case of her husband and son, both of whom had been admitted to an Isolation Hospital. Miss A. arrived at the shop during the lunch hour, and it was again suggested that it might be advisable to close the shop for the present. Permission was given for Mrs. A. and Miss A. to carry on the business, but Miss A. decided not to do this until the result of the examination of her faeces was known. Mrs. A. continued serving the customers with pre-wrapped goods, until the shop closed in the evening. 1st September.—No cases connected with the outbreak were reported. The second specimen of Mrs. A.'s faeces was reported as Positive, B. enteritidis Gaertner, and Miss A. (first specimen) Negative so far. Mrs. A. was immediately instructed to cease selling, and she decided under the circumstances to close the shop, which became effective at 12 noon. She was informed that three negative examinations of her faeces would be required, should she decide to help in the shop and handle food there at a later date. The shop and fittings and all drawers were thoroughly scrubbed with a hot, strong solution of lysol. The shop was closed from this date, and no further cases connected with the outbreak were notified. It was reported that Mrs. A. had been admitted to an Isolation Hospital. Summary. A report is submitted of an outbreak of food poisoning involving some 132 persons, of whom 82 were residents in the Metropolitan Borough of Finsbury. Three deaths were reported, giving a fatality rate of 2.3 per cent. The outbreak was due to one of the Salmonella group of food poisoning organisms, viz., B. enteritidis Gaertner, but the precise path of infection was not discovered. In 88 cases the illness was ascribed to ham, 34 to corned beef, 4 to breakfast sausage, 5 to either ham or corned beef, 138 and in 1 case the offending article of food was not proved. The source of the infection might have been from an animal. (i) The meat eaten may have been derived from an animal infected with the organism. (In this case it is assumed that the gammon was the first infected article of food.) (ii) The meat, originally sound, may have been infected with the organisms derived from animals (such as rats or mice) either suffering from the disease or acting as carriers, either at the place of origin, the wholesaler's, or Mr. A.'s premises. The infection, alternatively, might have been from a human source:— (i) A person suffering or recovering from the disease. (ii) A passive carrier. From the investigations made in this outbreak, it appeared that the outbreak was due to the gammon being infected with the B. enteritidis Gaertner, the breakfast sausage and corned beef being infected secondarily from infected knives or hands. It is impossible to say with any certainty by what means the gammon became specifically infected. If the original pig was diseased it would have been infected in its country of origin. On the other hand, if the meat was originally sound, it might have been infected in its country of origin, on the wholesaler's premises, in transit, or in Mr. A.'s shop. No evidence of this could be obtained. No rats had been found on the wholesaler's premises for some years ; mice had occasionally been found, but not in such numbers as suggested any undue infestation. The peameal used for dusting the bacon gave negative bacteriological findings. It appeared unlikely that the gammon was derived from a diseased animal, for if this had been the case one would have expected other outbreaks of food poisoning to have been reported in London or elsewhere from the distribution of the remainder of the infected pig. The fact that the interior of one uncooked gammon was found to be free from infection, and that all the uncooked gammons were found to be infected on the exterior, leads one to the conclusion that the infection of the gammons in question might have been a surface one. 139 The investigations made show that it was unlikely that infection from an animal source took place on the retailer's, Mr. A.'s, premises. It remains to consider the possibility of the infection originating from Mr. A. and his staff. The B. enteritidis Gaertner was isolated from the stools of Mr. A., his son, wife, and the errand boy. No history of any suspicious illness was obtained in these persons. Mr. A., who was the most intimately connected with the gammons in the first instance, would appear to be a carrier of the organism, not a common occurrence as far as is known. A Positive (1/40) agglutination reaction (trace 1/80) was obtained in this case. Mr. A. Junior, however, gave a negative agglutination reaction (1/20), which is not unknown in a carrier. Mrs. A. and the errand boy were not tested. If Mr. A. was the original source of infection, it is only reasonable to suppose that he had only recently become infected, as he had been boiling hams on the same premises for the last twelve years without any untoward results. It is known that a carrier may only excrete the pathogenic organisms intermittently, but even so it is inconceivable, if Mr. A. was a carrier of longstanding, that no infection of his food took place earlier. Mr. A. Junior and Mrs. A. might have been contact carriers, but it is difficult to explain the errand boy who is not one of the family ; possibly he was infected in the shop. It is possible that Mr. A. was himself infected from one of the gammons in question, assuming them to have been surface infected when they arrived at his shop. Alternatively Mr. A. may have recently become infected from an unknown source. It may be that Mr. A. became infected from one or other source on 19th or 20th August, but owing to his good state of health, having just returned from a holiday, and his practice of tasting the hams which he had cooked for the last twelve years or more, when he may have been receiving constant sub-infective doses of the bacillus, he suffered no recognisable ill-effects. It is suggested that at this time he was excreting the living bacilli in the stools, and owing to a lapse of cleanliness he further contaminated the gammon which was put on sale on the Saturday, 21st August ; the weather being favourable, rapid multiplication of the organisms took place and the gammon became heavily infected, and later other articles of food in the shop, leading to the explosive outbreak. 140 The bacteriological examinations of the faeces of Mr. and Mrs. A., his son and the errand boy were interesting in that they rapidly became negative, and would lead one to the conclusion that the infection (if any) was a mild, recent one without any symptoms. Bacteriological Examinations. Mr. A.— 26th August, 1937 Positive, B. enteritidis Gaertner. 28th August, 1937 Positive, B. enteritidis Gaertner. 1st September, 1937 Negative. 4th September, 1937 Negative. 7th September, 1937 Negative. Mr. A. Junior— 26th August, 1937 Negative. 28th August, 1937 Positive, B. enteritidis Gaertner. 1st September, 1937 Negative. 4th September, 1937 Negative. 7th September, 1937 Negative. Mrs. A.— 28th August, 1937 Negative. 31st August, 1937 Positive, B. enteritidis Gaertner. 4th September, 1937 Negative. 7th September, 1937 Negative. Errand Boy— 30th August, 1937 Positive, B. enteritidis Gaertner. 2nd September, 1937 Negative. 6th September, 1937 Negative. 9th September, 1937 Negative. These Negative findings obtained within such a short time of Positive results were similar to those obtained in the cases of three patients who rapidly became Negative after admission to hospital. There probably exist many more carriers of such pathogenic organisms than is now thought to be the case, and an investigation on these lines might reveal some illuminating results. The four Positive results obtained in this investigation must be very unusual. 141 The outbreak, however, cannot be ascribed with certainty to infection from a human source, although the possibility cannot be excluded. A number of those attacked were found to be engaged in the handling of food, and the necessary steps were taken to prevent contamination of the food handled. The shop remained closed from Wednesday, 1st September, until Saturday, 11th September, when it was re-opened by Mr. A., his son and the errand boy assisting as formerly. In conclusion, I would like to thank my staff, especially the Sampling Officer, the Ministry of Health, and the Deputy Town Clerk for their assistance in dealing with the outbreak. I have also to thank my colleagues in neighbouring Boroughs for the information which they placed at my disposal. 2. One girl of 19 years of age was notified as suffering from food poisoning during the outbreak mentioned above, but on investigation it was found that the case was not connected therewith. She had partaken of a sausage on a stick in a public-house in the Borough in company with two other persons who were unaffected. Her stools revealed the presence of B. aertrycke. No further cases from this source were traced. 3. One man of 27 years was notified from hospital as suffering from food poisoning, a few colonies of Newport's bacillus being isolated from the stools. Enquiries failed to reveal the source of infection. The patient had eaten the same food as other members of his family, who were unaffected. No meals had been taken in any cafe or restaurant. 4. Two persons were reported as suffering from abdominal pains and a rash on the chest and neck after partaking of some turkey and tongue paste bought in one of the market streets. Bacteriological examination of the paste was negative and the condition was thought to be urticarial in nature and not true food poisoning. 5. Three persons living outside the Borough were reported to be suffering from food poisoning following the consumption of a mince tart purchased in Finsbury. Examination of the tart, however, gave a completely negative result. 142 6. A man of 40 years was notified as suffering from food poisoning thought to be due to the consumption of pork pie ; he was admitted to hospital with acute vomiting and abdominal pain. Immediate enquiries were made, and it was found that the pork pie was obtained from a café in the Borough, and was part of a consignment from a firm in the Home Counties. None of the suspected pie was available for examination, but specimens of pies from the same consignment were examined with a negative result. No further cases arising from this source were reported. Subsequently I was informed by the hospital that the man was found to be suffering from acute intestinal obstruction, for which an operation, revealing an obturator hernia, was performed. The patient did not survive. 7. Six cases of suspected food poisoning were notified by one practitioner, who had seen all the patients in the course of two or three days. Investigations were made, but no common article of food was found, and in most of the households other persons in the families had taken the suspected food without ill effects. Mushrooms, steak and kidney pie, and jellied eels were blamed. The patients all recovered rapidly. A specimen of fasces from one patient was sent to the Pathological Laboratory, Ministry of Health, with negative results. Slaughter Houses. There is only one slaughter-house in the Borough, that owned by Mr. J. A. Mobbs, 14, Penton Street, in which sheep and lambs only are slaughtered; a total of 163 sheep and lambs were slaughtered in 1937. During the year 70 inspections were made by the Meat Inspector. The premises were maintained throughout in a clean and satisfactory condition. Slaughter of Animals Act 1933. Humane slaughtering by a mechanically operated instrument is made compulsory by this Act, but before this Act all animals were so slaughtered in the above premises. 143 Slaughtermen have also to be licensed and in connection with this, licenses were granted to Stephen George Tibby, 114, Barnsbury Road, N.l, John Henry James Mobbs, 54, Amwell Street, E.C.I, James Henry Mobbs, 14, Penton Street, N.l. Bakehouses. There are 33 bakehouses in use in the Borough, of which 22 are underground, and in 26 bakehouses machinery is used. The bakehouses were visited regularly during the year, 179 visits of inspection being made, and 27 notices were served for cleansing and other matters. During the year one bakehouse has been closed, and the oven was sealed off, and it is very improbable that the premises will again be used as a bakehouse. The Factories Act, 1937, which comes into force on 1st July, 1938, gives Local Authorities wider powers to deal with existing underground bakehouses. The Local Authority is required to examine every basement bakehouse during the first year, beginning at the date of the commencement of the Act (1st July, 1938), and in every fifth succeeding year after that year. After each of the examinations consideration shall be given as to whether, or not, the Local Authority continue to certify the use of a basement bakehouse as suitable. Under the new Act it will be illegal to use a basement bakehouse again, if it has not been so used for a period exceeding twelve months. Registration of Food Premises. Premises used for the purposes detailed below are required to be registered under the Public Health (London) Act, 1936, Section 187:— (a) the sale, or the manufacture for purposes of sale, of any commodity consisting of ice-cream, or any substance similar thereto, or the storage of any such commodity intended for sale. (b) the preparation or manufacture of sausages or potted, pressed, pickled or preserved meat, fish or other food intended for sale. 144 The following is a summary of the number of registered premises in the Borough at the end of year:— No. of Premises. Manufacture of ice cream 72 Storage and sale of ice cream 63 Fried Fish Shops 18 Butchers' Shops and stalls 108 Other premises, bacon smoking premises, etc., where food is cooked, preserved or pickled 73 Total number of premises 334 All the premises were regularly visited during the year. Food and Drugs (Adulteration) Act 1928. The number of official samples taken during 1937 was 600, of which the following is a summary:— Name of Article. Gen. Adult. Total Name of Article. Gen. Adult. Total Apricots 2 2 Paste (Fish) 2 2 Barley (Pearl) 6 — 6 Paste (Soup) 1 — 1 Beef (Corned) 12 — 12 Peas (Split) 4 — 4 Brawn 11 — 11 Peel (Candied) 4 — 4 Bread and Butter — 1 1 Plums (Oregon) 1 — 1 Butter 118 — 118 Powder (Lemonade) 3 — 3 Cheese 32 — 32 Rice 31 — 31 Cocoa 2 — 2 Rice (Ground) 1 — 1 Coconut 3 — 3 Roll (Meat) 1 — 1 Dripping 36 — 36 Sago 2 — 2 Egg Loaf 1 — 1 Salad Fruit (Dried) 1 — 1 Flour (Self-raising) 3 — 3 Sardines in Olive Oil 1 — 1 Flour (Maize) 1 — 1 Sausage (Cooked) 6 — 6 Fruit (Mixed) 5 — 5 Sausages 24 2 26 Ham 1 — 1 Semolina 2 — 2 Jelly 1 — 1 Sherbet 3 — 3 Lard 22 — 22 Suet (Shredded) 4 — 4 Macaroni 2 — 2 Sugar 11 — 11 Margarine 23 — 23 Sultanas 17 — 17 Maize Meal 1 — 1 Sweets 10 — 10 Milk 168 5 173 Tapioca 8 — 8 Mushrooms (dried) 1 — 1 Tea Dust 2 — 2 Oatmeal 2 - 2 Bread and Butter.—The butter in three slices of "bread and butter" purchased was found to consist of 100 per cent.of margarine; they were purchased for threepence at a restaurant in the Borough. The vendor stated that the containers of the butter and margarine were similar, and in his haste the margarine was served instead of butter. A cautionary letter was sent by the Town Clerk. 145 The statistics for previous years are subjoined:— Year. Total examined. Genuine. Adulterated. Percentage of adulterated samples. 1910 600 541 59 9•83 1911 600 549 51 8•50 1912 601 567 34 5•65 1913 601 570 31 5•1 1914 596 563 33 5•5 1915 600 566 34 5•6 1916 600 565 35 5•8 1917 601 544 57 9•5 1918 600 553 47 7•8 1919 591 569 22 3•7 1920 603 587 16 2•6 1921 602 588 14 2•3 1922 602 590 12 2•0 1923 602 593 9 1•5 1924 600 590 10 1•7 1925 600 589 11 1•8 1926 600 589 11 1•8 1927 602 577 25 4•1 1928 610 601 9 1•5 1929 601 590 11 1•8 1930 600 589 11 1•8 1931 600 589 11 1•8 1932 600 594 6 1•0 1933 600 591 9 1•5 1934 600 586 14 2•4 1935 600 583 17 2•8 1936 601 592 9 1•5 1937 600 592 8 1.3 14g Informal Samples.—In addition to the samples purchased officially in 1937, a number of samples were purchased without the usual formalities required to comply with the terms of the Food and Drugs Adulteration Act. These samples are known as informal samples and are really " feelers " to test the probity of the vendor without exciting his suspicion. The results were :— Name of Article. Gen. Adult, Total.l Name of Article. Gen. Adult Total. Almonds (Ground)... 4 — 4 Arrowroot ... ... 2 — 2 Cloves (Ground) ... 1 — 1 Cheese, Lemon ... 1 — 1 Crab, Dressed (canned) 1 — 1 Cream (Canned) ... 7 — 7 Curd, Lemon ... 1 — 1 Currants 1 — 1 Faggots 1 — 1 Flour ... ... 1 — 1 Flour (Self-raising) 1 — 1 Fruit (Mixed) ... 1 — 1 Ginger (Ground) ... 2 — 2 Herrings in Tomato Sauce (Canned) ... 4 — 4 Iodine, Tincture of 4 4 Jam ... ... 1 — 1 Jelly 2 — 2 Kipper Snacks (Canned) 1 — 1 Lemon Curd ... 1 — 1 Marmalade ... 1 — 1 Meat Pie ... ... 4 — 4 Meat Pieces ... 2 — 2 Milk 41 2 43 Milk (Condensed S.F.C.) 6—6 Milk (Condensed S.S.) 5 — 5 Mincemeat 2 — 2 Mustard ... ... 3 ■— 3 Nutmeg (Ground) ... 1 — 1 Oil (Camphorated) 1 — 1 Oil (Olive) ... ... 1 — 1 Ointment (Boracic) 3 — 3 Ointment (Zinc) ... 3 — 3 Paste (Fish) ... 1 — 1 Pepper ... ... 3 — 3 Peel (Chopped) ... 1 — 1 Pickles 2 — 2 Powder (Custard) 1 — 1 Powders (Grey) ... 2 — 2 Pudding (Black) ... 2 — 2 Raisins 2 — 2 Roll and Butter ... 3 1 4 Salmon (Canned) ... 4 — 4 Sardines ... ... 5 1 6 Sauce 1 — 1 Sauce (Mint) ... 1 — 1 Sausages ... ... 9 — 9 Saveloys ... ... 1 — 1 Scone and Butter ... 3 — 3 Sild 4 — 4 Spice (Ground) ... 1 — 1 Suet (Shredded) ... 2 — 2 Sugar ... ... 1 — 1 Sultanas ... ... 2 — 2 Tomatoes (Canned) 1 — 1 Tripe ... ... 1 — 1 Vinegar ... ... 1 — 1 Vineyar (Malt* ... 4 — 4 Lead in Sardines.—One sample of sardines last year was found to contain 40 parts per million of lead, a dangerous but fortunately unusual quantity. They were of Portuguese origin, and it appeared that before canning the sardines are cooked on metal grilles composed of an alloy which, in some cases in Portugal, contains an undue proportion of lead. Public Health (Condensed Milk) Regulations 1923-1927, and the Public Health (Dried Milk) Regulations 1923-1927. Examination of condensed milk exposed for sale has been made throughout the year, and 11 samples were taken for examination. No contravention of the Regulations was observed. 147 Public Health (Preservatives, etc., in Food) Regulations 1925-1927. All the samples submitted for examination are reported by the Public Analyst to have been tested for preservatives, the presence of which was reported in two formal samples of sausages; warnings were sent in each case. Artificial Cream Act 1929. No premises in the Borough are known where artificial cream is manufactured or sold. Pharmacy and Poisons Act, 1933 (Part II). This Act came into force on 1st May, 1936. Forty-four applicants were approved during the year by the Council as Listed Sellers of Poisons. In connection with the duties placed upon the Council by this Act, 125 visits of inspection have been made. The Listed Sellers of Poisons in this Borough are now fully informed of the requirements of the Act and Poison Rules made under the Act. They have been advised, in any case of doubt, to make application at the Town Hall for guidance, and advantage has been taken of this in many instances. There have been no contraventions observed. 148 SECTION F. Infectious and other Diseases. Notifiable Diseases.—The following diseases are now compulsorily notifiable to the Medical Officer of Health in Finsbury:— Anthrax; Cerebro Spinal Meningitis; Cholera; Continued Fever, Diphtheria, including Membranous Croup; Dysentery; Erysipelas; Enteric or Typhoid Fever, including Paratyphoid Fever; Encephalitis Lethargica (Sleepy Sickness); Glanders; Hydrophobia; Malaria; Ophthalmia Neonatorum (inflammation of the eyes in the newly born); Polio-encephalitis, Acute Poliomyeitis (Acute Infantile Paralysis); Pneumonia (Influenzal and Acute Primary); Plague; Puerperal Fever; Puerperal Pyrexia; Relapsing Fever; Scarlet Fever; Small Pox; Trench Fever; Tuberculosis, all forms; Typhus Fever. In addition, Measles and German Measles have been made compulsorily notifiable in Finsbury by Special Orders of the Ministry of Health. Zymotic Enteritis (Epidemic Diarrhoea) and Whooping Cough, have been made notifiable by Order made by the Borough Council, and confirmed by the Ministry. Food poisoning is now notifiable by the Public Health (London) Act, 1936. Chicken Pox is not notifiable in Finsbury. Case Rates of Infectious Diseases per 1,000 Living:— Finsbury. London. England and Wales. Smallpox 0.00 0.00 0.00 Scarlet Fever 1.94 2.09 2.33 Diphtheria 1.82 1.93 1.49 Enteric Fever 0.00 0.05 0.05 Erysipelas 0.46 0.44 0.37 The total number of infectious diseases notified and those removed to hospital are set out on the following page:— 149 NOTIFIABLE DISEASES, 1937. All ages. Under 1 yr. 1-5 yrs. 5-15 yrs. 15-25 yrs. 25-45 yrs. 45-65 yrs. 65 + Clerkenwell. St. Luke. St. Sepul. Total removals to hospital. Acute Influenzal Pneumonia 19 - 6 2 2 3 4 2 14 5 - 2 Acute Primary Pneumonia 79 6 25 9 12 11 10 6 55 24 19 Cerebro-spinal Meningitis 2 — 1 — — — — 1 1 1 — 2 Diphtheria (including Mem. Croup) 107 5 33 58 5 6 - - 83 24 - 107 Dysentery 18 2 6 1 1 1 3 4 15 3 — 10 Erysipelas 27 — — 2 2 7 10 6 20 7 — 18 Food Poisoning 101 — 3 9 32 31 15 11 95 6 — 6 Malaria (induced) 1 — — — — 1 — — 1 — — — Measles and German Measles 565 30 344 177 13 1 346 219 219 Ophthalmia Neonatorum 11 11 — — — — — — 8 3 — 2 Puerperal Fever 3 — — — — 3 — — 3 — — 1 Puerperal Pyrexia 14 — — — 4 10 — — 9 5 — 2 Pulmonary Tuberculosis 106 — 1 9 30 38 24 4 70 36 — — Other forms of Tuberculosis 17 — 2 8 4 2 1 9 8 Scarlet Fever 114 1 37 61 9 6 — 87 27 114 Whooping Cough 179 30 112 37 — — — — 101 78 — 80 Zymotic Enteritis 20 15 4 1 — — — — 19 1 — 8 1,383 100 574 374 114 120 67 34 936 447 — 590 The Zymotic Diseases.—Scarlet fever, whooping cough, diphtheria, diarrhoea, enteritis, and measles caused a total of 19 deaths—Scarlet fever 0, whooping cough 6, diphtheria 2, diarrhœa and enteritis (under 2 years) 11, and measles 0. The zymotic death-rate was 0.32 per 1,000 population. 150 Smallpox. Last year no cases of smallpox were notified in the Borough. The London County Council maintain a panel of experts who are gratuitously available for consultation in doubtful or suspected cases. Vaccination.—The Public Vaccinators and their times of attendance are given below:— No. 1.—Dr. R. K. Dadachanji, 389, City Road, E.C.I. Hours : 9.15 a.m. to 11.15 a.m. daily ; 6.30 p.m. to 8 p.m. (Except Thursday evenings and Sundays.) No. 2.—Dr. Susan A. Finch, 12, Lloyd Street, W.C.I. Hours: 9.39 a.m. to 11 a.m. daily; 5.30 p.m. to 7 p.m. (Except Thursday evenings and Sundays.) No. 3.—Dr. B. McKeown, 78, Myddelton Street, E.C.I. Hours: 11 a.m. to 1 p.m. ; 6 p.m. to 8 p.m. (Except Thursday evenings and Sundays.) No. 4.—Dr. R. E. Batson, 89, Goswell Road, E.C.I. Hours: 12 noon to 1.30 p.m. daily; 5 p.m. to 7.30 p.m. daily. (Except Saturday evenings.) (Ordinarily, Public Vaccinators do not vaccinate on Sunday.) The Vaccination Officer is Mr. P. Capps, attached to the Public Health Department. He is available for interviews with parents on Mondays to Fridays, 11 a.m. to 1 p.m.; Saturdays, 11 a.m. to 12 noon. Proceedings under the Vaccination Acts, 1867 to 1898 for 1936. No. of Births received from the Registrars 2,095 No. of Finsbury Births received from the Registrars 536 No. of Certificates of Vaccination received 872 No. of Deaths before Vaccination 85 Postponements by Medical Certificate 44 Certificates of Exemption granted after Declaration £52 No. of Certificates of Insusceptibility 4 Non-resident Cases— Notices to other Vaccination Officers 1,559 Addresses not traced 67 Finsbury Babies not vaccinated within the Statutory period of four months 49 No. of personal visits made during the year 632 151 Scarlet Fever. Last year 137 cases were notified as suffering from scarlet fever; of these, four were not Finsbury cases, and the notifications were transferred to the boroughs of residence. The number of cases wrongly diagnosed was 19, leaving 114 true cases, of which all were treated in isolation hospitals. There were no deaths. Those cases wrongly diagnosed were found to be suffering from:— Dermatitis 1 Measles 8 Erythema 1 Tonsilitis 5 Faucitis 1 Urticaria 1 Two cases were described as "not scarlet fever." The particulars of cases for the last 10 years are subjoined:— Year. No. of Cases. No. of Deaths. Case Mortality. No. of Deaths per 100 Cases. No. of Cases per 10,000 of Population. No. of Deaths per 10,000 of Population. 1927 229 2 •86 31•7 •28 1928 220 1 •46 30•7 •14 1929 272 1 •37 38•3 •14 1930 298 1 •36 42•3 •14 1931 153 -• — 21•8 — 1932 267 2 •75 38•7 •29 1933 411 1 •24 61•6 •15 1934 369 2 •54 56•8 •31 1935 189 1 •53 29•6 •16 1936 135 1 •74 22•2 .•16 1937 114 — — 19•4 — Seven patients developed scarlet fever whilst they were detained in hospital for other causes. There was one "return" case. Scarlet fever to-day is an exceedingly mild disease and causes very few deaths. Measles is far more fatal. When measles is epidemic, and there is a great shortage of hospital beds, cases of measles should be removed to hospital, and scarlet fever may well be treated at home. 152 The average length of stay in hospital of scarlet fever cases last year was 39 days. The period of stay in hospital varied from 12 days to 106 days. Prolonged detention in hospital is due to some complication such as ear or nasal discharge, mastoid disease, nephritis, sores or other condition which renders the patient still infectious. All the houses where cases occurred were visited and inspected. Nuisances that called for remedy were made the subject of notice and amendment. The rooms, the bedding and clothing were disinfected. Discharges.—Every case discharged from hospital is visited by the sanitary inspector soon after return home. The possibility of further infection is explained to the mother and a leaflet of instruction left with her. If found necessary, a visit is paid by the assistant medical officer. Special attention is paid to children who show signs of nasal discharge, running ears or sores, all of which sometimes develop after discharge from hospital. If suitable precautions against spreading infection cannot be taken owing to home circumstances, the child is sent back to hospital as potentially still infectious. School Children.—In connection with cases of diphtheria and scarlet fever arising amongst the elementary school children, visits were paid last year to five schools by medical officers of the London County Council. The Borough sanitary inspectors also visit the Schools when several cases have been notified from any particular School or class in the School within a short period, and advice is given to the Head Teacher on general lines and disinfection of a classroom is carried out during the week-end. Exclusion from School of Contacts of Infectious Diseases. By arrangement with the School Medical Officer, the names of children who, in the opinion of the Borough Medical Officer, should be excluded from school as contacts of cases of infectious diseases notified under the Public Health (London) Act, are forwarded to the head teachers by the Public Health Department. The periods of exclusion, except in exceptional circumstances, are those adopted by the London County Council. 153 Diphtheria. Last year 144 cases were notified as suffering from diphtheria and admitted to the isolation hospitals maintained by the London County Council. After admission it is sometimes found that an error of diagnosis has been made and 37 cases were sent home. These cases were diagnosed as follows:— Broncho-pneumonia 1 Measles 2 Coryza 3 Rhinitis 1 Faucitis 1 Tonsilitis 25 Laryngitis 2 One case was described as "not diphtheria," and one as "no obvious disease." When the figures are adjusted for wrong diagnosis, a total number of 108 cases is left, 14 of which were contracted in the hospital to which the patient had been admitted for some other disease. Deaths.—There were 2 deaths, equal to a case mortality of 1.8 per cent. In 1936 the number of deaths was 4, giving a case mortality of 3.2 per cent. The particulars of cases for the last 10 years are appended:— Year. No. of Cases. No. of Deaths. Case Mortality No. of Deaths per 100 Cases notified. No. of Cases per 10,000 of Population. No. of Deaths per 10,000 of Population. 1928 217 9 4•1 30•3 1•25 1929 187 6 3•2 26•3 •84 1930 302 9 2•9 42•9 1•28 1931 165 5 3•0 23•5 •71 1932 165 6 3•6 23•9 •87 1933 214 8 3•7 32•1 1•2 1934 213 13 6•1 32•8 2•0 1935 188 1 •53 29•8 •16 1936 126 4 3•2 19•9 •63 1937 107 2 1•8 18•2 0•34 154 All the cases are investigated by the Sanitary Inspectors and the source, if possible, traced. The premises are inspected and if any sanitary defects exist, a notice is served for their remedy. The drains are carefully examined and if necessary tested for defects. Facilities for Early Diagnosis.—Arrangements can be made for either the Medical Officer of Health or his assistant to see, at the request of the private practitioner, suspected or doubtful cases. Swabs are examined in the laboratory of the Public Health Department. It is very unwise, however, to rely on the result of a swab before administering anti-toxin. If a practitioner is so suspicious as to suspect diphtheria the immediate administration of anti-toxin should be undertaken. A negative swab does not necessarily mean that the patient has not diphtheria and a positive swab that he is suffering from diphtheria. The swab cannot, and should not, replace diagnosis by clinical signs and symptoms. Diphtheria Anti-Toxin (Order), 1910.—A supply of antitoxin is kept at the Health Department and is available for doctors for the treatment of necessitous Finsbury patients free of charge. Last year eight vials representing 24,000 units were issued to the practitioners. A fee of 5s. 0d. is also paid to medical men for administering the anti-toxin between the hours of 9 p.m. and 9 a.m., and 2s. 6d. at other hours. The average length of stay in hospital of cases of diphtheria last year was 72 days. Cases of diphtheria discharged from hospital as cured are examined very carefully shortly after their return home, and a record kept of their condition. If necessary, swabs are taken from the nose and throat for bacteriological examination. Any cases suspected of harbouring the diphtheria bacillus in nose or throat are kept under supervision by the Department and, if necessary, referred for treatment at one of the special "carrier" clinics mentioned below. 155 Leaflets of instruction are given to the parents of the patients on the removal of the patient, and on his discharge from hospital. Some children harbour, in their throats or noses, virulent diphtheria bacilli for prolonged periods, sometimes for years. They are a source of potential danger to the rest of the family and to the school children and others with whom they come into contact. The London County Council has established three clinics for the treatment of diphtheria carriers—at Guy's Hospital; the Hospital for Sick Children, Great Ormond Street; aad St. Mary's Hospital. Treatment for these carriers may be obtained by application to the School Medical Officer (S.H.3), the County Hall, London, S.E.I. Immunisation Clinic.—The clinic for the immunisation of persons against diphtheria held weekly at the Pine Street Centre, and the propaganda carried out to encourage attendance, have been continued. A special leaflet for parents, with application form attached, is sent to the mother of every baby at the age of one year, and is distributed by the Health Visitors and Sanitary Inspectors, as mentioned in my Report for 1935. The Centre Superintendents and the Assistant Medical Officers also endeavour to secure the co-operation of parents. Posters urging parents to protect their children against diphtheria are displayed throughout the Borough at frequent intervals. Special leaflets have been distributed and re-distributed at the London County Schools in the Borough. This is carried out regularly three times a year. Special certificates are issued to the parents of children immunised, and those found to be naturally immune are also given a certificate. The preservation of these certificates by the parents is important and should be a valuable guide to medical practitioners when they are called upon to deal with doubtful throats in such patients. Unfortunately, in spite of continuous propaganda, the Clinic is very sparsely attended. 156 Immunisation Clinic—contd.— The following figures show the use made of this Clinic in 1937. Total attendances at the Clinic 434. Number of Clinics held 47. Average attendance per Clinic 9. The following table gives comparative figures for the past four years:— Year. No. of New Cases. No. Schick Tested. No. Treated without Schick Test. No. Immunisation Completed. Nos. Discontinued Treatment. Nos. Re-Schicked. No. under Treatment at end of Year. 1-5. 5-14. Adults. 1-5. 5-14. Adults. 1-5. 5-14. Adults. 1-5. 5-14. Adults. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 1934 34 0 11 [2] 1 [0] 22 16 2 0 3 6 0 0 0 0 5 1935 180 0 36 [14] 3 [1] 118 90 6 2 15 14 1 79 5 2 12 1936 93 0 39 [27] 1 [1] 45 66 16 0 6 10 0 35 5 0 5 1937 135 0 10 [8] 0 100 55 51 0 7 3 0 88 41 0 19 The Numbers in brackets indicate those found to be Negative. Columns 7, 8, 9 indicate those who have received Three Doses of T.A.M. or T.A.F. Total number of cases since the scheme commenced in which it was found necessary to give more than three injections, nil. 157 Day Nurseries. The immunisation, with the parents' consent, of the babies and toddlers in attendance at the two Day Nurseries in the Borough, viz., the Municipal Nursery and Claremont, has been continued as follows:— Claremont Municipal Day Nursery. Day Nursery. Number immunised 25 4 Number of Schick tests 7 2 Immunisation by General Practitioners. This scheme, as outlined in the Report for 1935, has been continued, and 41 children were immunised. Diphtheria in Immunised Persons. Two children of 5 and 4 years of age were notified in December last year. They had been immunised and found to be negative in December, 1935. On investigation, it was found that one child was a virulent "carrier" (nasal) and not suffering from the disease clinically, and the other was not suffering from diphtheria but scarlet fever. Measles. Measles and German measles have been compulsorily notifiable in Finsbury from 8th January, 1923 (except cases occurring within two months of any notified case in the same household). 565 cases were notified last year. 158 Comparative Table.—The following table gives comparative figures of deaths in children under 5 years from measles, whooping cough, and other infectious diseases:— Period. Measles. Whooping Cough. Smallpox Scarlet Fever. Diphtheria 1901-5 278 211 13 53 80 1906-10 347 202 — 39 80 1911-15 366 169 — 27 48 1916-20 223 88 — 10 65 1921-25 98 82 — 12 68 1926-30 122 75 2 6 25 1931 3 7 — — 5 1932 41 12 — 2 6 1933 3 7 — 1 4 1934 14 5 — 2 11 1935 — 4 — 1 1 1936 21 7 — 1 1 1937 — 6 — — 2 Total 1,516 875 15 154 396 From this table it appears that the deaths in 37 years due to scarlet fever, diphtheria and smallpox, all taken together numbered 565, to whooping cough 875 and measles 1,516. In children under five years, therefore, it seems that measles kills nearly three times the number of children whose deaths are caused by smallpox, scarlet fever and diphtheria all combined. Whooping cough alone causes many more than the number of deaths accredited to these three named infectious diseases. And the matter does not end here. Measles leaves behind it a moderately large number of patients with discharging ears. Some of these die in later life when the discharge has invaded the brain and caused meningitis. Others suffer in varying degrees from complete or partial deafness and chronic lung disease. A special Health Visitor is appointed in epidemic times to visit notified cases of measles in the Borough. 159 In non-epidemic periods the visiting of those under five years of age is carried out by the Health Visitors, and of those over five years by the nurses of the Metropolitan District Nursing Association. The duties are to advise the mother as to the best way to deal with the case, to arrange for extra nourishment when the family is necessitous, to provide through the Metropolitan District Nursing Association skilled nursing in the home where necessary, to secure medical treatment where lacking, and to obtain early removal to hospital of those cases where the child could not be suitably nursed at home. Seven hundred and sixty-six visits and re-visits were paid for these purposes during 1937. Of the notified cases, 219 were removed to hospital, the remainder being nursed at home. Whooping Cough. Whooping cough is a dangerous disease, especially in babies, in whom it frequently causes broncho-pneumonia and death. Children are often left with weak chests after this distressing malady which is sometimes the forerunner of tuberculosis. This disease was the cause of death in 6 children under five years of age last year. Since 28th May, 1934, whooping cough has been made compulsorily notifiable in the Borough; 179 cases were notified in 1937; every case under five years is visited by the Health Visitor and arrangements made for hospital treatment if required. Provision of Vaccine.—A vaccine supplied by Genatosan, Ltd., is given to the local practitioners on application for the treatment of necessitous patients. Three doses are given to each case according to the age of the child. The vaccine was first tried out by the general practitioners in the Borough, and the results were stated to be good. Vaccine was supplied for seven cases last year. 160 Chicken-pox, Mumps and German Measles. These cases are only admitted to the isolation hospitals in exceptional circumstances. The admissions last year were:— Chicken-pox 91 Mumps 3 German measles 37 Anthrax. No case of anthrax was notified last year. Notification was received from the police of the distribution of cat's meat suspected to have been derived from an animal infected with anthrax, to retailers of such food in London, including a stallholder in one of the market streets in Finsbury. Immediate investigations were made, and the suspected meat was taken from the stall, together with the scales and weights, knives, board, etc. The meat was destroyed in the incinerator, and the other articles disinfected by steam. No spread of the disease to any animals or human beings was discovered or reported. Typhus Fever, Glanders, Hydrophobia, Acute Poliomyelitis. No case of these diseases was notified in 1937. Cerebro Spinal Meningitis. Two cases were notified in 1937; both were removed to solation hospital where one died soon after admission. The second case recovered and is now in apparently good health. Acute Primary Pneumonia. Seventy-nine cases of acute primary pneumonia and 19 of influenzal pneumonia were notified in 1937. In 24 cases of pneumonia in necessitous families the Borough Council provided a nurse; to these cases the nurses paid 450 visits. Influenza is not a notifiable disease; 20 deaths were ascribed to influenza last year. 161 Typhoid Fever (including Para-typhoid). In 1937 no cases of para-typhoid or typhoid were notified. Encephalitis Lethargica. No cases were notified last year. Patients who have been notified in former years are visited from time to time, and below will be found the present condition of the patients as far as can be ascertained:— One died in hospital from the disease. One had not had treatment for a considerable period and was considered cured. Three had removed to unknown addresses, and one had removed to Surrey. Diseases of Animals Act, 1894-1935—Rabies Order 1919. No notifications under the above Order were received from the Veterinary Inspector of the London County Council. Trench Fever, Malaria and Dysentery. One case of malaria, induced for therapeutic purposes, was notified last year. Eighteen cases of dysentery were notified in 1937. Cases of dysentery formerly have been admissible to the infectious hospitals only on the application of the Medical Officer of Health. They may now be admitted on the direct application of a medical practitioner. The cases of dysentery were all of the Sonne variety, and arose chiefly in residents of the Borough who were inmates of a hospital, in some cases for another illness. Puerperal Pyrexia, Puerperal Fever and Ophthalmia Neonatorum. These diseases are dealt with in the part of the Report dealing with Maternity and Child Welfare. 162 General. In connection with the prevention of the spread of infectious diseases, notice is given to the Health Department by the London County Council of children absent from school for various reasons. All those cases suspected to be suffering from infectious diseases are visited in the first instance by the Sanitary Inspector and if necessary by the Assistant Medical Officer of Health, and such action taken as may be thought advisable. The London County Council also transmit "following-up" cards relating to children of pre-school age discharged from the Council's hospitals. These cards give information as to any special recommendations for after-care which are noted by the Health Department. No cases of epidemic jaundice, undulant fever, glandular fever or psittacosis were brought to my notice. Venereal Disease. The administration of the Acts and Regulations with respect to venereal diseases is in the hands of the London County Council. The treatment centres nearest the Borough are the Metropolitan Hospital, Kingsland Road, E.8; the Royal Free Hospital, Gray's Inn Road, W.C.1; and the Hospital for Sick Children, Great Ormond Street, W.C.1. St. Paul's Hospital, Endell Street, ceased, after 31st March, to participate in the London County Council's V. D. Scheme. Special notices, drawing attention to the facilities for treatment in the neighbourhood at hospitals and treatment centres, are exhibited in the public conveniences, and all the staff of the Department can give information on this point. Cancer. The number of deaths from cancer have been gradually increasing. This is probably a real increase, and not to be explained by the increased age of the population (although this is no doubt an important factor), nor by improved methods of diagnosis. 163 In view of the marked tendency to a greater average age of the population arising from a lessening birth rate and lowered death rate, it appears inevitable that the vital statistics of the whole country will show, as time goes on, a gradual increase in the proportion of deaths due to this disease. The number of deaths from cancer in 1937 yielded a rate of 2.2 per 1,000 of the population. An increase in the rate will be noted. The following table shows the number of deaths from cancer and the death rates for the last 10 years. At the beginning of the century the death rate was 581 per 1,000. Year. No. of Deaths. Death Rate. 1928 122 1.7 1929 108 1.5 1930 115 1.6 1931 101 1.4 1932 102 1.5 1933 105 1.6 1934 127 1.95 1935 121 1.91 1936 113 1.88 1937 130 2.2 Insulin Treatment of Diabetes. Arrangements have been in force since July, 1931, under Section 77 of the Public Health (London) Act, 1891, for the provision of insulin for the treatment of poor persons suffering from diabetes. Applications are submitted to the Health Department; periodical reports of the progress of the patient, containing the dose of insulin given and the progress of the patient are sent to the Health Department in respect of each patient receiving the insulin at the expense of the Council. Last year four cases were accepted under the scheme at a cost to the Council of £9 7s. 6d. 164 Tuberculosis. The voluntary notification of pulmonary tuberculosis and of tuberculosis in other parts of the body associated with discharges was adopted by the Finsbury Borough Council in 1900. By the Public Health (Tuberculosis) Regulations, 1912, all forms of tuberculosis were compulsorily notifiable from and after 1st February, 1913. Amending regulations followed in 1921 and 1924. By the Public Health (Tuberculosis) Regulations, 1930, the provisions of the previous regulations are now consolidated and amended. Pulmonary Tuberculosis.—The following information is of interest as throwing some light on the approximate duration of cases of tuberculosis of the lungs after notification. 19201924 19251929 19301934 1935 1936 1937 Number of deaths from Phthisis 596 535 366 50 52 61 Number of cases notified only at death 44 (32) 30 (17) 19 (8) 0 1 (0) 1 (1) Number of cases dying non-notified 120 (65) 86 (32) 68 (19) 8 (3) 2 (0) 5 (2) Number of cases notified within a month of death 50 66 39 6 5 8 Number of cases notified within 1-3 months of death 55 67 28 6 9 7 Number of cases notified within 3-6 months of death 53 39 49 4 2 4 NOTE.—The figures in italics and bracketed indicate the numbers of the cases referred to who died in public assistance institution. From the table it appears that some cases of pulmonary tuberculosis are still not notified during life to the Public Health Authority. Others are still not notified until death is impending, or at a very late stage of the disease. This means that presumably few preventive measures are taken in these cases or they are taken at a stage too late to be of much serious benefit to the community. 165 Tuberculosis Notification Register. The total new cases of Tuberculosis, both pulmonary and non-pulmonary entered on the register in 1937 numbered 129. The age period details were as follows:— Age Periods. 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- Total Males Pulmonary — 1 2 4 6 8 9 12 8 10 4 60 Females Pulmonary — — 1 2 8 9 13 4 6 3 1 46 Males Non-pulmonary — — 2 2 2 — — — 1 — — 7 Females Non-pulmonary — 2 2 2 1 1 1 1 — — — 10 Of the above 123 cases, 24 were brought to notice otherwise than by formal notification, i.e., by death returns, by posthumous notification, and by transfer from other areas. The number of cases remaining on the register of notifications at 31st December, 1937, was as follows:— Males. Females. Total. Pulmonary 177 132 309 Non-Pulmonary 42 40 82 219 172 391 The number of cases removed from the register during the year was 146—due to withdrawal of notification 6, recovery from the disease 23, death 79 and miscellaneous 38. The numbers of notifications and deaths of Finsbury cases of Phthisis since 1901 in ten-year periods are appended :— PHTHISIS NOTIFICATIONS AND DEATHS 1901-1935. Year. Average No. of Primary Notifications. Average No. of Cases Notified per 10,000 of Inhabitants. Average No. of Deaths. Average Death Rate per 1,000. 1901-10 213 22.7 223 2.34 1911-20 327 41.0 146 1.87 1921-30 161 21.7 94 1.28 1931 135 19.3 85 1.21 1932 132 19.1 73 1.06 1933 122 18.3 78 1.15 1934 132 20.3 56 0.862 1935 101 16.0 50 0.792 1936 97 16.1 53 0.871 1937 106 18.1 59 1.005 166 The number of primary notifications received in 1937 was 106. Of these, 2 were from Public Assistance sources, 80 from hospitals and dispensaries, 14 from private doctors, and 10 from sundry sources. And, again, of these:— 70 were from Clerkenwell. 36 ,, St. Luke's. The Homes of the Patients.—The homes of the patients are often found to be unsatisfactory and unsuitable for a phthisical household. Prevention of the spread of the disease is thereby rendered more difficult. Every effort is made to help the patients as far as possible. Out of those notified last year 6 lived in one-roomed tenements, 21 lived in two-roomed tenements, and the remainder had three or more rooms. Overcrowding was noted in seven cases. Owing to restricted accommodation all the rooms have to be used for sleeping. The congested central area of London is not ideal for the residence of active tuberculous patients, especially when they live in the so-called "Model" dwellings. Frequently the patients are unable to afford the rent of accommodation on an L.C.C. estate and the question of assisting such persons to obtain improved accommodation should be seriously considered. When the tenements are overcrowded, the conditions for promoting the disease are as pernicious as they possibly can be. It is difficult to conceive a condition which favours the spread of the infection more than overcrowding. In phthisical families, the abatement of overcrowding is insisted upon as far as possible. No tenements were on the list of houses let in lodgings; 23 tenements were in so-called "Model" buildings, which, with their common landings and their many points of contact between the families who occupy them, are only too well adapted for the spread of phthisis. Of the houses occupied by the patients, three were used for the sale or preparation of food products. 167 A sanitary survey was made of every tenement, and the nuisances found were made the subjects of subsequent notices and amendment. Disinfection.—Free systematic and periodic disinfection is offered after the notification of the patients. In 1937 the rooms, bedding, feeding utensils, towels, handkerchiefs and linen were disinfected in 123 households. A leaflet of instruction is left in every home where a case of tuberculosis occurs and also after a death from tuberculosis, and its terms are explained to the head of the family. Sputum flasks are supplied free of charge. A disinfectant soap for cleansing purposes is given gratis to those who like to scour their rooms. Deaths.—In 1937 the number of Finsbury persons who died of phthisis or pulmonary tuberculosis was 61. In addition to these, three died from other forms of tuberculosis. The deaths from all forms of tuberculosis were 64. The deaths for previous years, in ten-year periods, are given in the following table:— PHTHISIS DEATHS AND DEATH RATES, 1901-1937. Year. Finsbury Deaths from Phthisis. Finsbury Deaths from other forms of Tuberculosis. Phthisis Death Rates per 1,000 Inhabitants. Finsbury. England and Wales. 1901-10 223 40 2.34 1.156 1911-20 146 42 1.87 1.140 1921-30 94 15 1.28 .823 1931 85 11 1.21 .742 1932 73 11 10.6 .82 1933 78 8 1.15 .690 1934 56 7 .862 .635 1935 50 4 .792 .605 1936 53 8 .871 .583 1937 59 3 1.005 .584 The phthisis death-rate in London for 1937 was 0.71 per 1,000 inhabitants. It is very probable, however, that this list does not contain all the deaths from phthisis which occur in Finsbury. Some are probably concealed on the death certificates and wrongly entered as due to pneumonia, bronchitis, pleurisy, asthma, or influenza. 168 Allotted to districts, 41 deaths from phthisis belonged to Clerkenwell and 20 to St. Luke's. The total deaths in the Borough, the deaths due to tuberculosis, and the resulting percentages of the total are given in the annexed table:— Comparative Table—Total Deaths and Deaths from Tuberculosis (All Forms), 1918-1937. Year. Total Deaths. Deaths from Tuberculosis. Tuberculosis precentage levied on the total deaths. 1911-20 1,486 188 12.7 1921-30 1,069 109 10.2 1931 983 96 9.7 1932 923 84 9.1 1933 855 86 10.0 1934 865 63 7.4 1935 794 54 6.8 1936 852 61 7.2 1937 855 62 7.2 In the main it will be seen from this table that over a period of years approximately 10 per cent. of all the deaths were directly due to tuberculosis, although in immediately recent years the percentage has been somewhat less. This is a very heavy toll taken on the community. Nor is this the complete count. There are many other deaths associated with tuberculosis and deaths where the existence of the disease has been concealed. Sixty-two per cent. of the total deaths due to tuberculosis took place in persons between 15 and 45 years of age. In recent years there has been a gradual transference of phthisis deaths from the older people to young adults between 15 and 30 years. This has been specially notable amongst females. Other forms of tuberculosis.—The number of new cases notified was 17. Clerkenwell 10, St. Luke's 7, cases. The parts chiefly affected were the cervical glands (4). There were three deaths from tuberculous diseases other than phthisis. Tuberculosis Death Rate (All Forms). The Finsbury death rate from all forms of tuberculosis in 1937 was 1.090 per 1,000; the corresponding rate for 1936 was 1015 per 1,000. 169 Public Health (Prevention of Tuberculosis) Regulations, 1925. No action was found necessary under these Regulations which relate to tuberculous employees in the milk trade. Compulsory Removal of Persons. There is no definite power in London for the compulsory isolation of infectious cases of tuberculosis. The provisions of the Public Health (London) Act 1936, give certain powers to a petty sessional court to order, subject to various safeguards, the removal to a suitable hospital or infirmary any aged infirm person or anyone suffering from a grave chronic disorder, where such person is unable to receive proper care and attention. No use has been made of the somewhat indefinite powers granted by this section. The Tuberculosis Dispensary. The Dispensary at 21 Whiskin Street is maintained by the Borough Council to serve as a diagnostic station and a centre for the supervision of cases of Tuberculosis. The principal objects of the work carried out here are to:— (1) Discover every case of tuberculosis at an early a stage as is possible. For this purpose, general practitioners and others are encouraged to send doubtful cases to the specialist Tuberculosis Officer for an opinion. (2) Examine contacts of cases already known in order to discover among these early cases of tuberculosis needing treatment, as it is well known that the disease tends to spread in those in close association with other cases. (3) Serve as a clearing house from which arrangements may be made for the hospital treatment of such cases requiring this. (4) Act as a centre from which advice and help may be given both for treatment and isolation of known cases and where supervision of such may be exercised. The Staff includes:— The Tuberculosis Officer, The Tuberculosis Visitor, The Janitor, One Lady clerk (part-time). 170 The Dispensary is open:— Monday, Wednesday and Friday : 10.0 a.m. to 12 noon. Tuesday 6.0 p.m. to 8.0 p.m. (for those at work). Saturday 10.0 a.m. to 12 noon (for children). At the present time six sessions per week devoted to tuberculosis work complies with the requirements of the Scheme. This does not take into account X-Ray work. Below will be found a summary of the work of tiie Tuberculosis Dispensary in 1937 :— New Cases Examined. Cases other than Contacts. Pulmonary. NonPulmonary. Total. (a) Definitely Tuberculous 80 11 91 (b) Diagnosis not completed 11 (c) Non-Tuberculous 92 Contacts. (a) Definitely Tuberculous 5 0 5 (b) Diagnosis not completed 1 (c) Non-Tuberculous 88 Total 288 Cases Written Off. (a) Recovered 16 6 22 (b) Dead 69 (c) Transferred to other areas 40 Totsl 131 Cases on Register at End of Year. (a) Definitely Tuberculous 301 75 376 (b) Diagnosis not completed 13 Total 389 Attendances at Dispensary 1,275 Specimens of sputum ex- Consultation with Doctors 260 amined 111 Visits made by Nurse 1,938 No. of X-Ray examinations 319 No. of "T.B. plus" cases on Home Visits by Tuberculosis Dispensary Register, 31st Officer 101 Dec., 1937 181 From the above table it will be seen that about 200 patients attended the dispensary for the first time and 91 were found to be definitely tuberculous. Amongst these were eleven children, six of whom had tuberculosis of the lungs, and five other forms of tuberculosis. 171 Cases Recovered or Non-Tuberculous. It will be noted that 22 cases were written off the Dispensary Register as "recovered" and 289 for other reasons. This latter number includes Contacts and New Patients examined last year. Special features of the work undertaken in connection with the Municipal Dispensary may be summarised as follows:— X-Ray Facilities. It has so far proved impracticable to instal an X-Ray plant in the dispensary on account of the insufficiency of the accommodation available. This method of examination is, however, very frequently absolutely essential in order to arrive at a certain diagnosis at an early stage, to control accurately the progress of a case or to exclude the presence of the disease where other examinations point to the possibility of its presence. The earliest signs of the disease are a change in the X-Ray appearances and may be missed altogether if not sought for in this way. The proper line of treatment may often only be discoverable before it is too late by carefully watching the extent, character, and changes in the X-Ray shadows. And again a number of cases whose symptoms suggest the presence of the disease may be relieved of much worry and the local authority relieved of expense on their behalf by an assurance which can only be given after an X-Ray that there is no evidence of tuberculosis. For example, hæmorrhage from the lung occurs in some cases of tuberculosis but also in some other diseases both of the heart and lung and without X-Ray examination it is inevitable that certain of the latter cases would be falsely diagnosed as suffering from phthisis. Arrangements are in operation for X-Ray examinations where required at University College Hospital. The Tuberculosis Officer attends personally the University College Hospital two or three times each month and himself screens the patients. A charge of 2s. 6d. is made for each case, together with a further charge of 2s. 6d. for each photograph taken. These arrangements have proved reasonably satisfactory, but the work would be rendered more efficient if the Dispensary were equipped with an X-Ray installation. It is impossible at present to arrange for evening X-Ray work, and it is, therefore, very difficult to arrange for 172 examination of patients and contacts at work. Moreover, doctors are at times hesitant about referring cases for an opinion when they realise that this will involve the patients being sent elsewhere for X-Ray examination. It further means that it is impossible to undertake pneumothorax work in the Dispensary. Hospitals and Sanatoria. Hospital and Sanatorium treatment is provided by the London County Council at their several institutions for patients recommended for this by the Tuberculosis Officer. During 1937, 218 patients received treatment in one or more institutions of whom 70 remained in hospital on 31st December. * These persons were treated in the following institutions:— 1. Special Hospitals:— 3. Children's Sanatoria:— Brompton Hospital 15 Children's San., Holt 1 City of London Hospital, Victoria Park 1 Heath End San., Farnham 1 High Wood Hospl., Brentwood 19 St. George's Home, Chelsea 5 Millfield San., Rustington 7 2. Sanatoria:— 4. Colonies:— Brompton Hosp. San. 1 Burrow Hill Colony, Fnmley... 2 Paoworth Village Settlement ... 3 Colindale Hospital 13 Preston Hall, Maidstone 5 Darvell Hall San., Robertsbridge 1 5. General Hospitals :— Douglas House, Bournemouth 4 East Anglian San. 10 Archway, Highgate 58 Fairlight San., Hastings 1 Bethnal Green 2 Hackney 1 Grosvenor San., Ashford 3 Highgate 6 Grove Park Hospl., Lewisham 22 Lambeth 1 Hawkmoor San., Lustleigh 1 Lewisham 1 Mile End I Hawthorndene San., I.O.W. 3 Paddington 1 Holy Cross San., Haslemere 3 St. Alphege's, Greenwich 1 Ipswich San. 2 St. Andrews, Bow 1 St. Charles. Ladbroke Grove 5 K. Geo. V San., Godalming 8 St. George-in-the-East 2 Liverpool San., Frosham 5 St. James, Balham 1 National San., Benenden 3 St. Joseph's Hospice, Hoxton 1 St. Leonard's, Shoreditch 6 National San., Ventnor 1 St. Luke's, Chelsea :s Northern Hosp., Winchmore Hill 7 St. Mary Abbot's, Kensington 3 Old Manor Ho., Broadstairs 1 St. Olave's, Bermondsey 1 Pinewood San., Wokingham 7 St. Stephen's, Fulham 4 S. Barnabas Home, Torquay 1 6. Surgical Tuberculosis Hospitals: St. Luke's Home, Torquay 1 Heatherwood Hospl., Ascot 4 St. Michael's Home, Hayle 2 Queen Mary's Hospl., Carshalton 16 S. Michael's Home, Axbridge 3 Roy. Nat. Orthopaedic Hospl., Stanmore 1 Tait Convalescent Home, Broadstairs 1 St. Luke's Hospl., Lowestoft 6 St. Nicholas Hosp., Pyrford l Tehidy San., near Camborne 1 St. Vincent's, Eastcote l 173 3. Provision of Extra Nourishment. The Borough Council provides extra nourishment for certain types of tuberculous cases. This usually consists of milk and eggs. One hundred and ten persons were granted extra nourishment during the year. Where patients are already receiving help from the Public Assistance Committee, however, extra nourishment is supplied by that body on the recommendation of the Tuberculosis Officer. The Council decided that unless specially recommended for a shorter period, all grants should normally be made for a period of three months. Such grants to expire at the end of each quarter. This procedure has simplified the giving of grants; all cases are considered before the expiry of each quarter by the Tuberculosis Officer and the necessary recommendations made. The Council has had under consideration the class of patient to whom grants can most usefully be made and the following types of case have been assisted in this way where the patient's finances appeared insufficient:— (1) Patients who have received an adequate course of sanatorium treatment and whose medical condition is such that with the grant of extra nourishment they may be expected to maintain or recover full working capacity. (2) Patients in whose cases ultimate arrest of the disease may reasonably be anticipated and who are waiting for admission to a sanatorium. (3) Quiescent or arrested cases in young adults where there appears to be a particular danger of recrudescence of the disease if food conditions are not maintained, and especially during periods of added strain such as when starting work. (4) Chronic cases where no permanent improvement is likely and yet are able to maintain a condition in which they are not an actual burden to others but need every help possible to preserve that degree of health which is left to them. 174 (5) Contacts of infectious cases although actually diagnosed as suffering from tuberculosis yet remaining under the observation of the Tuberculosis Officer. (6) Finsbury children attending Holly Court Open Air School and falling into one of the above categories (during the school holidays). Where patients or their families are already receiving help from the Public Assistance Committee, extra nourishment is provided by that body on recommendations made by the Tuberculosis Officer. During 1937, 35 persons received additional grants in this way. During the year three persons received additional grants from the Unemployment Assistance Board on recommendations made by the Tuberculosis Officer. Artificial Pneumothorax Refills. Owing to the want of X-Ray facilities it has proved impossible for these to be undertaken in the Dispensary. These cases are therefore referred either to sanatorium where this treatment was started or to one of the London Hospitals for the continuation of the treatment. During 1937,18 cases were referred to the following hospitals:— Grove Park 2 patients. Brompton 3 „ University College 1 „ Royal Chest 12 „ Artificial Sunlight Treatment. This treatment is only of limited use for a very few cases of tuberculosis. Arrangements were made in one case for this form of treatment to be administered at the Infant Welfare Centre. Supervision of Contacts. A register was prepared during 1936 of all contacts below the age of 25 of sputum positive cases of tuberculosis (i.e., presumably the most infectious cases). The endeavour is being continued 175 to keep these persons under some general supervision until they reach that age, even when the source of infection is removed by death or otherwise. Up to the age of five this is exercised in general under the Infant Welfare Scheme, reports on progress and special features of individual cases being exchanged between the Departments. These patients are not encouraged to attend the Dispensary except when this is considered desirable by the Maternity and Child Welfare Medical Officer. Between the ages of 5 and 14 supervision is exercised through the School Medical Service, annual routine reports on progress being forwarded by the School Medical Officer, and at other times if the School Medical Officer considers a particular reference to the Dispensary desirable. Reports on the condition of those cases which have been examined in the Dispensary are supplied to the School Medical Officer. These cases are encouraged to attend at the Dispensary at least once in order that an X-ray picture should be available in case this is later required, and in order that the Tuberculosis Officer should be better able to maintain touch with the child after leaving school. Over the age of 14 and up to the age of 25, when the danger of the development of the disease is greatest, these persons are urged to attend at the Dispensary for routine clinical and X-ray examination at intervals of 12 months or two years, and more frequently if the general health is not satisfactory, or if suspicious symptoms arise. Throughout all these periods attempts are made where necessary to maintain the highest standards of general health by arranging periods of convalescence, providing grants of extra nourishment and other means that may be possible in individual cases. The following table shows the total numbers on the contact register at the several age periods and the number of these who have attended at the Dispensary during the year 1937. This table reflects the great difficulty that is experienced in securing supervision for the young adults, although parents are often anxious to 176 bring the children to the Dispensary even when this is entirely unnecessary. Number of cases on Contacts Register. Infants (under 5). School Age (5-14). Adolescents (14-25). Total (0-25). Total number on Register 24 177 228 328 Number seen during 1937 9 55 37 101 The London County Council have arrangements whereby child contacts of tuberculosis persons can be boarded out, when either they are in danger of being infected with tuberculosis, or the parent or parents are receiving residential treatment for tuberculosis. It is considered a valuable scheme, making it possible for the parents to have treatment and removing them from serious danger of infection. In two cases where the parents have consistently refused boarding-out, it was found that one child had tuberculosis of the spine, and in the other case tubercular fibrosis of the lungs. Since 1930, 69 children have been boarded-out, of whom four were still away at the beginning of the year. During 1937 these have returned home, and three others, none of whom remained away at the end of the year, have been similarly dealt with. It would appear that the scheme is preventing a certain amount of infection of the closer contacts, and it is probable that if it could be extended would considerably reduce the incidence of tuberculosis in the future. Parents, however, are only rarely willing for this course to be adopted, and other difficulties arise from time to time. Sanocrysin Treatment. This form of treatment has been undertaken in the Dispensary for a few cases where it appeared likely to be of benefit. 177 After-care of Surgical Tuberculosis. In order to secure continuity of treatment, those orthopaedic cases which have been treated by the London County Council in certain of their hospitals can now be seen periodically by that surgeon who had charge of their treatment in hospital. This examination takes place at County Hall, Westminster, and reports with recommendations are forwarded to the Tuberculosis Officer. Dental Treatment. The County Council provide dental treatment and dentures (when necessary) for those undergoing residential treatment. Arrangements are made by the Borough Council for a qualified dentist to be in attendance at the Municipal Dispensary at intervals, as required. Routine treatment is given to the Dispensary patients, and in necessitous cases dentures also are provided. Where patients are in receipt of public assistance the cost of the dentures is, however, borne by the Public Assistance Committee. During 1937 the following work was undertaken:— Number of sessions held, 17. Number of new cases seen, 14. Total number of attendances, 67. Dentures supplied to 5 persons (three by Finsbury Borough Council, one by Public Assistance Committee). Dentures in hand—for 3 persons (two by Finsbury Borough Council, one by Public Assistance Committee). Supply of Clothing for Dispensary Patients. Clothing for necessitous patients undergoing residential treatment, and others at home, is provided when possible by the Care Committee and other voluntary organisations. The London County Council, however, supplies this for those in hospital on a certificate from the Medical Officer of Health that it cannot be provided by the patient, his family, or charitable sources. Nursing Services. The Council have an arrangement with the Metropolitan District Nursing Association whereby this society provides such nursing services as are required in cases of tuberculosis on the request of the Tuberculosis Officer; 24 patients were referred last year, and in these cases 548 visits were made by the nurses. 178 Provision of Beds.—The Borough Council supplies beds, bedding, bed rests, and other nursing requisites when these are recommended by the Tuberculosis Officer in order to prevent the spread of infection, or to make the lot of the patient easier. Very wide and extensive powers in this connection are given to the Borough Council by Clause 12 of the Public Health (Tuberculosis) Regulations, 1930, which enable a local authority to supply all facilities and articles which may reasonably be required for removing conditions which favour infection. Fourteen beds and bedding remained on loan to patients and six beds and bedding were loaned to further patients during the year. FINSBURY TUBERCULOSIS CARE COMMITTEE. Annual Report, 1937. The monthly meetings of the Committee were continued throughout 1937. The following appointments to and changes in membership of the Committee were made during the year:— Member. Representing. Councillor Mrs. F. E. Gilbert Finsbury Borough Council. Councillor Mrs. A. A. Simmons Finsbury Borough Council. Councillor Dr. H. J. Kingsley Finsbury Borough Council. Mrs. K. Procter Local Public Assistance Committee. Councillor Mrs. M. M. Twigg Local Public Assistance Committee. Councillor B. Heaps London Trades Council. These, with the undermentioned, constituted the membership of the Care Committee at the close of 1937:— Member. Representing. Miss E. F. Bolton Charity Organisation Society. Mr. S. G. Nunn Clerkenwell Charities Trustees. Mr. F. T. Foulger, O.B.E. Finsbury War Pensions Committee and (Chairman). United Services Fund. Miss. D. Cooper Invalid Children's Aid Association. Mrs. S. S. Nunn Local Association of Schools (Care Committee) . Mr. F. Berliner London Chamber of Commerce. Miss O. W. Cram L.C.C. District Organiser, Children's School Care Committee. Dr. M. Hogarth L.C.C. Divisional School Medical Officer. Dr. N. D. Dunscombe Medical Officer of Health. Miss E. Emly Metropolitan District Nursing Association. Dr. C. O. S. B. Brooke Tuberculosis Officer. Miss F. M. Prior Tuberculosis Nurse and Visitor. 179 We deeply regret to record the death of Mr. T. Batey, late Clerk to the London Insurance Committee, who was the representative of that authority on the Care Committee from the time of his appointment thereon by the Borough Council in 1922. His experience particularly in matters relating to National Insurance made his services of great value. The work of the Committee in providing clothing for needy patients, principally those about to enter hospitals and sanatoria, and for members of their families continued. The clothing store received a notable gift of articles from the Botany Bay Women's Institute, the members of which devoted their efforts during the spring months to the making of knitted and other articles for this purpose. It is so frequently the case that the patient is the principal wage earner, or at least a considerable contributor to the family funds; apart from the withdrawal of their financial assistance, inroads are made upon the family resources in aid of the patient, and the replacement of clothing often becomes a matter of impossibility. These difficulties are magnified when the patient, having in mind the serious financial consequences of the cessation of his earnings, does not seek treatment early, endeavours to continue his work, and does so intermittently; the family by their efforts to help the patient are gradually impoverished, and when a breakdown occurs, are financially almost helpless. It is particularly in such cases, and also in those where the income may be said nearly always to be below the poverty line, that the Committee have been enabled by the generous gifts of the Botany Bay Women's Institute and others to give needed help. The Voluntary Fund of the Committee has been of the greatest assistance throughout the year. This has made possible the purchase of clothing not in stock, and urgently needed, the provision of pocket money for destitute patients, the payment of fares for visitation by near relatives of patients at a distance, and to meet calls of similar need. In the matter of the provision of pocket money for destitute patients undergoing institutional treatment, the Tuberculosis Officer communicated with the Medical Superintendents of 180 institutions to which Finsbury patients are sent under the County Council's Scheme. The suggestion of regular remittances in needy cases was generally welcomed; the position of the patient who is not himself able to buy a newspaper even occasionally, or such necessities as postage stamps or razor blades and so on, may be easily imagined; even a very small sum may mean a more or less contented stay under treatment, the lack of it may lead to early self discharge agaimst medical advice. The Committee much desired to give greater assistance, but the funds at their disposal enabled a normal grant of only 1s. 6d. per week, which, nevertheless, in the opinion of the majority of the medical superintendents consulted, met the pressing need. The following notes illustrate types of the many cases which the Committee has dealt with:— (a) N.—A man whose record showed continuous residence in common lodging-houses. He was destitute and apparently without friends. A grant of pocket money averted early self discharge from hospital. (J) C.—A lad transferred to a treatment-training institution, was provided with a complete outfit of clothing suitable for his new occupation. (c) B.—A perambulating street trader without insurance benefit or other financial resources. He was given pocket money whilst in hospital. After his death relatives in Ireland undertook the care of one of his two small children. The necessary fares were paid out of the Voluntary Fund. (d) C.—An ex-service man badly in need of clothing which he could not afford to buy. The Committee represented his case to the British Legion, which provided him with a complete set of underclothing and redeemed his outer clothing from pawn. (e)B.—An itinerant mat repairer, who was not qualified for National Health or other benefit, entirely without financial resources, was supplied with pocket money whilst in a sanatorium, and also clothing. The Committee continued the preliminary examination of recommendations made by the Tuberculosis Officer for grants of extra nourishment and dentures. 181 In all 139 recommendations for grants and three dentures were forwarded to the Public Health Committee. We received during the year from the Tuberculosis Officer a report with reference to a particularly difficult type of patient for whom there is no suitable provision made. These belong to the class who have a positive sputum and who are not in hospital. They live at home and remain a grave source of infection to others. The London County Council provide treatment for patients in their several institutions, and at times send cases to such colonies as Papworth and Preston Hall. Patients are also admitted to general hospitals for isolation. Many, however, who do not require active treatment, and therefore are not suitable for retention in an ordinary sanatorium or hospital, are sufficiently fit to do some work, or at least to be about and occupy themselves with odd jobs. They are consequently unwilling to enter or remain for long in a general hospital where activities are necessarily very limited. These institutions appear to be quite unsuited to this class of patient, and it is not reasonable to expect some cases to remain in them. On the other hand, the industrial capacity is often very small, and it does not appear to be an economical proposition to send these patients to an established colony. We have become well acquainted with this type of case, and we readily endorse the opinion of the Tuberculosis Officer as to the urgent need in the London area for institutions to maintain chronic cases where there appears to be little prospect of permanent cure, and where working ability is greatly lowered. In such a place these patients could be maintained for prolonged periods and made reasonably content by not enforcing a strict discipline, and by the provision of suitable light occupations and amusements. Medical supervision, of course, would be given, but cases requiring active medical treatment would be transferred elsewhere when indication for this arose. Many patients would, of course, refuse admission to this type of hostel, especially those at present at work, but it is believed that others would enter, and some would be persuaded from time to time to enter, especially when they are unsuitable for sanatorium treatment, as an alternative to transfer to a general hospital. Further, suitable cases who now would be unwilling to enter the proposed type of institution, might well have been 182 willing to do so if they had the opportunity upon discharge after treatment in a sanatorium. We consulted the various Metropolitan Tuberculosis Care Committees on this matter, suggesting common action by way of recommendation to the respective Borough Councils for representations to the London County Council as to the necessity for the provision of institutional treatment as suggested. General agreement with the proposal was indicated, and upon the recommendation of the Committee the Borough Council referred the matter to the Metropolitan Boroughs' Standing Joint Committee, with a view to other metropolitan borough councils supporting representations to the County Council accordingly. In connection with Coronation celebrations arranged by the Borough Council as affecting school children, many cases were represented to the Committee dealing with this matter, of families who had been severely affected financially by the death of tuberculous wage earner or other special circumstances. The Committee concerned dealt most sympathetically with these cases. We have received complaints from time to time of alleged insufficiency of dressing gowns at institutions. This has been supported occasionally by requests from patients for these garments. We enquired into the matter and we were told that dressing gowns were available for patients in the County Council's institutions, but not to the extent of a separate gown for each individual. In other institutions where beds were retained, individual provision was not always made. We intend to further consider this matter. We regret to report that the arrangements for the admission of Finsbury patients to the Handicraft Class conducted at the Royal Chest Hospital by the Islington Care Committee has not attracted Finsbury patients to the extent we had hoped. The Tuberculosis Officer informs us that he intends to approach the matter afresh upon the opening of the new Finsbury Health Centre in 1938, when it is confidently expected that with the inception of the new Dispensary in up-to-date, well-lighted and more cheerful surroundings under the control of officers with 183 whom patients are well acquainted, a Handicraft Class will be fully successful. We took into consideration the question of affiliation of the Committee with the National Association for the Prevention of Tuberculosis. The Association offers to affiliated bodies the advantages of the Christmas Seal Sale, the right to use the double red cross sign, literature at cost price, the special consideration where necessary of individual cases requiring assistance that cannot be adequately dealt with by local bodies, the right to send a representative to the Association's Annual Conference, and we accordingly made application and were duly affiliated to the Association. We were invited by the Association to participate in the Association's Christmas Seal Sales Scheme. We found upon enquiry that very considerable sums in aid of the Voluntary Funds of Care Committees are obtained by the scheme, but in view of other efforts in the Borough we decided that the addition of this activity was impracticable. We have continued our efforts to give or obtain assistance in many cases of difficulty relating to such matters as National Health and Unemployment Benefit, and the provision of housing accommodation referred to us by the Tuberculosis Officer. We append hereto a statement of the Voluntary Fund for 1937. In conclusion we desire to record our appreciation of the constant help we have received from Dr. Dunscombe, the Medical Officer of Health, and from Dr. Brooke, the Tuberculosis Officer, who has brought to our notice so many cases in which the Committee has been able to render help. Also to Miss Prior, the Tuberculosis Nurse and Visitor, and to Miss Cooper, representative of the Invalid Children's Aid Association. F. T. FOULGER, Chairman. E. Q. BILHAM, Secretary. 184 FINSBURY TUBERCULOSIS CARE COMMITTEE. Voluntary Fund, 1937. Income. Expenditure. £ s. d. £ s. d. Balance in hand, 1st January, 1937 1 15 6 Clothing and Repairs 7 9 0 Contributions from Sunday Cinematograph Entertainments 40 0 0 Fares—Visiting by Patients' Relatives, etc. 4 14 8 Repayments of Loan to Patients 15 0 Gratuities to Patients—(Pocket money) 6 0 4 Other Repayments 1 3 6 Handicraft Class—Fees and Materials 6 8 Removal Expenses of Patient's Family 1 5 0 Carriage on gift of Clothing 1 8 Poundages 1 1 19 18 5 Balance 23 15 7 Total £43 14 0 Total £43 14 0 This is to certify that the above Statement of Income and Expenditure is correct, and is in accordance with the Books and Vouchers which have been examined. (Signed) H. S. SAUNDERS, A.I.M.T.A., Borough Accountant. 3rd March, 1938. 185 Acts of Parliament. The following Acts of Parliament affecting the Department were passed last year:— Hydrogen Cyanide (Fumigation) Act, 1937. Factories Act, 1937. Memoranda, Circulars, Orders and Regulations issued during the year:— Orders in Council. Public Health (London) (Repealed Enactments) Order, 1937. Ministry of Agriculture. Statutory Rules and Orders and Regulations. Regulations made under the Agricultural Produce (Grading and Marking) Acts, 1928 and 1931, relating to Eggs, Derby Cheese, Plums, Wheat Flour and Wheat Flakes, Fruit Products, Lancashire Cheese, Canned Vegetables, Wensleydale Cheese, Leicester Cheese. Ministry of Health. Statutory Rules and Orders and Regulations. Public Health (Ophthalmia Neonatorum) Amendment Regulations, 1937. Housing Act (Forms of Orders and Notices) Regulations, 1937. Housing Act (Overcrowding and Miscellaneous Forms) Regulations, 1937. Public Health (Imported Food) Regulations, 1937. Circulars and Memoranda. Notification and Treatment of Ophthalmia Neonatorum. Public Health (Imported Food) Regulations, 1925. Annual and Special Reports of the Medical Officer of Health. Public Health (Imported Food) Regulations, 1937 (2). Maternal Mortality. Meat Inspection. Local Health Services (Information at Post Offices). Midwives Act, 1936. Overcrowding—Duties of Local Authorities. Expectant Mothers—Supply of Milk, 186 LEGAL PROCEEDINGS, 1937. Date. Name and Address of Defendant Offence. Result. 1937. Public Health (London) Act, 1936. 5th Jan. James Hutchings, 14, Keystone Crescent, N.1. 1. Selling unsound chestnuts. Fine £2 Costs 2. Depositing for sale unsound chestnuts. Fine £2 £1. 12th Jan. Tom Pathejohns Isaac, Barnstaple, Devon. Depositing for sale diseased sheep plucks. Dismissed under Probation of Offenders Act. Costs £15 15s. 23rd Mar. W. H. Franklin & Co., 25, Thistlewaite Road, E.5. Failure to:— Dismissed under Probation of Offenders Act. Costs £59s. 1. Give notice of commencement of drainage work. 2. Deposit plans. 3. Construct W.C. in conformity with Bye-Laws. 13th Oct. R. F. Evans, 108, King's Cross Road, W.C.1. Food and Drugs Failure to register as a food preserver. (Adulteration) Act, 1928. Dismissed under Probation of Offenders Act. Costs £1. 24th Mar. Miss M. E. Morris, 114, Clerkenwell Road, E.C.1. Selling milk 5 per cent. deficient in fat. Fine £1. Costs £1s. 20th May R. V. Parry, 367, St. John Street, E.C.1. Selling milk 12 per cent. deficient in fat. Dismissed under Probation of Offenders Act. Costs £1 1s. 5th Aug. E. M. Hughes, 99, Lever Street, E.C.1. Selling milk 16 per cent. deficient in fat. Dismissed under Probation of Offenders Act. Costs £2 2s. Merchandise Marks Acts, 1887-1926. 14th May. West (Butchers) Ltd., 30, Chapel Market, N.1. Applying false trade description to foreign meat exposed for sale. Dismissed under Probation of Offenders Act. Costs £5 5s. 14th May. Robinson (Pork Butchers) Ltd., 16, Chapel Market, N.1. do. Dismissed under Probation of Offenders Act. Costs £5 5s. 31st May. H. Gilbertson, 11, Exmouth Street E.C.1. do. Fine £5. Costs £5 5s. 15th Dec. G. Randall (stallholder Exmouth Street, E.C.l. do. Fine £5. Costs £2.