LIBRARY FIN 19 Metropolitan Borough of Finsbury ANNUAL REPORT ON THE Public Health of Finsbury for the Year 1938 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 VAIL & CO; LIMITED (T.U.). FINSBURY, E.C. 1939 THE Metropolitan Borough of Finsbury ANNUAL REPORT ON THE Public Health of Finsbury for the Year 1938 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 VAIL & CO-. LIMITED (T.U.), FINSBURY, E.C. 1939 2 CONTENTS. Page Public Health Committee, 1938-39 3 Maternity and Child Welfare Committee, 1938-39 3 Introduction 8 Staff of the Department 5-7 Section A—Statistics and Social Conditions of the Area 11 Section B—General Provision of Public Health Services 24 Section C—Sanitary Circumstances of the Area 77 Section D—Housing 103 Section E—Inspection and Supervision of Food and Drugs 108 Section F—Prevalence and Control over Infectious and other Diseases 123 STATISTICAL TABLES. Page Statistical Summary 11 Public Assistance 13 Population 16 Births and Birth Rates 16 Deaths and Death Rates 19-22 Comparative Table 23 Maternity and Child Welfare 32 et seq. Nursing Services 36 Convalescence 40 Foster Mothers 44 Bacteriological Examination of Milk for Grants 49 Voluntary Centres 50 et seq. Infant Mortality 55 el seq. Midwifery Scheme 62-63 Page Home Helps 66 Maternal Mortality 66 Medical Inspection—School Children 70-72 Summary of Work — Sanitary Inspectors 77-78 Factories and Workshops 81—87 Canal Boats 92 Housing 103-104 Food Seized and Surrendered 114 Food Sampling 120-122 Notifiable Diseases 123-124 Diphtheria 128-131 Cancer 137 Tuberculosis 138 et seq. For detailed Index see page 4. 3 METROPOLITAN BOROUGH OF FINSBURY. Public Health Committee, 1938-1939. Chairman : Councillor W. BARRIE, M.P.S. Vice-Chairman : Councillor Mrs. F. E. GILBERT HIS WORSHIP THE MAYOR (Alderman Dr. C. L. Katial, J.P.) Alderman H. J. DAINTY. Alderman Mrs. E. MARTIN. Alderman H. RILEY. Councillor Mrs. A. E. GIBBS. Councillor Mrs. C. GRIFFITHS. Councillor Dr. H. J. KINGSLEY. 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, 1938-1939. Chairman : Alderman Mrs. E. MARTIN.*† § Vice-Chairman : Councillor Mrs. R. CURTIS.*†§ HIS WORSHIP THE MAYOR (Alderman Dr. C. L. Katial, J.P.) Councillor Mrs. E. K. ALLEN.* Councillor W. BARRIE, M.P.S. Councillor Mrs. F. E. GILBERT.*! Councillor Mrs. C. GRIFFITHS. Councillor Mrs. L. E. JEFFS. Councillor S. G. NUNN, J.P. Councillor Mrs. A. RAFE.†§ Councillor Mrs. A. A. SIMMONS. § Councillor Mrs. B. SOUTH.† Councillor A. G. WEBB.*† § * Maternity (Management) Sub-Committee. † 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 93 Agricultural Produce (Grading & Marking) Acts, 1928 & 1931 117 Ambulance Facilities 28 Artificial Sunlight Treatment 34 Bacteriological Examinations 27 Bacteriological Examination of Grants Milk 49 Bakehouses 120 Birth and Birth Rates 16 Birth Control 34 Births, Deaths and Population— Comparative Table 23 Blind Children 46 Cancer 137 Canal Boats 92 Chicken-pox 135 Cleansing Station 97 Compulsory Removal of Persons 93, 143 Common Lodging Houses 101 Comparative Statistics 23 Convalescent Treatment 38 Day Nursery 35 Deaths and Death Rates 19 Destruction of Rats 90 Diabetes—Insulin Treatment 137 Diphtheria 128 Diphtheria Immunisation Clinic 130 Diphtheria Immunisation— General Practitioners' Scheme 132 Disinfection 96 Disinfection for Export 97 Dispensaries—Tuberculosis 144 Voluntary 30 Drainage 79 Dysentery 136 Ear Clinic 33 Factories and Workshops 79 Food Export 118 Food Inspection 108 Food Poisoning 118 Food Sampling 120 Food Storage 96 Foster Mothers 44 German Measles 135 Grants Scheme 48 Health Centre 24-27 Health Visitation 48 Home Helps 65 Home Nursing 35 Hospital Treatment 36 Houses Let in Lodgings 95 Housing 103 Housing—Scheduled Areas 105 Housing Applications 107 Ice Cream 110 Imported Food Regulations 115 Infant Deaths 55 Infectious Diseases 123 Insulin Treatment 137 Inquests 21 Introduction 8 Lectures at Centres 34 Legal Proceedings 158 Licensed Houses 89 Lighting of Staircases 107 Maternal Mortality 66 Maternity and Child Welfare 30 Measles 132 page Meat Inspection 114 Members of Committees 3 Merchandise Marks Act, 1926 116 Midwifery Service 60 Milk Shops and Dairies 108 Milk (Special Designations) Order, 1936 109 Mortuary 96 Mumps 135 Municipal Centres 30 National Society for Prevention of Cruelty to Children 45 Noise 102 Notifiable Diseases 123 Notification of Births 17 Nursing Homes 76 Offensive Trades 87 Ophthalmia Neonatorum 45 Orthopaedic Conditions 46 Outworkers 86 Overcrowding 104 Pharmacy and Poisons Act, 1933 113 Pigeon Nuisance 102 Pneumonia 135 Population 15 Population—Birth and Death Rates 23 Propaganda 73 Public Assistance 13 Public Baths 100 Public Cleansing 97 Public Conveniences 93 Public Vaccination 125 Pulmonary Tuberculosis 138 Puerperal Fever 46 Rag and Bone Dealers 88 Rag Flock 95 Rat Nuisance 90 Registration of Food Premises 112 Sanitary Circumstances 77 Scarlet Fever 126 Schools 13 School Medical Service 70 School Milk 111 Shelter 96 Shops Act, 1934 93 Slaughter-houses 119 Smallpox 125 Smoke Abatement 89 Social Conditions 12 Staff 5-7 Statistics 11 Stillbirths 17 Street Traders 95 Tonsils and Adenoids 38 Tuberculosis 138 Tuberculosis Care Committee 152 Tuberculosis Dispensary 144 Unemployment 14 Vaccination 125 Venereal Disease 136 Verminous Premises 94 Voluntary Associations 50 Voluntary Dispensaries 30 Weighing Centres 47 Whooping Cough 134 Winter School for Health Visitors 45 Women's Country Holidays 35 Work of the Sanitary Inspectors 77 X-ray Facilities 146 5 STAFF OF THE PUBLIC HEALTH DEPARTMENT. 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 : C. M. M. Culver Evans, M.R.C.S., L.R.C.P. Public Analyst : J. K. Colwell, F.I.C., F.C.S. (part-time) Public Vaccinators : Dr. R. E. Batson. Dr. R. K. Dadachanji. Dr. B. McKeown. Dr. Susan A. Finch. Vaccination Officer : P. E. Capps (part-time) Clerical Staff : E. Q. Bilham (Assistant Administrative Officer) L. T. H. Mussett. J. E. McDowell. T. E. Williams. A. J. Truslove (appointed A. F. Cowan (comm. 21st Nov., 1938) Sanitary Inspector, 24th W. W. Goldberg (comm. 7th Nov., 1938) Oct., 1938) G. Hawthorn. Inspectorial Staff : Senior Meat Inspector—T. Penman. Assistant Meat Inspector—R. S. Barber. Sanitary Inspectors : E. A. Norman (Senior). H. Newdick. R. E. Lay. H. Clinton. H. Ward. A. C. Jenkins. Miss F. Hall. A. J. Truslove (from 1st Nov., 1938). 6 Tuberculosis Dispensary Staff Tuberculosis Nurse—Miss F. M. Prior. Clerk and Laboratory Assistant—Miss A. Rime Secretary of Care Committee—E. Q. Bilham. *Women's Clinic : Medical Officer—C. M. M. Culver-Evans, M.R.C.S., L.R.C.P. *Dental Clinic : Dental Surgeon—P. R. Asplet, L.D.S. Engl. Panel of Anaesthetists—Dr. R. E. Batson, Dr. B. McKeown, Dr. F. Robinson, Dr. B. J. Wilton. *Foot Clinic : Chiropodist—S. Philpot, M.I.S.Ch. *Solarium : Medical Officer—C. O. S. Blyth Brooke, M.R.C.S., L.R.C.P., D.P.H. Nurse Masseuse—Miss E. G. Fawcett, S.R.N., C.S.M.M.G. *Cleansing Station : L.C.C Nurse-in-Charge—Miss Francis. Bathing Women—Mrs. E. S. Connolly, Miss A. R. D'Arbour. *,These activities date from November/December, 1938, following the opening of the New Health Centre. Health Centre Cleaning Staff : The cleaning staff consists of one forewoman cleaner, six women cleaners, one male cleaner. Resident Engineer and Health Centre Keeper—F. W. Battle. Janitors—T. Richards, T. E. Doncaster. Disinfectors—J. Luke (senior), F. Readstone, E. J. Connolly (Driver). Maternity and Child Welfare : Italian Clinic Medical Officer—Dr. H. Lomas (part-time). Dental Surgeon—P. R. Asplet, L.D.S. Engl, (part-time). 7 Centre Superintendents— Leage Street—Miss M. Fillingham. Pine Street—Mrs. E. J. Hewlett. Health Visitors—Miss J. R. Turner, Miss M. Rock, Miss L. Breaman, Mrs. G. Hartney, Miss B. J. Scott. Dispensers—Miss E. M. Holland (part-time), Miss M. S. Kaye (part-time). Clerks—Miss W. A. Freeman, Miss C. A. Blunden. Cook-Cleaners— Leage Street Centre—-Mrs. A. Purcell and Mrs. A. Fletcher. Pine Street Centre—Mrs. M. A. Cunningham and Mrs. A. K. Grey. Day Nursery : 42, Lloyd Baker Street, W.C.i Matron—Miss I. V. Oakes. Nurse—Miss L. Wilkinson. Probationers—Misses M. C. Blunn, J. Robertson, F. Herbert. Cook—Mrs. L. Matthews. Cleaner—Mrs. A. L. Emmerton. His Majesty's Inspector of Factories for the Borough : Miss K. Crundwell, City-Gate House, Finsbury Square, E.C.2. Telephone No. : Metropolitan 1371. 8 To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Finsbury. Mr. Mayor, Ladies and Gentlemen, I have pleasure in presenting my Annual Report for the year 1938, upon the sanitary circumstances and state of the public health generally. Health Centre.—The Health Centre in Pine Street referred to in previous reports was officially opened on Friday, 28th October, by Lord Horder, G.C.V.O., M.D., F.R.C.P., who said it was a privilege to open such a unique building, through whose portals so many thousands of people would seek and find health and happiness. The Centre represents a breakaway from traditional lines, and centralises in one building the majority of the public health services formerly scattered throughout the Borough. The services are a Dental Clinic, a Clinic comprising the functions of the Tuberculosis Dispensary, with an X-Ray Department, a Foot Clinic, a Clinic for Women primarily suffering from menopausal conditions, a Solarium for ultra-violet ray and massage treatment, and a Laboratory for the bacteriological examination of swabs from the nose and throat, sputa and the like. The building also includes a Cleansing and Disinfecting Station, Mortuary and a Reception House for the temporary accommodation of families whose premises require disinfection or disinfestation. Provision is also made for the Administrative Offices of the Health Department, and a Lecture Hall seating 80 persons. That this unique building has been a matter of interest to many is evidenced by the number of visits paid by many people from all parts of the country. A more detailed description will be found in the body of the report. The Clinics have been available to the public since November 28th. Vital Statistics.—The general death-rate was 12.9 per 1,000 population, as compared with 11.6 per 1,000 for the whole country, and 14.6 per 1,000 in the Borough during the year 1937. Infantile Mortality.—The infantile mortality rate was 73 per 1,000 births, as compared with 71 per 1,000 in 1937. The rate for London was 57 per 1,000 births. 9 Maternal Mortality.—The puerperal mortality rate was 1.35 per 1,000 total (live) births, and the total Maternal Mortality (including associated deaths) 4.05 per 1,000. The rate of 1.35 per 1,000 compares with a rate of .89 per 1,000 for England and Wales. Birth-Rate.—The birth-rate was 13.0 per 1,000, as compared with 13.4 per 1,000 for London as a whole and 13.8 per 1,000 in the Borough in 1937. Infectious Diseases.—The number of cases of Scarlet Fever was 144, as compared with 114 in 1937. The number of cases of Diphtheria notified was 101, as compared with 108 in 1937. Diphtheria Immunisation.—A total of 246 persons were immunised last year, as compared with 181 in 1937. The immunisation is carried out either at one or other of the Municipal Welfare Centres or by the general practitioners under a scheme in operation in the Borough since 1935. Housing—Busaco Street Area.—The re-development of this area referred to in previous reports is proceeding. Many of the houses have been demolished. Sadler Street Area.—An enquiry in respect of this area was held last year in respect of certain properties included in the Scheme. It is proposed to erect 112 flats on the site. Maternity and Child Welfare.—The activities of this section of the work of the Department are dealt with in detail in the body of the report. The scheme under the Midwives Act, 1936, for a service of domiciliary midwifery, for which the London County Council is responsible, commenced at the beginning of the year. The Borough Council have made the necessary arrangements for those matters not covered by the domiciliary service, reference to which will be found on pages 60-65 of this report. 10 In conclusion, I wish to thank the Chairman and Members of the Public Health, Maternity and Child Welfare and Housing Committees for their continued confidence and support. 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 during an exceptionally strenuous year. I have the honour to be, Your obedient servant, NICHOLAS D. DUNSCOMBE, Medical Officer of Health. April, 1939. 11 SECTION A. Statistics and Social Conditions of the Area. Area (in acres) 587 Registrar-General's estimate of resident population 1938 56,960 Number of inhabited houses end of 1938 (according to Rate Books) 8,924 Rateable value £1,263,200 Sum represented by a penny rate £4.894 Extracts from vital statistics of the year :— Live Births :— Total. Males. Females. Legitimate 702 348 354 Illegitimate 39 18 21 Birth Rate per 1,000 population Finsbury 13.0 London 13.4 England and Wales 15.1 Deaths :— Total. Males. Females. 734 377 357 Death Rate per 1,000 population Finsbury 12.9 London 11.4 England and Wales 11.6 Deaths from puerperal causes :— Deaths. Rate per 1,000 total (live) births. Puerperal sepsis 0 0.0 Other puerperal causes 1 1.35 Deaths not classed to pregnancy and childbearing but associated therewith 2 2.70 Total Maternal Mortality 3 4.05 Death Rate of infants under one year of age :— All infants per 1,000 live births Finsbury 73 London 57 England and Wales 53 Legitimate infants per 1,000 legitimate live births 70 Illegitimate infants per 1,000 illegitimate live births 51 12 Deaths from measles (all ages) 1 „ whooping cough (all ages) 7 „ diarrhoea (under 2 years of age) 16 In comparison with figures for 1937, the following matters are of interest:— Diphtheria showed a slight decrease in 1938. Scarlet fever was somewhat more prevalent. The number of cases of measles notified in 1938 was higher than in 1937. The notifications of all forms of tuberculosis were less in 1938. Whooping cough was much more prevalent in 1938 as compared with 1937. The number of deaths and the death-rate were lower in 1938. The infant mortality was 73 per 1,000 births. The deaths due to influenza, tuberculosis, cancer, heart disease, pneumonia and other respiratory diseases and violence were all less in 1938. In the case of no single disease was the increase in deaths of any note. Social Conditions and Character. The Metropolitan Borough of Finsbury was formed by the London 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. 13 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. 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 1937-8:— 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. 1937. 1938. 1937. 1938. March 1,703 1,297 3 2 June 1,416 1,281 1 2 September 1,340 1,284 0 3 December 1,280 1,331 4 3 14 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 employment position in the Borough of Finsbury for the year 1938 continued to improve slightly and may be considered satisfactory. The following table gives the total number of placings, by departments, effected during the year:— Notified. Filled. Local Applicants Placed in Other Districts. By Local Applicants. By Applicants from Other Districts. Total Filled. Men 15,176 8,976 5,348 14,324 4,732 Women 6,169 3,296 830 4,126 3,014 Boys 3,642 1,804 338 2,142 372 Girls 3,329 1,530 516 2,046 200 It will be noted that apart from those for whom employment was found locally, a considerable number of persons were found employment in other districts. The shortage of certain skilled types of workmen referred to in the last report still remains, and in filling vacancies for such types it has on occasion been necessary to import workmen from other districts. The majority of the persons unemployed in the Borough of Finsbury are unskilled, and the fact must be faced that the prospect of finding these persons more or less regular employment is somewhat remote. The position with regard to these male persons has been alleviated somewhat by the institution of the Council's Casual Labour Recruitment Scheme, which gives unemployed persons six weeks' employment during the year. It is pleasing to record, therefore, that the majority of such 15 persons have had some employment, even although of a short duration, and very few have remained continuously unemployed. The Live Register at the end of the statistical year for 1938 was as follows :— Men 6,059 Women 1,460 Boys 60 Girls 30 Total 7,609 The above figures represent those persons registered at the King's Cross Employment Exchange, Barnsbury Road, and, in addition to Finsbury residents, include a certain number of residents in the neighbouring Boroughs of Islington, Shoreditch, St. Pancras and Holborn. On the other hand, there are a number of Finsbury residents registered at the Shoreditch Employment Exchange, Kingsland Road, E.2. The main industries in the area have during 1938 been reasonably brisk, but certain of the luxury trades, viz. : jewellery, have suffered from the slump. Several skilled craftsmen in this industry have found employment in the general engineering and aircraft industries. The demand for juvenile labour has remained much the same and there is still a heavy demand for both sexes of juveniles which cannot be met, especially between the ages of 14 and 15 years. Several firms employing one hundred or more workpeople have removed from the district to areas on the outskirts of London, and in the majority of cases have not taken their labour with them. To balance this there have been a number of new factories erected and occupied during the year, but no new industries have been introduced. Certain firms have, however, commenced the manufactire of goods previously imported and are meeting with a measure of success. 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 1938 is estimated by the Register General to be 56,960, which is the figure 16 used in compiling this report. The population has gradually diminished since the census of 1901. Estimate of Population, 1937. Estimated population 1938. Census population 1931. Census population 1921. Clerkenwell 37,309 45,777 50,322 St. Luke 19,005 23,319 24,592 St. Sepulchre 646 792 1,081 Totals 56,960 69,888 75,995 The estimate does not include the Finsbury residents detained in various London County Council Public Assistance Institutions Births and Births Rates. These are given in the annexed table:— Year. Population in the middle of each year. Corrected Births. Corrected Births. Rates. 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 1938 56,960 741 13·0 The rates for the various districts in 1938 were as follows:— Population. Births. Birth Rate. Clerkenwell 37,39 499 13·4 St. Luke 19,005 236 12·4 St. Sepulchre 646 6 9·3 56,960 741 13·0 17 The corresponding birth rates for the rest of the country are attached:— England and Wales 15·1 London 13·0 Finsbury 13·0 126 great towns 15·0 148 smaller towns 15.4 The number of Finsbury births reported as illegitimate was 39. The number of deaths in illegitimate children under one year was 2. The total number of stillbirths was 38. Notification of Births. The number of Finsbury births notified in 1938 was 849, of which 37 were stillbirths. Notifications were received of 10 pairs of twins. The number of births notified by parents was 7, by midwives 204, by doctors 11, by hospitals, infirmaries and nursing homes 398, and by others, chiefly professional assistants, 229. In 1938 the number of instances in which parents omitted to notify, and where there was no notification from any other source, was 6. 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. 18 The table below gives particulars of the stillbirths allocated to the Borough registered last year:— Legitimate Males 16 Females 19 Illegitimate Males 2 Females 1 Total 38=4.9% of total births. In 1937 the percentage was 3·4. The stillbirths are investigated by the Assistant Medical Officer of Health. The following reasons were ascertained as the cause:— Maternal Causes. Abnormalities of (a) Labour 3 (b) Presentation 6 (c) Uterus 2 (d) Placenta 3 Disproportion 5 Haemorrhage, accidental 3 Toxaemia 3 Unknown 6 31 Foetal Causes. Abnormalities of (a) Cord 2 (b) Developmental (i) anencephaly 2 (ii) hydrocephaly 1 (iii) meningocele and spinabifida 1 Prematurity 1 7 Of the abnormal presentation cases four were breech and two persistent occipito-posterior; in only one case was the state diagnosed in the ante-natal period. Of the cases associated with uterine abnormality, one was due to primary uterine inertia and one to rupture through an old caesarian scar. Of the toxaemia cases, all were recognised during the ante-natal period, two being treated in hospital during this time. Of these one severe case of eclampsia admitted at first attendance, caused a maternal death. Of the unknown cases, one was associated with trauma (a severe fall), one with the cord round the neck and precipitate labour, and one with a history of a previous stillbirth. In three cases, no contributory cause could be ascertained. 19 Deaths and Death Rate. The number of Finsbury residents who died in 1938 was 734, this is equivalent to a crude death rate for the whole Borough of 12.9. 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 1938, it is given by the Registrar General as 1.09. By the use of this correction factor, the death rate for Finsbury for 1938, the "standardised" death rate, is 14.1. The death rates for previous years are given in the attached table:— Deaths Rates, 1912-1938. Year. The Borough. Year. The Borough. 1912 18·5 1925 14·3 1913 18·4 1926 13·7 1914 19·6 1927 14·0 1915 21·5 1928 15·1 1916 19·3 1929 16·0 1917 20·4 1930 13·1 1918 23·7 1931 14·02 1919 15·4 1932 13·4 1920 14·7 1933 12·8 1921 14·7 1934 *13·4 †14·6 1922 16·5 1935 12·6 13·7 1923 13·5 1936 14·0 15·3 1924 14·7 1937 14·6 15·9 1938 12·9 14·1 * 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 1938. England and Wales 11.6 per 1,000 London 11.4 „ Finsbury 12.9 „ 126 great towns 11.7 ,, 148 smaller towns 11.o „ Age at Death.—There were 389 deaths of persons in Finsbury at 65 years of age and over, and of these 192 were of persons over 75 years of age. 20 Deaths, 1937. Causes of Death. All Ages. 0- 1- 2- 5- 15- 25- 35- 45- 55- 65- 75- Measles 1 1 - - - - - - - - - - Scarlet Fever 0 - - - - - - - - - - - Whooping Cough 7 2 4 1 - - - - - - - - Diphtheria 3 1 - - 2 - - - - - - - Influenza 0 — — — — — — - — - — - Encephalitis Lethargica 2 - - - - 1 1 - - - - - Cerebro-spinal Fever 2 2 - - - - - - - - - - Tuberculosis of respiratory system 35 - - 1 1 5 8 4 8 6 2 0 Other tuberculous diseases 3 - - - - - 1 1 1 - - - Syphilis 1 - - - - - - - 1 - - - General paralysis of the insane, tabes dorsalis 3 - - - - - - - - 1 2 - Cancer, malignant disease 113 - - - 1 - - 2 19 34 39 18 Diabetes 10 - - - - - - 1 1 1 7 - Cerebral haemorrhage, etc. 20 - - - - - - - 1 4 13 2 Heart disease 240 — — — 1 2 5 4 15 32 72 109 Aneurysm Other circulatory 4 — — — 1 — — — — 3 — — diseases 30 - - - - - - - - 5 8 17 Bronchitis 29 3 — — — — 1 — 5 7 8 5 Pneumonia (all forms) 46 7 2 1 2 - - 1 3 9 12 9 Other respiratory diseases 3 - - - - - 1 - - - 2 - Peptic Ulcer 10 - - - - - - 3 1 4 2 - Diarrhoea, etc. 17 15 1 — — — — — 1 — — - Appendicitis 3 — — 1 1 — — — 1 — — — Cirrhosis of Liver 5 — — — — 1 — — 2 1 — 1 Other diseases of Liver, etc. 3 - - - - - - 1 - - - 2 Other digestive diseases 8 - - - 1 - - - 1 - 5 1 Acute and Chronic Nephritis 18 - - - - 2 2 - 5 1 5 3 Puerperal Sepsis 0 - - - - - - - - - - - Other puerperal causes 1 - - - - - 1 - - - - - Congenital debility, premature birth, malformation,etc. 17 17 - - - - - - - - - - Senility 5 — — — — — — — — — 1 4 Suicide 5 — — — — — 1 — 1 2 — 1 Other violence 25 1 — — 1 3 2 4 1 1 3 9 Other defined diseases 65 5 - 2 - 4 3 5 7 12 16 11 Causes ill-defined or unknown 0 - - - - - - - - - - - All Causes 734 54 7 6 11 18 26 26 74 123 197 192 21 From the previous table it will be seen that the chief causes of death were as follows:— (a) Diseases of the heart and circulatory system 274 (b) Malignant disease 113 (c) Respiratory diseases 78 (d) Pulmonary tuberculosis 35 (e) All forms of tuberculosis 38 The following table shows the number of deaths from cancer and the death rates for the last 13 years. At the beginning of the century the death rate was 0·70 per 1,000:— 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 1938 113 1·99 Inquests. Inquests were held on 42 residents of the Borough last year, as compared with 50 in 1937. The table below gives the findings of the inquests:— Accidental: Asphyxia 1 Burns 3 Falls 12 Motor vehicle accidents 6 Overdose of insulin 1 Ruptured uterus 1 22 Suicidal: Coal gas poisoning 1 Fall under train 1 Fall from window 1 Shooting 1 Hanging 1 Other : Bronchitis 2 Cirrhosis of liver 1 Heart disease 1 Heart failure—pregnancy 1 Heart and kidney disease 1 Phthisis 2 Pneumonia 3 Toxaemia 1 Tuberculous meningitis 1 Deaths on the Road. 1936 9 1937 9 1938 6 Deaths of Persons 1-5 Years. Thirteen deaths occurred last year of persons between the ages of one and five years. The deaths were ascribed to the following causes:— 1934 1935 1936 1937 1938 Violence 12 4 0 4 0 Measles 11 0 12 0 0 Scarlet fever 2 1 1 0 0 Whooping cough 3 1 3 0 5 Diphtheria 13 1 1 0 0 Phthisis 4 2 0 0 0 Other tuberculous diseases 3 2 2 0 1 Heart disease 5 0 0 0 0 Pneumonia and bronchitis 11 6 8 6 3 Other diseases 11 11 6 6 4 Totals 75 28 33 16 13 23 Comparative Table. The following table shows the general birth and death rates and infant mortality in each of the Metropolitan Boroughs:- City or Borough. Estimated population. Birth rate. Death rate : Infant Mortality rate. Crude. Adjusted West Districts. Paddington 137,400 13·74 11·33 11·21 66 Kensington 174,100 12·8 11·7 10·9 78 Hammersmith 125,100 15·5 11·3 11·6 61 Fulham 137,700 14·2 11·6 11·7 51 Chelsea 56,050 10·2 13·5 11·5 80 City of Westminster 124,400 8·3 10·4 10·7 54·9 North Districts. St. Marylebone 90,680 8·84 11·12 11·0 60 Hampstead 90,480 11·7 11·4 10·7 57 St. Pancras 179,400 13·5 11·5 11·7 64 Islington 292,300 15·32 11·90 12·02 65 Stoke Newington 50,480 13·8 11·0 10·5 43·2 Hackney 205,200 13·4 10·7 11·2 56·46 Central Districts. Holborn 34,350 7·28 10·51 11·25 84 Finsbury 56,960 13·0 12·9 14·1 73 City of London 8,780 6·6 10·7 11·8 51·8 East Districts. Shoreditch 80,360 14·7 11·4 12·5 64 Bethnal Green 92,910 14·2 11·3 12·8 59·3 Stepney 200,500 13·06 11·05 12·92 60·7 Poplar 134,400 14·9 11·4 12·7 60 South Districts. Southwark 145,300 14·0 12·5 13·4 57 Bermondsey 97,420 14·8 11·0 12·54 45 Lambeth 272,800 14·09 11·9 11·7 51 Battersea 141,700 14·92 11·82 11·70 53·45 Wandsworth 340,100 11·92 11·17 10·38 46 Camberwell 222,400 13·97 12·27 12·27 61 Deptford 95,460 14·4 11·8 * 54 Greenwich 95,770 13·64 10·89 11·1 42 Lewisham 229,000 13·9 10·49 10·5 47 Woolwich 150,900 13·6 10·4 11·0 50 * Not available. 24 SECTION B. General Provision of Public Health Services- Staff. A list of the members of the staff at the close of the year is given on pages 5-7 of this report. Health Centre. In this building, referred to at the beginning of the report, the majority of the Public Health Services have been centralised, with the exception of the Council's two Maternity and Child Welfare Centres which are accommodated in comparatively new premises, and the Day Nursery which is situated in Lloyd Baker Street. First Floor.—On the top floor will be found the Administrative Department: on one wing the offices of the Medical Officer of Health the Deputy Medical Officer of Health, who is also the Tuberculosis Officer and the Assistant Medical Officer for Maternity and Child Welfare, the Assistant Administrative Officer, the clerical staff, the Vaccination Officer, the Senior Sanitary Inspector, and the District and Special Sanitary Inspectors. The centre wing comprises a Lecture Hall, to accommodate 80 persons, Male and Female Staff Rooms, and the office of the Health Visitors and Lady Sanitary Inspector. A roof terrace has been provided on this wing for the use of the staff of the Department. On the other wing there is a two-bedroom flat for the use of Caretaker, and a Reception House or Shelter for the accommodation of families when required during the disinfection of their rooms after the removal of cases of infectious disease. The Shelter comprises Male and Female Wards, a communal kitchen, male and female bathrooms and sanitary accommodation. The approach is distinct from that to the Clinics and Administrative Offices. Ground Floor.—On the ground floor are situated the various clinic rooms providing up-to-date facilities for the practice of preventive medicine in all its branches. In one wing we find a modern dental surgery, with X-ray facilities and a Mechanic's room, where patients attending the Municipal Dispensary, Maternity and Child Welfare patients and others are able to obtain dental treatment, including dentures at a cost according to their circumstances. 25 It is hoped that this service will fulfil a need not hitherto fullyprovided for. The Scheme approved by the Council for this work is a considerable extension of former arrangements as treatment will be available for adolescents and adults generally. There also are the Foot and Women's Clinics, both new branches of the service. The Foot Clinic is conducted by a fully qualified chiropodist, and deals with such conditions as corns, warts and the like, the cause of much unnecessary disability especially amongst those who spend much time standing. The Women's Clinic is primarily a clinic for women "over forty" suffering from disease consequent upon "change of life," but will also deal with minor gynaecological conditions: a special treatment room has been provided for this purpose. The Centre wing consists of a large Waiting Hall, with a Janitor's desk and office, from which all callers are directed to the appropriate clinic or office. At the rear of this is the Solarium, another new service provided for the use of patients referred by the various clinics in the building and outlying Maternity and Child Welfare Centres, Municipal and Voluntary. The Massage and Light Clinic, formerly conducted in the adjoining Pine Street Maternity and Child Welfare Centre, has been transferred to the Solarium: the Light Clinic provided at the Leage Street Centre will, however, be continued. It is provided with four special treatment cubicles, one room for collective treatment by means of carbon-arc lamps and showers. In the other wing is the Clinic equipped with a modern X-ray apparatus and dark room, and the latest equipment for the cure and prevention of Tuberculosis, replacing dwelling house premises converted temporarily for this use in 1931. A special surgery is incorporated in the Clinic for the treatment of patients by collapse therapy. The Bacteriological Laboratory formerly was housed in the administrative offices of the Public Health Department: in the new buildings improved accommodation has been provided in this wing in which the work can be more efficiently carried out under the direct supervision of the Tuberculosis Officer, who is also the Deputy Medical Officer of Health. 26 Sub-ground Floor.—Finally there is the sub-ground floor, the centre portion of which consists of a modern Disinfecting Station and Cleansing Station. The Disinfecting Station was hitherto situated in Northampton Road in an old building which also included the Reception House and Mortuary. In the new Disinfecting Station, approached by a ramp at the rear of the Centre, modern steam raising plant has been installed, one large and one small high pressure steam apparatus being provided. The station includes the foreman's office, staff room and a bathroom, with a shower for the staff of the Station, and three garages. Cleansing Station. The only Cleansing Station in the Borough until the erection of the new Centre was an old building provided by the London County Council adjoining an elementary school, and for the use of school children only. Adults requiring treatment for these conditions were referred to a neighbouring Borough, and no satisfactory arrangements existed for those under school age. The new Cleansing Station, with its two sides for verminous conditions and scabies, enables this service to be provided locally. By arrangement with the Education Authority the service is also available to children referred from the elementary schools in the neighbourhood. It is approached at the rear by means of steps. On one side wing we find a mortuary with a waiting room, receiving chapel and a special refrigerating chamber. The transformer in connection with the X-ray apparatus, and the heating plant, complete this wing. The other wing includes a large archive room for the storage of papers and documents, the garages mentioned above, the electrical intake room, and a room for the temporary deposition of meat seized or surrendered. It will be seen from this brief description of the New Health Centre that many new branches of Preventive Medicine are offered to the public for their benefit. This has only been possible by the erection of the present building with its modern layout and equipment. The Clinics are available to the following persons:— Dental Clinic.—All Finsbury residents, and all persons working in Finsbury but not residing therein. 27 Foot Clinic.—Finsbury residents and persons working in Finsbury but not residing therein. Women's Clinic.—Residents of Finsbury only. Cleansing Station.—All Finsbury residents. L.C.C. school children wherever residing. Municipal Chest Clinic.—All Finsbury residents. Non-resident workers in Finsbury for purposes of diagnosis only. Artificial Pneumothorax Clinic.—All residents of Finsbury. Non-Finsbury cases upon payment by local authority. X-Ray Clinic.—All residents of Finsbury. Non-resident workers upon payment by hospital, clinic, or medical practitioner. Artificial Light and Massage Clinic.—All resident in Finsbury. Non-resident working in Finsbury. Charges are made to patients for the various services provided, except for the following:— Solarium.—Free to M. and C.W. patients and those attending Chest Clinic. X-Ray Clinic.—No charge. Artificial Pneumothorax Clinic.—No charge to local residents. Cleansing Station.—No charge. Dental Clinic.—Free to children under five years of age, expectant and nursing mothers and tuberculous persons (except provision and repair of dentures). Provision is made for reduced charges according to the circumstances of the family. Bacteriological Examinations. The following examinations were carried out last year:— No. of Throat and Nasal Swabs examined for the Diphtheria Bacillus 890 Of these, Positive results were found in 46 cases. No. of Sputums examined for Tubercle Bacilli 155 Of these, Positive results were found in 29 cases. 28 Eighty-two samples of milk obtained as specially designated pasteurised milk as follows, were examined and as such were found to comply with requirements:— Council grants 12 Hospital supplies 6 School supplies 47 Licensed Dealers 17 82 In three cases labelling requirements were not complied with, and the dealers were duly warned. Thirteen samples of milk were obtained for test purposes during the processes of pasteurisation. Five samples of Tuberculin Tested milk were submitted for examination to the Clinical Research Association; these complied with all requirements except in the case of one sample which failed in the test for B. Coli and was noted for further investigation. One dental specimen was also reported upon by the Association. Twenty-five samples of Ice Cream and five of Swimming Pool water were examined in the Council's laboratory with satisfactory results. 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; 29 (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 page 123). 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.1. Ambulances are also available upon payment from the St. John Ambulance Brigade, St. John's Gate, E.C.1. The ambulance service of the Borough is very satisfactory. 30 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.1; the Finsbury Dispensary, Friend Street, E.C.1. For the latter institutions, I am enabled to give the following figures for 1938 by the kindness of the Secretaries. Finsbury Dispensary. No. of out-patients—Finsbury residents 7,994 No. of out-patient attendances 21,945 No. of visits to patients'homes 2,142 Royal General Dispensary. Number of new out-patients 1,351 Number of out-patients attendances 2,957 Number of visits made to patients' homes by R.M.O. 1,035 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. Tuesday and Thursday, 2 p.m.—Doctor sees mothers, babies and toddlers, weighing of babies and toddlers, sale of dried milk. Wednesday, 2 p.m.—Italian Clinic attended by Doctor speaking Italian, weighing of babies and toddlers, sale of dried milk. Monday, Wednesday and Friday, 9 a.m. to 9.45 tions taken for milk and dinner grants. 10 a.m. applications taken for Home Helps. Tuesday, 3 p.m. to 4 p.m.—Women's Holiday Fund. Saturday, 10.30 a.m.—Diphtheria Immunisation by appointment. (Immunisation also conducted by Doctor at Clinics.) Daily 9.30 a.m. to 10. a.m.—Dried milk to mothers receiving grants and from 12 noon to 1 p.m. dinners served to mothers and toddlers. 31 Sunlight treatment; Massage treatment; Dental treatment.— Given by appointment at adjacent Health Centre. Leage Street. Monday, Wednesday and Friday 2 p.m.—Doctor sees mothers, babies and toddlers, weighing of babies and toddlers, sale of dried milk and of clothing. Wednesday, 2 p.m., Monday and Thursday by appointment the Dentist attends. Wednesday, 3 p.m. to 4 p.m.—Women's Holiday Fund. Tuesday, Thursday and Saturday, 9 a.m. to 9.45 a.m.—Applications taken for milk and dinner grants. Tuesday and Friday, 10 a.m.—Sunlight treatment by appointment. Tuesday, 2 p.m.—Sewing class. Daily, 9 a.m. to 12 noon.—Applications taken for Home Helps; from 9 a.m. to 10 a.m.—Dried milk given to mothers receiving grants and from 12 noon to 1 p.m.—Dinners served to toddlers. Diptheria immunisation conducted by Doctor at Clinics. Massage Treatment given by appointment at Health Centre, Pine Street. Test Feeds given at both Centres as may be necessary. Special Hospital and Convalescent Trratment arranged for expectant and nursing mothers, babies and toddlers as recommended by the doctor. Women's Holiday Fund.—A Representative attends at Pine Street and at Leage Street Centres on Wednesdays from 3 to 4 p.m. from February to September. Mothers who would normally attend Leage Street receive their dinners at the Home of Service, King Square. Attendances at the Clinics and classes in 1938:— Leage Street. Pine Street. Mothers, individual 299 184 do. attendances 982 442 Children, 1 to 5 years, individual 606 454 do. attendances 4,585 4,151 Babies, individual 328 468 do. attendances 2,965 4,261 (The above figures do not include the service of meals.) 32 At the various clinics numbers were allocated as follows:— Mothers— Leage Street. Pine Street. No. attended 136 146 Attendances 227 349 Children's Clinic— Leage Street Pine Street. No. of children, 1—5 years 422 365 Attendances 3,662 2,775 No. of babies 309 344 Attendances 2,792 3,315 Dental Clinic— No. of Clinics held 80 Not held at Pine Street. No. of nursing mothers 72 No. of attendances 306 No. of expectant mothers 14 No. of attendances 79 No. of mothers of children, 1—5 years 85 No. of attendances 356 No. of children 1—5 years 120 No. of attendances 254 Gas anaesthesia attendances 263 Local anaesthesia attendances 9 No. of partial or complete dentures 31 No. of dentures repaired 7 Artificial Sunlight Clinic— No. of mothers 3 9 No. of attendances 14 93 No. of children, 1—5 years 64 51 No. of attendances 669 449 No. of babies 19 20 No. of attendances 173 185 * Italian Clinic— No. of mothers Not held at Leage Street. 36 No. of attendances 79 No. of children, 1—5 years 89 No. of attendances 621 No. of babies 86 No. of attendances 761 * (These figures are included above) 33 Massage Clinic— No. of children Not held at 18 No. of attendances Leage Street 306 Dinners— The numbers of dinners served at the centres were as follows:— Leage Street. Pine Street. To mothers Nil. 2,750 To children 8,234 5,250 Sale and Grants of Dried Milk— Sale of Dried Milk 1,304½ 1,777 1b. Free Grants of Dried Milk 1,109 1b. 2,527 lb. Home visits were paid by the Superintendents in 639 cases, to 94 expectant mothers and 545 general visits. The Health Visitors also made 1,027 visits to expectant mothers in connection with preparations for confinement. 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, 100 attendances being recorded; the late Matron of the Day Nursery, Miss M. Ditchman, conducts the class. 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.i. 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 18 cases were referred for treatment at this special clinic. 34 Artificial Sunlight Treatment. Artificial Sunlight treatment was given at both the Municipal Centres during 1938 for the following conditions:— Children.—Anaemia; Debility ; Marasmus; Skin diseases, various ; Rickets. Mothers.—Anaemia; 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. The Clinic at Pine Street was transferred to the Health Centre in December. Lectures at Centres. Lectures were given at the Centres by the Health and Cleanliness Council, the Dental Board, and the Milk Publicity Council. The lectures were given on clinic days and were somewhat hampered for this reason. The sewing class at Leage Street which is held on a non-clinic day, will now afford better facilities for talks to mothers, and it is hoped to extend this activity to Pine Street Centre. Birth Control. The Goswell Women's Welfare Centre, 39, Spencer Street, Goswell Road, referred to in previous reports 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 79 Number of attendances 157 Reasons for coming:— Medical 12 Economic 41 Medical and Economic 26 Patients recommended from Medical Sources:— Mother and Child Welfare Centres, etc. 30 Hospitals 7 Private Doctors 9 35 Patients informed through other sources:— Other patients 24 Publicity 9 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. Subject to the consent of the Ministry of Health it was decided to make a grant of £10 for these services. The Day Nursery. The Municipal Day Nursery is situated in 42, Lloyd-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. The total attendances of babies and toddlers in 1938 numbered 7,282 as compared with 5,701 in 1937 and 5,605 in 1936. 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 there were 843 free attendances. The average daily attendance was 28.4 as compared with 23.3 in 1937. The milk supplied to the Day Nursery is of a special gradeTuberculin Tested. The tenancy of the Nursery was renewed for a further period of one year from the expiry of the existing lease (25th September, 1938). The Council still have under consideration the provision of an up-to-date Nursery. Home Nursing Service. The Borough Council pays £275 a year to the Metropolitan Nursing Association for nursing Finsbury residents in their homes, 36 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.1 (Telephone No. Museum 0352), from the Public Health Department, and are invariably attended to without delay. This work has always been extremely well done. The cases nursed by the Metropolitan District Nursing Association in 1938 for the Public Health and the Maternity and Child Welfare Committees were as follows:— Condition. Maternity. Public Health. Cases. Visits. Cases. Visits. Tuberculosis — — 28 948 Pneumonia — — 9 148 Maternity conditions 30 378 — — Measles and German measles 259 533 122 247 Chicken pox 1 7 5 32 Ophthalmia neonatorum 2 10 1 7 Miscellaneous 4 59 — — 296 987 165 1,382 Total cases 461 Total visits 2,369 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. 37 Twenty-five cases were admitted last year under the Scheme, for the following conditions:— Bronchitis, with d. and v. 2 Cervical adenitis 1 Bronchitis and otorrhoea 1 Acute mastoid 1 Bronchial ulcerations 1 Sub-max. swelling with high temp. 1 Bronchitis 8 Broncho-pneumonia 2 Wasting 1 Pneumonia 2 Myocarditis 1 Marasmus 2 Observation 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. 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 £25 per annum plus a weekly charge of 30s. per week in respect of each case actually admitted. Last year five cases were admitted to the Hospital under the Scheme:- Bronchitis 4, Tonsilitis and bronchitis 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 17 babies and children were admitted for treatment and nursing:—Bronchitis 6, Pneumonia 2, Diarrhoea and vomiting 3, Otitis media 1, Fractured skull 1, Acute mastoid 1, Post-measles 1, Convulsions 1, Observation 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. 38 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 1938 two cases were 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 past. The Borough Council pays the hospital 16s. od. for each case. During 1938 the number of children referred for treatment was 42, of which number 16 were operated upon during 1938, and 2 are awaiting treatment; in 6 cases treatment was not advised, and in 8 cases treatment was postponed. 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. During last year arrangements were made with the Queen's Hospital for Children, Hackney Road, for the admission of cases for a period of two days, or three if found necessary, at a charge of 7s. 6d. per day inclusive. Last year five children were referred for treatment under this scheme. One child was operated upon, in three cases operation was postponed ; there was one refusal. 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 treatment 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. 39 (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,t 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 92 children completed convalescent treatment last year:— Dedisham 7 St. Andrew's 6 Hurstleigh 3 Noel Home 12 Basing 17 I.C.A.A. 47 Eleven children remained under treatment at 31st December, 1937, and seven 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. Convalescent Treatment—For Mothers after Confinement. The Council have arrangements for the convalescence of mothers after confinement. A bed has been endowed at the St. Mary's Convalescent Home, Birchington, Kent. In addition, cases have been sent on payment to the Mayfield Convalescent Home of the Association of Maternity and Child Welfare Centres which, however, is now closed and the Zachary Merton Convalescent Home at Rustington has provided needed accommodation. The new arrangements made by the Council have been much appreciated by the mothers of Finsbury, and the table below shows the use made of the available beds. *Closed September, 1938; to make up for this deficiency the Council instructed that accommodation should be obtained when necessary at other homes. †Closed December, 1938; from this date the four cots were reserved entirely at the Noel Home. 40 Convalescence completed. 1932 3 1933 3 1934 2 1935 12 1936 3 1937 25 1938 17 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: † Whooping cough. † Measles (two kinds). † Influenza. * Sent only from April to September. † Sent during periods of epidemics only. When the baby is one year old, the following two leaflets are sent to the mother :— Diphtheria Immunisation. Impetigo. 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. 41 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 1,027 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. 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. 42 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 Total Births. Total Visits to Children under 1 year. Total Visits to Children aged-1-5 years. No. 1 178 1,763 2,005 No. 2 158 1,659 2,245 No. 3 143 1,811 1,791 No. 4 161 1,838 1,652 No. 5 116 1,772 2,050 Totals 756 8,843 9,743 In 1938 the total number of Finsbury births notified was 702. In addition to the above numbers, 2,473 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 1938 5 8,843 9,743 18,586 * 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 1938, 2,457 visits were fruitless for this and other reasons. 43 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 - 1 1 2 2 6 Respiratory — 2 0 0 0 2 Marasmus 2 0 0 1 4 7 Illegitimacy 3 4 3 0 6 16 Twins 4 6 6 6 4 26 *Others 5 0 3 4 6 18 14 13 13 13 22 75 Results. Died 2 0 1 2 0 5 Still '' Special " 7 8 8 4 4 31 Satisfactory 4 5 4 6 18 37 Removed 1 0 0 1 0 2 14 13 13 13 22 75 *Others. Poor progress 6 Underweight 2 Malnutrition 2 Anaemia 2 Erbs Palsy 1 Mongolism 1 Hypospadias 1 Blindness 1 T.B. contact 1 Unsatisfactory enviroment 1 18 Thirty-seven of the 75 babies dealt with as special cases recovered satisfactorily; 5 died; 31 continued under close observation; and 2 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. 44 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 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.—The issue of special birthday cards to the toddlers on their 1st, 2nd, 3rd and 4th birthdays has been continued. 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., 1938. Approved number of nurse children. Attwood, Mrs. V. 28, Busaco Street 1 1 Evans, Mrs. H. 5, River Street 1 1 Hall, Mrs. H. 163, Central Street 1 1 Nuttall, Mrs. E. 27, Gt. Percy Street 2 3 Slade, Mrs. D. 27, Percy Circus 1 1 Tyler, Mrs. A. 20, Rahere Street 1 1 Additions to the List during 1938. Franklin, Mrs. E. 41, Wynyatt Street 1 1 Lashbrook, Mrs. E. 22,Lloyd Baker Street 0 1 Bowey, Mrs. J. 13, Claremont Square 1 1 Watts, Mrs. C. 26, Kings Cross Road 0 2 *The name of this foster mother was removed from the List upon her removal to an unknown address before the end of 1938. The following number of Notices were received during 1938:— Reception of nurse children in Finsbury 34 Removal of nurse children from Finsbury 12 Deaths of nurse children in Finsbury 1 45 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. The total number of visits made by the Health Visitors in connection with infant life protection work during the year was 82. 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 28th, 1938, to January 6th, 1939, by Miss Breaman and Miss Turner. 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. Last year 11 cases were referred for the attention of the Inspector. Ophthalmia Neonatorum. No. of Finsbury Cases notified 1938 Cases treated No. Vision unimpaired No. Vision impaired Total Blindness No. of Deaths at Home in Hospital 13 7 6 13 0 0 0 Each home-treated case was visited and revisited by a Health Visitor until its termination. thirty-one visits in all were made. In no case was there impairment of vision. The London County 46 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 is one blind child under 5 years of age known to the Department. Puerperal Pyrexia and Fever. Out of 813 Finsbury births (live and still) notified in 1938 there were 9 cases of Puerperal Pyrexia and 4 cases of Puerperal Fever. The causes were as follows:— Malaria (Induced—Treatment for G.P.I.) 1 Pyelitis 4 Uterine Sepsis 5 Unknown origin 3 The statistics for puerperal fever for previous years are appended:— Years. 1922 -26 1927 -31 1932 -36 1937 1938 Notifications 41 28 12 3 4 Deaths 8 7 1 0 0 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 Health Centre 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 until later on. 47 Other Orthopaedic Conditions.—Very few orthopaedic 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 come 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. Severe cases are recommended to the London County Council for admission to Queen Mary's Hospital, Carshalton, and to the Lower Southern Hospital, Dartford. 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. Average Attendances. Attendance. No. of Babies and Children up to 5 years. Leage Street 149 6,454 43 731 Pine Street 153 6,090 40 709 Totals 302 12,544 415 1,440 The number of new babies brought during the year was 444. 48 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. 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 mothers during the last five months of pregnancy, or earlier on special recommendation. Dinners.—Mothers are encouraged to aftend 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. 49 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. • During the year 1938, 4,692 grants were made, an average of 391 per month , 568 families received these grants. The grants comprised 65,844 pints of milk, 3,688 lbs. of dried milk, and 53,122 dinners. Bacteriological Examination of Milk for Maternity and Child Welfare Grants. All milk supplied to Finsbury mothers and children under orders issued by the Finsbury Borough Council is 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 12 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— 6 showed counts of below 30,000 bacteria per m.l. 5 showed counts above 30,000 but below 100,000 per m.l. 1 showed counts above 100,000 but below 500,000 per m.l. None showed counts above 500,000. 50 (2)Presence of Bacillu Presences 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 1/1 m.l. and that faulty pasteurisation or subsequent contamination has taken place when it is demonstrable in i/i00 m.l. or lese. Of the samples examined for the presence of this organism :— Bacillus coli were not discovered in i/io m.l. in 9 cases. „ „ were discovered in 1/10 m.l. but not in 1/100 m.l. in 2 „ „ „ were discovered in 1/100 m.l. in 1 „ Thus 91 per cent. of the milks failed to reveal the presence of B. coli in 1/100 m.l. as compared with 90 per cent. in 1937. This maintains the standard of last year, and is 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, 1938) 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). 51 Women's League of Service Councillors Mrs. C. Griffiths and for Motherhood, 128, Mrs. B. South. Pentonville Road, N. 1 (Welfare Centre). 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 Councillors Mrs. C. Griffiths Hospital, City Road, and B. South. E.C.i (Welfare Centre and Midwifery Service). St. Bartholomew's Hospital, Alderman Mrs. E. Martin and Smithfield, E.C.1 (Mid- Councillor Mrs. R. Curtis. 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. 52 Special Cases Consultations are held on Tuesdays, Thursdays and Saturdays at 10.30 a.m. Number of meetings in 1938 302 Number of attendances by mothers 504 Post-Natal Clinics Held on Mondays and Thursdays at 2.30 p.m. to 4.30 p.m. Number of meetings held in 1938 100 Number of attendances :— Babies under 1 year of age 276 Children from 1 to 5 years 129 (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 1938 100 Number of Attendances :— Babies under 1 year 871 Children from 1 to 5 years 1,275 Sewing Class .. .. Held on Tuesdays at 2 p.m. to 4 p.m. Number of meetings held in 1938 38 Lectures .. .. Held on Mondays at 2 p.m. to 4 p.m. Number of meetings held in 1938 45 (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 32 Total attendances 5,856 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 53 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 £15 os. yd. (representing the extra cost incurred). (4) Maternity Nursing Association. Ante-Natal Clinics .. Held on Wednesdays 9 a.m. to 12 noon and Fridays at 2 to 4 p.m. Number of meetings held in 1938 103 Number of attendances 1,461 Post-Natal Clinics .. Held on Mondays, Tuesdays and Thursdays at 2 p.m. to 4 p.m. Number of meetings held in 1938.. 155 Number of attendances :— Babies 2,006 Children from 1 to 5 years 565 Dental Clinics .. Held on 1st Tuesday in the month from 10 a.m. to 12 noon. Number of meetings held in 1938 13 Number of attendances 50 Dinners are provided to mothers as required. 711 visits were paid to babies and 527 visits to expectant mothers in 1938. (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 1938 86 Number of attendances :— Babies 551 Children 1,247 54 Dental Clinics Held on 2nd and 4th Wednesday from 12 noon to 1.30 p.m. Number of meetings held in 1938 21 Number of attendances :— Mothers of children under 1 year 25 Mothers of older children 30 Children under 5 years 54 Sewing Class Held on Wednesdays from 2.30 p.m. to 4 p.m. Number of meetings held in 1938 35 Average attendance 12 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 1938 33 Average attendance 29 Dinners 5,906 dinners were served to Finsbury mothers. 14,547 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' Hospitals, 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. 55 Infant Mortality, 1938—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. Measles - - - - - - - - 1 1 1 - - Whooping Cough - - - - - 1 - - 1 2 2 - - Diphtheria - - - - - - 1 - 1 1 - - Cerebro-spinal Fever - - - - - 1 1 2 2 - - Bronchitis - - - - - - 2 1 - 3 1 2 - Pneumonia - - - - - 3 - 4 - 7 6 1 - Diarrhoea and Enteritis - - 1 1 2 2 7 4 - 15 5 10 - Congenital Debility, Prematurity, etc. 13 1 1 1 16 - - 1 - 17 9 8 - Accident of birth 1 - - - 1 - - - - 1 - 1 - Other defined causes - - - - - 2 2 1 — 5 3 2 - Total 14 1 2 2 19 9 12 12 2 54 30 24 - 56 Infant Deaths. From the previous table it will be seen that the number of infant deaths was 54 ; the infantile mortality is 73 per 1,000. In 1937 the rate was 71, and in 1936 the rate was 81 per 1,000. Neo-natal Mortality. By Neo-natal Deaths we mean the deaths of children under 28 days old and in 1938, 19 deaths were registered under this heading, equal to a rate of 27.1 per 1,000 live births registered as compared with a rate of 22.2 in 1937. Below will be found the number of neo-natal deaths in the Borough for the last 14 years. Rate per 1,000 7 days and live births Year. Under 7 days. under 28 days. registered. 1924 31 18 29.4 1925 18 14 18.2 Average 1926 32 13 27.1 5 years. 1927 20 12 22.1 24.4 1928 24 13 25.2 1929 26 13 28.4 1930 24 10 26.2 1931 21 9 23.8 24.36 1932 18 7 22.6 1933 17 4 20.8 1934 7 8 15.3 1935 15 5 21.5 1936 13 2 17.9 20.8 1937 16 2 22.2 1938 14 5 27.1 It will be noted that of the 54 infants who died 14 were in their first week of life, whilst 28 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 4 deaths last year as compared with 6 in 1937. 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. 57 Infectious Disease. Whooping cough accounted for 2 deaths as compared with 6 deaths in 1937. 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 10 deaths last year as compared with 18 in 1937. 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 11 cases , in 8 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. Twelve 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 pneumonia. Many cases are sent in to hospital in a moribund condition. The question of cross-infection in infants' wards is 58 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. lnfant Deaths, 1911-30. 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 1938 Total. Measles 137 17 21 22 9 — 1 207 Diphtheria 14 9 — 1 — — 1 25 Scarlet Fever 3 1 2 1 — — — 7 Whooping Cough 87 28 32 18 4 6 2 177 Diarrhoea and Enteritis 469 94 53 44 18 11 15 704 Premature Birth 446 166 120 74 7 9 13 835 Congenital Defects 20 23 13 25 4 6 4 95 Marasmus 170 27 16 8 1 — — 222 T uberculous Meningitis 40 2 6 4 - - - 52 Other Tubeculous 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 3 217 Pneumonia. 394 147 102 62 12 16 7 740 Overlying 103 11 5 — — — — 119 Hæmorrhagic Disease of the Newborn - - - 2 - - - 2 Other Causes 335 91 86 47 10 7 8 574 Totals 2,530 681 492 324 68 58 54 4,197 59 In 1938 the infant deaths were : in Clerkenwell, 30 ; St. Luke's, 24 ; and in St. Sepulchre's, o deaths. Infant Mortality by Districts. The following table compares Finsbury with London and England and Wales generally :— England and Wales 53 London 57 Finsbury 73 126 great towns 57 148 smaller towns 51 The infant mortality rates for the period 1909 to 1938 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 1ll 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 - 1938 73 62 97 - 60 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 1938 741 54 73 London County Council Scheme ; Midwives Act, 1936. The London County Council Scheme for domiciliary midwifery and for domiciliary maternity nursing in the administrative County came into operation on 1st January, 1938. This was effected by a whole-time service of salaried midwives, either employed by the Council directly or by arrangement with voluntary organisations. For purposes of administration the Borough of Finsbury was included in one of the five areas into which London was divided, 61 viz., (Area B.), comprising, in addition, the City of London, and the Boroughs of Holborn, Islington and St. Pancras. Four salaried midwives are employed directly by the Council in this area, of which one may be regarded as the Finsbury midwife. In addition the following hospitals, etc. are included in the Scheme for the Area :— 1. Middlesex Hospital. 2. Royal Free Hospital. 3. St. Bartholomew's Hospital. 4. University College Hospital. 5. City of London Maternity Hospital. 6. Elizabeth Garrett Anderson Hospital. 7. Royal Northern Hospital. 8. Metropolitan District Nursing Association. It should be noted that the three hospitals with whom the Borough Council had an agreement for a complete midwifery scheme are included in the scheme of the County Council. A scheme of co-operation with the County Council was drawn up, and Ante-natal Clinics established both at Leage Street and Pine Street Municipal Welfare Centres, where the mothers booking the Finsbury midwife could attend for ante-natal care should they so desire. Arrangements were made by means of special forms for the making of appointments, sending of ante-natal reports and the submission of a report on the confinement and a post-natal report. As the majority of the mothers book for their confinements at one or other of the hospitals, the Ante-natal Clinics at Leage Street and Pine Street were only occasionally utilised for those persons booking the Finsbury midwife. Nine mothers made 31 attendances. Scheme of the Borough Council. Reference has been made in previous annual reports to the complete scheme of the Borough Council, which had been in operation for some years. As a result of the Act it became necessary for the Borough Council to reconsider their scheme, the agreements for which did not expire until September, 1939. The scheme of the Borough Council provided not only for domiciliary midwifery, but for in-patient treatment and medical ante- and post-natal care. A new agreement was therefore entered into by the Borough Council, which excluded arrangements for a domiciliary service, for which the County Council were made responsible by the Act. A meeting 62 with the three hospital authorities, viz, St. Bartholomew's Hospital, City of London Maternity Hospital and the Royal Northern Hospital, was held to discuss the modifications necessary. The new agreement provides for the following :— 1. Notification to the Medical Officer of Health of all cases booking for confinement, with the consent of the mother. 2. Submission of the following reports :— (a) Report on Confinement (Domiciliary and In-patient cases). (b) Post-natal Reports. 3. The provision of ante-natal and special post-natal clinics which shall be open for L.C.C. midwives' cases as well as for cases booked at the Institutions. 4. The provision of consultative ante-natal clinics, to which patients may be referred by a private practitioner or from the Borough Council's ante-natal clinics. 5. The provision of ante-natal beds for patients. 6. The provision of beds for cases desiring admission to hospital for confinement, or who should be admitted to hospital by reason of some complication or bad home conditions. The Council agreed to contribute the sum of 5s. to the hospital concerned in respect of each Finsbury case attending the ante-natal and/or post-natal clinics under the Scheme, and a sum of £4 4s. od. towards the cost of maintenance of each case admitted to hospital for confinement. If a patient is retained in hospital for 14 days or longer after confinement an additional sum of 10s. 6d. is paid towards the increased cost of maintenance. Below I have indicated an analysis of the confinements of Finsbury mothers last year at the three hospitals under the Scheme :— In-Patients : St. Batholomew's Hospital 112 City of London Maternity Hospital 64 Royal Northern Hospital 3 179 63 Domiciliary Patients.—The numbers of mothers confined in their own homes, attended from the three hospitals, were :— St. Bartholomew's Hospital 181 City of London Maternity Hospital 27 Royal Northern Hospital 155 Attendances at hospital ante- and post-natal clinics were as follows:— Ante-natal. Post-natal. St. Bartholomew's Hospital 1,677 I27 City of London Maternity Hospital 550 616 Royal Northern Hospital 1,465 42 The attendances at the Council's ante- and post-natal clinics were :— Ante-natal. Post-natal. Leage Street Maternity and Child Welfare Centre 28 106 Pine Street do. 25 240 Panel of Consultants.—It was considered that the smooth working of the arrangements under the Midwives Act 1936, would be facilitated if the boroughs comprised in Area B agreed to pool its list of consultants. The consultants were to be available to attend women in their homes, at the request of a medical practitioner, either for puerperal fever or pyrexia, or in connection with any complication arising during pregnancy, labour or the puerperium. The Finsbury Borough Council for some years have had a panel of seven consultants for these purposes, and after negotiations all the five constituent boroughs agreed to make arrangements with these seven to act throughout Area B, two additional consultants being added to the pool. The following is the complete list of consultants for the Area last year:— John Beattie, M.D., F.R.C.S., M.C.O.G., 20, Upper Wimpole Street, W.1. J. B. Blaikley, F.R.C.S., M.C.O.G., 55, Harley Street, W.1. R. L. Dodds, M.Ch., F.R.C.S., 9, Harley Street, W.1. Gladys H. Dodds, F.R.C.S., M.C.O.G., 20, Upper Wimpole Street, W.1. Malcolm Donaldson, F.R.C.S., F.C.O.G., 145, Harley Street, W.1. 64 Dame Louise Mcllroy, M.D., D.Sc., 115A, Harley Street, W.1. J. V. O'Sullivan, M.D., F.R.C.S., M.C.O.G., 7, Wimpole Street, W.1. N. White, F.R.C.S., M.C.O.G., 115A, Harley Street, W.1. A. J. Wrigley, M.D., F.R.C.S., 17, Harley Street, W.1. Emergency Units.—Experience throughout the country has shown that some lives are lost through women being sent to hospital because the necessary expert services are not available in their homes. Although not applicable to London so much as to less populated districts, the Council decided, on the recommendation of the Maternity and Child Welfare Committee, to make available to Finsbury mothers, emergency units available day and night to attend mothers whom it would be dangerous to move into hospital. It was agreed that the most satisfactory arrangement would be, as in the case of the consultant services, for the unit or units to be available throughout Area B. The five constituent boroughs agreed to the proposal that two emergency units should be provided for the Area, one by St. Bartholomew's Hospital and the other by the University College Hospital. Each borough agreed to pay a sum of £5 to each hospital towards the cost of the equipment, and £7 7s. each time the unit is called upon to deal with an obstetrical emergency in their Area. The emergency units consist of an obstetrician, a house-surgeon and a nurse,with all the necessary equipment to deal with emergencies such as a transfusion outfit, etc. In the case of a grave emergency a midwife is authorised to call in the service direct. The service is obtainable by ringing up St. Bartholomew's Hospital—Telephone No. NATional 4444—or the University College Hospital—Telephone No. EUSton 5050. No calls were made last year. Confinements in London County Council Hospitals. Last year 66 Finsbury mothers were admitted to neighbouring London County hospitals for their confinements. The hospitals concerned were St. Pancras Hospital, Pancras Road; St. Mary's Hospital, Highgate Hill; St. Leonard's Hospital, Hoxton Street, Bethnal Green Hospital, Cambridge Road; Hammersmith Hospital, Du Cane Road; St. Leonard's Hospital, Nuttall Street; Mile End Hospital, Bancroft Road; Sheffield Street Hospital, and St. James' Hospital, Ouseley Road. A scheme of co-operation for the ante-natal care of mothers booking with these hospitals for confinement was 65 arranged early last year. The name and address of the mother, with her consent, is sent to the Medical Officer of Health. On receipt of this information a home visit is paid by the health visitor for the district in connection with environmental and sanitary conditions. Any special requirements, such as the provision of extra nourishment or home helps are provided by the Council on a recommendation from the Medical Officer of the hospital, ante-natal clinic or the almoner. If the mother expresses a desire to attend one of the Finsbury ante-natal clinics, and the Medical Officer of the hospital agrees, a special form is sent to the Medical Officer of Health. Arrangements are then made for the mother to attend either Leage Street or Pine Street and to be seen regularly there until the 32nd or 36th week, when the mother is sent back to the hospital clinic. In this way the mother is saved unnecessary travelling to the hospital ante-natal clinics. In the event of any abnormality the mother is referred at once to the hospital. 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 5 occasions. 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 twelve 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 182; sixteen were cancelled for various reasons. 66 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 1938 166 Home helps are supplied both during the ante-natal and postnatal periods. 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. 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 0.00 1.33 1.61 0.00 2.90 4.21 1933 0.00 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 0.84 0.94 1.23 2.29 3.11 1938 0.00 0.79 0.89 1.35 1.91 3.08 * Not available. 67 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 1938 was due to failing heart and one to Graves disease and broncho-pneumonia, giving a total maternal mortality for Finsbury of 4.05 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. In the report of the Ministry on an investigation into maternal mortality, Finsbury was included in Group D areas, i.e., those areas where the rate is lower than that of England and Wales by 20 per cent. or more. I have set out below particulars regarding the three deaths due to or associated with childbirth. Maternal Deaths. I. This woman had one previous pregnancy in 1937, when it was found necessary to perform an operation for the removal of the child on account of Placenta Praevia. Ante-Natal Care.—She originally booked for her confinement on 21st January; her physical condition was stated to be good and the blood test normal. She paid six visits to the Ante-Natal Clinic up to the 20th April and she was found to be progressing favourably She attended again on 20th April owing to the fact that she had been struck by a motor-lorry in the street on that day, and wondered if any harm had been done; no indication could be found by the Hospital that any trouble had resulted therefrom. She was visited in her home on three occasions in the next five days but no abnormality in the pregnancy had developed. She re-attended again on 26th April and was admitted to await the labour which was expected on 3rd May. On 27th April labour began and progressed normally without obstruction until 4.30 p.m. on the 28th April, when she suddenly collapsed. Diagnosis.—This patient was extremely shocked and collapsed and was immediately given an intravenous injection of gum-saline followed by blood transfusion, as she was diagnosed to have a ruptured uterus. As soon as she had recovered from the shock, an operation was performed, and a still-born child removed from the abdominal cavity, the uterus having ruptured throughout the length 68 of the old scar (Caesarian Section). The tear was sutured and two further blood transfusions given. Unfortunately the operation wound became infected and she developed a fistula, and an infection due to B-coli and Haemolytic Streptococcus followed by a double basal pneumonia ; she died on 23 rd May due to Toxaemia, following wound infection and pneumonia, following operation made imperative by rupture of the uterus. Inquest.—An inquest was held owing to the history of being knocked down by a lorry, but it was considered that this had no connection with death. Summary.—This woman had expert skill and attention in Hospital and died from toxaemia, peritonitis and sepsis following rupture of the uterus, a complication stated to occur only in 1 in 3,000 to 5,000 deliveries : 94 per cent. occur in multipara; the maternal mortality varies from 60 to 80 per cent., the prognosis therefore is very grave, death occurs most often from sepsis, as in this case. It would appear that this death could not have been prevented. 2. A woman was admitted to the Archway Hospital, Archway Road, Highgate, on 9th January, 1938, in a dying condition. She was about ten weeks pregnant, and had had no ante-natal care; neither had she made arrangements for her confinement with a Hospital, Midwife or General Practitioner. She had no children. She had suffered from heart disease and bronchitis for years, and had complained of shortness of breath for two years, and had gradually been getting worse for the last six months, her ankles swelling. Two hours before admission she had a severe haemorrhage from the vagina, and on arrival at the hospital she was very collapsed and short of breath. No further haemorrhage occurred whilst in hospital. In spite of treatment, she died the same day. A post-mortem examination was performed and revealed all the signs of " failing heart," a " Heart Failure " lung and liver. The death was due to failure of a rheumatic heart, the pregnancy having no connection with death. Summary.—This woman died from heart failure, but as she was at the same time about ten weeks pregnant, her death was registered as " associated with pregnancy and childbearing." The death is not a " Maternal Death " of common parlance and as usually understood. 69 3. This woman was reported to be in comfortable circumstances and had had no previous pregnancies; she originally booked for her confinement on 4th April, 1938, when she was considered to be 38 weeks pregnant. She therefore had no ante-natal care. Previous Health.—She was suffering from well-marked Exophthalmic Goitre (Graves Disease), and could therefore not be in a good condition to withstand the strain of pregnancy. When seen at the Ante-Natal Clinic she was found to be suffering from Bronchitis, marked Graves Disease, swelling of the lower limbs, a high blood pressure and rapid pulse. Her urine was loaded with albumin. She was admitted immediately, as she was clearly suffering from wellmarked pre-eclamptic toxaemia. Intensive treatment was given for the condition found, but in spite of this she had three eclamptic fits on 8th April, when labour began, lasting twelve hours. She was delivered by means of forceps on 9th April under gas and oxygen anaesthesia. The child was stillborn as was to be expected. Her condition improved somewhat after delivery, but the heart condition became more acute with increasing respiratory difficulty. She died suddenly on the same day. A Post-Mortem examination was conducted and revealed that she had Broncho-pneumonia in addition to the other conditions found. Summary.—This woman was suffering from marked Graves Disease, and although 38 weeks pregnant and suffering from headaches and swelling of the limbs, at this late stage had made no arrangements for her forthcoming confinement; no ante-natal care had been arranged for, and she was admitted to Hospital on her own initiative in an advanced stage of toxaemia. She had therefore very little chance of survival, her death being aggravated by the pre-existing Graves Disease. Ante-natal care, with possibly earlier termination of preganacy, would probably have saved her life. 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, Myddleton Square. It is controlled by the Holborn Deanery Association and is grant aided by the County Council. 70 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, 1938:— Finsbury Centre, 31, Spencer Street, E.C.1. Ailment. No. of cases treated. No. of attendances made. Minor Ailments 1,847 27,481 Teeth 1,986 3,907 Dental inspections in the schools. No. inspected. No. found to require treatment. 5,737 4,018 Pentonville Centre, 11, Cynthia Street, Pentonville Road, N.1. Ailment. No. of cases treated. No. of attendances made. Minor Ailments 1,8l0 22,007 Teeth 1,472 2,731 Dental inspections in the schools. No. inspected. No. found to require treatment. 3.933 3,039 Overleaf are certain particulars relative to the routine medical inspection of the children attending the elementary schools in the Borough for the year 1938. 71 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 460 109 349 2 48 378 34 - 450 9 1 453 7 - 261 160 39 - - - Girls 424 108 316 — 71 332 21 — 406 16 2 422 1 1 251 132 41 — — — Age 7 : Boys 333 70 263 — 23 288 22 — 324 9 — 332 1 — 217 102 14 217 76 40 Girls 337 75 262 — 28 286 23 — 310 22 5 334 3 — 206 100 31 214 77 43 Age 11 : Boys 356 94 260 2 31 302 23 — 349 6 1 355 1 — 243 108 5 216 66 74 Girls 385 134 250 1 70 298 17 — 349 32 4 382 2 1 292 88 5 216 78 89 Age 14 : Boys 464 110 353 1 80 364 20 — 459 5 — 460 4 — 344 109 11 314 69 80 Girls 433 105 328 — 74 352 7 — 421 11 1 428 5 — 321 105 7 263 85 83 Total 3,192 805 2,381 6 425 2,600 167 — 3,068 110 14 3,166 24 2 2,135 904 153 1,440 451 409 Percentage 25.2 74.6 0.2 13.3 81.5 5.23 96.1 3.5 0.4 99.2 0.8 0.0 66.9 28.3 4.8 62.6 19.6 17.8 London 54.6 45.1 0.3 16.2 77.2 6.6 97.7 2.0 0.3 98.7 1.2 0.1 70.2 26.3 3.5 67.8 19.0 13.2 72 Examination of Elementary School Children in Finsbury. Boys. Girls. Entrants. Age 7. Age 11. Age 14. Entrants. Age 7. Age 11. Age 14. Number examined 460 333 356 464 424 337 385 433 Cases * Cases * Cases * Cases * Cases * Cases * Cases * Cases * - - - - - - - - - - - - - - - - Malnutrition 8 8 6 6 2 2 5 5 5 5 5 4 4 4 3 3 Skin disease 6 4 4 4 1 1 7 3 5 1 2 1 2 1 7 5 Defective teeth - 194 — 114 — 112 — 119 — 169 - 126 - 89 - 111 Enlarged tonsils 63 23 28 11 11 6 17 10 58 20 23 7 6 4 10 6 Adenoids 2 1 — — 1 1 — — 3 3 3 — 1 1 1 1 Enlarged tonsils and adenoids 6 5 4 4 — — 1 — 2 1 1 1 - - 1 1 Other nose and throat defects 5 — 3 1 2 2 1 1 4 3 — — - — 1 1 Enlarged glands 11 1 4 — 3 — 4 — 16 2 2 — 2 — — — Eye disease 10 9 8 3 6 3 4 4 5 2 8 3 9 8 3 2 Vision defect — — — 29 — 55 — 53 — — - 39 - 71 - 62 Otorrhoea — — 5 2 4 4 2 — 5 4 5 5 3 2 1 1 Other ear disease 3 1 1 1 1 1 1 — 2 1 1 - — - 2 - Defective hearing — — 2 2 1 — — — 1 — — — 2 1 4 3 Speech defects 2 — 4 4 — — 1 1 — — — — 1 - 1 - Heart defects 19 1 12 2 7 1 13 — 15 — 7 — 12 1 8 1 Anaemia 4 — 2 — 2 1 1 — — — 2 1 - - 1 - Lung defects 15 2 9 1 4 2 1 — 13 2 4 3 — - 1 1 Nervous defects 1 — 2 2 — — — — 2 — — — 3 1 - - Phthisis — — — — — — — — — - — - - - - - Other T.B. disease 2 1 - - - - - - - - - - - - - - Rickets 4 - - - - - - - 1 - - - - - - - Spinal deformities — — — — 2 1 2 1 1 1 — - 4 3 1 1 Other deformities 2 1 3 2 — — 4 3 1 — — — 6 5 4 3 Other defects 11 3 9 7 9 8 10 6 7 1 11 5 8 5 13 8 Number of children noted for treatment — 222 — 156 — 154 — 180 — 192 — 164 - 157 — 173 * Defects however slight are included under " cases " ; those severe enough to require treatment are shown under *. 73 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, October, 1937 to March, 1938, as follows :— (1) October.—A campaign to encourage the use of the Health Services. (2) November and December.—Maternity and Child Welfare Services. 74 (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. Post Offices.—At the request of the Ministry of Health, special leaflets detailing the Health Services available in the Borough, are supplied 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. British Social Hygiene Council. On the 26th January a special lecture for adults under the auspices of the British Social Hygiene Council was given in the Town Hall by Dr. Forgan dealing with venereal diseases. It was followed by a film " Test for Love " which portrayed the importance of early and continuous treatment. The hall was well filled and the meeting appeared to be much appreciated. Handbook—Public Health Services. A special handbook relating to the Public Health Services in the borough was prepared last year and sent to all those to whom it might be of value, including the general practitioners practising in the district. 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. 75 Hop-Picking. Special leaflets giving precautions for preventing the introduction of infectious disease in the hop-fields were distributed 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 76 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. 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. At the request of the County County, all the medical practitioners in the neighbourhood have been asked to report to the Department or direct to the County Council any unregistered nursing homes of which they were aware. 77 SECTION C. SANITARY CIRCUMSTANCES. The district work of the Sanitary Inspectors during 1938 is presented below in tabular form:— Mr. Norman Mr. Newdick Mr Lay. Mr. Jenkins. Mr. Ward Mr. Longden Mr. Truslove Mr. Clinton Totals Houses damp, dirty or dilapidated, remedied 132 101 101 143 185 - - - 662 Doors, windows, floors, walls, ceilings, sashcords repaired 69 88 78 59 296 - - - 590 Overcrowding cases abated in other than Registered Houses - 5 2 - - - - - 7 Water closet defects remedied 112 79 123 70 164 — — — 548 Water closets erected 65 139 233 162 42 — — - 641 Urinal defects remedied 4 14 9 3 5 — — — 35 Urinals erected 7 11 24 12 2 — — — 56 Soil pipe and ventilating shaft defects remedied 4 4 11 5 16 - - - 40 Soil pipe and ventilating shafts erected 17 35 45 35 38 - - - 170 Yard defects remedied 40 34 70 24 49 — — - 217 Waste pipe defects remedied 14 8 8 22 35 — — — 87 Waste pipes erected 31 43 58 48 129 — — — 309 Water cistern defects remedied 2 6 7 39 — — — — 54 Accumulations of rubbish or removed 27 10 11 10 36 - - - 94 Dung or dust receptacles repaired or renewed 52 22 28 30 35 - - - 167 Drains relaid or amended 31 8 48 42 32 — — — 161 Drains cleared 19 17 13 28 23 — — - 100 Rain water pipes cleared, repaired or renewed 27 5 21 7 20 - - - 80 Water supply to houses reinstated 2 6 2 4 31 — — — 45 Roofs and gutters repaired 73 38 63 36 95 — -— — 305 Area defects remedied 25 14 16 18 11 — — — 84 Washhouse defects remedied 57 24 46 21 92 — — — 240 Animal nuisances abated 2 — 3 3 — — — — 8 Floor space unventilated 6 — 2 2 6 — — — 16 Stables cleansed or repaired 1 — 3 3 - — — — 7 Smoke observations — 10 26 146 20 — — - 202 Water supply laid on to upper storeys of house 27 11 7 23 22 - - - 90 Miscellaneous nuisances abated 14 27 12 38 93 — — — 184 Drains tested 88 65 55 62 131 — — - 401 Bakehouses, inspections — — — — — — — 262 262 Bakehouses cleansed or repaired - - - - - - - 33 33 Restaurants, No. of inspections - - - - - - - 603 603 Restaurants cleansed or repaired - - - - - - - 63 63 Milkshops—No. of inspections - - - - - - - 534 534 Milkshops cleansed or repaired - - - - - - - 7 7 Public Houses cleansed or repaired 6 5 9 3 — — — 8 31 Ice Cream Premises—No. of inspections - - - - - - - 316 316 78  Mr. Norman Mr. Newdick Mr. Lay Mr. Jenkins Mr. Ward Mr. Longden Mr. Truslove Mr. Clinton Totals Ice Cream Manufactories cleansed - - - - - - - 5 5 Food Stalls—No. of inspections 1,320 1,091 1,252 471 414 — — 275 4,823 Butchers' shops cleansed or repaired - - - - - - - 2 2 Fish Purveyors' Shops cleansed or repaired - - - - - - - 3 3 Registered food premises—No. of inspections - - - - - - - 193 193 Registered food premises — cleansed - - - - - - - 9 9 Registered houses—visits of inspection 425 426 271 312 251 - - - 1,685 Registered houses—overcrowding cases abated - - - 2 - - - - 2 Registered houses—cleansed 72 68 54 81 103 — — — 378 Registered houses — Intimation (Cleansing) Notices served 72 68 56 81 103 - - - 380 Registered houses — Statutory (Cleansing) Notices served 22 21 8 12 17 - - - 80 First visits (complaints, casual visits) 2,908 3,253 2,852 2,524 2,229 725 543 - 15,034 Re-visits 2,272 1,851 2,351 2,049 2,566 281 321 — 11,691 Intimation Notices served 332 231 210 227 373 — 49 — 1,422 Statutory Notices served 46 31 31 18 50 — — — 176 Infectious disease investigations 51 57 61 86 108 — — — 363 House inspections 332 363 274 291 334 — — — 1,594 House to house inspection 132 148 143 131 172 — — — 726 Canal boats inspected — — — 94 — — — — 94 Slaughterhouses—No. of inspections 113 - - - - - - - 113 Verminous tenements—No. of inspections 63 59 47 140 106 - - - 415 Verminous tenements cleansed by Borough Council - - - - - - - - 167 Underground rooms — No. of inspections 176 61 37 38 197 613 — — 1,122 The number of complaints of insanitary conditions and nuisances received in the Public Health Office during the year numbered 1,24.8. Details of the Work of the Lady Sanitary Inspector during 1938. Visits and Re-visits:— Factories (other than out-workers' premises) 1,028 Outworkers' premises (sub-contractors) 441 „ „ (domestic) 955 Complaints of vermin (L.C.C.) 256 Public health complaints 8 Public sanitary conveniences 77 2,765 79 Intimation Notices served 88 Statutory Notices served 4 Summary of Matters for which Notices were Served:— 1. Damp, dirty, verminous and dilapidated premises 45 2. Leaky roofs 1 3. Sanitary conveniences dilapidated, dirty, insufficient, not separated for sexes, unsuitable, choked 67 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 2 8. Smoky chimney 9. Overcrowding 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. Ninety-four plans were deposited last year. These related to :— The provision of additional sanitary accommodation 52 Reconstruction of drainage of existing buildings 13 New buildings 26 Sanitary fittings only 3 Factories Act, 1937. The Factories Act of 1937 came into force on 1st July, 1938, and is a consolidating and amending measure. The old distinction between a factory and workshop is abolished, only one term " factory " being employed, and the operative provisions for factories generally are contained in the Factories Act itself. The general definition of factory now covers the cleansing or washing or breaking up or demolition of articles by way of trade or for purposes of gain, and is supplemented by the specific inclusion of certain works or premises. 80 Health (General Provisions). A new provision is that relating to the temperature of every workroom. The Borough Council will be responsible for seeing that a reasonable temperature is maintained in each workroom of a factory in which mechanical power is not used. A thermometer must be provided in every workroom in which a substantial portion of the work is done sitting and does not involve serious physical effort. Similarly they will have the duty of enforcing the provisions as to cleanliness, overcrowding, ventilation and drainage of floors in factories where mechanical power is not used. This will mean the inclusion of certain premises which under the old Act were " factories " and for which provisions the Local Authority were not formerly responsible. Special functions of Medical Officer of Health. The Medical Officer of Health is to have the following administrative powers:— 1. To approve alternative methods of cleaning walls. 2. To decide whether, or not, the exemption clause as to cleaning of the walls of any factory where less than 10 persons are employed, shall be applied or not. 3. To grant certificates of exemption from Section 2 (2) (Overcrowding provisions) workrooms in which explosive materials are manufactured or handled. 4. To require mechanical ventilation in the case of an existing workroom which will be "overcrowded" according to the new standards. 5. To allow the notice under Section 2 (6) (viz., as to the number of persons who may be employed in a workroom) to be dispensed with. Sanitary Conveniences. Under the new Act effective provision must be made for lighting the conveniences. The provisions as to sanitary conveniences are applied to certain building operations and works of engineering construction. Cleanliness. New provisions have been made to secure higher standards by the adoption of more methodical arrangements for cleaning, viz., 81 the daily removal of accumulations of dirt and refuse from the floors and benches of workrooms and from the staircases and passages and the weekly cleansing of every floor. Overcrowding. A new standard for the prevention of overcrowding in workrooms has been laid down. The requirement of cubic space per person employed is raised from 250 to 400 cubic feet, and no space more than 14 feet from the floor is to be taken into account. In the case of rooms used as workrooms on 30th July, 1937, the old figure of 250 cubic feet is allowed for a period of 5 years, and if suitable mechanical ventilation is installed before 30th July, 1942, the concession is continued for a further 5 years (e.g., 30th July, 1947). The Medical Officer of Health (in certain cases) may require such ventilation to be installed during the first five year period. The sections dealing with ventilation (Sec. 4) and drainage of floors (Sec. 6) substantially follow previously existing law. Lighting. A new provision is introduced requiring sufficient and suitable lighting, whether natural or artificial, in every part of a factory in which persons are working or passing (enforced by the Factory Inspector). Homework. The sections of the new Act re-enact with some modifications the old Act requiring list of outworkers to be kept in certain trades, and empowering the district council by notice to prohibit the giving out of work to be done in a place dangerous to the health of the persons employed there. The chief changes are:— (i) The lists are to be sent to the district council during February and August (not as previously, on or before 1st February and 1st August) and are to show all outworkers employed during the previous six months. (ii) It is made clear that the section applies to outwork, irrespective of whether the materials for the work are supplied by the factory occupier, or not. 82 (iii) The period for compliance with a notice as to the employment of persons in unwholesome premises is reduced from one month to ten days. From the above it will be seen that the provisions as to Cleanliness, Overcrowding, Temperature and Sanitary conveniences have been changed and amended, requiring the special attention of the Factory Inspector, particularly those relating to overcrowding; a gradual survey will be necessitated, paying particular attention to these points. Underground Bakehouses. With regard to Underground Bakehouses, in respect of which a certificate of suitability was issued in 1902, the Act imposes upon the Council the duty of causing them to be re-examined during the year beginning on 1st July, 1938, and in every fifth succeeding year. Unless the Council are satisfied as a result of the examination that the bakehouse is suitable for use as such as regards construction, height, light, ventilation and any hygienic respect, the certificate issued under the Act of 1901 shall cease to have effect. The occupier may appeal to a Court of Summary Jurisdiction against the decision of the Local Authority to terminate the certificate, and may further appeal to Quarter Sessions. The prohibition of the use of basement bakehouses under the new Act is enforceable by the Local Authority in all cases, whereas under the 1901 Act it was enforceable by the Local Authority in the case of retail basement bakehouses only. There are at the present time 20 occupied Underground Bakehouses in respect of which a certificate was issued in 1901. It will be necessary for a complete survey to be made of these bakehouses, in order that the Committee can consider whether they are able to recommend the certificate to be continued. The survey has been commenced, and I propose when it is completed to report further on the matter. Summary. (i) The Factories Act of 1937 came into force on 1st July, 1938, and is a consolidating and amending measure. 83 (ii) The provisions relating to Cleanliness, Overcrowding, Temperature and Sanitary conveniences have been changed and amended, necessitating a gradual detailed survey of the Factories in the Borough. (iii) The general definition of a factory has been supplemented by the specific inclusion of certain works or premises. (iv) The Underground Bakehouses of the Borough will be required to be surveyed with a view to deciding as to the continuation of the certificate. The number of factories without mechanical power on the register at the end of 1938 was 2,492, compared with 2,523 at the end of 1937. During the year under review, 90 entries were removed from the register owing to the closing of premises, or to the removal of the occupier to other places of business The number of factories newly registered was 59. The factories on the register at the end of 1938 numbered 2,252, compared with 2,232 at the end of 1937. The list included four 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 with mechanical power, the duty of inspection is mainly carried out by H.M. Factory Inspector. 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 factories without mechanical power, the Health Department deal with the above matters and in addition have other duties, including the supervision of cleanliness, ventilation, overcrowding, drainage of floors, and temperature. Co-operation is maintained with the Factory Inspector in dealing with factories in accordance with the Factories Act, 1937. The persons employed in the factories in Finsbury are approximately:—Males, 33,129: Females, 32,608. During the year, 1,688 first visits and 792 re-visits were made by the Council's inspectors to factories. 84 The Home Office.—One notice of occupation was received from the Home Office during the year and 60 notices of complaint relating to the following matters :— Premises dirty 3 Sanitary conveniences insanitary 6 „ „ with no artificial light 28 „ „ insufficiently ventilated 19 Water closet accommodation insufficient 3 Absence of separate accommodation for the sexes 3 Miscellaneous 11 The notices sent to the Home Office were as follows :— Abstract of the Factories Act not affixed, or wrongly affixed 12 New occupation 7 Details of Defects and Defaults in Factories, Workshops and Workplaces, for which Notices were Served in 1938. Factories. Factories (power). Factories (nonpower) . Total. Smoke nuisance 3 3 Cisterns dirty or covers broken 2 — 2 Drains coked 3 — 3 Drains leaky 1 — 1 Dustbins broken or absent 7 5 12 Guttering or rain-water pipe broken, leaking or inadequate 4 2 6 Manhole covers broken 1 1 2 Refuse accumulations 7 6 13 Roofs leaky 2 4 6 Ceilings broken — 2 2 Sanitary conveniences not separate for the sexes 4 3 7 Sanitary conveniences defective 34 14 48 Sanitary conveniences dirty 61 22 83 Sanitary conveniences insufficient 1 6 7 Sanitary conveniences unsuitable 65 10 75 Sanitary conveniences not lighted 15 1 16 Soil pipes leaky 7 3 10 Staircases and landings dirty 11 3 14 Urinals foul 2 — 2 Water closets choked 7 2 9 Waste pipes choked or leaky 6 1 7 Water fittings leaky 4 — 4 Premises dirty — 16 16 Absence of thermometer — 2 2 Yard walls dirty 1 1 2 Miscellaneous 4 2 6 Total 252 106 358 In connection with these matters, 297 intimation notices and 5 statutory notices were served. 85 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 (power) 1,731 148 Nil Factories (non-power) 749 63 Nil Total 2,480 211 Nil Defects Found in Factories, Workshops and Workplaces. Particulars. Found Remedied. Referred to H.M. Inspector. No. of Prosecutions. Overcrowding 115 115 — — Unreasonable temperature — — — — Inadequate ventilation — — — — Ineffective drainage of floors — — — — —Insufficient 7 7 _ _ Sanitary —Unsuitable or accommodation —Defective 150 150 - - —Not separate — for the sexes 7 7 — — Other Offences 79 79 — — Total 673 655 — — 86 Other Matters. Matters notified to H.M. Inspector of Factories :— Failure to affix abstract of the Factories Act (S. 114) 12 Action taken in matters referred by H.M. Inspector as remediable by the Council 60 Reports (of action taken) sent to H.M. Inspector 60 Complaints referred to ditto 3 Outworkers. The number of outworkers dealt with by the Public Health Department during the year 1938 was as follows :— No. of Outworkers notified by firms in Finsbury .. 4,959 „ „ „ „ „ Local Authori 5.534 The number of firms employing outworkers on the Register at the end of 1938 was 364. The number of Finsbury outworkers notified to the Department during 1938 was as follows :— No. notified by Finsbury firms 744 " " " other Local Authorities 575 1,319 Outworkers to the number of 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. 87 The following analysis shows the trades followed by the Finsbury outworkers :— Finsbury Outworkers Notified During 1938. (Lists sent in twice yearly.) Trade. Contractors. Homeworkers. Totals. Tailoring 162 53 215 Mantles, Gowns and Blouses 339 42 381 Coats, Costumes and Skirts 52 25 77 Uniforms 7 1 8 Furriers 103 30 133 Underwear 11 17 28 Shirts and Pyjamas 1 3 4 Neckwear 5 9 14 Woollen Goods 4 — 4 Children's Wear 8 8 16 Baby Linen 3 1 4 Millinery — 17 17 Linen and Cotton Goods 9 16 25 Needlework and Embroidery 4 18 22 Coathangers — 27 27 Umbrellas — 14 14 Handbags — 11 11 Fancy Goods 4 14 18 Hairnets — 3 3 Artificial Flowers 1 73 74 Button and Hairpin Carding — 11 11 Box-making 2 80 82 Paper Bags — 1 1 Christmas Crackers — 41 41 Toy-making 1 1 2 Lampshades — 1 1 Brushes 2 16 18 Gloves — 1 1 Apron and Caps — 1 1 Envelopes 2 — 2 Fancy Stationery — 15 15 Electro-platers and Silversmiths 2 — 2 Jewel and Plate Cases 2 7 9 Clockmakers and Opticians 6 2 8 Feather Sorting — 11 11 Belts — 15 15 Silk Mercers 3 — 3 Boots — 1 1 733 586 1,319 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. 88 The Meat Inspector paid 360 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 11 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 13 visits last year. 89 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 194 licensed premises in the Borough.—Public houses 127, beer houses 34, hotels and restaurants 3, off-licence houses 30; 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 19 Total number of observations made 214 Number of preliminary notices served 7 Number of Statutory notices served 3 Legal proceedings nil. 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. 90 There are 22 buildings in which mechanical stokers are employed. 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, 7th to 12th November, 1938. The Council's efforts for the suppression of rats in the borough are continuous throughout the year, that is, by the distribution of handbills of instructions and supplies of rat poison which are given freely to all Finsbury residents who apply, and by the special visits and advice given by the Sanitary Inspectors of the Council in all cases where complaints are received of the prevalence of rats in any premises, by the exhibition of posters throughout the borough at intervals during the whole year, and by supplies of freshly prepared rat poison (squill) to the staff under the direction of the Borough Engineer and Surveyor for baiting in the sewer manholes. A special exhibition of the Council's posters, supplemented by the special posters issued by the Ministry of Agriculture, is made during rat week on hoardings throughout the borough and on the Council's special notice boards, of which there are many in connection with the open spaces and public sanitary conveniences and on the rolling stock of the Council. By reason of the fact that the efforts of the Council are not principally confined to National Rat Week but extend throughout the year, the number of complaints received during and about rat week were not numerous. Two special enquiries were received from 91 occupiers of business premises, and twelve were received from the general public during and immediately after National Rat Week. During the year ninety-five requests were received by the Public Health Department for assistance in rat suppression. All of these complaints were followed by visits from inspectors of the department to advise on the spot and by the distribution of poison. The Borough Engineer and Surveyor reports as follows as to the distribution of rat poison in sewer manholes : "... the work of rat poisoning at the beginning of each month has been continued as usual, but particular note was taken in November of the baits laid, and the number of cases in which it had disappeared. The work of laying the poison was carried out from 27th to 29th October on the Western District, and from 31st October to 2nd November on the Eastern side. The Western District was inspected on the 3rd—5th November and the Eastern District 7th—9th November. " There are roughly 550 maholes in the Borough, 290 being in the Eastern District and 260 in the Western District, of which 70% can be treated. Bait was laid in 50% of these, and 80% of the bait had disappeared before the inspection was made. This compares with figures of 70% and 84% respectively obtained in previous years. Wet weather, the presence of H²S in various sewers and the fact that some of the newly appointed men are not thoroughly conversant with Finsbury sewerage had reduced the previous high figures for manholes treated. "For the first time in several years approximately 80% of the bait has disappeared in both the Eastern and Western Districts. Previously much more has disappeared in the Western than in the Eastern District. The figure of 20% for baits remaining is about twice as much as in several previous years. This may be due to the rats tiring of the flavour of the present bait or gradually realising its import. I arranged for the recipe for the bait to be slightly altered and also for another few days to elapse before the inspection is carried out. "A number of dead rats have been found in the sewers of the Western District, but no increase has been noticed on the Eastern District." 92 Canal Boats. During the year 1938 the total number of Canal Boat inspections made was 94, none of which carried any offensive cargo. Contravention of statutory requirements has taken place in three instances for which complaint notices were served upon the owners for abatement. The infringements were in respect of the following:— 1. Registration Certificate observed in dilapidated condition. 2. Absence of Registration Certificate. 3. Registration number on boat not corresponding with number on Certificate. Since the service of these notices, the contraventions have been remedied and further action has not been found necessary. The table below gives statistics relating to the Canal Boa inspections made during the past 5 years. Year. Boats Inspected. Persons found on Boats. Total. Registered for. Men. Women. Children. 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 1938 94 129 52 51 232 331 Of the 94 Canal Boats inspected, 50 were occupied by men only, 15 by men and women, and 29 by men, women and children. The number of children on boats was 51, of which 31 were of school age and 20 were under school age. The children accompanying their parents on the boats appeared to be well cared for. There has been no discovery or notification of an infectious disease case on the Canal Boats, therefore isolation of patients and detention of boats has not been found 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. 93 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. The Shops Act, 1934. At the end of the year there were some 1340 premises in the Borough to which this Act applies. 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 681 No. of Notices served 13 No. of shops in which extra sanitary conveniences were provided 6 No. of shops in which means of heating were provided 6 No. of exemption certificates granted 6 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, 94 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, 9 persons on the register kept for the purpose, to whom 82 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). One hundred and thirty-seven 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 27 No. of Council houses disinfested 27 No. of other houses found to be infested 137 No. of other houses disinfested 137 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. 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 disinfested by a company at the request of the owner. The belongings of 6 families were dealt with. 95 Houses Let in Lodgings. At the end of the year there were 742 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. 1,699 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. Three samples of rag flock were submitted to the Public Analyst last year, and were found satisfactory. Street Traders. There were at the end of the year 323 persons engaged in street trading in foodstuffs within the Borough. It was arranged during the year that all applications for licences to trade in foodstuffs 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. 573 inspections were made for that purpose. 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. 96 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. One hundred and seven notices were served last year for the provision of ventilated food cupboards. In all 209 such cupboards were installed. Mortuary, Coroner's Court, Shelter and Disinfecting Station. The use of these premises at Nos. 47 and 49 Northampton Road was discontinued when the Health Centre was opened. Twelve bodies were received last year. The following table gives particulars of the disinfection work during the year 1938, both at the old and new premises. Premises disinfected after :— Diphtheria 137 Measles 564 Vermin and Scabies 349 Scarlet Fever 165 Tuberculosis 125 Whooping cough 224 Miscellaneous reasons 181 By request 196 Bedding and mattresses were steam disinfected for the following institutions :— St. Mark's Hospital, St. Barnabas' Hospital, Royal London Ophthalmic Hospital. A total of 15,558 articles were disinfected last year. These were chiefly mattresses, pillows, bolsters, sheets, blankets, quilts and wearing apparel. Four persons were temporarily housed in the shelter in 1939. 97 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. 602,999 articles were disinfected last year under this heading and the fees charged amounted to £580. 0 Cleansing Station. The Cleansing Station at the Health Centre was opened on 1 st December last, and below I have given the details of the work carried out. School Children— School Children— Number of Scabies cases dealt with 291 Number of Verminous cases dealt with 119 Total number of attendances of school children 491 During last year 62 adult persons were referred to the Cleansing Station in St. Pancras for treatment prior to the opening of the new Station. Of this total, 27 were sent for verminous conditions and 35 for scabies. School Children.—205 school children who were suffering from scabies, and one from verminous conditions, 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. Public Cleansing. The following particulars have been kindly supplied by the Cleansing and Markets Superintendent:— 98 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 litter 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 6,300 tons are disposed of annually in this manner. Over 4,982,000 gallons of water were used in street and gully cleansing. Five hundred and eighty 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. 99 List of courts for flushing :— Albion Place. Killicks Cottages. Angel and Porter Court. Lambs Passage. Arthur Passage. Lambs Buildings. Bayer Street. Lensden Place. Basterfield Street. Locks Gardens. Baynes Court. Lewins Court. Berkley Court. Macclesfield Place. Briset Street. Masons Place. Blue Anchor Alley. Medcalf Place. Broad Arrow Court, Memel Court. Bell Place. Myddelton Passage. Brunswick Close (North). Nelson Passage. Brunswick Close (South). Nelson Place. Chequer Alley. Northwest Place. Charlotte Place. Northeast Place. Compton Passage. Peters Lane. Chapel Place. Pickburn Place. Chequer Street. Pinks Row. Crawford Passage. Pentonville Road, 207-227. Cumberland Gardens. Rawstorne Place. Donegal Row. Roberts Place. Dufferin Avenue. Rose Passage. Eagle Court. Sally Place. Emmens Buildings. St. Johns Passage. Elizabeth Place. Shrewsbury Court. Faulkners Alley. Spa Cottages. Flag Passage. Sidcup Place. Francis Court. Union Place. Fryes Buildings. Vineyard Gardens. Glasshouse Yard. Vineyard Walk. Godson Street. Vineyard Mews. Goswell Terrace. Withers Place. Hot Water Court. Warwick Yard. Howards Place. Wardens Place. Haywards Place. White Horse Alley. Ironmonger Passage. Wilmington Square. James Gardens. Wynford Place. Jerusalem Passage. Youngs Buildings. Kemp Place. There are 9 surface urinals which are flushed daily, including Sundays. 100 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 1938 amounted to 24,270 tons. In addition there were 5,840 tons of street sweepings and market garbage, and 476 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, Washhouses, and Swimming Pools. Under this heading there are two establishments in the Borough, viz., the Public Washhouse 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 Washhouse 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. 101 The numbers of persons using the baths last year were as follow:— Swiming Baths—Merlin Street 82,634 Ironmonger Row 18,795 Slipper Baths, Merlin Street 140,937 Slipper and Turkish Baths, Ironmonger Row 132,349 The number of women using the wash-tubs last year was as follows:— No. of Washers. Merlin Street Establishment 28,175 Ironmonger Row Establishment 23,805 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 to these Baths was opened by His Worship the Mayor, Alderman C. A. Allen, J.P., on 22nd October last. A Large Swimming Pool, a special Children's Swimming Pool, a Cafe and a Turkish Bath Suite have been provided. These new services should do much to increase the health and efficiency of the inhabitants of the Borough. 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 1938 was i2i. 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:— 102 88, Old Street: Licensed No. of Beds 348 men Beds occupied 263 „ No. known to be in receipt of public assistance 45 „ No. of beds paid for by charitable organisation 2 „ 57, White Lion Street: Licensed No. of Beds 92 „ Beds occupied 29 „ No. known to be in receipt of public assistance 1 „ No. of beds paid for by charitable organisations nil. 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 Corporation Dwellings. Altogether 500 pigeons were destroyed. 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. Two complaints of noise were received last year, but no action under the Act was taken. 103 SECTION D. Housing. Particulars of Inspections. 1. Inspection of Dwelling-houses during the year:— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 2,263 (b) Number of inspections made for the purpose 2,520 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 724 (b) Number of inspections made for the purpose 958 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation nil. (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 1,418 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 86 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 nil. (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners nil. (b) By local authority in default of owners nil. 104 (b) Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 1,728 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 1,728 (b) By local authority in default of owners nil. (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 nil. (2) Number of dwelling-houses demolished in pursuance of Demolition Orders nil. (d) Proceedings under Section 12 of the Housing Act, 1936:- (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made nil. (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit nil. 4. Housing Act—Overcrowding:— The 1st October 1938 has been fixed as the appointed day for the purpose of Section 62 of the Act and 1st April, 1939 for the purposes of Sections 6 (2), 59, 60, 64. In a report presented to the Council by the Housing Committee in December, 1938, the number of overcrowded dwelling-houses in Finsbury was stated on the result of the completed survey of the Borough to be 1,470— Information obtained within a reasonable degree of accuracy at the end of 1935, through the special survey undertaken under the Housing Act of that year, revealed that the number of dwellings then overcrowded was 2,442. 105 Busaco Street Area.—This area comprises the following properties: Nos. 1-42 (consecutive), Busaco Street ; Nos. 21-61 (odd numbers), Cumming Street ; Nos. 38-86 (even numbers), Southampton Street ; Nos. 10-24 (even), Collier Street. A local enquiry was held on 13 th September, at which your Medical Officer of Health gave evidence. The re-development of this area is proceeding, many of the dwellings being demolished. 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. Sadler Street (Adjoining Land) Order, 1937. A public enquiry was held in respect of the above Order on Wednesday, 23rd February, 1938, and evidence was given by your Medical Officer of Health. The scheme will provide for the erection of 112 flats in stages, and when completed, will rehouse 13 families in excess of those residing in the whole area, viz., 107. Jay's Buildings Area. On 15th November I made an official representation in respect of this area, which includes stable dwellings and massed dwellings. The following premises were included in the representation:- Jay's Buildings, Nos. 1-8 (consecutive); Rodney Street, No. 32; Rodney Residences, Rodney Street, Nos. 1-30 (consecutive); Penton Residences, Risinghill Street, Nos. 1-30 (consecutive); Risinghill Street, Nos. 9-19 (odd numbers); Risinghill Street, Nos. 1-7 (odd numbers). Lands outside the Clearance Area declared by the Council include the following premises :— Nos. 48-74 (even numbers), Wynford Road. Nos. 34, 61 and 63, Rodney Street. No. 23, Risinghill Street. 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 1936. It is 106 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). Little Northampton Street Area.—The London County Council declared the Little Northampton Street Area to be a Clearance Area on 16th February, 1937. 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. The Order comprises the following premises:— Nos. 1-7 (consecutive) and 12 and 13, Compton Passage. Nos. 4, 5, 6, 7, 7a, 7½, 11 and 12, Compton Street. Nos. 2, 4, 6, 7, 8, Cyrus Street. Nos. 3 and 11-33 (consecutive), Little Street. No. 10, Malta Street. Nos. 33-40 (consecutive) and 40a and 41-57 (consecutive), Northampton Street. Nos. 1-14 (consecutive), Valetta Street. The Order was confirmed, with modifications, on 8th February, 1938. 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 90 working-class flats, with provision for a communal washing-house with electric washing and drying machines. Many of the houses are empty at the present time. London County Council (Gee Street), Finsbury, Nos. 1, 2, 3 Clearance Orders, 1936. This area has now been cleared. No. 4, Coldbath Square.—These premises were excluded by the Minister of Health from the L.C.C. (Baker's Row, Finsbury), Clearance Order, 1936, owing to technical reasons. I accordingly represented it as unfit, and a Demolition Order was subsequently made by the Borough Council. No. 169, Farringdon Road.—These premises were similarly excluded from the Order upon an undertaking by the owner to carry out a scheme of reconstruction of the premises and to cease to use them for human habitation. 107 On the nth January I accordingly represented the premises as unfit for human habitation, and the Council made a Closing Order prohibiting its use for human habitation. Underground Rooms.—The Council made Regulations in 1937 for controlling the occupation of underground rooms. The Regulations are similar to the Model Regulations issued by the Ministry of Health. Last year 86 rooms were re-conditioned. 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 four notices were served in this matter, and the mecessary lighting was provided. Housing Applications. 115 families last year were recommended for priority treatment by the Health Department. 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 321 No. of applications received for County Dwellings 60 No of cases of hardship 118 No of cases with no relative hardship 263 No. of applicants for accommodation in Finsbury removed from register: (a) Withdrawals 1 (b) Removed from recorded address 5 No. of applications transmitted on behalf of Borough Council to the London County Council with priority recommendation 115 No. of recommended applicants accommodated by L.C.C. 32 No. of recommended applicants refused by L.C.C. 0 No. of direct applications to L.C.C. acceded to last year 89 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. 19 108 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.—Twenty-four applications for registration were considered during the year; two 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 1937 180 No. of Purveyors removed from Register during the year 31 No. of Purveyors added to Register during the year 24 No. of Purveyors of Milk on Register at end of year 1938 173 534 visits of inspection were made and 7 notices served for cleansing and repairs. Dairymen of this Borough have been found to appreciate any advice that will lead to improvement in their premises, and generally any suggestion made is readily carried out. One of the modern gas or electric refrigerators for storage purposes is now in use at nearly all shops selling milk. 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 number 64. Six 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 is being overcome by having the milk for "bottle sales" delivered to them already bottled by their wholesalers. 109 The Milk Bill, which received so much publicity during the year, was found to be an obstacle in getting dairymen to take any active steps to install steam-sterilizing apparatus. However, since the dropping of the Milk Bill, some of the dairy occupiers are again considering this matter. The Milk (Special Designations) Order, 1936. 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 9 (2) To use the designation "Accredited" Milk 1 (3) To use the designation "Pasteurised" Milk 40 (4) Pasteurisation 1 (5) Supplementary licences to sell 8 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. During the year 79 samples of designated pasteurised milk were procured from dealers specially licensed under the Order, for bacteriological examination. Eleven 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 furnised to this Department. This has enabled a better check to be maintained on the bacterial purity of all the milk pasteurised in the Borough. 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 15 samples were taken for examination. No contravention of the Regulations were observed. 110 Ice Cream. There were 137 vendors of ice-cream on the Register at the end of the year. Three hundred and sixteen 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 59. This ice-cream is purchased by the retailer already wrapped by the manufacturers, and affords a very cleanly method of dealing in ice-cream. The number of retailers in this Borough manufacturing their own ice-cream with electrical freezers has increased. 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. Twenty-five samples of ice-cream were examined last year bacteriologically, and the results are summarised below. Total bacterial count:— Per ml. No. (a) Less than 2,000 2 (b) Less than 5,000 but more than 2,000 1 (c) Less than 10,000 but more than 5,000 4 (d) Less than 100,000 but more than 10,000 10 (e) Less than 750,000 but more than 100,000 5 (f) Over 100,000 3 25 B. Coli were present in 1/100 m.l. in 4 samples B. Coli were present in 1/1,000 m.l. in 1 sample. B. Coli were present in 1/10,000 m.l. in 2 samples. 1ll When B. Coli is present in 1/100 m.l., or less, 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 1/100 m.l. 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 some of the samples taken is not satisfactory ; thus groups (a) to (e), 22 in all, may be regarded as generally good ; those under (/) 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. 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 id. per one-third of a pint instead of a id. 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 and Drugs (Adulteration) Act) and the results are shown below, 112 Schools at which Samples taken. No. of Samples. Result. Amwell Street 2 Genuine 2. Bath Street 1 „ 1. Bowling Green Lane 6 „ 6. Central Street 1 „ 1. Chequer Street 1 „ 1. Compton Street 5 „ 5. Hugh Myddelton 4 „ 4. Moreland Street 3 „ 3. Risinghill Street 4 „ 4. St. Luke's 4 „ 4. St. Mark's 3 „ 3. SS. Peter and Paul 1 „ 1. Vernon Square 4 „ 3* White Lion Street 5 „ 5. Winton 2 „ 2. * One sample obtained at Vernon Square School was certified to contain 3'7% added water. A repeat sample was taken formally and was certified to be genuine. Forty-seven samples were bacteriologically examined. Of these, 37 were within the limit of 100,000 bacteria per millilitre. Twenty-five of these contained less than 50,000 per m.l., and of these 25, 9 contained less than 20,000 per m.l. Of the 10 samples over standard, five contained less than 200,000 bacteria per m.l. It will be seen that all the samples except 10 complied with the requisite standard. Thirteen samples, however, showed the presence of B. Coli in 1/10 c.c. Three samples in 1/100 c.c. and two in 1/1000 c.c. In each case of non-compliance with standard a warning letter was sent to the supplier. 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:— (а) 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. 113 The following is a summary of the number of registered premises in the Borough at end of year:— Manufacture of ice-cream 75 Storage and sale of ice-cream 62 Fried fish shops 17 Butchers' shops and stalls 1 05 Other premises, bacon smoking premises, etc., where food is cooked, preserved or pickled 85 Total number of premises 344 All the premises were regularly visited during the year. Cowhouses.—There are no cowhouses in the Borough. 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 six formal samples of sausages; warnings were sent in five cases and proceedings taken in one instance. 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, 115 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. Four samples have been taken, and each was found to comply with the requirements. 114 Meat and Other Foods. The work of meat inspection continues to be carried out by Mr. Penman, who is assisted generally by Mr. Barber. 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 butchers' shops and market streets is carried out by Mr. Penman. Summary of foodstuffs seized by or surrendered to the meat inspector during 1938:— Tons. Cwts. Qrs. Lbs Diseased Meat 42 13 2 13 Diseased Offals 13 11 0 20 Decomposed, etc., Meat 66 7 3 10 Decomposed, etc., Offals 50 9 0 16 173 1 3 3 Unsound Bacon released for Soap Boiling 21 2 1 9 Total 194 4 0 12 Imported Mutton and Lamb (Caseous Lymphadenitis):— Carcases of Mutton 46 Do. Lamb 2 Pieces of Mutton 81 Do. Lamb 30 The annual amount of meat and offal seized and surrendered by the Meat Inspector in Finsbury from 1927 to 1938 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 1938 42½ 13½ 88 50½ 194½ 115 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. The Public Health (Imported Food) Regulations, 1937. During the year these regulations came into force and by reason of the fact that the Mount Pleasant Post Office Depot is a Customs Port, Finsbury Borough Council has certain duties to carry out in conjunction with H.M. Customs and Excise in dealing with certain meat and meat products imported in contravention of the law. The meat products chiefly dealt with are animal casings, i.e., cleaned animal intestines, used as sausage casings. It is required by the regulations that such goods when imported shall bear an "official certificate" of the country of origin. These "official certificates" are certificates granted by the exporting country with the consent of the Ministry of Health after the Ministry has made an enquiry and has satisfied itself as to the satisfactory standard of meat inspection in that country. There are many countries which cannot grant these official certificates, viz., India, Iran, Egypt, China (with the exception of the Shanghai International Settlement), etc., yet casings find their way here from such countries through the post, in many instances as much as 22 lbs. weight being imported in one consignment. Many of the parcels, however, are small and evidently "samples" of casings. Casings are offered for sale in London by "sample" and the bulk casings are held at such "free" ports as Hamburg and Danzig. These bulk casings are of unknown origin, and without "official certificates" they cannot enter Gt. Britain. As no provision has been made in the Regulations for "samples," which samples are quite capable of being used for human food, and 116 as many of the parcels contain sufficient casings to stock a small sausage factory, these parcels, on notification from H.M. Customs and Excise, were rightly refused entrance into this country, and were accordingly re-exported or destroyed. Representations were made by the London Chamber of Commerce for an alteration of procedure on behalf of the members, and a deputation from that body was received and their proposals discussed. It was agreed that the Public Health Department should regard such parcels of casings without "official certificates" as "samples" for "testing" or other technical purpose only, and that a signed guarantee should be obtained from each addressee before the parcels were delivered, to that effect, and undertaking that the goods should not be used for human food but be destroyed or reexported after use. Incidentally, the local authorities were to be notified by the Public Health Department of the coming into their areas of such "samples." This procedure is now in force and appears to work quite well. It has occasioned, however, a good deal of visiting Mount Pleasant and additional clerical work to the Department. 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. 117 The Merchandise Marks (Imported Goods) No. 3 Order, 1934 Bacon and Ham. The Merchandise Marks (Imported Goods) No. 5 Order, 1934 Dead Poultry. 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; 118 Dressed Poultry; Celery; Apples; Pears; Jam; Canned Fruits; Honey; Natural Rhubarb; Stilton Cheese. 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 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. 1938 Cream 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 1938 was 320. Most of these were for Australia. A few were issued for the United States, Canada, France, Finland, the Philippine Islands, and Demerara. Food Poisoning. Food poisoning is now notifiable under the Public Health (London) Act, 1936, Section 182. During the year 2 cases were notified. 119 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 195 sheep and lambs were slaughtered in 1938. During the year 65 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. Slaughtermen have also to be licensed, and in connection with this, licences were granted to Stephen George Tibby, 114, Barnsbury Road, N.1 John Henry James Mobbs, 54, Amwell Street, E.C.1 James Henry Mobbs, 14, Penton Street, N.1. Prosecutions.— Several prosecutions have been successfully undertaken against offenders under the Merchandise Marks Acts and the Public Health (London) Act, 1936. In one case taken under Section 187, Public Health (London) Act, 1936, the offender was found to be making sausages in a private house and hanging the prepared sausages on a clothes line with dirty washing. In the case of R. Steel, cattle dealer, Beccles, who was fined £25 and 15 guineas costs for depositing certain diseased meat for sale in the Borough, it is interesting to note that as a corollary to this prosecution a slaughterman at Beccles, Suffolk, was prosecuted under the Public Health (Meat) Regulations, 1924, by the Beccles Town Council, at Beccles, and fines totalling £30 were imposed on this man. Inspector Penman gave evidence at Beccles. The Merchandise Marks (Imported Goods) No. 7 Order, 1934, which provides for identification of origin of meats and offals to the purchasing public must prove to be of advantage to the housewife who is able to discriminate at will "Englishand the produce of other countries. It should be noted, however, by the discriminating housewife that the term English or the lack of any label on meats— denoting English— does not imply best quality. A great deal of English meat sold in butcher shops is meat of inferior quality, i.e., meat from old parent animals. Therefore the discerning housewife must still rely on her knowledge of meat, or her butcher, when she wants the best. Constant supervision of butcher shops and meat stalls in the Borough ensures that labels are affixed as required by law. 120 Bakehouses. There are 29 bakehouses in use in the Borough, of which 20 are underground, and in 24 bakehouses machinery is used. The bakehouses were visited regularly during the year, 262 visits of inspection being made, and 33 notices were served for cleansing and other matters. The provisions of the Factories Act, 1937 (which came into force on the 1st July, 1938), applying to underground bakehouses, has been referred to on pp. 79-83 of this report. On the 1st October, 1939, the Food and Drugs Act, 1938, comes into force. This Act repeals the Sub-section 1 of Section 157, and the whole of Part I of the Third Schedule of the Factories Act, 1937. This will result in the sanitary requirements for all bakehouses, now enforced under the Factories Act, 1937, being enforced under the Section 13 of the Food and Drugs Act, 1938, which section lays down specific requirements to prevent the contamination of all foods (except milk) intended for human consumption the provisions of the Factories Act, 1937, relating to the control of underground bakehouses, however, will not be affected. Food and Drugs (Adulteration) Act, 1928. The number of official samples taken during 1938 was 600, of which the following is a summary:— Name of Article. Gen. Adult. Total. Name of Article. Gen. Adult. Total. Apricots 2 - 2 Milk 173 9 182 Barley, Pearl 6 — 6 Oatmeal 1 1 Beef, corned 5 — 5 Peas, Split 5 5 Black Pudding 1 — 1 Peel, candied 2 2 Brawn 17 2 19 Powder, Lemonade 1 1 Butter 116 — 116 Prunes 1 1 Cheese 41 — 41 Raisins 2 - 2 Coconut 2 — 2 Rice 27 27 Currants 2 — 2 Sago 4 4 Dripping 30 — 30 Salad, dried Fruit 5 5 Flakes, Oat 1 — 1 Sausage, breakfast 2 2 Fruit, dried mixed 2 — 2 Sausage, cooked 7 7 Fruit, mixed 7 — 7 Sausages 22 6 28 Fruit, Salad dried 1 — 1 Smolina 3 - 3 Ham 1 — 1 Shortening 1 1 Lard 13 — 13 Suet, Shredded 5 5 Lentils 1 — 1 Sugar 7 7 Macaroni 3 — 3 Sultanas 14 - 14 Maize Flour 1 — 1 Sweets 10 - 10 Margarine 34 — 34 Tapioca 2 2 Meat Roll 2 - 2 Tea Dust 1 — 1 121 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 1938 600 583 17 2.8 Notification was received from a neighbouring borough that samples of marmalade and black-currant jam had been found to contain 69 and 75 parts per million of sulphur dioxide, respectively both were supplied from a shop in Finsbury. Under the Public Health (Preservative, etc., in Food) Regulations, jam (which includes marmalade) may contain only up to 40 parts per million of sulphur dioxide. The Finsbury shop was visited and the proprietor was informed. He carried a large stock of this particular brand of jams, and he was told of the risk he was running in allowing this jam to be sold. He willingly agreed to take the whole stock from sale, until it was decided whether or not it complied with the requirements of the Regulations. Upon this undertaking a sample of each marmalade and several jams was submitted for analysis. Each of these was certified by the Public Analyst to contain varying amounts of sulphur dioxide, ranging from 55 to 82 parts per million. 122 The manufacturers were informed and they requested that all the jams be returned to them for remaking, so that the requirements could be satisfied. This was agreed to and the Local Authority for the district was notified. This brand of jam has since been analysed and was found to comply with the Regulations. Informal Samples.— In addition to the samples purchased officially in 1938, 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 "feelersto test the probity of the vendor without exciting his suspicion. The results were:— Name of Article. Gen. Adult. Total. Name of Article. Gen. Adult. Total. Anchovy Fillets 2 — 2 Mincemeat 4 — 4 Butter 5 — 5 Mustard, French 1 — 1 Cheese 1 — 1 Ointment, Boracic 2 — 2 Cherries, canned 1 — 1 Ointment, Sulphur 1 — 1 Cinnamon, ground 1 — 1 Ointment, Zinc 2 — 2 Cloves, ground 1 — 1 Paste, Fish 2 — 2 Crab, canned 1 — 1 Pepper 2 — 2 Cream, canned 3 — 3 Pickles 1 — 1 Cream Salad 1 — 1 Plums, bottled 1 — 1 Currants 3 — 3 Powder, Baking 2 — 2 Cubes, Beef 1 — 1 Powder, Custard 2 — 2 Flour, selfraising 2 — 2 Powder, Liquorice 1 — 1 Fruit Pudding 1 — 1 Powders, Grey 1 — Fruit Salad, canned 1 — 1 Pudding, Christmas 1 — 1 Ground Ginger 1 — 1 Raisins 4 — 4 Herring Fillets in Salmon, canned 1 — 1 Peanut Oil 1 — 1 Sardines 3 — 3 Herrings in Tomato Sausage, cooked 1 — 1 Sauce 1 — 1 Sausages 5 1 6 Jam 2 5 7 Sild in Olive Oil 1 — 1 Jelly 1 — 1 Soup, Tomato 1 — 1 Ketchup, Tomato 1 — 1 Spice, mixed 1 — 1 Kipper Snacks, Sugar, Foot 2 — 2 canned 1 — 1 Sultanas 4 — 4 Marmalade 1 1 2 Tincture, Amnion, Milk 47 1 48 Quinine 1 — 1 Milk, condensed evap. Tomatoes 1 — 1 F.C 2 — 2 Tripe 1 — 1 Milk.condensedS.F.C. 7 — 7 Tunny Fish in Olive Milk, condensed S.S. 6 — 6 Oil 1 — 1 123 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 Poliomyelitis (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. Measles and Whooping Cough are compulsorily notifiable in London by Regulations of the Ministry of Health. Zymotic Enteritis (Epidemic Diarrhoea) has 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 i,ooo Living : — Finsbury. London. England and Wales Smallpox o.oo o.oo 0.00 Scarlet Fever 2.53 2.05 2.41 Diphtheria 1.77 1.90 1.58 Enteric Fever o.oo 0.05 0.03 Erysipelas o.59 0.46 0.40 The total number of infectious diseases notified and those removed to hospital are set out on the following page:— 124 NOTIFIABLE DISEASES, 1938. All ages. Under 1 yr . 1-5 yrs. 5-15 yrs. 15-25 yrs. 25-45 yrs . 45-65 yrs. 65 + Clerken well. St. Luke. St. Sepul. Total removals to hospital. Acute Primary Pneumonia 55 2 16 10 4 11 7 5 44 11 19 Acute Influenzal Pneumonia 4 — — - 1 1 1 1 4 — — — Cerebro-spinal Meningitis 1 — 1 - — — — — — 1 — 1 Diphtheria (including Me. Croup) 101 3 34 53 10 1 — — 66 35 — 101 Dysentery 20 1 10 5 — — 2 2 15 5 — 13 Erysipelas 34 — 1 4 7 9 5 8 26 8 — 20 Food Poisoning 2 — — — — — 2 — 2 — — — Measles and German Measles 635 44 382 198 7 4 — — 394 239 2 261 Ophthalmia Neonatorum 13 13 - - - - - - 10 3 — 6 Acute Poliomyelitis 1 — 1 — — — — — 1 — — 1 Puerperal Pyrexia 9 — — — 3 6 — — 7 2 — 3 Puerperal Fever 4 — — — 1 3 — — 3 1 — 4 Scarlet Fever 144 2 53 73 12 3 1 — 109 35 — 144 Pulmonary Tuberculosis 100 — 1 7 32 32 23 5 68 29 3 — Other forms of Tuberculosis 22 — 2 6 5 7 2 — 14 8 — Whooping Cough 339 36 189 114 — — — — 252 84 3 93 Zymotic Enteritis 14 10 4 - - - - - 13 1 — 5 1,498 111 694 470 82 77 43 21 1,028 462 8 671 The Zymotic Diseases.— Scarlet fever, whooping cough, diphtheria, diarrhoea, enteritis and measles caused a total of 27 deaths— Scarlet fever 0, whooping cough, 7, diphtheria, 3. diarrhoea anr' enteritis (under 2 years) 16, and measles 1. The zymotic death-rate was -474 per 1,000 population. 125 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.1. 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.1. Hours : 9.30 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 Wednesdays 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 1938. No. of Births received from the Registrars 2,033 No. of Finsbury Births received from the Registrars 495 No. of Certificates of Vaccination received 864 No. of Deaths before Vaccination 56 Postponements by Medical Certificate 43 Certificates of Exemption granted after Declaration 558 No. of Certificates of Insusceptibility 3 Non-resident Cases — Notices to other Vaccination Officers 1,538 Addresses not traced 66 Finsbury Babies not vaccinated within the Statutory period of four months 47 No. of personal visits made during the year 643 120 Scarlet Fever. Last year 167 cases were notified as suffering from scarlet fever. The number of cases wrongly diagnosed was 23, leaving 144 true cases, of which all were treated in isolation hospitals. There were no deaths. Those cases wrongly diagnosed were found to be suffering from:— Chicken Pox 3 Eczema 1 Coryza 2 Measles 9 Erythema 1 Tonsilitis 7 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. 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 — 1938 144 — — 25.3 — Twelve patients developed scarlet fever whilst they were detained in hospital for other causes. There were no return cases. 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. 127 The average length of stay in hospital of scarlet fever cases last year was 42 days. The period of stay in hospital varied from 6 days to 163 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 one school by a medical officer 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. 128 Diphtheria. Last year 138 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:— Asthma 1 Pharyngitis 2 Coryza 1 Scarlet Fever 3 Laryngitis 5 Tonsilitis 19 Whooping Cough 1 Four cases were described as not diphtheria,and one as no obvious disease." When the figures are adjusted for wrong diagnosis, a total number of 101 cases is left, 9 of which were contracted in the hospital to which the patient had been admitted for some other disease. Deaths.— There were 3 deaths, equal to a case mortality of 3 per cent. In 1937 the number of deaths was 2, giving a case mortality of i-8 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. 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 .34 1938 101 3 3.0 17.7 .52 129 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 anto-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 nine vials representing 28,000 units were issued to the practitioners. A fee of 5s. od. 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 65 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. 130 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 and 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. Immunisation treatment is also given at the Leage Street Centre. 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. 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. 131 Immunisation Clinic— contd. Total attendances at the Clinics (Pine Street) 291 No. of Clinics (Pine Street) 49 (Leage Street) 424 „ (Leage Street) No separate clinics. Average attendances per clinic (Pine Street) 6 Year. No. of New Cases. No. S chick Tested. No. Treated without Schick Test. No. Immunisation Completed. Nos. Discontinued Treatment. Nos. Re-Schicked. No. under Treatmenl 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 Pine Street 1938 81 0 19 (17) 0 118 37 39 0 19 12 0 37 39 0 9 Leage Street 1938 120 0 0 0 120 56 8 0 51 6 0 59 8 0 35 Municipal Day Nursery 1938 30 0 0 0 30 26 0 0 4 0 0 26 0 0 4 1938 231 0 19 (17) 0 268 122 47 0 74 18 0 122 47 0 48 The Numbers in brackets indicate those found to be Negative. Columns 7, 8, 9 indicate those who have received full doses of immunising fluid. Total number of cases since the scheme commenced in which it was found necessary to give more than three injections— Nil 132 I have to report an encouraging increase in the numbers immunised during the past year. In April we commenced using another form of immunising fluid at Leage Street and the Day Nurseries in the Borough. This method needs only two instead of three injections. We have found it entirely satisfactory and propose to use it in future for all routine cases in the pre-school child. The smaller number of attendances required per case will of course be reflected in the total attendances figures. The cost is proportionately less. Day Nurseries. The immunisation, with the parents' consent, of the Finsbury babies and toddlers in attendance at two Day Nurseries, viz., Claremont and St. Leonard's (Foundling Estate), has been con- tinued as follows Claremont Day Nursery. St. Leonard's (Foundling Estate). Number immunised 12 4 Number of Schick tests 12 1 Immunisation by General Practitioners. This scheme, as outlined in the Report for 1935, has been continued, and 36 children were immunised. Diphtheria in Immunised Persons. One immunised child was notified last year as suffering from Diphtheria and was admitted to an infectious diseases hospital. She received three immunising injections in the latter part of 1937 and on subsequent reschicking was found to be negative in March, 1938. On inquiries it was found that the child was a virulent carrier, Schick negative, suffering clinically from tonsillitis and not diphtheria. Measles. 635 cases were notified last year. By an Order made by the Ministry of Health, the Finsbury Order made in 1923 as to the notification of Measles and German Measles was revoked, and Measles is now notifiable throughout London. German Measles is no longer notifiable. 133 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 — — J 2 1938 1 7 — 3 Total 1,517 882 15 151 399 From this table it appears that the deaths in 38 years due to scarlet fever, diphtheria and smallpox, all taken together numbered 568, to whooping cough 882 and measles 1,517. 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. 134 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. Nine hundred and thirty-one visits and re-visits were paid for these purposes during 1938. Of the notified cases, 261 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 of 7 children under five years of age last year. Since 28th May, 1934, whooping cough has been made compulsorily notifiable in the Borough the Order made by the Council has now been superseded by an Order made by the Ministry of Health. 339 cases were notified in 1938 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 Research Products, 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 eight cases last year. 135 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 55 Mumps 24 German measles 8 Anthrax. No case of anthrax was notified last year. Typhus Fever, Glanders, Hydrophobia. No case of these diseases was notified in 1938. Cerebro-Spinal Meningitis. One case was notified in 1938; the patient was removed to isolation hospital but died soon after admission. Acute Primary Pneumonia. Fifty-five cases of acute primary pneumonia and 4 of influenzal pneumonia were notified in 1938. In 9 cases of pneumonia in necessitous families the Borough Council provided a nurse; to these cases the nurses paid 148 visits. Influenza is not a notifiable disease; no deaths were ascribed to influenza last year. Acute Poliomyelitis. One case of acute poliomyelitis was notified, and was removed to an isolation hospital. Typhoid Fever (including Para-typhoid). In 1938, no cases of para-typhoid or typhoid were notified. Contacts of cases notified in a neighbouring Borough were kept under observation for the usual period of 14 days. Encephalitis Lethargica. No cases were notified last year. 136 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. Twenty cases of dysentery were notified in 1938. 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. 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 137 Inn Road, W.C.i; and the Hospital for Sick Children, Great Ormond Street, W.C.i. 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 has been gradually increasing in recent years, although lower in 1938. 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. 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 1938 yielded a rate of 1.98 per 1,000 of the population. 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. 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 1938 113 1.98 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. 138 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 cases were accepted under the scheme at a cost to the Council of £2 6s. 0d. 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 1938 Number of deaths from Phthisis 596 535 366 50 52 61 35 Number of cases notified only at death 44 (32) 30 (17) 19 (8) 0 1 (0) 1 (1) 2 (1) Number of cases dying non-notified 120 (65) 86 (32) 68 (19) 8 (3) 2 (0) 5 (2) 9 (5) Number of cases notified within a month of death 50 66 39 6 5 8 4 Number of cases notified within 1-3 months of death 55 67 28 6 9 7 7 Number of cases notified within 3-6 months of death 53 39 49 4 2 4 5 NOTE.—The figures in italics and bracketed indicate the numbers of the cases referred to who died in public assistance institution. 139 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. Tuberculosis Notification Register. The total new cases of Tuberculosis, both pulmonary and non-pulmonary entered on the register in 1938 numbered 122. The age period details were as follows :— Age Periods. 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- Total Males Pulmonary - 1 4 1 6 9 6 10 13 7 3 60 Females Pulmonary - — - 2 7 10 8 8 2 1 2 40 Males Non-pulmonary - — 3 — 1 1 1 1 1 1 — 9 Females Non-pulmonary — 2 2 1 1 2 2 3 — — — 13 Of the above 122 cases, 33 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, 1938, was as follows :— Males. Females. Total. Pulmonary 199 139 338 Non-Pulmonary 44 42 86 243 181 424 The number of cases removed from the register during the year was 93—due to withdrawal of notification 4, recovery from the disease 8, death 44 and miscellaneous 37. 140 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 1,000 of Inhabitants. Average No. of Deaths. Average Death Rate per 10,000. 1901-10 213 22.7 223 23.4 1911-20 327 41.0 146 18.7 1921-30 161 21.7 94 12.8 1931 135 19.3 85 12.1 1932 132 19.1 73 10.6 1933 122 18.3 78 11.5 1934 132 20.3 56 8.6 1935 101 16.0 50 7.9 1936 97 16.1 53 8.7 1937 106 18.1 59 10.0 1938 116 20.3 35 6.2 The number of primary notifications received in 1938 was 100. Of these, 12 were from Public Assistance sources, 49 from hospitals and dispensaries, 24 from private doctors, and 15 from sundry sources. And, again, of these :— 68 were from Clerkenwell. 29 „ St. Luke's. 3 „ St. Sepulchre. 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 oneroomed tenements, 21 lived in two-roomed tenements, and the remainder had three or more rooms. Overcrowding was noted in nine 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. 141 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. Three tenements were on the list of houses let in lodgings; 26 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, two were used for the sale or preparation of food products. 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 1938 the rooms, bedding, feeding utensils, towels, handkerchiefs and linen were disinfected in 135 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 1938 the number of Finsbury persons who died of phthisis or pulmonary tuberculosis was 35. In addition to these, three died from other forms of tuberculosis. The deaths from all forms of tuberculosis were therefore, 38. The deaths for previous years, in ten-year periods, are given in the following table:— 142 DEATH RATES, 1901-1938 (PHTHISIS AND OTHER FORMS OF TUBERCULOSIS). 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 1.06 .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 1938 35 3 .62 .532 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, or influenza. Allotted to districts, 24 deaths from phthisis belonged to Clerkenwell, 8 to St. Luke's and 2 to St. Sepulchre. 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), 1918-1938. Year. Total Deaths. Deaths from Tuberculosis. Tuberculosis percentage 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 1938 734 38 5.2 143 It will be seen from this table that in 1938 5.2 per cent, of all the deaths were directly due to tuberculosis. 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. Fifty 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 23. Clerkenwell 14, St. Luke's 9, cases. The parts chiefly affected were the cervical glands (5) and knee (3). 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 1938 was .667 per 1,000 ; the corresponding rate for 1937 was 1.090 per 1,000. 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 this section. 144 The Tuberculosis Dispensary. The work of the Tuberculosis Dispensary was carried on as in previous years at 21, Whiskin Street until the end of November, when the work was transferred to the New Health Centre, Pine Street and carried on in the Municipal Chest Clinic. The principal objects of the work carried out are to :— (1) Discover every case of tuberculosis at as 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 at 21, Whiskin Street included :— The Tuberculosis Officer, The Tuberculosis Visitor, The Janitor, One Lady clerk (part-time). The Dispensary is open :— Monday, Wednesday and Friday : 10 a.m. to 12 noon. Tuesday 6 p.m. to 8 p.m. (for those at work). Saturday 10 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. 145 Below will be found a summary of the work of the Tuberculosis Dispensary in 1938 :— New Cases Examined. Cases other than Contacts. Pulmonary. NonPulmonary. Total (a) Definitely Tuberculous 75 20 95 (b) Diagnosis not completed 14 (c) Non-Tuberculous 91 Contacts. (a) Definitely Tuberculous 5 0 5 (b) Diagnosis not completed 0 (c) Non-Tuberculous 63 Cases Written off. (a) Recovered 8 3 11 (b) Non-Tuberculous 164 Cases on Register at End of Year. (a) Definitely Tuberculous 317 79 396 (b) Diagnosis not completed 19 Attendances at Dispensary 1,348 Specimens of sputum Consultation with Doctors 238 amined 155 Visits made by Nurse 1,609 No. of X-ray examinations 319 No. of " T.B. plus " cases on Home Visits by Tuberculosis Dispensary Register, 31st Officer 37 Dec., 1937 182 From the above table it will be seen that about 200 patients attended the dispensary for the first time and 95 were found to be definitely tuberculous. Amongst these were twelve children, five whom had tuberculosis of the lungs, and seven other forms of tuberculosis. Cases Recovered or Non-Tuberculous. It will be noted that 11 cases were written off the Dispensary Register as " recovered " and 164 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 :— 146 X-Ray Facilities. The arrangements with the University College Hospital in force in previous years for the X-Ray examination of patients referred by the Tuberculosis Officer, continued in operation until the transfer of the dispensary from Whiskin Street to the Health Centre towards the end of the year. From that time X-Ray examinations were carried out with the equipment installed there. The close relation of the X-Ray Department now provided, to the other activities of the clinic, should greatly advance the utility of the scheme in future. 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 1938, 211 patients received treatment in one or more institutions of whom 78 remained in hospital on 31st December. * These persons were treated in the following institutions:— 1. Special Hospitals :— 3. Children's Sanatoria :— Brompton Hospital 23 High Wood Hospl., Brentwood 7 Royal Chest Hospital 1 Millfield San., Rustington 1 St. George's Home, Chelsea 6 4. Colonies :— Burrow Hill Colony, Frimley 2 2. Sanatoria :— Papworth Village Settlement 2 Bishopsbourne Home, Broadstairs 2 Preston Hall, Maidstone 3 5. General Hospitals :— Brompton Hosp. San., Frimley 3 Archway, Highgate 39 Church Army Lads' San., Farnham 1 Bethnal Green 3 Highgate 1 Colindale Hospital 11 Lambeth 2 Lewisham 1 Creaton San., Northants. 3 Mile End 2 Douglas House, Bournemouth 3 St. Andrews. Bow 1 East Anglian San. 4 St. Bartholomew's 2 Fairlight San., Hastings 1 St. Charles, Ladbroke Grove 2 Grosvenor San., Ashford 4 St. George-in-the-East 2 Grove Park Hospl., Lewisham 9 St. James, Balham 1 Hawthorndene San., I.O.W. 1 St. Leonard's, Shoreditch 1 Holy Cross San.. Haslemere 4 St. Luke's, Chelsea 1 Ipswich San. 2 St. Mary Abbot's, Kensington 3 King Edward VII., Midhurst ... 1 St. Olave s, Bermondsey 2 K. Geo. V. San., Godalming 11 St. Peter's, Kilburn 1 St. Peter's, Whitechapel 1 Marillac San., Warley 1 St. Stephen's, Fulham 3 National San., Bournemouth 2 St. Thomas's 1 Nayland San., Colchester 2 6. Surgical Tuberculsis Hospitals: Northern Hosp., Winchmore Hill 6 Healtherwood Hospl., Ascot 1 Old Manor Ho., Broadstairs 1 Queen Mary's Hospl., Carshalton 7 Pinewood ban., Wokingham 8 St. Luke's Hospl., Lowestoft 4 S. Barnabas Home, Torquay 2 St. Nicholas Hosp., Pyrford 1 St. Michael's Home, Hayle 1 St. Vincent's, Eastcote 1 147 Provision of Extra Nourishment. The Borough Council provides extra nourishment for certain types of tuberculous cases. This usually consists of milk and eggs. 140 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. 148 (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 1938, 28 persons received additional grants in this way. During the year seven 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 have therefore been referred either to sanatorium where this treatment was started or to one of the London Hospitals for the continuation of the treatment. During 1938, 19 cases were referred to the following hospitals:— Grove Park 2 patients. Brompton 3 „ University College 2 „ Royal Chest 11 „ Southwark Dispensary 1 „ 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 is kept of all contacts below the age of 25 of sputum positive cases of tuberculosis (i.e., presumably the most infectious 149 cases). The endeavour is being continued 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 London County Council have arrangements whereby child contacts of tuberculous 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. 150 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, 72 children have been boarded-out. During 1938, 7 further children 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. 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 have been 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. 151 During 1938 the following work was undertaken :— Number of sessions held, 12. Number of new cases seen, 9. Total number of attendances, 46. Dentures supplied to 3 persons (two assisted by Finsbury Borough Council). On the transfer of the clinic towards the end of the year to the Health Centre, the Dental work has been undertaken in the Dental Department established there. Six cases under treatment in the Municipal Dispensary at Whiskin Street were transferred to this Department and two further cases were recommended. 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; 28 patients were referred last year, and in these cases 948 visits were made by the nurses. 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 one bed and bedding was loaned to a further patient during the year. 152 FINSBURY TUBERCULOSIS CARE COMMITTEE. Annual Report, 1938. The Committee continued to meet monthly during 1938. The following changes occurred in the personnel of the Committee:— The London Insurance Committee nominated Mr. J. C. Gilbert, Clerk to the Insurance Committee, as their representative in succession to Mr. Thomas Batey, whose death was recorded in our last Report. Other appointments were made as follows:— Name. Representing. Councillor Mrs. F. E. Gilbert } Councillor Dr. H. j. Kingsley} Finsbury Borough Council. Councillor Mrs. A. A. Simmons} Mrs. K. Proctor } Local Public Assistance Committee. Councillor Mrs. M. M. Twigg} Councillor B. Heaps London Trades Council. Alderman Mrs. E. Martin Clerkenwell Charity Trustees. Rev. H. B. Brewer St. Luke's Parochial Charities. Dr. M. C. Polhill Divisional Medical Officer, L.C.C. These, with the undermentioned, constituted the membership of the Committee in 1938:— Name. Representing. Miss E. F. Bolton Charity Organisation Society. F. T. Foulger, Esq., O.B.E. North London District War Pensions Committee. Miss D. Cooper Invalid Children's Aid Association. Mrs. S. S. Nunn Local Association of Schools (Care Committee). F. Berliner, Esq. London Chamber of Commerce. Miss O. W. Cram L.C.C. District Organiser, Children's School Care Committee. Miss E. Emly Metropolitan District Nursing Association. Dr. N. D. Dunscombe Medical Officer of Health. Dr. C. O. S. B. Brooke berculosis Officer. Miss F. M. Prior Tuberculosis Nurse and Visitor. Prior to 1938 the detail work of the Committee was undertaken by a representative Executive Sub-Committee who reported at intervals of three months to the full Committee. It had become apparent, however, that this method failed to secure the continuous 153 and sustained interest so essential to the work of the Committee, and it was decided to discontinue the Sub-Committee and to call the full Committee monthly to deal with all matters in detail. This practice has operated since March, 1938. The Committee have continued their consideration of and report to the Public Health Committee upon patients recommended for the supply of dentures, for grants of bedding to enable separate sleeping accommodation, and the supply of extra nourishment ; as to the latter grants, the extension of this service to children attending the L.C.C. Open-Air School at Holly Court whilst at home during school holidays has been continued. The Committee's Voluntary Fund has proved of great assistance during the year. It is reasonably certain that in several cases a desire to return home before the completion of treatment has been allayed by grants which have enabled reasonably frequent visiting by relatives, and also by weekly grants to destitute patients themselves for the purchase of small personal requirements. In one case a patient, who in addition to suffering from tuberculosis was further adversely affected by disturbed domestic conditions, was unable to afford the cost of a journey to Scotland to stay with relatives. The travelling expenses of the patient were paid by the Committee, and the Tuberculosis Officer arranged for the continued medical supervision and treatment of this patient whilst away from home. The family of another patient secured housing accommodation on one of the outlying estates of the London County Council; although able to pay their way otherwise, this family could not afford the cost of removal and the key money; a grant was made to cover these expenses. Other patients helped involved cost of repairs to patients' boots, of a patient's journey to hospital for the repair of spinal jacket, of frequent visits of parents to a child lying dangerously ill in hospital, of a holiday for a young girl in poor health and a close contact with a tuberculous father, of the cost of a motor driving licence, of the cost of spectacles, of rent in the case of two daughters of a tuberculous father in hospital and who were not able to meet their rent owing to non-receipt of wages at public holidays, and many similar cases; in the case of the last-mentioned the cost of a combined holiday for 154 these girls and a visit to their parent were met by the kindly action of one of the members of the Committee. The wife of a patient in hospital in Cornwall was given her fare to visit her husband, and a letter from the Committee to the Medical Superintendent of the hospital resulted in her being given accommodation at the hospital for a few days. The Committee continue to maintain a stock of clothing from which many patients and their dependants have been helped. This type of assistance has always hitherto been a matter of some difficulty in view of the former somewhat stringent requirements of the County Council, including investigating every possible source of help before an application was made to that Authority for assistance. With a modification of these requirements the Committee was able to decide that in view of occasional difficulties in obtaining replenishment of stock, articles should be retained for issue only to contacts and to patients in exceptional cases, and that otherwise recommendations as to patients' requirements should be forwarded to the County Council, by whose amended scheme that Authority make grants of clothing under much more generous conditions than formerly. The needs of patients and their families still impose some strain upon our resources, but with donations of clothing we have had, supplemented by purchases from the Voluntary Fund, needs so far have been met. The question of housing accommodation continues to be difficult in many cases. Assistance has been rendered by the Tuberculosis Officer to some families by way of support to their applications to the County Council by medical recommendations on the grounds of tuberculosis. We have received a letter from the Lewisham Care Committee referring to the self-discharge of patients in an advanced stage of disease, by reason of alleged distress occasioned by deaths in the same ward, and asking the opinion of this Committee as to the desirability of such patients being placed in private wards and so retained in suitable circumstances as to nursing and other care, rather than going to homes where they cannot be properly nursed and are a source of danger to others. This matter was before this Committee some time since, when they specially considered the provision which had been made by 155 the County Council at one of the County Hospitals of single bed wards for the accommodation of dying patients ; this, and other methods proposed for segregation, were soon found to acquire a sinister aspect and it was thought better to leave the matter as at present to such considerate arrangements as could be made by the respective medical superintendents. It was also suggested by the Tuberculosis Officer that advanced and dying patients might be treated in wards in suitable proportions with precautions to prevent wards acquiring the sinister reputation which it is said attaches to the single bed ward. In connection with the Voluntary Fund and the donations received from moneys allocated to charities from the receipts of sundry cinema performances under the scheme of the County Council, certain requirements are prescribed by that Authority as to deposit of funds, withdrawals and audit. The County Council expressed agreement with a proposal to continue the use of the Post Office Savings Bank in connection with the Fund provided that withdrawals are made on the signatures of at least one member of the Committee together with those of one or more officers. The Borough Accountant kindly continues to audit our accounts, We append hereto a statement of the Voluntary Fund for 1938. We have again to express our appreciation of the services rendered to the Committee by Miss D. Cooper, the representative of the Invalid Children's Aid Association. The Tuberculosis Officer and Deputy Medical Officer of Health, Dr. C. O. S. Blyth Brooke, and Miss F. M. Prior, Tuberculosis Nurse and Visitor, have rendered notable service by bringing to the notice of the Committee many cases in which they have been able to give needed help. F. T. FOULGER, Chairman. E. Q. BILHAM, Secretary. 156 FINSBURY TUBERCULOSIS CARE COMMITTEE. Voluntary Fund, 1938. Income. Expenditure. £ s. d. £ s. d. Balance at 31st December, 1937 23 15 7 Gratuities 6 18 0 General Theatre Corporation, Ltd. 37 0 0 Fares—Patients and Relatives 17 19 4 Repayments of Loans 1 16 0 Convalescence 4 10 0 Donations 2 17 0 Clothing and Repairs 4 10 10 Removal expenses of Patient's Family 1 0 0 Rent Assistance 1 8 7 Maintenance Assistance Grants 1 5 0 Spectacles for Patient 0 10 9 Handicraft Class 1 7 0 Conference Subscription 0 5 0 Miscellaneous 0 1 11½ 39 16 5½ Balance in Hand 25 12 1½ £65 8 7 £65 8 7 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. H. S. Saunders, Borough Accountant. 157 Act of Parliament. The following Act of Parliament affecting the Department was passed last year:— Food and Drugs Act, 1938. Memoranda, Circulars, Orders and Regulations issued during the year:— Ministry of Agriculture and Fisheries. Regulations made under the Agricultural Produce (Grading and Marking) Acts, 1928 and 1931, relating to Cream Cheese. Ministry of Health. Statutory Rules and Orders. Milk (Special Designations) Amendment Order, 1938. Circulars and Memoranda. Public Health (Imported Food) Regulations, 1937. Health Visitors—Training. Bacteriological Investigation with reference to puerperal sepsis. Water supplies. Smallpox. Food and Drugs Act, 1938. Factories Act, 1937. Secretary of State. Statutory Rules and Orders and Regulations. Local Authorities (Transfer of Enforcement) Order, 1938. Factories (Cleanliness of Walls and Ceilings) Order, 1938. Sanitary Accommodation Regulations, 1938. Poisons (Amendment) Rules, 1938. Poisons List (Amendment) Order, 1938. 158 LEGAL PROCEEDINGS, 1938. Date. Name and Address of Defendant. Offence. Result. 1938. Public Health (London) Act, 1936. 17th Feb. Robinson (Pork Butchers), Ltd., 83, Chapel Market, N. l. 1. Depositing and 2. Exposing for sale diseased pig's head, collar and offal. Costs £5 5s. 0d. Costs £5 5s. 0d. 16th May. R. Steel, London Road, Beccles. Depositing for sale at Cowcross Street unsound and diseased meat (4 charges). 1. Costs £15 15s. 0d. 1. Fine £10. 2. Fine £5. 3. Fine £5. 4. Fine £5. 16th May. Andreas Esposito, 50, Lloyd Baker Street, W.C.1. Failing to register premises used for sausage making. Fine £1. 8th Nov. Moore & Jerrold, Ltd., 2, Old Street, E.C.1. Failing to abate nuisance choked drain, 200, Old Street. Costs £2 2s. 0d. Food and Drugs (Adulteration) Act, 1928. 3rd May. E. M. Hughes, 99, Lever Street, E.C.1. Selling milk 32% deficient in fat. Fine £2. Costs £3. 5th July. E. Price, trading as E. Wainwright, 3, New Charles Street, E.C.1. Selling milk 26% deficient in fat. Costs £2 2s. 0d. Dismissed under Probation of Offenders Act. 8th Aug. Mrs. S. Griver, 40, Ironmonger Street, E.C.1. Selling milk 10% deficient in fat. Costs £3 3s. 0d. Dismissed under Probation of Offenders Act. 8th Aug. J. Sard, 22, Lizard Street, E.C.1. Selling milk 11.3% deficient in fat. Costs £3 3s. 0d. Dismissed under Probation of Offenders Act. 25th Oct. S. D. Matthews, Cross Road Farm, Ovington, Norfolk. Selling milk 14.6% deficient in fat. Fine £1. Costs £3 3s. 0d. Merchandise Marks Acts. 8th Dec. M. Rogers, 4, White Conduit Street, N.1. Exposing for sale imported meat without labelling. Fine £5. Costs £2 2s. 0d. Public Health (Preservatives in Food) Regulations. 14th Mar. Keens (Watford), Ltd. Selling sausages containing preservative without being labelled. Costs £4 4s. 0d.