7 LIBRARY To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Finsbury. Mr. Mayor, Ladies and Gentlemen, I herewith present to you my first Annual Report of the work of the Public Health Department during the year 1939. In pursuance of the policy laid down by the Ministry of Health in order to save the expense, labour and paper involved in the preparation of a full account of the years work, this Report gives information on a few of the most important features of the Health Services only. Records have been compiled of the operation of each section of the Department in detail, and these will be preserved for future reference. I have to thank you, ladies and Gentlemen, for the confidence shewn in me by appointing me as your Medical Officer of Health and have pleasure in informing you that during the early part of the year the Department generally and the Health Centre services in particular were steadily advancing in the service of the public. The outbreak of war caused some temporary dislocation of the work, and war-time conditions introduced fresh problems to be faced. Section A. Satics and social condition of the Area Summary of vital statistics. Area (in acres) 587 POPULATION. Registrar-General's estimate of (a) resident population, mid-1939 55,110 (b) average population appropriate to the calculation of death rates 51,480 No. of inhabited houses (end of 1939) according to Rate Books 8,832 Rateable value £1.272.924 - sum represented by Id rate £4,960 EXTRACTS FROM VITAI STATISTICS OF THE YEAR:- Total M. F. LIVE BIRTHS Legitimate 649 347 17 302) Births rate per 1,000 estimated resident population mid-1939 21) 38 Illegitimate 364 687 323) 12.2 STILLBIRTHS 16 11 5 Rate per 1,000 total (live and still) births 22.7 365 338 Death rate per 1,000 estimated average population DEATHS 703 13.6 The comparative rates for London. England and Wales were as follows:- Live Births Deaths London 12.3 Still Births not available 11.9 England & Wales 15.0 12.1 DEATHS FROM PUERPERAL CAUSES:- Rate per 1,000 (live & still births) Deaths Puerperal Sepsis 0 - Other puerperal causes 0 - Total 0 - 2 The comparative rates (total) for London & England and Wales, were respectively:- London not available. England & Wa1es 282 DEATH RATE OF INFANTS UNDER ONE YEAR OF AGE:- All infants per 1,000 live births 33.5 Legitimate infants per 1,000 legitimate live births 27.7 Illegitimate infants per 1,000 illegitimate live births 131.6 The comparative rates for London & England and Wales were respectively:- London England and Wales All Infants 48 50 Legitimate Infants Not Available Not Available Illegitimate Infants do. do. DEATHS FROM:- Cancer 96 Measles 1 Whooping Cough 0 Diarrhoea (under 2 years of age) 7 SOCIAL CONDITIONS AND CHARACTER Public Assistance The following information has been kindly supplied to me by the Local Public Assistance Officer:- No. of persons in receipt of domiciliary relief during last week of quarter ending March 31st 1939 was 1,341 June 30th 1939 was 1,283 Sept. 30th 1939 was 1,077 Dec. 31st 1939 was 1,167 This represents a slight reduction towards the end of the year, probably on account of some increased employment due to war conditions, the average number of persons during 1938 having been 1,300. Some of the reduction may, however, have been on account of the evacuation of children. The Manager of the local Employment Exchange kindly gives me the Live Register figures at the end of the statistical year for 1939, as follows:- Men 5,685 Women 3,188 Boys 79 Girls 95 9,047 - an increase of 1,438 on 1938. Population The Registrar General's estimate of the population is 55,110 and this represents a decrease on 1938 of 1,850. This figure takes no account of the Government evacuation scheme of expectant mothers, infants and schoolchildren, nor of a certain number of voluntary evacuations which also took place, nor of the conscription into the Army of a large number of men under 25. No exact figures are available as to the extent of evacuation but it may 3 be stated that the number of persons registered under National Registration on 29th September 1939 was 39,739. Immediately evacuation had taken place, however, a gradual return followed. NOTIFICATION OF BIRTHS. The total number of notified Finsbury births, including stillbirths, from all sources, was 655. Of this number, 194 were notified by midwives. CLASSIFICATION OF DEATHS: The total number of deaths allocated to Finsbury was 703 giving a crude death rate of 13.6 standardized 14.8. This represents approximately the average for the past 5 years. The deaths include 419 persons over 65 years of age; of these 198 were persons aged over 75 years. The causes of death in the several age groups are given in the following table:- Causes of Death All Ages 0- 1- 2- 5- 15- 25- 35- 45- 55- 65- 75- Measles 1 1 ! I I I I 1 I I I I 4 14 I I 10 Senility 8 I I 1 Suicide 1 4 2 1 1 I I I 2 I I Diphtheria 2 i r ! I ! ; ! ! 2 Influenza Encephalitis Lethargica 1 i \ i I i 1 I I I 1 I I I 30 2 I 5 Violence 3 1 1 13 4 Tuberculosis of Respiratory system 36 I i I 5 8 2 4 7 10 Tuberculous Diseases Non-Respiratory 7 1 3 i 1 1 1 i 5 I* i i I I I I 2 1 1 1 Syphilis General paralysis of the insane, tabes dorsalis 5 I ! I .. ! ! ! ! I I I ! I f I 2 2 1 Cancer, malignant dis. 11 25 96 I I t 1 4 39 16 15 I ! I I I I 1 I I 1 4 5 4 Diabetes 1 Cerebral haemorrhage ,& 3 12 8 23 I ' I " I 213 I i i t I I I I ! . 2 42 71 Heart Disease 8 7 83 Aneurysm 6 i I I ! I I 1 2 1 I 17 2 Other Circulatory Dis. 45 I ! i 21 7 2 Bronchitis 35 I 1 I ; i ! 4 8 12 15 11 1 Pneumonia (all forms) 57 3 1 3 9 15 1 i I 7 3 I ! i I 1 Other Respiratory Dis. 1 i . I I. 1 10 I -1 I I 2 2 Peptic Ulcer 4 2 7 f I I I I I 111 ■■ I i I 3 Diarrhoea 11 1 Cirrhosis of Liver 2 I 1 "I 3 I I I Other diseases of Liver Etc. 1 mm i i I i I I 111 I Other Digestive Diss. 12 i I i i i 1 I I I. 3 4 4 12 m 11 I 2 2 i I I I 5 3 Acute & Chronic Nephritis Congenital Debility, premature birth, malformation, etc. 8 8 i i mm I i i I I i i . 2 I i i ! i I ! ! I 111 1 . Appendicitis 1 ! 7 4 7 Other defined diseases 40 1 J I -I—1 1 J I 4 4 12 All Causes 703 23 5 3 7 15 11 33 131 221 198 56 4 INFANT MORTALITY. There were 23 deaths of infants under one year of age. The causes of deaths were as follows:- Pneumonia (all forms) 3 Diarrhoea 7 Congenital debility, premature birth, malformation, etc. 8 Violence 1 Other defined diseases 4 Total 23 SECTION "B" - GENERAL PROVISION OF HEALTH SERVICES Staff. On the outbreak of the war all the members of the staff were allocated to assist in A.R.P. Services, and for a few weeks were employed largely in the organisation of the several services. The Public Health Department continued throughout, however, to maintain the essential services and by October the Health Services had returned fully to their pre-war activities. Most of the staff, however, continued to give a great deal of their time to Civil Defence, in addition to undertaking their normal, and in some cases, actually increased normal duties. Dr. C.O.S. Blyth Brooke, Deputy Medical Officer of Health, in October 1939 was appointed as Medical Officer of Health in succession to Dr. Nicholas D. Dunscombe who had resigned on appointment elsewhere. The following members of the staff joined H.M. Forces Mr. G.E. Hawthorn, Mr. A.F. Cowan and Mr, W.C.E. Keutenius. Temporary appointments were subsequently made to provide service during the absence of these officers. Laboratory. The examinations undertaken in 1939 in the Council's Laboratory were as follows:- Throat & Nose Swabs 752 Milk Samples 78 Ice-cream Samples 14 Swimming-Bath Waters 4 Treatment Centres and Clinics. The following is a summary of clinics, sessions and attendances:- Clinics No. of Sessions Total Attendances Foot 485 2,241 Dental 148 2,139 Artificial Sunlight & Massage 344 6,910 Women's 65 638 Cleansing Station - open continuously -Scabies Vermin 2,415 2,007 Despite the outbreak of war the first year's work, both of the Dental Clinic and of the Artificial Sunlight & Massage Clinic has been one of steady growth. In both Clinics it was necessary to arrange for additional sessions and this necessitated the appointment of two extra part-time assistants in the Artificial Sunlight & Massage Clinic. There was also a steady responsel, uninterrupted by the war, to the Women's Clinic which is undoubtedly fulfilling a widespread want in the borough. Nursing in the Home. The arrangements with the Metropolitan District Nursing Association to undertake the nursing of cases of illness occurring in expectant and nursing mothers, and the nursing of children under 5 years of age suffering from any illness, and of tuberculous patients at home, was continued throughout the year, the total number of visits being 16,688 (581 cases). Ambulance Facilities are provided by the London County council and the St. John's Ambulance Brigade. 5 Hospitals. The principal hospitals used by Finsbury residents are;- General Hospitals St. Bartholomew's, E.C.I. Royal Free Hospital, Gray's Inn Road, W.C.I. University College Hospital, Gower Street, W.C.I. Hospital for Sick Children, Gt. Ormond Street, W.C.I. Special Hospitals City of London Maternity Hospital, 102, City Road, E.C.I. Royal London Ophthalmic Hospital, City Road, E.C.I. St. Mark's Hospital for Diseases of the Rectum, City Road, E.C.I. Voluntary Dispensaries. There are four voluntary dispensaries which do extensive work in Finsbury Fins bury Dispensary, Friend Street, E.C.I. Royal General Dispensary, Bartholomew Close, E.C.I. City of London and East London Dispensary, 40 Wilson St., E.C.2. Cecile Booysen Clinic, 39, Spencer Street, E.C.I. MATERNITY AND CHILD WELFARE Midwifery Scheme. Domiciliary Midwifery is under the control of the London County Council. In-patient Midwifery is arranged under agreements with the Borough Council and St. Bartholomew's, City of London Maternity and the Royal Northern Hospitals. The total number of cases admitted for confinement in 1939 was 187. Ante-natal attendances numbered 3,086: post-natal attendances 876. Midwifery Consultants. The Council maintains a panel of midwifery consultants. Emergency obstetric units are maintained by the University college Hospital & St.BartS. Extra Nourishment Grants - the Council have maintained their Scheme for the grants of extra nourishment to expectant and nursing mothers and children under 5 years of age. Dinner grants during 1939 numbered 1,399 and grants of milk 3,273. Dried milk grants numbered 634. Home Helps. The Council maintains a panel of Home Helps to assist in the homes of necessitous mothers during their confinement. Convalescent Treatment. The Council provided convalescent treatment for 10 mothers. For this purpose a bed normally is reserved at St. Mary's Convalescent Home, Birchington. From the outbreak of war it was not possible for further cases to be taken at Birchington or elsewhere, however, the position of the Homes rendering it impossible for them to carry on their normal services. Day Nursery. The Council's Day Nursery, which operated successfully for many years at 42, Lloyd Baker Street, was upon the outbreak of war evacuated under the Government Scheme to Taplow Court, Nr. Maidenhead. Four Day Nurseries in all were housed in these premises under the Scheme. It soon became apparent, however, that Taplow Court was a most unsuitable place for the purpose, both on account of the unsuitable arrangement of the rooms, halls and passages, and also the fact that the housing of a large number of children in improvised premises led to many difficulties. Successful administration, largely by reason of the fact that four Day Nurseries, each with its own system of control were suddenly brought together under one administration, was difficult, and there was the tendency for infectious and contagious complaints to spread rapidly amongst the large number of very young children housed in one premises which were not specially designed to deal with this contingency. Later, in response to the kindly offer of Dr. Dunscombe, the late Medical Officer of Health, the Nursery was evacuated from Taplow Court to his house at Chalford Hill, near Stroud, Gloucestershire. By the close of the year, however, it appeared that a further evacuation to more suitable premises was desirable. 6 Dental Treatment is provided at the Leage Street Maternity and Child Welfare Centre. Total patients numbered 242: total attendances 832. These are in addition to cases dealt with at the Health Centre. Women's Country Holiday Fund. A grant of £10 was made to this Fund. Puerperal Pyrexia & Puerperal Fever. Twelve cases of puerperal pyrexia and five cases of puerperal fever were notified during 1939: no deaths. Maternal Mortality. There were no deaths attributable to diseases normally associated with childbirth. Health Visitors and Child-life Protection. The number of visits paid by the Health Visitors was 6,161 to babies, and 7,059 to children, in addition, 39 systematic visits to the few foster-children in the Borough. Visits were also paid by the nurses employed by voluntary institutions to the number of 2,785- Municipal Welfare Centres. The work of the Municipal Maternity and Child Welfare Centres has continued on the lines laid down in previous Reports, the mothers, children and babies attending and attendances made, being as follows Centre Mothers Children 1-5 years Babies Leage Street 284 487 284 (individuals) 1,033 3,541 2,347 (attendances) Pine Street 159 321 339 (individuals) 245 2,515 3,l20(attendances) Voluntary Centres are four in number. The tatal number of baby attendances at these Centres numbered 2,917, and of children 3,076. Hospitals and Convalescent Treatment. Under the special arrangements made by the Council 26 babies and children were admitted to hospital for treatment, and 70 children for convalescent treatment. 29 cases of minor ailments were referred for treatment under the agreement with the London County Council. SECTION "C" - INSPECTION AND SUPERVISION OF FOOD AND DRUGS Milk Shops. The number of registered milk premises is 173. 322 inspections were made and 9 notices served as to cleansing and repairs. Milk (Special Designations) Order. Licences issued in 1939 were as follows:- Tuberculin Tested Milk 8 Pasteurised Milk 39 Pasteuriser's Licence 1 Supplementary Licences 9 Ice-Cream. 261 enspections were made at the premises of 103 registered vendors of ice-cream. School-Children's Milk. 32 samples of milk supplied to school children were examined. All were found genuine. Inspections of Registered Premises where Food is prepared or offered for sale. Regular visits were paid to these registered premises. The numbers on the register were as follows Ice-Cream 103 Fried Fish 16 Butchers' Shops & Stalls.103 Other Premises 78 Certification of Food for Export. The number of certificates issued in 1939 was 333. 7 Sale of Food and Drugs. Samples taken for analysis were as follows Formal Samples 417 (12 adulterated) Informal Samples 332 ( 8 adulterated) The adulterations duly reported and the appropriate action taken by the Committee. Basement Bakehouses. Under the provisions of the Factories Act, 1937, a special survey was made of the 20 basement bakehouses in the borough. 3 were closed and 17 now reasonably comply with the special requirements of the Council. Unsound Food Seized and Surrendered. In connection with the continuous inspection made of meat and other foods, including offals and bacon deposited or exposed for the purpose of sale within the borough, a total amount of 256 tons was surrendered or seized. SECTION "D" - INFECTIOUS AND OTHER DISEASES Notifiable Diseases. A total of 700 cases of the notifiable diseases were reported in the year. Of these, 293 cases were removed to hospital. The principal diseases notified were Whooping Cough 267 Pulmonary Tuberculosis 84 Scarlet Fever 70 Ophthalmia Neonatorum 21 Measles 96 Diphtheria 58 Acute Primary Pneumonia 40 Disinfection. 1,158 premises were disinfected following the occurrence of infectious disease and also upon request by persons who had found reasonable cause for desiring disinfection of their premises or effects. Vaccination. The Vaccination Officer reports that notices of 1,764 births were received from Registrars: 1,319 were referred to other districts, leaving 445 Finsbury births. A total of 463 certificates of exemption were granted. The number of personal visits made during the year was 587. Tuberculosis. 81 new cases of pulmonary and 11 cases of non-pulmonary tuberculosis were notified or came to knowledge through other sources. The total number of deaths from all forms of tuberculosis was 43, the death rate being 83 per 1000 of the estimated population. Tuberculosis Dispensary. The number of new cases examined was 276. 76 of these were definitely tuberculous. 70 contacts were also examined but in none of these was tuberculosis diagnosed. The number of attendances at the Dispensary was 1,220. 1,149 visits were made by the Nurse. The Tuberculosis Officer visited 22 patients at their homes. 195 specimens of sputum were examined and 644 X-Ray examinations were made in connection therewith. The total number of cases on the register at the 31st December 1939 was 193. Other activities in connection with the control of tuberculosis, such as artificial pneumothorax treatment, grants of extra nourishment and dental treatment (given through the Council's Dental Clinic) were continued. SECTION 'E" - SANITARY CIRCUMSTANCES &c ADMINISTRATION During the year 17,857 inspections (including re-inspections) were carried out by the Sanitary Inspectors. Included in this total number were 865 inspections on complaint of nuisance and 161 with reference to infectious disease. The number of inspections of Factories, Workshops and Workplaces was 2,419. Defects were found and remedied in 356 instances. 1,216 Intimation Notices and 184 Statutory Notices under the Public Health (London) Act, 1936 were served during the year. 8 Disinfestation. See Infectious Disease, page 7. Cleansing Station. See General Provision of Health Services, page 4. SECTION 'E" - HOUSING The total number of dwelling houses inspected for housing defects was 998, the number found not to be in all respects reasonable fit for human habitation being 262. The number rendered fit in consequence of informal action by the Sanitary Inspectors was 262, and the number in respect of which Statutory Notices were served requiring defects to be remedied was 71. House-to-house inspection was carried out during the year, 251 houses being inspected and recorded by the Inspectors. C. 0. S. BLYTH BROOKE Medical Officer of Health. November, 1940.