FIN 21 1 To the May or, Aldermen and Councillors of the Metropolitan Borough of Finsbury Mr. Mayor, Ladies and Gentlemen, I herewith present to you a summarised Annual Report of the work of the Public Health Department during the year 1940. This has been prepared in continuation of the policy laid down by the Ministry of Health for the Annual Report for the previous year in order to save labour and the expense which would be involved in the publication at the present time of a full account of the year's work. Detailed records have been compiled of each section of the department, and these will be preserved for future reference. During the early and middle periods of the war the work of the department continued without serious interruption under war-time conditions and there was no special matter to which your attention should be drawn. During the later part of the year the intensive enemy attacks on London inevitably caused some changes and dislocation of normal work and introduced new problems with regard to the use of public air-raid shelters and in connection with persons either temporarily or permanently displaced from their dwellings by enemy action, on the other hand, the furoe r evacuation of children and infants relieved some of the concern which would otherwise have been the responsibility of the department. On the whole, I am glad to be able to state that I am satisfied that the general standard of health of the inhabitants of Finsbury remained good throughout 1940 and that no serious outbreak of opidemic disease of any kind occurred. There has been a rise in the birth rate for the borough as compared with the rate for 1939, whereas the actual number of births has decreased. This increased rate, owing to the fact that the numbers and distribution of the non-civilian population are not available, was based on the civilian population of 1940 as used for the death rate, and too much significance should not therefore be attached to it. There has also been a marked increase in the death rate which is affected largely by deaths due to war operations. There has been a rather considerable increase in the deaths due to tuberculosis of the respiratory system but otherwise there has been no serious increase in the death rate from any particular cause. The general life of the inhabitants of the borough was changed during the last four months of the year by reason of the heavy air raids which caused large numbers of persons to spend evenings and nights in the public air raid shelters. At one time the shelter population probably reached the figure of over 10,000. These conditions introduced many attendant problems connected with hygiene and comfort of the shelters. Further, as a result of damage done to residential properties, to the main gas, water and electricity connections and because of the danger from unexploded bombs, many persons were temporarily or permanently removed from their homes or found themselves without the normal amenities of life. The delays which necessarily followed in the remedy of these conditions lead to the crowding of Rest Centres and introduced further problems in public health organisation. SECTION A. STATISTICS AND SOCIAL CONDITION OF THE AREA Summary of vital statistics Area (in acres) 587 POPULATION. Registrar-General's estimate of- Civilian population 1940 for calculation of birth rate and death rate 40,090 No. of inhabited houses (end of 1940) according to Rate Books 8,473 Rateable value £1,234,603 - sum represented by Id rate £4,890 EXTRACTS FROM VITAL STATISTICS OF THE YEAR:- Total M. F. LIVE BIRTHS Legitimate 538 275 263 Birth rate per 1,000 estimated civilian population 1940 Illegitimate 18 18 14.3 36 574 293 281 STILLBIRTHS 15 4 11 Rate per 1,000 total (live and still) births 25.5 DEATHS 928 469 459 Death rate per 1,000 estimated average population 23.1 The comparative rates per 1,000 population for London, England and Wales were as follows:- Stillbirths Deaths Live Births London 13.7 .44 17.8 .55 14.3 England & Wales 14.6 Finsbury 14.3 .37 23.1 DEATHS FROM PUERPERAL CAUSES:- Deaths Rate per 1,000 (live & still births) Puerperal Sepsis 2 3.68 Other puerperal causes 0.00 3.68 - 2 Total The comparative rate for England & Wales 2.16 London Not Available DEATH RATE OF INFANTS UNDER ONE YEAR OF AGE:- All infants per 1,000 live births 68 Legitimate infants per 1,000 legitimate live births 61 Illegitimate infants per 1,000 illegitimate live births 167 The comparative rates for London and England and Wales were respectively:- London England and Wales All Infants 50 55 Legitimate Infants Not Available Not Available Illegitimate Infants do. do. DEATHS FROM:- 92 Cancer Measles 0 Whooping Cough 0 Diarrhoea (under 2 years of age) 6 SOCIAL CONDITIONS AND CHARACTER Social Welfare The following information has been kindly supplied to me by the Local Social Welfare Officer:- No. of persons in receipt of domiciliary relief during last week of quarter ending March 31st 1939 was 1,173 (1,341) June 30th 1,136 (1,283) Sept. 30th 1,410 (1,077) Dec. 31st " " 291 (1,167) These figures represent a general redaction on last year's figures (as shown in brackets). Subsequently to 3rd August 1940, a number of persons were transferred from this department of the London County Council to the Assistance Board under the old Age and Widows' Pensions Act, 1940. These persons are entitled to medical relief only. The Manager of the local Employment Exchange kindly gives me the Live Register figures at the end of the statistical year for 1940, as follows:- Men 1,001 Women 1,576 Boys 33 Girls 36 2,646 - a decrease of 6,401 on 1939 Population The Registrar Ganeral's estimate of the population is 40,090 and this represents a decrease of 15,020 on the figure supplied by the Registrar General for 1939. Apart from the normal decrease in population which has been observed during the past few years, this marked decrease has been brought about by war conditions involving evacuation of women and children and the departure from the borough of persons serving with His Majesty's Forces. The figure given by the Registrar General for the previous year 1939, took no account of evacuation. NOTIFICATION OF BIRTHS. The total number of notified Finabury births, including stillbirths, from all sources, was 475. Of this number, 276 were notified by midwives. CLASSIFICATION OF DEATHS: The total number of deaths allocated to Finsbury was 928 giving a crude death rate of 23.1 standardized " " " 23.4 The deaths include 451 persons over 65 years of age. The causes of deaths in the several age groups are giving in the table overleaf. INFANT MORTALITY. There were 37 deaths of infants under one year of age. The causes of deaths were as follows:- Pneumonia (all forms) 7 Diarrhoea 6 Congenital debility, premature birth, malformation, etc. 12 Phthisis 1 Heart Disease 1 Bronchitis 1 Other digestive diseases 2 War operations 4 Other causes 3 Total 37 - 4 - DEATHS 1940 Causes of death All 0-1 1-5 5-15 15-45 45-65 65+ Typhoid and paratyphoid fevers - - - - - - 0 Cerebro-spinal fever 2 - - 1 - 1 - Scarlet Fever 0 - - - - - - Whooping Cough 0 - - - - - - Diphtheria 2 - 1 1 - - - Diphtheria Tuberculosis of Respiratory System 62 1 - 1 28 25 7 Other forms of tuberculosis 9 3 1 4 1 - - Other forms of tuberculosis Syphilitic diseases 5 - - 4 1 - - Influenza 4 - - - 3 - 1 Measles 0 - - - - - - 0 - - - - - - Acute polio-myelitis and polio-encephalitis Acute inf. encephalitis 1 - 1 - - - - Cancer of buccal cavity and oesoph.(M.) uterus (F) 12 - - 1 5 6 - Cancer of stomach and duodenum 18 - - - 1 8 9 11 - - - - 5 6 Cancer of breast Cancer of all other sites 51 - - - 1 22 28 1 - - - 1 Diabetes - - Intra-cranial vascular lesions 32 - - 1 7 24 - Intra-cranial vascular lesions Heart disease 189 - 3 4 44 138 - Heart disease Other diseases of circulatory system 30 - - 1 - 5 24 Bronchitis 103 - - 6 33 63 1 Pneumonia 59 7 2 - 5 12 33 Other respiratory diseases 16 - - 2 7 7 - Ulcer of stomach or duodenum 11 - - - 1 7 3 Diarrhoea under 2 years 6 6 - - - - - Appendicitis 0 - - - - - - Other digestive diseases 21 2 - - 3 5 11 Nephritis 14 - - 1 - 4 9 Puerperal and post-abortive sepsis 2 - - - 2 - - Other maternal causes 0 - - - - - - Premature birth 5 5 - - - - - Congenital malformation, birth injury, infant dis. 10 8 1 1 - - - Suicide 3 - - - 2 1 - Road traffic accidents 17 - 1 1 4 5 6 Other violent causes 188 4 6 64 60 40 14 All other causes 44 3 1 3 3 7 27 928 37 15 27 133 269 447 SECTION B - GENERAL PROVISION OF HEALTH SERVICES Staff. By the beginning of the year most of the staff had been relieved of the duties to which they had been allocated at the outbreak of war to assist the A.R.P. Services and the officers had returned to their normal duties. Many of them, however, continued to give their services to Civil Defence in a voluntary capacity. The follwing are the principal changes in the staff during the year:- (1) Dr. A.B. Stewart appointed Deputy Medical Officer of Health and Tuberculosis Officer (2) Mr. E.Q. Bilham, Assistant Administrative Officer appointed as Milk Officer (3) Mr. H. Ward (former Sanitary Inspector) appointed Chief Clerk (4) Mr. J. lewis appointed as temporary Sanitary Inspector to replace Mr. 11. Ward (5) Miss Calpen appointed as Nurse Masseuse in place of Miss Fawcett who resigned upon her marriage (6) Dr. C.M.M. Culver Evans, Assistant Medical Officer of Health joined H.M. Forces. - 5 - It is with regret that I have to report the loss due to enemy action of Miss Lewis who was employed in the Cleansing Station as a Bathing Attendant. Laboratory. The examinations undertaken in 1940 in the Council's Laboratory were as follows:- Throat & Nose Swabs 498 Milk Samples 50 Ice-Cream Samples 18 Swimming-Bath Waters 2 Treatment Centres and Clinics. The following is a summary of clinics, sessions and attendances:- Clinics 1940 1939 1940 1939 No. of Sessions Total Attendances Foot 617 485 2,628 2,241 Dental 189 148 2,833 2,139 Artificial Sunlight & Massage 506 344 8,101 6,910 Women's 63 65 506 638 Cleansing Station - open continously - Scabies Vermin 2,323 2,415 1,342 2,007 Despite a fall in the attendances towards the end of the year due to enemy activities and black-out conditions, the work generally throughout the year showed steady growth and it was found necessary to increase the total number of sessions held in the Foot, Dental, Artificial Sunlight & Massage, and Women's Clinics by 333 on the number which was held during the previous year. The total attendances in these clinics showed an increase of 2,140 on the figure for 1939. 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 12,465 (390 cases). Ambulance Facilities .are provided by the London County Council and the St. John's Ambulance Brigade. Hospitals. The principal hospitals used by Finsbury residents are:- General Hospitals St. Bartholomew's, E.C.1. Royal Free Hospital, Gray's Inn Road, W.C.1. University College Hospital, Gower Street, W.C.1. Hospital for Sick Children, Gt. Ormond Street, W.C.1. Special Hospitals City of London Maternity Hospital, 102, City Road, E.C.1. Royal London Ophthalmic Hospital, City Road, E.C.1. St. Mark's Hospital for Diseases of the Rectum, City Road, E.C.1. The City of London Maternity Hospital was largely destroyed as a result of enemy action during September 1940, though it was found possible to continue the use of the Out-Patient Department. No casualties were suffered by patients or staff, the former having been evacuated to the Friern Hospital during the heavy bombardments which immediately preceded the damage. MATERNITY AND CHILD WELFARE. Midwifery Scheme. Domiciliary Midwifery is under the control of the London - 6 - 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 1940 was 51. Ante-natal attendances numbered 2,369; postnatal attenances 127. Midwifery Consultants. The Council maintains a panel of midwifery consultants. Emergency obstetric units are maintained by the University College Hospital and St. Bart's. 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. During the year 1940 2,213 grants were made, an average of 185 per month. 366 families received these grants and the grants comprised 34,169 pints of milk, 2,305 lbs. of dried milk and 16,784 dinners. The coming into operation in July 1940 of the National Milk Scheme which provides for the supply of liquid milk free or at 2d per pint according to income to all expectant and nursing mothers and to children under 5 years, and for the supply of dried milk to infants under 12 months, had the effect of considerably modifying the Council's scheme especially in relation to liquid milk grants. Convalescent Treatment. From the outbreak of war it was not possible for further cases to be taken for convalescent treatment, the position of the Homes rendering it impossible for them to carry on their normal services. Home Helps. The Council maintains a panel of Home Helps to assist in the homes of necessitous mothers during their confinement. Day Nursery. During the year the evacuated Day Nursery remained at Chalford Hill, Stroud (residence of Dr, Dunscombe, late Medical Officer of Health). An agreement was reached between the Finsbury council and the Gloucestershire County Council whereby the ultimate administrative responsibility, supervision and arrangements for the welfare of the children was vested in Gloucestershire County Council. The Maternity and Child Welfare Committee of this council was, under this arrangement however, still to preserve their interests in the Nursery. At the close of the year there were 12 children over 2 years and 6 under 2 years resident at the Nursery. Dental Treatment is provided at the Leage Street Maternity and Child Welfare Centre. Total patients numbered 143; total attendances 414. These are in addition to cases dealt with at the Health Centre. Puerperal Pyrexia and Puerperal Fever. Two cases of puerperal pyrexia and two cases of puerperal fever were notified during 1940. Maternal Mortality. There were two deaths attributable to diseases normally associated with childbirth. Health Visitors and Child-Life Protection. The number of visits paid by the Health Visitors was 6,338 to babies and 8,511 to children; in addition, 18 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 2,969. 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 248 462 261 (individuals) 1,990 (attendances) 573 2,807 Pine Street 237 290 269 (individuals) 312 1,723 2,241 (attendances) - 7 - Voluntary Centres fire four in number. The total number of baby attendances at these Centres numbered 2,470, and of children 2,355. Hospitals and Convalescent Treatment. Under the special arrangements made by the Council 16 babies and children were admitted to hospitals for treatment, and 61 children for convalescent treatment. 24 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 132. 591 inspections were made and 6 notices served as to cleansing and repairs. Milk (Special Designations) Order. Licences issued in 1940 were as follows:- Tuberculin Tested Milk 6 Pasteurised Milk 36 Pasteuriser's licence 1 Supplementary Licences 9 Ice-Cream. 223 inspections were made at the premises of 98 registered vendors of ice-cream. School-Children's Milk. 3 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 98 Fried Fish 13 Butchers' Shops & Stalls 97 Other Premises 69 Certification of Food for Export. The number of certificates issued in 1940 was 210. Sale of Food and Drugs. Samples taken for analysis were as follows:- Formal Samples 43 (6 adulterated) Informal Samples 712 (7 do.) The adulterations duly reported and the appropriate action taken by the Committee. 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 289 tons was surrendered or seized. SECTION D - INFECTIOUS AND OTHER DISEASES Notifiable Diseases. a total of 654 cases of the notifiable diseases were reported, in the year. Of these, 330 cases were removed to hospital. The principal diseases notified were :- Erysipelas 22 Whooping Cough 12 pulmontary Tuberculosis 88 Scarlet Fever 33 Ophthalmia Neonatorum 8 Measles 371 Diphtheria 27 Acute Primary pneumonia 37 - 8 - Disinfection. 1,196 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 1,282 births were received from Registrars: 923 were referred to other districts, leaving 359 Fins bury births. A total of 358 certificates of exemption were granted. The number of personal visits made during the year was 596. Tuberculosis. 105 new cases of pulmonary and 21 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 71, the death rate being 1.77 per 1000 of the estimated population. Tuberculosis Dispposary. The number of new cases examined was 223. 75 of these were definitely tuberculous. 49 contacts were also examined and in 5 of these tuberculosis was diagnosed. The number of attendances at the Dispensary was 1,261. 1,015 visits were made by the Nurse. The Tuberculosis Officer visited 32 patients at their homes. 446 specimens of sputum were examined and 597 X-Ray examinations were made in connection therewith. The total number of cases on the register at the 31st December 1940 was 380. 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 & ADMINISTRATION During the year 13,582 inspections (including re-inspections) were carried out by the Sanitary Inspectors. Included in this total number were 618 inspections on complaint of nuisance and 106 with reference to infectious disease. The number of inspections of Factories, Workshops and Workplaces was 844. Defects were found and remedied in 126 instances. 1,154 Intimation Notices and 129 Statutory Notices under the Public Health (London) Act, 1936 were served during the year. Cleansing Station. See General Provision of Health Services, page 5. SECTION F - HOUSING. The total number of dwelling houses inspected for housing defects was 1,496, the number found not to be in all respects reasonably fit for human habitation being 536. The number rendered fit in consequence of informal action by the Sanitary Inspectors was 536. House-to-house inspection was carried out during the year, 121 houses being inspected and recorded by the Inspectors. C.O.S.BLYTH BROOKE Medical Officer of Health August 1941.