Fin 22 -1- library To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Finsbury- Mr. Mayor, Ladies and Gentlemen, I have pleasure in submitting to you the following brief summary of the work of the Public Health Department during 1941. In order to conserve paper this includes a reference only to the most important features and for reasons of security no statistics are given of the estimated population or other figures from which this could be readily calculated. I have, however, prepared a very full report for publication after the war, including a section on the activities in connection with Shelter Health and it is hoped that this will provide a very complete record of the work of the Department under war-time conditions. During the first five months of the year there were more or less continuous air raids and in consequence many persons moved to other areas and large numbers of those remaining in the borough spent the night-time in public air-raid shelters. The effect of the. evacuation referred to lessened to some extent the work involved in certain aspects of public health but at the same time the maintenance of public health under war-time conditions introduced hew features and responsibilities. The outstanding features of the year were the facts that, in spite of the war, the general health of the population was maintained at a high level, and that though the community was sleeping in public air-raid shelters to a very large extent, there was a marked absence of epidemic disease. SECTION A - VITAL STATISTICS On account of the continual movements of the population during the year the. significance of rates dependant on an estimate of the population is not great. Further, a proper allocation of births and deaths to particular areas has frequently been imporssible and full information as to these has often not been available. It has been found that the figures supplied by the Registrar-General have in some instances differed materially from those prepared locally and in consequence both have been given below. The table given below should only be accepted as a general trend of the rates in Finsbury. 1941 Registrar-General's estimate 1941 M.O.H.'s estimate 1939 1940 Birth rate (Finsbury) 12.5 14.3 14.8 10.8 (London) 12.3 13.7 8.9 - (England & Wales) 15.0 14.6 14.2 - Stillbirth rate (Finsbury) 0.37 0.40 0.60 - (London) 0.44 0.33 - - (England & Wales) 0.55 0.51 - - Death rate (Finsbury) 13.6 23.1 24.7 22.3 (19.5) (London) 11.9 17.8 16.3 - (England & Wales) 12.1 14.3 12.0 - (+excluding deaths by enerny action) Maternal Mortality - There was one death from maternal causes other than Puerperal Sepsis. Infant (Finsbury) 33.5 68 70 77 Mortality (London) 48 50 68 - (England & Wales) 56 55 59 - The only significant feature of a study of the table of the causes of death is that of the death rate from pulmonary tuberculosis,namely, 1.42 (Reg.-General's estimate) or 1.56 (M.O.H.'s estimate). The corresponding figures for the years 1937-1940 were 1.00, 0.62, 0.65, and 1.54 respectively. SECTION B - GENERAL PROVISION OF HEALTH SERVICES. Staff.- After many years of service with the Finsbury Borough Council Bilham, Essistant administrative officer, resigned on attaining the age of 60. His wide experience and courteous manner had endeared him to members of the Council as well as of other staff and his presence was greatly missed. His efficient assistance in the administration of the Public Health Department had become recognised far and wide. Mr. E.A. Norman, senior sanitary inspector, resigned after 40 years of service with the Finsbuy Borough Council on attaining the age of 60. During his service he was able to lead and witness great developments of Public Health measures, in many of which he took an active part. Appointments during the year include (1) Zv. Obermer as Assistant Medical Officer for Shelter Health; (2) Dr. R.Woolf as Assistant Medical Officer of Health for Maternity and child Welfare; and (3) Mr. H. No /dick aS Senior Sanitary Inspector. General.- The general provisions of the public health services in the borough remained substantially the same as in previous years, During the early part of the year there was some diminution of the work undertaken, but during the latter part of the year when continuous air raiding had ceased, the extent of the work increased and became greater than before the war. On account of the great increase in the incidence of scabies improved conditions were established in the Cleansing Station towards the end of the year, including the appointment of a nurse to supervise the treatment and to carry out the necessary home visiting. Maternity & Child Welfare.- No change took place in the general provisions of the midwifery service, but a large number of expectant mothers were evacuated for their confinements. The municipal and voluntary centres remained, open throughout the year and all the ancillary services available. During the early part of the year a considerable proportion of mothers and young children were evacuated, but later, as bombing became reduced in intensity, large numbers returned to Finsbury and attendances at the centres returned to normal figures. The Ministry of Food Scheme for milk to expectant and nursing mothers and children under 5 continued in operation, and supplemental grants were made by the Council in the same categories of cases as in previous years. National Dried Milk was issued under both schemes from the municipal centres. Towards the end of the year the distribution of vitamin preparations was also undertaken in these and certain of the voluntary centres on behalf of the Ministry of Food. Extra clothing coupons for expectant mothers were distributed from the Public Health Dept on behalf of the Board of Trade. The regular visitation of expectant mothers and of children under 5 was continued by the Health Visitors and during the year 13,086 visits were paid by the Council staff, and 1,662 by those attached to certain voluntary organisations. The council's Nursery formerly at Lioyd Baker Street was maintained as a residential nursery by the Gloucestershire County Council. It was transferred in the Spring to premises at Bown Hill Farm, Woodchester. These proved very satisfactory and the conditions for the children excellent, in autumn, the council determined upon the policy of opening war-time nurseries in Finsbury. SECTION C - INSPECTION AND SUPERVISION OF FOOD & DRUGS Continuous inspection of food and of food premises was maintained during the year and 709 samples, including 27 of milk, were taken for submission to the Public 3 Analyst. Only 11 of these were certified as adulterated and none indicated any gross fraud on the public. In view of the conditions prevailing as regards the limitations of supply, this may be taken as exceedingly satisfactory. It was found possible to continue to urge and enforce strict cleanliness in the handling of foodstuffs and a circular suitable for display, headed "Precautions against contamination of food" which was prepared at the end of the preceding year, was distributed with a covering letter to all food premises in the Borough. SECTION D.- INFECTIOUS & OTHER DISEASE It is pleasing to be able to record that in spite of apparently adverse conditions the incidence of infectious disease has remained very low, and apart from tuberculosis presents no special problem for consideration. Diphtheria.- There were 35 cases and no deaths during the year. Considerable progress was made in the schools and among infants in immunisation, and this was completed for 548 children. It may be reckoned that probably about 30% of the under 14 population have now been protected. Although this figure represents a considerable advance there is a need for much intensive propaganda if our children are to be saved from this threat to their early life. Measles.- There were 207 cases during the year and two de ths. Whooping Cough.- There were 172 cases and one death during the year. Analysis of these cases shews an attack rate of about 12$ in the under 5 population generally and 1.7% among 293 children who had received a full course of whooping cough vaccine. This is evidence of the value of the whooping cough protection work which was undertaken in conjunction with diphtheria immunisation in the welfare clinics for the past 2 years. Cerebro-spinal Fever.- This disease is particularly likely to be prevalent in war-time, but fears as to its assuming serious proportions have not materialised. There were 9 cases and no deaths during the year. Typhus.- In view of the possible introduction of this disease into the country preliminary consideration was given as to the measures to be adopted in this eventuality, and these were being actively pursued at the end of the year. Tuberculosis.- As in all other parts of the country there has been an increased number of deaths and of notifications of new cases in respect of tuberculosis. The causes are little understood, and the problem can only be attacked by an intensification of the normal measures undertaken in the Tuberculosis Dispensary. This has been unfortunately hampered by a shortage of institutional provision and the difficulty of ameliorating unsatisfactory environment and social conditions in the home. The incidence of other infectious diseases does not call for special mention. SECTION E.- SANITARY CIRCUIvETANCES AND ADMINISTRATION During the year 12,914 inspections (including re-inspections) were carried out by the sanitary inspectors. This number includes 528 first visits on complaint of nuisance and 161 with reference to infectious disease. The number of inspections of factories was 1,871 and the number of defects fo* which notices were served was 101. 335 Intimation Notices and 7 Statutory Notices under the Public Health (London) Act, 1936, were served during the year. attention was directed during the year to the sealing of disused drains on demolished sites lest these later become a harbourage fcr rats. 4 Two sites have been used for small piggeries in the borough under the Defence Regulations and these have been inspected regularly. Two samples taken under the Rag Flock Regulations were found to contain excessive chlorine. In regard to these and a further contravention in 1942 by the same firm, proceedings were taken in 1942. The case against the firm was dismissed, but a conviction against the Warrantors was recorded, followed by a dismissal under Probation of Offenders Act on payment of the firm's and the Council's costs. One action during the year was taken in respect of an old lady being by reason of age and chronic disease unable to look af&er herself and having no friend or relative able to give her proper attention, a Court order for removal to hospital was secured, and she was removed by ambulance to the Archway Hospital. Special attention was directed during the year to the prevention of vermin and the treatment of verminous persons. The Council made arrangements for the domiciliary care of old persons likely to become verminous, and towards the end of the year appointed a trained nurse to give half her time to the visiting of the homes of verminous persons so as to secure disinfection and to seek contacts themselves needing treatment. The Scabies Or&er, 1941, has given wide powers to the Medical Officer of Health to secure, compulsorily, if need be, the examination of persons suspected to be verminous, the disinfection of premises and the treatment of all cases. A report on the work of the Cleansing Station appears in Section B. The appointment on Ist December is there recorded of a nurse whose duties include the home visitation of all cases of vermin and scabies* There has undoubtedly been an increase in the incidence of scabies since the commencement of the War, and it is to be hoped that the measures taken will lead to its control. SECTION F. - HOUSING On account of the damage to housing properties by enemy action and wartime conditions generally, no long term policy under the Housing Acts has been possible and no action was taken under the statutory powers conferred by the Housing Act, 1936, The sanitary inspectors carried out routine inspections of first-aid repairs effected in respect of damaged properties to ensure that as far as possible the standard of work maintained was in conformity with the Housing (Emergency Powers) Act, 1939. , SECTION G-.- SHELTER HEALTH, &c. A great deal of attention was given throughout the year to all aspects o Shelter Health, A medical and nursing service centred in six medical aid posts in the six largest shelters was maintained, together with that of first-aid volunteer assistants in many of the smaller shelters., Routine disinfestation of all shelters and the use of chloros sprays according to c:'.rc ! imstances was carried out. Later in the year the regular cleaning of the shelters was instituted by sub 11 payments made to selected vol unteers from a/aong the shelter users. An endeavour was made to ensure as satisfactory a service of canteens as was possible„ Control of cases of infectious disease and cf verminous persons in the Shelters was effectively secured without resource except on one occasion to the compulsory powers vested in the Medical Officer of Health for this purpose. Continued inspection of the hygiene arrangements in the Rest Centres was carried out, and medical assistance to the sick was provided by the Borough Council and nursing ansistance by the County Council under the supervision of the Medical Officer of Health. 17 children were examined under the Defence Regulations which provide for the compulsory evacuation of those suffering or likely to suffer in mind or body as a result of hostile attacks. 9 of these were found to fall into this category and were evacuated without application to the Courts. C.O.S.BLYTH BROOKE Medical Officer of Health. 9th July 1942.