LIBRARY FIN 23 THE METROPOLITAN BOROUGH OF FINSBURY. ANNUAL REPORT on the PUBLIC HEALTH OF FINSBURY for the Year 1942. By A. B. STEWART, M.D., D.P.H. Acting Medical Officer of Health. METROPOLITAN BOROUGH OF FINSBURY: PUBLIC HEALTH COMMITTEE: MATERNTY & CHILD WELFARE COMMITTEE: CHAIRMAN: Councillor W.Barrie, M.P.S. CHAIRMAN: Alderman Mrs.E.Martin VICE CRAIRMAN: Councillor MrS. F.E.Gilbert VICE-CRAIRMAN: Councillor MrS.R.Curtis Alderman C. A. Allen Councillor Mre.E.K.Allan Councillor J. T. Bellamy Councillor W.Barrie.M.P.S. Alderman H. J. Dainty Councillor Mrs.A.S.Gibbs Councillor Mrs.M.E.Hancock Councillor Mrs.F.E.Gilbert Councillor Mrs.L.E.Jeffs Councillor Mrs.L.E.Joffs Alderman Mrs. E.Martin Councillor S.G.Nunn,J.P. Councillor S. G. Nunn, J. P. Councillor Mrs.A.Rafe Councillor Mrs. A. Rafe Councillor Mrs.A.A.Simmons Alderman H. Riley Councillor Mrs.B.South Councillor Mrs. M.M.Twigg Councillor J.Wilkins , J.P. STaFF: MEDICAL OFFICER OF HEALTH: * C.O.S. Blgth droo;ce, L.R.C.P. ,M.R.C .S.J).P.H. ACTING MEDICAL OFFerER OF HEALTH: A.E.Stownrt, M.D., D.P.H. .-iCT PIG DEPUTY MEDICAfL OFFICER OF HEALTH R. VJoolf, M.8., 8.5., h.R.C.S.L.R.C.P. ,D.P.H. ASSISTANT lIEDICaL OFFICERS: « C.M.H.Culvcr-Ev.'.ns, M.R.C.S., L.R.C.P. E. Obomor, M.D., M.R.C.S., L.R.C.P. H. Lojl;s, M.D., M.R.C.S., L.R.C.P. (Part-time) PUBLIC ANALYST: J.K.Col'./011, F.1.C., F.C.S. (P;.irt-tirao) PUBLIC VACCINATOR: Dr. R.E.8...tG0n Dr. R.K.Dudachanji Dr. B. McKoown Dr. R. Sacks VACCINATION OFFICER: P.S. C. ••:>:« (P.rt-timc) CLERICS STAFF: H. Wt'.rd (Chief Clerk) T. E. Williams J.E. McDowell Miss W. Freeman (M. & 0.W.) Miss C. Blundon (M. & C> r .) Resigned 31/10/42). Miss A. Riii',l (T.B. Clerk and Laboratory Assistant). a W. Kuutunius a A»F.Cow*.n h W.W. Gol.berg ai G. Hawthorn 2. Miss F. Levy Miss Li. Gardner (Civil Defence) J. Field E. Mitchell Miss P.S. Hunt (Resigned 19/9/12) S..\NIT..RY INSIT-jCTORS t, ML-.T iL J. Ne'.vdick (Senior Sanitary I-cjactor) INSPECTORS. H. Clinton Miss F. Hall Mr. R. E. Lay Mr. A. C. Jenkins Mr. A. J. Truslove I ;::. J . Lewis (Temporary ) T. Poa ii, M.B.S. (Meat Inspector - Seconded to Ministry of Food) R. S. B rber (Assistant 11...X Inspector) M. £c C.VJ. CZI'JTRE SUPERINTENDENTS: Miss M. Filj (Lea tJ e Soroet) Mrs. E< J. Hewlett (Pine Stroet) (R3i.lrod 30/G/1942. HEALTH VISITORS: Miss J. R.Turner Mir-H M Rcc: , : Hiss L. B/e-iK.n (Sscondod to kiaistry of Hα.lth) Mrs. G. H.-.rtney Miss B. J. Rock Mj.l o L. E. Hi-c».ings (Liommenced 19/ /i2 Temporary) TUBERCULOSIS iIURSII; Mioo F. Lit Prror SISCRETARX , OF TUHSRCULCSIS CiiRE COMMITTEE: H. 5S . . WOMEN'S CLINIC: Dame Louise Lcllroy, 0.8.L., M.D., F.R.C.P., F.R.C.0.G., L.l..Rotunda D.So. , L.L.D. (Medical Officer in Charge) DENTAL CLINIC: _ P. R. As:let, L.D.S. (Dental Surg) H. Llillett, L.R.C.P., M. .C.S., L.D.S., (Dontal Surf,) i-u:re sthetists: Dr. A. F.^irweather Dγ, B .: ua Dr. A. H. Ruwntree Dr. E. F. Rcpsd.ile Dr. 3. J. n 'ilton Dr. lioKoovjn Dr. B tson FOOT CLINIC: 5. : r al,_>ot, M.I.S.Ch. (Chiropodist) ... H. C "tor, M.l.S.Ch(Chiropodist) - A . full-time from 7/12/<l2, CLEANSING STATION: Mrs. D.I.M. Lloyd (Nurse in Charge) SOLARIUM; Miss U. C .l;ien (Nurse in Charge) Mrs. K. S.rcston (assistant Masseuse) Mrs. A.L. Ka'ierton(Solarium Assistant) RESIDENT ENGINEER aND HEALTH CENTRE F. If. Battle SHELTER HYGIENE SUPERVISOR; G. B.iley To the Mayor > .aldermen and Councillors of the Metropolitan Borough of Finsbury. Mr* M yor, L.dies and Gentlemen, I h.ve pleasure in submitting herewith the Annual Report ef the work of the Puulic Health Department during 1942. Qace a t ain this Rg ,ort takes the form of an interim statement as suggested by the Minister of Health and on grounds of national security total population figures are not quoted. In the absence of Dr. C.O.S. Blyth Brooke I have prepared this Report in my capacity as Acting Medical Officer of Health though my responsibility for the De :artment extended over the last three months of the year only. It is difficult to comment on the birth and death rate figures owing to the altered circumstances occasioned by the war, both rates being above those applicable to the country as a whole. Although the total number of infant deaths (2C) is small it represents a rate of 64 per 1000 live births, comparing unfavourably with the figures for the rest of the country. Deaths from pneumonia and enteritis appear to represent the greater proportion of the more obviously preventable deaths in this group. On the other hand deaths from infectious diseases are few and the results of the diphtheria immunisation campaign gratifying and hopeful. A feature of the work of the department during the year was the opening of four war-time nurseries and planning of further expansion of this work. Several summonses under the Food and Drugs Act were withdrawn owing to the unsatisfactory position regarding the laying down of standards particularly in relation to fruit drinks. arrangements were made for a comprehensive bacteriological and pathological service with the London County Council supplementary to work carried out at the laboratory in the Health Centre. Mrs. S. J. Hewlett, Superintendent of the Pino Street Maternity and Child Welfare Centre, after 25 years' loyal service with the Council, resigned during the year for health reasons. Mrs. Hewlett's many friends wish her a speedy recovery and an enjoyable retirement. I wish to place on record my thanks to the Members of the Public Health and Maternity and Child Welfare Cafftiittees for their assistance and to the entire staff for their co-operation and enthusiasm in carrying out the work of the department in spite of tho many difficulties which have arisen as a result of the war. I have the honour to be, Your obedient Servant SECTION "A" - VIT-L STATISTICS. The area of the Borough is 587 acres. The Registrar-General , s estimate of resident population is not available for publication. I.' l'J'6) the estimated /lobulation was 56,960. Th total number of live births belonging to the Borou.,h occurring during 1942 was 452, including 39 illegitimate births, and consisting of 227 males and 225 females. The total number for 1941 was 447. The total number of still-births allocated to the Borou-h during the year was 19. Tills figure represents 4. of the total births. The causation of these was as follows:- 4 cases due to prematurity, in one case due to kidney trouble and in the other throe cases cause was unknown. 7 cases due to congenital malformations. 1 case of asphyxia owing to the cord being tightly wound round the child's neck. 2 cases due to prolapsed cord. 4 cases due to toxaemia of pregnancy. In three of these the toxas mia was associated with haemorrhage. 1 case due to ante partum has morrhage, cause unknown. It is possible that some of these still births due to prematurity and tox lemia may have been avoided by better ante natal care. The total number of deaths belonging to the Borough registered during 1942 was 50m, consisting of 267 males and 241 females. The total number for 1941 was 747.. T'io comparative tables for birth rates, still births and deaths have been omitted for security reasons. The following table shows the causes of, and ages at death during the year 1942:- Total All Ages CAUSE OF DEATH 0 - 1 - 5 - 15 - 45 - 65 - 1. Typhoid and parattyphoid Fevers - - - - - - - 2. Cerebro-Spinal Fever - - - - - - - - - - - - - - 3. Scarlet Fever 2 1 - 4.Wooping Cough 1 - - - 5. Diphtheria 1 1 - - - - - - - - 21 13 9 6. Tuberculosis of Roseiratory System 43 7. Other Forms of Tuberculosis 6 1 1 2 1 1 - - 2 4 8. Syphilitic Dis eases 9 - - 3 9. Influenza 7 1 3 1 2 - - - - - - 10. Measles - - - 11. Acute Polio-Hyelitis and Polio-Encephalitis - - - - - - - - - - - - - - 12. Acute Infectious Encoephalitis 13. Cancer of Buccal Cavity and Œsophagus and Uterus 14 1 8 5 - - - 14. Cancer of Stomach & Duodenum 8 - - - 1 1 6 - - 1 5 1 15. Cancer of Breast 7 - 3 15 16. Cancer of all other sites 40 1 21 - - 17. Diabetes 1 - - - - - 1 18. Intru-Cranial Vascular Lesions 2 12 24 38 - - - 109 - - - 4 28 77 19. Heart Disease 20. Other Diseases of Circulatory System 16 6 10 - - - - - - 12 28 46 6 21. Bronchitis - 22. Pneumonia 41 7 3 1 1 7 22 23. Other Respiratory Diseases 8 - - - 2 3 3 24. Ulcer of Stomach or Duodenum 7 3 10 - - - - 4 4 - - - - - 25. Diarrhoae under 2 years 26. Appendicitis - - - - - - - 13 - 1 - 1 5 6 27. Other Digestive Diseases 28. Nephritis 12 1 2 9 - - - 2 - - - 2 - - 29. Puerperal & Post-Abortive Sepsis 50. Other Maternal causes - - - - - - - 31. Premature Birth 8 8 - - - - - 32. Cong.Malf.,Birth Injuries, Infant Dis. 7 5 - 1 1 - - - - - - - - - 33. Suicide 34. Road Traffic Accidents 4 2 - 1 1 - - 12 - - - 1 4 7 35. Other Violent Causes 36. All other causes 40 2 6 5 27 - - 267 19 5 - 36 87 M 120 241 10 5 1 58 141 F 26 508 29 10 1 62 145 261 Total All Causes ovision o? :rvices TREj. The attendances at the various Treatment Centres and Clinics have shown a considerable expansion during recent years and there were record attendances in most Of them during 1942, as shown the following table. ATTENDANCES &C. AT TREATMENT CENTRES AND CLINICS. 1940 1941 1939 1942 No. of Sessions No. of New Cases To tal No. Attes Total No. Attes No. of Sessions Total No. Attes No. of Sessions Total No. Attes CLINIC No.of sessions No. of New cases No. of New Cases No.of New Cases FOOT CLINIC 485 538 2241 617 430 2628 510 470 2343 833 655 4600 DENTAL CLINIC 148 519 2139 189 705 2833 187 694 2943 312 907 3858 344 SOLARIUM 595 6910 506 474 8101 415 453 7267 473 772 13154 133 65 638 63 120 506 19 62 WOMEN'S CLINIC 203 49 186 502 1785 1042 11928 1375 1729 14068 1131 1679 TOTALS 12756 1667 2520 22114 Iditional full-time chiropodist to d Lnic. Additional sessions were necessary in the ' Jlinic the service w is extended t • . . Iks, ';c, h lvo continued to bo carrie out ' tlth Centre and the foi; brief summary of ti . - & ■117 No. i - 'or T. 3. 225 , 51 ~. 2 The Coi by special examinations are undertaken at th by the L.C.C. Gruu. athologist, J.M. /lis! INtjPESTS: L._uests were held on 23 residents during the year, the findings being as follows:- Cerebral Hie i lorrhage ... 1 Struct Accidents ... 4 - Violence ... 13 C j cur ... 2 ... 1 Pr.euroonio ... 2 I.IORT.ILITY: Tiiaro were two deaths from puerperal causes during the year giving, a maternal mortality rate of 4*2 per 1,000 Tot 1 (Live: -nd Still) Births. INFANTILE MORTALITY: There were 29 deaths amongst infants under one year of age and the infant mortality rate based on 1,000 live births was 64. The following are comparative infant mortality rates. INFANT MORTALITY RATES FINSBURY 1939 1940 1941 1942 33.5 68 70 64 LONDON 68 48 60 50 56 49 ENGLAND & WALES 59 55 DEATHS IN RELATION TO DISE^SI): There was one death from diphtheria in the 19 notified cases of this disease. Duaths from tuberculosis still form a high proportion of the total deaths, particularly in the 15-43 age group. However, no deaths from typhoid, paratyphoid, cerebro-spinal fever, scarlet fever, measles, acute-poliomyelitis, polioencephalitis, appendicitis, or suicide during the year. Of the 29 deaths in the age group under one year of age 13 wero due to premature birth or congenital causes, which in the present state of our knowledge must be considered as not entirely preventable. Pneumonia and diarrhoea caused the larger proportion of the remainder. It is to this group that our attention is directed as likely to show improvement as a result of our efforts. I.inTSRNITY «ffl CHILD : The attendances at the two Municipal Maternity and Child Welfare Centres is briefly outlined in the following table and a comparison is shown with the figures which obtained in 1941. i [ PINE STREET LEAGE STREET 1941 1942 1941 1942 Mothers, Individual 187 277 85 134 Mothers, Attendances 249 539 113 213 Children (1-5 years) Individual 351 439 294 282 Children (1-5 years) attendances 1834 2813 1847 2030 Babies, Individual 220 348 140 180 Babies, Attendances 2012 3622 1086 1497 MUNICIRiL T .'JELF.,RE CENTRES: Sewing CI £ses were started in September, 1942, at Pine Street. The number of mothers attending these classes was not very large but those who did attend came regularly and derived benefit and enjoyment from the classes. A Cookery Demonstration was held at this Centre in July, 1942. The mothers showed great interest in this demonstration and it would bo oxtremoly useful to hold frequent lectures and demonstrations in the Welfare Contre, but the promises now in use are so small and inconvenient that it is not possible to do this at present. GRANTS SCHEME: A total of 9,454 dinners were granted to necessitous persons at tho two Cw..*tros and lbs of Drii u Mil ■ were issued under the provisions of the CoUUCil'v G.r. *Lts S'::: w ..e. CLOTHING COUPONS FOR EXPECTANT MOTHERS: Clothing coupons for expectant mothers under the 80.,.rd of T:?fdo Scheme were continued to be issued and during the year 474 expectant mothers were dealt with under this provision. HEALTH VISITING: The ro ; ulur visitation of expectant mothers and children under five years was continued by tho Health Visitors and during tho year a total of 12,231 visits were paid by tho Council Staff in addition to visits made by officers from certain Voluntary Centres in the Borough. Special visits were paid by the He :Ith Visitors during the year to 40 infants. Thcso were classified as - Marasmus - 1; pemphigus - 1; bad home conditions - 1; unwanted child/iiysterical mother - 1; slow progress - 2; twins - 6 sets; premature - 7; small, frail infant - 3; illegitimate - 18. At the end of the year these cases were:- Sutisfactory - 22 and 5 sets of twins; Loft borough - 6 and 1 set of twins; evacuated to residential nursery - 4; died - 2. VOLUNTARY CENTRES: The Council has continued grants to the under mentioned Voluntary Centres and a brief outline of the work carried out at these Centres is shown below. INSTITUTION NO. OF MEETINGS HELD NO. OF ATTENDANCES. City of London Maternity Hospital 262 584 870 Claremont Central Mission 101 203 2281 Maternity Nursing Association 50 Women's Leage of Service 1232 DaY NURSERIES: The Fjnsbury Evacuated D. ; Nursery remained throughout the year at Boat. Hill F .rm, Woodchester, Gloucester and at the close of the year there was a total of 24 children resident thero; of these 17 were Fi>sbury children. Four wartime nurseries were opened in the Borough during the course of the year which added considerably to the administrative work of the Do v.rtment. The following table shows the average daily attendances of children at those Nurseries. AVERAGE DAILY ATTENDANCES: APRIL MAY JUNE JULY AUG SEPT. OCT. NOV. DEC. NURSERY 18.08 17.59 12.6 9.30 19.08 16.24 18.8 24.84 15.07 Claremont - 28.68 32.91 - 22.0 21.10 19.04 31.89 27.72 King square (Opened 30/6/42) - 16.45 10.63 12.92 4.0 7.9 10.5 - Closed 30/11/ 1942 Lloyd Baker St (Opened 16/6/42) - - - 8.83 25.99 27.68 - 32.20 42.12 Lloyd Square (Opeued 25/8/42) 17 HOME NURS LJQ: Tho arrangomenta with the Metropolitan District Nursing association to undortako tho nursing of casos of illness occurring in expectant and nursing mothers and the nursing of children under five years of age suffering from any illness at home, was continued throughout the year, the total number of visits being 603 to 50 cases. EVACUATION: applications for the evacuation of 10V children under the Scheme for "under fives" were dealt with during the year. This figure included 22 children for whom temporary accommodation was arranged during the mothers' absence from homo for confinement. The number of expectant mothers who wore evacuated under tho L.C.C. Scheme for expectant mothers was 121. NaTION.iL MUK aND vnaJalNS SCHEIE: The administration of this Scheme in Finsbury was curried out in the Public Health Department until June, 19 .c2, when it was transferred to the Food Office. After this date, however, the Municipal and Voluntary Centres still operated as distributing points for vitamin products and national driad milk. MJD'HFERY: In-patient arrangemonts: Tho scheme with St. Bartholomew's, the Royal Northern (Maternity Nursing Association) and City of London Maternity Hospitals has boon continued throughout tho year. Owing to war-time conditions St. Bartholomew's have, in fact, only admitted emergency cases to their wards and havo arranged for the evacuation of all other in-patient cases. All Finsbury cases booking at tho City of London Maternity Hospital have again been Sacuatod to Brockett Hall for their confinement. The total number of in-patients der this scheme during tho year was 41. In the case of University College Hospital and the Royal Free Hospital tho Council pays £1 for each necessitous case which is admitted as an in-patient. There woro 17 such cases during 1942. Throughout tho course of the year almost half of the in-patient maternity cases have been dealt with under the L.C.C.Evacuation scheme. .J-though there is a shortage of beds under this scheme all mothers desiring this service have boon evacuated. In 1942, 121 expectant mothers were sent away. Co-operation was maintained between tho Hospitals concerned and tho la tornity and Child Kclfaro Department. Attendances at ante natal clinics aro notified and ante natal visits are made by our Health Visitors. Domiciliary midwifery U> carried out by St. B rcholomew's and the Matornity Nursing dissociation; 2i2 confincients wore attended. There is no L.C.C. I/iidwifo practising in Finsbury and no Finsbury case has been delivered by an L.O.C.Mia.-ife. Purt N .'■ 1 Cii . :U: I" r/-'C oarlior part of ti.o year it w&s noticed th:it many of tho mothers were not having routine post natal examinations. IL i: thought to bo duj to tho fact that many of them wore being; delivered in recaption areas and did not return to the Hcepital thoy had attondod during the ante natal period. T Juiio, 1C : -.-2, i post natal clinic was started at the Pine Stroet Mai r-ity and Child '.Mfare Cctru ad mothers attending the municipal welfare clinics were urged to attend this clinic if they had not been given an appointment elsewhere. 77 new cases attended this clinic during the year and 140 attendances were made. Attondancos at this clinic have been good and it has done much useful work. II ay of the mothers coming for examination have needed treatment both for local minor gynaecological conditions and for their general health. Since this clinic has been started the Hon it.,ls who deal with Fii'-sbury cases have improved their own post natal clinic arrangements and the numbers attending their clinics have increased. H0,.:; E.los: «T'v. Council provides a service of Hoj.icj Hal.jS during o post natal and 'into natal period for domiciliary cases. D_~ ito the fact that it has boon difficult to got enough people to do this work, the He io Hal service has been adequately raaintcinod and has worked satisfactorily. Ho:ie Hoi i ttended IC. c SuS during the yo:ir. HO SP ITiJL TREATMENT: TJie arrangement between the Couucil and the Elia buth G .rratt Anderson Hosait ,1 for the retention of one cot has persisted throughout the year and has worked very satisfactorily. the children admitted to this Hos .ital have done very woll and the mothers havo been very satisfied with the arrangement. Thcro were 12 admissions to this cot during the year. la addition, the Can oil has an arrangement with the Rova.l Free Hop ait_.l, University Collate Hospital and the QjUwon'e Hoe"oital for Children whereby 30/-d er week is paid for any cot occupied by a Finsbury child. TIi.jTC woro 4 admissions under this Scname. Eur, No! .. d Thro-.t Hospitals: Tlig Roy.-.l Fr-; Hospital has continued to admit Fi. sbury childron requiring tonsillectomy at a fee of 16/- oor case. TL~ number of childron referred to this Hot: )ital during the year was 15. Thle schomo has often necessitated a very lone wait as the Hospital has an extremely long waiting list for tonsillectomy. In July, 1942 similar arrangements were made with the Central E~r, Noac .u Thro b Her ital. This arrangomont has been satisfactory and 10 ciaildren wero referred to than during tho year. PUERPERAL FEVER ~ND EEURPERaL PYREXIA: During 1942 there were eight cases of puerperal pyrexia notified in Fi.a.oury. Dob ils of the notifications are as follows:- 3 cases of septic abortion wore admitted to Hospital• 3 cases had local uterine infections which cloarod up rapidly; one of these crises was an Uiuaarried mother who had no mite natal care and was unattended during delivery. 1 case of mastitis which cleared up rapidly. 1 case of staphylococc: , .! sopticoamia which subsequently died; tho full report of this case is given under "M t rnal Deaths", CONVALESCENT TREATMENT: The Council has continued their arrangement with the Dodisham Convalescent H??? where two cots are retained and with Letchworthorth where four cots are retained. The ??? of children admitted to these Ho???es during the year was 13. These cots have been used to their fullestextent during the year and a11 the children who have been sent there have benefited greatly in health. In, ???dition, childron are referred for convalescence through the ??? valid Children's Aid Association which has d???lt with 34 cases during the year. It was felt that a convalescent home, where mothers and children could bo sent away togethsr was greatly needed. The Council has made arrangements with the L???c> Council of Socia1 Service whereby three beds are reserved at Grand Street House , Wor???lesdon Hill, Surrey. U???a...r this scheme mothers with one or more children under five are sent to this He???, usually for a three weeks period. From the Ist December the number of beds was increased to four. There were 8 mothers and 7 children admitted to this H??? during 1942. This He has proved extremely useful and a certain number of young mothers suffering from post natal debility have benefited markedly from convalescence here. FOSTER PARENTS: There were no registered foster mot??? in Fi???sbury during 1942. INEANT DEATHS: There were 29 were 29 infant deaths in Fi???sbury during 1942.The ???-natal deaths, i.e., occurring within the first twenty-eight day, numbered 15; details of these deaths are as follows:- 8 prematurity - one case due to appendicitis in the mother necessitating operation; one case of pyelitis during the ante natal period; one case of twins; one case of toxaemic ante partum haemorrhage; one an unmarried mother; three cases where cause unknown. 2 cases of cerebral injury at birth; one of these followed a precipitate labour; one medical induction of labour owing to toxaemia. 1 case of congenital deformity 1 case of asphyxia. 3 cases of broncho-pneumonia. The bulk of these ne???-natal deaths was due to premature delivery of the and appeared in the majority of cases to have been unavoidable. Three cases from broncho-pneumonia during the ne???-natal period is rather a high number and it is possible that those could have been prevented with better post natal care. Deaths of children from one month to One year 14. Analysis of cases shows:- 7 cases of broncho-pnouuonia. 4 cases of gastra-onteritis. 1 case of miliary tuberculosis - and child a mongolian idiot. 1 c ase of hydrocephalus. 1 case of influenzri and heart failure. It will be seen that the main cause of these infant deaths is still broncho-pneumonia and gastro-enteritis: of these cases which died of enteritis none of the babies was breast fed. MATERNAL DEATHS: There were two maternal deaths in Flasbury during the year. Case 1.???ross of pregnancy was normal until the 32nd week when signs of toxæmia developed. There was no improvement after rest at home and the patient was admitted to Hospital after ten days. ??? again sent home to rest but re-admitted after one week - the toxæmia had again become worse. Labour was induced and twins were delivered by forcees. During labour the patient was found to have a urinary infection. ??? first day of the puerperim a local uterine in infection was present and despite treatment, the infection spread and became a generalised septicæmia. There was no reaction to treatment in the form of sulphadiazine and blood transfusion and the patient died one month after delivery. ??? natal supervision seems to have been adquate in this case, but the toxæmia of preguaney had obviously lowered this patient's resistance. Case 2. Self induced abotion. ??? had had two previous normal pregnecios. ??? three months misearriage and was subsequently admitted. ???way Hospital where curettago was performed. Following this operation she developed pyrexia and was admitted to the North Western Hospital with pelvic peritonitis which subsequently spread and became a general peritonitis. Death occurred three weeks after the miscarriage. 15. SECTION ??? SANTARY CIRCURSTANCES. Summary of inspection made by sanitary Inspector- Total number of first visits 9192 Total number of re-visits 7111 Shoes infections 147 Visits to vorminous promises 310 561 Infections of ??? House to ??? infections 32 House infections 1254 114 I???rectious ??? Investigation Investigation of ??? 895 Visits to houses let in lodgings 1281 Visits to ??? 3594 Visits to public sanitary ??? 381 street ??? 161 DRAINAGE: The number of drainage plans deposited and approved during the year was 12 and a total of 312 inspections with dranage work. The following is a summary of the work done:- water close ??? 267 water closed orected 207 Ur??? defects romedied 13 Urinals orected 11 soil ??? shaft defects romedied 31 Soil ??? shafts crected 32 waste pipe defects romedied 81 waste pipe erocted 77 Drains re-laid or amended and senled 342 135 Drains cleared ??? repaired or renewed 73 96 Drains tested COMPLAINTS: The total number of complaints received was 895 NOTICES SERVED: The following numbers of notices were served requiring the abatement of nuisances and the romedying of defects. Number fo statutory notices 982 Number f Statutory Notices 75 RAT REGRESSION: 271 complaints were received in 1942 on which the necessary investigations wore made by the Sanitary Inspectors and appropriate action taken. Rat poison was supplied in certain cases to private householders and occupiers of business promises. RECEPTION HOUSE: There was no occasion during 1942 for the occupation of the Reception House for the special purpose for which it was provided. The arrangement was kept in force whereby Holborn residents were to use the Reception House if the need arose. ERADICATION OF BUGS: In the case of 23 Council flats aid 220 other houses, bugs were found and romedial measures were taken. arrangements were also made in the case of 35 new entrants to the Council's flats for routine disinfostation of their furniture by moans of cyanide gas by arrangement with the Islington Borough Council. CLOSING OF VERNINOUS PERSONS: The following is a summary of the cases dealt with in the Health Centre Cleansing Station during the year. VERMIN SCABIES NO. OF TREATMENTS 386 368 6,475 L.C.C. School-children 1,203 5,457 152 P atients other than the above The latter group comprised 425 men, 679 women and 251 children under five years. The arrangements whereby the London County Council used the Cleansing Station for the treatment of school-children were revised. The County Council now use the Station during the mornings only, leaving it free for the Borough Council in the afternoon. The increased incidence of scab??? made the oh .age necessary and a revision of the staffing arrangements followed. The arangement with the Shoroditch Borough Council to treat their cases continued throughout the year. Home visiting of scabies was intensified, the Nurse-in-Charge of the Cleansing Station making 814 home visits during the year. SHOPS: The numbur of inspections made under the Shops ??? 1934 during 1942 was 147. RAG FLOCK: THe number of samples of R??? Flock taken during the year was 4. Legal proceedings werehv instituted in one case where it was found that the sample contained excess chlorine. The case was dismissed under the Probationer of Offenders Act on payment of costs. ??? ??? During the year the total number of ??? inapected was 46, none of which carried any offensive cargo. Contravention of statutory requirments had taken place in two instances. There was no discovery or notification of infectious disonse. The number of children on the bonts was 20, of whom 12 were of school ago. AGED AND IN???PERSONS: No application for compulsory removal to hospital was during the year. Aged persons known to the Department to be living alone are visited periodieally to ensure the institutional treatment or core is obtained if necessary. There were at the end of the year 23 persons on the register kept for the purpose, to whom 164 visits were made. STRICT TRADERS: 161 visits were made to the premison of street traders foodstuffs. COMMON LODGING HOUSES: There is one Common Lodging House in th Borough,situato at No, 88 Old Street and the number of visits made by the Sanitary Inspector was 45. HOUSE LET IN LODGING: At the end of the year there were 520 houses on the Register and 1,231 visits were in connection with the Houses Let In Lodgings Byelaws. MORTUARY: 59 bodies were received at the mortuary attached to the Kealth Centre promisos. DISINEECTION The following table gives particulars of the disinfection work carried out during 1942. Promises disinfected after:- Diphtheria 41 Measles 81 Vermin and Scabies 971 Scarlet Fever 49 Tubereulosis 41 Whooping Cough 63 Miscelloneous 128 By request 119 A total number of 26,527 articles were disinfected, being chiefly mattresses, pillows, bolsters, shoots, blankets and wearing apparol. In addition, 37,981 articles were disinfected prior to Export and foos charged for this work "mounted to £77. 10. od. OFFENSIVE TRADES: The following are licenced offensive trade premises - (a) Messrs. Hanson, 187, Whitecross Street, E.C.l. (b) Mossrs. F. & W. Warman, Ltd., 5, Eagle Court. (c) Messrs. T. Kondon & Charterhouse Mows. 380 visits were made in res pect of these promises during the year OUTWORKERS: No. of Finsbury firms employing outworks at the end of 1942 143 Total number of cutworkers employed by Finsbury firms ... 1122 Number of outworkers residen in finsbury FACTRIES ACT, 1937: During the year 734 first visits and 205 re-visits were made to factories and 80 intimation notice were served requiring the remedy of defects found. The following is a summary of defocts found. NUMBER OF DEFECTS: TOTAL PARTICULARS FACTORTES FACTORIES (NON-PO WER) Refuse accumulation 4 1 5 Roof leaky 1 1 - Ceiling broken 1 2 3 Sanitary Conveniences - defetive 14 14 - " " - dirty 18 4 22 " " - insufficient 1 1 - 3 " " - unlabelled 6 9 " " - with no artificial light 12 3 15 " " - unsuitable 19 2 21 Staircase dirty 2 1 3 Insufficient ventilation of workrooms 1 1 - 1 Water fittings leaky Workroom dirty 1 - 4 4 - Yard walls dirty 2 2 - 14 notices of complaint were received from the Home Office relating to the following matters:- Sanitary conveniencos dirty 7 Sanitary conveniences unscreened 5 Sanitary conveniences insufficiently ventilnted 1 Sanitary convaniences cistern defect 1 32 notices were sent to the Home Office regarding the following matters:- Abstract absent 20 Now occupation, notification 12 19 LADY SANITARY INSPECTOR'S WORK. The following is a summary of the visits made by the Lady Sanitary Inspecter during 1942. Facteries 941 Outworkers premises (Sub-Contractors 167 Outworkers premises (Domestic) 750 Public Health complaints 4 Public Sanitary Conveniences 73 Miscellaneous visits 25 Total 1,960 Number of Intimation Notices served ••• 80 Number of Statutory Notices served HOUSING - SECTION D. INSPECTION: Hereunder will be found particulers or inspections corried out and action taken during the year:- A. (1) (a) Total number of dweĺing-houses inspected for housing defects (under Public Health or Housing Acts) (b) Number of inspections made for the purpose.. 1,147 (2) (a) Number of dweĺing-houses (included under sub-head (1) above) Which were inspected and recorded under the Housing Consoldidated ERagulations,1925 (b) Number of inspections made for the purpose 40 (3) Number of dwelling-houses found to be in a state so dangersous or injurious to health as to be unfit for human habitaion. (4) Number of dwellin-houses (exclusive of those referre to under the preceding sub-head ) found not to be in all respects reasonably fit for human habitation 8. Number of dwelling-house rendered fit in consequence of informal action by the Local authority or their officers C. Action under satutory Powers during the Year. (a) Proceedings under Secton 9???10 amd 16 of the Housing Act, 1956:- (1) Number of dwelling-houing in respect of which Notice were served re???ing repairs. (2) Number of dwelling-houses which were rendered fit after service of formal notices (a) By Owners (b) By Local authority in default of O???rs (b) Proceding under Public Health acts:- (1) Number of dwelling-houses in respect of which notices were served requiring defects to be re???edied (2) Number of dwelling-houses in which defects were remedied after service of formal notices (a) By Owners (b) By Local Authority ??? default of owners (c) Proceedings under Sectinons 11 and 13 of the Housing Act, 1936. Number of dwelling-houses in respect of which demolition orders were made ... ... ... ... ... Number of dwelling-houses demolished in purcuance of demolition orders ... ... ... ... ... Proceedings under Section 12 of the Housing Act, 1936. (1) No. of senarate tenements or underground rooms in respect of which closing orders were made ... ... No. of separate tenements or underground rooms in respect of which closing orders were determined, the tenement or room having been rendered fit... ... HOUSING APPLICATIONS: 96 families were rehoused during 1942, 35 in Borough Council flats and 61 by the L.C.C. SECTION "E" - INSPECTION AND SUPERVISION OF FOOD AND DRUGS. MILK SUPPLY. Analysis of Milk. During the year 24 samples of milk were submitted to the Public Analyst. Two samples were found to be adulterated - one 2% fat abstracted and one 2-8% added water. IN both cases a letter of warning was sent to the Vondors concerned. Bacterilogical Examination of Milk. Is samples of Designated Milionard 39 samples of Ordinary Milk were submitted for bacteriological examination. Of offset on improved to be unsatisfactory and steps were taken to offset on improvement in the position. Milk Sho stand Deiries. Number of applications for Registration approved ... ... 5 Number of Purveyors on the Register at the end of 1942 ... 115 Number of Purveyors removed from the register during the year 13 Number of Purveyors on the Register at the end of 1911 ... 123 Number of visits of inspection carried out ... ... 365 Number of Notices served for cleansing and repair of dairy primses ... 4 Milk (Special Designations) Orders. Number of applications for Licences received (a) Tuberculin Tested Milk - Dealors ... ... .. 3 (b) Pasterised Milk - Dealers ... ... ... 26 (c) Pasteurised ... ... ... ... ... - (d) Supplementary licences ... ... ... ... 9 (e) Number of samples taken for examination ... ... 13 Pasteuring Establishment. No licenses was issued this year. The dairy in the Berough usually granted a Pastcuriser's License did not apply this year because faults developed in the plant which could not be remedied, owing to war conditions, and the intended conversion of the plant to High Temperature Short-Tire procoss, under the Provisional Regulations, 1941 was not possible because of inability to obtains device for automatically diverting any milk not retained for the specified time and temperature. Milk in Schools scheme: One sample of the milk delivered to the Schools was taken during the year and sent for analysis to the Public Analyst and was found to be genuine. Five samples were submitted for bacteriological examination - four proved to be satisfactory. Condensed Milk and Dried Milk: Examinations were made through the year of the labelling requirements for these milks. No contraventions of the Regulations were observed. MEAT AND OTHER FOODS: Food Inspection: The work of food inspection continues to receive the closest attention. The in duties, as in past years, have been carried out by Mr. Clinton and Mr. Beroer. The street markets, butchers' shops and stalls were inspectod regularly by the District Secritary inspectors. ICE CREAM. There were 68 vendors of ice cream on the Register the end of September, 1942, and 107 visits of inspection were made. Throe notices were served for clesnsing and other purposos. Five samples were examined bacteriologically and one sample proved to be unsatisfactory. The vendor from whom the unsatisfactory sample was obtained was approached in an effort to improve the standard of bacterial cleanliness. Note: The: Ice-cream (Prohibition of Manufacture & Sales) Order, 1942. Dated September 24, 1942 (S.R. & O. 1942 No. 1962. This order was made by the Ministry of Food and, briefly, prohibits the manufacture or sale of ice-cream, except in an institution or ina any house-hold (not being a cateing establishment) for comsumption in such institution or household, after 50th Sept 1942. REGISTRATION OF FOOD PREMISES: The premises re gistered under section 14 of the Food and Drugs Act, 1936, at the end of the year are detailed as follows:- Manufacture, salo and storage of ice-cream ... ... 68 Fried Fish Shops ... ... ... ... ... ... 12 Butchers' shops and Stalls ... ... ... ... 89 Other promises where food is cooked, preserved or picklad ... ... 62 Total number of premises ... 231 All the premises were visited regularly during the year. Food Stalls: All food stalls are inspected daily. 24. Pharmacy and Poisons Act, 1933. The work under this Act has continued to be carried out by Mr. Cltinton and 33 applicants of Poisons and 55 visits were made. No contravention of the Act or Rules was observed. Unsound Food: The work of meat inspection, in the absence of Mr. Poisan, is carried out by Mr. R. S. Barber assistant Meat Inspector. Regular inspection is made of the various wholesale butchers and offal shops, bacon factories and warehouses and the Public Cold Air Stores in the Borough. Summary of Foodstuffs siezed by or surrendered to the Meat Inspector during 1942. Diseased or unsound meat 7,142 lbs Diseased or unsound offal and other foodsstuffs Total 45,045 lbs 52,187 lbs Careases of mutton or lamb affected with casoous lymphadenitis caseous lymphadenitis 3 Livestock (Restriction on Slaughtering) (No.2) Order, 1940. On the 2nd June, 1942, Mr. Douglas Coopar, a wholesale dealer in horse flesh for human consumption, trading under the mane of DERBY STAKS, 18/20 St. John Street, E.C.l., was fined £50 and 20 guineas costs for having in his possession knacker meat which was not stained in the preseribed manner. Slaugherhouses: The slaughterhouse owned by Mr. J. A. Mobbs, 14 Parton Street, was closed down on the outbroak of the war. No animals were slaughtered there during 1942. Disposal of Condemned Meat. The disposal of condemned moat continues to be carried out by the Smithfield animal Products, Court Farm, Stanwell, Middlesex. Food Decontamination. A food decontamination centre was built in the Bunhill Row area during the year. This building was designed according to the recommendations of the Ministry, Mr. Clinton, the food inspector, is in charge and has trained volunteers from the retail and wholesale food firms in the borough. Food Poisoning: During the year there were no cases notified under the Food and Drugs Act, 1938, amongs Finsbury residents. Bakehouses: There are 25 bakehouses in use in the Borough of which 17 are Basement Bakehouses and in 22 bakehouses machinery is used. 89 visits of Inspection were made during the year and ten notices were served for cleansing and other matters. Adulteration of Food: The toal number of samples taken in 1942 under the Food and Drugs Act 1938 was 735 of which 29 were official samples and 706 informal samples. The following table gives full information with regard to the official samples submitted to Mr. Kear Colwell, the Council's Public Analyst. GENUINE NAME OF ARTICLE ADULTERATED TOTAL Milk 22 2 24 Cordials 4 4 - Vinegar (Non-brewed) - 1 1 Food Prosecution: The following prosecutions were effected during the year - TYPE OF FOOD INFRINGEMENT REMARKS No sungar or alcohal Grape-fruit flavoured Cordial Summons dismissed Lime flavoured Cordial ... ... Summons withdrawn ... ... Lemon-citric flavoured cordial Summons withdrawn Cardial Orange flavour Hearing not completed ... ... Milk Fined 10/-d and £3,3.0 costs Filling bottle in street Salvage of Foodstuffs: Seuzed Postal Parcels. In continuance of the arrangements made in July, 1941, the contents of 128 parcels were examined and those considered fit for human consumption were sold to the Council's Canteen for the total sum of £41.5. 10d. The parcels were seized by H.K. Customs & Excise, Mourt Plensant, London, E.C.l. as they did not comply with Post Office Regulations. Salvage Divsion - M. O. F. Large quantities of foodstuffs have been examined during the year in co-operation with the Minstry of Food's Salvage Officers. These foods are examined as to their fitness for human consumption of suitability for other purposes and are disposed of accordingly by the Salvage Officers. These salvage oprations arise from the loss of labels or other means of ascertaining the ownership, and through packages becoming contaminated with other substances, or package sustained during transport by carriers whose pemises are situated in this Borough. Number of porsonal visits made during the year ... 697 Cases notified from other Boroughs for enquiry ... 173 Certificates of exemption granted after declaration 33 Scarlet Fever: The number of cases notified during 1942, namely 33, was apporo ximately half that for the previous year. All the cases were removed to Hospital and the average length of stay in Hospital was 28 days. There were no deaths from this disease. Routine visits to pationts following discharge were continued. Diphtheria: 19 coses of diphtheria were notified and there was one death. All the coses wore removed to Hospital and the average length of stay was 70 days. The following table shows th e cases notified during the last ten years and the number of deaths. Year No. of Cases Notified No. of Deaths 1933 214 8 1934 213 13 1935 188 1 1936 126 4 2 1937 107 1938 101 3 1939 58 2 1940 27 2 1941 35 - 1942 19 1 Further efforts were made during the year to secure a greater degree of immunisation in the child population by display of posters, distribution of loaflate, show of films, advertisemants in the local pross, and work by the Health Visitors. A new method of intensive visiting by Health Visitors and Sanitary Ins pecters was tried in a street or block where a case of diphthoria occurred. When unimmunised children were found efforts were made to persuade the parents to agree to immunisation and appointments made to have this carried out. The success of these various measures can be judged by the fact that in 1942, 1,148 children under 15 years of age were immunisod, 361 under 5 years find 787 between 5 and 15 years. The figures for 1941 were 675 children, 255 under 5 years and 420 between 5 and 15 years. It was eatimated that by the and of 1942 approximately 48% of the total child population under 15 years had been treated. SECTION F. INFECTIOUS AND OTHER DISEASES. Notifications of Infectious Disease: The following table shows the notifiable cases of Infectious Disease during 1942 in various age groups and indicates the total number of cases removed to Hospital. All Ages Under 1 Year 1-5 Yrs 5-15 Yrs 15-25 Yrs 25-45 Yrs 45-65 Yrs 65— Total Rmvls to Hosp. Acute Influenzal Pneumonia 3 1 1 1 - - - - - Acute Primary Pneumonia 2 26 2 5 1 5 8 3 3 Cerebro-spinal Meningitis 2 1 1 1 1 2 6 - - Diphtheria ( Including Mom. Group) 19 2 1 19 6 10 - - - Dysentery 9 1 3 2 1 2 8 - - Erysipelas 11 - 1 2 5 3 11 - - Typhoid 2 - 1 1 2 - - - - Measles 85 13 37 34 1 41 - - - Opht halmia Neonatorum 3 3 4 - - - - - - Puerperal Fever 1 1 - - - - - - - Puerperal pyrexia 7 1 6 - 4 - - - - 1 - Searlet Fever 33 9 23 - 33 - - Pulmonary Tuberculosis 83 3 6 17 29 24 4 - - Other Forms of Tuboreculosis 14 4 - 1 1 2 3 3 - 95 - 31 Whooping Cough 11 50 34 - - - Zymotic Enteritis 7 2 4 - 1 - 4 - - Polio Myelitis 1 1 - - - - - - - TOTALS 405 35 117 117 27 53 44 12 162 Smallpox and Vaccination; - No cases of smallpox occurred in the Borough during 1942. The following is a summary of under the Vaccination Acts 1867 to 1898. No. of birth notifications received from Registrar 240 No. of Finsbury birth notifications received from R egistrar 240 No. of Certificates of Vaccination received 173 No. of deaths before Vaccination 10 Postponements of medical certifica te 32 - No. of certificates of insusceptibility No. of notices to other Vaccination officers re non-resident cases 65 No. of addresses not traced 80 No. of Finsbury babies not vaccinated within Statutory period of four months 28 Cancer: There wore fewer deaths from cencer during the year than last year, but owing to the changing nature of the population it is not possible to comment on the significance of this. Tuberculosis: The total number of new cases of tuberculosis, both pulmonary and non-pulmonary, entered in the Register in 1942 was 97. The age period details were as follows:- 5- 10- 15- 20- 25- 35- 45- 55- 65- 0- 1- Total all ages Males Pulmonary 1 1 2 4 3 11 6 12 8 4 52 - Females Pulmonary 2 2 1 6 4 7 5 4 31 - - - Males Non-Pulmonary 1 1 1 1 2 6 - - - - - - Females Non-Pulmonary 1 1 1 1 - 2 - 2 - - 8 - 1 Total 4 3 5 11 9 21 12 16 11 4 97 Of the above cases 17 wore brought to notice otherwise than by formal notification. The number of cases removed from the Register during the year was 102 and these remaining on the Register of Notificitions at 31st December, 1942 were as follows:- Males Females Total 245 136 381 Pulmonary Non-Pulmonary 45 94 49 290 185 475 The following is a summary of the Tuberculosis Dispensary work in 1942. No. of cases on Dispeneary Register - Pulmonry ... ... 329 Non-Pulmonary ... ... 70 Total 399 Sputum positive Cases ... 177 Sputum Negative Cases ... 152 Cases notified from Services 9 Whooping Cough: Notifications showed this to be the most prevalent infectious disease in 1942 in Finsbury although the figure of 95 cases was about half of that of 1941. Thar two deaths from whoopingcough. Prophylactic treatment has been continued in conjunction with diptheria. Measles: There were no deaths from measles during the year. Of the 85 cases which occurred 41 were removed to hospital, partly on medical and partly on social grounds. Special visits were paid by the Health Visitors to all cases nursed at home. Typhus: In accordance with the arranements made with the adjoining Boroughs in doctor 3, the; Health Centre has been earmarked for anti-typhus measurer in the event of an epidemic. Training of personnel recruited from the Fellowship of Reconciliation was carried out during the year and Protection offered in the form of immunisation with Cox's. The vaccine - prepared in Toronto - was received finistry of Health. The effect of the vaccine given by the Medical Research Council. Members of the Finsbury and Shoreditch staffs and of the of Reconciliation were immunised. Typhoid: Although there vere but two cases during the year mention must of the new method of differentiation of these organisms by Phage-typing. This work carried out in London by Dr. Felix. One of the Finisbury proved by means of this refinement of bacteriological diagnosis to have have been infected at a restaurant in an adjoining brough. The new gives promise of being of great assistance source of infection in a higher proportion than ha i possible previously. Infective Hebatitis: Although not notifiable this disease was know to have caused some illness, ply in children. Diabetes and Pernicious Anacmia: Treatment of these diseases is prolonged and usually for the duration of the patient,s life, By virtue of Section 227 of the Public, Health (London) Act. 1936, the borough continues to bear the cost of necessitous persons suffering from these diseases. New Cases Examined (other than Contacts). Pulmonary Non-Pulmonary Total (a) Definitely Tuberculosis 70 12 82 (b) Diagnosis not completed 27 (c) Now Tuberculosis 152 Contacts: (a) Definitely Tuberculosis 8 (b) Diagnosis not completed 13 (c) Now Tuberculosis 141 Total 423 Cases Written Off: (a) Recovered 8 (b) Now Tuberculosis 8 Total 16 Number of attendances at Dispensary 2065 Consultation with Doctors 260 Visits made by Nurse 1345 Number of X-Ray Examinations 887 Home Visits by Tuberculosis Officer 100 Specimens of sputum examined 225 Number of patients attending for Artificial Pneumothorax Refills 34 Number of refills given 385 X-RAY DEPARTMENT: Details of the work in the X-Ray Departement during 1942 are as follows:- Chest Cases: Other Cases: Large films used 760 Small films used 101 Screen examinations 1657 Ante-Natal cases 4 Women's Clinic cases 6 Doctors' cases 15 PROVISION OF EXTRA NOURISHMENT: The. Borough Council has continued to provide extra nourishment for certain types of tuberculosis cases. 62 persons were granted extra nourishment during the year. Although there has been a marked increase in the number of attendance at the Chest Clinic, 2065 as against 1492 in 1941, and an increase in the number of new cases seen, 383 as against 353 in 1941, there has been a reduction in the number of cases of tuberculosis. This reduction is similar to that experienced throughout the country and suggests that the abnormal war-time conditions which appear t.o have been .responsible for the sudden increase in tuberculosis in 1940 end 1941 have become stabilised to some degree. The Ministry of L ; hour and National Service commonces enquiries regarding women in certain age groups suffering from tuberculosis as they had done in the case of men. With the approval of the Labour and National Committee the Department colleberted with the National Association for the Prevention of Tuberculosis in an investigation into the effect of tuberculosis on the circumstances of the patient and his family. Owing to Dr. Brooke's absence on military duty a re-arrangement of the work in the Dispensary was made. The Tuberculosis Officer's duties were shared by Oborner and Dr. Stewart. SHELTER HEALTH: The largo shelter a steady nightly population during the first half of cl or. As the lull became prolonged the shelters gradually emptied. By August the nightly population was so small that it became possible to close all the shelters, with the exception of ben of the larger shelters. An was of coursr made for the opening of all shelters on an alert. My department, however, remained responsible for shelter cleanliners and hygiene. Under the direction of a Sanitary Supervisor all shelters were regularly visited by the spray squad and the lavatory cleaning squad. Further, the cleaning of the shelters by women volunteers from among the shelterers continued, though after August most of these women were put on half time.