Acu 341 FIN 24 4 THE METROPOLITAN BOROUGH OF FINSBURY. ANNUAL REPORT on the PUBLIC HEALTH OF FINBURY. for the year 1943. By- K. S. STEWART, M.D., D.P.H. Acting Medical Officer of Health. 73025 METROPOLITAN BOROUGH OF FINSBURY. PUBLIC HEALTH COMMITTEE: CHAIRMAN: Alderman C.W.E. Drew VICE CHAIRMAN: Councillor J.T. Bellamy ALderman C.A. Allen Alderman H.J. Dainty Alderman Mrs. E. Martin Councillor S. G. Nunn, J.P. Councillor Mrs. A. Rufe Councillor W. Barrie, M.P.S. Councillor Mrs. F.E. Gilbert Councillor Mrs. L.B.Comley Councillor Mrs. C. Griffiths Councillor Mrs. V.F. Prythergeh Councillor Mrs. B. South MATERNITY AND CHILD COMMITTEE: CHAIRMAN: Alderman Mrs. E. Martin VICE CHAIRMAN: Councillor Mrs. V.F. Prythergch Alderman H. J. Dainty Alderman C. W. E. Drew Councillor Mrs. F. E. Gilbert Councillor Mrs. L. E. Jeffs Councillor Mrs. A. Rafe Councillor Mrs. B. South Councillor J. Wilkins, J.P. Councillor Mrs. L.B. Comley Councillor Mrs. C. Griffiths Councillor T. W. Rafe STAFF. MEDICAL OFFICER OF HEALTH: C.O.S. Blyth Brooke, L.R.C.P., M.R.C.S., D.P.H. ACTING MEDICAL OFFICER OF HEALTH: A.B. Stewart, M.D., D.P.H. ACTING DEPUTY MEEICAL OFFICER OF HEALTH: R. Woolf, M.B., B.S., M.R.C.S., L.R.C.P., D.P.H. ASSISTANT MEDICAL OFFICERS: C.M.M. Culver Evans, M.R.C.S., L.R.C.P. E. Obermer, M.D., M.R.C.S., L.R.C.P. H. Lomas, M.D., M.R.C.S., L.R.C.P. (Part-time) J.K. C.Colwell, F.I.C., F.C.S. (part-time) PUBLIC ANALYST: PUBLIC VACCINATORS: Dr. R. E. Batson Dr. R. K. Dadachanji Dr. G. P. Barua Dr. R. Sacks P. E. Capps (Part-time) VACCINATION OFFICES: H. Ward (chief Clerk) CLERICal STAFF: T. E. Williams J. E. McDowell Miss W. Freeman (M.& C.W.) Miss J. S. Dodd (M.& C.W.) Miss A. Rimel (T.B. Clerk and Laboratory Asst) W. Keutenius A. F. Cowan G. Hawthorn Miss F. Levy (Resigned 20/2/43) Miss M. Gardner J. Field E. Mitchell J. E. Newman (From 3/5/43) Mrs. E.K. Dawson (From 1/3/43) With H.M. Forces. SANITARY INSPECTORS & MEAT INSPECTORS. M.& C.W. Centre SUPERINTENDENTS: HEALTH VISITORS: TUBERCULOSIS NURSE: SECRETARY OF TUBERCULOSIS CARE COMMITTEE: WOMEN'S CLINIC: DENTAL CLINIC: Anaesthetists: FOOT CLINIC: CLEANSING STATION: SOLARIUM: RESIDENT ENGINEER AMD HEALTH CENTRE KEEPER: SHELTER HYGIENE SUPERVISOR: H. J. Newdick (Senior Sanitary Inspector) H. Clinton. Miss F. Hall Mr. R. E. Lay Mr. A. C. Jenkins Mr. A. J. Truslove Mr. J. Lewis (Temporary) Mr. T. Penman, M.B.E. (Meat Inspector- Seconded to Ministry of Food) Mr. R. S. Barber (Assistant Meat Inspector) Miss M. Fillingham (Leage Street M.& C.W. Centre) Miss J. R. Turner (Pine Street M.& C.W. Centre) Miss M. Rock Miss L. Breaman (Seconded to Ministry of Health) Mrs. G. Hartney Miss B. J. Scott Miss L.S. Hitchings Miss F.M. Prior Mr. H. Ward Dame Louise McIlroy, O.B.E., M.D., F.R.C.P., F.R.C.O.G., L.M. Rotunda D.Sc., L.L.D. Medical Officer in Charge P. R. Asplet, L.D.S. (Dental Surgeon) H. Millett, L.R.C.P., M.R.C.S., L.D.S. (Dental Surgeon) Mrs. C. Roberts, Dental Nurse (From 29/5/43) Dr. A. Fairweather Dr. Barua Dr. A. H. Rowntree Dr. E. F. Rossdale Dr. B. J. Wilton Dr. R. E. Batson S. Philpot, M.I.S.Ch. (Chiropodist) R. H. Carter, M.I.S.Ch. (Chiropodist) Mrs. D.I.N. LIoyd (Nurse in Charge) Miss M. Calpen (Nurse in Charge) Mrs. K. Sproston (Assistant Masseuse) Resigned 9/4/43. Mrs. I. Aperguis " " From 3/5/43. Mrs, A. L. Ertherton (Solarium Assistant) Mr. F. M. Battle Mr. G. Bailey (Died 23/7/43) To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Finsbury. Mr. Mayor, Ladies and Gentlemen, I have pleasure in submitting herewith the Annual Report of the work of the Public Health Department during 1943, in the continued absence of Dr. Brooke on military service. Once again the Report is in abbreviated form, as suggested by the Minister of Health, and figures from which the total population can be calculated have been omitted for security reasons. An outstanding feature was the introduction of the Tuberculosis Maintenance Allowance Scheme, undoubtedly the most important step forward in the care of the tuberculous since the inception of the Tuberculosis Scheme itself. The wartime nursery work was again expanded during the year. Both these items added considerably to the clerical work of the department, a constant source of worry in wartime. (Comment has been made elsewhere in the report on the position regarding Wartime Nurseries). The Borough is now very well served and may reasonably claim to be one of the best provided districts in the country. The Infant Mortality rate is reduced this year, and for the first time since 1939 is below the average figure for the London boroughs. The reduction is due mainly to a fall in the number of deaths caused by pneumonia. The diphtheria immunisation campaign was continued during the year with good result. In 1942 18% only of the children under 15 had been immunised; by the end of 1943 approximately 50% of the children under 15 had been immunised. The increased incidence of Venereal Disease caused concern throughout the country and the Borough joined in the widespread drive to encourage sufferers to have treatment, suitable posters being displayed and talks to young people were arranged. Scabies was made notifiable during the year and a system of home and contact visiting introduced. It was with great regret that news was received during the year that a member of the clerical staff, Flying Officer Goldberg, was reported missing and later believed killed. A remising junior member of the staff Mr, Goldberg claimed the affection and respect of all. The shelter supervisor, Mr. Gilbert Bailey, died after a regrettably short period of service with the Council. It is a pleasure once again to thank the members of the Public Health and the Maternity and Child Welfare Committees for their attentive assistance and the entire staff for their cheerful acceptance of additional tasks and for their loyal co—operation. I have the honour to be, Your obedient Servant, A. B. STEWART. acting Medical Officer of Health. 10th October 1944 3, SECTION "A" - VITAL STATISTICS. AREA: The area of the Borough is 587 acres. POPULATION: The Registrar-General's estimate of resident population is not available for publication. In 1938 the estimated population was 56,960. BIRTHS: The total number of live births belonging to the Borough occurring during 1943 was 466, including 24 illegitimate births, and consisting of 226 males and 240 females. The total number for 1942 was 452. STILL-BIRTHS: The total number of still-births allocated to the Borough during the year was 14. This figure represents 2.92% of the total births. DEATHS: The total number of deaths belonging to the Borough registered during 1943 was 407, consisting of 253 males and 234 females. The total number for 1942 was 508. The comparative tables for birth rates, still births and deaths have been omitted for security reasons. 5. The following table shows the causes of, and ages at death during the year 1943:- CAUSE OF DEATH Total All Ages 0- 1- 5- 15- 45- 65- 1. Typhoid and Paratyphoid Fevers - - - - - - - 2. Cerebro-Spinal Fever - - - - - - - - - - 3 Scarlet Fever - - - - 1 4. Whooping Cough 8 2 - - - - 5. Diphtheria - - 2 - - 2 - - 6. Tuberculosis of Respiratory System 35 - - 22 0 4 - - - 7. Other Forms of Tuberculosis 2 - - 1 8. Syphilitic Diseases 3 - - - - 1 2 7 - - 4 9. Influenza - 1 2 - 10. Measles - - - - - - 11. Acute Polio-Myelitis and Polio- Encephalitis - - - - - - - - 12. Acute Infectious Encephalitis - - - - - - 7 - 13. Cancer of Buccal Cavity and Œsophagus and Uterus - - - 5 2 14 - - - 1 6 14. Cancer of Stomach & Duodenum 7 - 2 15. Cancer of Breast 3 - - - 1 16. Cancer of all other sites 48 - - - - - - 11 37 - - - - - 17. Diabetes - 18. Intra-Cranial Vascular Lesions 30 - - - 5 25 19. Heart Disease 117 - - - 23 90 4 15 20. Other Diseases of Circulatory System 15 - - - - - 9 28 21. Bronchitis 39 1 - - 1 22. Pneumonia 50 3 - - 5 15 27 - 1 23. Other Respiratory Diseases 1 - - - - 24. Ulcer of Stomach or Duodenum 10 - - - 1 4 5 7 7 - - 25. Diarrhoae under 2 years - - - 26. Appendicitis - - - - - - - - - 6 1 10 27. Other Digestive Diseases 16 - - - - 1 28. Nephritis 11 - 9 - - - - - - 29. Puerperal & Post-Abortive Sepsis - - 1 - - 30. Other Maternal Causes 1 - - - - 31. Premature Birth 2 2 - - - 32. Cong. Malf. Birth Injuries, Infant Dis. 8 - - 1 1 1 11 1 2 - - - 1 33. Suicide - - - - - 1 34. Road Traffic Accidents 1 - 13 35. Other Violent Causes 2 - - - 2 9 3 7 22 36. All other causes 37 1 - 4 M 253 14 1 2 21 70 145 157 22 F 234 12 - 3 40 302 5 43 487 26 1 Total All Causes 110 SECTION B - GENERAL PROVISION OF HEALTH SERVICES. TREATMENT CENTRES AND CLINICS. The attendances at the various Treatment Centres and Clinics have shown a steady expansion since their inception and there were record attandances in most of them during 1943, as shown by the following, table. ATTENDANCES & C. AT TREATMENT CENTRES AND CLINICS. CLINIC 1943 Total No. Atts. 1940 1941 1942 No. of Sessions No. of New Cases Total No. Atts. No.of Sessions No. of New Cases Total No. Atts. No. of Sessions No. of New Cases No. of Sessions No. of New Cases Total No. Atts. FOOT CLINIC 617 430 2628 510 470 2343 833 655 4600 1195 849 6638 DENTAL CLINIC 327 986 189 705 2833 187 2943 312 3858 907 694 4291 SOLARIUM 506 7267 693 8101 772 474 415 203 473 3154 499 14567 453 63 120 119 WOMEN'S CLINIC 62 186 502 45 19 506 49 1667 373 TOTALS 1679 2520 22114 2066 2647 25869 1375 1729 14068 1131 12756 It was found necessary to obtain additional assistance and equipment for the Foot Clinic to deal with the additional work and additional sessions were necessary in the dental clinic and solarium. LABORATORY: Routine examinations of swabs, sputum, milks, &c., have continued to be carried out at the Laboratory in the Health Centre and the following is a brief summary of the work undertaken- No. of throat and nasal swabs examined. 782 No. of sputums examined for T.B. 213 Milk samples 98 The Council has now an arrangement whereby special examinations are undertaken at the Archway Group Laboratories by the L.C.C. Group Pathologist, Doctor J.M. Alston. INQUESTS: Inquests were held on 29 residents during the year, the findings being as follows:- Bronchitis 1 Pneumonia 3 Chronic alcoholism 1 Suicide 2 Accidents 13 Status Epilepticus 1 Cancer 1 Heart Failure 2 Asphyxia 1 Brain Contusion 1 Peritonitis 1 Haemorrhage 1 Cerebral Compression 1 MATSRNAL MORTALITY: There was one maternal death during the year giving a maternal mortality rate of 2.08 per 1,000 Total (Live and Still) Births. INFANTILE MORTALITY: There were 26 deaths amongst infants under one year of age and the infant mortality rate based on 1,000 live births was 56. The following are comparative infant mortality rates. INFANT MORTALITY RATES. FINSBURY 1939 1940 1941 1942 1943 68 70 64 56 33.5 LONDON 68 60 48 50 58 49 56 59 49 ENGLAND & WALES 55 DEATHS IN RELATION TO DISEASE: For the first time since 1939 the infant mortality figure for Finsbury was batter than that for the whole of London. This was due in the main to the reduction in the infant deaths caused by pneumonia. Diarrhoea continued to be an important factor in infant mortality. The sharp influenza epidemic at the end of the year which had a high morbidity rate did not form a great danger to life and there was no increase in the number of deaths from influenza in the borough during the year. The measles epidemic although extensive caused no deaths. MUNICIRAL WELFARE CENTRES. The attendances at the two Municipal Maternity and Child Welfare Centres ar briefly outlined in the following table and a comparison is shown with the figures which obtained in 1942. PINE STREET LEAGE STREET 1942 1943 1942 1943 Mothers, Individual 277 305 134 137 Mothers, Attendances 539 520 213 223 Children (1-5 years) Individual 439 415 282 249 Children (1-5 years) Attendances 2,813 3,345 2,030 1,672 Babies, Individual 348 390 180 179 Babies, Attendances 3,622 3,835 1,497 1,844 GRANTS SCHEME: A total of 5,070 dinners wore granted to necessitous persons at the two Centres and 1,619½ lbs of Dried Milk were issued under the provisions of the Council's Grants Scheme. CLOTHING COUPONS FOR EXPECTANT MOTHERS: The issue of clothing coupons for expectant mothers under the Board of Trade Scheme was continued until July, 1943, when the administration of the Scheme was transferred to the Local Food Office. HEALTH VISITING: The regular visitation of expectant mothers and children under five years was continued by the Health Visitors and during the year a total of 12,519 visits were made by the Council Staff in addition to visits made by the officers from certain Voluntary Centres in the borough. 496 visits were made by the Council's visitors in respect of special cases. 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 393 316 101 Җ Claramont Central Mission 867 Maternity Nursing Association 216 1,897 Women's Leage of Service 49 483 Җ The evacuated nursery attached to the Claremont Central Mission was closed on 30/4/43 and the annual Council Grant of ceased from that date. 9. NURSERIES: The Fins bury Evacuated Nursary remained throughout the year at Down Hill Farm, Woodchester, Gloucester, and at the close of the year there was a total of 25 children resident there; of these 16 were Finebury children. Three wartime nurseries were in operation in the borough throughout the year, a fourth was opened in Banner Street in November and the Lloyd Square Nursery was extended to cater for additional children. The following tabie shows the average daily attendances of children at these nurseries. JAN. FEB. MARCH APRIL MAY JUNE JULY AUG. SEPT. OCT. NOV. Claremont 24.38 19.66 18.11 22.74 15.15 20.68 23.55 24.72 25.62 26.46 22.30 King Square 26.2 28.2 14.63 24.65 22.42 22.12 24.95 25.76 26.38 27.0 24.10, Lloyd. Square 34.84 29.12 22.88 24.84 30.31 30.64 45.59 45.56 46.07 43.91 40.15 Banner Street - 21.44 85.42 76.98 55.62 72.23 67.88 73.44 94.09 96.04 98.07 97.37 107.99 The Council's tenancy of the promises at 42, Lloyd Baker Street, which were previously used as a Day Nursery and 1ater as a Wartime Nursery, was terminated at the end of the year. Taking into consideration the small size of the B rough the number of nursery places available for children is very high. It s probable that the borough has more nursery accommodation in proportion to its size than any other authority in the country. From the administrative point of view there have been staffing difficulties and from the parents' point of view the difficulty in controlling infectious disease. In spite of all these difficulties a considerable number of mothers have been able to take up war work, surely sufficient justification for the establishment of the nurseries. HOME NURSING: 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 five years of age suffering from any illness at home, was continued throughout the year. EVACUATION: Applications for the evacuation of 84 children under the Scheme for "under fives" were dealt with during the year. The. number of expectant mothers who were evacuated under the L.C.C. Scheme for expectant mothers was 70. NATIONAL MILK AND VITAMINS SCHEME. The Municipal and Voluntary Centres continued to operate as distributing points for vitamin products and national dried milk. MIDWIFERY: Under the Council's Midwifery arrangements as detailed in previous annual reports the following numbers of patients were admitted to the various hospitals. (a) St. Bartholomew's Hospital . 62 (b) Thy Royal Northern Hospital . 1 (c) The City of London Maternity Hospital . 14 (+ 23 evacuated) (d) The University College Hospital 12 Corporation was maintained between the Hospitals concerned and the Maternity and Child Welfare Department, Attendances at ante-natal clinics are notified and antenatal visits are made by our health visitors. POST NATAL CLINIC: In June, 1942, a post natal clinic was started at the Pine Street Maternity and Child Welfare Centre and mothers attending the municipal welfare clinics were urged to attend this clinic if they had not been given an appointment elsewhere, 48 clinics were held during the year and 108 new cases attended. Attendance at this clinic have been good and it has done much useful work, Many of the mothers coming for examination have needed treatment for local minor gynæ cological conditions and for their general health. HOME HELPS, The Council provides a service of Home Helps during the post natal and ante natal period for domiciliary cases, Despite the fact that it has been difficult to got enough people to do this work, the Home Help Service has been adequately maintained and has worked satisfactorily. Home Helps attended 81 cases during the year. HOSPITAL TREATMENT: The arrangement between the Council and the Elizabeth Garrett Anderson Hospital for the retention of one cot has persisted throughout the year and has worked very satisfactorily. All the children admitted to this hospital have done very well and the mothers have been very satisfied with the arrangement. There were 4 admissions to this cot during the year. In addition, the Council has an arrangement with the Royal Free Hospital, University College Hospital and the Queen's Hospital for Children whereby 30/-d per week is paid for any cot occupied by a Finsbury child, but there was no occasion to use these facilities during the year. EAR, NOSE AND THROAT HOSPITALS. The Royal Free Hospital has continued to admit Finsbury children requiring tonsillectomy at a fee of 16/-d per case. The number of children referred to this Hospital during the year was 10. Similar arrangements exist with the Central London E.r, Nose and Throat Hospital and 4 children were referred to them during the year. PUERPERAL FEVER AND PEURPERAI PYREXIA: During 1943 there were four cases of puerperal pyrexia and two cases of puerperal fever notified in Finsbury. Details of the notifications are as follows:- Breast Abscess . 1 Uterine Sepsis . 2 Cause unknown.1 Pyelitis. 1 Difficult L bour . 1 CONVALESCENT TREATMENT: The Council has continued their arrangement with the Dedisham Convalescent Home where two cots are retained and with Letchworth where four cots are retained. The number of children admitted to these Homes during the year was 21. These cots have been used to their fullest extent during the year and all the children who have been sent there have benefited greatly in health. In addition, children are referred for convalescence through the Invalid Children's Aid Association which has dealt with 40 cases during the year. The Council has made arrangements with the London Council of Social Service whereby four beds are reserved at Grand Street House, Worplesdon Hill, Surrey, where mothers and children can be sent away together. Under this scheme mothers with one or more children under five are sent to this Home, usually for a three weeks period. There were 14 mothers and 17 children admitted to this Home during 1943. The Home has proved extremely useful and a certain number of young mothers suffering from post natal debility have benefited markedly from convalescence there. FOSTER PARENTS: There wore no registered foster mothers in Finsbury during 1943. INFANT DEATHS: There were 26 infant deaths in Finsbury during 1943 and the mortality rate based on 1,000 .live births was 56. The neo-natal deaths, i.e., occurring within the first twenty-eight days, numbered 6, details of these deaths are as follows:- Asphyxia - 3 Meningeal Haemorrhage - 1 Prematurity - 1 Hydrocephalus - 1 Deaths of children from one month to one year. 20 Analysis of cases shows:- Bronchitis - 2 Broncho-pneumonia - 3 Enteritis -7 Asphyxia - 1 Whooping Cough -2 Marasmus - 2 Meningitis - 1 Hydrocephalus - 1 Other Causes - 1 A small but gratifying improvement in the infant mortality figures is largely due to a reduction in the number of deaths from pneumonia. Enteritis continues as an important cause of death. Paediatricians have devoted considerable attention to this subject recently and since breastfed babies are apparently unaffected by this disease attention has turned recently to cows milk as a vehicle of infection. Some think that some hitherto unsuspected virus which may resist pasteurisation is the cause• SECTION "C" - SANITARY CIRCUMSTANCES. Summary of inspections made by Sanitary Inspectors - Total number of first visits 6621 Total number of re-visits. 6088 Shops Act Inspections 131 Visits to verminous premises 249 Inspections of Air Raid Shelters 158 House to House Inspections 46 House Inspections 828 Infectious Disease Investigations 216 Investigation of complaints 766 Visits to houses let in lodgings . 509 Visits to Butchers Shops and Stalls 2873 Visits to public Sanitary Conveniences 403 Street Traders' Premises Inspected 96 DRAINAGE. The number of drainage plans deposited and approved during the year was 20. The following is a summary of the work done:- Water closet defects remedied 160 Water closets erected 95 Urinal defects remedied 9 Urinals erected 3 Soil pipe and ventilating shaft defects remedied 17 Soil pipe and ventilating shafts erected 24 Waste pipe defects remedied 52 Waste pipes erected 51 Drains re-laid or amended and sealed 123 Drains cleared or tested 166 Rain water pipes cleared, repaired or renewed 47 COMPLAINTS. The total nunber of complaints received was 766 NOTICES SERVED. The following numbers of notices were served requiring the abatement of nuisances and the remedying of defects:- Number of Intimation Notices . 388 Number of Statutory Notices . 2 RAT REPRESSION. 366 complaints were received in 1943 on which the necessary investigations were made by the Rodent Officer and appropriate action taken. 13. At the beginning of the year one of the Sanitary Lnspectors was seconded to this work. He was assisted in the first place by two volunteers from the Civil Service who worked on their "off duty" days as operators. After some experinontation in methods of trapping and poisoning, a standard method known as "pro-baiting", was adopted, as suggested by the Ministry of Food. There was an increased demand for the service during the year and additional operators were appointed and suitably trained. During the year the Ministry of Food introduced Infestation Ordor, 1943, and certain directions were carried out in the borough, all major infestations wor: mapped and later all other infestations. The Ministry of Food arranged a public campaign at this time and much information was obtained as a result of this public From the 1st October to the 31st December, 1943 , 242 reports wore received from the public regarding infestations. The completod survey revealed a further 475 promised infosted, making a total of 717 promises which were known to be infosted with rats. Dealing with theose promises proved a very considerable undertaking and the work was carried out in a systematic manner. One of the difficulties experienced was to assure people who reported the presence of rets that the work was being done, as the naturally expected immediate action. A further direction from the Ministry of Food required the treatment of the sewerage system in the borough. For the first tinm a co-ordinated attack in the whole of the soworage system was carried out in the whole of London, we were much indebted to the work carried out by the Borough Engineer and his staff in the baiting andprebaiting and of the Finsbury sewors. Calculations made according to the formula provided by the Ministry of Food suggested that a conservative number, 6,835 rats, was destroyed during this campaign. A re-estimate lator suggested that a more representative figure for the borough would be approximately 10,000 rats killed. It was gratifying to learn that this co-ordinated method of attack was to be continued and from time to time directions issued for further treatment of the sewers. The following figures show the extent of the operations carried out during the year:- No. of houses treatod ... 109 No. of promises for which a charge was made ... 87 Number of other premises 15 Total 211 It was found difficult during the year to arrive at a satisfactory method of charging for the work carried out. The Local Authority is obliged to make a charge under the Rats and Mice (Destruction) act, 1919, but it was felt that in a large number of cases the charge was unjust and for an experimental period it was decided that no charge should be made for the treatment of residential propertices and that other propertices be charged a fee approved by the Council. RECEPTION HOUSE: There was no occasion during 1943 for the occupation of the Reception House for the social purpose for which it was provided. The arrangement was kept i force whereby Holborn residents were to use the Reception House if the need arose. I May .1943 now premises were securod at 21, whiskin Street to replace those which were formerly used at 42, Lloyd Beker Street. ERADICATION OF BUGS: In the case of 30 Council flats and 116 other houses, bugs wore found and remedial measures were taken, Arrangements were also made in the case of 7 new entrants to the Council's flats for routine disinfestation of their furniture by means of cyanide gas by arrangement with the Islington Borough Council. CLEANSING OF VERMINOUS PERSONS: Tho following is a summary of the cases dealt with in the Health Centre Cleansing Station during the year. L.C.C. School-children Total Number of Treatments for Vermin and Scabies. 4,661 Patients othor than the above. 2,460 The latter group comprised 157 men, 356 women and 273 children under five years. The arrangements whereby the London Country Council use the Station during the mornings only, leaving it free for the Borough Council in the afternoon, was continued throughout the year. Theo arrangement with the Shoroditch Borough Council to treat their cases was also continued, but there was a large reduction in the number of cases referred. Home visiting of scabies cases and contacts was continued and the Nurse-in-Charge of the Cleansing Station made 512 home visits during the year. SHOPS: The number of inspections made under the Shops Act 1934 during 1943 was 131, RAG FLOCK: The number of samples of Rag Flock taken during the year was 2, CANAL BOATS: The total number of canal boats inspected during the year was 38, none of which carried any offensive cargo. Contravention of statutory requirements had taken place in three instances. There was no discovery or notification of infectiou disease. The number of children on the boats was 20, of whom 10 were of school age. AGED AND INFIRM PERSONS: No application for compulsory removal to hospital was made during the year. Aged persons known to the Department to be living alone are visited periodically to ensure that institutional treatment or care is obtained if neccessary, Thereo were at the end of the year 19 persons on the register kept for the purpose, to whom 141 visits were made. STREET TRADERS: 96 visits were made to the premises of street traders dealing in foodstuffs. COMMON LODGING HOUSES: There is one Common Lodging house in the Borough, situate to at No, 88, Old Street and the number of visits made by the Sanitary Inspector was 32. 15 HOUSES LET IN LODGINGS: At the end of the year there were 488 houses on the Register and 509 visits were made in connection with the Houses Let in Lodgings Byelaws. MORTUARY: 53 bodies were received at the mortuary attached to the Health Centre premises. DISINFECTION: The following table gives particulars of the disinfection work carm out during 1943. Premises disinfected after:- Diphtheria 53 Measlos 314 Vermin and Seabies 420 Scarlet Fever 137 Tuberculosis 16 Whooping Cough 37 Miscellaneous 116 By request 122 A total number of 20,761 articles were disinfectod, being chiefly mattrossos, pills bolsters, shoots, blankets and wearing apparel. In addition, 13,109 articles were disinfected prior to Export and fees charged for this work amounted to £32. 10. 0. OFFENSIVE TRADES: The following are licenced offensive trade premises:- | (a) Messrs, Hanson, 187, Whitecross Street, E.C.I. (b) Messrs. F. & W. warman, Limited, 5, Eagle Court. (c) Messrs. T. Kondon & Sons, Charterhouse Mews. 335 visits were made in respect of these premises during the year. OUTWORKERS No. of Finsbury firms employing outworkers at the end of 1943 168 Total number of outworkers employed by Finsbury firns 2540 Number of outworkers resident in Finsbury 343 FACTORIES aCT, 1937: During the year 968 first visits and 968 re-visits were made to factories and 141 intimation notices were served requiring the remedy of defects found. The following is a summary of defects found:- PARTICULARS NUMBER OF DEFECTS: FACTORIES (POWER) FACTORIES (NON- POWER) TOTAL Refuse accumulation or absence of dustbin 10 3 13 Roof leaky 6 10 4 1 4 Coiling broken 3 30 Sanitary Conveniences - defective 28 2 28 11 39 dirty 2 not separated or insufficient 5 7 44 9 unlabelled 53 7 with ne artificial light 62 69 unsuitable 35 7 42 - Staircase dirty 4 4 Insufficient ventilation of workrooms - - - 9 3 Water fittings leaky 12 3 14 Workrooms dirty 11 1 Yard walls dirty 1 2 9 notices of complaint were received from the Home Office; relating to the following matters:- W.C. accommodation insufficient W.C' s dirty W.C. defective w.C. unlabelled w.C. for opposite sex not properly separated. 39 notices were sent to the Home Office regarding the following matters Abstract absent 21 Now occupation, notification 18 LADY SANTARY INSPECTOR'S WORK: The following is a summary of visits madE by the Lady Sanitary Inspector - Factories 1936 Outworkers premises (Sub-Contractors) 56 Outworkers premises (domestic) 506 Public Health Complaints 5 Public Sanitary Conveniences 77 Miscellaneous visits 7 TOTAL 2587 Number of Intimation Notices served 154 Number of Statutory Notices served 1 17 HOUSING - SECTION D. INSPECIIONS: Hereunder will be found particulars of inspections carried out and action taken during the year:- (A) (1) (a) Total number of dwelling-houses inspected for housing dofects (under Public Health or Housing acts) 2,256 (b) Number of inspections made for the purpose 2,581 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected end recorded under the Housing Conselldatod Regulations, 1925. 46 (b) Number of inspections made for the purpose 59 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 46 (4) Nunbor of dwelling-houses (exclusive of those referred to under the proceding sub-head) found not to be in all respects reasonably fit for human habitation 388 (B) Number of dwolling-houses rendered fit in consequence of informal action by the Local authority or their officiers (C) Action under Statutory Powers during the year. (a) Procedings under Sections 9, 10 and 16 of the Housing Act, 1936:- (1) Number of dwelling-houses in respect of which noticcs were served requiring repairs. ... (2) Number of dwelling-houses which wore rendered fit after service of formal notices (a) By Ownors (b) By Local authority in default of Owners (b) Proceedings under Public Health Acts:- (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 388 (2) Number of dwelling-houses in which defects were remedied after services of formal notices - (a) By Owners 388 (b) By Local Authority in default of Owners - 18. (c) Proceedings under Sections 11 and 13 of the Housing Act, 1936. (1) Number of dwelling-houses in respect of which demolition orders were made (2) Number of dwelling-houses demolished in pursuance of demolition orders (d) Proceedings under Section 12 of the Housing Act, 1936. (1) Number of separate tenements or underground rooms in respect of which closing orders were made 50 (2) Number of separate tenements or underground rooms in respect of which closing orders wore determined, the tenement or room having been rendered fit HOUSING APPLICATION: 60 families were rehoused during 1943, 29 in Borough Council Flats and 31 by the L.C.C. NORTHBURGH STREET BUILDINGS: These buildings comprise two blocks of flats known as Nos, 2 and 4 Northburgh Street Buildings and contain ton one-room and 40 two-room dwellings. During 1943 they were found to be in a grave state of disrepair and at that time the ownor was untraced. Representations were made for the closure and demolition of Northburgh Street Buildings under Section 11 of the Housing Act, 1936, SECTION "E" - INSPECTION SUPERVISION OF FOOD AND DRUGS. MILK SUPPLY Analysis of Milk. During the year 16 samples of milk were submitted to the Public Analyst, No samples were found to be adulterated. Bacteriological Examination of Milk. 23 samples of Designated Milk and 74 samples of Ordinary Milk were submitted for bacteriological examination, Milk Shops and Dairies. Number of applications for Registration approved 9 Number of purveyors on the Register at the end of 1943 117 Number of purveyors removed from the Register during the year 7 Number of purveyors on the Register at the end of 1942 115 Number of visits of inspection carried out 334 Number of notices served for cleansing and repairs to dairy premises 3 Milk (Special Designations) Regulations 1936-1943. Number of applications for licences received - (a) Tuberculin Tested Milk - Dealers 3 (b) Pasteurised Milk - Dealers 27 (c) Pasteurisers 1 (d) Supplementary Licences 9 (e) Number of samples taken for examination 23 A Pasteuriser's Licence was granted to the City of London Dairies, Limited, 116/130, Goswell Road, E.C.1., in September of this year. A high temperature short-time pasteurising plant was installed and on examination and test was found to fulfil all the requirements of the Provisional Regulations, 1941. Milk in Schools. Five samples of the milk delivered to the Schools were taken during the year and submitted for bacteriological examination. Food Poisoning: During the year there were no cases notified under the Food and Drugs Act, 1938, amongst Finsbury residents. Bakehouses: There are 23 bakehouses in use in the Borough of which 17 are basement bakehouses, and in 22 bakehouses machinery is used. 62 visits of inspection were made during the year and ten notices were served for cleansing and other matters. Adulteration of Food: The total number of samples taken in 1943 under the Food and Drugs Act, 1938, was 750 of which 17 were official samples and 733 informal samples. The following table gives full information with regard to the official samples submitted to Mr. Kear Colwell, the Council's Public Analyst. NAME OF ARTICLE GENUINE ADULTERATED TOTAL Milk 12 Nil 12 Sal Volatile 1 Nil 1 Cloves 1 Nil 1 Butter 1 1 2 Chocolate,DrinkinG 1 Nil 1 Golatine 1 1 2 Food Prosecutions: The following prosecutions were effected during the year - TYPE OF FOOD INFRINGEMENT REMARKS Butter Fine £5. 0. 0. Costs £5. 5. 0. 44 Foreign Fat 50% Margarine Gelatine Excess of Preservative (s. o2) Summons dis-missed under Probation of Off.Act on payment of £10.10. costs Dismissed under Probation of Off.Act.on payment of £2.2.0. costs See note overleaf. Milk Filling milk bottles in street Cordial Not of nature, quality and substance demanded The Council instituted proceedings against a vender for selling "Cordial Orange Flavour which contained neither sugar nor alcohol. The Vendor brought the Manufacturer to Court. The Vendor was acquitted and the Manufacturer fined £10.0.0. with costs. On appeal to London Sessions, however, the Police Court findings were rejected and costs awarded against the Council. This action was one of many brought by local authorities in similar circumstances with varying results. Fortunately the Ministry of Food has now laid down standards for soft drinks. Since July 1943 "Cordials" must contain a specified amount of sugar. (The Soft Drinks Order, 1943, S.R. & 0. 1943 No. 838). Pharmacy and Poisons Act, 1933. The work under this act has continued to bo carried cut by Mr. Clinton and 33 applicants wore approved during the year by as Listed Sellers of Poisons and 75 visits wore made. No contravention of the Act or Rules was observed. Unsound Food; The work-of meat inspection, in the absence of Mr. Penman, was carried by Mr.R. 'S. Barber, Assistant Moat Inspector. 1 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 and of retail butchers shops and stalls„ Summary of Foodstuffs seized by or surrendered to the Meat inspector during 1943. Diseased or unsound meat 13,741 lbs 22,392 lbs Diseased or unsound offal and other foodstuffs Total 36,133 lbs 95 Carcases of mutton or lamb affected with caseous lymphadenitis Slaughterhouses: The slaughterhouse owned by Mr J.A MObbs, 14, Penton. Street, was closed down on the outbreak of the war. No animals were Sloughered there during 1943. Disposal of Condemned Meat: The disposal of condemned meat, formerly carried out by the Smithfield Animal Products, is now performed by the Sheppy Glue & Chemical works Limited, 34 Ceylon Street, S.W.B. following: the pooling of transport arrangement. Salvaged Foodstuffs: Seized Postal percels: In continuance of the arrangment made in July, 1941, the contents of 20 parcels were examined and those considered fit for human consumption were sold to the Council's Canteen for the total sum of £9. 17. 4. The parcels were seized by H.M. Customs £o Excise, Mount Pleasant, London, E.C.I., as they did not comply with Post Office Regulations. Salvage Division - M.O.F. Large quantities of foodstuffs have been examined during the year in co-operation with the Ministry of Food's Salvage Officers. Those foods are examined as to their fitness for human consumption or suitability for other purposes and are disposed of accordingly by the Salvage Officers These salvage operations arise from the loss of labels or other means of ascertaining the ownership, and through packages becoming contaminated with other substances, or damage sustained during transport by carriers whose premises are situated in this Borough. Two examples of this Department's co-operation with the Ministry of Food are worth special mention - (1) More than ten tons of foodstuffs that had been affected by fire and wator was salvaged, .At the request of the Ministry of Food all of the salvaged foodstuffs were examined and approximately 90 % was passed as fit for human consumption. (2) A firm of transport contractors was found by the Ministry of Food to have more than three tons of various unclaimed foodstuffs accumulated in a warehouse situated in this Borough. The Borough Food Inspector examined the foodstuffs' as to its fitness, or otherwise, for human consumption at the request of the Ministry of Food. SECTION F. INFECTICUS AND OTHER DISUSES. Notifications of Infectious Disease: The following table shows the notifiable cases of Infectious Disease during 1943 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 - - 6 - - - - - - Acute Primary Pneumonia 25 3 2 2 8 4 - - Cerebro-spinal Meningitis 1 3 3 - - - - - - Diphtheria(lncluding Mem.Group). 24 5 15 2 2 24 - - - Dysentery 3 3 2 8 9 1 - - - Erysipelas 13 1 2 3 3 4 8 - - Typhoid - - - - - - - - - 1 196 Measles 454 32 247 169 3 2 - Ophthalmia Neonatorum 6 6 1 - - - - - - Puerperal Fever 2 1 2 - - - - - - Puerperal Pyrexia 4 2 2 2 - - - - - Scarlet Fever 7 115 123 1 50 62 3 - - Pulmonary Tuberculosis 89 6 30 32 15 6 - - - Other Forms of Tuberculosis 16 1 7 3 1 2 - 2 - Whooping Cough 50 16 24 9 1 26 - - - Zymotic Enteritis 1 1 - - - - - - - Polio Myelitis - - - - - - - - - 35 Scabies 174 8 27 52 32 17 3 - 993 66 368 306 104 81 24 TOTALS 44 382 Smallpox and Vaccination: No cases of smallpox occurred in the Borough during 1943. The following is a summary of proceeding under the Vaccination Acts, 1867, to 1898, Number of Fins bury birth notifications received from Regiester 230 Number of Certificates of Vaccination recevied 139 Number of deaths before Vaccination 8 Postponements of medical certificate 22 Number of certificates of insusceptibility - Number of notices to other Vaccination Officers re non-resident cases 42 Number of addresses not traced 62 Number of Finsbury babies not vaccinated within Statutory period of four months 18 Number of personal visits made during the year 719 Cases-notified from other Boroughs for enquiry 159 Certificates of exemption granted after declaration 34 During the year Doctor Barua was appointed as Public Vaccinator for No.3 District. Scarlet Fever: The number of cases of scarlet fever notified during 1943 was 123, of which 115 were removed to Hospital, the average length of stay in Hospital being 27 days. There were no deaths from this disease. Routine visits to patients following discharge were continued. Diphtheria: 24 cases of diphtheria were notified and there were two deaths. All the cases were removed to Hospital and the average length of stay was 74 days. The following table shows the cases notified during the last ton years and the number of deaths. Year No. of Cases Notified No. of Deaths 1934 213 13 1935 188 1 1936 126 4 1937 107 2 1938 101 5 1939 58 2 1940 27 2 1941 35 - 1942 19 1 1943 24 2 Efforts were continued during the year to secure a creator degree Q f immunisation in the child population by of further propaganda and intensive visits by the Health Visitors and Sanitary Inspectors. The method of intensive visiting has been reported in detail olsewhere (Medical Officer 15th April 1944, page 125). It was ostimated that-by the end of 1943 approximately 55.4% of the child population between the ages of 5 and 15 years had boon treated and approximately of the under fives. The number of immunizations carried out during the year was 537 consisting of 273 under 5 years of ago and 264 between 5 and 15 years. Whooping Cough: Notifications of whooping cough numbered 52. There wore throe deaths. Prophylactic treatment has been continued in conjunction with diphtheria prophylaxis. 24, Measles: There were no deaths from measles during the year. Of the 454 cases which occurred 196 were removed to hospital, partly on medical and partly on social grounds. Special visits were paid to all cases nursed at home. Typhus: The anti typhus arrangements described in the annual Report for 1942 were kept in operation and groups of volunteers trained during the year. Typhoid: There were no notifications during, the year. Influenza: In November there was a sharp outbreak of influenza. Memories of 1913-1919 caused considerable apprehension. The outbreak continued during December but subsided without developing a high virulence. It is noteworthy that there was no increase in the number of deaths due to influenza. In December a conference was called at County Hall by Doctor Daley which did much to clarify and co-ordinate the efforts which wore being made by the various bodies during the epidemic. Diabetes and Pernicious Anaemia: Treatment of these diseases is prolonged and usually for the duration of the patient's life. By virtue of Suction 227 of the Public Health (London) Act, 1936, the borough continues to bear the cost of necessitous persons suffering from these diseases. Tuberculosis: The total number of new cases of tubercrculceis, both pulmonary and nonpulmonary,- entered in the Register in 1943, was 82. The ago period details were as follows:- 0- 1- 10- 20- 25- 35- 45- 55- 65- Total all ages 5- 15- Males Pulmonary - - 2 5 2 6 5 9 3 5 37 - Females Pulmonary - - 1 1 8 11 9 1 1 - 32 - Males Non-Pulmonary 1 2 - 1 1 1 - 1 - _ 7 - Females Non-Pulmonary - 4 - - - - - - 1 6 - - - 7 3 14 14 17 6 10 4 6 Total 1 82 Of the above cases 23 wore brought to notice otherwise than by formal notification. The number of cases removed from the Register during the year was 91 and those remaining on the Register of Notifications at the 31st December, 1943, were as follows:- Males Females Total Pulmonary 253 141 394 Non-Pulmonary 48 47 95 301 188 489 The following is a summary of the Tuberculosis Dispensary work in 1943:- Number of cases on Dispensary Register - Pulmonary 342 Non-Pulmonary 68 Total 410 Sputum Positive Cases 172 Sputum Negative Cases 170 Cases notified from Services 6 New Cases Examined (other than Contacts). Pulmonary Non-Pulmonary Total (a) Definitely Tuberculous 69 10 79 (b) Diagnosis not completed 24 24 - (c) Non-Tuberculous 235 235 - 338 Contacts: - (a) Definitely Tuberculous 3 3 (b) Diagnosis not completed 7 - 7 (c) Non-Tuberculous 128 - 128 •i-... :± - ' ■ 138 Cases Written Off: (a) Recovered 8 2 10 (b) Diagnosis not confirmed - 1 1 11 35 Number of attendances at Dispensary 2,479 Visits made by Nurse 1,201 Number of X-ray examinations and screenings ... 1,839 Home visits by Tuberculosis Officer 14 Specimens of sputum examined 205 Number of patients attending for artificial pneumothorax refills 30 Number of refills given 377 X-RAY DEPARTMENT: Details of the work in the X-Ray Department during 1943 are as follows :— Chest Cases: Large films used 835 Small films used 106 Screen examinations 837 Other Cases: Ante-Natal cases 2 Women's clinic cases 19 Doctors' cases 41 Tuberculosis Maintenance Allowances Scheme; The scheme for the provision of maintenance allowances for the dependants of patients who have to give up remunerative work in order to undergo treatment, and to persons who, though having no dependants, are still in need of allowances during institutional or home treatment, came into operation on 30/6/43. The Council's T.B. Dispensary machinery is used for the institution of the necessary enquiries and for the presenting of the applications. During the year 66 new applications were dealt with and of these 40 maintenance allowances, 13 special allowances and 1 discretionary allowance were granted. In addition 133 cases were presented to the Assessment Officer for review, The total cash allowances paid out during the six months was £760.0.0. PROVISION OF EXTRA NOURISHMENT: The borough Council has continued to provide extra nourishment for certain types of tuberculosis cases. 83 persons were granted extra nourishment during the year. Although there has been again a marked increase in the number of attendances at the Chest Clinic, 2,479 as against 2,065 in 1942, there was a decrease in the number of new cases seen, 338 as against 383 in 1942, there has been a reduction in the number of cases of tuberculosis. The arrangements in the Chest Clinic have remained unaltered during the year. The cordial relationship between the Care Committee Secretary, Mr. Ward, and the chest Clinic staff has proved invaluable in the work of inaugurating the Maintenance Allowances scheme. SHELTER HEALTH. The lull in enemy activity from August, 1942, continued with little interruption during the year. My department, however, remained responsible for shelter cleanliness and hygiene. All shelters were regularly visited by the spray squad and the lavatory cleaning squad. This work was carried out under the general direction of the Medical Officer of Civil Defence.