Fin 25 T H E METROPOLITAN BOROUGH OF FINSBURY ANNUAL REPORT on the PUBLIC HEALTH OF FINSBURY for the year 1944 By - A.B.STEWART, M.D., D.P.H., Acting Medical Officer of Health METROPOLITAN BOROUGH OF FINSBURY 1. PUBLIC HEALTH COMMITTEE: MATERNITY AND CHILD WELFARE COMMITTEE: CHAIRMAN: Alderman C.W.E.Drew CHAIRMAN: Alderman Mrs. E.Martin VICE CHAIRMAN: Councillor J.T.Bellamy VICE CHAIRMAN: Councillor Mrs. V.F.Prythergeh Alderman C.A.Allen Alderman H.J.Dainty Alderman H.J.Dainty Alderman C.W.E.Drew Alderman Mrs. E.Martin Councillor Mrs.F.E.Gilbert Councillor S.G.Nunn, J.P. Councillor Mrs.L.E.Jeffs Councillor Mrs. A.Rafe Councillor Mrs. A.Rafe Councillor W. Barrie, M.P.S. Councillor Mrs. B.South Councillor Mrs. L.B.Comley Councillor J.Vilkins, J.P. Councillor Mrs. C.Griffiths Councillor Mrs. L.B.Comley Councillor Mrs. V.F.Prythergch Councillor Mrd. C.Griffiths Councillor Mrs. B.South Councillor T.VJ.Rafe Councillor Miss G.Martin Councillor Miss G.Martin 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 MEDICAL OFFICER OF HEALTH: R.Woolf, M.B., B.S., M.R.C.S., L.R.C.P.,D.P.H. ASSISTANT MEDICAL OFFICERS: 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) pUBLIC ANALYST: J.K.Colwell, F.I.C., F.C.S (Part-time) (Now deceased) PUBLIC VACCINATORS: Dr. R.E.Batson Dr. R.K.Dadachanji Dr. G.P.Barua Dr. R.Sacks VACCINATION OFFICER: P.E.Capps (Part-time) CLERICAL STAFF: H.Ward, M.S.I.A, (Chief Clerk) 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) x W.Keutenius x A.F.Cowan x G.Hawthorn Mrs. M.Haynes J.Field E.Mitchell J.E.Newman Mrs. E.K.Dawson x with H.M. Forces. 2 SANITARY INSPECTORS & H.J.Newdick, H.S.I.A. (Senior Sanitary InSpeetor) Meat INSPECTORS: H.Clinton, M.S.I.A. Miss F.Hall, M.S.I.A. Mr. R.E.Lay, M.S.I.A. Mr. A.C.Jenlcins, M.S.I.A, (Resigned 31/8/44) Mr. A.J.Truslove, M.S.I.A. Mr. J.Lewis, M.S.I.A. (Temporary) Mr. T.Penman, M.B.E, M.S.I.A, (Meat Inspector - seconded to Ministry of Food) Mr. R.S.Barber, M.S.I.A.(Assistant Meat Inspector) M.& C.W.Centre SUPERINTENDENTS: Miss M.Fillingham (Leage St. M.& C.W.Centre) Miss J.R.Turner (Pine Street M.& C.W.Centre) M.& C.W.DISPENSER: Miss I.Lloyd (Part-time) HEALTH VISITORS: Miss M.Rock Miss L.Breaman (Seconded to ministry of health) Mrs. G.hartney Miss B.J.Scott Miss L.E.Hitchings TUBERCULOSIS NURSE: Miss F.M.Prior SECRETARY OF TUBERCULOSIS CARE COMMITTEE: Mr. H.Ward WOMEN'S CLINIC: Dame Louise Mcllroy, 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) DENTAL CLINIC: P.R.Asplet; L.D.S. (Dental Surgeon) H.Millett, L.R.C.P., M.R.C.S., L.D.S. (Dental Surgeon) J.W.White, L.D.S. (Dental Surgeon) From 6/7/44 Mrs. C.Roberts (Dental Nurse) Anaesthetists: Dr. A.Fairweather Dr. Barua Dr. A.H.Rowntree Dr. E.F.Rossdale Dr. B.J.Wilton Dr. R.E.Batson FOOT CLINIC: Mr. S.Philpot, M.I.S.Ch. (Chiropodist) (Resigned 29/1/44) Mr. A.H.Carter, F.C.Ch.A. (Chiropodist) Miss P.M.Vincent A.I.S.Ch. (Asst. Chiropodist) Miss R.V.Akker, M.C.Ch.A. (Asst.Chiropodist) CLEANSING STATION: Mrs. D.I.M.Lloyd (Nurse in Charge) SOLARIUM: Miss M.Calpen (Nurse in Charge) Mrs. I.Aperguis (Asst. Masseuse) Miss M.Haslett (Part-time Asst-masseuse) Mrs. A.L.Emmerton (Solarium assistant) RESIDENT ENGINEER AND HEALTH CENTRE KEEPER: Mr. F.M.Battle 3. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Finsbury. Mr. Mayor, Ladies and Gentlemen, I have the honour to present the Annual Report of the work of the Public Health Department during 1944 in the continued absence of Dr. C.O.S. Blyth Brooke on military service. The restrictions previously imposed, on the grounds of national security, have now been removed and it is possible to give figures previously witheld. The population figures given in tabular form in the vital statistics section make interesting reading. It is noteworthy that the increase in the number of deaths is accounted for by 70 due to violence. As this report has been completed after the end of the war in 1945 it is possible to say that fuller comment on these matters is to be embodied in the next Annual Report. Much that has been hitherto obscure in the war time reports will appear in a new light, for example the small reduction in the number of tuberculosis patients compared with a reduction by half of the population, which suggests that the tuberculous person was unable to afford evacuation or was in some other way restricted in his or her efforts to leave London. This question was the subject of a paper in the British Medical Journal by Sir Allen Daley and Mr. Franklin of the London County Council some time ago. It is worthy of note that the Tuberculosis Allowances Scheme which received a warm welcome everywhere, in spite of its limitations, has continued to operate satisfactorily. A considerable onus has been put upon the Tuberculosis Officer. The experience so fur gained augurs well for more comprehansive schemes covering wider fields. This experience may be summed up in one word, "Reasonableness". This has been shown, in our experience, by the Assessment Officer, the Dispensary and Care Committee Staffs, the London County Council, the Ministry of Health and not least by the patients and their relatives. The Care Committee continues to fill, most ably, the gap which legislation has not yet closed. During the year co-operation with the London County Council continued in relation to publicity in the campaign against Venereal Diseases, the Borough arranging for the display of suitable posters. The number of illegitimate births was 47 among the 427 births which occurred during the year, as compared with 24 out of 466 in 1943. The increase in the illegitimate births has been of concorn during the war and the Council agreed to participate fully in the proposals put forward for the Metropolitan area. These are outlined later in the report but the position is still unsatisfactory in that the supply of foster mothers is poor and evasion of the law common. The Ministry of Health suggestions regarding the care of premature infants were also implemented in the course of the year, as sot out in the appropriate section of tho report. 4. A further fall in the infant mortality figures is gratifying; it now approximates to that of tho figure for England and Wales. Having regard to local conditions, our expectations have been exceeded but there is still room for improvement. In the main there was a fall in the number of notifications of infectious disease, whooping cough being the exception. Diphtheria caused no deaths, giving encouragement to those engaged in the immunisation campaign which has been continued during the year. Wartime nurseries continued to operate during the year, although Claremont Nursery was closed during the year, mainly because of the small attendance due to the flying bomb activity. It was found necessary • to open the new nursery at Donegal Street with accommodation for 65 - 71 children. Staffing difficulties were as acute as ever during 1944, and were only overcome by tho enthusiasm shown by the staff themselves. A slight drop in the total attendance figures at the Health Centre Clinics was due to the flying bomb attacks which caused a considerable number of cancelled appointments, particularly in elderly and cripple people, but the clinics continued to be popular, the dental and foot clinics showing en increase over 1943. The number of verminous cases rose from 158 in 1943 to 293 in 1944. Almost all the cases were of head infestation and the majority occurred in adolescent girls in industry. A close liason is maintained with factory doctors and a system of home follow-up sometimes reveals a source of infection in the home. This method of treating the family as a unit is found to give-results of greater permanance than treating individual cases as they occur. Housing became a greater problem as a result of destruction by flying bombs. Comment is made on this question in the Housing Section of the report. It is my intention to review the position in a comprehensive manner when the final war-damage data are available. Finally I wish to thank the members of the Public Health and maternity and Child Welfare Committees for their kind assistance and helpful suggestions during the year and to thank the loyal members of my staff who overcame the problems of this most difficult year of the war. I have the honour to be Your obedient servant. A. B.STEWART Acting Medical Officer of Health 5. SECTION "A" - VITAL STATISTICS AREA: The area of the Borough is 587 acres. POPULATION: The Registrar-General's estimate of resident civilian population was 26,740. In 1938 the estimated population was 56,960. BIRTHS: The total number of live births belonging to the Borough occurring during 1944 was 427, including 47 illegitimate births, and consisting of 229 males and 198 females, giving a birth rate of 16.0 per 1,000 population. The total number of births during 1943 was 466. STILL-BIRTHS: The total number of still-births allocated to the Borough during the year was 11. This figure represents 2.51% of the total births, and .41 per 1,000 civilian population, compared with .42 for London Administrative County and .50 for England and Wales. \ DEATHS: The total number of deaths belonging to the Borough registered during 1944 was 533, consisting of 281 males and 252 females, giving a death rate per 1,000 population of 19.9. The total number for 1943 was 487. COMPARATIVE STATISTICS 1938 - 1944 Owing to the ban on the publication of population figures during the war some of the following information, which is based on statistical data supplied by the Registrar-General, has not appeared in previous annual reports: 1938 1939 1940 1941 1942 1943 1944 Population 56,960 55,110 40,090 30,280 28,420 27,830 26,740 Birth rate (per 1000 population) 13.0 12.5 14.3 14.8 15.9 16.7 16.0 Death rate ( -do- ) 12.9 13.6 23.1 24.7 17.9 17.5 19.9 Maternal Mortality (per 1000 live births) 4.05 0 3.68 2.8 4.4 2.1 2.4 Death rate, infants under 1 ( -do- ) 73 33.5 68 70.4 64 56 47 Death rate of illegitimate infants under 1 (per 1000 illeglive births) 51 131.6 167 125 76.9 83.3 128 Still births (percentage of total births) 4.9 2.3 2.6 4.0 4.04 2.92 2.51 T.B.Death rate per 1000 inhabitants (all forms) 0.67 0.78 1.77 1.65 1.72 1.33 1.46 Illegitimate Births. 39. 38. 36. 33. 39. 24. 47. 6. The following table shows the causes of, and ages at death during the year 1944:- CAUSE OF DEATH Total All Ages. 0 – 1 – 5 – 15 – 45 – 65 – 1. Typhoid and Paratyphoid Fevers – – – – – – – 2. Cerebro-Spinal Fever – – – – – – – 3. Scarlet Fever – – – – – – – 4. Whooping Cough 1 1 – – – – – 5. Diphtheria – – – – – – – 6. Tuberculosis of Respiratory System 38 – – – 17 16 5 7. Other Forms of Tuberculosis 1 – – – 1 – – 8. Syphilitic Diseases 9 – – – 2 5 2 9. Influenza 3 – – – – 2 1 10. Measles – – – – – – – 11. Acute Polio-Myelitis and PolioEncephalitis – – – – – – – 13. Acute Infectious Encephalitis – – – – – – – 13. Cancer of Buccal Cavity and Œsophagus and Uterus 5 – – – 1 – 4 14. Cancer of Stomach & Duodenum 12 – – – 2 5 5 15. Cancer of Breast 7 – – – 1 4 2 l6. Cancer of all other sites 40 – – – 1 18 21 17. Diabetes 1 – – – – – 1 l8. Intra-Cranial Vascular Lesions 39 – – – 1 12 26 19. Heart Disease 116 – – – 6 22 88 20. Other Diseases of Circulatory System 16 – – – – 3 13 21. Bronchitis 43 – – – 3 10 30 22. Pneumonia 40 5 2 – 3 11 19 23. Other Respiratory Diseases 6 1 – – 1 2 2 24. Ulcer of Stomach or Duodenum 16 – – – 2 8 6 25. Diarrhoae under 2 years 5 5 – – – – – 26. appendicitis 2 – – 1 – – 1 27. Other Digestive Diseases 11 – 1 – 1 4 5 28. Nephritis 9 – – – 1 2 6 29. Puerperal & Post-Abortive Sepsis – – – – – – – 30. Other Maternal Causes 1 – – – 1 – – 31. Premature Birth 3 3 – – – – – 32. Cong. Malf. Birth Injuries, Infant Dis. 2 1 – – – 1 – 33. Suicide 3 – – – 1 2 – 34. Road Traffic Accidents 5 – – – 1 1 1 35. Other Violent Causes 70 1 2 3 22 23 19 36. All other causes 29 3 – – 3 4 19 M 281 11 3 5 37 95 130 F 252 9 2 1 34 60 146 Total All Causes 533 20 5 6 71 155 276 7. 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 attendances in the Dental and Foot Clinics. ATTENDANCES &C. AT TREATMENT CENTRES AND CLINICS CLINIC 1941 1942 1943 1944 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 Total No. Atts. No.of sessions. No.of new cases Total No. Atts. FOOT CLINIC 510 470 2343 833 655 4600 1195 849 6638 11358 800 8037 DENTAL CLINIC 187 694 2943 312 907 3858 327 986 4291 357 979 4413 SOLARIUM 415 453 7267 473 772 13154 499 693 14567 415 529 10032 WOMEN'S CLINIC 19 62 203 49 186 502 45 119 373 44 52 321 TOTALS 1131 1679 12756 1667 2520 22114 2066 2647 25869 2174 2360 22803 An additional part-time Dental Surgeon was appointed during the years and the full-time personnel in the foot clinic was increased to three, apart from part-time assistants, who were appointed from time to time as the need arose. As from 1st July, 1944, the Council decided to restrict the treatments available at the above clinics to inhabitants of the Borough only. Facilities for treatment had previously been afforded to non-resident workers in the area in addition to residents. This decision was taken at a time when the attendances of residents were increasing, with the result that there was no appreciable reduction in the work of the clinics. 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 370 No.of sputums examined for T.B 173 Milk samples 128 The Council continued the arrangement whereby special examinations are undertaken at the Archway Group Laboratories by the L.C.C.Group Pathologist, Doctor J.M.Alston. 8. INQUESTS: Inquests were held on 22 residents during the year, the findings being as follows: Bronchitis 2 Suicide 3 Road Accidents 4 Misadventure 9 Violence 2 Cerebral Thrombosis 1 Arsenical Dermatitis 1 MATERNAL MORTALITY: There was one maternal death during the year giving a maternal mortality rate of 2.28 per 1,000 Total (Live and Still) Births. INFANTILE MORTALITY: There were 20 deaths amongst infants under one year of age and the infant mortality rate based on 1,000 live births was 47. The following are comparative infant mortality rates. INFANT MORTALITY RATES 1940 1941 1942 1943 1944 FINSBURY 68 70 64 56 47 LONDON 50 68 60 58 61 ENGLAND & WALES 55 59 49 49 46 DEATHS IN RELATION TO DISEASE: During the year there was an increase of 46 in the number of deaths from 487 to 533, but of the 533 deaths 70 were due to violent causes. There were no deaths from Diphtheria, Measles, Typhoid or Scarlet Fever during the year. There has been a further fall in the infant mortality. It is gratifying to note that the Finsbury figure approximates to the figure for England and Wales. Having regard to local conditions this is a satisfactory achievment but there is still room for considerable improvement. 9. MUNICIPAL WELFARE CENTRES: The attendances at the two Municipal Maternity and Child Welfare Centres are briefly outlined in the following table and a comparison is shown with the figures which obtained in 1943: PINE STREET LEAGE STREET 1943 1944 1943 1944 Mothers, Individual 305 138 137 115 Mothers, Attendances 520 329 223 174 Children (1-5 yrs) Individual 415 441 249 221 Children (1-5 yrs) Attendances 3,345 2,153 1,672 1,236 Babies, Individual 390 377 179 157 Babies, Attendances 3,835 2,700 1,844 1,272 GRANTS SCHEME: A total of 2,058 dinners were granted to necessitous persons at the two Centres, under the provisions of the Council's Maternity and Chief Welfare Grants Scheme.. Towards the end of the year the Council extended their arrangements for the supply of dinners to provide for selected cases ho were outside the income group for free dinners. A charge was made for such cases at the rate of l/3d. per dinner for adults and 6d per dinner for children under 5 years. 743 lbs. of Dried Milk were also issued to necessitous persons free of charge; 339 lbs. were issued at half cost and 4,241 lbs at cost price. PRIORITY DOCKETS FOR EXPECTANT MOTHERS: In accordance with the Ministry of Health Circular 154/44 arrangements were made through the Maternity and Child Welfare Services for the issue of priority dockets to enable expectant mothers, being confined at home, to obtain a supply of utility sheets. 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 9,740 visits were made by the Council Staff in addition to visits made by the officers from certain Voluntary Centres in the borough. The following special cases necessitated frequent visits by the Health Visitors:- Nature of Case No.of cases Results Prematurity 4 Died - 2 Marasmus 1 Satisfactory - 25 Illegitamacy 24 Removed to other Twins 7 areas — 6 Poor Progress 3 Still special Under Weight 2 at end of year - 9. Unsatisfactory enviroment 1 10. VOLUNTARY CENTRES: The Council has continued grants to the undermentioned Voluntary Centres and a brief outline of the work carried out at those Centres is shown below: INSTITUTION NO. of MEETINGS HELD NO. of ATTENDANCES City of London Maternity Hospital 312 286 (Finsbury) Claremont Central Mission 96 546 Maternity Nursing Association 256 1701 Women's League of Service 52 1269 NURSERIES: The Finsbury Evacuated Nursery remained throughout the year at Bourn Hill Farm, Woodchester, Gloucester, and at the close of the year there was a total of 24 children resident there; of these 9 were Finsbury children. Five Wartime Nurseries wore in operation in the borough during the year. The Donegal Street Wartime Nursery was opened in August with a capacity for 65 - 71 children. The Claremont Nursery was closed temporarily during the same month due to the low attendances attributed to the Flying Bomb attacks, and has not since been re-opened. Banner Street. Nursery was closed during August and September, due to damage by a Flying Bomb. The following table shows the average daily attendances: JAN. FEB. MAR. APR. MAY. JUN. JUL. AUG. SEPT. OCT. NOV. DEC. Claremont 20 17 18 20 22 18 9 - - - - - King Square 23 24 28 28 24 26 22 28 22 25 27 17 Lloyd Square 34 39 43 49 53 51 36 22 34 40 44 36 Donegal Street - - - - - - - 39 46 41 47 45 Banner Street 18 27 28 33 34 38 24 - - 23 33 29 95 l07 117 130 133 133 91 89 102 129 151 127 The staffing of Nurseries remained a problem as in 1943. Even during the period when attendances were low it was not always possible to have the full complement of staff. Probationers often find that they have no aptitude for nursing; the nurseries serve a useful purpose here in being a testing ground prior to hospital work, but it is small consolation to the Matrons in their difficult task of making do with available staff. 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 ago suffering from any illness at home, was continued throughout the year. 11. EVACUATION: Arrangements were made through the Borough Council for the evacuation of 36 children under 5 years and 97 Expectant Mothers, during the year. 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 85 (b) The Royal Northern Hospital 1 (c) The City of London Maternity Hospital 12 (d) The University College Hospital 11 Co-operation was maintained between the Hospitals concerned and the Maternity and Child Welfare Department. Attendances at ante-natal clinics are notified and ante-natal visits are made by our Health Visitors. CARE OF PREMATURE INFANTS: A space has been provided in the notification of Birth Cards for the Weight at Birth when this is 5½1bs or less. Close co-operation is maintained with the hospitals which ensures a follow-up of all cases after discharge from hospital and all premature infants are regarded as "Special Cases" necessitating frequent visits by the Health Visitors. Special Equipment is available for loan in the home, consisting of draught proof cots with detachable linings, warm and suitable clothing, hot water bottles and special feeding bottles. The Council's Home Help Service is also made available for such cases. During the year there were 27 births notified where the birth weight was 5½lbs or less, 13 of which were in respect of premature births. 7 of these were nursed at home and 6 in hospital and all survived at the end of one month. 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 boon given an appointment elsewhere. 46 clinics wore held during the year and 98 individuals attended on 239 occasions. Attendances at this clinic have boon good and it has done much useful work. Many of the mothers coming for examination have needed treatment for local minor gynaecological conditions and for their general health. 12. 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 boon difficult to got enough people to do this work, the Homo Help Service has boon maintained and has worked satisfactorily. 62 applications for this service wore received during the year, 4 of which were withdrawn. At the end of the year the panel of Home Helps consisted of four persons. 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. There were 6 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. Similar arrangements exist with the Control London Ear, Nose and Throat Hospital and Archway Hospital. Special mention must bo made of the assistance rendered by Mr. Milloy F.R.C.S. Medical Superintendent of Archway Hospital, who has dealt promptly with cases who had been on waiting lists elsewhere. PUERPERAL FEVER AND PEURPERAL PYREXIA: During 1944 there was one case of puerperal pyrexia and no cases of puerperal fever notified in Finsbury. This gives a rate per 1,000 Live and Still births of 2.29 as compared with 10.34 for England and Wales and 14.14 for the London Administrative County. OPHTHALMIA NEONATORUM: The number of cases of Opthalmia Neonatorum notified was 4. Two of the cases were treated at home and two in hospital. In no case was there impairment of vision. CONVALESCENT TREATMENT: The Council has continued their arrangement with the Dedisham Convalescent Home where two cots are retained and with Noel Home, Letchworth where four cots are retained. The number of children admitted to these Homes during the year was 16. In addition, children are referred for convalescence through the Invalid Children's Aid Association which has dealt with 21 cases during the year. 13. The Council has also continued their 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 bo sent away together. Under this scheme mothers with one or more children between one and five are sent to this Homo, usually for a three weeks period. There were 15 mothers and 18 children admitted to this Homo during 1944. The Home has proved extremely useful and a certain number of young mothers suffering from post natal debility have benefited markedly from convalescence there. It was found necessary to close the children's section as from the end of November 1944, and unaccompanied mothers only have been admitted since that time. FOSTER PARENTS: There were no registered foster mothers in Finsbury at the end of 1944. INFANT DEATHS: There wore 20 infant deaths in Finsbury during 1944 and the mortality rate based on 1,000 live births was 47. The neo-natal deaths, i.e., occuring within the first twenty-eight days, numbered 7, details of these deaths are as follows:- Gastro enteritis 1 Hydrocephalus 1 Broncho-pnoumonia 1 Haemophilia 1 Other causes 3 Deaths of children from one month to one year 13. Analysis of cases shows:- Gastro enteritis 6 Broncho-pneumonia 5 Asphyxia 1 Whooping Cough 1 ILLEGITIMATE CHILDREN: The Council accepted in principle the Metropolitan Standing Joint Committee recommendation regarding the guaranteed uniform payment of foster mothers, i.e. 17/6 per week up to the age of one year, and thereafter 15/- per week. The Council also agreed to contribute a stipulated sum in aid of the Voluntary Association carrying out Moral Welfare Work in the Borough, St. Faith's Home, Myddelton Square. 14. SECTION "C" - SANITARY CIRCUMSTANCES Summary of inspections made by Sanitary Inspectors- Total number of first visits 7834 Total number of re-visits 4546 Shops Act Inspections 84 Visits to verminous premises 259 Inspections of Air Raid Shelters 277 House to House Inspections 176 House Inspections 1206 Infectious Disease Investigations 126 Investigation of complaints 453 Visits to houses let in lodgings 717 Visits to Butchers Shops and Stalls 4431 Visits to Public Sanitary Conveniences 536 Street Traders' Premises Inspected 76 DRAINAGE: The number of drainage plans deposited and approved during the year was 12. The following is a summary of the work done:- Water closet defects remedied 169 Water closets erected 79 Urinal defects remedied 9 Urinals erected 0 Soil pipe and ventilating, shaft defects remedied 18 Soil pipe and ventilating shafts erected 36 Waste pipe defects remedied 37 Waste pipes erected 60 Drains re-laid or amended and sealed 77 Drains cleared or tested 164 Rain water pipes cleared, repaired or renewed 16 COMPLAINTS: The total number of complaints received was 453 NOTICES SERVED: The following numbers of notices were served requiring the abatement of nuisances and the remedying of defects:- Number of Intimation Notices 338 Number of Statutory Notices 2 RECEPTION HOUSE: There was no occasion during 1944 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. 15. ERADICATION OF BUGS: In the case of 23 Council flats and 90 other houses, bugs were found and remedial measures were taken. Arrangements were also made in the case of 8 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: The London County Council continued to utilize the Cleansing Station for the treatment of school-children during mornings only, the afternoons being reserved for dealing with Finsbury adults and pre-school children. 3,591 treatments were given during the year to L.C.C. school-, children and 1,926 treatments to all other cases Home visiting of scabies cases and contacts was continued and the Nurse-in-Charge of the Cleansing Station made 325 home visits during the year. SHOPS: The number of inspections made under the Shops Act 1934 during 1944 was 84. RAG FLOCK: The number of samples of Rag Flock taken during the year was 3. CANAL BOATS: The total number of canal boats inspected during the year was 75, none of which carried any offensive cargo. Contravention of statutory requirements had taken place in 12 instances. There was no discovery or notification of infection disease. The number of children on the boats was 35, of whom 21 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 necessary. There were at the end of the year 14 persons on the register kept for the purpose, to whom 103 visits were made. STREET TRADERS: 76 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 at No. 88, Old Street and the number of visits made by the Sanitary Inspector was 38. 16. HOUSES LET IN LODGINGS: At the end of the year there were 488 houses on the Register and 717 visits were made in connection with the Houses Let in Lodgings Byelaws. MORTUARY: 47 Bodies were received at the mortuary attached to the Health Centre promises. DISINFECTION: The following table gives particulars of the disinfection work carried out during 1944. Premises disinfected after:- Diphtheria 19 Measles 177 Vermin and Scabies 236 Scarlet Fever 67 Tuberculosis 16 Whooping Cough 90 Miscellaneous 127 By request 158 A total number of 27,150 articles were disinfected, being chiefly pillows mattresses, bolsters, sheets, blankets and wearing apparel. In addition, 13,850 articles were disinfected prior to Export and foes charged for this work amounted to £24. 0s. 0d. OFFENSIVE TRADES: The following are licenced offensive trade premises: (a) Messrs. Henson, 187 Whitecross Street, E.C.I. (b) Messrs. F. & W. Warden, Limited, 5 Eagle Court. (c) Messrs. T. Kondon & Sons, Charterhouse Mews. 329 visits were made in respect of those premises during tho year. OUTWORKERS: No. of Finsbury firms employing outworkers at the end of 1944 167 Total number of outworkers employed by Finsbury firms 1305 Number of outworkers resident in Finsbury 283 FACTORIES ACT, 1937: During the year 684 first visits and 460 re-visits were made to factories and 73 intimation notices were served requiring the remedy of defects found. 17. The following is a summary of defects found:- NUMBER OF DEFECTS FACTORIES (POWER) FACTORIES (NON-POWER) TOTAL Refuse accumulation or absence of dustbin. 10 1 11 Roof leaky 4 1 5 Ceiling broken 1 2 3 Sanitary Conveniences - defective 12 - 12 " " - dirty 28 4 32 " " - not separated or insufficient. 3 - 3 " " - unlabelled 19 2 21 " " - with no artificial light 24 3 27 " " - unsuitable 26 2 28 Staircase dirty 12 2 14 Insufficient ventilation of workrooms - - - Water fittings leaky 2 - 2 Workrooms dirty 1 5 6 Yard walls dirty — 1 1 8 notices of complaint were received from the Home Office. 14 notices were sent to the Home Office regarding the following matters:- Abstract absent 7 New occupation, notification 7 LADY SANITARY INSPECTOR'S WORK: The following is a summary of visits made by the Lady Sanitary Inspector- Factories 1144 Outworkers premises (Sub-Contractors) 179 Outworkers premises (domestic) 927 Public Health Complaints 9 Public Sanitary Conveniences 87 Miscellaneous visits 20 TOTAL 2366 Number of Intimation Notices served 90 Number of Statutory Notices served Nil RAT REPRESSION: No. of rat complaints received - 320; No. of houses treated - 125; No. of premises for which a charge was made - 96; No. of other premises - 65; Estimated No. of rats killed during the year as a result of sewer treatment - 2,213 (January '44). 18. ORGANISATION: The employment of six men from the Light Rescue Service on their "Off duty" days was continued throughout the year, three men operating each day. All the men have attended the Ministry of Food training course, and have had considerable practical experience. The methods used are those recommended by the Ministry, whose research department issues details of new developments in methods and materials. The headquarters of the Infestation Branch of the Ministry of Food is in Blooms bury and this department has on a number of occasions found demonstration sites for the Branch's courses of instruction. At one site, excellent photographs were taken by Professor Hewer, to illustrate the work of the Infestation Branch. BLOCK CONTROL: Block treatment as required by the Minister's "Direction" of the 9th November 1943, commenced during the year, and a considerable part of the Borough north of Pentonville Road was treated in this manner. SEWER TREATMENT: The second "Directed" treatment was carried out in January, resulting in an estimated kill of 2,213 rats. Very few bodies were found on this occasion, as the poison used was slow in action, and was not likely to take effect until the rats were back in their homes, which are invariably outside the sewers. No further "directions" have been issued by the Ministry in this connection, but a recommendation was contained in circular N.S.6.(29th August, l944) that sewers should be treated every six months in the periods May/June, and November/December. The modified treatment suggested by the Ministry was used by the department. This maintenance treatment takes only three days as against the seven days of the initial "directed" treatments. The time saving is brought about by reducing the number of prebaiting days, and dispensing with the poison take check. It is thus possible for the regular sewer staff to treat the whole of the sewer system of the borough, section by section in fifteen days. As there is no check on the amount of poison bait taken by the rats, no estimate can be made of the number killed, but it is proposed to keep a graph with the information available. This should give a fair indication of the degree of infestation in the sewers. Preliminary figures for the first maintenance treatment in progress at the end of the year suggests the sewers were as badly infested in December 1944 as in December 1943, and I feel it was most unfortunate that almost a year should have elapsed between the second directed treatment and the first maintenance treatment. It is to be hoped that regular six monthly treatments will keep the rat population at a much lower level than formerly. Apart from the obvious desirability of reducing the number of rats in the sewers, these treatments undoubtedly benefit the residents of the borough, as many surface infestations reported during the 1943 publicity campaign were found to have ceased when visits were made preparatory to action under the block control scheme. CHARGES: Until October no charge was made for treating dwelling houses, but following representations by the Ministry of Food, pointing out the legal responsibility of occupiers to rid their premises of rats and mice, the Committee decided to make a nominal charge of 2/6d per house in these cases. Charges for other premises continue to be submitted to the Committee for approval. 19. HOUSING - SECTION "D" INSPECTIONS: 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 defects (under Public Health or Housing Acts) 1961 (b) Number of inspections made for the purpose 2157 (2) (a) Number of dwelling-houses (included under head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 176 (b) Number of inspections made for the purpose 211 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 17 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 338 (B) Number of dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers - (C) Action under Statutory Powers during the year. (a) Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936:- (1) Number of dwelling-houses in respect of which notices were served requiring 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 Owners - (b) Proceedings under Public Health acts:- (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 338 (2) Number of dwelling-houses in which defects were remedied after service of formal notice - (a) By Owners 338 (b) By Local Authority in default of Owners - 20. (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 (2) Number of separate tenements or underground rooms in respect of which closing orders were determined, the tenement or room having boon rendered fit HOUSING APPLICATIONS: 46 families were rehoused during 1944, 24 in Borough Council Flats and 22 by the L.C.C. EUSACO STREUT AREA: The proposed rehousing site was inspected and reported upon with a view to gaining control of the whole area by clearance or other means. A start was made towards the end of the year to the erection of "Uni-seco" huts for the temporary housing of homeless families. It is hoped that 75 such huts will be built on vacant sites in the borough. This measure can be but a small contribution to a big problem but the number of vacant suitable sites is not large in this congested borough. 21. SECTION "E" - INSPECTION AND SUPERVISION OF FOOD AND DRUGS MILK SUPPLY Analysis of Milk. During the year 32 samples of milk were submitted to the Public Analyst. Two samples were found to be adulterated. Bacteriological Examination of Milk. 101 samples of Designated Milk and 34 samples of Ordinary Milk were submitted for bacteriological examination. Milk Shops and Dairies. Number of applications for Registration approved 5 Number of purveyors on the Registered at the end of 1944 116 Number of purveyors removed from the Register during the year 6 Number of purveyors on the Register at the end of 1943 117 Number of visits of inspection carried out 259 Number of notices served for cleansing and repairs to dairy premises. 1 Milk (Special Designations) Regulations 1936-1944. Number of applications for licences received- (a) Tuberculin Tested Milk - Dealers 3 (b) Pasteurised Milk -Dealers 24 (c) Pasteurisers 1 (d) Supplementary Licences 8 (e) Number of samples taken for examination 101 Milk in Schools. Eight samples of milk delivered to the Schools were taken during the year and submitted for bacteriological examination. Food Poisoning: Turing the year there were no cases notified under the Food and Drugs Act, 1938, amongst Finsbury residents. Bakehouses: There were 22 bakehouses in use in the Borough at the end of the year, of which 17 were basement premises, and in 21 bakehouses machinery is used. 54 visits of inspection were made during the year and ten notices were served for cleansing and other matters. The 22. Bakehouses (contd). quinquennial survey of the basement bakehouses under the provisions of section 54 of the Factories Act, 1937, was carried out during the year. Following the consideration of the report the Council decided to prolong the certificates of suitability in each case for a further period of five years. Adulteration of Food: The total number of samples taken in 1944 under the Food and Drugs Act, 1938, was 749 of which 27 were formal samples and 722 informal samples. The following table gives full information with regard to the formal samples submitted to Mr. Kear Colwell, the Council's Public Analyst. NAME OF ARTICLE GENUINE ADULTERATED TOTAL Milk 22 2 24 Sal Volatile - 1 1 Cloves 1 - 1 Butter 1 1 2 Chocolate, drinking 1 - 1 Gelatine 1 1 2 Sweets 2 - 2 Pharmacy and Poisons Act, 1933. The work under this Act has continued to be carried out by Mr. Clinton and 34 applicants were approved during the year by the Council as Listed Sellers of Poisons and 79 visits were made. No contravention of the Act or Rules was observed. Unsound Food: The work of meat inspection, in the absence of Mr. Penman, was continued 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 and of retail butchers shops and stalls. Summary of Foodstuffs seized by or surrendered to the Meat Inspector during 1944 Diseased or unsound meat 38,423 lbs Diseased or unsound offal and other foodstuffs 24,200 lbs Total 62,623 lbs 23. Slaughterhouses: The slaughterhouse owned by Mr. J.A. Mobbs, 14, Penton Street, was closed down on the outbreak of the war. No animals were slaughtered there during 1944. Salvage Division (Ministry of Food): Examination of foodstuffs-have again been carried out in co-operation with the Minister of Food's Salvage Officers. The examinations were necessitated as the result of enemy action and from loss of labels etc. to packages during transport by the carrier firms in the Borough. Ice Cream: Under the provisions of S.R.&.0.1944, No.1280, which revoked the Ice-cream (Prohibition of Manufacture and Sales) Order, 1942, the manufacture and sale of Ice-cream with skimmed milk powder became permissible after the 15th November, 1944. Very little Icecream was in fact made or sold within the area during the remainder of the year, owing to the season and to the difficulties in obtaining the necessary ingredients. 24. SECTION "F" - INFECTIOUS AND OTHER DISEASES. Notifications of Infectious Disease: The following table shows the notifiable cases of Infectious Disease during 1944, in various age groups and indicates the total number of cases removed to Hospital: All Ages Under 1 Yr. 1 - 5 Yrs. 5 - 15 Yrs. 15 25 Yrs. 25- 45 Yrs. 45 65 Yrs. 65 Total Rmvls. to Hosp. Acute Influenzal Pneumonia 1 - - - - - 1 - - Acute Primary Pneumonia 24 3 2 2 5 4 6 2 - Cerebro-spinal Meningitis 1 - - - - 1 - - 1 Diphtheria (Incl. Mem.Group) 10 - 2 8 - - - - 10 Dysentery 23 - 12 5 3 2 1 - 20 Erysipelas 15 - - 2 5 1 4 3 9 Typhoid - - - - - - - - - Measles 148 8 84 53 2 1 - 63 Ophthalmia Neonatorum 4 4 - - - - - - 2 Puerperal Fever - - - - - - - - - Puerperal Pyrexia 1 - - - - 1 - - 1 Scarlet Fever 39 16 20 2 1 - - 38 Pulmonary Tuberculosis 62 - 2 2 22 22 12 2 - Other forms of Tuberculosis 9 - 2 3 2 2 - - - Whooping Cough 147 36 85 26 - - - - 63 Zymotic Enteritis 3 1 1 1 - - - - - Polio Myelitis - - - - - - - - - Scabies 304 4 40 63 94 61 37 5 - Malaria (Induced) 1 - - - - 1 - - - TOTALS 792 56 246 185 135 97 61 12 207 Notification Rates (Comparative Table) Finshury England and Wales 126 C.B's & great towns including London 148 smaller towns. Res. population 25,000 to 50,000 at 1931 census. London Adm. County. Typhoid Fever 0.00 0.01 0.01 0.01 0.01 Paratyphoid Fever 0.00 0.01 0.00 0.01 0.01 Cerebro-spinal Fever 0.04 0.05 0.06 0.04 0.06 Scarlet Fever 1.46 2.40 2.41 2.67 1.57 Whooping Cough 5.5 2.49 2.49 2.29 2.90 Diphtheria 0.37 0.58 0.67 0.69 0.31 Erysipelas 0.56 0.29 0.32 0.28 0.37 Smallpox 0.00 0.00 0.00 0.00 0.00 Measles 5.54 4.16 4.51 3.94 2.98 Pneumonia 0.93 0.97 1.13 0.82 0.93 25. Smallpox and Vaccination: No cases of small-pox occurred, in the Borough during 1944. The following is d summary of proceeding under the Vaccination Acts, 1867 to 1898. Number of Finsbury birth notifications received from Registrar 169 Number of Certificates of Vaccination received 234 Number of deaths before Vaccination 1 Postponements of medical certificate 18 Number of certificates of insusceptibility - Number of notices to other Vaccination Officers re nonresident cases 43 Number of addresses not traced 62 Number of Finsbury babies not vaccinated within Statutory period of four months 17 Number of personal visits made during the year 548 Cases notified from other Boroughs for enquiry 163 Certificates of exemption granted after declaration 22 Scarlet Fever: The number of cases of Scarlet fever notified during 1944 was 39, of which 38 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: 10 cases of diphtheria were notified there being no deaths. All the cases were removed to Hospital and the average length of stay was 56 days. The following table shows the cases notified during the last ten years and the number of deaths. No. of cases No. of Year notified deaths. 1935 188 1 1936 126 4 1937 107 2 1938 101 3 1S39 58 2 1940 27 2 1941 35 1942 19 1 - 1943 24 2 1944 10 Efforts were continued during the year to secure a greater degree of .immunisation in the child population by means of further propaganda and intensive visits by the Health Visitors and Sanitary Inspectors. The method of intensive visiting has been reported in detail elsewhere (Medical Officer 26. 15th April, 1944, page 125). It was estimated that by the end of 1944, approximately 73.7% of the child population between the ages of 5 and 15 years had been treated and approximately 45.2% of the under fives. The number of children immunised at the Municipal Centres during the year was 178; 71 were also immunised at L.C.C. schools and 12 by local Medical Practitioners under the Council's scheme of payment. Whooping Cough: Notifications of whooping cough numbered 147. There was one death. Prophylactic treatment has been continued in conjunction with diphtheria prophylaxis. Measles: There were no deaths from measles during the year. Of the 148 cases which occurred 63 were removed to hospital, partly on medical and partly on social grounds. Special visits were paid to all cases nursed at home. I • Typhoid: There were no notifications during the year. Influenza: In contrast to the sharp outbreak in 1943, Influenza did not reach epidemic proportions during the year. Provision of Insulin: By virtue of Section 227 of the Public Health (London) Act, 1936, the borough continued to bear the cost of the treatment of diabetes in the case of necessitous persons. Two persons received assistance during the year at a cost to the Council of £8. 9s. 2d. Tuberculosis: The total number of new cases of tuberculosis, both pulmonary and non-pulmonary, entered in the Register in 1944 was 70. The age period details were as follows:- Total 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- all Ages Males Pulmonary - - - - 4 6 7 4 7 3 1 32 Females Pulmonary - 2 1 - 9 4 8 3 1 1 - 29 Males Non-Pulmonary - 1 1 1 - - - 2 - - - 5 Females Non-Pulmonary - 1 1 - 1 1 - - - - - 4 Total - 4 5 1 1 4 1 1 1 5 9 8 4 1 70 Of the above cases 8 were brought to notice otherwise than by formal notification. The number of cases removed from the Register during the year was 89 and those remaining on the Register of Notifications at the 31st December, 1944, were as follows:- 27. Males Females Total Pulmonary 237 151 388 Non-Pulmonary 50 46 96 287 197 484 The following is a summary of the Tuberculosis Dispensary work in. 1944:- Number of cases on Dispensary Register - Pulmonary 326 Non-Pulmonary 59 Total 385 Sputum Positive Cases 165 Sputum Negative Cases 161 Cases notified from Services 8 New Cases examined (other than Contacts). Pulmonary Non- Pulmonary Total (a) Definitely Tuberculous 56 4 60 (b) Diagnosis not completed 17 - 17 (c) Non-Tuberculous 183 - 183 260 Contacts: (a) Definitely Tuberculous 4 - 4 (b) Diagnosis not completed 6 - 6 (c) Non-Tuberculous 116 - 116 126 Cases Written Off: (a) Recovered 2 (b) Diagnosis not confirmed - 2 28. Number of attendances at Dispensary 2,693 Visits made by Tuberculosis Visitor 1,204 .Number of X-ray examinations and screenings 2,017 Home visits by Tuberculosis Officer 14 Specimens of sputum examined 173 Number of patients attending for artificial pneumothorax refills 41 Number of refills given 503 X-RAY DEPARTMENT: Details of the work in the X-ray Department during 1944 are as follows:- Chest Cases: Large films used 839 Small films used 77 Screen examinations 1,101 Other Cases: Women's Clinic cases 6 Doctors' cases 23 Sunlight Clinic 11 Dental Clinic 1 Tuberculosis Maintenance Allowances Scheme: The scheme for the provision of maintenance allowances in certain cases, 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 of home treatment, continued to operate smoothly during the year. The Council's T.B.Dispensary machinery is used for the institution of the necessary enquiries and for the presenting of the applications weekly to the Social Welfare Officer. During the year 42 new applications were dealt with and there were 64 persons who received maintenance allowances 5c 29 who received special allowances. In addition to new cases, 294 were presented to the Assessment Officer for review. The total cash allowances paid out during the year was £2,193. 0s. od. PROVISION OF EXTRA NOURISHMENT; The Borough Council has continued to provide extra nourishment for certain types of tuberculosis cases. 51 persons were granted extra nourishment during the year. 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 connected with the Maintenance Allowances Scheme