LIBRARY (1) Fin 28 THE METROPOLITAN BOROUGH OF FINSBURY ANNUAL REPORT on the PUBLIC HEALTH OF FINSBURY for the year 1947 By - C.O.S.BLYTH BROOKE, M.B., 8.5., L.R.C.P., M.R.C.S., D.P.H. Medical officer of Health Finsbury Health Centre, Pine Street, London, E.C.I. PUBLIC HEALTH COMMITTEE (November, 1946 - November, 1947) CHAIRMAN: Coun.W.Barrie, M.P.S. VICE-CHAIRMAN: Coun.Miss B.P.Boauchamp. Alderman C.W.E. Drew Councillor 'Miss K. Beauchamp " Mrs. M.M. Champion " Miss N.Cordner-James " Mrs. E.R. Gannon " Mrs. F.E.- Gilbert „ Mrs. C. Griffiths „ A.A. Harris „ Mrs. A.J. Mahon „ Mrs. O. Pannett „ Mrs. E. Potter „ A.G. Webb „ Miss M.A. Westerman (2) MATERNITY AND CHILD WELFARE COMMITTEE (November, 1946 - November, 1947) CHAIRMAN: Coun.Mrs.F.E.Gilbert. VICE-CHAIRMAN: Aid.Mrs. V.M.Heaps. Alderman W.L. Prowse Councillor W. Barrie „ Mrs. M.M. Champion „ Mrs. E.F. Drake „ Mrs. E.R. Gannon „ Mrs. C. Griffiths „ A.A. Harris „ W. Kingham „ Mrs. A.J. Mahon „ Mrs. O. Pannett „ Mrs. E. Potter „ Miss G.L. Tutty „ Miss M.A. Westerman STAFF MEDICAL OFFICER OF HEALTH DEPUTY MEDICAL OFFICER OF HEALTH AND TUBERCULOSIS OFFICER ASSISTANT HEDICAL OFFICERS OF HEALTH PUBLIC ANALYST PUBLIC VACCINATORS SANITARY INSPECTORS MEAT INSPECTORS C.O.S.Blyth Brooke, M.B., 8.5., L.R.C.P., M.R.C.S., D.P.H. W.D.R.Thompson, M.R.C.S., L.R.C.P., D.P.H., Barrister-at-Law. I.Hood, M.B., Ch.B., D.C.H., (from 11/3/47) K.M.Lane, 8.A., M.R.C.S., L.R.C.P., (parttime) C.Harcourt Wordsworth, B.Sc. Dr. R.E.Batson Dr. R.K.Dadachanji Dr. G.P.Barua Dr. R.Sacks (To September, 1947) Dr. E.Rossdale (From October, 1947) H.J.Newdick, M.S.I.A., (Senior S.I.) H.Clinton, M.S.I.A., (Food & Drugs) (Died 10/4/47) Miss F.Hall, M.S.I.A. R.E.Lay, M.S.I.A. A.J.Truslove, M.S.I.A. J.Lewis, M.S.I.A. W.Keutenius, M.S.I.A.(resigned 28.2.47) G.Hawthorne, M.S.I.A.(resigned 20.4.47) T.Penman, M.B.E., M.S.I.A. (Seconded to Ministry of Food) R.S.Barber, M.S.I.A. ADMINISTRATIVE AND CLERICAL STAFF M.& C.W. SUPERINTENDENTS M.& C.W.DISPENSER HEALTH VISITORS DAY NURSERIES Lloyd Square Banner Street King Square TUBERCULOSIS NURSE & VISITOR SECRETARY OF TUBERCULOSIS CARE COMMITTEE WOMEN'S CLINIC (3) H.Ward, D.P.A., M.R.S.I., (Assistant Administrative Officer) T.E.Williams, (Senior Clerical Assistant) J.E.McDowell, (Statistical Clerk) Miss W.Freeman (M.& C.W.Assessment Clerk) R.W.Leach (P.H.Assessment Clerk) Miss J.S.Dodd, (M.& C.W.Clerk) J.W.Field, (Clerk) D.S.Ward, (Clerk) Miss J.L.Faulkner (Shorthand- Typist) Miss D.Wall (Shorthand-Typist) I.L.Bedford, (Clerk - Dental Clinic) J.Lindsay, (Clerk - Sanitary Inspectors) Mrs. G.L.Rance, (Clerk) Mrs. J.E.Gade, (Temporary Clerk - Foot Clinic - from 9.4.47) E.Mitchell, (Clerk - with H.M.Forces) J.B.Higgins, (Office Junior - resigned 25/1/47) R.K.Robertson, (Office Junior - from 9/6/47) Mrs. M.Parker (Leage St.M.& C.W.Centre) Miss J.R.Turner (Pine St.M.& C.W.Centre) Miss I.Lloyd (part-time) Miss B.J.Scott, Miss M.Rock (duties terminated 21.5.47) Mrs. G.Hartney, Miss L.Breaman, Miss G.Finnegan (from September, 1947) Miss A.Sumka (Temporary - from 0ct.1947) Mrs. M.G. Havers (Matron) Miss M.k.Robson (Deputy Matron - to 22.3.47) Miss E.M.Hutchings (Deputy Matron - as from 24.3.47) Miss K.Turner (Matron - to 24.1.47) Miss D.I.Bowe (Matron - as from 3.2.47) Miss E.M.Hutchings (Deputy Matron - to 24.3.47) Mrs. V.M.Brown (Deputy Matron - from 1.4.47) Mrs. M.E.Halliday (Matron) Mrs. F.R.Rogers (Deputy Matron) Miss F.M.Prior H.Ward, D.P.A. Margaret Salmond, M.B.E., M.D., M.B., B.S., M.R.S.C., L.R.C.P., F.R.C.S., F.R.C.O.G., (part-time Medical Officer in charge) DENTAL CLINIC Panel of Anaesthetists FOOT CLINIC CLEANSING STATION PHYSIOTHERAPY DEPARTMENT LABORATORY TECHNICIAN RESIDENT ENGINEER AND HEALTH CENTRE KEEPER ASSISTANT SUPERVISOR DOMESTIC HELPS (4) J.W.White, L.D.S., (part-time Dental Surgeon) (resigned 30.10.47) W.R.Gray, L.D.S., (part-time Dental Surgeon to 30.6.47. full-time from 1.7.47) J.F.Partridge, L.D.S., (part-time as from February, 1947) R.Drew, L.D.S., R.C.S.(Eng), (part-time as from June, 1947) Mrs. M.A.Blackwell, (Dental Nurse) Miss A.E.Pholps (Clinic Attendant) Dr. G.P.Barua Dr. A.H.Rowntree Dr. B.J.Wilton Dr. R.E.Batson A.H.Carter, F.Ch.S. (Chiropodist in charge) R.E.Marchant, N.Ch.S. W.M.Long, N.Ch.S. Mrs. R.E.Ross, N.Ch.S. F.L.Lydon, M.B., M.R.C.P., (part-time Consultant) Mrs. D.I.M.Lloyd (Nurse in charge) E.F.C.Wadge, M.R.C.S., L.R.C.P., (part-time Consultant, from 18.4.47) Miss A.E.Nicholas (Physiotherapist in charge) Mrs. I.Aperguis (Assistant Physiotherapist to 6.8.47) Miss M.Haslett (Part-time Assistant Physiotherapist - to 11.8.47. Mrs. A.L.Emmerton (Clinic Attendant) Mrs. E.Cotton (Part-time Assistant Physiotherapist - to 23.12.47) Miss P.E.Russenberger Mr. F.M.Battle Mrs. G.M.Coppen - from 7.10.47. (5) To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Finsbury. I have the honour to present Annual Report for 1947 of the work of the Public Health Department. Special interest centred round the outbreak of acuto Poliomyolitis which sproad through this and other countries during the summor. For- tunately the incidenco in this Borough was not as high as in some other parts of London and at no time gave rise to any serious alarm. There were no fatal cases and the majority of the 10 cases which were notifiod were very mild. It is probablo that a number of other abortive cases occurred but remained unrecognizod. Some concern was felt when one case occurred in a Day Nursery, but it was decided not to close it in view of the hardship which such a step would cause. Parents were, however, warned of the occurrence and permitted to withdraw. A few did so for a few days, but soon the Nursery was again filled to capacity. The dopartment remained throughout the opidemic soason preparod to take all reasonable precautions possible to safeguard the community, but did not institute any panic measures. The year othorwise was uneventful and represented a further stage in the transition from war to peace conditions - a process that proved to be slower than most of us had anticipated. Unfortunately, the Medical Officer of Health, is not in a position to assess the general health of the community with any degree of accuracy as he has no source of detailed information as to the incidence of sickness, other than infectious disease. The general health may therefore only be estimated by means of the vital statistics. It must be remembered, however, that these are liable to lead to false deductions unless it is constantly borne in mind that they may reflect health conditions of previous years and these in turn may be dependent on environmental conditions of yet earlier years. For example, bad conditions in one year may not adversely the health of the individual to the next or suceeding years and perhaps not at all if not continued, and then may only reduce the span of life by a few years and so only affect mortality rates many years later; or, again, adverse conditions in childhood may influence motherhood and so affect infant mortality ten or more years later. With these reservations it is pleasing, however, to note the following points: The birth rate was 22.2, the highest recorded rate since 1926. The death rate was 14.9, the lowest rate since 1940, and may probably be considered as satisfactory when compared with the lowest rates of 12,6 and 12.8 recorded in 1935 and 1933 respectively, when it is remembered that allowance should be made for a larger percentage of persons living now in the older age groups. It may be noted that out of the total of 522 deaths, 305, or 59%, were of persons over 65 years of age. This compares with 53% in 1938, 42% in 1934 and very strikingly with 17% in 1882 (St. Lukes). There was no particular cause of (6) death to which I desire to call attention other than Tuberculosis (see later). The maternal mortality was 1.3, but it must be remembered that this figure is subject to very wide fluctuations because of the small population of the Borough and represents one death only. This was not from any condition recognized as preventable. Infant mortality was 32, the lowest rate hitherto recorded in Finsbury and follows the steep downward gradient which has occurred since 1917, when the rate was 118. Even the rate for illegitimate infants, it may be noted with pleasure, was only 47. The stillbirth rate also fell to 1.6% of the total births. The Tuberculosis death rate, however, was 1.25, which is a slight increase on the previous two years, hen it was 1.07 and 0.96. On the other hand, an unusually large number of these deaths were among those aged over 65, namely 275%, to the relief of the numbers aged 45 to 65. Apart from Poliomyelitis there was no unusual incidonce of infectious disease and the incidence of Scabies and verminous conditions became almost nogligible. Speaking generally, from these statistics one may reasenably believe that the health of the community remained satisfactory and this was confirmed by personal impressions which supported this view in regard to Physical Health. Unfortunately they also led to the conclusion that joy and happiness in life, which have an important bearing on Mental Health, were depressed owing to the frustration caused by the slow amelioration of unsatisfactory environmental conditions. Some progress was made during the year in securing remedies for the overcrowded and unsatisfactory housing conditions in the Borough, but was admittedly very slow, not only on account of the continued shortage of labour and materials, but also on account of the outworn and outdated . character of so many of the buildings which remain well nigh unrepairable and impossible to modernize at a reasonable cost and have long been ripe for demolition. The Personal Health Services continued to provide for many of the needs of the Borough. Some extension of the Domestic Help Services, particularly for the aged, took place. The purity and hygiene of food sold received careful attention and no serious case of adulteration was discovered. I have to thank the members of the several committees for their continued and generous support and the members of my staff for their ready help and assistance. I have the honour to be Your obedient servant, C.O.S.Blyth Brooke, Medical Officer of Health. (7) AREA: POPULATION: LIVE-BIRTHS: STILL-BIRTHS: DEATHS: SECTION "A" - VITAL STATISTICS The area of the Borough is 587 acres. The Registrar General's estimate of resident civilian population was 35,120. In 1938 the estimated population was 56,960. The total number of live births belonging to the Borough occurring during 1947 was 779 including 42 illegitimate births, and consisting of 403 males and 376 females, giving a birth rate of 22.2 per 1,000 population. The total number of births during 1946 was 687. The birth rate for England and Wales was 20.5 and for the London Administrative County 22.7, por 1,000 civilian population The total number of still-births allocated to the Borough during the year was 13. This figure represents 1.6% of the total births, and .37 per 1,000 civilian population, compared with .49 for London Administrative County and .50 for England and Wales. The total number of deaths belonging to the Borough registered during 1947 was 522, consisting of 282 males and 240 females, giving a death rate per 1,000 population of 14.9. The total number of deaths for 1946 was the same figure of 522. The comparable death rates in London and England and Wales during 1947 were 12.8 and 12.0 respectively. COMPARATIVE STATISTICS, 1940 - 1947 1943 1944 1945 1946 1947 1940 1941 1942 30,280 28,420 27,830 27,990 26,740 33,400 35,120 Population 40,090 15.9 16.9 17.1 22.2 16.7 16.0 20.6 Birth rate (per 1,000 population) 14.3 14.8 17.9 19.9 53.6 15.6 14.9 Death rate ( -do- ) 23.1 24.7 17.5 Maternal mortality (per 1,000 live births) 2.1 2.4 1.5 2.8 4.2 1.3 4.4 3.68 56.0 54.0 70.4 47.0 55.0 32.0 64.0 Death rate, infants under 1 ( -do- ) 68.0 Death rate of illegitimate infants under 1 (per 1,000 illeg. 125.0 76.9 83.3 47.6 live births) 128.0 118.0 167.0 2.51% Still-births (percentage of total births). 2.7% 4.04% 2.92% 1.6% 2.6% 4.0% 3.6% 1.72 1.33 1.46 1.25 1.65 1.07 T.B.Death rate per 1,000 inhabitants (all forms) 0.96 1.77 42 Illegitimate births 39 24 47 56 68 36 33 (8) The following table shows the causes of, and ages at death during the year 1947:- CAUSE OF DEATH Total all a ges. 0- 1- 5- 15- 45- 65- 1. Typhoid and Paratyphoid Fevers - - - - - - - - 2. Cerebro-Spinal Fever 1 1 - - - - - - - - - - - - - - 3. Scarlet Fever - 1 - - 4. Whooping Cough 1 - - - - 1 - 5. Diphtheria 1 - 10 - 1 20 9 6. Tuberculosis of Respiratory System 40 - 2 2 7. Other forms of Tuberculosis 4 - - 1 8. Syphilitic Diseases - - - 1 3 5 - - - - 1 9. Influenza 1 - 10. Measles 2 - 2 - - - - 11. Acute Polio-myelitis and Polio- Encephalitis. - - - - - - - 12. Acute Infectious Encephalitis - - - - - - - 6 13. Cancer of Buccal Cavity and Œ sophagus and Uterus. 13 - - 5 2 - 14. Cancer of Stomach & Duodenum 18 - - 2 6 10 15. Cancer of Breast 11 - - - 1 6 4 - 2 18 16. Cuncer of all other sites 45 - - 25 17. Diabetes 2 - - - - 1 1 18. Intra-Cranial Vascular Lesions 33 - - 1 10 22 - 19. Heart Disease 121 - — 3 26 92 - - - 19 20.Other Diseases of circulatory Sesyem - - 22 3 21. Bronchitis 57 - - - - - 40 17 22. Pneumonia 39 2 1 3 9 24 4 23. Other respiratory diseases 5 - - - 1 - 1 24. Ulcer of Stomach or Duodenum 7 - - - 2 4 25. Diarrhoea under 2 years 3 3 - - - - - — 1 26. Appendicitis 1 - - - - 8 - - - 1 - 7 27. Other digestive diseases 11 - - 3 28. Nephritis - 3 5 29. Puerperal & Post-Abortive Sepsis - - - — - -- - 1 - - - 1 — 30. Other maternal causes - - - 31. Premature birth 3 3 - — - 10 - - - - 32. Cong.Malf.Birth Injuries. Infant Dis. 10 - 33. Suicide 34. Road Traffic Accidents 35. Other Violent Causes 36. All other causes 8 - - 1 1 1 5 1 2 - 5 24 20 - 2 - 5 - 5 2 12 - 1 5 - — 4 10 12 1 27 84 155 M F Total All Causes 282 3 240 13 3 30 150 - 44 522 25 6 1 57 128 305 (9) SECTION "B" - GENERAL PROVISION OF HEALTH SERVICES TREATMENT CENTRES AND CLINICS The attendances at the various treatment centres and clinics have shown a further steady expansion and there were record attendances in the Dental, Foot and Women's Clinics. ATTENDANCES &C. at TREATMENT CENTRES AND CLINICS CLINIC FOOT CLINIC DENTAL CLINIC SOLARIUM WOMEN'S CLINIC TOTALS No.of sessions 1358 357 415 44 2174 1944 No.of new cases 800 979 529 52 2360 Total No. Atts. 8037 4413 10032 321 22803 No.of sessions. 1572 423 438 47 2480 1945 No.of new eases 701 1298 497 90 2586 Total No. Atts. 10244 4967 9122 295 24628 No. Of sessions 1774 527 605 59 2965 1946 No.of new cases 721 1506 464 194 2885 Total No. Atts. 11121 5747 9345 738 26951 No. of sessions 1949 724 580 103 3356 1947 No.of new cases 740 1742 370 203 3055 Total No. Atts. 12062 6735 8675 1170 28642 LABORATORY: Routine examinations of swabs, sputum, milk samples, etc, were continuedto be carried out in the Laboratory and the following is a brief summary of the work undertaken - No.of throat and nasal swabs examined 424 No.of sputums examined for T.B 367 Milk samples (Bacteriological examinations) 308 Other Pathological specimens examined 38 Ice cream samples 70 Blood Counts 104 Mycelium Investigations (Foot Clinic) 21 Miscellaneous Food Samples 3 Samples of Well Water 18 The Council continued the arrangements whereby special examination are undertaken by the Archway Group Laboratories by the L.C.C.Group Pathologist, Doctr J.M.Alston. INOUESTS: Inquests were hold on 43 residents during the year, the findings being as follows: Drowning 1 Broanchitis 1 Road Accidonts 5 Miadventure 3 Violence 13 Self Neglect 2 Suicide 9 Broncho-pneumonia 2 Tuberculosis 1 Heart Failure 3 Murder 1 Judicial Hanging 2 (10) MATERNAL MORTALITY: There was one maternal death during the year, giving a maternal mortality rate of 1.4 per 1,000 Total (Live and Still) Births. INFANTILE MORTALITY: There were 25 deaths amongst infants under one year of age and the infant mortality rate based on 1,000 live births was 32. Of these deaths 14 occurred in the neo-natal period, two of the infant deaths occurred in illegitimate children and there were 5 deaths due to prematurity. The comparative infant mortality rates for London and England and Wales were 37 and 41 rospectively. INFANT MORTALITY RATES I I ! FINSBURY 1941 1942 1943 1944 1945 1946 1947 64 56 47 54 32 55 70 53 LONDON 58 37 60 61 41 68 41 ENGLAND & WALES 49 46 43 59 49 46 DEATHS IN RELATION TO DISEASE: The number of deaths was the same as for 1946. There was one death from Diphtheria, and none from Typhoid or Scarlet Fever during the year. The deaths from Cancer, Heart Disease, Bronchitis and Intra cranial Vascular lesions form a high proportion of the total deaths, and it is to be noted that these deaths occur to a largo extent in the 65 years and over group. Of the total of 522 deaths, 305 occurred in the ago group of 65 years and over. GRANTS SCHEME: 2,491 dinners were granted free of charge to necessitous mothers and children at the two Centres, under the provisions of the Council's Maternity and Child Welfare Grants Scheme. The scheme to provide dinners for selected cases who were outside the income group for free dinners was continued Charges were made for such cases at the rate of 1/3d per dinner for adults and 6d per dinner for children under 5 years, and a further 3,387 dinners were provided under this scheme. 230 lbs.of Dried Milk were also issued to necessitous persons free of charge, and 7,573 lbs. at cost price. 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 1946. I Mothers, Individual PINE STREET LEAGE STREET 1946 1946 1947 1947 60 41 103 140 Mothers, Attendances 69 43 169 116 231 Children (1-5 years) Individual 385 365 319 Children (1-5 years) Attds. 2409 1578 2402 1596 Babies, Individual 470 590 273 362 Babies, Attendances 6080 4387 2241 3266 PRIORITY DOCKETS FOR EXPECTANT MOTHER: In accordance with the Ministry of Health Circular 154/44, arrangements were continued through the Maternity and Child Welfare Services for the issue of vouchers to onable oxpectant mothers, being confined at home, to obtain a supply of utility sheets. During the year 313 vouchers were issued. HEALTH VISITING: The regular visitation of expectant mothers and children under 5 years was continued by the Health Visitors and during the year a total of 10,294 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 25 ) Died - 3 Marasmus 5 ) Satisfactory -37 Illegitimacy 18 ) Removed to other Twins 22 ) areas - 1 Ophthalmia Neonatorum 2 ) Still special at Frail Infant 1 ) end of year - 32. VOLUNTARY CENTRES: The Council has continued grants to the undermentioned Voluntary Centres, and a brief outline of the work carried out at these centros is shown below: INSTITUTION No.of CHILD WELFARE CLINICS HELD No. of ATTENDANCES City of London Maternity Hospital 102 244 (Finsbury) Claremont Central Mission 96 607 Maternity Nursing Association. 100 1473 NURSERIES: Three day nurseries, with places for 155 children, were in operation in the Borough throughout the year. The following table shows the average daily attendances: King Square JAN. FEB. MAR. APL. MAY. JUN. JUL. AUG. SEP. OCT. NOV. DEC. 26 34 32 22 18 20 33 34 31 34 39 60 38 137 38 51 50 53 60 57 60 Lloyd Square 59 43 53 51 56 41 44 43 48 35 37 44 Banner Street 46 46 41 33 Total 128 128 124 138 127 123 133 127 112 116 117 HOME NURSING: The arrangements with the Metropolitan District Nursing Assn: 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. NATIONAL MILK AND VITAMINS SCHEME: The Municipal and Voluntary Centres continued to operate as distributing points for vitamin products and national dried milk. 2,731 bottles of Cod Liver Oil, 10,477 bottles of orange juice and 325 Cod Liver Oil Capsules wore issued during the year, through the two Municipal Centres. CARE OF PREMATURE INFANTS: In accordance with recommendations contained in Ministry of Health Circular 20/44. (a) a space is provided on the Birth Notification forms for recording the weight of babies of 5½lbs or less; (b) a supply of equipment is kept in stock for premature infants nursed at home; (c) a panel of Home Helps is available and (d) the Health Visitors regard premature births as 'Special cases' necessitating more frequent visiting. During the year 32 births were notified where the birth weight was 5½ lbs.or less; of these 20 were nursed entirely at home and survived at the end of one month. (12) 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. Bartholomews Hospital ... 119 (b) The City of London Maternity Hospital ... 48 (incl.Brocket Hall cases) (c) L.C.C.Emergency Maternity Homes ... ... 22 (d) St. Mary's (Islington) Hospital ... ... 53 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. The following table shows the attendances at the various ante-natal and post-natal clinics: Health Centra City of Lon. Mat. Hosp. Royal Northern Hospital. St. Barts Hospital. Ante Natal 487 344 1,486 3,063 Post Natal 113 33 42 HOME & DOMESTIC HELPS: The Council provides a service of Home Helps during the post-natal and ante-natal period for domiciliary cases. 84 cases were attended during the year. At the end of the year the panel of Home Helps consisted of 3 regular persons. The staff shortage for this work continued and as a result the Council agreed during the year to the employment on a short-term basis of suitable persons nominated by the Mothers themselves. The scheme has worked well and became increasingly popular. The Council was again able to give practical application to the recommendations of the Ministry of Health under Circular 179/44 regarding the provision of Domestic Helps to the sick and infirm as apart from the Maternity Home Help Service. 32 Domestic Helps were engaged on part-time duties to assist in 38 urgent cases at a net cost to the Council of £643.17.9d. HOSPITAL TREATMENT: The arrangements between the Council and the Elizabeth Garrett Anderson Hospital for the retention of one cot has continued throughout the year. Arrangements were made during the year for the admission of two children to Hospital under these arrangements. Other admissionsduring the year were made to Archway Hospital, Cromwell House and St.Barts Hospital. PUERPERAL FEVER AND PUERPERAL PYREXIA: During 1947 there were 8 cases of puerperal pyrexia and 4 cases of puerperal fever notified in Finsbury, none of which proved fatal. This gives a rate per 1,000 Live and Still Births of 15.2 as compared with 7.16 for England and Wales, and 8.15 for the London Administrative County. OPHTHALMIA NEONATORUM: The number of cases of Ophthalmia Neonatorum notified was two. One of these cases were treated home and one in hospital. In neither case was there impairment of vision. POST NATAL CLINIC: A post natal clinic was inaugurated at the Health Centre during 1946. FOSTER PARENTS: At the end of 1947 there was one registered foster mother in the borough. (13) CONVALSCEHT TREATMENT: The Noel Home, Letchworth closed on 30th January, 1947 The four children in these reserved cots completed their treatment on that day. The arrangement with Dedisham Convalescent Homo for the rotention of two cots was continued and six children were admitted during the year. An arrangement was commenced with St. Christopher's, Tunbridge Wells - 2 cots reserved - on the 5th March, 1947. Four admissions were made. The home closed and the agreement terminated on the 30th September, 1947. Commencing on the Ist July, 1947, four cots were reserved at Melbury Vale House, West Melbury, near Shaftesbury, Dorset. Eleven children wore admitted to these cots. Four children were admitted, by arrangement commencing 13th February, 1947, to the Sydenham Invalid Babies' Nursery, Sydenham Hill, S.E. There were eleven children admitted to other Convalescent Homes by agreement with the Invalid Children's Aid Association. Ten mothers and ten children were sent for a fortnight's holiday through the Women's Holiday Fund. LEGITIMATE CHILDREN: The Council contribute an annual sum of £101 towards the improvement of the services of voluntary organisations for Moral Welfare in London, and is suitably represented on the Council of Moral Welfare. The Health Visitors pay frequent visits to illegitimate cases and work in collaboration with the Moral Welfare Worker of the Local Organisation at St. Faith's Home. BLOOD TRANSFUSION SERVICE: The Council continued to co-operate with the North London Blood Supply Depot by arranging blood donation sessions at the Health Centre. (14) SECTION "C" - SANITARY CIRCUMSTANCES The following is a summary of work undertaken by the Sanitary Inspectors during 1947:- Houses, damp, dirty or dilapidated, remedied 612 Doors, windows, floors, walls, ceilings, sashcords repaired 501 Overcrowding cases abated in other than Registered Houses 37 Illegal occupation of underground rooms - Water closet defects remedied 469 Water closets erected 126 Urinal defects remedied 8 Urinals erected 3 Soil pipe and ventilating shaft defects remedied 75 Soil pipe and ventilating shafts erected 40 Yard defects remedied 83 Waste pipe defects remedied 153 Waste pipes erected 59 Water cistern defects remedied 82 Accumulations of rubbish or manure removed 100 Dung or dust receptacles repaired or renewed 57 Drains relaid, amended or sealed 62 Drains cleared or tested 239 Rain water pipes cleared, repaired or renewed 102 Water supply to houses reinstated 32 Roofs and gutters repaired 319 Area defects remedied 20 Wash-house defects remedied 57 Animal nuisances abated 3 Infectious Disease Investigations 104 Stables cleansed or repaired 1 Smoke observations 70 Water supply laid on to upper storeys of house 14 Miscellaneous nuisances abated 233 Common Lodging Houses (visits) 28 Butchers Stalls, etc. (visits) 3928 Street Traders Storage (visits) 137 Old & Infirm Verminous Persons - No.of inspections 54 Shops - Inspections 286 Shops - No.of notices 12 Public Houses cleansed or repaired 17 Public Houses - No.of inspections 72 Public Conveniences - Inspections 430 First visits (complaints, casual visits) 8890 Re-visits 6085 Intimation Notices served 1317 Statutory Notices served 34 Canal Boats inspected 49 House inspections 1560 House to house inspections 36 Piggeries- No.of inspections 2 Complaints received 2003 Verminous premises cleansed by Borough Council - Council property. 37 Other property 146 (15) RECEPTION HOUSE: 6 persons used the Reception House during 1947 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. VEWINOUS PREMISES: During the year 183 premises wore found to bo voeminous and disinfestation measures were carried out. In addition the treatment of the accommodation and furniture of now entrants to the Council's dwellings was systematically performed. CLEANSIHG 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. 2,414 treatments were given during the year to L.C.C. school-children and 825 treatments to adults and pre-school children. Home visiting of scabies cases and contacts was continued and the Nurse-incharge of the Cleansing Station made 121 home visits during the year. SHOPS: TheThe number of inspections made under the Shops Act, 1934 during 1947 was 286. 12 notices were sorved for contravontions. RAG FLOCK: The number of samples of Rag Flock taken during the year was 5, all of which proved satisfactory. CANAL BOATS: The total number of canal boats inspected during the year was 49, none of which carried any offensive cargo. Contravention of statutory requirements had taken place in 6 instances. Thore was no discovery or notification of infectious disease. The number of children on the boats, all of whom appeared to be well cared for, was 60, of whom 45 were of school age. 17 visits in addition were paid by the Health Visitors. 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. It was arranged for one of the Council's nurses to spend a portion of her time in visiting Aged and Infirm persons. STREET TRADERS: At the end of 1947, 290 persons were licensed to engage in Street Trading of Foodstuffs within the Borough. 137 visits were made to the places of storage where foodstuffs were sold. COMMON LODGING HOUSES: There is one Common Lodging House in the Borough, licensed for 348 bods, situate at No.88 Old Street, and the number of visits made by the Sanitary Inspector was 28. HOUSES LET IN LODGINGS: At the end of the year there were 488 houses on the Register. These were regularly inspoeted and cleansing notices were served in accordance with the bye-laws but rigid onforcement was impossible owing to the difficulties prevailing in obtaining labour and materials. RAG & BONE DEALERS: There are 10 premises within the Borough in which the business of Rag and Bone Dealer is carried on. 25 visits were made to these premises. (16) SMOKE EMISSION: 28 complaints were received during the year regarding excessive smoke emission. 76 smoke observations were made. MORTUARY: 5 Bodies were received at the mortuary attached to the Health Centre premises. DISINFECTION: The following table gives particulars of the disinfeetion work carried out during 1947. Diphtheria 14 Measles 269 Vermin and Scabies 434 Scarlet Fever 80 Tubereulosis 26 Whooping Cough 61 Miscellaneous 83 By request 105 'A total number of 15,337 articles were disinfected, being chiefly pillows, mattresses, bolsters, sheets, blankets and wearing apparel. In addition 691,843 articles were disinfected prior to Export and fees charge for this work amounted to £771. OFFENSIVE TRADES: The following are licenced offensive trade premises: (a) Messrs. Henson, 187 Whiteeross Street, E.C.I. (b) Messrs. F.& W.Warman, Ltd., 5. Eagle Court, E.C.I. (c) Messrs. T.Kendon & Sons, Charterhouse Mows, E.C.I. (d) Messrs. Reubens, Ltd., 71/73 St.John Street, E.C.I. Regular visits were made in respect of these premises during the year. FACTORIES ACT, 1937: The number of factories on the register at the end of 1947 was 2,200 comprising 1,350 power factories and 850 non-power factories. 145 firms were added to and 103 removed from the register during the year. The following is a summary of defects found: NUMBER OF DEFECTS FACTORIES (POWER) FACTORIES (NON-POWER) TOTAL Refuse accumulation or absence of dustbin 6 1 7 Roof leaky 17 3 20 37 64 Dampness and dilapidations 27 Sanitary Conveniences-defective 15 7 22 21 27 " " -dirty 6 " -not separated for Sexes or insufficient 5 5 0 " " -with no artificial light or unlabelled 22 30 8 " -absence of intervening ventilated space 13 15 2 24 28 " " -unsuitable and insuff- icient ventilation 4 Water fittings or waste pipes defective 3 1 4 Thermometer absent - - - 17 Factories Act, 1957 (contd) 31 notices of complaint and 150 notices of occupation were received from H.M.Factory Inspector. 20 notices were sent to the Factory Inspector regarding the following matters:- Abstract absent 10 New occupation, notification 10 LADY SANITARY INSPECTOR'S WORK: The following is a summary of visits made by the Lady Sanitary Inspector - Factories 1583 Outworkers promises (Sub-contractors) 158 Outworkers premises (domestic) 714 Number of Intimation Notices served 104 Number of Statutory Notices served 4 Miscellaneous visits 89 OUTWORKERS: No.of Finsbury firms employing outworkers at the end of August, 1947. 201 Total number of outworkers employed by Finsbury firms 4343 Number of outworkers rosident in Finsbury 592 RAT REPRESSION: No.of complaints and requests for treatment received - 605. No.of additional premises found infested - 572. No.of houses treated - 1075. No.of other premises treated - 699. No.of visits made by rat-catchers to houses - 7,994 and to other premises - 6,313. Two treatments of the Council's sewers were carried out during the year and although the record of bait takes suggests the rat population remains high, it is considerably lower than it was before regular treatments commenced. 18 SECTION "D" - HOUSING 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) 3703 (b) Number of inspections made for the purpose 4073 (2) (a) Number of dwelling-houses (included unaer sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 36 (b) No.of inspections made for the purpose 54 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 5 (4) Number of dwelling houses (exclusive of these referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 1317 (B) Number of dwelling houses rendered fit in consequence of informal action by the Local Authority or their officers 73 (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 0 (2) Number of dwelling houses which were rendered fit after service of formal notices 0 (a) By Owners 0 (b) By Local Authority in default of Owners 0 (b) Proceedings under Public Health Acts:- (1) Number of dwelling-houses in respect of which notices wore served requiring? defects to bo remedied 1351 (2) Number of dwelling houses in which defects were remedied after service of formal notice - (a) By Owners 1350 (b) By Local Authority in default of owners 1 (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 0 (2) Number of dwelling-houses demolished in pursuance of demolition orders 0 (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 0 (2) Number of separate tenements or underground rooms in respect of which closing orders were determined, the tenement or room having been rendered fit 0 RE-HOUSING: 220 families consisting of 840 persons were rehoused by the Council in premises requisitioned for the purpose. 6 families, consisting of 13 persons were accommodated in the Council's flats and 42 families consisting of 159 persons were rehoused by the London County Council. (19) SECTION "E" - INSPECTION AND SUPERVISION OF FOOD AND DRUGS ANALYSIS OF MILK: During the year 167 samples of milk were submitted to the Public Analyst. 10 samples were found to be adult rated. BACTERIOLOGICAL EXAMINATION OF MILK: 308 samples of Designated Milk and 72 samples of Ordinary Milk were submitted for bacteriological examination. MILK SHOPS AND DAIRIES: Number of applications for registration approved 3 Number of purveyors on the register at the end of 1947 114 Number of purveyors removed from the Register during the year 1 Number of purveyors on the register at the end of 1946 115 Number of visits of inspection carried out 55 MILK (Special Designations) REGULATIONS 1956-1944 Number of applications for licences received - (a) Tuberculin Tested Milk - Dealers 18 (b) Pasteurised Milk - Dealers 34 (c) Pasteurisers 1 (d) Supplementary Licences 8 (e) Number of samples taken for examination 308 To encourage the small trader to deal in Special Designated Milks, the Council decided to continue to waive the payment of licence fees. Of the samples taken, 9 proved unsatisfactory and appropriate action was taken with satisfactory results. MILK IN SCHOOLS: 25 samples of milk delivered to the Schools were taken during the year and submitted for bacteriological examination. All the samples proved satisfactory. FOOD POISONING: During the year there was 1 isolated case of Food Poisoning notified under the Food and Drugs, Act, 1938, amongst Finsbury Residents. BAKEHOUSES: There were 23 bakehouses in use in the Borough at the end of the year, of which 17 were basement premises. In all the bakehouses machinery is used. 76 visits of inspection were made during the year. ADULTERATION' OF FOOD: The total number of samples taken in 1947 under the Food and Drugs Act, 1938, was 750 of which 14 were formal samples and 736 informal. 9 informal and 1 formal sample were found to be adulterated. In one case legal proceedings were instituted. PHARMACY AND POISONS ACT, 1933: 41 applicants were approved during the year by the Council as Listed Sellers of Poisons and 23 visits were made. 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 damage and from loss of labels, etc, to packages during transport. ICE-CREAM: During 1947 there were 87 registrations for the manufacture, sale or storage of Ice-cream. 72 visits of inspection were made and 70 samples of ice-cream were submitted for bacteriological examination with the following results - Very satisfactory - 25; Satisfactory - 13; Unsatisfactory - 32. REGISTERED FOOD PREMISES: The following is a summary of Registered Food Premises in the Borough at the end of 1947 - Manufacture of Ice-cream 37 Storage and Sale of Ice-cream 50 Fried Fish Shops 12 Butchers Shops and Stalls 51 Other premises 28 Total 178 221 visits were made to these premises during the year. UNSOUND FOOD: The work of meat inspection in the area of the Smithfield Meat Market continues, since the secondment of Mr. Penman to the Ministry of Food, to be carried out by Mr. R.S.Barber. Regular inspections of the meat and offal consigned to the various wholesale butchers and offal shops and to the depot of the London Wholesale Moat Supply Association were carried out and were also made of the various bacon factories, wholesale bacon and provision warehouses and Public Cold Air Stores. Visits and inspections of the retail butchers shops in the borough were also carried out. Summary of Foodstuffs seized by or surrendered to the Meat Inspector during 1947 Diseased or unsound moat 67,667 lbs. Diseased or unsound offal and other foodstuffs 40,291 lbs. Total 107,958 lbs. The number of carcases of Mutton and Lamb found to be affected with Caseous Lymphadentis was 408, and 18,026 lbs. of pieces of mutton and lamb. SLAU GHTERHOU SES: The slaughterhouse owned by Mr. J.A.Mobbs, 14 Pen ton Street was closed down on the outbreak of the war. No animals were slaughtered there during 1947. (21) SECTION "F" - INFECTIOUS AND OTHER DISEASES Notification of Infectious Disease: The following table shows the notifiable cases of Infectious Disease during 1947, 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 Remvls. to Hosp. Acute Influenzal Pneumonia - - - - - — - - - 1 7 1 2 8 Acute Primary Pneumonia 27 2 6 - 1 - - - - Cerebro-spinal Meningitis 2 1 - - Diphtheria (Inc.Mem.Croup) 2 3 1 6 6 - - - - 1 Dysentery 4 - 2 - 1 - - 2 Erysipelas 3 3 1 3 7 - - - - 1 Para-typhoid 1 - - 1 - - - - 33 158 68 6 5 57 Measles 270 - - 2 - Ophthalmia Neonatorum 2 - - - - 1 - - - 4 Puerperal Fever 4 - 2 2 - - — - 4 Puerperal Pyrexia 8 - 4 - - 2 1 24 53 3 2 - - 35 Scarlet Fever 83 7 3 20 Pulmonary Tuberculosis 83 - - 25 19 9 n/a Other forms of Tuberculosis 4 2 1 1 - - - - - Whooping Cough 21 - 36 110 26 63 - - - Food Poisoning - - - - - 1 1 - Poliomyelitis - 5 2 2 10 10 1 - - 4 Scabies 123 3 34 52 18 10 2 - - - - - - Malaria - - - - 745 299 209 60 58 34 18 Totals 67 158 Notification Rates (Comparative Table) oer 1,000 population. Finsbury England and Wales 126 C.B's & great towns including London 148 smaller towns, Res. population 125,000 to 50,000 at 1931 census. London Adm. County. Typhoid Fever .00 .01 .01 .00 .01 Paratyphoid Fever .03 .01 .01 .01 .01 .06 .05 Cerebro-spinal Fever .05 .06 .05 Scarlet Fever 2.50 1.54 1.31 1.37 1.37 Whooping Cough 2.41 2.80 2.28 2.22 2.02 Diphtheria .17 .13 .15 .14 .14 Erysipelas .19 .19 .21 .18 .22 Smallpox .00 .00 .00 .00 .00 Measles 7.69 9.41 9.13 9.58 5.29 Pneumonia .76 .79 .89 .68 .64 (22) Smallpox and Vaccination: As from the Ist January, 1947 the Medical Officer of Health was appointed Vaccination Officer, the clerical work being undertaken by the Senior Clerical Assistant. These changes were necessitated by the resignation of Mr. P.E.Capps, part-time Vaccination Officer on the 31st December, 1946. Dr. R.Sacks resigned his appointment as Public Vaccinator (No.2 District) and the resulting vacancy was filled by Dr.E.F.Rossdale. The following is a summary of proceedings under the Vaccination Acts, 1867 to 1898. Number of Finsbury birth notifications received from Registrar 408 Number of certificates of Primary Vaccination received 180 Postponements by medical certificate 1 Number of Finsbury babies not vaccinated within period of four months 307 Certificates of exemption granted after declaration There were no cases of Smallpox. 69 Scarlet Fever: The number of cases of scarlet fever notified during 1947 was 83, of which 35 were removed to Hospital. There were no deaths from this disease. Routine visits to patients following discharge were continued. Diphtheria: 6 cases of diphtheria were notified there being one death. All the cases were removed to Hospital. Of these, none had been immunised. The following table shows the cases notified during the last ten years and the number of deaths. Year No.of cases notified No of deaths 101 1938 3 1939 58 2 27 1940 2 1941 35 - 1942 19 1 1943 24 2 10 1944 - 13 1945 - 6 1946 - 1947 6 1 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. It was estimated that by the end of 1947, approximately 650 of the child population under five years of age had been immunised against Diphtheria. The number of children of this age group immunised during the year was 438. Whooping Cough. Notifications of whooping cough numbered 110, and there was 1 death. Prophylactic treatment has been continued in conjunction with diphtheria prophylaxis. (23) Measles: There were two deaths directly attributable to measles during the year. Of the 270 cases which occurred 57 were removed to hospital, partly on medical and partly on social grounds. Special visits were paid to all cases nursed at home. Para-typhoid: There was one notification during the year. Provision of Insulin: By virtue of Section 227 of the Public Health (London) Act, 1936, the borough continued to boar the cost of treatment of diabetes in the case of necessitous persons. 8 persons received assistance during the year at a cost to the Council of £44.1.4d. Tubereulosis: The total number of now cases of tuberculosis, both pulmonary and non-pulmonary, entered in the Register in 1947 was 87. The ago period details were as follows: Total all ages 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- Males Pulmonary 1 1 3 6 9 8 5 - 4 8 7 52 3 1 2 9 5 3 4 2 2 31 Females Pulmonary - - - 1 - 1 Males Non-pulmonary - - - - - - - - Females Non-pulmonary - 1 1 - 1 - - - 3 - - - Total - 7 3 2 5 16 15 11 9 10 9 87 The number of cases removed from the Register during the year was 127 and those remaining on the Register of Notifications at the 31st December, 1947 were as follows: Males Females Total Pulmonary 220 145 365 Non-pulmonary ■—I 40 81 41 261 185 446 The following is a summary of the Tuberculosis Dispensary work in 1947:- Number of cases on Dispensary Register - Pulmonary 310 Non-pulmonary 52 Total 362 Sputum Positive Cases 176 Sputum Negative Cases 134 Cases notified from services 3 New Cases examined (other than contacts). Pulmonary Non-pulmonary Total 56 (a) Definitely Tuberculous 3 59 (b) Diagnosis not completed 20 20 - (c) Non-Tubereulous 288 288 - 367 Contacts: (a) Definitely Tuberculous 5 5 - (b) Diagnosis not completed 56 56 - (c) Non-tuberculous 98 98 - 159 (24) Cases Written Off: (a) Recovered 28 (b) Diagnosis not confirmed 2 30 Number of attendances at Dispensary 2252 Home visits by Tuberculosis Officer 28 Visits made by Tuberculosis Visitor 672 Specimens of sputum examined 353 Number of patients attending for artificial pneumothorax refills 56 Number of refills given 412 X-RAY DEPARTMENT: Details of the work in the X-ray department during 1947 are as follows:- Chest cases: Largo films used 1005 Small films used 135 Screen examinations 1095 Other cases: Private Medical Practitioners 22 Physiotherapy Dept. 41 Day Nursery Staff 44 Miscellaneous 9 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 or home troatment, continued to operate smoothly during the year. The Council's T.B.Dispensary machinery is used for the institution of the necessary onquiries and for the presenting of the applications weekly to the Tuberculosis Assessment Officer. During the year 28 new applications were dealt with. In addition to new cases, 264 cases were presented to the Assessment Officer for reView. The total cash allowances paid out during the year was £2,111.11s.6d. PROVISION OF EXTRA NOURISHMENT: The Borough Council has continued to provide extra nourishment for certain types of tuberculous cases. 73 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. JR1\70