LIBRARY 24341 FIN 29 THE Metropolitan Borough of Finsbury ANNUAL REPORT ON THE Public Health of Finsbury for the Year 1948 By— C. O. S. BLYTH BROOKE, M.8., 8.5., D.P.H. Barrister-at-Law. Medical Officer of Health. Finsbury Health Centre, Pine Street, London, E.C.i. Printed by Vail & Co., Ltd. (t.u.), Finsbuby, e.c. 1949 68590 THE Metropolitan Borough of Finsbury ANNUAL REPORT ON THE Public Health of Finsbury for the Year 1948 By— C. O. S. BLYTH BROOKE, M.B., B.S., D.P.H. Barrister-at-Law. Medical Officer of Health. Finsbury Health Centre, Pine Street, London, E.C.i. Printed by Vail & Co., Ltd. (t.u.), Finsbury, e.c. 1949 HEALTH COMMITTEE. Chairman : Councillor A. J. COMAN Vice-Chairman : Councillor Mrs. F. E. GILBERT Alderman Mrs. V. M. HEAPS C. H. SIMMONS Councillor Miss K. BEAUCHAMP Mrs. E. B. BROMFIELD Mrs. M. M. CHAMPION H. DUNGER Mrs. E. R. GANNON W. O'LEARY Mrs. O. PANNETT E. ROWLEY J. SCOTT Miss M. A. WESTERMAN W. E. WHITE Medical Officer of Health : C. O. S. Blyth Brooke, M.B., B.S., D.P.H., Barrister-at-Law. Deputy Medical Officer of Health and Tuberculosis Officer: W. D. R. Thompson, M.R.C.S., L.R.C.P., D.P.H., Barrister-at-Law. (T.) Assistant Medical Officers of Health : I. Hood, M.B., Ch.B., D.C.H., (t.) K. M. Lane, B.A., M.R.C.S., L.R.C.P. (part-time), (t.) Public Analyst : C. Harcourt Wordsworth, B.Sc. *Public Vaccinators: Dr. R. E. Batson Dr. R. K. Dadachanji Dr. G. P. Barua Dr. E. Rossdale Sanitary Inspectors: H. J. Newdick, M.S.I.A. (Senior S.I.) Miss F. Hall, M.S.I.A. R. E. Lay, M.S.I.A. A. J. Truslove, M.S.I.A. 3 Sanitary Inspectors—continued. J. Lewis, M.R.San.I. E. Ditchburn, M.S.I.A. (from 1.5.48) D. M. Warner (Student from 5.4.48 —31.7.48, S.I. from 1.8.48). J. T. Midgley (Student from 1.8.48) Meat Inspectors : T. Penman, M.B.E., M.S.I.A. (Seconded to Ministry of Food). R. S. Barber, M.S.I.A., Barrister-at-Law. Administrative and Clerical Staff: H. Ward, D.P.A., M.R.S.I., (Assistant Administrative Officer), (t.) T. E. Williams (Senior Clerical Assistant), (t.) J. E. McDowell (Acting Chief Clerk from 5.7.48). Miss W. Freeman. (t.) R. W. Leach. (t.) Miss J. S. Dodd). (t.) J. W. Field. (t.) D. S. Ward. (t.) Miss J. L. Faulkner Miss D. Wall I. L. Bedford. (t.) Mrs. G. L. Rance. (t.) J. Lindsey Mrs. J. E. Gade (t.) E. Mitchell (with H.M. Forces). (t.) Mrs. M. Hall (Temporary from 10.6.48). (t.) R. Robertson A. Phillips (from 11.10.48). M. and C. W. Superintendents : Mrs. M. Parker (Leage St. M. and C. W. Centre). (t.) Miss J. R. Turner (Pine St. M. and C. W. Centre). (t.) M. and C. W. Dispenser : Miss I. Lloyd (part-time). (t.) 4 Health Visitors : Miss B. J. Scott. (t.) Mrs. G. Hartney. (t.) Miss L. Breaman (left 7.4.48) Miss G. Finnegan. (t.) Miss A. Sumka (Temporary). (t.) Day Nurseries : Lloyd Square : Mrs. M. G. Havers (Matron). (t.) Miss E. M. Hutchings (Deputy Matron), (t.) Banner Street: Miss D. I. Bowe (Matron). (t.) Mrs. V. M. Brown (Deputy Matron). (t.) King Square: Mrs. M. E. Halliday (Matron). (t. ) Mrs. F. R. Rogers (Deputy Matron). (t.) Tuberculosis Nurse and Visitor: Miss F. M. Prior (t.) Secretary of Tuberculosis Care Committee : H. Ward, D.P.A. Women's Clinic: Margaret Salmond, M.B.E., M.D., F.R.C.S., F.R.C.O.G., (part-time Medical Officerin-charge). (t.) Dental Clinic : W. R. Gray, L.D.S. (t.) J. F. Partridge, L.D.S. (part-time). (t. R. Drew, L.D.S., R.C.S. (Eng.) (part-time). (t. W. R. Graves-Morris, L.D.S. (part-time from 21.6.48). (t.) Mrs. M. A. Blackwell, S.R.N. (Dental Nurse). (t.) Miss A. E. Phelps (Clinic Attendant). (t.) Panel of Anaesthetists: Dr. G. P. Barua Dr. A. H. Rowntree Dr. B. J. Wilton Dr. R. E. Batson 5 Foot Clinic : A. H. Carter, F.Ch.S. (Chiropodist-in-charge). (t.) R. E. Marchant, M.Ch.S. (t.) W. M. Long, M.Ch.S. (t.) Mrs. R. E. Ross, M.Ch.S. (t.) Cleansing Station : F. L. Lydon, M.B., M.R.C.P., (part-time consultant). Mrs. D. I. M. Lloyd, (Nurse-in-Charge) Physiotherapy Department: E. F. C. Wadge, M.R.C.S., L.R.C.P., (perttime Consultant), (t.) Miss A. E. Nicholas, (Physiotherapist-in-Charge). (T.) Mrs. Bodley, (Assistant Physiotherapist-parttime from 3.2.48). (t.) Mrs. Goodson (Assistant Physiotherapistpart-time from 18.5.48). (t.) Mrs. A. L. Emmerton (Clinic Attendant). (t.) Laboratory Technician : Miss P. E. Russenberger. (t.) Resident Engineer and Health Centre Keeper F. W. Battle Assistant Supervisor Domestic Helps : Mrs. G. Coppen (t.) Those names in the foregoing list of staff marked with a (t.) were, as a result of the redistribution of Public Health and Maternity and Child Welfare Services under the National Health Act, 1946, transferred to either the London County Council or the Regional Hospital Board on the 5th July. * These Appointments lapsed on 5-7-49, 6 To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Finsbury. Mr. Mayor, Ladies, and Gentlemen, I have the honour to present my Annual Report for 1948 of the work of the Public Health Department. This report is prepared along the lines of recent years in an abbreviated form in accordance with instructions given by the Ministry of Health. The year was chiefly eventful for the coming into operation of a number of enactments which changed the whole structure of social legislation on the 5th July. Of particular importance in this connection was the National Health Service Act, 1946, but it is too early to present any report on the effect of the changes on the Health and Welfare of the people of Finsbury. From the appointed day the Personal Health Services including all the maternity and child welfare provisions were transferred to the London County Council and the Specialist Clinic Services to the North East Metropolitan Regional Hospital Board, though these latter have to some extent remained under the control of the Borough Council on an agency basis. Many regrets were felt at the loss by your Council of so many of those branches of Public Health work which you, over a period of years, had done so much to initiate, encourage and raise to a high level of efficiency. Consequent upon these transfers a number of very highly respected staff, who, in some cases had given many years of loyal and devoted service, passed over into the employment of other authorities. The Health Centre has remained, for the time being, the property of the Finsbury Borough Council who still use more of it than any other authority. I am glad to be able to report that the general health of the community has remained good and that there was no serious outbreak of any infectious disease. In considering the vital statistics it should be remembered that the information available as to the population figures, and particularly the age distribution of the population, is not known with any certainty. This is not likely to be remedied until the results of the 1951 census become available. The birth rate was 18.9. This is a decrease from the two previous years but is considerably higher than in the pre-war and early war years. It has been pointed out that the present high rate is partly, if not largely, due to anticipated births occurring earlier on account of marriages taking place at an earlier age. The proportion of illegitimate births to the total births shows no decline from 1947, and is still 32 per cent above the 1938 proportion though greatly decreased from the 1945 and 1946 figures. The still birth rate can be regarded as very satisfactory although it did not maintain the low record of the 1947 rate. The crude Death Rate was 11.9 Without more precise information as to age distribution, its exact significance cannot be evaluated. In general terms it may be regarded as exhibiting the downward trend that has been apparent in this and all other Western European countries during the past few years. It is with pleasure that I report that there were no maternal deaths nor any from the ordinary infectious diseases. Thus an important record in Public Health in Finsbury was constituted. The record low infant mortality in 1947 of 32.0 was very nearly but not quite, maintained at 32.6. The Tuberculosis Death Rate was considerably reduced from 1.25 in 1947 to 0.72. The reduction occurred evenly at all ages and the incidence of deaths from disease in the older age groups as compared with young adults was again high. I referred to this feature in my last Annual Report as it indicates a change in perspective of the Tuberculosis Problem which has taken place throughout the country. Unfortunately I cannot report much advance in dealing with the problems of environment and housing, though some general improvement did take place during the year. Everyone, however, was looking forward to the completion of the Spa Green estate and the hope that it would start a new era in the Housing conditions in the Borough. 8 I have to thank the Chairman and Members of the Health, and other 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. 9 SECTION A. Vital Statistics. Area. The area of the Borough is 587 acres. Population. The Registrar General's estimate of resident civilian population was 35,640. In 1938 the estimated population was 56,960. Live-Births. The total number of live births belonging to the Borough occurring during 1948 was 674 including 50 illegitimate births, and consisting of 346 males and 328 females, giving a birth rate of 18.9 per 1,000 population. The total number of births during 1947 was 779. The birth rate for England and Wales was 17.9 and for the London Administrative County 20.1, per 1,000 civilian population. Still-Births. The total number of still-births allocated to the Borough during the year was 16. This figure represents 2.4 per cent, of the total births, and .45 per 1,000 civilian population, compared with .39 for London Administrative County and .42 for England and Wales. Deaths. The total number of deaths belonging to the Borough registered during 1948 was 423 consisting of 239 males and 184 females, giving a death rate per 1,000 population of 11.9. The total number of deaths for 1947 was 522. The comparable death rates in London and England and Wales during 1948 were 11.6 and 10.8 respectively. Comparative Statistics, 1941-1948. i 1943 1945 1946 1947 1948 1941 1942 1944 Population 30,280 28,420 27,830 26,740 27,990 33,400 35,120 35,640 Birth rate per 1,000 population) 14.8 15.9 16.7 16.0 16.9 20.6 22.2 18.9 24.7 17.9 17.5 19.9 15.6 14.9 11.9 Death rate (do.) 17.1 Maternal mortality (per 1,000 live births) 2.8 4.4 2.1 2.4 4.2 1.5 1.3 0.0 Death rate, infants under 1 (do.) 70.4 64.0 56.0 47.0 55.0 54.0 32.0 32.6 Death rate of illegitimate infants under 1 (per 1,000 illegitimate live births) 125.0 76.9 83.3 128.0 53.6 118.0 47.6 60.0 Still-births (percentage of total births) 4.0% 4.04% 2.92% 2.51% 2.7% 3.6% 1.6% 2.3% T.B. death rate per 1,000 inhabitants (all forms) 1.65 1.72 1.33 1.46 1.07 0.96 1.25 0.72 39 Illegitimate births 33 24 47 56 68 42 50 10 The following table shows the causes of, and ages at, death during the year 1948 :— Total all ages Cause of Death 0- 1- 5- 15- 45- 65- 1. Typhoid and Paratyphoid Fevers — — — — — — — 2. Cerebro-Spinal Fever — — — — — — — 3. Scarlet Fever — — — — — — — 4. Whooping Cough — — — — — — — 5. Diphtheria — — — — — — — 6. Tuberculosis of Respiratory System 23 11 10 2 — — — 3 1 1 1 7. Other forms of Tuberculosis — — — 5 4 1 8. Syphilitic Diseases — — — — 9. Influenza — — — — — — — 10. Measles — — — — — — — 11. Acute Polio-myelitis and Polio-Encephalitis — — — — — — — 12. Acute Infectious Encephalitis 1 1 — — — — — 13. Cancer of Buccal Cavity and Oesophagus and Uterus 6 1 5 — — — — 14. Cancer of Stomach and Duodenum 8 13 5 — — — — 4 15. Cancer of Breast 7 — — — 3 — 65 2 23 40 16. Cancer of all other sites — — — 17. Diabetes — — — — — — — 18. Intra-Cranial Vascular Lesions 1 8 24 33 — — — 91 3 17 71 19. Heart Disease — — — 20. Other diseases of circulatory System 18 2 16 — — — — 25 21. Bronchitis 36 1 1 9 — — 3 1 6 18 22. Pneumonia 28 — — 4 1 3 23. Other respiratory diseases — — — — 24. Ulcer of Stomach or Duodenum 6 4 2 — — — — 25. Diarrhoea under 2 years 1 1 — — — — — 26. Appendicitis — — — — — — — 8 3 3 2 27. Other digestive diseases — — — 28. Nephritis 6 2 2 2 — — — 29. Puerperal and Post-Abortive Sepsis — — — — — — — 30. Other maternal causes — — — — — — — 31. Premature birth 6 6 — — — — — 32. Cong. Malf. Birth Injuries. Infant Dis. 1 1 11 9 — — — 6 4 1 1 33. Suicide ... ... ... — — — 3 2 1 34. Road Traffic Accidents — — — — 35. Other Violent Causes 11 3 2 6 — — — 36. All other causes 32 2 2 2 9 17 — 13 1 22 64 135 M. 239 4 F. 184 9 1 1 11 49 113 2 33 113 423 22 Total —All Causes 5 248 11 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 and Foot Clinics. Attendances, &c., at Treatment Centres and Clinics. Clinic 1945 1946 1947 1948 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 1,572 701 10,244 1,774 721 11,121 1,949 740 830 1,563 394 91 13,298 12,062 2,136 Dental Clinic 1,298 4,967 1,506 5,747 1,742 6,735 1,026 7,086 423 527 724 Solarium 497 9,122 580 370 8,675 614 6,365 438 605 464 9,345 Women's Clinic 47 90 295 59 194 738 103 203 1,170 49 589 Totals 2,480 2,586 2,965 2,885 26,951 3,356 3,055 28,642 3,825 2,878 27,338 24,628 Laboratory. Routine examinations of swabs, sputum, milk samples, etc,, were continued to be carried out in the Laboratory and the following is a brief summary of the work undertaken— No. of throat and nasal swabs examined .. .. .. 502 No. of sputums examined for T.B... .. .. .. 389 Milk samples (Bacteriological examinations) .. .. 356 Other Pathological specimens examined .. .. .. 60 Ice cream samples .. .. .. .. .. .. 86 Blood Counts .. .. .. .. .. .. 82 Miscellaneous Food Samples .. .. .. .. 2 Samples of Well Water .. .. .. .. .. 8 Rectal Swabs and Faeces .. .. .. .. .. 116 The Council continued the arrangements whereby special examinations are undertaken by the Archway Group Laboratories by the L.C.C. Group Pathologist, Doctor J. M. Alston. 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. 12 Inquests. Inquests were held on 28 residents during the year, the findings being as follows :— Birth injury 1 Road Accidents 3 Misadventure 8 Violence 1 Peritonitis 3 Suicide 6 Broncho-pneumonia 2 Asphyxia 2 Heart Failure 2 Maternal Mortality. There were no maternal deaths during the year. Infantile Mortality. There were 22 deaths amongst infants under one year of age and the infant mortality rate based on 1,000 live births was 32.6. Of these deaths 12 occurred in the neo-natal period, three of the infant deaths occurred in illegitimate children and there were 6 deaths due to prematurity. The comparative infant mortality rates for London and England and Wales were 31 and 34 respectively. Infant Mortality Rates. 1942 1943 1944 1945 1946 1947 1948 Finsbury 64 56 47 55 54 32 32 London 60 58 61 53 41 37 31 England and Wales 49 49 46 46 43 41 34 Deaths in Relation to Disease. The number of deaths was nearly 100 less than in 1947. There were no deaths 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 large extent in the 65 years and over group. Of the total of 423 deaths, 248 occurred in the age group of 65 years and over. 13 The Services Referred to in the Rest of this Section were Transferred Under the National Health Service Act, 1946, on the 5th July, 1948. The Figures Given Relate to the Period 1st January, 1948 —31st July, 1948. Home and Domestic Helps. 391 cases were attended during this period. At the end of the period the panel of Home and Domestic Helps consisted of 4 regular persons and other part-time personnel. 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. Grants Scheme. 1,327 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 1s. 3d. per dinner for adults and 6d. per dinner for children under 5 years, and a further 2,399 dinners were provided under this scheme. 102 1bs. of Dried Milk were also issued to necessitous persons free of charge, and 3,702 1bs. 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 1947. Pine Street Leage Street 1947 1948 1947 1948 Mothers, Individual 60 18 41 17 Mothers, Attendances 69 19 43 22 Children (1-5 years) Individual Children (1-5 years) Attendances Babies, Individual 365 247 231 238 2,409 1,979 1,578 1,191 367 590 362 179 Babies, Attendances 6,080 1,774 3,635 3,266 14 Priority Dockets for Expectant Mothers. 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 enable expectant mothers, being confined at home, to obtain a supply of utility sheets. During the period, 39 vouchers were issued. Health Visiting. The regular visitation of expectant mothers and children under 5 years was continued by the Health Visitors and a total of 5,971 visits were made by the Council Staff in addition to visits made by the officers from certain Voluntary Centres in the borough. Voluntary Centres. The Council has continued grants to the undermentioned Voluntary Centres, and a brief outline of the work carried out at these centres is shown below : — No. of Attendances Institution No. of Child Welfare Clinics Held City of London Maternity Hospital 124 269 Claremont Central Mission 58 484 1,061 Maternity Nursing Association 82 Nurseries. Three day nurseries, with places for 155 children, were in operation in the Borough throughout this period. The following table shows the average daily attandances : — J an. Feb. Mar. May Jul. Apl. Jun. King Square 26 31 40 37 37 33 34 54 45 55 57 61 63 59 Lloyd Square 34 35 45 48 42 34 Banner Street 41 120 126 142 126 Total 119 137 131 Home Nursing. The arrangements continued 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. 15 National Milk and Vitamins Scheme. The Municipal and Voluntary Centres continued to operate as distributing points for vitamin products and national dried milk. 1,329 bottles of Cod Liver Oil, 5,420 bottles of orange juice and 211 Cod Liver Oil Capsules were issued during this period, 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 5½ 1bs. 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. 11 births were notified where the birth weight was 5½ 1bs. or less. 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 .. .. .. 75 (b) The City of London Maternity Hospital .. 23 (c) L.C.C, Emergency Maternity Homes .. 1 (d) St. Mary's (Islington) Hospital .. .. 27 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 Health Visitors. The following table shows the attendances at the various antenatal and post-natal clinics :— Health Centre City of Lon. Mat. Hosp. Royal Northern Hospital. St. Barts. Hospital. Ante Natal 842 325 175 1,439 Post Natal 32 20 30 Hospital Treatment. The arrangements between the Council and the Elizabeth Garrett Anderson Hospital for the retention of one cot have continued. Three children were admitted to Hospital under these arrangements. Admissions to other hospitals were also arranged. 16 Post Natal Clinic. A post-natal clinic previously inaugurated at the Health Centre continued in operation. Foster Parents. There was one registered foster mother in the Borough. Illegitimate 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. Convalescent Treatment. There were seven children admitted to Convalescent Homes by agreement with the Invalid Children's Aid Association. Three mothers and three children were sent for a fortnight's holiday through the Women's Holiday Fund. 17 SECTION C. Sanitary Circumstances. The following is a summary of work undertaken by the Sanitary Inspectors during 1948. Houses, damp, dirty or dilapidated, remedied 750 Doors, windows, floors, walls, ceilings, sashcords repaired 986 Overcrowding cases abated in other than Registered Houses 22 Illegal occupation of underground rooms 0 Water closet defects remedied 339 Water closets erected 154 Urinal defects remedied 18 Urinals erected 18 Soil pipe and ventilating shaft defects remedied 44 Soil pipe and ventilating shafts erected 6 4 Yard defects remedied 99 Waste pipe defects remedied 100 Waste pipes erected 89 Water cistern defects remedied 42 Accumulations of rubbish or manure removed 82 Dung or dust receptacles repaired or renewed 40 Drains relaid, amended or sealed 85 Drains cleared or tested 207 Rain water pipes cleared, repaired or renewed 83 Water supply to houses reinstated 19 Roofs and gutters repaired 294 Area defects remedied 61 Wash-house defects remedied 104 Animal nuisances abated 5 Infectious Disease Investigations 1 50 Stables cleansed or repaired 1 Smoke observations 118 Water supply laid on to upper storeys of house 10 Miscellaneous nuisances abated 260 Common Lodging Houses (visits) 26 Butchers Stalls, etc. (visits) 5,767 Street Traders Storage (visits) 229 Shops—lnspections 318 Shops—No. of notices 71 18 Sanitary Circumstances—continued. Public Houses cleansed or repaired 38 Public Houses—No. of inspections 64 Public Conveniences—Inspections 463 First visits (complaints, casual visits) 9,507 Re-visits 6,435 Intimation Notices served 1,061 Statutory Notices served 45 Canal Boats inspected 59 House inspections 1,581 House to house inspections 9 Complaints received 1,836 Verminous premises cleansed by Borough Council— Council property 163 Other property 114 Reception House. No person used the Reception House during 1948 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. Verminous Premises. During the year 163 premises were found to be verminous and disinfestation measures were carried out. In addition the treatment of the accommodation and furniture of new entrants to the Council's dwellings was systematically performed. 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. 1,705 treatments were given during the year to L.C.C. school-children and 329 treatments to adults and pre-school children. Home visiting of scabies cases and contacts was continued and the Nurse-in-charge of the Cleansing Station made 23 home visits during the year. Shops. The number of inspections made under the Shops Act, 1934 during 1948 was 249. 6 notices were served for contraventions. 19 Rag Flock. The number of samples of Rag Flock taken during the year was 3, all of which proved satisfactory. Canal Boats. The total number of canal boats inspected during the year was 59, none of which carried any offensive cargo. Contravention of statutory requirements had taken place in 30 instances. There 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 52 of whom 26 were of school age. 81 visits in addition were paid by the Health Visitors. Aged and Infirm Persons. One application was made and granted for the compulsory removal of an aged person who was unable to maintain herself in a proper state of health, or herself and room in a proper state of cleanliness. The application was carried out with the utmost tact and kindliness by the Police in the presence of the Medical Officer of Health. Aged persons known to the department are visited regularly and every effort is made to give them help and encouragement in looking after themselves. Active interest was shewn and help given to various voluntary organisations undertaking services, particularly dinners for aged persons. Arrangements have remained in force for providing nursing services through the Metropolitan District Nursing Association where these are required. Street Traders. At the end of 1948, 290 persons were licensed to engage in Street Trading of Foodstuffs within the Borough. 249 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 beds, situate at No. 88 Old Street, and the number of visits made by the Sanitary Inspector was 26. 20 Houses Let in Lodgings. At the end of the year there were 478 houses on the Register. These were regularly inspected and cleansing notices were served in accordance with the bye-laws but rigid enforcement was impossible owing to the difficulties prevailing in obtaining labour and materials. Rag and Bone Dealers. There are 7 premises within the Borough in which the business of Rag and Bone Dealer is carried on. 12 visits were made to these premises. Smoke Emission. 29 complaints were received during the year regarding excessive smoke emission. 118 smoke observations were made. Mortuary. 6 Bodies were received at the mortuary attached to the Health Centre premises. Disinfection. The following table gives particulars of the disinfection work carried out during 1948 :— Diphtheria 19 Measles 276 Vermin and Scabies 357 Scarlet Fever 69 Tuberculosis 32 Whooping Cough 50 Housing 106 St. Marks Hospital 33 Miscellaneous 105 By request 98 A total number of 12,572 articles were disinfected, being chiefly pillows, mattresses, bolsters, sheets, blankets and wearing apparel. In addition 445,618 articles were disinfected prior to Export and fees charged for this work amounted to £861. Offensive Trades. The following are licensed offensive trade premises : — (a) Messrs. Henson, 187 Whitecross Street, E.C.I. (b) Messrs. F. &W. Warman, Ltd., 5, Eagle Court, E.C.I. 21 (c) Messrs. T. Kendon & Sons, Charterhouse Mews, 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 1948 was 2,240 comprising 1,399 power factories and 841 non-power factories. 130 firms were added to and 91 removed from the register during the year. The following is a summary of defects found :— Number of Cases in which defects were found Found Referred To H.M. Inspector By H.M. Inspector Want of Cleanliness (S.1.) 47 1 5 Overcrowding (S.2.) - - - Unreasonable Temperature(S.3.) 1 - - Inadequate Ventilation (S.4.) 1 1 - Ineffective Drainage of floors (S.6.) - - - Sanitary Conveniences (S.7.) - - (a) Insufficient - - - (b) Unsuitable or defective 114 25 - (c) Not separate for sexes 3 1 - 9 Other Offences against the Act 38 12 204 13 41 Total 41 notices of complaint and 107 notices of occupation were received from H.M. Factory Inspector. 24 notices were sent to the Factory Inspector regarding the following matters : — Abstract absent .. .. .. .. 12 New occupation, notification .. .. 12 Lady Sanitary Inspector's Work. The following is a summary of visits made by the Lady Sanitary Inspector :— Factories .. .. .. .. .. .. 1,333 Outworkers premises (Sub-contractors) .. .. 175 Outworkers premises (domestic) .. .. 717 Number of Intimation Notices served .. .. 82 Number of Statutory Notices served .. .. 2 Miscellaneous visits .. .. .. .. 109 22 Outworkers. No. of Finsbury firms employing outworkers at the end of August, 1948 .. .. .. 236 Total number of outworkers employed by Finsbury firms .. .. .. .. .. .. 4.279 Number of outworkers resident in Finsbury .. 554 Rat Repression. No. of complaints and requests for treatment received .. .. .. .. .. .. 659 No. of additional premises found infested .. 270 No. of houses treated .. .. .. .. 730 No. of other premises treated .. .. .. 582 No. of visits made by rat-catchers to houses .. 5,033 To other premises .. .. .. .. .. 4,242 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. Fly Prevention and Control. During 1948 measures were taken for the prevention and control of the fly nuisance in the Borough ; for this purpose a campaign was inaugurated. A female operator was engaged and extensive treatment was undertaken during the months when the flies were most prevalent, May to October. The weather conditions were not such as to favour a fly nuisance, but it is felt that the undertaking was successful and a considerable amount of good achieved. Vacant sites, rubbish dumps, and likely breeding grounds, were dealt with and particular attention was given to restaurants and food premises. During the period the campaign was in operation, roughly 6 months, 424 visits were made to various premises ; 642 premises and 46 vacant sites, etc., treated. 23 SECTION D. Housing. Inspections. Hereunder will be found particulars of inspections carried out and action taken during the year :— (A) (I) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) .. .. .. .. .. 3,576 ( b) Number of inspections made for the purpose 3,933 (2) (a) Number of dwelling-houses (included under sub-head (I) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 .. .. .. .. 9 (b) No of inspections made for the purpose .. 16 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation .. .. .. o (4) Number of dwelling houses (exclusive of those referred to under the preceding subhead) found not to be in all respects reasonably fit for human habitation .. .. .. 1,061 (B) Number of dwelling houses rendered fit in consequence of informal action by the Local Authority or their officers .. .. .. 23 (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 .. .. .. .. .. o (2) Number of dwelling houses which were rendered fit after service of formal notices .. .. .. .. .. o (a) By Owners .. .. .. o (b) By Local Authority in default of Owners .. .. .. o 24 Housing —continued. (b) Proceedings under Public Health Acts :— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied .. .. .. 1,070 (2) Number of dwelling houses in which defects were remedied after service of formal notice — (a) By Owners .. .. .. 1,070 (b) By Local Authority in default of Owners .. .. .. .. o (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 5 (2) Number of dwelling-houses demolished in pursuance of demolition orders .. o (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 .. .. 5 (2) Number of separate tenements or underground rooms in respect of which closing orders were determined, the tenement or room having been rendered fit .. .. .. .. .. o Re-Housing. 104 families consisting of 379 persons were rehoused by the Council in premises requisitioned for the purpose. 20 families, consisting of 57 persons were accommodated in the Council's flats and 53 families consisting of 224 persons were rehoused by the London County Council, and 123 families consisting of 345 persons were rehoused in Co-operation with Local Agents. 25 SECTION E Inspection and Supervision of Food and Drugs. Analysis of Milk. During the year 206 samples of milk were submitted to the Public Analyst. 4 samples were found to be adulterated. Bacteriological Examination of Milk. 322 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 .. 9 Number of purveyors on the register at the end of 194 8 .. .. .. 115 Number of purveyors removed from the Register during the year .. .. .. .. .. 8 Number of purveyors on the Register at the end of 1947 .. .. .. .. .... .. .. .. ..114 Number of visits of inspection carried out .. .. 84 Milk (Special Designations) Regulations 1936-1944. Number of applications for licences received : — (a) Tuberculin Tested Milk—Dealers .. .. 26 (b) Pasteurised Milk—Dealers .. .. .. 38 (c) Pasteurisers .. .. .. .. .. 1 (d) Supplementary Licences .. .. .. 5 (e) Number of samples taken for examination .. 356 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 5 proved unsatisfactory and appropriate action was taken with satisfactory results. Milk in Schools. 37 samples of milk delivered to the Schools were taken during the year and submitted for bacteriological examination. All the samples proved satisfactory. 26 Food Poisoning. During the year there were 3 cases of Food Poisoning notified under the Food and Drugs Act, 1938, amongst Finsbury Residents. 4 outbreaks were investigated at premises in the borough, details as under, the larger number of cases being resident in other districts : Organisms or other agents responsible with No. of outbreaks of each Total No. of outbreaks No. of cases No. of deaths Food involved with No. of outbreaks of each 4 Nil approx. 170 Pressed Beef (one outbreak) Coagulase Positive Staphylococcus Serological Type IIIc Phage Type 6/47 (one outbreak) Others—no conclusions Others—no definite conclusions Details :- $ O 1 T-» .'il "\ 1. A luncheon club (30.8.48) approx. 35 Nil Coagulase Positive Staphylococcus Serological Type IIIc Phage Type 6/47 Pressed Beef (one outbreak) 2. A school (26.1.48) Nil Not known Not known approx. 58 3. A school (11.2.48) Nil approx. 48 Not known Not known 4. A school (29.9.48) approx. 29 Nil Not known Not known In addition to the outbreaks recorded the following incidents occurred :— (a) an infant aged 13 months was notified as suffering from enteritis caused by Salmonella Typhi-murium. No source of this infection was traced. (b) information was received that several members of a family suffered from diarrhoea after the consumption of some fish paste. The doctor, however, was not convinced that these were cases of true food poisoning and thought they might have been due to gastric influenza. Information was received too late to allow of satisfactory investigations being carried out. (c) information was received from 2 hospitals independently that both of two infants of one family were suffering from infection by Salmonella enterides. Investigations showed that the father had suffered from chronic diarrhoea for a year or more and that his stools on culture yielded a growth of this organism. He was admitted to Hospital and treated with streptomycin and his stools have since remained negative. Other investigations yielded no further information. 27 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. 82 visits of inspection were made during the year. Adulteration of Food. The total number of samples taken in 1948 under the Food and Drugs Act, 1938, was 750 of which 8 were formal samples and 742 informal. 10 informal and 1 formal sample were found to be adulterated. In one case a warning letter was sent. Pharmacy and Poisons Act, 1933. 45 applicants were approved during the year by the Council as Listed Sellers of Poisons and 45 visits were made. Salvage Division (Ministry of Food). Examination of foodstuffs have again been carried out in cooperation 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 1948 there were 90 registrations for the manufacture, sale or storage of Ice-cream. 119 visits of inspection were made and 83 samples of ice-cream were submitted for bacteriological examination with the following results—Very satisfactory—3 ; Satisfactory —54 ; Unsatisfactory —26. 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 53 Fried Fish Shops 12 Butchers Shops and Stalls 51 Other premises 28 Total 181 258 visits were made to these premises during the year. 28 Unsound Food. The work of meat inspection continues to be carried out by Mr. R. S. Barber, since the secondment of Mr. T. Penman, M.B.E., to the Ministry of Food. The work is mainly centred around the Smithfield Meat Market where there are a considerable number of wholesale meat and offal shops, bacon factories, wholesale bacon and provision warehouses and Public Cold Air Stores. Regular inspections of these premises were carried out as well as frequent visits to the retail butchers shops in the Borough. Summary of Foodstuffs seized by or surrendered to the Meat Inspector during 1948. Diseased or unsound meat 58,806 lbs. Diseased or unsound offals and other foodstuffs 45, 15 6 lbs. Total 103,962 lbs. Caseous Lymphadenitis. —From January to April the meat inspector examined for Caseous Lymphadenitis 120,000 carcases of Imported mutton and lamb which had been sent into the Borough for special examination. The carcases were originally consigned to the continent but arrived in this country instead and consequently to comply with the more stringent regulations in force in this country, they were treated as a special consignment. The examination of the whole of these carcases demonstrated that 15 per cent, were diseased and altogether 53 carcases and 5,208 parts of carcases were condemned for disease. Collection of Unsound Foods. —The condemned meat and offals are collected daily by the Sheppey Glue and Chemical Works, Ltd., Battersea. Slaughterhouses.—The slaughterhouse owned by Mr. J. A. Mobbs, 14 Penton Street, was closed down at the outbreak of war and no animals were slaughtered there during 1948. Export Certificates. A total of 78 certificatees were issued during the year and were mostly in respect of meat extracts from Australia, South America and Egypt. 29 SECTION F. Infectious and Other Diseases. Notification of Infectious Disease. The following table shows the notifiable cases of Infectious Disease during 1948, in various age groups and indicates the total number of cases removed to Hospital:— All ages Under 1 yr. 15- 25 yrs. 45- 65 yrs. 65 + Total Remvls. to Hosp. 25- 45 yrs. 1-5 yrs. 5-15 yrs. Acute Influenzal Pneumonia - - 1 1 12 6 - 54 2 2 1 45 - - 23 - - - - 147 - - - - - - - - 24 2 7 2 7 5 1 Acute Primary Pneumonia - 1 1 Cerebro-spinal Meningitis Diphtheria (Inc. Mem. Croup) - - - - - - 1 - 1 - - - - - 17 2 2 2 Dysentery 11 - - - Erysipelas 8 1 1 2 2 2 - - - Para-typhoid - - - - - - - Measles 441 24 281 130 5 1 - - 7 Ophthalmia Neonatorum 7 - - - - - - 3 Puerperal Fever 3 - - - - - - Puerperal Pyrexia 5 1 4 - - - - - 21 Scarlet Fever 63 1 37 3 1 - - 8 Pulmonary Tuberculosis 82 8 22 26 14 4 - Other forms of Tuberculosis 2 7 1 2 2 - - - Whooping Cough 141 19 88 34 - - - - 3 1 1 1 Food Poisoning - - - - Poliomyelitis - - - - - - - - 1 27 5 3 3 Scabies 40 1 - Malaria - - - - - - - - 56 26 8 Totals 843 422 242 39 50 Notification Rates (Comparative Table) per 1,000 population. 148 smaller towns, Res. population 25,000 to 50,000 at 1931 census 126C.B'S.& great towns including London England and Wales London Adm. County Finsbury Typhoid Fever 0.00 0.01 0.00 0.01 0.00 0.01 0.03 1.37 3.13 0.10 0.22 - 9.17 0.57 Paratyphoid Fever 0.00 0.01 0.01 0.01 Cerebro-spinal Fever 0.03 0.03 0.03 0.02 1.82 Scarlet Fever 1.21 1.73 1.90 Whooping Cough 3.11 3.42 3.51 3.31 Diphtheria 0.03 0.08 0.10 0.09 Erysipelas 0.22 0.21 0.23 0.21 Smallpox - - - - 12.37 9.75 8.84 Measles 9.34 Pneumonia 0.67 0.73 0.84 0.60 30 Smallpox and Vaccination. The Medical Officer of Health continued to occupy the appointment of Vaccination Officer until the sth July, when this appointment was abolished by the new Act. The following is a summary of proceedings under the Vaccination Acts, 1867 to 1898. (Figures given are up to the sth July when this service was taken over by the L.C.C.) Number of Finsbury birth notifications received from Registrar 151 Number of certificates of Primary Vaccination received 136 Postponements by medical certificate 1 Number of Finsbury babies not vaccinated within period of four months 142 Certificates of exemption granted after declaration 23 There were no cases of Smallpox. Scarlet Fever. The number of cases of scarlet fever notified during 1948 was 63, of which 45 were removed to Hospital. There were no deaths from this disease. Diphtheria. I case of diphtheria was notified and removed to Hospital. The Patient had been Immunised and the disease was of a very mild character. The following table shows the cases notified during the last ten years and the number of deaths. No. of cases notified No. of Deaths Year 1939 58 2 1940 27 2 1941 35 - 1942 19 1 1943 24 2 1944 10 - 1945 13 - 1946 6 - 6 1947 1 1948 1 - 31 The responsibility for securing the greatest degree of immunisation in Children was transferred to the London County Council on the sth July. Until that date intensive propaganda was continued. The number of children immunised up to the 5th July was 315. Whooping Cough. Notifications of whooping cough numbered 141. Prophylactic treatment has been continued in conjunction with diphtheria prophylaxis, and the number immunised to the 5th July was 174. Puerperal Fever and Puerperal Pyrexia. During 1948 there were 5 cases of puerperal pyrexia and 3 cases of puerperal fever notified in Finsbury, none of which proved fatal. This gives a rate per 1,000 Live and Still Births of 11.59 as compared with 6.89 for England and Wales, and 7.34 for the London Administrative County. Ophthalmia Neonatorum. The number of cases of Ophthalmia Neonatorum notified was 7. 5 of these cases were treated at home and 2 in hospital. Measles. Of the 441 cases which occurred 54 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 were no notifications during the year. Provision of Insulin. By virtue of Section 227 of the Public Health (London) Act, 1936, the borough continued to the end of the June quarter to bear the cost of treatment of diabetes in the case of necessitous persons. 6 persons received assistance at a cost to the Council of £26 18s. Id. Tuberculosis. The total number of new cases of tuberculosis, both pulmonary and non-pulmonary, entered in the Register in 1948 was 89. The age period details were as follows:— 39 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- - 3 2 1 5 4 11 7 6 7 4 Males Pulmonary - 5 3 2 5 8 5 3 - 1 - Females Pulmonary 1 Males Non-pulmonary - 1 1 - 2 - - - - - - Females Non-pulmonary - - - - - 2 - - - - 9 Total - 6 4 10 14 18 10 6 8 4 The number of cases removed from the Register during the year was 114 and those remaining on the Register of Notifications at the 31st December, 1948 were as follows:— Males Females Total Pulmonary 349 218 131 Non-pulmonary 35 37 72 253 168 421 The following is a summary of the Tuberculosis Dispensary work in 1948 : — Number of cases on Dispensary Register— Pulmonary 297 Non-pulmonary 47 Total 344 Sputum Positive Cases 164 Sputum Negative Cases 180 Cases notified from services 2 Transferred into Area 11 New Cases examined (other than contacts). Pulmonary Non-pulmonary Total (a) Definitely Tuberculous 80 7 87 (b) Diagnosis not completed - 29 29 (c) Non-Tuberculous 402 - 402 33 Contacts: (a) Definitely Tuberculous 7 — 7 (b) Diagnosis not completed 88 88 — (c) Non-tuberculous 77 — 77 172 Cases Written Off: (a) Recovered 34 (b) Diagnosis not confirmed 1 (c) Transferred out of Area 30 (d) Deaths 25 (c) Lost Sight of 11 101 Number of attendances at Dispensary 2,310 Home visits by Tuberculosis Officer 27 Visits made by Tuberculosis Visitor 546 Specimens of sputum examined 292 Number of patients attending for artificial pneumothorax refills 45 Number of refills given 454 X-Ray Department. Details of the work in the X-Ray department during 1948 are as follows:— Chest cases: Large films used 1,091 Small films used 163 Screen examinations 768 Other cases : Private Medical Practitioners 30 Physiotherapy Dept. 17 Day Nursery Staff 5 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 treatment, continued to operate smoothly 41 until 5th July. The Council's Tuberculosis Dispensary machinery was used for the institution of the necessary enquiries and for the presenting of the applications weekly to the Tuberculosis Assessment Officer. In addition to new cases, 230 cases were presented to the Assessment Officer for review. The total cash allowances paid out to 5th July was £1,305 IIs 9d. Provision of Extra Nourishment. The Borough Council continued to provide extra nourishment for certain types of tuberculous cases to the 5th July and 64 persons were granted extra nourishment. 35