AC 4341 LIBRARY FIN 30 THE Metropolitan Borough of Finsbury ANNUAL REPORT on the Public Health of Finsbury for the Year 1949 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. 1950 THE Metropolitan Borough of Finsbury ANNUAL REPORT on the Public Health of Finsbury for the Year 1949 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. 1950 2 HEALTH COMMITTEE Chairman : Councillor A. J. COMAN Vice — Chairman: Councillor Mrs. E. K. ALLEN Alderman Mrs. V. M. HEAPS „ C. H. SIMMONS, J.P., L.C.C. Councillor R. A. J. BENNETT „ Mrs. E. B. BROMFIELD „ C. S. BROWN „ Miss A. T. CALLAGHAN „ W. J. DAVIES „ H. DUNGER „ A. E. HAYNES „ E. I. JONES „ G. V. J. MARTIN „ W. O'LEARY „ J. W. TOZER Medical Officer of Health: C. O. S. Blyth Brooke, M.B., B.S., D.P.H., Barrister-at-Law. Deputy Medical Officer of Health: W. D. R. Thompson, M.R.C.S., L.R.C.P., D.P.H., Barrister-at-Law until 31st August, 1949 (by courtesy of Regional Hospital Board). Public Analyst: C. Harcourt Wordsworth, B.S.c 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. R. S. Barber, M.S.I.A., Barrister-at-Law A. J. Truslove, M.S.I.A. J. Lewis, M.R.San.I. E. Ditchburn, M.S.I.A. D. M. Warner, M.R.San.I. J. T. Midgley (Resigned 6th August, 1949) 3 Meat Inspector: T. Penman, M.B.E., M.S.I.A. (Seconded to Ministry of Food) Administrative and Clerical Staff: A. G. Holmes (Chief Clerk from 12.12.49) J. E. McDowell (Acting Chief Clerk until 9.5.49) Mrs. G. L. Rance (Acting Chief Clerk from 10.5.49 to 12.12.49, by courtesy of the Regional Hospital Board). Miss J. L. Faulkner Miss D. Wall (Resigned 16.7.49) Mrs. A. H. Bradford (From 13.9.49) J. Lindsay R. Robertson (With H.M. Forces) A. Phillips (Tem.). Cleansing Station Nurse and Visitor to the Aged: Mrs. D. I. M. Lloyd Infectious Disease Visitors : Mrs. V. C. Wilkinson (From 14.2.49 to 30.9.49). Mrs. R. Pepper (From 1.10.49) Resident Engineer and Health Centre Keeper : F. W. Battle 4 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 1949 of the work of the Public Health Department. This report is prepared as in recent years in an abbreviated form in accordance with instructions given by the Ministry of Health. 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. Although full information as to changes in the age and sex constitution of the population will not be available until the results of the next census are known, some preliminary investigations have been conducted by the Registrar General and I would like to direct attention to his conclusions as set out in the report. Not only do they confirm local estimates of the large number of persons of the older age groups now living, but also show the tremendous changes that have occurred since the beginning of the century in the age structure of society which now has far fewer children to support, but so many more elderly persons. These changes are of far reaching social-economic significance, and their import has as yet not been fully realized. Vast as these changes have been throughout the country they are shown to have been even greater in Finsbury than elsewhere. The Percentage increase in the proportion of those over 65 to those between 15 and 65 who maintain the life of the nation has been 116 in England and Wales, 147 in London as a whole, and 181 in this Borough. There has been little change in the Birth and Death rates which were 18·6 and 13·7 respectively. Last year I referred to the high proportion of illegitimate births. In 1948 the percentage of all live births rose to 7·4 after falling from the high 1945 War Time peak of 11·9 to 5·4 in 1947, whereas in England and Wales the rate fell from 9·3 in 1945 to 5·3 in 1947 and 5·4 in 1948, and in London as a whole it fell from 11·3 in 1945 to 6·7 in 1947 and 7·0 in 1948. In 1949 the percentage in Finsbury 5 again rose to 7·7 whilst that for the country generally fell to 5·0: and for London to 6·9 It should be recognised that these figures are not by any means necessarily an index of morality, nor do they constitute the serious threat to infant life that they once did. Nevertheless, infant mortality is still appreciably higher for illegitimate infants than for others, and over and above the threat to life there can be no doubt that such children face life with many handicaps that hinder their full physical and mental development. Consequently I cannot regard the rate but with considerable concern from the standpoint of Public Health. The Tuberculosis Death Rate again fell and was 0·56 per thousand. The incidence of all infectious diseases except Pneumonia and Whooping Cough was lower than the average for either London or the whole country, and the rate for Pneumonia was only slightly higher than these averages, and for Whooping Cough although slightly more than that for London was lower than that for England and Wales. In the substance of the report, I have referred at length to the milestone reached in Finsbury when for the first time there was no case of Diphtheria during the year. Several outbreaks of Food Poisoning occurred but none were serious. The problem of carriers arose on more than one occasion. Investigations in one case produced some evidence than hens kept under unsuitable conditions might have been a source of infection and the results were published in the Ministry of Health Bulletin. A feature of the year's work was the inauguration of a holiday scheme for aged persons whereby a fortnight's holiday at the seaside or in the country was made available to all men in the Borough above 65 and women above 60 at, in nearly all cases, a cost of 10/- a week to the individual. This was arranged through grants to voluntary organisations maintaining suitable Holiday Homes. The scheme proved very successful and it is believed has helped many to retain health of body and vigour of mind, as well as having provided much pleasure. The sanitary conditions generally remained reasonably satisfactory though many open sites still remain an eyesore and also a 6 potential danger to health by the deposit on them of refuse. There was some improvement in the outward appearance of property which mitigated the drab aspect of some areas and in the interior decorations which removed some of the cheerlessness of many of the homes. The completion and occupation of the first parts of the Council's post war building scheme on the Spa Green Estate in Roseberry Avenue was an event of outstanding happiness to all, stirring up our hopes for the eventual day when Finsbury will be transformed into a Borough with good housing conditions, cheerful surroundings and happy homes. 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. 7 SECTION A. Vital Statistics. Area. The area of the Borough is 587 acres. Population. The Registrar-General's mid-year estimate is: Civilian Population 36,010 Total Population 36,060 In order to provide reliable information as to the age and sex distribution of the population, which was known to have changed very considerably since the 1931 census, before the analysis of the 1951 census could be made available, the Registrar-General prepared an estimate of this data on December 31st, 1947 on the basis of Food Office returns and other reports in his possession. The tables for each area were published during the year and may be accepted provisionally as reliable for the year 1948. The population of Finsbury is given as 35,370 distributed in the following way:— Males Females Total 0-4 1,433 1,363 2,796 5-14 2,156 2,064 4,220 15-17 736 814 1,550 18-19 243 675 918 20-24 1,195 1,550 2,745 25-34 2,963 2,878 5,841 35-44 2,544 2,484 5,028 45-54 2,152 2,461 4,613 55-64 1,664 2,038 3,702 55-59 — (1,089) (1,089) 60-64 — (949) (949) 65-74 1,224 1,574 2,798 75-84 388 641 1,029 85 and over 41 89 130 Total 16,739 18,631 35,370 8 The significant changes which have occurred since the beginning of the century in the age-constitution of the population and which have been suspected are here confirmed. Chart i shows the population of Finsbury in 1901 and 1948, and from it, it is seen that the great drop in population from 102,000 to 35,000 has been entirely among those of the lower age groups, and that there are actually more persons over 65 now than in 1901. Chart 2 demonstrates the changed age character of the population during the period under consideration. The following figures illustrate the increase in the proportion of the population of those aged 65 and over. It is seen that whereas in 1901 this was in Finsbury below the general average for London and the rest of the country, now it is slightly above the corresponding figures. In consequence the rate of increase has been much higher in Finsbury than in most other areas. Finsbury London England and Wales Proportion of Population aged over 65: per cent. per cent. per cent. 1901 3.1 4.1 4.7 1948 11.2 10.8 10.9 Percentage Increase from 1901 to 1948 261 163 132 Live Births. The total number of live births belonging to the Borough was 671 including 52 illegitimate births and consisting of 355 males and 316 females, giving a rate of 18.6 per 1,000 civilian population. The birth rate for England and Wales was 16.7 per 1,000 total population and 18.5 per 1,000 civilian population. Stillbirths. The total number of stillbirths allocated to the Borough during the year was 16. This figure represents 2.3 per cent of the total births compared with a similar figure for England and Wales and 2.0 per cent for the administrative County of London. Expressed as a proportion of the population the figures are 0.44 per 1,000 civilian population for Finsbury as against 0.37 for the Administrative County of London and 0.39 for England and Wales (total population). 9 CHART I Population of Finsbury by Age Groups 1901 and 1948 10 CHART II Proportion of Persons in several Age Groups—5 yearly. 1901 and 1948 15% 11 They were distributed by sex and legitimacy as follows:— Legitimate Illegitimate Total Males 9 2 11 Females 5 — 5 Total 14 2 16 Deaths. The total number of deaths belonging to the Borough registered during 1949 was 494, consisting of 271 males and 223 females, giving a general death rate of 13·7 per thousand of the civilian population. The corresponding rate in the Administrative County of London was 12·2, and of the total population of England and Wales was 11·7. Comparative Statistics, 1943-1949. 1943 1944 1945 1946 1947 1948 1949 Population 27,830 26,740 27,990 33,400 35,120 35,640 36,010 Birth rate per 1,000 population) 16.7 16.0 16.9 20.6 22.2 18.9 18.6 Death rate (do.) 17.5 19.9 17.1 15.6 14.9 11.9 13.7 Maternal mortality (per 1,000 live births) 2.1 2.4 4.2 1.5 1.3 0.0 3.0 Death rate, infants under 1 (do.) 56.0 47.0 55.0 54.0 32.0 32.6 25.3 Death rate of illegitimate infants under 1 (per 1,000 illegitimate live births) 83.3 128.0 53.6 118.0 47.6 60.0 76.9 Still-births (percentage of total births) 2.92 2.51 2.7 3.6 1.6 2.3 2.3 T.B. death rate per 1,000 inhabitants (all forms) 1.33 1.46 1.07 0.96 1.25 0.72 0.56 Illegitimate births 24 47 56 68 42 50 52 12 1949 Table of Causes of, and Ages, at Death. Cause of Death Total all ages 0- 1- 5- 15- 45- 65- 1. Typhoid and Paratyphoid Fevers - - - - - - - 2. Cerebro-Spinal Fever 1 - - - - 1 - 3. Scarlet Fever - - - - - - - 4. Whooping Cough - - - - - - - 5. Diphtheria - - - - - - - 6. Tuberculosis of Respiratory System 20 - - - 8 8 4 7. Other forms of Tuberculosis — - - - - - - 8. Syphilitic Diseases 5 — - - - 2 3 9. Influenza 4 1 - - 1 — 2 10. Measles - - - - - - - 11. Acute Polio-myelitis and Polio-Encephalitis - - - - - - - 12. Acute Infectious Encephalitis - - - - - - - 13. Cancer of Buccal Cavity and Oesophagus and Uterus 6 - - - - 2 4 14. Cancer of Stomach and Duodenum 17 - - - - 7 10 15. Cancer of Breast 5 — - - — 2 3 16. Cancer of all other sites 64 — 1 - 6 18 39 17. Diabetes 4 - - - - 2 2 18. Intra-Cranial Vascular Lesions 45 - - - - 6 39 19. Heart Disease 137 — - - 8 30 99 20. Other diseases of circulatory System 32 - - - - 7 25 21. Bronchitis 40 - - - 2 10 28 22. Pneumonia 33 4 1 - — 10 18 23. Other respiratory diseases 6 - - - - 4 2 24. Ulcer of Stomach or Duodenum 7 - - - - 4 3 25. Diarrhoea under 2 years 1 1 - - - - - 26. Appendicitis 1 - - - - - 1 27. Other digestive diseases 8 — 1 - — 1 6 28. Nephritis 8 — - - 2 3 3 29. Puerperal and Post-Abortive Sepsis 1 - - - 1 - - 30. Other maternal causes 1 - - - 1 - - 31. Premature birth 5 5 - - - - - 32. Cong. Malf. Birth Injuries, Infant Dis. 5 4 - - 1 - - 33. Suicide 6 — - — 1 2 3 34. Road Traffic Accidents 4 — 2 — — 1 1 35. Other Violent Causes 7 1 — - 1 2 3 36. All other causes 21 1 - — 1 4 15 M. 271 10 2 - 19 76 164 F. 223 7 3 — 14 50 149 Total—All Causes 494 17 5 — 33 126 313 13 The main feature displayed by this table is that the increase in the number of deaths during 1949 was among those over 65. The deaths from the notifiable infectious diseases and maternal causes as well as those under 1 are referred to elsewhere in this report. There were 4 deaths certified to be from Influenza: there was, however, no epidemic during the year. There were 4 deaths from diabetes, these were all among the older age groups over 45. It is unfortunate to record 4 deaths (2 among those aged 1-5, one 15-45, and one over 65) from Road Traffic Accidents. Deaths from cancer were practically the same number as in the previous year. There were 5 deaths among those aged 1-5. Two of these were from Road Accidents (already referred to) and 1 each from Pneumonia, digestive diseases and cancer. Maternal Mortality. There were two maternal deaths during the year. One was in a woman aged 42 and was certified by the Coroner without inquest to be from cardiac failure due to infected abortion (Natural), and the other in a woman aged 23 from eclampsia. The maternal mortality rate was 3.0 per 1,000 (alive and stillbirths). Inquests. Inquests were held on 18 residents during the year. The causes of death found were:— Natural Causes 2 Road Accidents— (Males, 48, 3 and 2, and Female, 75) 4 Accidental Falls— (Females 83, 83, 73 and 63) 4 Industrial Accidents— (Male 30) 1 Asphyxia due to inhalation of vomit— (Male, 5 months) 1 14 Suicide— (Males, 78 (Drowning), 78 (Coal Gas Poisoning), 77 and 49 (Aspirin poisoning), 48 (Lysol Poisoning), and 36 (Fall from roof) 6 Infant Mortality. There were 17 deaths amongst infants under one year of age and the Infant Mortality rate based on 1,000 live births was 25·3. Of these deaths 12 occurred in the neonatal period, 4 occurred in illegitimate children all in the neonatal period. The neonatal mortality rate was 17·9. The comparative infant mortality rates for London and England and Wales were 29 and 32 respectively. The causes of death were:— Prematurity: (All at ages of less than 1 day) 5 Pneumonia: (At ages of ii, 7, and 4 months, 2 weeks) 4 Birth Injuries: (At ages of 1 week, 1 day, and 5 minutes) 3 Congenital Malformations: (At the age of 23 days) 1 Gastro enteritis: (At the age of 4 months) 1 Influenzal Pneumonia: (At the age of 1 month) 1 Meningitis (B.Coli): (At the age of 5 days) 1 Inhalation Asphyxia: (At the age of 5 months) 1 15 SECTION B General Provision of Health Services Health Centre. The Council continued to maintain the Health Centre for the administration of the Public Health Services, and arrangements continued in force for the use by the Regional Hospital Board and by the London County Council of these portions of the building which were occupied by services transferred to those bodies under the National Health Service Act, 1946. The Council also continued to act as an agent for the Regional Hospital Board in respect of certain services controlled by them. Laboratory. The Laboratory serves the needs of the Public Health Department in the control of Infectious Disease and the bacterial cleanliness of foodstuffs. The work was carried out by the laboratory technician who was transferred to the Regional Hospital Board, and has operated in close association with the Public Health Laboratory service Laboratories in Colindale. It has also undertaken work on behalf of the Regional Hospital Board. In some cases special examinations have been carried out by arrangement with the Archway Group Laboratories. Works of the Public Health Departmental Throat and Nose Swabs for Diphtheria Number positive Total number examined 0 302 836 Sputums for Tubercle Bacilli 83 466 Post nasal swabs and/or cough Plates for H. Pertussis 0 1 Faeces and Rectal Swabs for Salmonella, etc. 6 67 16  Number unsatisfactory r poor Milk—Pasteurised 1 2 305 494 Heat Treated 1 0 30 Tuberculin Tested Pasteurised 0 1 25 Sterilised 0 0 44 Ice Cream 9 13 90 Other foods 34 98 Water—Wells 9 Tanks 4 Swimming Bath 5 Various 46 Total 1,428 Work of the Regional Hospital Board. For General Practitioners For Various Clinics Total Blood Counts 39 61 100 Blood Sedimentation Rate estimations - 18 18 Urine examinations 14 13 27 Various 1 27 28 Total 173 Blood Transfusion. The Council continued to co-operate with the North London Blood Supply Deport of the National Blood Transfusion Service, by arranging Blood Donation Sessions at the Health Centre. Two sessions were held during the year. Health Education. This was continued during the year by the exhibition of Public Posters and by the distribution of literature from suitable centres. It may also be said that the character of the Health Centre building which houses the Public Health Department was designed to inspire the conception of Health among the many members of the Public who use it for one purpose or another. 17 Aged Persons. The Council continued its very active interest in the Health and Welfare of that section of the community comprised of men over 65 and women over 60. Those known to the department were visited regularly according as their needs were known and every effort was made to give them help and encouragement in looking after themselves. Arrangements remained in force for providing nursing services through the Metropolitan District Nursing Association where these are certified on behalf of the Council as being required. 1,487 visits were paid in this connection during the year. Difficulties arose frequently owing to the shortage of hospital accommodation in securing admission to an institution when proper care was not obtainable at home. This caused many distressing circumstances to arise as many old persons live alone and have no one to care for them in the event of illness. There is an urgent need for the provision of sick bays where such persons may stay for short periods to receive attention during minor illnesses as well as for further hospital provision for more serious cases. Were this available I believe many persons would be saved from permanent sickness which results partly from failure to have proper care in the early stages of diseases such as Acute Bronchitis and Influenza. It was not found necessary to make any application under the National Assistance Act for compulsory removal during the year. The Council encouraged all Voluntary Organisations in the Borough to extend the services for meals and recreation. Grants were made on the basis of reports made to the Council on the work of each society and amounted in all to £337 10s. od. between five organisations. In the summer a new service was brought into operation designed to preserve the health of the elderly by allowing those sufficiently strong to benefit from a stay of 2 weeks in the country or at the seaside. Applications were invited by public announcement and through variously interested clubs and societies, and these were 18 made to the Department. Each applicant was required to contribute a small amount towards the cost, normally 10s. 0d., but varied slightly in 11 cases. Arrangements were then made for the holiday at one or other of the four following holiday homes:— Eastwood Lodge, Rayleigh, Essex. Fairlawn, Herne Bay. Singholm, Walton-on-the-Naze. Whitechapel Mission Holiday Home, Southend. A grant was made to each of these homes to cover the cost including the railway fare and their necessary travelling expenses, less that amount which the individual was required to contribute. In this way a holiday was provided for 121 persons comprising 6 married couples, 33 men and 76 women, at a total cost to the Council of £550. A number of minor difficulties were experienced in the initiation of the Scheme, some of them due to the fact that it was already late before the details were formulated and approved. On the whole, however, the Scheme proved an unqualified success as was evidenced by the large number of appreciative letters received, and in other ways. I am more than satisfied that the arrangements not only brought much pleasure to many elderly and perhaps lonely persons but aided materially in maintaining their physical and mental health. 19 SECTION C. Sanitary Circumstances. Water. The Borough is freely supplied with water by the Metropolitan Water Board. As this supply is under continuous control no examinations were made of this water. In addition there are 3 wells in use in the Borough. Samples of water from these wells have been regularly examined and have been found consistently satisfactory. There are also certain other wells but these are not normally used. Swimming Baths. There are 4 indoor swimming baths in the Borough, 3 of which belong to the Council all of which maintain regular chlorination of the water. Bacteriological examination has shown an almost complete freedom from contamination. Sanitary Conditions. The Sanitary conditions of the Borough were subject to routine inspection and investigations were made into the circumstances of all complaints made. The work undertaken apart from that detailed elsewhere in this report is summarized in the following table:— Sanitary Conditions. The following is a summary of work undertaken by the Sanitary Inspectors during 1949. Houses, damp, dirty or dilapidated, remedied 955 Doors, windows, floors, walls, ceilings, sashcords repaired 1,062 Overcrowding cases abated in other than Registered Houses 66 Water closet defects remedied 237 Water closets erected 200 Urinal defects remedied 35 Urinals erected 17 Soil pipe and ventilating shaft defects remedied 40 20 Sanitary Conditions—continued Soil pipe and ventilating shafts erected 54 Yard defects remedied 47 Waste pipe defects remedied 183 Waste pipes erected 111 Water cistern defects remedied 102 Accumulations of rubbish or manure removed 151 Dung or dust receptacles repaired or renewed 55 Drains relaid, amended or sealed 119 Drains cleared or tested 241 Rain water pipes cleared, repaired or renewed 48 Water supply to houses reinstated 13 Roofs and gutters repaired 610 Area defects remedied 45 Wash-house defects remedied 42 Animal nuisances abated 4 Stables cleansed or repaired 3 Water supply laid on to upper storeys of house 18 Miscellaneous nuisances abated 206 Public Conveniences—Inspections 417 First visits (complaints, casual visits) 7,375 Re-visits 7,346 Intimation Notices served 1,315 Nuisance Notices served 77 House inspections 2,461 Complaints received 2,585 Nuisance Notices were served in all instances where necessary but in most cases co-operation with owners by informal approach and the service of Intimation Notices secured the abatement of nuisances and in addition on many occasions other improvements in living conditions. In a number of cases time, additional to that provided for in notices had to be allowed owing to such circumstances as shortage of material and of labour. It was frequently found that landlords were willing to comply with requirements but experienced delay in securing builders to execute the necessary works. 21 Legal proceedings instituted under the Public Health (London) Act, 1936 for non-compliance with Nuisance Notices only occurred in the cases set out in the following table:— Date Premises Offence Result 12.9.49 2, Culpeper Street Failing to abate nuisances. Costs £3 3s. 0d. Order to do the work within 28 days. 14.9.49 12, Calshot Street do. Costs £1 1s. 0d. Order to do the work within 14 days. 14.9.49 16, Calshot Street do. Costs £1 1s. 0d. 14.9.49 18, Calshot Street do. Costs £1 1s. 0d. 14.9.49 18, Calshot Street do. Costs £1 1s. 0d. 14.12.49 14, Calshot Street do. Costs £1 1s. 0d. Order to do the work within 14 days. 14.12.49 16, Calshot Street do. Costs £1 1s. 0d. 14.12.49 18, Calshot Street Failing to comply with a Court Order. Fine £5. Costs £2 2s. 0d. 14.12.49 22, Shene Street Failing to abate nuisances. Costs £1 1s. 0d. Order to do the work within 14 days. 14.12.49 23, Shene Street do. Costs £1 1s. 0d. Order to do the work within 14 days. 20.12.49 50, Killick Street do. Costs £3 0s. 0d. Order to do the work within 14 days. Much of the property remains in a dilapidated and outworn condition. A considerable improvement was, however, effected during the year although this may not be very apparent from the outside. An attempt was made to improve the cleanliness and hygienic condition of the courtyards and areas of one large block of tenement buildings where the tenants had been guilty of throwing rubbish out of the windows, and other careless and untidy habits, by circulating a personal appeal to each one. It was felt that the result was to some extent successful. The dreary and desolate character of many parts of the Borough was enhanced by the frequent deposit of rubble and rubbish on 22 vacant sites which was difficult to control. The presence of harmless rubbish on vacant ground apart from being unsightly leads to the dumping thereon of vegetable and other refuse which may well constitute a danger to health, especially for children who play there. When such deposits were recognised as likely to be injurious to health they were removed by the Council. Common Lodging Houses. The only common Lodging House is that situated at 88, Old Street, which is licensed for 348 beds. Nineteen visits of inspection were made. Canal Boats. The City Basin has now been closed and canal boats do not normally halt during their passage along the short stretch of canal in Borough. No inspections were made of any boats. Shops. The number of inspections made under the Shops Act, 1934, during 1949 was 162, and 25 Notices were served for contraventions. Rag and Bone Dealers. There are 7 premises within the Borough in which this type of business is conducted. Twelve visits were made to these premises. Rag Flock. Two samples were taken during the year, both of which proved satisfactory. Offensive Trades. The following premises were licensed for the purpose of carrying on offensive trades:— (a) Messrs. Henson, 187, Whitecross Street, E.C.i. (b) Messrs. F. & W. Warman, Ltd., 5, Eagle Court, E.C.i. (c) Messrs. T. Kendon & Sons, Charterhouse Mews, E.C.i. (1i) Messrs. Reubens, Ltd., 71/73, St. John Street, E.C.i. All were regularly visited. Numerous complaints were received in respect of the last named in respect of smells, flies and maggots. Assistance in the investigations was given by one of the leading 23 experts of the Natural History Museum, and it was established that the trade in skins carried on was responsible for the breeding of flies. The licensed expired in the summer and the firm having obtained other premises, no application was made for its renewal. Factories. A register of Factories is maintained which indicates which are designated "Power" and which "Non-Power" Factories. Power: Number added to the Register during 1949 86 Number removed from the Register during 1949 81 Number on Register at end of 1949 1,405 Number Employed—13,064 men, 14,389 women—27,453 Persons. Non-Power: Number added to the Register during 1949 8 Number removed from the Register during 1949 24 Number on Register at end of 1949 824 Number Employed—1,464 men, 775 women,—2,239 Persons. Total Number on Register at end of 1949 2,229 Total Number Employed—14,528 men, 15,164 women—29,692 Persons. These factories were visited and inspected when first registered as regards those matters which are the responsibility of the Borough Council. They have been further inspected on receipt of complaints and as far as possible at regular intervals. It has not been possible to visit each factory every year. The general standard of Hygiene and compliance with legal requirements was found to be very good and only occasionally were defects, as set out below, discovered. In such cases notices were served. Number of Inspections—Power Factories 1,047 —Non-Power Factories 149 —Total 1,196 24 Number of complaints received from H.M. Inspector of Factories 44 Number of complaints received from others 27 Number of Defects discovered:— Want of cleanliness 45 Unreasonable temperature 1 In relation to Sanitary Conveniences 83 Various 18 Total 147 Number of Notices served 65 No prosecutions were instituted during the year. Number of notices sent to H.M. Inspector of Factories 12 (The information given here is exclusive of Bakeries and certain other premises which are referred to elsewhere in this report.) Outworkers. Number of firms in the Borough who employ outworkers 234 Number of notifications received of:— 1. Finsbury outworkers employed by Finsbury Firms 520 2. Outworkers in other districts employed by bury Firms 3,988 3. Finsbury outworkers employed by Firms in other districts 167 Total number of notifications received in respect of:— 1. Finsbury outworkers employed 687 2. Outworkers employed by Finsbury Firms 4,508 Outworkers who are sub-contractors are normally occupiers of Premises registered as Factories and inspected as such. Domestic outworkers are visited in their homes to ensure that work is not carried out in unsuitable surroundings. Number of visits to Domestic outworkers 870 Number of notices served in respect of unsatisfactory conditions 21 25 Smoke Abatement. Ten complaints were received and 70 observations made during the year in regard to smoke emission. No notices were served. Generally speaking I am of opinion that there has been some diminution of atmospheric pollution in recent years. Verminous Premises and Articles. During the year 427 premises (189 of which were Council or requisitioned property) were found to be verminous, and disinfestation measures were carried out. Similar measures have been carried out on certain other occasions on request. In all Disinfestation measures were carried out in 500 premises. The measures adopted have been the spraying of the room thoroughly with a D.D.T. Solution on one occasion, and the steam disinfection of the bedding in most cases and whenever considered necessary. As a routine measure for the control of vermin, disinfestation is carried out in the case of tenants moving into the Council's Housing Estates (other than Spa Green Estate), or requisitioned property. This was carried out on 316 occasions during the year. The normal routine is for old accommodation of the prospective tenant to be sprayed with a D.D.T. Solution some days before the removal, and at the same time for the proposed new accommodation to be treated in the same way. On the day of removal bedding is collected from the old address, steam disinfected in the Council's ovens, and then removed to the new premises. In the case of Spa Green Estate the Council has entered into arrangements for the furniture and effects to be treated with hydrogen cyanide gas before removal to the Estate. Verminous Persons. The Borough Council continued the operation of the Cleansing Station in the Health Centre for the treatment of verminous conditions, and the arrangements whereby school children were treated on behalf of the London County Council under the supervision of 26 a nurse appointed by them. At other times the work was carried out under the supervision of the nurse appointed by the Borough, who also undertook the Home Visiting. Arrangements were also made during the year by which cases were treated on behalf of the Shoreditch Borough Council. The Service has worked very satisfactorily, but owing to the very small incidence of these conditions, the total numbers have been small. Total number of treatments given to Finsbury cases (other than school children) 52 Total number of treatments given to Shoreditch cases (other than school children) 12 Total number of treatments given to School children 1,118 Total number of Home Visits paid 18 Rodent Control. This service was continued under the supervision of the Senior Sanitary Inspector who is designated Rodent Officer. A foreman and rodent operatives have been employed. These is undoubtedly considerable infestation in the Borough and in the sewers, but this is certainly much less than it was some years ago. Without continued attention it would grow very rapidly into a serious menace once again. Number of complaints and requests for treatment received 747 Number of additional premises found infested 292 Number of houses treated 787 Number of other premises treated 355 Number of visits made to houses 4,445 Number of visits made to other premises 3,980 Number of treatments of sewers carried out 2 Reception House. The Reception House which is maintained by the Council in the Health Centre, was used on two occasions during the year for persons who could not remain in their rooms whilst these were being cleansed and repaired. In one case by one elderly man, and in the other by a husband, wife and five children. 27 Disinfection. Disinfection is carried out in all cases after infectious disease has occurred when this is considered necessary, and in other casese on request generally after advice has been given that it would be advisable for it to be carried out. During the year it was carried out in the following instances for the reasons set out:— Suspected Diphtheria 5 Suspected Scarlet Fever 43 Suspected Measles 73 Suspected Whooping Cough 23 Tuberculosis 28 Scabies 1 On behalf of St. Marks and other Hospitals 31 Miscellaneous 253 Bedding and clothing were brought to Disinfecting Station in the Health Centre in these cases, and disinfected with steam. In all, including the cases where this was carried out for the control of vermin, 13,011 articles were treated. Goods, mostly clothing, were also disinfected on behalf of certain export firms as follows:— Number of articles 727,371 Number of times disinfecting plant charged 897 Mortuary. The mortuary attached to the Health Centre remained available for the reception of bodies throughout the year: no bodies were however received. This mortuary is primarily intended for the isolation of the bodies of those dying from infectious disease and the early removal from overcrowded rooms of the bodies of those dying from other conditions when this cannot otherwise be effected. At the present time other facilities are usually made available by undertakers and there have been no deaths from any serious infectious disease. It is, however, of great value to have this provision for use in an emergency. 28 SECTION D. Housing. General. It is estimated that there are 9,890 houses in the Borough. Unfortunately a very considerable proportion are dilapidated and outworn, and incapable at a reasonable expense of being reconditioned to comply with modern standards. Deterioration is proceeding almost as rapidly as temporary improvements can be effected. Nevertheless it can be accepted that there was some betterment during the year. Again much of the property was built many years ago and is unsuitable for conversion into the type of accommodation that it is desired to provide at the present time. Until such time as demolition and rebuilding can be carried out on an extensive scale, it is clear that every effort must be exercised to preserve houses wherever possible and prevent the falling off of even those amenities that are available to residents. Most of the work to secure this has been undertaken under the Public Health Act by informal action. Proceedings under the Housing Act. No representations were made and no notices served under Section 9 and 10 of the Housing Act, 1936 requiring notices to be served. 163 House to House inspections were carried out. Two representations were made under Section 11 that premises were unfit for habitation and could not at a reasonable expense be made fit as follows:— 1. In respect of a tenement house. The representation was agreed by the Council, proposals by theowners not having been accepted, and a Demolition Order was made, but the house had not been demolished by the end of the year. 2. In respect of buildings comprising 60 tenements. This was under consideration by the Council at the end of the year. Closing orders were made in respect of 5 flats being part of a large block which had been the subject of representations made previously. 29 One new representation was made in respect of an underground room, but no closing order was made by the Council. Tabular Statement prepared in accordance with the Housing Consolidated Regulations, 1932. Number of Houses considered on inspection to be unfit for human habitation 3† Number of Houses wherein defects were remedied by informal action Nil. Number of Representations made with a view to: (a) serving notices requiring the execution of works Nil. (b) making demolition or closing orders 3† Number of Notices served requiring the execution of repairs Nil. Number of Houses rendered fit after service of notices Nil. Number of demolition or closing orders made 6* Number of Houses in respect of which undertakings were accepted Nil. Number of Houses Demolished Nil. * Includes 5 in respect of representations made previously. † One of these was in respect of a block of 60 flats. Houses let in Lodgings. The register constructed in 1935 was maintained and at the end of the year contained entries in relation to 456 houses. No action was taken during the year under the Byelaws applicable to them. Housing. This year an appreciable amount of fresh housing accommodation became available to relieve the overcrowding in the Borough. Below is a list of the new properties which have been completed since the war:— 30 Finsbury Borough Council Number of Flats Completed Spa Green Estate:— Wells House 48 12. 2.49 Sadler House 33 23. 6.49 Tunbridge House 48 13.12.49 London County Council Percival Street Estate:— Tompion House 80 12. 5.48 Earnshaw House 10 11. 3.49 Private Enterprise Cable House, Lloyd Street 16 13.10.48 Proposals in regard to the erection of further accommodation include:— Busaco Street Scheme 361 by Finsbury Borough Council. Holford Square Scheme 134 „ Killick Street Scheme 24 ,, Wilmington Square Scheme8 „ Farringdon Road Scheme 8 „ 119, Percival Street Scheme24„ Myddelton Passage Scheme 30 by Private Enterprise. Great Percy Street Scheme 20 „ Much War Damaged property has been repaired and restored to use. The Borough Council Housing Estates consisted at the end of the year of the flats set out in the following table:— Lloyd Baker Street 119 Margery Street 144 Cyrus House 40 Mandeville Houses 118 Grimaldi House 15 Royley House 12 Spa Green Estate 129 Total 577 31 These flats contained the number of rooms as under:— 1 Room—10 Flats 3 Rooms—323 Flats 5 Rooms—13 Flats 2 Rooms—40 Flats 4 Rooms—191 Flats 473 premises having been requisitioned remained in use for housing purposes at the end of the year. In addition the Borough Council remained in possession of "Corporation Buildings" consisting of 183 Flats. This is old property acquired before the War as a site for rebuilding. The County Council Housing Estates consisted at the end of the year of the flats as set out in the following table:— Costers Buildings 56 Wenlake Buildings 86 Chadworth Buildings 136 Mallory Buildings 33 Amias House 29 Tompion House 80 Earnshaw House 10 Total 430 Slum Clearance. Towards the end of the year attention was given to the problem of slum clearance for the first time since the war. A general, but not detailed, survey of property in the Borough was undertaken and as a result a schedule with maps was prepared indicating groups of properties housing about ten families or more, which might reasonably be represented as clearance areas. These properties were divided into three categories according to the degree of their unfitness. The tentative proposals thus constructed were submitted and approved by the Council and forwarded by it to the London County Council. Rehousing. Applications for rehousing by the Borough Council are made to the Housing Department and these are assessed according to their need according to a points scheme. This was amended during the year. When accompanied by medical certificates to support the application on medical grounds these are referred to the Medical 32 Officer of Health. Enquiries are then made by the Nurse/Visitor into the detailed nature of the family health and the apparent bearing of the accommodation in use on this, and when desirable, an inspection is carried out by the Sanitary Inspector. These reports are then correlate with the medical certificates, and a degree of medical priority is then allotted according to the scheme. This scheme was instituted towards the end of the year and medical priorities which had previously been allocated on the evidence of medical certificates alone were reconsidered. The number thus dealt with was 509. Applications for rehousing by the London County Council are made to that body. Reports are then frequently asked for and supplied in regard to existing overcrowding and sanitary defects. If accompanied by medical certificates, further information is given on request to the Medical Officer of Health to the London County Council, who is responsible for allocating priorities on medical grounds. During the year 290 families consisting of 1,000 persons were rehoused. Of these :— 77 families consisting of 228 in the Borough Council housing estates. 75 families consisting of 257 in the Requisition Premises. 83 families consisting of 353 by the London County Council 55 families consisting of 162 in co-operation with local landlords. Rent and Mortgage Restriction Act. No certificates of unfitness previously issued, remained in operation at the beginning of the year, and 3 new certificates were issued. As there were no cancellations, these remained in operation at the end of the year. 33 SECTION E. Food Food Hygiene. Particular attention was given during the year to the problem of the hygienic handling of food, and the various possible means of improving it were reviewed. The Council agreed in principle that washing facilities should be available free of charge in the Public Conveniences. A lecture-demonstration was arranged on one occasion and all managers of the smaller cafes were invited to attend. A useful discussion followed but little enthusiasm was displayed for further meetings or for talks to employees. The formation of a Food Hygiene Guild was put forward as a suggestion to the Council, and remained under consideration at the end of the year. Adulteration of Food. The examinations made by the Public Analyst of samples of foods and drugs show that there is now only a negligible amount of adulteration carried out by traders, and very few contraventions of the labelling orders and other requirements with regard to the sale of food. In all 750 samples were taken and only 8 were reported upon by the Public Analyst as not genuine. This figure represents one per cent. of the total. In order to disturb traders as little as possible, to avoid the spending of the time involved in the taking of formal samples, to preserve as far as possible, and to safeguard against the necessity to take formal action, on one result alone nearly all the samples taken were purchased informally, the formal procedure being mainly reserved for those cases in which informal results indicated the probability of adulteration. The very small number of adulterated samples among those purchased informally show this to be completely satisfactory. 34 The following is a summary of the samples taken:— Samples Taken Number Adulterated Milk 250 5 (See under Milk). Ice Cream 49 0 (See under Ice Cream). Meat Products 62 2 (See below). Other Foods: Samples Taken Number Adulterated Butter 12 1 Margarine, Cooking Fat, etc. 27 Jams, etc. 8 Cheese 9 Flours, etc. 24 Cereals 17 Coffee, Tea, Extracts, etc. 36 Sauces, Vinegar, etc. 23 Herbs, Spices, Condiments 25 Powders—Baking, etc. 71 Canned Vegetables, etc. / 8 Non alcoholic Drinks 9 Various 34 Total 303 1 Drugs: Simple Medicines 27 Nill Powders 23 Tablets 23 Saccharines 4 Ointments 9 Total 86 Nil. Unsatisfactory samples were: 1. Two samples of Pork Sausage which were deficient in meat to an extent of 40 per cent. 2. One sample of Egg substitute which came from old stock and in regard to which there was an infringement of the labelling regulations. It was not considered necessary to institute proceedings in any of these cases. 35 Milk. On October 1st various new enactments came into force. These were:— 1. Food and Drugs Act (Milk and Dairies), 1944. 2. Milk and Dairy Regulations, 1949. 3. Milk (Special Designations) Act, 1949. 4. Special Designations (Raw Milk) Regulations, 1949. 5. Special Designations (Pasteurised and Sterilised) Regulations, 1949. They provide for a closer supervision of the various designated milk supplied and of the conditions under which all milk is treated and handled. They provide for the first time for the use of the designation " Sterilised." Striking changes have taken place in the Milk Trade in recent years and comparatively little milk is handled in the Borough, the majority of it being bottled outside the Borough and sold as received. This change in character is still continuing. It does not refer to the considerable quantities treated and bottled at 116/120, Goswell Road by the City of London Dairies under a licence for pasteurisation. The new application for registration as milk distributors have been in connection with the sale of sterilised milk. 1. Dairies: Number registered on 1st January 45 There were no applications for registration or cancellations during the year. 2. Milk Distributors: Number registered on 1st January 88 Number of Transfers approved 11 Number of new applications received and approved 19 No registrations were cancelled other than as a result of transfer. 3. Designated Milks: Number of licences issued:— Pasteurisers 1 Dealers in T.T. Milk 32 supplementary 5 Dealers in Pasteurised Milk 67 supplementary 6 Dealers in Sterilised Milk 54 supplementary 3 36 4. Quality: Number of samples submitted to Public Analyst 245 Number of these reported as adulterated 5 The average quality of the milk supplied was very good. Of the samples submitted the average content of fat was 3·4 per cent. and of non-fatty solids 8·87 per cent., there being little seasonal variations. Apart from the adulterated samples only 2 had a content of non-fatty solids below 8·50 per cent. and these had a fat content of 3·3 per cent. Three of the adulterated samples had been taken from canteens informally, and from enquiry it was established that they had been watered for use in tea or cooking subsequent to delivery. One further sample also from a restaurant had been taken informally and was repeated formally and again found to be adulterated. Prosecution was undertaken and the case was dismissed on payment of £1 1s. 0d. by each of two conjoined defendants. 5. Cleanliness: It will be seen from the laboratory report that of the 404 samples of milk examined, only 2 could be regarded as unsatisfactory and only 3 others are described as below the desired standards. The handling of these milks was carefully investigated. It can be accepted that the cleanliness as well as the quality supplied in the Borough is highly satisfactory. 6. Total Number of inspections 243 Ice Cream. The number of premises registered for the— manufacture of ice cream was 25 storage and/or sale of ice cream was 74 There are no official standards for the quality of ice cream but the Ministry of Food require a percentage of fat of not less than 2·5 in those products for whose manufacture they have allowed special allocations of rationed commodities. The Council has agreed to undertake analyses and to make the results available to the Ministry of Food. Number of samples taken 49 with fat content greater than—15 per cent. 3 131 „ „ 1 11 „ „ 2 10 „ „ 3 9 „ „ 3 37 With fat content greater than—8 per cent. 5 7 „ „ 6 6 „ „ 4 5 „ „ 4 4 „ „ 2 3„ „ 8 2.5 „ „ 5 2.0 „ „ 1 1.0 „ „ 2 The average fat content was approximately 6.5 per cent. In none of the cases with a percentage of less than 2.5 had a special allocation been made. Again there are no official standards in regard to bacteriological cleanliness, but certain standards have been informally adopted by the department for guidance in the general supervision exercised over the manufacture and sale, and samples were taken for this purpose. Total number of samples taken 90 Number of samples exhibiting a satisfactory standard 68 Number of samples exhibiting a poor standard 13 Number of samples exhibiting an unsatisfactory standard 9 In all cases where a poor or unsatisfactory result was obtained the methods adopted in the manufacture or sale were thoroughly investigated and further examinations made of samples obtained during the several processes. This accounts for some of the samples not reported as satisfactory. Number of Inspections of Premises where Ice Cream was made or sold 159 Meat. 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 1949. In the neighbourhood of the Smithfield Market there are a number of wholesale meat and offal shops, bacon factories, wholesale bacon and provision warehouses, Public Cold Air Stores, etc., Regular inspection of these premises was carried out during the year. 38 A systematic examination of all imported frozen carcases of mutton and lamb for caseous lymphadenitis took place and 63 carcases were found to be affected. Nearly 4,000 bags of whalemeat were deposited in the various Cold Air Stores during the early part of the year. They were not accompanied by a vetinary certificate as required by the Food and Drugs (Whalemeat) Regulations, 1949, and in consequence were released for anumal feeding purposes only. 91 certificates for the export of meat extracts mostly to Australia, South America, Egypt and the Philipine Islands were issued during the year. 2,576 visits to the 47 retail butcher shops and stalls were paid. Bakehouses. There were 24 bakehouses in use at the end of the year, and of these 17 were basement premises. Machinery is used in all of them. 57 inspections were made during the year. Registered Food Premises. The number of premises registered for the preparation or manufacture of sausages, potted, pressed, pickled or preserved food at the end of 1949 was 87. Of these 12 were in respect of Fried Fish Shops. The number of premises registered for carrying on the business of a wholesale dealer in Margarine was 14. Apart from premises whose formal registration is required there are a very large number of places where food is handled and many persons are employed in one way or another in the handling of food. It is estimated that there are in the Borough 159 Restaurants and Cafes, and 180 Canteens (exclusive of Public-Houses). All food premises remained under supervision as far as was possible and 1,068 visits of inspection were made. Much food is handled in the Street markets and licences were issued for 266 stalls during the year. In each case any storage 39 accommodation used for foodstuffs was inspected throughout the year. Licensed Premises and Public Houses. There were 136 licensed premises in the Borough, 126 of which were Public Houses. 105 inspections were carried out. Unsound Food. No food was seized and formally condemned during the year. On the other hand considerable quantities of unsound food were voluntarily surrendered, either on the initiative of the trader or on its discovery by an inspector, and were then disposed of for animal food or industrial use. The following table gives a summary of the quantities surrendered:— Meat Diseased 1,106 lbs. Total 32,159 lbs. Meat Unsound 17,153 lbs. Bacon 13,900 lbs. Offals Diseased and unsound 32,805 „ Poultry 6,688 „ Game 1,490 „ Rabbits 9,030 „ Cereals 303 „ Cheese 423 „ Fish 541 „ Fats 3,985 „ Dried Fruit 393 „ Tins 33,090 „ Other Foodstuffs 7,972 „ Total 128,879 „ =57.54 Tons. It is found now that it is not often that any effort is made by traders to dispose of unsound food to the public. In many cases they themselves call attention to the condition of the food and surrender it voluntarily in order, on the evidence of the certificate, 40 to make a claim on their suppliers for financial re-imbursement and/or for replacement of controlled commodities. At times there is even a desire to surrender food which though perhaps unsaleable is not unfit for human consumption. The headquarters of certain multiple stores are in this Borough and often unfit food from many of the branches is returned before official attention is called to its condition. For this reason the amount of canned goods surrendered is greater than it would otherwise be. Several complaints were received from customers that food purchased was unwholesome. In most cases the complaint was not regarded as serious or did not evidence any carelessness or negligence by the vendor, and was dealt with by the issue of a warning letter. In one case proceedings were instituted against a firm in respect of grease found in a loaf of bread. It was thought that this had occurred through failure to clean tubes through which air was blown upon the dough. The firm pleaded guilty and the case was dismissed with no order as to costs. Shortly before Christmas information was received that part of a consignment of Silver Balls for cake decoration had arrived in the Borough from a foreign country and that chromium had been used in their manufacture instead of silver. As it was thought there might be some danger of poisoning further distribution was stopped and very few reached the Public. On 31st March, Fabon, which had been responsible during the war period for the collection of unsound meat and other food, was disbanded. The collection was then resumed by the Smithfield Animal Products, Ltd., Court Farm, Stanwell, Middlesex, who before the war were under contract with the Council for the purpose. By this contract a residual value is paid to the Council for certain foodstuffs collected and this amount less 7½ per cent. to cover administrative costs is remitted to the person who surrendered them. Food Poisoning. During the year seven cases were formally notified and in addition information was received in other ways about other cases. There were no deaths. 41 The following outbreaks due to identified causes occurred:- 1. Day Nursery (September)—30 cases—0 Notified— Nonheat resistant Cl. Welchii. —Pressed Beef. 2. Works Canteen (December)—20 cases—0 Notified— Toxin Staphylococci—Stew. In addition outbreaks due to unidentified causes were as follows:— 3. Domestic (August)—2 cases—1 Notified—Suspected by patients Sardines. 4. Domestic (August)—4 cases—1 Notified—Chicken. 5. Works Canteen (September)—10 cases—0 Notified— Stewed Steak. Apart from these outbreaks the following individual cases were investigated:— 1. A case was notified in January. The individual thought that the cause was food taken at a dance in another Borough. Enquiries in that Borough did not reveal any other case arising after the dance and further investigations were not thought likely to serve a useful purpose. 2. A young man reported in March that he had been found to be a Salmonella carrier some 6 months previously, and had been on that account dismissed from his post as a Male Nurse in a Hospital. Examination showed that he was still a carrier. He was treated with large doses of Sulphaquanidine and although this appeared to reduce the number of carrier organisms, it did not eliminate them. He was then admitted to St. Bartholomew's Hospital and there treated with Streptomycin successfully. 3. A child of 2 was found in May by a Hospital, to have a Salmonella infection. Intensive investigations were carried out and it was finally believed that infection had occurred from a sick hen which was found to be similarly infected. Full details are being published elsewhere. 4. Two cases were notified in July, but arose as part of a large outbreak that was fully investigated in another districte. 5. A notification was received in October that a woman had developed a Salmonella infection and was being treated in Hospital. 42 She attributed the infection to Tinned Pork. It was considered that the notification was received too late for investigations to be usefully made. None of the outbreaks were at all serious, but they do so serve to illustrate the danger of cooking foods overnight, and particularly made-up meat dishes such as stews, and leaving them overnight elsewhere than in a refrigerator. This occurred in outbreaks i, 2 and 5. One child aged 5 was removed to hospital in October with Gastro enteritis. Pathological investigations revealed Salmonella Typhi-murium as the cause. The source of the infection was not traced. Listed Sellers of Poisons. Forty-seven applicants were approved by the Council in accordance with the Pharmacy and Poisons Act, 1933, each of whom were visited. 43 SECTION F. Infectious Diseases. General. The incidence of infectious diseases of all kinds has been very low throughout the year, and there have been no outbreaks which gave rise to any serious concern. The Metropolitan District Nursing Association have in the past undertaken visiting duties in connection with measles and whooping cough. Owing to staff shortage they found it difficult to continue these visits and in February 1949, the Council appointed a part-time Infectious Diseases Visitor, which appointment was made full time in May 1949. All cases notified were visited either by her or a Sanitary Inspector and energetic measures taken wherever indicated to ensure adequate treatment for the patient and the minimization of the danger of infection to others. Number of visits by Infectious Disease Visitor 820 Number of visits by Sanitary Inspector 33 The following table shows the cases of notifiable diseases of which information by notification or otherwise was received in the several age periods set out:— All ages Under 1 yr. 1-5 yrs. 5-15 yrs. 1525 yrs. 2545 yrs. 4565 yrs. 65 + Total Remvls to Hosp. Acute Influenzal Pneumonia 2 - - - - 1 - 1 - Acute Primary Pneumonia 41 2 14 6 2 7 6 4 6 Dysentery 2 1 - - - 1 - - 2 Erysipelas 4 - - 1 - 1 2 - 2 Measles 204 26 141 36 1 - - - 36 Ophthalmia Neonatorum 8 8 - - - - - - 4 Puerperal Pyrexia 5 - - - 3 2 - - 3 Scarlet Fever 40 - 23 15 2 - - - 25 Pulmonary Tuberculosis 91 2 4 3 31 27 19 5 - Other forms of Tuberculosis 8 - 1 1 4 2 - - - Whooping Cough 78 10 45 23 - - - - 17 Food Poisoning 7 1 - - - 4 2 - 4 Poliomyelitis 1 - 1 - - - - - 1 Scabies 33 - 7 16 3 6 1 - 1 Totals 524 50 236 101 46 51 30 10 101 44 Incidence Rates. The rates per thousand of the population are set out below, together with the corresponding rates for England and Wales, the larger towns, the smaller towns, and London as a whole for comparison:— (Notification Rates (Comparative Table) per 1,000 population.) Finsbury England and Wales 126C.B's. & great towns including London 148 smaller towns, Res. population 25,000 to 50,000 at 1931 census London Adm. County Typhoid Fever 0.00 0.01 0.01 0.01 0.01 Paratyphoid Fever 0.00 0.01 0.02 0.01 0.01 Cerebro-spinal Fever 0.00 0.02 0.03 0.02 0.02 Scarlet Fever 1.11 1.63 1.72 1.83 1.46 Whooping Cough 2.16 2.39 2.44 2.39 1.70 Diphtheria 0.00 0.04 0.05 0.04 0.07 Erysipelas 0.11 0.19 0.20 0.19 0.17 Smallpox 0.00 0.00 0.00 0.00 0.00 Measles 5.66 8.95 8.91 9.18 8.54 Pneumonia 1.19 0.80 0.91 0.65 0.55 Influenzal Pneumonia. Two cases were notified, both in April. Acute Primary Pneumonia. Forty-one cases were notified and these were distributed throughout the year with but little preponderance in the winter months. There was at no time an alarming number of cases. Cerebrospinal Meningitis. There was one death in December in a man aged 81. The diagnosis was not made before death and the case was not notified. As he lived alone further details were not obtained. Diphtheria. There were no cases of diphtheria during the year. The year 1949 will be recorded as the first year in which there was no case of Diphtheria. This must be regarded as a great triumph for the Public Health Services for the way in which the problems in connection with the disease have been handled in general and for the energy that has been displayed by the Council and its staff in the last decade or more in securing the immunization of a very large proportion of infants. 45 Hitherto Diphtheria has taken a heavy toll of life, or left in its wake the lasting effects of its ravages. The decline in Finsbury is shown by the following table :— Years 1901 to 1940 1905 to 1909 1910 to 1914 1915 to 1919 1920 to 1924 1925 to 1929 1930 to 1934 1935 to 1939 1940 to 1944 1945 to 1948 187 137 132 130 263 191 212 116 23 6.5 Average number of cases per year. 19 15 15 18 34 26 32 19 7 2 Average annual rate per ten thousand of the total population. 25 18 13.5 10 23 6 8 2.4 1 0.25 Average number of deaths per year. 2.4 1.6 1.5 1.5 3.0 0.8 1.2 0.4 0.3 less than 0.1 Averageannual death rate per ten thousand of the total population. The immunization of infants was commenced in Finsbury in the year 1928 but was only carried out sporadically until 1934 when serious attention began to be given to its extensive use. A substantial proportion of children had already been protected by 1939. In the early years of the war propaganda to secure immunization of all infants was conducted on a national basis and was pressed very intensively in this Borough. Thus there is good reason to attribute the happy results to this procedure. From the table given it is clear that the reduction in the mortality and the incidence began to occur between 1935 and 1939, and has continued even more rapidly since 1940. This is more clearly shown in the next table where the numbers of cases and of deaths are given for each year since 1935. No rates are given because of the uncertainties with regard to the total population in the years since 1939. 46 Year Number of Cases Number of Deaths 1935 188 1 1936 126 4 1937 107 2 1938 101 3 1939 58 2 1940 27 2 1941 35 0 1942 19 1 1943 24 2 1944 10 0 1945 13 0 1946 6 0 1947 6 1 1948 1 0 1949 0 0 Dysentery. One case in a van driver developed in February. It was of a severe and rare form —Schmitz type. No clue was obtained as to the source and there were no further cases. There was one further case in a baby in the early summer, and it is probable that some of the cases of gastro enteritis were in fact dysenteric infections. Erysipelas. Four cases were notified during the year. Two were treated in Hospital. All were mild and recovered. Gastro enteritis. In Finsbury Zymotic enteritis in those under 2 is a notifiable disease. During the year notifications were received and accepted in respect of six cases (one subsequently withdrawn), and 17 other cases also came to the notice of the Department making a total of 22 cases in all. Of these cases 5 were in adults and 2 in children aged 5. These cases were treated in Hospital, but there were no deaths. The other 15 cases occurred in children under 2. Unsatisfactory home conditions have undoubtedly an influence on the development of the disease; they were discovered in 11 of the cases. It seems that at the present time there is not a great seasonal variation as the cases were distributed (as far as can be ascertained having regard to the 47 fact that there is often a time lapse between early symptoms, final diagnosis, and notification to this Department) according to months as follows:— One case in February One case in September Three cases in March Two cases in October Three cases in April Two cases in November Three cases in August The nature of the infection is by no means certain in most of these cases, but it is probable that many are either caused by the Dysentery organisms, or by the food poisoning organisms. This is known to have been the case in one of the children aged 5 who had an infection with Salmonella Typhi-murium. Measles. Information by notification or in other ways was received of 204 cases, by far the majority of which were very mild. This number was well below those of the previous four years. Ophthalmia Neonatorum. Eight cases were notified, but in no case was there any probability of the infection having been venereal in character, and in every case there was full recovery. Poliomyelitis. Finsbury was fortunate in that only one case developed during the year in spite of a number of cases in the surrounding districts, and the epidemic in the country and London generally. This case was a girl aged 4 who developed paralysis of her right leg in November, and was making satisfactory progress at the time of this report. Supervision was maintained of known contacts of this case and of cases in other areas. Puerperal Pyrexia. Five cases were notified. In every case recovery was rapid and complete, and in no case was there any infection of a serious nature. Scarlet Fever. This disease continued in the mild form which it has adopted in recent years, and did not in any case lead to complications. There were 40 cases during the year. 48 Smallpox. No cases occurred in Borough. A few contacts arriving here of cases which originated abroad were supervised during the period of possible incubation. Typhoid and Paratyphoid Fevers. No cases occurred. Whooping Cough. Seventy-eight cases came to the knowledge of the department. The cases were, in the main, mild. Tuberculosis. The total number of new cases entered into the register during the year was 99. The distribution by sex and age, and according as to whether the case was of Pulmonary or Non-Pulmonary Tuberculosis, was:— 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65 + Total Males Pulmonary 0 1 0 1 1 9 7 6 7 9 4 45 Females Pulmonary 2 3 1 1 9 12 11 3 2 1 1 46 Males Non-pulmonary 0 1 1 0 1 0 0 0 0 0 0 3 Females Non-pulmonary 0 0 0 0 1 2 2 0 0 0 0 5 Total 2 5 2 2 12 23 20 9 9 10 5 99 Meningitis has been classified as Pulmonary. The Non Pulmonary cases include 2 cases of spinal disease (M4F26), 1 Sacroiliac (F17), 1 Hip (M8), 2 Peritonitis (M15F25), 1 Salpingitis (F23), and 1 Glands (F22). The numbers are slightly higher than last year (when there were 89 notifications), and are equivalent to a notification rate of 27·5 per 10,000. Too much significance must not, however, be attached to this figure as it varies from year to year according to the clinical standards accepted for diagnosis. The average figure in Finsbury from 1931 to 1938 was 18·5, and in London for 1948 was 17·9. The distribution as show in the table is very similar to that in recent years. 49 The total number of cases remaining on the register after adjustments for deaths and transfers was on the 31st December, 1949, as follows:— Males Females Total Pulmonary 189 139 328 Non Pulmonary 26 27 53 Total 215 166 381 The full details of each case obtained by the Tuberculosis Visitor were by kind co-operation of the London County Council made available to, and any preventive measures possible co-ordinated with those of the Borough Council. Each case was visited with a view to tracing the source of infection, the conditions which may have influenced its development, the actual spread which may already have taken place, and the means that could be adopted or advised to prevent further danger of spread as well as to give help and advice. Disinfection was carried out whenever thought advisable and on request. Nineteen deaths occurred from Pulmonary Tuberculosis as set out:— 0- 15- 45- 65+ All ages Male 0 2 8 2 12 Female 0 5 1 1 7 Total 0 7 9 3 19 There were no deaths from Non Pulmonary Tuberculosis. The Tuberculosis Death rate from all forms was 0·53 per thousand. This is the lowest rate hitherto recorded in Finsbury and would, therefore, be regarded as very satisfactory were it not for the upward rise in notifications. In only 3 cases did death take place in those not previously notified and most cases had been notified several years before.