AC 4341 ACR 14/11JT FIN 36 METROPOLITAN BOROUGH OF FINSBURY THE Public Health of Finsbury ANNUAL REPORT 1955 and Review of the Years 1946-1955 BY — C. O. S. BLYTH BROOKE, M.D., B.S., D.P.H. Medical Officer of Health. FINSBURY HEALTH CENTRE, PINE STREET, LONDON, EC.1. METROPOLITAN BOROUGH OF FINSBURY THE Public Health of Finsbury ANNUAL REPORT 19 5 5 and Review of the Years 1946-1955 BY — C.O.S. BLYTH BROOKE, M.D.,B.S., D.P.H. Medical Officer of Health. FINSBURY HEALTH CENTRE, PINE STREET, LONDON, E.C.1 2 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 1955 on the work of the Health Department. In the preparation of this report I have taken the opportunity to review the period which has elapsed since the end of the second world war with particular reference to the last five years. There can be no doubt but that the health of the citizens of this borough shews, generally speaking, very considerable improvement on pre-war years, This is demonstrated by the very happy fall in the general death rate and especially the infant mortality rate. When we come to consider infectious diseases we may be almost elated at the transformation of the scene. Diphtheria has disappeared and measles and scarlet,fever have become more a nuisance than a worry and whooping cough and cerebrospinal fever (now included under the wider expression of meningococcal infections) though still the cause of a few deaths and more ill-health have lost much of their former virulence. Tuberculosis, however, remains a serious threat to Life and Health but even its powers for evil have been considerably restricted. It is true that dysentery has spread widely and is frequently attacking young children and even adults but its effects are normally not lasting Unfortunately against all this poliomyelitis has now become a more frequent cause of serious permanent injury but in this respect Finsbury has suffered less than most areas. On the other hand two conditions have become much more common than before; coronary thrombosis and cancer, and in particular cancer of the lung. It is not very long since these diseases were comparatively rare and now between them they are responsible for 15 per cent. of deaths, and mortality from them appears to be still rising These comments refer to the rates throughout the country generally In Finsbury the rates for coronary thrombosis are comparable with the general rates but for cancer of the lung they are among the highest in the country. We know so little of the causation of these diseases that not much can be done by way of prevention at present but a constant study will, it is to be hoped, point the way to effective measures 3 One of the principal health problems that has of late become much more pressing has been that of preserving the health of the ageing members of the population and caring for their needs. In this work your council has for some years now been in the forefront of the authorities throughout the country who have initiated services with these aims, and its foresight and sympathy has been very widely recognized in this country and beyond. In particular the inauguration of sheltered employment for the elderly has not only been applauded but has already been copied in several other places. Nevertheless proud as we are of these services, much remains to be done for the increasing number and proportion of older persons in the community. Environmental conditions have improved out of all proportion in recent years. The progressive policy of the council in regard to Housing has alleviated many of the cases of greater hardship and of overcrowding and many of the former slum houses have disappeared including in 1954 the remaining properties of Bastwick Street which for over 50 years had been represented by successive Medical Officers of Health as unfit. The conditions of many other properties which deteriorated greatly during the war were considerably improved. Much advance has been made in the clean handling of food and the purity of that sold. Although we may well be proud of these improvements yet many further problems lie ahead, The need for the replacement of many older houses and quasi slums by houses or flats up to modern standards is too obvious to require stress. Atmospheric pollution of all kinds is a continued cause of much ill-health. The development of a better social conscience with regard to litter in the streets and backyards is needed not only psychologically to improve appearances but also to further a policy of general cleanliness. It is clear that health measures ought not to be abated but rather pressed forward, Many administrative changes in the Health Services occurred in 1948 on the coming into force of the National Health Service Act 1946, and a number of services were transferred to the Hospital Board or the 4 London County Council Some of these have lost much of their personal touch and their co-ordination with the services still administered by your council has been difficult. These effects have been generally appreciated and discussions have been taking place regarding their return to the Borough Council. I am convinced that by this a more comprehensive preventive health service enjoying the confidence of the public, their representatives on your council and the general practitioners in the district could be developed which would eventually lead to Better Health for all. It is with pleasure that I thank you Mr Mayor and the chairman and members of the Health and other Committees of the Council and their predecessors during the period under review for the continued friendly and generous support they have given me in carrying out my duties, And finally, I wish to thank my staff, including many who have now left, for their loyal help and co-operation and without which little would have been accomplished I have the honour to be Your obedient Servant, C.O.S. BLYTH BROOKE Medical Officer of Health. 5 HEALTH COMMITTEE Chairman: Councillor J.TROTTER Vice.Chairman: Councillor J.CROSSLEY Alderman J.T. BELLAMY Mrs C.P. FENN Councillor A ASHTON ,, Miss A.T. CALLAGHAN ,, Mrs.S.CLIFFE ,, W.J.DAVIES ,, E.I.JONES " A.E.LEY Medical Officer of Health: C.0.S BLYTH BROOKE M.D.B.S.,D.P.H. Deputy Medical Officer of Health: M SCOTT STEVENSON, M.B.,Ch.B.,D.P.H. Public Analyst: C.HARCOURT WORDSWORTH, B.Sc. Sanitary Inspectors: A. J. TRUSLOVE M S, I.A (Deputy Chief San.I.) J LEWIS, M.R.S.H E.DITCHBURN, M.S.I.A R. E. RICHARDS, M.S.I.A (Resigned 6.2.55) S.G FISHER, F.S.I.A (from 18.4.55) A. TREVETHICK, M.S.I.A., M.R.S.H (from 25.7.55) S.J. CASSIDY, M,S I.A. (from 4.4.55) Student Sanitary Inspectors: B.G.F. PAYNE, D.F. C K PALMER J.M. SOUTHWICK Housing Inspector: H.J. NEWDICK, M.S.I.A. (from 13.1.55) 6 Senior Meat Inspector: R. S. BARBER,M.S.I.A. Rodent Officer: P. L. MOSELEY Administrative and Clerical Staff: A.G. HOLMES (Assistant Administrative Officer) J.T. LINDSAY (Senior Clerical Assistant) Miss J. L. Faulkner Mrs. A. H. BRADFORD A. PHILLIPS (Resigned 19.8.55) F. W. HAYNES I. PATIENCE J. R. DALTON (National Service 4.7.55) D. NATTRESS (from 12.9.55) Cleansing Station Nurse and Visitor to the Aged: Mrs, D. I. M. LLOYD, S.R.N. Infectious Disease Visitor: Mrs. R PEPPER, S.R.N. Health Centre Caretaker: E. H. JAMES 7 SECTION A PHYSICAL FEATURES AND SOCIAL CONDITIONS General Area of the Borough (acres) 587 Population, 1951 census 35,370 Population Density 60 Rateable Value £1,023,209 Product of a penny rate £4,110 General rate 23s. Finsbury, one of London's 28 Metropolitan boroughs, is situated in Central London. The Borough as a whole is built up and congested and possesses very few open spaces; all of which are small in size. A large part of the Borough, particularly in the South East, is essentially industrial and the day population of the Borough has been estimated as between 150,000 and 200,000. The industries accommodated are very varied and include, besides the clock and watch trade which has been associated with Clerkenwell for many years, the scientific and optical instrument making, jewellery, printing and clothing trades. The residential parts of the Borough are mainly working class in character. During the late war Finsbury suffered the loss of many factories, warehouses, and offices, especially in the eastern part of the Borough and there still exist many bombed sites, Residential property also suffered considerable damage. The rateable value has steadily increased since 1951 when it was £956 228 consequent on rebuilding of war damaged properties and of devastated areas A feature of postwar development has been the erection of large blocks of modern flats. 8 PRINCIPAL VITAL STATISTICS Population (Mid year estimate) 35,100 Marriages registered 340 Live Births Legitimate Males 347 Females 296 Total 643 Illegitimate " 25 " 25 " 50 Total " 372 " 321 " 693 Birth Rate (standardized) 17.0 England & Wales 15.0 Stillbirths Legitimate Males 9 Females 7 Total 16 Illegitimate " 0 " 0 " 0 Total " 9 " 7 " 16 Stillbirth Rate Percentage total births 2.26 Per 1,000 Population (standardized) 0.40 England & Wales 0.35 Deaths Males 210 Females 149 Total 359 Death Rate (standardized) 10.4 England & Wales 11.7 Infant deaths 21 Infant Mortality 30.3 England & Wales 24.9 Neonatal deaths 13 Neonatal Mortality 18.8 Illegitimate infant deaths 0 Illegitimate infant mortality 0 Maternal deaths 1 Maternal mortality 1.4 England & Wales 0,64 Tuberculosis (all forms) death rate 0.42 England & Wales 0.15 Area comparability factors - Births 0.86 Deaths 1.02 9 COMPARATIVE STATISTICS 1946-1955 1946-1950 1951 1952 1953 1954 1955 1951-1955 1.Population 35,200 35,620 35,740 35,640 35,490 35,100 35,500 2. Birth Rate Per 1,000 Population 19 5 p.a. 17.9 19.1 18.9 19.7 19.7 18.9 p.a. 3.Sex Ratio Male/Female 1,105 - - - - - 1,084 4. Illegitimate Birth Rate Per 1 000 Population 1.4 p.a. 1.1 1.1 1.3 1.3 1.4 1.2 p.a. Per 1,000 Live Births 72 64 60 68 66 72 66 5. Stillbirth Rate Per 1,000 Population 0,45 p.a. 0.34 0.39 0.42 0.20 0.46 0.36 p.a. Per 1,000 Total Births 23 19 20 22 10 23 19 6. Death Rate Per 1,000 Population 13.5 p.a. 14.3 13.4 9.9 8.6 10.2 11.3 p.a. 7. Infant Mortality Per 1,000 Live Births 33 21.9 16.2 22.2 30.0 30.3 24 8. Infant Mortality Illegitimate Per 1,000 Illegitimate Live Births 72 - - - - - 27 9. Neonatal Mortality Per 1,000 Live Births 18 16 9 12 27 19 17 10. Maternal Mortality Per 1,000 Total Births 1.1 - - - - - 0.6 11. Tuberculosis (all forms) Death Rate Per 1,000 population 0.77 p. a. 0.59 0.61 0.31 0.34 0.42 0.45 p.a. Crude Population Rates have been given in every case A dash indicates that numbers are too small for the calculation of a significant rate. 10 CAUSES OF DEATH - 1955 0- 1- 5- 15- 25- 45- 65- 75- Total M F M F l. Tuberculosis, respiratory 1 7 6 1 15 2. Tuberculosis. other . 3. Syphilitic disease . 4. Diphtheria . 5. Whooping Cough . 6. Meningococcal infections . 7. Acute poliomyelitis . 8. Measles . 9. Other infective and parasitic diseases 1 1 10. Malignant neoplasm - stomach 6 2 2 10 11. ,, ,, - lung bronchus 9 7 2 2 1 21 12. ,, ,, - breast 2 1 1 4 13. ,, ,, - uterus 1 1 2 14. Other malignant and lymphatic neoplasms 4 8 4 4 9 5 34 15. Leukaemia, aleukaemia 1 1 1 3 16. Diabetes 1 1 17. Vascular lesions of nervous system 6 3 4 3 8 24 18. Coronary disease, angina 1 12 14 6 7 11 51 19. Hypertension with heart disease 1 1 5 7 20. Other heart disease 1 4 9 4 13 8 39 21. Other circulatory disease 2 2 2 6 22. Influenza 1 1 2 23. Pneumonia 3 3 3 1 4 6 20 24. Bronchitis 2 1 9 9 4 7 6 38 25. Other diseases of respiratory system 1 4 2 1 1 9 26. Ulcer of stomach and duodenum 4 1 5 27. Gastritis, enteritis and diarrhoea 1 1 28. Nephritis and nephrosis 1 1 29. Hyperplasia of prostate 2 2 30. Pregnancy, childbirth, abortion 1 1 31. Congenital malformations 3 2 5 32. Other defined and ill-defined diseases 11 2 9 5 3 4 34 33. Motor vehicle accidents 1 1 1 1 4 34. All other accidents 1 4 3 2 1 1 12 35. Suicide 5 2 7 36. Homicide and operations of war Totals 21 1 1 1 14 99 68 35 55 64 359 11 Population It is estimated that there has been little change in the population or in its age structure in recent years. Extracts from the first report on the 1951 Census returns for the County of London containing some of the more important statistics and including details of the sex and age distribution of the population were published as an appendix to the Annual Report for 1953. Births The birth rate appears to have become stabilized at about 19, a figure slightly above that for the country generally,, This is higher than the prevailing rate of 13.5 in the years before the war and little below that of 21 and 22 in 1946 and 1947 when the rate was raised as nearly always occurs after a war by what may be called 'Delayed Births'. The illegitimate birth rate of 1.4 per thousand of the population or 72 per thousand live births remains high. This rate is above the rate for the whole country and shews only a little tendency to fall from the maximum reached at the end of the war. Stillbirths The stillbirth rates have shewn a happy tendency to fall and for the five year period 1951-1955 were slightly below those for the whole country at 0,36 per thousand of the population and 19 per thousand total births. Unfortunately, however, they were rather high though not unduly so in 1955 when they reached 0.46 and 23. Deaths The standardized deaths for 1955 was 10.4 (crude rate 11.3) which compares favourably with that of 11.7 for England and Wales. In spite of a discrepancy in the calculation of the rate because deaths that occur in St. Matthew's Hospital are allocated to Shoreditch, considerable satisfaction may be felt in this figure particularly as it has exhibited a downward trend in the last few years. A suggestion was made by the Registrar General that the significance of death rates might be brought out more clearly by calculation of the number of years of expected life lost from particular and all causes. Such figures were published in the annual reports for 1953 12 and 1954 but as their chief value lies in a comparison with those of other areas and as these have only been published for a small number of districts, the preparation of this table is not continued this year. The table shewing the ages at death from the principal causes for 1955 is annexed,, As there is considerable fluctuation from year to year owing to the small number of persons involved, a summary has been prepared of the tables for the past five years. The death rates in the several age groups have been compared with those for the whole country, A comparison has also been made with the number of deaths that would have been expected if the same rates for England and Wales in 1954 had prevailed in the population at risk in Finsbury. Although the full table is not included in this report the following extracts are worthy of consideration: , 1. Ages Death rates per 100,000 at ages stated Finsbury England & Wales 1 to 4 12.5 9.5 5 to 14 4.1 3.9 15 to 24 5.6 7.5 25 to 44 16.4 17.4 45 to 64 130 109 65 to 74 (men) 590 533 -do- (women) 325 324 75 and over (men) 1,370 1,375 -do- (women) 980 1,055 It is thus seen that death rates in Finsbury have been higher than average in the age groups 1 to 4, 5-14, 45-64 and men 65 to 74, and lower than average in the age groups 15-24, 25-44 and women of 75 and over. Infant mortality rates are commented upon elsewhere. 13 2 Cause of death Number of Finsbury deaths 1951-1955 Number of expected deaths if England & Wales rates (1954) had prevailed. 1.&2. Tuberculosis, all forms 81 31 10. Cancer of Stomach 58 56 11. " " Lung & Bronchus 109 65 12. " " Breast 19 33 13. " " Uterus 14 15 14. Other Cancers 192 181 10 to 14. Total all Cancers - 392 - 350 17. Vascular lesions C.N.S. 156 288 18. Coronary disease 268 268 19 -21. Heart and circulatory disease 356 475 23&24. Pneumonia & Bronchitis 323 177 33. Motor Accidents 18 18 34. Other Accidents 55 43 35. Suicide 24 20 There were no deaths during the five years from Diphtheria, Poliomyelitis or Measles. (One death from Diphtheria 60 years previously was recorded in 1951). Comments on deaths from Tuberculosis appear elsewhere. There was one death from Whooping Cough and from meningococcal infection both in 1951. Deaths from cancer give rise to increasing concern. They have been rising in the country generally and are seen to be particularly high in Finsbury. This is almost entirely by reason of cancer of the lung, the deaths from cancer of the breast and of the uterus having actually been relatively fewer in Finsbury than elsewhere. Cancer of the lung is undoubtedly becoming much more frequent It is generally commoner in urban areas, the expected number for connurbations in England and Wales was 79 and for London 94 as against the figure given above of 65 for all areas: all these figures, however, are substantially lower than that of 109 for the actual deaths in Finsbury. 14 Deaths from vascular diseases of the nervous system, that is cerebal thrombosis and embolism as well as those from heart (other than coronary) and circulatory diseases have been considerably less frequent in Finsbury than elsewhere. Deaths from coronary disease are unfortunately increasing although probably not more so than elsewhere. The number of deaths from Pneumonia and Bronchitis has been considerably above average. Although the number of deaths from motor and other accidents and from suicide (mainly in the age group 45-64) has closely approximated to the average, attention should continually be directed to this wastage of life which cost 97 lives in the five years under consideration. Maternal Mortality The maternal mortality rate for the five year period 1946-1950 was 1.14 compared with 1.05 for England and Wales and for 1951-1955 was 0.6 compared with the approximate figure of 0.75 for the whole country. There was one death in 1955 in a woman of 36 from toxaemia of pregnancy. This would give a figure of 1.4 as the rate for 1955 but as the numbers in the Borough are small no rate for a period of less than 5 years should be considered. Inquests Inquests were held on 27 residents during the year. The causes of death found were:- Natural causes: (Males 46 and 45) 2 Road Accidents: (Males 54, Females 85 and 74) 3 Accidental Falls, excluding industrial: (Males 83, 69 and 35, Female 82) 4 Carried Forward 9 15 Brought Forward 9 Industrial Accidents: (Males 46, 42, 30 and 28) 4 Misadventure: (Males 71, 60 and 46, Female 36) 4 Complications of surgical operations: (Male 50, Female 8) 2 Asphyxia due to Inhalation of vomit: (Male 2 months) 1 Starvation and neglect: (Male 61) 1 Suicide: (Males 74, 60 and 55, Female 60 (Coal gas poisoning), Male 70 (Drowning), Female 49 (Razor)) 6 Total 27 Infant Mortality There were 21 deaths among infants under one year of age thus constituting an infant mortality rate of 30 Of these 13 occurred in the neonatal period constituting a neonatal mortality rate of 19. The corresponding rates for England & Wales were 25 and 18 (1954) respectively. There were no deaths of illegitimate infants. Although the rates have been rather high in the last two years it must be remembered that with small numbers fluctuations are considerable. The quinquennial infant mortality rate has, however, fallen from 33 in the years 1946 to 1950 to 24 in the past five years and the neonatal mortality rate from 18 to 17. We may thus be reasonably satisfied that the remarkable improvement in the chances of survival for each new baby born is being continued though at a slower rate. Congenital malformations and immaturity continue, nevertheless, to take a heavy toll of infant life. They must either be due to hereditary factors or to the condition of the pregnant mother but we remain in most cases ignorant of the causes and in consequence further preventive measures are difficult. 16 In an appendix to this report an analysis of infant mortality during the first half of the century is given. It is pleasing to note the absence of deaths of illegitimates and that their quinquennial infant mortality rate has fallen from 72 in 1946 to 1950 to 27 in the last five years. INFANT MORTALITY, 1955 - CAUSES OF DEATH Cause of Death 0-1 wk. 1 -2 wks. 2-3 wks. 3-4 wks. Total under 4 wks. 1-3 mths. 3-6 mths. 6-9 mths. 9-12 mths . Total under 1 yr. Bronchitis - - - - - 1 1 - - 2 Congenital malformation 2 - 2 - 4 - 3 - - 7 Birth Injury and other diseases of early infancy 2 - - - 2 - - - - 2 Immaturity 5 - - - 5 - - - 5 Inhalation Asphyxia - - - - - 1 - - - 1 Pneumonia 2 - - - 2 1 - - - 3 Other defined causes - - - - - - 1 - - 1 TOTALS 11 - 2 - 13 3 5 - - 21 (In this case the international rules for classification have not been strictly follow) 17 SECTION B GENERAL PROVISION OF HEALTH SERVICES Health Centre The Health Centre which was opened by Lord Horder in 1938 provided accommodation for a number of services which were transferred to the Regional Hospital Board and London County Council in 1948 under the National Health Service Act, 1946. The Borough Council has, however, continued to own and maintain the building, and there has been little change in the nature of the services provided. The offices of the Public Health Department have continued to occupy part of the centre and agreement was reached with the other authorities concerned for the services now under their control to make use of other portions. The Council has acted as agent for the Regional Hospital Board in relation to certain of their services. There is no doubt in my mind that the Centre continues to be of value to the public not only for the services available but as a place to which they may readily come for help and advice in regard to many Health problems. The very existence of the Building as an expression of the Ideals of Health remains useful in regard to Health Education. Very large numbers of visitors and organized parties both from this country and overseas, including a number of members of the Supreme Soviet, have been welcomed since the war. Although the numbers have recently declined owing to the opening of other Health Centres in and around London some visitors were received in 1955, Laboratory The laboratory in the Health Centre has been maintained jointly with the Regional Hospital Board since 1948 and undertakes the routine work of the Public Health Department in the control of infectious disease and the bacteriological examination of milk and other foodstuffs and has operated in close association with the Central Public Health laboratory service at Colindale. In addition it continues to undertake simple routine pathology on behalf of the Chest Clinic, other clinics in the Health Centre and of medical practitioners in the district. 18 A particular feature has been the large use made of the facilities for the taking and examination of swabs for the early diagnosis of Whooping Cough. This has been of particular value. Work of the Public Health Department Number examined Throat & Nose Swabs 36 Sputums 310 Per-nasal Swabs (for Whooping Cough) 179 Faeces 1,109 Various Foods 26 Water 9 Number examined Milk (Methylene blue & Phosphatase tests): T.T. Pasteurised 1 Pasteurised 52 Sterilised 4 Ice Cream 56 Swimming Bath Water 5 Work of the Regional Hospital Board For General Practitioners For Clinics Total Blood counts and similar examinations 98 38 136 Blood Sedimentation tests 4 73 77 Sera collected and prepared for Kahn and similar tests 7 10 17 Urines collected and prepared for Pregnancy tests 19 - 19 Bacteriological examinations of Urine 16 11 27 Sundry bacteriological examinations 2 2 4 Antibiotic sensitivity tests 8 - 8 Domiciliary visits by technician 6 Blood Transfusion Service The Council has co-operated with the North London Blood Supply Depot of the National Blood Transfusion Service for some years now by arranging Blood Donation Sessions at the Health Centre, Three or four sessions have been held each year and from two to three hundred donors gave blood During 1955 there were three sessions with 265 donors International Certificates of Vaccination and Inoculation The international form of certificate of vaccination and inoculation approved since the war requires the signature of the medical practitioner issuing the certificate to be authenticated by the 19 Medical Officer of Health. The certificates are required by persons proceeding to certain foreign countries. Arrangements were made and continued for this authentication and from 70 to 150 applications have been received in recent years. No case of an improper signature has been discovered and no applications in consequence refused. In 1955 165 certificates were authenticated. Burial or Crenation of the Dead It is provided by Section 50 of the National Assistance Act, 1948, that the Local Authority shall arrange burial or cremation in the case of any person who has died or been found dead in the Borough, in any case where it appears to the authority that no suitable funeral arrangements have been or are being made. Between 3 and 6 persons have been buried or cremated each year in accordance with this provision and in 1955 the number of persons was three. Health Education The Health Propaganda undertaken during post war years was on a comparatively small scale and as a consequence, the then existing programme received detailed consideration by the Council in 1950. It was suggested that increased use should be made of Posters and Literature, and that the following methods should be used to increase the efficiency of the Health Propaganda service:- Lectures to the Public; Discussion Groups with talks; Showing of film strips and pathological demonstrations; Film Shows at the Health Centre and at local cinemas,, In 1951 a joint meeting, was convened at the Health Centre, of headmasters,, education officers, and the school medical officers to discuss Health Education in the schools with a view to furthering the ends of Health Propaganda in schools as part of the programme for the rest of the community During the same year, a series of Health Talks accompanied by the showing of a film was given by the Medical Officer of Health to groups of school leavers (boys and girls). These latter were very well received and were considered to have been well worth while. 20 In 1953 a series of talks, on various aspects of Food Hygiene was given by the Food Inspector to groups of local school children A brochure was produced in 1953 detailing the various services available to aged persons resident in the Borough and was much appreciated both by the elderly themselves and by the various statutory and voluntary organisations. All these efforts to increase the efficiency of the Health Education programme were supplementary to the exhibition of Public Posters and the distribution of literature from suitable centres Home Safety In the early part of the year arrangements were made under the aegis of the Health Committee with a firm of publishers for the pro duction of 2,000 copies of a Safety Handbook for local distribution. The handbook contained a Foreword by His Worship the Mayor and an Introduction by myself drawing attention to the tragic loss of life, injury and suffering caused by accidents in the home The handbook also contained articles on how common accidents happen in the home the safe use of electricity and gas industrial safety; notes on first aid; and road safety Distribution was as widespread as possible via statutory bodies, voluntary organisations and through various departments of the Council. The booklet was issued free of charge and without cost to the Council, the revenue being obtained by the publishers from advertisements obtained from local tradesmen. Clean Food and Health Guide In the latter part of the year, a Clean Food and Health Guide was produced also under the aegis of the Health Committee The production was by the same firm who published the Safety Handbook and the detailed arrangements were as outlined above in respect of that hand book. Leaflets and Posters Health Education was continued during the year by the exhibition of Public Posters and by the distribution of literature from suitable centres. The two large poster sites (formerly Empire Marketing Boards) were kept posted during the year with special poster sets. 21 An Exhibition Stand situated in the entrance hall of the Health Centre was used to display amongst other publicity matter the display sets issued by the Ministry of Health Enamelled panels, showing details of hospitals with times for attendance where advice or treatment on Venereal Diseases can be obtained, were renewed as necessary in the Council's Public Conveniences. The Council also continued to co-operate in the health publicity programme organised by the London County Council Health Division III, and in the Accidents in the Home' campaign organised by the County Council during the week commencing 14th November 1955 The booklet 'Better Health' was distributed monthly to each member of the Council and to members of the public through the Council's libraries and other public offices As in past years the Council made a contribution towards the work of both the Central Council for Health Education and the Home Safety section of the Royal Society for the Prevention of Accidents Aged Persons A great feature of the Council's Health work in the years succeeding the war has been the provision of an increasing number of services to help the aged to preserve their health and well-being and to add to the happiness they are able to enjoy in their declining years. These services also enable many to end their days in the surroundings of their old homes which are familiar and dear to them without the necessity of entering an institution except possibly a hospital at the very last. The number of those of the pensionable ages was 4,837 according to the 1951 census. Many of these live with their spouses, relations or friends but on the other hand many others live alone and often with no relatives living near to keep a watchful eye on their needs. In relation to all the services very close collaboration has existed between myself as Medical Officer of Health and the many other statutory and voluntary bodies which endeavour to help the elderly in so many different ways, as well as with the doctors in the area. The development of these services has attracted attention from many quarters and Finsbury has become recognized as one of the places that has done most for its older citizens. 22 Although I am most reluctant to issue the necessary certificates to secure the compulsory removal to a hospital of any old person this step is occasionally necessary in the interests of such people them selves.. Normally agreement to voluntary removal can be obtained when this is necessary by the use of persuasion coupled with tact and patience Since 1946 five applications (1 in 1948, 2 in 1952 and 2 in 1954) for a warrant were made to a magistrate, and all were granted It was, however, not necessary in the end to use force in all cases A Nurse/Visitor is employed whose duties involve the regular visiting of aged persons particularly those living alone who are likely to be in need of care and attention in order to ensure as far as possible that this is available. Her work is so varied including as it does assisting the aged in so many different ways that it cannot be detailed Her paramount duties, however, are in connection with those persons living alone who because of mental or physical debility find it difficult to take proper care of their premises or themselves. The work undertaken in 1955 is summarized as under but figures cannot reflect adequately the value of this service. Some cases may require frequent but short visits to ensure that all is well whereas many patient hours must be spent with others. Number of Visits to Aged Persons 902 A laundry service was commenced in 1951 and this provides for the incontinent and those unable to cope personally with their washing or arrange for it to be done. The articles are collected on a Monday, disinfected, checked and sent to a commercial laundry, returned again, checked and redelivered the Friday or Saturday of the same week. A varying number of about 25 to 30 persons have in this way been enabled to retain their clothes and bedlinen in a wholesome condition. Occasional cleaning services have been provided since 1951 for those aged persons where their accommodation has been allowed to become so dirty and unwholesome that it had become beyond their capabilities to get it clean again although possibly able with or without the aid of a domestic help to keep it at least for a time sanitary once it had been cleaned. This service was provided on six occasions in 1955. Some of the aged find difficulty in using the Council's bathing establishments as the attendants have not the time to assist them in and out of the baths or with their dressing, since 1951 facilities have been made available in the Cleansing Station at the Health Centre. 23 when this is not in use for the cleansing service, on two afternoons in the week. Although appreciated by some, relatively little use has been made of it, the number of attendances for this purpose being only 27 in 1955. Nursing services have been provided by the Metropolitan District Nursing Association and these have been invaluable to the aged sick. A very close liaison has been maintained with the Health Department and this has proved most useful. The Council has given a grant towards the extra expenses involved by the Association in this way. Many of the aged, particularly those who live alone, are apt to take insufficient food not only because of expense but also because of difficulty and trouble involved in preparing a satisfactory meal for one. Dinner services have been instituted through voluntary associations throughout the Borough. A grant is given to the associations to cover their expenses and a further grant is made by the London County Council to enable the meals to be supplied at a cost of lOd, per head to the aged. This service, which commenced Immediately after the war, has been gradually extended, and in 1955 20,019 dinners were served. The centres in operation which are open on 3-5 days a week are:- 1. Women's Voluntary Service, 68, Exmouth Market, E.C.1. 2 British Red Cross Society, Old People's Centre, 9, Walmsley Street, E.C.1. 3 Field Lane Institution, 16, Vine Hill, Clerkenwell Road, E.C.1. 4, Claremont Central Mission, White Lion Street, N.1. 5. St. Clement's Hall, Lever Street, E.C.1. In addition a mobile dinner service for housebound persons was inaugurated in 1949 through the medium of the Invalid Kitchens of London, This has also been extended and now serves some 40-50 old persons a day from Monday to Friday. The number of meals supplied in 1955 was 11,391. In 1949 a holiday scheme which has proved an unqualified success was inaugurated Grants have been given by the Council to various holiday homes and voluntary organizations whereby any old person may have a fortnight's holiday at the seaside or in the country,, The nominal charge established for the individual is 10/-d. a week and travelling expenses are paid for. Arrangements are made for the contribution to be saved during the previous winter by savings stamps if desired. In 1955 holidays were arranged in Walton on the Naze, Clacton, Ramsgate, Brighton, Leigh-on-Sea, Herne Bay, Cliftonville, and 80 men and 221 women benefited. 24 Not only does the holiday provide pleasure at the time but it is enjoyed for a long time both in anticipation and in retrospect and does much to preserve the mental and physical well-being of those who participate. In 1951 an Employment Scheme was inaugurated by the Council in association with The Employment Fellowship. Through this scheme remunerative employment for those of the pensionable ages has been provided. The lecture hall in the Health Centre was used at first but after about six months in September 1951 premises were leased at 352, St. John Street and work was provided for some 60 persons working in 2 shifts of two hours five days a week. In view of the success of the enterprise and the unsatisfactory nature of the premises, a prefabricated building was erected on a site in Gloucester Way. This was made possible as a result of a number of generous benefactions The new centre opened by Lord Horder in 1954, has proved eminently satisfactory in every way and is able to give room to some 110 elderly persons. The work undertaken by the elderly has been mostly outwork on behalf of many firms who have generously co-operated but some articles have been made for sale to the trade or direct to the public. The persons employed have been of an average age of 72 and those not able or not sufficiently strong to be engaged in the normal labour market but very happy to be occupied with useful work under sheltered conditions. A small wage amounting to 10/-d. a week which is slightly more than the actual value of the labour has been paid. This scheme has not only brought joy and happiness to many elderly people but has been of great value in preserving their health of mind and body. The Council has given grants to a number of clubs and organizations in the Borough in respect of various services conducted by them on behalf of the aged. These organizations are as follow: British Red Cross Society Claremont Central Mission Clerkenwell & Islington Medical Mission Family Welfare Association Field Lane Institution Finsbury Mission Finsbury Old People's Welfare Committee 25 Finsbury Employment Scheme for the Elderly Invalid Kitchens of London Leysian Mission St. James' (Pentonville) Lodies Guild St. James' (Clerkenwell) Women's Fellowship St. Luke's Parochial Mission The S.O.S. Society (Angel Hostel) Toe H Women's Association, Carshalton Branch (St. Clement's Meal Service) Women's Voluntary Service All these voluntary organizations have been engaged in providing facilities for the aged consisting of employment, mid-day dinner services, club meetings and outings throughout the year. In some cases these facilities allow the premises to be used for games, reading, etc., apart from the times of the actual meetings. In addition numerous small personal services are provided and housebound persons visited in their homes. The British Red Cross Society maintains club rooms open daily at 9, Walmsley Street. The work of these and other organizations is co-ordinated as far as possible by the Finsbury Old People's Welfare Committee which consists of representatives of most of those bodies who are concerned with the elderly and of which I am privileged to be Honorary Secretary. It operates, therefore, in close association with the services provided by the Council, and has received from the latter financial grants each year. Apart from the co-ordination of other voluntary bodies it has under its aegis inaugurated the following services: Domiciliary Chiropody Service: The Domiciliary Chiropody Service was inaugurated in 1951 for those aged persons who are unable by reason of senility, chronic sickness, etc. to attend personally the Foot Clinic at the Finsbury Health Centre. This service has proved well justified, in so far as it has enabled the aged and infirm to get about at home in reasonable comfort and do things for themselves, and so retain the independence essential to their mental and physical well-being. The domiciliary visits have increased from ninety annually to two hundred and fifty during the year January-December 1955, During the past year new cases numbered forty of which six were bedridden and four blind. 26 The ages of the persons visited ranged from 63 to 96 years. It is also of interest to record that during the year numerous voluntary donations of small amounts were received from aged persons receiving domiciliary chiropody service as an expression of their appreciation of the service provided and the benefits secured. Coal and Logs: Coal - The Committee is registered in the Licensed Merchants Register in relation to the district of Finsbury as a licensed merchant to furnish supplies of coal in quantities not exceeding 28 lbs. This coal is stored at the Health Centre and the service was used on numerous occasions during the year to provide coal to the aged in an emergency. Logs - As the result of the generous gift of tree trunks by The Charterhouse and considerable voluntary effort in sawing them into logs of a suitable size, the Committee was able to distribute 2,275 logs to aged persons, and to retain a stock of approximately 750 logs for issue as the need arises. Mending Scheme for the Aged: This Scheme provides in association with the Finsbury Employment Scheme for the Elderly a Mending Service for the aged. There is a definite need for this service which effects repairs to such items of clothing as socks, underclothes, etc., and is particularly useful in respect of the Male aged living alone. Substantial use was made of the Scheme during the year. There is no charge to the aged. The "Wireless for the Bedridden Society": The Committee continued to act as Sponsor in respect of applications received from bedridden or housebound Finsbury aged persons desiring wireless facilities provided by the above Society. Wireless Relay Services: The Committee continued to finance the provision of a Wireless Relay Service for the use of the hundred and ten aged persons participating in the Finsbury Employment Scheme for the Elderly at Brooke House' 39/41, Gloucester Way, E.C.1. At the end of the year the Committee agreed to bear the expense of providing and maintaining Relay Wireless facilities at the Women's Voluntary Service Meal Centre in Exmouth Market, E.C.1. and at the 27 St. Clement's Meal Centre, Lever Street, E.C.1. These have now been installed and are much appreciated by the elderly persons using the Meal Centres. During the year the Committee entered into an agreement with the two Relay Wireless Companies which cover the greater part of the Borough whereby relay wireless facilities are provided for elderly persons at a reduced rental; the Committee to be responsible for ensuring that each aged person has a current Wireless Receiving Licence. It was agreed that the service should initially be restricted to a maximum of twenty aged persons who, whilst not housebound or bedridden, were in the opinion of the officers, deserving of the provision of wireless facilities and that in such cases the rental should be paid by the Committee. At the end of the year eight persons were enjoying such facilities (either relay or a wireless set where Relay Service does not operate). S.O.S. Card Scheme: The S.O.S. Card Scheme operated by the Committee in the Borough has functioned very successfully in the past. No use, however, was made of the Scheme during 1955. The purpose of the Scheme is to enable old people living alone to contact someone outside their home in an emergency. The Scheme besides having a practical value also has a comfort value, as many of the aged express the sense of security which possession of the card affords them. Visiting of the Aged in Hospital: Arrangements have been made for members of the voluntary organizations represented on the Committee to visit Finsbury persons accommodated in hospital, who are not receiving regular visits from friends and relations. Nutritional Supplements: The arrangements continued with Messrs. Wander Ltd. and Messrs. Bovril Ltd. whereby 'Ovaltine' and 'Hospital Extract Bovril' are supplied to the various organizations represented on the Committee for resale to the aged persons attending their Clubs at a price considerably less than the normal retail price. 28 In September last the Scheme was extended to include "Marmite". The arrangements have proved very popular with the aged and considerable Quantities have been sold to them. Consideration was also given to the possibility of including 'New Laid Eggs' among the Nutritional Supplements provided under the aegis of the Committee, but it was ultimately decided that bearing in mind the considerable difficulties involved in handling eggs-the cheap price at which it was possible for aged persons to obtain broken or cracked eggs-that the proposal be abandoned. Ophthalmic Service: The Committee being of the opinion that there was a considerable need for a special Ophthalmic Service for elderly people, there being many who were in need of glasses or other treatment, but who found it too much trouble to make an appointment at a Hospital or other clinic, approached Moorfields Eye Hospital with a view to special arrangements being made. Forty-seven elderly persons received ophthalmic treatment in this way in the period under review. In addition, through the kindness of a local optician it was possible to arrange for three elderly persons to receive domiciliary service. Barber Service: At the end of the year under review the Committee were investigating the practicability of providing a Barber Service (Haircutting and Shaving) for elderly men who are housebound or bedridden. It should be noted that as well as the services outlined above operated by or in close relation to the Council, the following services provided by London County Council are available: 1. Domestic Help Service. 2. A Chiropody clinic in the Health Centre. Further, a Physiotherapy clinic provided by the Hospital Management Committee is available in the Health Centre. This report on the care given to the health and welfare of aged persons in Finsbury would not be complete without a recognition of the medical services rendered by the general practitioners in the district and their close co-operation with me and officers of my department and without an appreciation of the willing assistance at all times of Dr. Morris and later Dr. Stern, the Medical Superintendents of St. Matthew's Hospital and the cordial relations existing between us and our staffs which have not only made our tasks more easy and pleasant but have enabled the sick aged to be treated more expeditiously according to their needs. 29 SECTION C SANITARY CIRCUMSTANCES Water The Borough is freely supplied with water from the Metropolitan Water Board. As this supply is under continuous control no regular examinations have been made. A large number of premises receive their individual supply, however, from a storage tank although in most cases a tap with a mains supply is provided for drinking purposes. Each year a number of storage tanks have been inspected, sometimes as a result of complaints, and samples of the water from them have been examined bacteriologically. No case of gross contamination has been discovered but on a number of occasions action has been taken to secure the cleaning and more efficient covering of the tanks. During 1955 two such examinations were made. At one time there were a considerable number of deep wells in the Borough but the great majority of them have been sealed off during the last 70 or 80 years. A number of bore holes existed on bombed sites and particular attention was paid during the war to seeing that they were adequately sealed to prevent seepage liable to contaminate the waters beneath the clay. At present the only known remaining deep wells are situated in the premises of 1. The Royal London House, Finsbury Square 2. City Gate House, Finsbury Square 3. Bovril, Ltd., Old Street (Not in actual use) 4. Nicholson's Gin, St. John Street. The first two mentioned premises are in crown occupation and the waters from the wells are regularly examined on behalf of the Ministry of Works. Occasional bacteriological examinations of the waters from the other wells have been conducted and no evidence of contamination has been discovered. In 1955 two examinations were made. Swimming Baths The Council maintains two establishments, one in Ironmonger Row and the other in Merlin Street, both of which provide in addition to a large indoor warmed swimming pool, slipper baths and facilities for the washing of clothes. That in Ironmonger Row is particularly well equipped in every way and also contains a Turkish Bath section. 30 Both establishments have been in full operation since the war and are well used. The water in the pools is satisfactorily chlorinated and bacteriological examinations of the water have been made regularly and no evidence of contamination has ever been discovered. At the Ironmonger Row Baths there is also a small Children's Pool with an area of about 1,000 square feet and an even depth of 3½ feet. For a time it was not in frequent use but in the last few years has been used fortnightly by a club for the physically handicapped including many spastics. The temperature of the water is raised to 25°C for the use of the club (as when strenuous exercise is not possible greater warmth is needed), under water exercises are taught and much help has in this way been given in the rehabilitation of weakened limbs to the 30-40 persons now mainly children who make use of the arrangements. There is also an indoor Swimming Pool maintained by the Northampton Polytechnic open at times to the public but only used in the summer months. The water is chlorinated and regular chemical and bacteriological examinations have been made. Sanitary Conditions Investigations into the environmental hygenic conditions obtaining in the Borough continue to form a major part of the work of the Sanitary Inspectors. Every complaint received by the Department was investigated and appropriate action taken where necessary under the nuisance sections of the Public Health (London) Act, 1936. The following table gives details of repairs and drainage work carried out during the year and certain other information not itemised under separate headings. As in the past, the percentage of nuisances abated following service of informal intimation notices was very high-in the region of 90 per cent.-as a result of long standing co-operation between owners and the officers of the Department. In the remaining 10 per cent., owing to unwarranted delays, the nuisances were abated only after statutory nuisance notices had been served. Summonses were issued and Abatement Orders obtained in respect of 2 premises. During the 10 years following the 1939-1945 war a vast amount of repair work has been carried out to houses and flats in the Borough Quite a lot of this has been done as a result of formal or informal action by the Sanitary Inspectors. It would also be true to say, however, that most of the dwellings in Finsbury have been subject to war damage repairs and redecoration at some time or other since 1945 31 Whereas before the war, a landlord was generally prepared to undertake essential cleansing or redecoration of occupied premises, owing to the comparative high cost of decoration and apart from any legal requirement, that situation no longer prevails, particularly since the repeal of the Tenement House Bye-laws. Tenants of private property are now doing their own redecoration-in most cases quite successfully. The creation of vacant bombed sites during the war has led to difficulties in Finsbury as it has elsewhere in London. Even when the building rubble has been cleared away the dumping of unwanted bedding and furniture and vegetable refuse has led to unsightly if not unhygienic conditions which may well constitute a danger to the health of children who play there. In such cases disinfestation is carried out and removal of refuse arranged. Nuisances have also arisen through the burning of waste materials on vacant sites. Disused static water tanks have been the subject of complaints during the post-war years and the London Fire Brigade have co-operated in pumping out stagnant water and treating the tanks to mitigate nuisances and the breeding of mosquitoes. Looking back on these past years one may realize that a good deal of improvement has taken place not only in the condition of the premises in which people live and work but also in the general appearance of the Borough. The rate of improvement often seemed slow, as one difficulty after another was encountered but certainly sanitary conditions are much better now than they were immediately after the war in 1946. As regards housing properties I feel that the policy already referred to of endeavouring to maintain co-operation with owners by dealing with sanitary defects as far as possible informally has been justified: it may be that in a few cases this has resulted in somewhat slower action than otherwise might have been accomplished, but on the other hand has undoubtedly been the means of achieving repairs and renovations which could not have been enforced through legal channels. We must not be content, however, with present day conditions and must look to and press forward to much greater advances. Although there has been much repair to buildings this has often been of a very superficial and patchwork nature leaving the structure as a whole in a condition far from sound but able to stand the stresses of further years of use. Two matters in particular call for attention at the present time although they have not the serious character of some years ago. I refer to the conditions of the market streets and the amount of rubbish deposited in improper places and of litter scattered about the 32 Borough. The latter depends largely on the education of the public in clean and tidy habits. During the last few years all the tenants of certain blocks of flats where possibly only a few of the tenants were causing especial nuisance were circulated with a letter in forceful terms but nevertheless appealing to them to assist in preserving whatever amenities they possessed. SANITARY CONDITIONS The following table gives a summary of work undertaken by the Sanitary Inspectors during 1955 including details of public health nuisances abated and drainage installations supervised:- Houses, damp, dirty or dilapidated, remedied 512 Doors, windows, floors, walls, ceilings, sashcords repaired 545 Water closet defects remedied 136 Water closets erected 494 Urinal defects remedied 7 Urinals erected 98 Soil pipe and ventilating shaft defects remedied 20 Soil pipe and ventilating shafts erected 58 Yard defects remedied 37 Waste pipe defects remedied 63 Waste pipes erected 127 Water cistern defects remedied 64 Accumulations of rubbish or manure removed 75 Dung or dust receptacles repaired or renewed 16 Drains relaid, amended or sealed 181 Drains cleared or tested 236 Rain water pipes cleared, repaired or renewed 76 Water supply to houses reinstated 2 Roofs and gutters repaired 395 Area defects remedied 32 Wash-house defects remedied 13 Animal nuisances abated 3 Water supply laid on to upper storeys of house 1 Miscellaneous nuisances abated 47 Total No. of first visits 5,868 Total No. of re-visits 5,883 Intimation Notices served 950 Nuisance Notices served 86 House inspections 2,470 Complaints received during year 1,781 33 Legal proceedings were instituted under the Public Health (London) Act, 1936 for non-compliance with Nuisance Notices in the cases set out in the following table:- Date Premises Offence Result 7.9.55 47, Wilmington Square An accumulation of droppings and filth, in and underneath the pigeon houses, the yard surface and near area. Summons adjourned 14 days on defendant undertaking to comply with the items on the summons. 21.9.55 Nuisance abated: summons withdrawn. £2.5.0 agreed costs. 5.10.55 110, Wynford Road Leaking roof: defective windows: broken flooring, sashcords and yard paving: damp walls. Order for work to be done in 21 days. £3.3.0 costs. 21.11.55 Abatement Order not complied with. Nuisance subsequently abated. Summons withdrawn 21.11.55. Common Lodging Houses The only common Lodging House in the Borough is that at 88, Old Street owned by the Salvation Army. The accommodation is for men only and from the end of the war up to 1951 it was licensed for 348 beds but from then onwards as a result of alterations providing improved amenities for the staff it has only been licensed for 313 beds. The number of beds has been determined on the basis of the standards adopted by the London County Council prior to the transfer of functions in 1933. The building consists of five storeys, the dormitories being on the first and higher floors, the arrangements for ablutions and sanitary conveniences in the basement and with a hall and canteen on the ground floor. 34 The general condition and the amenities provided are far from good but partly as a result of representation from this department improvements have been made and it is hoped that further ones will be effected in the near future. In spite of this the general administration of the Lodging House has been good and no formal action has been required to deal with any matter. The type of person making use of the accommodation has changed considerably since before the war and now a number, particularly elderly, have become more or less permanent residents. It is most unfortunate that the Salvation Army have up to date been unable to provide a Welfare Worker among both the long term and the short term residents. There is much scope for social rehabilitation and welfare work generally. Regular inspections have been made throughout, and 28 such inspections were made in 1955. Canals, Canal Boats and Open Water There is a small stretch of the Regents Canal about 200 yards in length and including a lock along the Northern Boundary of the Borough: extending southwards from it for about 400 feet is the City Basin. Formerly canal boats halted regularly by the wharves along the sides of the Basin but since 1948 it has been only on rare occasions, and boats do not normally halt in their passage along the canal. Until recently horses were stabled in buildings along the Northern bank of the canal and nuisances from smells and flies arose from time to time. The use of horses was gradually given up and now the stables have been demolished. No complaints have been received for a long time as to nuisances from the waters and bathing in them has not been observed and is unlikely to occur. Inspections have been made from time to time and the samples of the water examined. Neither the inspections nor the examinations of the water have revealed any gross or dangerous pollution and it had appeared that the channels have been cleared as and when necessary. One inspection and examination of the water was made during 1955. 35 Shops A varying number of inspections of retail shops and wholesale premises and warehouses have been carried out by the sanitary inspectors during the past few years to ensure that adequate and proper sanitary conveniences are provided and that sufficient means of ventilation and heating are maintained. Appropriate action has been taken where necessary to secure compliance with the requirements and to improve conditions for shop workers. There has been a fair general improvement in these conditions and the standard prevailing now is undoubtedly better than in the years immediately after the war, nevertheless there still exist many shops where the conditions ought to be much further improved although they may comply with statutory demands. The new shops constructed are setting a higher standard. A number of exemption certificates granted by the Council in respect of shops where it is impractical owing to restricted accommodation to provide sanitary conveniences and where suitable alternative arrangements are available remain in force. No applications for exemption certificates were received in 1955. During the current year 279 visits were paid to shops and in 10 premises unsatisfactory matters were dealt with on the service of informal notices. Rag and Bone Dealers From the end of the war until and including 1955 there were 10 premises in which rags were dealt with and these were regularly inspected. There are now five such premises in the Borough. No unsatisfactory features were discovered and nuisances did not arise. The attention of the Fire Service was called on one occasion where there was thought to be some risk. Rag Flock Several samples of Rag Flock were taken each year until 1951 and were found to be satisfactory. In 1951 The Rag Flock and Other Filling Materials Act, 1951 came into operation and superseded previous legislation and regulations were made by the Minister under the new Act. Eight premises are now registered to use the filling materials specified and 4 premises are licensed for the manufacture or storage of Rag Flock. 36 Samples have been taken of various types and submitted to the approved analyst. Only one sample (in 1954) has not been found fully satisfactory. In 1955 6 samples were taken. The registered and licensed premises have all been regularly in spected and satisfactory standards were discovered on each occasion The number of such inspections was 10 in 1955. Offensive Trades The following premises have been licensed since the war: (a) Messrs. Henson, 137, Whitecross Street, E.C.1. (Processing of raw tripes) Very little trade of this nature has been carried out by this firm in recent years. (b) Messrs. F. & W. Warman, Ltd., 5, Eagle Court, E.C.1. (Processing of raw tripes) Regular visits of inspection have been made and the conduct of this business has been found to be consistently satisfactory and has not given rise to any complaints. (c) Messrs. T. Kendon & Sons, Charterhouse Mews, E.C.1. (Processing of raw tripes) No trade of this nature has been carried out by this firm since 1951 and the premises were closed in December 1952. (d) Messrs. Reubens, Ltd., 71/73, St. John Street, E.C.1. (Processing of rabbit skins) These premises were licensed in 1945 and numerous complaints in respect of smells, flies and maggots were from time to time received. 37 Frequent inspections were made and measures to try to control the nuisances insisted upon. Assistance was given to the department by experts of the Natural History Museum in 1949. The firm, however, succeeded in the Summer of that year in obtaining more suitable premises elsewhere and the licence was not renewed. Factories A register of factories is maintained indicating those that are designated 'Power' in relation to which the Council has few responsibilities other than as to sanitary conveniences, and 'Non Power' in which it has other specified duties. Full co-operation is maintained with H.M. Inspector of Factories. There has been a marked trend in post war years for the introduction of mechanical power of various kinds into non power factories thereby decreasing their number and increasing that of the power factories. The register of 'non power' factories is, however, difficult to maintain accurately because technically it should include some shops and other premises not normally regarded as factories and more conveniently dealt with under other categories and also because some premises may be temporarily converted into factories by the employment in what might be described as a family or home business of one outsider during a rush of work. Unfortunately, due to shortage of staff, systematic inspection has to some extent had to be relaxed for considerable periods in the last ten years and has only been carried out as time and circumstances have permitted or when complaints have been made. For this reason undue significance must not be attached to statistical information and no attempt is made to compare that submitted year by year. Generally speaking it may be said that the standard of hygiene and compliance with legal standards has been good and has been consistently improving with the new buildings that are being constructed and the modernisation of the older buildings which is taking place. 38 The statistics for 1955 are as follow INSPECTIONS for purposes of provisions as to health (including inspections made by Sanitary Inspectors) Premises Number on Register Number of Inspections Written notices Occupiers prosecuted (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 642 18 5 - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 1,379 665 26 - (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 8 5 - - TOTAL 2,029 688 31 - CASES IN WHICH DEFECTS WERE FOUND Particulars Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied Referred To H.M. Inspector By H.M. Inspector Want of cleanliness (S.l) 9 7 3 2 - Overcrowding (S.2) - - - - - Unreasonable temperature (S.3) - - - - - Inadequate ventilation (S.4) 7 6 2 - - Ineffective drainage of floors (S.6) - - - - - Sanitary Conveniences (S.7) (a) Insufficient 3 2 - - - (b) Unsuitable or defective 24 21 - 5 - (c) Not separate for sexes 1 1 - 2 - Other offences against the Act (not including offences relating to Outwork) 5 4 14 - - TOTAL 49 41 19 9 - 39 OUTWORK Nature of Work Section 110 Section 111 No. of outworkers in August list required by Sect. 110(1)(c) No. of cases of default in sending lists to the Council No. of prosecutions for failure to supply lists No. of instances of work in unwholesome premises Notices served Prosecutions Wearing apparel Making, etc. 1,646 - - - - - Household linen 16 - - - - - Curtain and furniture hangings 14 - - - - - Furniture and upholstery 6 - - - - - Fur pul1ing 11 - - - - - Umbrellas, etc. 21 - - - - - Artifical flowers 52 - - - - - The making of boxes or other receptacles or parts thereof made wholly or partially of paper 198 - - - - - Brush making 21 - - - - - Feather sorting 17 - - - - - Carding, etc. of buttons, etc. 65 - - - - - Cosaques, Christmas crackers, Christmas stockings, etc. 53 - - - - - Lampshades 36 - - - - - TOTAL 2,156 - - - - - Outworkers Many firms arrange for some work to be undertaken as outwork either under contract by other factories or by homeworkers and in order to check the spread of vermin or of infectious disease information as to such outwork must be supplied in relation to certain classes of work. Because Smallpox and Scarlet Fever, the two diseases considered most likely to be spread in this way, are no 40 longer of serious concern and verminous premises only infrequently discovered, the supervision of outwork has become of less importance than heretofore. Nevertheless, the information supplied, which it must be remembered does not embrace all forms of outwork, is still of use in that it enables some supervision of the home circumstances. A proportion of the homes have been visited each year and the conditions are on the whole satisfactory and no evidence has been found of children being required to spend long hours on this type of work or of it being carried out by groups of persons working in unhygienic ill ventilated and ill lit rooms as occurred frequently at one time. The rate of pay for outwork may not be good but it often provides occupation for those who for one reason or another are unable to go out to work and eases financial stresses. The number of firms employing outworkers in 1955 was 200 The number of Finsbury outworkers employed by them was 365 The number of non Finsbury outworkers employed by them was 4,436 The number of Finsbury outworkers employed by firms outside the Borough was 150 The total number of Finsbury outworkers employed by firms in or outside the Borough was 515 Of these 119 were firms and 396 homeworkers. Number of visits paid to homes 257 The registers of outworkers which firms are required to maintain are inspected as part of the routine during the inspection of the factories concerned. Comparing these figures with those for pre-war years it is noted that there are now only 200 firms employing outworkers whereas in 1938 the number was 744. This may be largely due to much destruction in the industrial parts of the Borough. On the other hand outworkers now employed are 4,801 which is little short of the 4,959 employed in 1938 and it, therefore, seems that outwork by firms may have tended to increase in volume. The total number of workers employed in Finsbury was 1,319 in 1938 as against the 515 given above for 1955. The fall in the number is proportionately more than the drop in population. 41 Atmospheric Pollution Since the war more and more attention has been given to the problem of atmospheric pollution which is the undoubted cause of much ill-health, economic loss through damage to buildings and in other ways, and psychologically of lack of cheer, It may or may not have a bearing on the increasing incidence of cancer of the lung but it certainly had a bearing on the development of a smog which lasted several days in December 1952 and which precipitated the death of many elderly persons. Monthly measurements of deposits and sulphur dioxide pollution on the roof of the Health Centre were initiated in July 1953 and daily assessments of the amount of smoke and of free sulphur dioxide in May 1955. The chief value of these recordings lies in their critical and expert analysis in relation to those made at other stations in this part of the country over a period of years which is undertaken by the Department of Scientific & Industrial Research. The only general observations which would seem justified up to date, and they must be regarded as provisional, are: 1. That pollution in Finsbury is rather less than that in the City, Holborn and Westminster, and rather more than that in Islington, St. Pancras and Shoreditch particularly in summer. 2. That pollution in summer is only about half that in winter on average, thus pointing to the great amount of pollution caused by domestic heating in addition to that by industrial processes which might be expected to be uniform throughout the year. The council has been represented on the National Smoke Abatement Society, the London and Home Counties Smoke Abatement Advisory Council, and the Standing Conference of Co-operating Bodies convened by the Department of Scientific & Industrial Research. The principal sources of pollution are: 1. Industrial Premises. Whenever a smoke nuisance is observed on complaint or otherwise the management of the firm have been interviewed and warned. In addition considerable effort has been expended in endeavouring to get the firm and its employees concerned with the problem and in the giving of advice. 42 Two major hindrances to securing smoke abatement have been (a) the character of the solid fuel supply. This has considerably improved in recent years and several firms have been persuaded to convert their plant to oil combustion, and (b) lack of concern by stokers. Some success in overcoming this has been achieved by the personal influence of the inspectors. Whenever possible the provision of mirrors to enable the firemen to observe the emission from their chimneys has been encouraged. A short course for stokers and boiler men was organized in 1954 in co-operation with the Northampton Polytechnic. 2. Domestic Premises. These are, taken altogether, the greater polluters of the air and it is regretted that little advance has been made in reducing the smoke emitted from them, although appliances suited to the burning of smokeless fuels have been installed in not a few cases and new blocks of flats have been supplied with some form of central heating. The principal difficulty has been in the supply and cost of the smokeless fuels. 3. Railway Engines. Although there are no main line stations or shunting yards in the borough and this source of smoke is not such a serious nuisance as in some other areas, yet belching of smoke from exposed portions of the line from King's Cross to Moorgate which passes alongside and below King's Cross and Farringdon Roads adds materially to the pollution of air in this part of Finsbury and is frequently a nuisance to those close by. 4. Diesel Engines. The pollutants from these engines are particularly noxious when there is faulty adjustment, when freshly started up and when ascending hills. Although little research has yet taken place in regard to this matter it has probably less significance here than in those areas with steaper or longer hills. Nevertheless it is not a problem that may be ignored. Generally speaking I am of opinion that there has been a very considerable reduction of pollution in the years since the war although the number of complaints has been slightly higher in recent years. This may well be due to a greater realization by the public of the damage caused to health by smoke. 43 The number of complaints received in 1955 was 16. The number of formal observations on smoke emission was 150. No formal action was found necessary. Verminous Premises and Articles Since the war the extent of infestation with bed bugs in the Borough has undoubtedly been less than in earlier years and is gradually diminishing. With only few exceptions the bug infestations have been comparatively small and confined to only one room, but by inspection and precautionary spraying of other rooms and furniture in the infested premises a better control is now maintained. In 1955 175 premises infested with cimex were disinfested, the method employed being the use of a spray with a 5 per cent solution of D.D.T. to leave a residual film; this is repeated after 14 days if on re-inspection it appears desirable. In some cases bedding is also removed for steam disinfection. In addition 117 premises were disinfested as a routine measure on unconfirmed reports of infestation by tenants or as part of the Council's policy on transfers of tenancy in Council property or requisitioned premises. Various other insect pests have been dealt with during the year. These were- Cockroaches and Steam Fly 30 instances Ants 21 " Moths 10 " Beetles (various types) 38 " Fleas (human and animal) 12 " Flies (all types) 4 " These have been effectively dealt with, usually by spraying with either D.D.T., in liquid or powder form, or with Lindane or B.H.C. powder, and in general the first treatment has been sufficient. Cleansing of Verminous Persons The low incidence of scabies and verminous conditions since the war has been a striking feature of Public Health. At no time was any concern felt in regard to the problem in Finsbury which has chiefly centred around a few cases of scabies and the verminous heads of 44 school children. Cases of body lice on adults have been almost confined to men from lodging houses and elderly persons who have neglected themselves. These cases have been dealt with in the cleansing station in the Health Centre: in the last five years there has been little variation in the extent to which it has been used. The station has been available to the London County Council in the mornings, in continuation of arrangements suitably modified made in 1938 for the treatment of school children. At other times it has been operated for other Finsbury residents under the supervision of a trained nurse who also visits the homes when this is necessary. Arrangements were made in 1949 for cases from Shoreditch to be similarly treated on behalf of that Borough Council and these have been continued. Body lice have been dealt with by means of a hot bath during which the clothing is steam disinfected and then powdered with D.D.T. Head lice have been dealt with by the usual methods of washing and combing the hair together with the use of Suleo, a preparation containing D.D.T. Scabies has been treated by painting the body after a hot bath with Benzyl Benzoate on the first attendance followed by a further hot bath on the next day and the application of calamine lotion. The clothes are not normally disinfected. Scarcely any recurrences have taken place. Vermin Scabies Total Total number of treatments given to Finsbury cases (other than School children) 74 40 114 Total number of treatments given to Shoreditch cases (other than School children) 10 25 35 Total number of treatments given to School children (all the School children treated were not resident in Finsbury: a proportion being from adjacent boroughs) 693 195 888 Total number of Home Visits paid Nil 45 Rodent Control Rats and their control have for many years been a serious problem in the Borough and infestations are of two types. Rattus norvegicus or the common rat is commonest in the residential parts of the Borough and invades properties from a large reservoir in the sewers often finding an egress through broken drains. During the times of air bombardment an intensive effort was made to fill up disused drains and to seal off their openings in the sewers and these have been continued since together with the undertaking of much repair work to old worn out drains, but many damaged plus some disused drains remain: also some rats escape in other ways such as where interceptor caps have been removed. The other type of rat is rattus rattus which breeds in the large warehouses in the South of the Borough. Soon after the war a block treatment of the whole borough was carried out and temporarily reduced the rat population considerably. The rats in the sewers and underground waterways form the most important reservoir. Although their numbers have been reduced, they quickly increase again if control efforts are relaxed. Throughout, attention has been given to clearing the sewers as far as possible and six-monthly treatments have been carried out in association with neighbouring boroughs. In 1952 one or two cases of Weil's disease with one death occurred in sewermen and special six-monthly treatment of the sewers in the area where it was thought this disease was contracted were carried out for two years. In July 1955 modifications were introduced into the methods adopted but it is too early to comment on the results. Over recent years there has probably been some reduction in the number of surface infestations of the common rat but this cannot be claimed for rattus rattus. Inspection and general surveying is carried out continuously and all complaints are investigated and treated according to the circumstances. Pull co-operation with the public has been achieved and no formal action under the relevant legislation has been necessary for some years. There has been a considerable increase in 1955 in the amount of rodent control carried out by the department on behalf of business firms. The normal method of pre-baiting has been usually adopted followed by the use of one of the recognized poisons. In the case of infestations by rattus rattus warfarin without pre-baiting has been employed on occasions. Wherever possible rat proofing by the owner has been pressed. 46 Although a recent block treatment of the whole borough has not been possible whenever an infestation is discovered it is dealt with on as wide a basis as is reasonably practicable and all surrounding properties are inspected and treated and every effort expended in tracing the breeding ground or source. The establishment of colonies in association with bombed sites has created constant trouble since the war and on one in particular in Goswell Road in 1955. In dealing with these problems as well as with those in domestic and business premises attention is directed towards eliminating the availability of food wastes and rubbish likely to attract rats. A particularly bad infestation in a portion of a dust chute of a block of flats was discovered during 1955 and was effectively dealt with. It had served as a reservoir of rats leading to continuing infestation in the flats for some years in spite of determined efforts to control it. Number of complaints received Business premises 181 Domestic premises 481 Number of additional infestations found Business premises 181 Domestic premises 261 Number of houses treated 742 Number of other premises treated 362 Number of visits made to houses 14,742 Number of visits made to other premises 8,961 The Pet Animals Act, 1951 The Pet Animals Act, 1951 came into operation on the 1st April 1952. The purposes of the Act are:- (1) To secure that animals are kept in suitable accommodation adequately supplied with food and drink and are not sold at too early an age: (2) Precautions are taken to prevent the spread of Infectious diseases by animals: (3) That steps are taken to guard against fire emergencies. Under the Act, licensing of all shops, including market stalls, where pets are sold is necessary. 47 Very few animals have been sold in the Borough in recent years and the circumstances surrounding these sales have been generally satisfactory. When the act came into operation the opportunity was taken to secure a few minor improvements that were considered desirable and conditions generally agreed as between the Metropolitan Boroughs have been attached to each licence issued. During 1955 four licences were issued, viz;- one in relation to a shop, two in relation to market stalls and one in relation to a firm engaged in the breeding and sale (mainly for export) of tropical fish. The amount of business involving the keeping or sale of animals carried out by the shop and the market stalls was small. All the premises were formally inspected at least once during the year and conditions were observed on passing on other occasions. No unsatisfactory feature was reported. Beating Appliances (Fireguards) Act, 1992 This Act which prohibits the sale or letting of unguarded domestic electric fires, gas fires or oil heaters came into force on 1st October 1953. The Regulations made by the Secretary of State require that suitable and adequately fixed guards shall be attached to all such appliances. Standards are laid down with regard to the construction and the tests to be applied to fireguards. As far as is known there are no manufacturers of heating appliances in Finsbury and investigations are restricted to shops and warehouses selling fires and heaters and 4 formal inspections were made in 1955 as well as frequent observation of goods exposed for sale. One wholesale firm consulted the Council with regard to a type of oil heater being imported into the country. After an inspection and test had been carried out the Officers of the Department were satisfied that the heater in question complied with the Regulations. The attention of a retailer was drawn to an unguarded reconditioned gas fire offered for sale in his shop as a result of which steps were immediately taken by him to comply with the Regulations to the satisfaction of the Department. Reception House A portion of the Health Centre consisting of a partly furnished flat with 2 large rooms and a small kitchen was retained by the Council until 1950 to provide temporary accommodation for persons who could not remain in their rooms whilst these were being disinfected to prevent the spread of any infectious disease in accordance with the requirements of Section 195 of the Public Health (London) Act 1936 and for other similar purposes. 48 It was only required for this use, however, on a few rare occasions and had never been used by Holborn who, by agreement, shared in this provision. In January 1950 this accommodation was leased to the North East Metropolitan Regional Hospital Board for the use of the administrative section of their Mass Radiography Unit, and has since been used for this purpose. Through the courtesy of the Islington Borough Council arrangements were made for the accommodation of Finsbury residents at their Reception House should the need for this arise. During 1950 as a result of an outbreak of Typhoid Fever in one house 6 adults and 4 children, immediate contacts of the patients, were isolated for a period of approximately one month in accordance with these arrangements. No subsequent use, however, has been made of them. Disinfection Generally speaking the amount of disinfection undertaken has decreased throughout the years following the war. It is carried out in all cases after infectious disease when this is considered desirable and in other cases on request. During 1955 it was carried out on the following occasions: For Suspected Scarlet Fever 33 " " Poliomyelitis 17 " " Dysentery or Gastro enteritis 79 " " Measles 79 " " Whooping Cough 29 " Tuberculosis 9 On behalf of St. Marks and other hospitals 21 Miscellaneous 48 Bedding and clothing is brought to the disinfecting station in the Health Centre and is disinfected with steam. In all, including the work carried out in connection with the control of vermin, 3,963 articles of clothing etc. were treated in 1955. 49 Goods have also been disinfected on behalf of certain export firms and until 1954 the quantities were very considerable involving more than a million articles in some years The quantities have now fallen and in 1955 86,630 articles were dealt with in this way. During 1955 some disinfection, including that of some goods for export, was also undertaken on behalf of the Islington Borough Council whilst their station was under reconstruction Nuisance from Pigeons In order to control the number of pigeons in the Borough licences have been granted for catching them in the streets and open spaces, as they are liable to become a public nuisance and to do much damage. Enquiries are made as to the means employed by those authorized, to ensure that they are humane and as to disposal of the carcasses to ensure that birds unfit for human consumption are not sold for this purpose. The pigeon population has remained fairly stable in recent years as far as can be gauged. During 1955 three licences were in force, one of which was cancelled during the year as the licensee failed to supply the information referred to above. Mortuary The mortuary attached to the Health Centre has remained available for the reception of bodies This mortuary is primarily intended for the early removal from overcrowded rooms of the bodies of those dying in them and for the isolation of the bodies of those dying from infectious disease It is of great value to have this provision for use in an emergency, but other facilities have been made available by undertakers for some years and there have been no deaths at home from serious infectious disease for a long time: in consequence only occasional use has been made of these facilities since the war. One body was accommodated during the year. 50 SECTION D HOUSING General The population of the Borough has dropped from 125,000 in 1850 to 101,000 in 1901 and again to 55,000 just before the war in 1938 During the war wide fluctuations occurred due to air raid damage and evacuation but by 1951 the population became stable at a little over 35,000. This represents 60 persons per acre as against 190 in 1901 and 213 in 1850. The estimated number of dwellings in 1955 was 9,497 comprising 3,583 houses, 5,866 flats and 48 huts. The flats are owned as follow By the Finsbury Borough Council 1,476 London County Council 559 Metropolitan Police 126 Housing Associations 2,463 Private ownership 1,242 Immediately after the war the general condition of housing was very bad and the shortage of accommodation was acute. The property generally shewed evidence of neglect; only very necessary work having been carried out to keep it wind and weatherproof. Nevertheless, attention should be drawn to great improvements in conditions which had come about during the first half of the century This is illustrated by the following figures abstracted from the 1951 census report: 1911 1921 1931 1951 Number of rooms occupied 53,700 49,617 47,641 35,479 Number of persons per room 1.59 1.49 1.42 0.96 Percentage of persons living more than 3 to a room 13.5 10.1 10.6 0.3 „ „ „ „ „ „ 2 „ „ 39.9 34.0 29.4 3.4 „ „ „ „ „ „ 1½ „ „ 64.1 58.5 52.2 16.1 „ „ „ „ „ „ 1 „ „ 80.1 77.1 72.5 42.4 The majority of the houses in the Borough are from 80 to 130 years old and are in varying degrees of multi-family occupation They were originally built for use by one family only but have gradually become occupied by 2 or 3 families with unfortunately very little alteration to provide amenities for each family. 51 This multi-occupation is unsatisfactory as, apart from the lack of amenities, the standard is poor and no privacy is provided for ordinary family life They are mostly ill arranged and congested and on modern standards unfit for habitation. It is true that some improvements have been effected during the last say five years as a result of action taken under the Public Health (London) Act as well as by informal action and voluntarily by the owners but these have been more in the nature of "touching up" without changing the fundamental unsuitableness of the accommodation provided Tenement dwellings are a very significant feature of Finsbury life and apart from those constructed by the Council, were mostly built between 1862 and 1890 some extra amenities have been added in some cases but by and large they are exactly as originally built and contain no more than the bare necessities for family life Under present standards some of the block buildings may be considered as obsolete, lacking modern amenities, congested on the site, badly planned and arranged and many of the rooms are dark, dismal and depressing with the access of light and air impeded, on modern standards they too are unfit for habitation At the present time a further deterioration of much of the old property of all types is taking place rapidly and there is an urgent need to retard this process as many years must of necessity elapse before it can all be done away with Post War Housing It is with pleasure that I record that since the war a very considerable amount of new housing accommodation of a standard commensurate with present day conception has been completed. This consists of - 1 By the Finsbury Borough Council - Spa Green Estate 129 flats Priory Green Estate 269 " Stuart Mill House 24 " Harold Laski House 24 " Greenwood House 24 " Southwood Court 48 " Bevin Court 118 " Holford House 12 " Stafford Cripps Estate 180 " 8/11 Farringdon Road 8 " 144/6 Wilmington Square 8 " Total 844 " 52 2. By the London County Council - Percival Street Estate 219 flats 3. By Private Owners - Myddelton Square 30 " Benyon House 12 " Worthington House 18 " Cable House 16 " Bunhill Row 21 " Saunders House 20 " Total 117 " The following, in addition, were in course of construction at the end of 1955 - By Pinsbury Borough Council - Priory Green extension 104 flats City Corporation - Golden Lane 340 " Peabody Trust - Roscoe Street 192 " and other schemes were under active consideration and planning Tabular Statement prepared in accordance with the Housing Consolidated Regulations, 1932 Number of houses considered on inspection to be unfit for human habitation 74 Number of houses wherein defects were remedied by informal action Number of representations made with a view to: (a) serving notices requiring the execution of work (b) making demolition or closing orders 74 Number of notices served requiring the execution of repairs Number of houses rendered fit after service of notice Number of demolition or closing orders made 13 Number of houses in respect of which undertakings were accepted Number of houses demolished 53 Houses let In Lodgings A register compiled in 1935 consisting of houses which appeared to be covered by this definition in Byelaws made by the London County Council was maintained until 1954 when there were entries in relation to 427 houses. No formal action had, however, been taken since the war under these Byelaws which were repealed in 1954 by the Housing Repairs & Rents Act of that year. Underground Rooms Before 1939 an endeavour was made when underground rooms became vacant either to improve them to an extent of compliance with the Council's Regulations or to voluntarily agree to discontinue their use for sleeping or living purposes. At that time this arrangement worked satisfactorily and many underground rooms ceased to be used for habitation, During the war, however, many such rooms were reoccupied because of the slightly added protection they were thought to have against air raid damage, and after the war when many properties changed ownership, new owners unaware of or ignoring earlier arrangement, caused a large number of these rooms to be reoccupied. Until 1951 it was not felt to be practicable to take measures to have these and other unsatisfactory underground rooms closed because of the acute housing shortage that existed Since 1951, however, closing orders have been made in respect of the more unsatisfactory underground rooms which were vacant and appeared likely to be reoccupied and in a few other cases where rehousing could be arranged or where the closure of the rooms would not involve overcrowding in the rest of the house, The strict standards of the regulations, however, have not been followed and representations have only been made where conditions have been substantially worse than those required for full compliance Two prosecutions were instituted in 1954 for the use of basement rooms in contravention of a closing order, but in no case was this found necessary in 1955, the occasional case in which such contravention was discovered was dealt with by informal action Generally speaking,, closing orders have been respected but adequate Inspection is difficult. 54 Premises Rooms No. of closing orders in force on 1st Jan 59 112 (1 order made in 1940, 14 in 1951, 4 in 1952, 22 in 1953 and 18 in 1954) No. of Representations under consideration on 1st Jan. 1 1 No. of Representations made during 1955 93 128 No. of Representations under consideration on 31st Dec. 68 99 No. of undertakings accepted - - No. of closing orders made 26 30 No. of closing orders determined during 1955 1 2 (order made in 1951) No. of closing orders in force on 31st Dec 84 140 Unfit Parts of Houses (other than Underground Rooms) From time to time it has become necessary to take action in re spect of a few individual rooms in houses still regarded technically as fit for habitation where these have for one reason or another deteriorated in condition beyond reasonable possibility of being rendered fit. No. of closing orders in force on 1st Jan 1955 (2 made in 1952, 1 in 1953, and 2 in 1954) Premises Rooms 5 10 No. of representations under consideration on 1st Jan - - No. of representations made during 1955 3 7 No. of representations under consideration on 31st Dec. 3 7 No. of undertakings accepted during 1955 - - No. of closing orders made during 1955 - - No. of closing orders determined during 1955 1 2 In addition to the closing orders detailed in the above table certain other orders have been made under Section 12 of the Housing Act, 1936, in respect of whole flats which have been for the purpose considered as part of the building in which they were incorporated These are included in the paragraph entitled Unfit Houses but are clearly distinguished. Repair of Houses under Sections 9 and 10 Housing Act, 1936 No action has been taken since the war under these Sections. 55 Unfit Houses Although it has not been possible to secure the demolition or closure of many of the unfit houses in the Borough because of the difficulties in securing accommodation for displaced occupants and because of the general housing shortage, it has been found necessary to do this in a limited number of instances where the property was particularly unhealthy. The procedure was easier in some cases where the property was not occupied. The following table sets out the properties which have been dealt with as unfit since the war and in respect of which demolition or closing orders have been made on representations submitted 1949 4 Warden's Place D Present Position Still occupied. 2,3,9,10,11 Cavendish Dwellings (Dealt with as parts of buildings) C1 Closed. 1950 Northburgh Street Buildings (50) D Demolished 1951. 1951 2 Jay's Buildings (Dealt with as part of building) C1 Closed. 42-58 (consec.) Bastwick Street D Demolished 1954. 11 Wynford Place D Demolished 1953. 62 Muriel Street D Demolished 1953. 8 Medcalf Place D Gutted. 1953 5 Northwest Place D Demolished 1953. 69-71 Gee Street D Demolished 1954. 1 Coleman's Buildings C2 Closed. 21-24 Shene Street C2 Used for storage of timber authorised. 1954 127 Golden Lane C2 Permission given for use of premises after conversion as toilet accommodation in connection with adjoining licensed premises. 1955 16 Calshot Street 4,7,22,24,25,26,31,40,45,47, C2 Closed. 51,56, Cavendish Dwellings C2 Closed. D-Demolition: C1-Closing Order: C2-Closing Ordeer: made in lieu of Demolition Oder. 56 In all, Orders have been made in respect of 99 premises, and in addition 61 representations were under consideration at the end of the year Slum Clearance In the first few years of recovery from the affects of the second world war it was impossible to carry out any measures of slum clearance because of the shortage of labour and materials although many areas in Finsbury, as elsewhere, had even before the war been earmarked to be dealt with in this way and had by the passage of time and by neglect during the war become even more unfit. In 1949 a careful survey of the Borough was undertaken as it was then considered that a limited programme of slum clearance might be initiated. As a result of this survey which did, however, not include a house to house inspection it was found that there were very many areas in the Borough which could be represented for clearance. These consisted of five large areas and some 60 or more smaller areas of varying size Altogether it was thought that there were about 1,817 unfit properties involved Following detailed examination of the reports by the council and conferences with the London County Council a five year programme for 1951-1955 was agreed This did not include any large areas as it was felt that the rehousing problem would be too difficult to deal with The areas agreed upon were as follow 1 Bastwick Street - 17 Premises This area was dealt with by the council by way of individual demolition orders on the remaining houses in this street and these were finally cleared in 1954 This marked the end of some particularly bad conditions which had existed for half century, the first representation in regard thereto having been made by the Medical Officer of Health to the Vestry of St. Luke's before the formation of the Metropolitan boroughs. 2 Faulkner's Alley - 2 Premises This area was represented in 1953 and a clearance order was made in 1954 but the site is not yet cleared. 3 Macclesfield Place - 19 Premises Represented in 1953, clearance order made 1954. This area has not yet been cleared. 57 4 Lizard Street and Ironmonger Passage - 3 Premises Represented in 1955, clearance order made 1955. This area has not yet been cleared. 5. James' Gardens including Frye's Buildings - 25 Premises Represented in 1951, clearance order made 1953. This area has not yet been cleared. 6. St. James Row - 8 Premises Represented in 1953, clearance order made in 1953. This area has not yet been cleared. 7. Buxton Buildings) ) 8. Herbal Hill) ) These areas have not been represented as yet. 9. Field Place) ) 10. Medcalf Place) 11. King Square - 2 Premises This area is to be dealt with by the London County Council and a clearance order has been made, but the area has not yet been cleared. 12. Rosoman Street - 5 Premises This area is to be dealt with by the London County Council and a clearance order has been made, but the area has not yet been cleared. 13. Jay's Buildings (including Penton & Rodney Residences) - 68 Premises This area has not yet been dealt with by the London County Council by whom it is to be undertaken. 14. Cavendish Dwellings - 72 Premises This area was represented by the London County Council in 1955 but a clearance order has not yet been made By 1954 it was felt that in view of some improvement in the arrangements for rehousing it was possible to consider the clearance of a large area which would provide a site for redevelopment. In consequence the smaller sites of 10 Premises in Murton Street which were to have been dealt with by the Borough Council and of 31 Premises 58 in Waterloo Street and 4 Premises in Galway Street which were to have been dealt with by the London County Council were merged into a larger area including the whole of Galway Street and the North side of Radnor Street including in all 158 Premises and covering an area of about 3.5 acres. This area was represented in 1955 and a clearance order was made in the same year. Inspections Owing to shortage of staff it has been impossible since the war to institute regular house to house inspections apart from those necessary in connection with representations for slum clearance or demolition orders. Moreover, such inspections would have given rise to much public dissatisfaction in that many defects not remediable under the Public Health Acts would have been discovered and no effective measures would have been possible to deal with them Nevertheless, owing to the very large number of sanitary complaints received information on the housing conditions in a majority of the properties in the Borough was available and a clear knowledge of the prevailing standards was in this way maintained. In 1955 it was, however, found possible to carry out a limited house to house inspection of the properties in Affleck Street. The total number of house to house inspections for these purposes in 1955 was 278. Overcrowding It is not possible to supply statistical information with regard to the prevalence of overcrowding, but the impressions gained over the years are of interest. Whenever overcrowding is discovered the occupant has been urged to apply for rehousing either to the Borough or the County Council though in most cases this has already been done. Appropriate information is then supplied to the authority concerned. Occasionally wilful overcrowding has been discovered. This has occurred from time to time with intent to advance claims for alternative housings. A number of other cases have been by Irish, Cypriots or other foreigners coming to London to seek employment and whose standards of housing are not as high as those in this country Pressure has been exercised both directly on the occupiers and indirectly through the landlords on the whole successfully to remedy the overcrowding, although in no case have legal proceedings been instituted Landlords generally have been warned of their responsibilities in this connection. 59 By and large the number of cases of serious overcrowding discovered has greatly diminished during the last ten years and particularly in the last five years and only in a few isolated instances does it exist now and probably there are not a large number of cases where the legal standards are infringed. It must be remembered, however, that these standards are not as satisfactory as is desired. Rehousing Applications for rehousing by the Borough Council are made to the Housing Manager and these have been assessed for some years according to a points scheme. When accompanied by medical certificates to support the application on medical grounds these have been referred to the Medical Officer of Health. Enquiries are then made by the Nurse/ Visitor into the detailed nature of the family health, and the apparent bearing on this of the accommodation in use, and when desirable, an inspection is carried out by the Sanitary Inspector. These reports are then correlated with the medical certificates, and a degree of medical priority is then allotted. About 500 applications have been dealt with in this manner each year. 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 Divisional Medical Officer of the London County Council who is responsible for allocating priorities on medical grounds. The approximate number of families rehoused during the last five years and in 1955 were:- Rehoused in Council Flats 1951/55 1955 523 51 Rehoused in requisitioned property 240 31 Rehoused from Clearance Areas, etc. 178 53 Families rehoused by L.C.C. 387 37 Families rehoused in new towns 25 11 60 Certificates of Disrepair Since the war only five applications were received for certificates under the Increase of Rent and Mortgages Interest (Restrictions) Act, 1930, and in each case they were issued., One given in 1952 was revoked in 1955 when the work specified was carried out, and one given in 1955 remained in force at the end of the year: the others were revoked in previous years. Seven applications for certificates under the Housing Repairs and Rents Act, 1954 were received in 1954 and 15 in 1955 and 7 and 13 respectively were issued in consequence. Five of these certificates were revoked in 1955. Improvement Grants It is unfortunate that owners of property have made little use of the financial assistance available under the Housing Acts at the discretion of the Council towards securing improvements in unsatisfactory houses. Only 4 formal applications have been made, 2 were granted, 1 refused and 1 was still under consideration at the end of the year. Those granted were as follow: 1. For the conversion of two houses with a low standard of amenities in Paget Street to 3 self contained flats. Grant was approved in 1954 and the work satisfactorily completed in 1955. The resulting flats may be regarded as very good and the improvement of conditions considerable. 2. For the conversion of three houses in Myddelton Square into 10 self contained flats. Grant was approved in 1955 and work was still in progress at the end of the year. The refusal was mainly on the grounds that the improvements would not render the accommodation fully self contained. 61 SECTION E FOOD Food Hygiene There are a large number of food premises in the Borough. Under this heading may be classed many wholesale warehouses and cold stores around Smithfield Meat Market, street market stalls and other business concerns referred to elsewhere. In addition there are approximately 231 Restaurants, 174 Factory canteens, 180 Grocers, 37 Bakers and Confectioners, 74 Sweet shops, 10 Fried fish shops, 21 Fish shops. In 1955 the total number of visits paid to food premises was 1,223 and to food stalls 2,209. Much attention has been given to the subject of the clean handling of food during the post-war years and much propaganda by means of posters and in other ways has been directed to the public generally to make them conscious of the need for a high standard. Considerable headway has been made in persuading business firms to gradually improve their standards, but this work has been severely hampered by the shortage of sanitary inspectors and in the last year or more by the uncertainty of the terms in which proposed new legislation would be enacted. In 1950 the council gave prolonged consideration to the advisability of establishing a Clean Food Guild but on the whole it was thought that the advantages would not outweigh the many administrative difficulties and some disadvantages, and the project was eventually abandoned. Until 1953 much assistance was obtained from the local office of the Ministry of Food who insisted that new retail food premises requiring a licence from them were constructed and equipped to the satisfaction of this department before it was granted. A few talks were given from time to time to small groups of food handlers and to children in the schools by the Medical Officer of Health, food inspector, and laboratory technician. In 1955 conjointly with other neighbouring boroughs an exhibition demonstrating with photographs ways in which some food premises including some small businesses had been able to introduce equipment which would facilitate a high standard of hygiene was held in Shoreditch Town Hall. This was visited by many persons with business interests in Finsbury. 62 Probably the most important and valuable means adopted of improving standards has been by the personal influence and persuasion backed where necessary by legal sanctions of the Inspectors. This, however, is very time consuming and as already stated shortage of staff has prevented greater efforts of this nature. The pathological laboratory has been used for many examinations of food apart from occasions when particular food has been suspected as a cause of food poisoning. Generally speaking I am satisfied that the standard of food hygiene in the Borough has not compared unfavourably with that of other districts of a similar type, but it is nevertheless necessary to point out that the standard is far below that which ought to prevail, not only to prevent the spread of diseases the dangers of which may at times have been exaggerated, but also to inculcate an all round higher conception of the value of cleanliness in our daily lives. The trades concerned are more and more realizing not only their legal and moral obligations but also the advantages in adopting a higher standard, but they have been confronted with many difficulties such as restriction of capital, delays in getting structural improvements carried out and shortage of labour and indifference on the part of employees. Adulteration of Food Throughout the period since the war now under review the examination of samples of food and drugs has been continued The proportion of samples not reported on as genuine has been very low in every year. namely about one per cent which contrasts strikingly with that of from 1 to 3 per cent in the years before the war and even more so with that of 5 to 10 per cent before 1920 The public may be well satisfied that on the whole these commodities are of the standard of quality claimed for them by vendors or expected by the ordinary purchaser The policy of informal sampling extended during the war has been continued. This method is fully justified as long as only an occasional sample is found to be adulterated when this occurs a further formal sample is immediately taken when this is again found to be adulterated appropriate action, including legal proceedings if necessary, is taken by the Council. By taking informal samples traders are not disturbed by the formalities associated with formal sampling and much time is saved. The sampling is carried out by one of the Food Inspectors with the assistance of a part-time agent. The samples for chemical analysis are submitted to the Public Analyst whose office and laboratory is conveniently situated in the Town Hall. 63 In 1955 a total of 600 samples of food and drugs were submitted to the Public Analyst. Of these, 2 were formal and the remainder were informal samples. Details are appended:- No. of Samples Obtained Foods Milk 88 Cream and Condensed Milks 9 Ice Cream 29 Sausages 29 Meat and Fish Pastes 3 Other Meat Products 75 Butter 2 Cheese 9 Jams. etc. 9 Dried Fruits 17 Cake and Pudding Mixtures, etc. 21 Cereals, etc. 2 Flours, etc. 3 Tea, Coffee, Cocoa, Extracts 9 Sauces, Vinegar, etc. 11 Soups 7 Herbs, Spices and Condiments and flavours 41 Powders (Baking, etc.) 14 Canned Vegetables, Fruits, Fish, etc. 43 Non-Alcoholic Drinks 17 Confectionery 52 Table jellies and gelatine 8 Various 8 Drugs Simple Medicines 35 Powders 14 Tablets 28 Ointments, lotions, etc. 17 Total 600 One informal sample of a medicine prescription was found to be deficient in dilute hydrochloric acid to the extent of 23% Formal samples of both the medicine and the hydrochloric acid were subsequently purchased and found to be genuine. 64 Bacteriological Examination of Food The pathological laboratory has been used for the bacteriological examinations of foodstuffs whenever suspicion of contamination has arisen and to some extent as a routine measure of control Apart from examinations of milk and ice cream details of which are given elsewhere, the following foodstuffs were also examined during 1955:- Shellfish 5 Synthetic Cream 3 Egg Albumen 2 Frozen Egg 2 Gelatine 2 Sausages 3 Pork Pie 1 Jellied Eels 1 Others 7 Total 26 The bacterial quality of these goods was found to be generally satisfactory and no pathogenic organisms were isolated This was in accordance with the results in previous years. Large quantities of Chinese egg albumen have been found to be infected with Salmonella organisms. Owing to the impracticability of sterilizing this commodity at present, such goods when found to be infected have been released by Port Health Authorities for industrial purposes only. In connection with this arrangement several Finsbury firms, mostly engaged in the printing trades, have been interviewed and warned of appropriate steps to be taken to prevent the spread of infection. Food Complaints From time to time complaints are received from members of the public in respect of alleged unsound food purchased from shops in the Borough. There has been a very slight increase in the number of complaints in recent years probably due to the public becoming more food hygiene conscious as a result of educational publicity by the Government, Local Authorities and the Press. Eighteen such complaints were made last year ranging from insects and other foreign bodies in food 65 to dirty milk bottles and mouldy pies. In every case an investigation was made and, where necessary, a bacteriological examination or chemical analysis was carried out and a report submitted to the Health Committee. A few of the complaints were considered to be unjustified and some were insufficiently serious to warrant further action. Legal proceedings were successfully instituted in 3 instances. The Council instituted legal proceedings under the Food & Drugs Act, 1938 as under:- Date Premises Offence Result 21. 7.55 72 White Lion Street A loaf of bread with a cockroach embedded therein, sold in contravention of Section 3 Food & Drugs Act, 1938. Fined £7.0.0. 21. 7.55 46 Exmouth Market Meat pies and mashed potatoes containing a cockroach sold in contravention of Section 3 Food & Drugs Act, 1938. Fined £7.0.0. 6.12.55 53 Chapel Market Bacon affected with fly grubs sold in contravention of Section 3 Food & Drugs Act, 1938. Offence proved: defendants given an absolute discharge. £ 7.0.0. costs. Milk Since October 1951, when London was made a 'Specified Area', all milk sold in the Borough has been Designated and is bottled by the large dairy firms at central establishments in other parts of London. During 1950 the largest dairy in Finsbury ceased to pasteurise and bottle milk, and apart from the few storage depots, all the registered premises in the Borough now are retail milk shops. 118 visits were paid to milk premises during 1955. Routine sampling of milk for chemical analysis and bacteriological examination is carried out. In addition to shops, depots and roundsmen, samples are taken from schools, day nurseries and other institutions. In spite of trade difficulties the quality of milk has continued to remain well above the required legal standard. 66 Summary No. of Dairies on register at end of 1955 9 No. of Distributors on register at end of 1955 123 No. of transfers approved during 1955 9 No. of new applications approved during 1955 5 No. of premises removed from register during 1955 2 Designated Milk Licences issued Dealers Supplementary Tuberculin Tested 53 26 Pasteurised 73 26 Sterilised 80 29 Quality of Milk No. of samples submitted to Public Analyst 88 No. of samples reported as adulterated NIL Average fat content of milk samples 3.53% Average non-fatty solids content 8,65% No. of samples submitted for bacteriological examination 57 No. reported as fully satisfactory 50 (Some of the tests on the remaining 7 samples were rendered void owing to the shade temperature exceeding the prescribed maximum). Ice Cream At one time Finsbury was the centre of a flourishing ice cream trade, the article being manufactured on a small scale in many parlours, kitchens and back yards. Even before the second World War these had almost entirely disappeared, but there still remained several small premises where ice cream was made in restricted unsuitable accommodation though the sale of the prewrapped commodity prepared in large central factories was spreading. During the war and in the years immediately succeeding the rationing of food stuffs and later the requirements of new regulations with regard to heat treatment led to the closing down of most of the small firms and prevented others from commencing manufacture. Much attention was devoted to the supervision of the manufacture wherever it was carried on and this frequently involved elaborate investigations including the bacteriological examination of many samples taken at various stages during the process. 67 Attention has been throughout directed also to the character of ice cream whether loose or wrapped sold in the borough but manufactured elsewhere. By 1955 there only remained 3 places where manufacture actually took place although the registration of other premises remained valid: one of these was in many ways unsatisfactory and was removed from the register during the year, thus leaving only two premises on which the manufacture was continued. Practically all the ice cream sold from the retail shops in the borough is supplied by the large manufacturers and is pre-wrapped. The number of visits to ice cream premises by the Food Inspectors during 1955 was 100. Special attention was paid to the premises and the plant of the firms manufacturing ice cream particularly when the examination of samples indicated that conditions might not be entirely satisfactory. Assistance and advice was given in tracing the possible causes of contamination. Certain samples of bulk ice cream taken in course of delivery to a Finsbury firm from another area were found not to be fully satisfactory and the matter was taken up with the Authority concerned. Summary - Premises No. of premises registered for manufacture 22 No. of premises registered for storage and sale 107 No. of premises registered for storage only 2 No. of new registrations during 1955 6 - Sampling No. of samples submitted to Public Analyst 25 No. reported as adulterated NIL No. of bacteriological samples taken 56 No. reported as fully satisfactory 26 No. reported as indicating possible unsatisfactory conditions during manufacture or storage 30 Meat Inspection There are now no licensed slaughterhouses in the Borough and no slaughtering has taken place since the war The slaughterhouse in Penton Street which was closed down at the outbreak of war has not been relicensed. 68 In the neighbourhood of the Smithfield Meat Market there are a considerable number of wholesale butchers and offal shops, bacon factories, wholesale bacon and provision warehouses, poultry, game and rabbit shops and Public Cold Air Stores, all of which are regularly inspected. From the time of the war until 1954 meat and similar foodstuffs were controlled by the Ministry of Food and many of the larger ware houses were taken over by the Minister for the bulk storage of foodstuffs. In many of these premises large stocks of foodstuffs were stored, all of which came under the supervision of the meat inspector. Thousands of tons of Continental and Scandinavian offals and tinned hams were imported into the Borough by private traders under licence from the Ministry of Food. In many cases condemnation of these foodstuffs took place either as a result of decomposition or faulty sterilization. In June 1954, the Minister relinquished control of these articles and trading reverted to the type carried on before the war. Wholesale butchers and offal premises were re-opened mostly for the sale of old cow and bull beef for manufacturing purposes. Due to the nature of these carcases a rigid inspection is maintained to ensure that diseased meat is not passed on to the public. Since 1946 approximately 581,000 carcases of imported frozen mutton and lamb have been examined for Caseous Lymphadenitis in the Cold Air Stores. These carcases are slightly defrosted before examination and where a diseased carcase is found, it is adjudicated upon and either the whole or part of the carcase is condemned. The presence of the diseased lesion has been found to be as high as 15 per cent in some consignments. From time to time bags of frozen Australian briskets of beef were imported into the Borough and on examination about 8 per cent. were found to contain a 'worm nodule', the Onchocerca Gibsoni. During the last 10 years 492 certificates (including 77 in 1955) have been issued for the export of sausage casings, meat essence and bacon. During the period 1946 to date, several different firms contracted to undertake the disposal and collection of unsound meat and food condemned in the Borough During 1955 the contractors were Messrs Hanson & Burbidge, Ltd. The meat inspector has regularly visited and inspected the 36 retail butcher shops and 4 meat stalls in the Borough. In 1955 2,348 visits were paid. 69 Bakehouses The Factory and Workshops Act 1901 came into force in 1904 and since then the establishment of any new underground bakehouse has been prohibited. There were at that time 46 in use and their continued operation was subject to a certificate of suitability by the Council. 40 such certificates were issued. The Factories Act, 1937 required a review of these certificates in 1939 and each succeeding fifth year and to revoke the certificate wherever the standards in specified ways were not satisfactory. The Council adopted recommendations made by the Metropolitan Borough Standing Committee as a guide to standards which they would require in Finsbury. On the first survey under the Act in 1939 it was found that only 20 certificates remained in force the premises to which the remainder applied having been abandoned as a bakehouse in the meantime. In some of these the standards were found to be unsatisfactory and in most cases the owners effected improvements but in 3 cases the certificates were revoked. Owing to wartime conditions in 1944 and restrictions on building in 1949 the standards required were not strictly interpreted and no certificates were revoked. However, in 1950 a careful inspection was carried out as a preliminary to the 1954 review in order to give the owners long notice of the Council's probable requirements in order that they might effect substantial improvements where necessary, be saved the expense of lesser improvements not likely to satisfy the Council or have ample time in which to seek alternative accommodation. In consequence most of the owners carried out extensive improvements but in 3 cases the certificates were revoked in 1954. As a result of air raid damage, further voluntary closures and the total of 6 revocations referred to, only 11 certificates remained in force in 1954 and there have been no changes since then. In addition to the underground bakehouses there were 6 other bakehouses in use from the end of the war till 1950 but since then the number has been reduced to 4. The bakehouses have been regularly inspected each year, 43 inspections having been made in 1955. Preserved Food and Sausages There have been few changes in the number of premises registered during the past few years for the preparation or manufacture of sausages, potted, pressed, pickled or preserved food. At the end of 1955 72 premises were so registered. 70 Margarine There were 13 premises registered in 1955 for the business of a wholesale dealer in Margarine. There have been very few alterations in regard to this since the war. Street Markets There are 4 main Street Markets in the Borough, namely, Chapel Market, Exmouth Market, Farringdon Road and Whitecross Markets, and a total of 590 stalls are licensed by the Council of which 178 are food stalls. The amount of food sold by stallholders forms quite a large proportion of the retail trade in the Borough. The Pood Inspectors visit the Market Streets every day and during 1955 some 2,209 inspections were made. In addition the storage accommodation used by licensed traders is inspected annually. The supervision of the Market Streets has received the close attention of the officers and the appropriate Committees of the Council during the past year with particular reference to the provision of bins by the stallholders and keeping the streets free of litter., The Borough Engineer arranges for the daily collection of the refuse and has endeavoured to effect improvements by a more frequent clearing where necessary. The maintenance of a satisfactory standard of hygiene in the handling of food has been one of the most difficult Public Health problems of recent years and closely related with this the adequate control of refuse and litter from the stalls. Some improvements in the conditions has been effected lately but they still remain in a far from satisfactory state Not only do they often render the food sold liable to contamination but also and probably more important they have an unfavourable influence on the minds of the public in relation to Pood Hygiene. Licensed Premises and Public Houses Finsbury has 132 licensed premises all but 9 of which are public houses. The number of inspections carried out during the year was 147 of which 47 were visits in connection with the transfer of licences and other matters under the Licensing Act, 1953. In this way the Licensing Justices are advised of unsatisfactory conditions particularly of insufficiency of sanitary accommodation for customers in public houses. Matters requiring remedy under the Public Health or Food & Drugs Act are dealt with in accordance with these Acts. 71 Since the war and more so since the de-restriction of building work, a considerable number of licensed premises have been repaired, cleansed or modernised either voluntarily or as a result of pressure by the Health Department. In particular many of the kitchens of public houses selling cooked meals have been improved. During 1955, 14 premises were dealt with in this way. Pharmacy and Poisons Act Forty-four applications for names to be placed or retained in the Council's list of sellers of Part II poisons were approved and each of the premises were visited during the year. The number has varied little in recent years. On inspection the labelling and the type of container in which the poisons were kept were observed and compliance with the requirements was found to be general. Unsound Food No formal seizure and condemnation of food under Section 10 of the Food & Drugs Act, 1938 was necessary during the year. There is little evidence of attempts by traders to sell unwholesome food to the public, in fact it is the traders themselves who generally notify the department of any suspected unsound food in their possession. In such cases voluntary surrender of food is accepted and certificates issued by the Food Inspectors accordingly. Over the years the amounts dealt with have remained high. This is because, in addition to the many retail food shops in the Borough, certain multiple stores have their headquarters in Finsbury to which doubtful food is returned from branches all over London. Similarly large quantities of foodstuffs are received at the depots of the British Transport Commission in the area and the Food Inspectors are often called in to adjudicate on food that has been damaged or contaminated in course of transit, The details of unsound food surrendered during the year are as follows:- lbs. Meat - diseased 23,360 Meat - unsound 33,956 Meat - products 3,070 Bacon 11,831 Offals - diseased and unsound 30,073 Poultry 9,232 Carried forward 111,522 72 lbs. Brought forward 111,522 Game 296 Rabbits 1,043 Canned foodstuffs 28,533 Bottled Fruit, Pickles, etc. 71 Dried Fruit 187 Confectionery 252 Preserves 105 Cheese 6,927 Fruit and Vegetables 3,966 Fats 85 Fish 155 Cereals 51 Eggs 1,052 Other Foodstuffs 1,497 Total 155,742 lbs. 69.53 tons Food Poisoning In the years since the war public attention has been drawn to an apparently increasing number of cases of food poisoning This is probably much greater than the actual increase as information has been much more frequently given to the Medical Officer of Health on the occurrence of small outbreaks of incidents involving one or two persons in a household and of individual cases than was formerly the case. Nevertheless there has probably been some real increase due to the greater number of persons taking their meals in school centres, works canteens and luncheon clubs. Most of the outbreaks have been caused by food being prepared one day, kept without adequate cooling, and then reheated for consumption the next day. The outbreaks are rarely serious in their effects and although unpleasant and apt to cause disorganization complete recovery within a day or two is the rule. Between the end of the war and 1950 several outbreaks involving 10-60 persons occurred but none were serious. Each year there have been a few cases involving 2 or 3 members of a household or individuals. Many such cases have not been such as are normally meant by the words Food Poisoning and the cause has remained unknown. 73 In 1949 a child of 2 was found to have a Salmonella Typhi-murium infection and this was believed to have been contracted from hens kept in a small back yard, possibly through an infected egg. Full details were published in the monthly Bulletin of the Ministry of Health. Information reaches the Medical Officer of Health in many other ways than formal notification and is occasionally from hospitals where a Salmonella infection has been discovered some time after the event. Careful laboratory investigations have been made in all cases including individual cases wherever this has been possible. When a Salmonella infection has been discovered investigations have been extended to family contacts. In 1955 there were 19 cases of food poisoning coming to the notice of the department. In 2 instances two members of the same family were involved and the remaining 15 were isolated cases affecting one individual only. Salmonella Typhi-murium infection was responsible for 6 cases, all young children, one an infant of only six weeks. In one case the infection apparently arose in hospital. In no case was there any direct evidence of the source of the infection. In spite of full investigation no cause for the symptoms was discovered in any of the other cases nor was any particular foodstuff clearly implicated though several items fell under suspicion. 74 SECTION F INFECTIOUS DISEASES General The Information given in this and the succeeding paragraphs is based on the total number of cases of the diseases referred to, which arose in Pinsbury residents and which came to the knowledge of the department The figures do not correspond with those for notification which in some cases is directed to another Borough as where Poliomyelitis for example is notified by a hospital in which the diagnosis is finally confirmed to the Medical Officer of Health of the area in which it is situate although the infection arose whilst the patient was living at home. For this reason the tables do not correspond with those supplied by the Registrar General. Even so amended it must be remembered that the locus of infection is not by any means always in the same district as the residence of the patient. In the particular instances, however, of food poisoning outbreaks and infections in day nurseries and schools suitable comments can sometimes be given in regard to circumstances in this Borough In 1953 new regulations superseding those issued in 1927 for the control of Typhoid Fever, Dysentery and certain other diseases came into force and the Council authorized the Medical Officer of Health and in his absence his Deputy to issue notices under them in an emergency In 1949 when the Metropolitan District Nursing Association who had until then undertaken the visiting of cases of measles and whooping cough found that they were unable to continue this service, a trained nurse with fever experience was appointed as visitor to perform these duties and the enquiries and investigations in relation to other infectious diseases until then carried out by the Sanitary Inspectors The latter however, remain available to assist whenever problems pertaining to their more peculiar work arise The number of visits paid by the Infectious Disease Visitor during 1955 was 2,454. Striking differences have occurred in the nature and character of infectious diseases in the years since the second World War and consequentially on the methods required for their control. Diphtheria has at least for the time being disappeared and Scarlet Fever has become so mild that it no longer causes any concern except in relation to women about to be confined and some food handlers. Measles also has become a milder disease and complications arising from it are rare Gastro enteritis in babies is much less common than formally and although still a serious disease is not so frequently fatal also it occurs uniformly throughout the year and the incidence is not necessarily greatest in the summer months 75 On the other hand Poliomyelitis has now become a dreaded disease each summer and until now we have been able to do little in regard to its prevention and control. Dysentery in a mild form known as Sonne has become an increasingly disturbing factor in day nurseries and among small children generally and in many cases has involved adults also As with gastro enteritis cases occur all the year round and have not been more numerous in the summer months. Whooping Cough has remained, however, unchanged in character as one of the threats to the health and even the life of young children Although some infectious diseases such as Scarlet Fever. Measles and Dysentery are now not serious in their effects on health it must not be forgotten that they cause much disturbance in family and economic life by necessitating some degree of isolation and nursing care of the individual. The most important epidemics that have occurred in recent years were (1) Typhoid Fever involving 11 cases in 1950, the source of which was never discovered but which was fortunately confined to the resi dents in one house; (2) Measles in 1951 when there were 901 cases, and (3) Whooping Cough in 1953 when there were 364 cases The highest incidence of Poliomyelitis has been 5 cases in 1950 and 5 cases in 1955 The following table shows the incidence of notifiable diseases in 1955:- All Ages Under 1 yr. 1-4 yrs. 5 14 yrs. 15 24 yrs. 25 44 yrs. 45 64 yrs. 65½ Cases treated in Hosp. Acute Pneumonia 38 1 8 8 6 8 7 32 Dysentery 119 6 71 22 3 13 2 2 58 Erysipe las 11 - - - 1 2 6 2 4 Food Poisoning 21 1 6 7 2 5 - 4 Gastro enteritis (under 2 yrs) 33 26 7 - _ - - - 26 Measles 562 43 318 196 3 2 - - 93 Meningococcal Meningitis 1 - 1 - - - - - 1 Ophthalmia Neonatorum 2 2 - - - - - - 2 Paratyphoid Fever 1 1 - - - - - - 1 Puerperal Pyrexia 1 - - - 1 - - - 1 Poliomyelitis 5 - 3 - 2 - 7 - 5 Scabies 16 1 2 9 3 1 - - - Scarlet Fever 35 - 11 23 - 1 - - 23 Tuberculosis (pulmonary) 40 - 2 3 5 14 11 5 - Tuberculos is (Non-Pulmonary) 6 - - 1 5 - - - - Whooping Cough 105 16 58 30 - 1 - - 33 996 97 487 299 25 45 27 16 283 76 DISEASES NOTIFIABLE IN FINSBURY Diphtheria The eradication of Diphtheria has now been almost completed and this disease which until 1943 regularly killed one or two children in Finsbury each year and was responsible for between one and two hundred cases of often prolonged illness each year until the war has gradu ally disappeared and since 1947 has only occurred sporadically. Thus in 1948 there was only one case: in 1950 a Finsbury resident aged 62 developed the disease whilst under treatment in a hospital in another Borough and an employee aged 22 in a Finsbury firm resident elsewhere also contracted it: in 1952 a child of five developed nasal diphtheria but was otherwise not ill In other years no cases developed nor were any Finsbury persons known to have been in contact with any cases from outside the Borough. Also no deaths have occurred from diphtheria since 1947 apart from the allocation in 1951 of one reported as due to a complication of the disease which occurred 53 years previously. This happy state of affairs may be largely attributed to the energy displayed by the Council and its staff in securing the immunization of a very large proportion of infants in the years from 1934 onwards. The Immunization of infants was commenced in Finsbury in 1928 and in 1934 serious attention was given to its extensive use, By 1939 a substantial proportion of children had been protected. In that year Dr. C. L Katial. then chairman of the Public Health Committee sug gested to the local division of the British Medical Association that it should press for the extension of immunization on a national basis The recommendation was accepted and put forward to the Annual Representative meeting of the Association held in Aberdeen two months before the outbreak of war by the late Dr Fettes and myself and was acclaimed as an accepted policy. This undoubtedly encouraged the Ministry of Health a year or two later to undertake nation wide propa ganda to secure the immunization of all infants. The campaign to secure immunization was continued with success during the war in spite of the difficulties associated with air raid conditions and evacuation and after the war until 1948 since when it has been continued by the London County Council. 77 Smallpox No case of smallpox has occurred since the war. A few persons resident in the Borough who had been in possible contact elsewhere were placed under surveillance in 1950 and 1951 during the incubation period and in 1955 3 persons who had been on board the s.s. Chusan' on which a case had occurred. Enteric (Typhoid) Fever In 1950 there was a localised outbreak of 10 cases all from one house: some of the cases were severe but there was eventual recovery in all. They were treated in the South Eastern Hospital; the severe cases receiving chloramphenicol which was introduced for use in this country in that year. Full investigations were conducted but the source of the infection was never traced. Apart from this incident and the development of the disease in one child who was clearly infected whilst on holiday in Italy also in 1950, and the occurrence of a case in another area attending a Finsbury School in 1952, there have been no cases, carriers or contacts discovered in the Borough since the war. Enteric (Paratyphoid) Fever There have been only occasional cases since the war and the only ones in the last five years were 2 boys in 1954 resident in another Borough attending a Finsbury School and a baby in 1955 admitted to hospital in the first place as a case of measles. All the infections were of Paratyphoid 'B' type and the cases and contacts were fully investigated. Also in 1955 one man who had been in contact with a case in hospital and 10 children who had been in similar contact in a holiday camp were placed under surveillance, otherwise no contacts or carriers have been known in the last five years. Ophthalmia Neonatorum There have been no serious cases of ophthalmia neonatorum since the war. A few cases have been notified each year, and these have fully recovered. In 1955 2 such cases were notified but one referred to a case in a Finsbury hospital coming from another area, the condition itself not having arisen in this Borough. No information was received as to the notification of any case developing in this Borough from a hospital in another area. 78 Puerperal Pyrexia There has been no serious incidence of puerperal pyrexia since the war, A few cases have been notified each year and since 1948 these have been investigated where necessary by the London County Council as Local Health Authority. In 1955 one case was notified. Finsbury cases occurring in hospital are notified in the area in which the hospital is situate: no information was received during the year as to any such notification. Meningococcal Infections There have been only occasional cases since the war with 4 in the last 5 years. These were all in babies, Information regarding the case was received so late in each case that no practical measures of surveillance or control could be carried out. One baby died in 1952 and the three remaining cases which occurred in 1955 recovered fully. Malaria The only case known of in recent years was in a soldier who had returned from Korea in 1953, He was treated in hospital. Erysipelas In recent years this disease like Scarlet Fever has been very mild and readily amenable to the newer treatments,, In all 40 cases have been notified in the last five years 10 of which were in 1955, 18 in all (3 in 1955) were treated in hospital. Only one case was severely ill and one moderately ill (both in 1955) and the remainder were only mild. There was full recovery in all cases. Poliomyelitis This distressing disease which often gives rise to prolonged illness, lifelong disabilities and not infrequent death has been since the war a most serious concern of Public Health officers and has caused much alarm among the public generally. From 1946 to 1949 there were 12 cases (10 in 1947) the age distribution one under 1, two 1-4, five 5-14, two 15-24 and two 25-44. In 1950 new regulations arranged for a distinction to be made between paralytic and nonparalytic cases. In 1950 there were 5 paralytic cases, in 1951 none, in 1952 1 case, in 1953 and 1954 none and in 1955 6 cases All were in the age group 1-4 except for one infant under 1 in 1955. 79 In addition a diagnosis of meningoencephalitis was made in one man aged 23 which may or may not have been an infection with a similar virus. Only a few nonparalytic cases have been notified (1 child in 1951, 1953 and 1954 respectively and a man and a woman both of 23 in 1955). It is probable, however, that a number of other cases occurred without a diagnosis being made. There have been no deaths throughout the whole period. The 6 cases in 1955 included 1 very severe case which was treated in a respirator for a prolonged time and had paralysis of both arms, 3 with paralysis left leg, 1 with paralysis right leg and one with paralysis of the muscles of the right eye. Though all recovered progress in some of the cases has been very slow and residual paralyses are probable. All the cases were fully investigated and no direct contact was ever established between any of the cases or with any other case in another area, nor did it appear that the giving of any injection or the carrying out of any surgical operation had played any part in precipitating the disease. All known close contacts were excluded from the handling of food, having dealings with children, school or nursery for 3 weeks, and were placed under surveillance. Contacts at work of a few cases employed in the Borough but resident elsewhere were warned to attend their doctor in the event of any indisposition, however mild, and to inform him of the contact: absentees from unknown causes were investigated. Considerable anxiety by employers and other workers was often felt as to adult home contacts being allowed to remain at work. Every effort was made to give advice and relieve this anxiety but exclusion in all such cases would not have been practicable All in all Finsbury has not suffered as severely as many areas. Pneumonia Acute Primary There have been notified about 40 cases each year recently but a number of these have probably been more in the nature of bronchopneumonia than the specific illness which should be understood from this description and have occurred in children and in old persons. Although each case is carefully followed to ensure as far as possible that adequate treatment is given clinical and pathological details have not been available, and in consequence no analysis of the cases would yield any information likely to be of use Most of the cases were treated in hospital and there were a few deaths each year amongst the aged. 80 In 1953 there were, however, 61 cases, many of them in January and probably associated with the Smog in December 1952,, In 1955 there were 33 cases with no deaths. Scarlet Fever Scarlet Fever has remained a very mild disease since the war and although as many as 80 cases have been notified in one year (1952) no special measures for its control have been found necessary The majority have been in children and more than half the cases have been treated in hospital. In the last five years only four developed complications of any kind and these were not serious. Particular attention was given to preventive measures where any of the known contacts were engaged in the handling of food or, being pregnant, were approaching time. In 1955 35 cases were notified of whom 23 were treated in hospital and they did not develop any complication. Whooping Cough This has been during the period under review the most serious infectious disease, particularly on account of the fact that it in so many cases attacks babies under 1, who form sometimes as many as one quarter of the total numbers. Only occasionally have adults been involved, the remainder being children and largely those under 5. In 1950 and 1952 respectively there was an infant death The number of cases has varied considerably from year to year the highest being 356 in 1953 when there was a considerable epidemic. During that outbreak a careful analysis was made of the cases in relation to previous vaccination and the results were published in the monthly bulletin of the Ministry of Health for September 1955. It was concluded that there was some evidence that previous vaccination had reduced the incidence of severe and moderate attacks of the disease. Laboratory facilities for assisting in the diagnosis of doubtful and early cases were made available in 1950, and this has led to more cases coming to the knowledge of the department and a definite diagnosis being established in many very mild cases that otherwise would not have been accepted as such. 81 The disease has not varied greatly in severity, the proportion of severe cases has remained fairly constant between 5 and 10 per cent, during the past five years. In 1955 there were 102 cases (7 severe, 56 moderate and 39 mild) including 1 adult. 32 were removed to hospital, The complications recorded were Bronchitis 6, Lung Collapse 1, Otitis Media 2, Enteritis 1. Measles Measles still remains the commonest infectious disease of childhood although it has for long now lost its terrors and no deaths have occurred from it since the war. Generally speaking it has been mild, though each year a few really severe cases have occurred and complications have arisen in rather more instances but full recovery has been the unbroken rule. There has been very little evidence of periodicity in the incidence and the numbers recorded in successive years from 1949 have been 204, 298, 901, 488, 460, 309 and 547 in 1955. Of the latter 299 were seconded as moderately severe and 5 as severe: and the complications as 7 with bronchitis, 3 with otitis media and 1 with encephalitis. It was noted that those in the second quarter of the year tended to be more severe than those at other times. In most years there have been a few cases among adults but in 1954' there was only one and in 1955 none. Hospital admission as a routine measure has not been employed and has only been practiced where cogent social or medical need has arisen. In 1955 92 were admitted for these reasons. Scabies The number of formal notifications of Scabies received during 1955 was 16 and in addition 23 cases came to the knowledge of the department in other ways. For further comments see Section entitled Verminous Persons. Dysentery Since the war dysentery has more or less continuously been a cause of some concern and much time and effort has been absorbed in efforts to control it. All the cases, however, except one isolated case in 1949 of the Schmitz type have been of the Sonne type which is generally mild. Outbreaks have occurred frequently in day nurseries, sometimes in schools, and on one occasion in 1954 in the children's ward of a hospital. The infection has spread widely in these institutions and many cases were found with few or no symptoms but where pathological examination demonstrated the presence of the causative organism, which often proved difficult to eradicate. On the other 82 hand cases occurred not infrequently where symptoms were present, even severe symptoms, without the discovery of any organism responsible for them sometimes this may have been accounted for by the masking effect of treatment given. The infection also often spread in the families concerned involv ing adults as well as children Apart from cases directly or in directly associated with institutions a considerable number of scattered cases throughout the Borough have occurred and there must be substantial reservoir of infection in the population The cases have arisen on the whole fairly evenly throughout the year with perhaps a slight preponderance in the winter months Although the disease is generally mild a few severe cases have occurred from time to time and even the mild and symptomless carriers often cause economic hardship by their exclusion from nursery school or even work in the case of food handlers The routine control policy has been such exclusion of all cases discovered whether or not they have exhibited symptoms until 3 nega tive specimens taken at defined intervals have been obtained Investigation has included the pathological examination of specimen sometimes repeated of all home and institutional contacts of all cases as they have been recognized. A detailed analysis of the statistics available is not submitted as it would be liable to be misleading The figures depend to a con siderable extent on the criteria adopted for distinguishing between actual cases and symptomless excretors of the organism and these vary widely from area to area and have also varied in Finsbury to some extent during the past few years They also depend in some degree on the circumstances of each case or outbreak as to the completeness with which investigations can be carried out. The following information in regard to 1955, however, may be taken as an approximate guide to the incidence of this disease and does not differ materially from that available for recent years. The total number of cases reported during the year was 116 (14 of whom were adults) of which number 54 were clinical cases (36 of whom had one or more positive stool examinations) and 62 were symptomless 83 excretors. 47 cases arose in connection with day nurseries and 7 in connection with a school. 58 of these cases were removed to hospital. Two nurseries, one of them twice, and one school were involved in outbreaks. Gastro enteritis under 2 This is a notifiable disease in Finsbury, and each year notification or other information has been received of a number of cases which have, however, in the main been of a mild or moderate character though more than half were treated in hospital. The disease can be said to have lost entirely its former status of a serious and dreaded threat to infancy,, Some of the cases at first diagnosed in this way have been found to be dysentery or salmonella infections, but the aetiology of most has been uncertain. The number of cases has varied from 10 in 1951 to 31 in 1954 with 25 in 1955. In the last five years the only death was in 1953. Thus the annual incidence may be taken as between 20 and 40 and the death rate as less than 0 33 per thousand births in each case. These figures contrast markedly with the large number of cases which used to occur before the war for which no figures are available and with the death rate of about 15 per thousand births in the period 1936-1940 and even more strikingly with the death rate of 28 between 1901 to 1905, which was more than the present infant mortality from all causes Gastro enteritis (over 2 years) and Enteritis A few cases of these types have come to the notice of the department each year, sometimes for investigation as possible cases of dysentery or of food poisoning and sometimes for other reasons. Each case is fully investigated according to the circumstances In 1955 there were eleven such cases not dealt with in any other paragraph. Rubella Although not a notifiable disease each case coming to the knowledge of the department was investigated with a view to the discovery of any expectant mother in the first four months of pregnancy who had not had the disease among the contacts. One such case was discovered during a considerable outbreak in 1952 when 276 cases became known She was working in a nursery in which cases were occurring and was excluded 11 cases in all became known in 1955. 84 DISEASES NOT NOTIFIABLE IN FINSBURY Chickenpox About a hundred cases come to the knowledge of the department each year; in 1955 the figure was 94. The great majority are mild including all those known in 1955 and recovery has been rapid and complete,, A visit is paid to these cases if circumstances allow Mumps There were a large number of cases in 1954 and 134 cases were known- The majority were mild but one case developed encephalitis and orchitis, recovery however being subsequently complete. In other years many fewer cases have occurred and in 1955 only 14 became known. Infective Hepatitis In 1953 it was known that a number of cases amounting to a mild outbreak occurred in the Borough and nine cases came to the knowledge of the departments Otherwise only occasional cases have occurred and in 1955 2 such cases were known. A family or school contact between cases is often noted but there has been, as far as is known, no extensive outbreak connected with a particular pool of infection Enquiries are made in regard to each known case. Food Poisoning Please see Section 'E' - Food Influenza and Influenzal Pneumonia There has been no severe outbreak of influenza since the war involving more than a few cases of influenzal pneumonia, The largest number of notifications of the latter was in 1951 with 7 cases and one death. In 1955 there was one case. Typhus The only occasion in recent years when any persons in the Borough were known to have been in possible contact with Typhus was in 1951 when 2 seamen arrived from an infected port. They were placed under surveillance. Glandular Fever An outbreak of a disease which may have been a variety Glandular Fever occurred in a neighbouring Borough but did not spread, at any rate as was known, into this Borough in 1955. Three cases, however, 85 were known and these had no connection with the outbreak referred to In other years only occasional cases have occurred and these in most instances have not been referred to the department. Tuberculosis In the last ten years tuberculosis in the country generally has been assuming a much less serious threat to life. This is shewn by the death rate which was 62 per 100,000 in 1945, about 36 in 1950 and 18 in 1954. The disease has also changed its character and been much less rapid and severe in its course and no longer kills so many young girls and women who not so long ago were its principal victims On the other hand the toll taken by it has been little reduced if not actually increased in older men. It still remains a major preventable disease. Unfortunately in Finsbury the position is not too happy in that the death rate has not fallen so rapidly and is now much higher than average. Thus the rate for Finsbury in 1955 was 42 as against 18 for England & Wales (1954). And from the table given under Deaths in Section "A" it is seen that there were 81 deaths in Finsbury during the period 1951-1955 as against an expected number on the national average for 1954 of 31. On the other hand the deaths as elsewhere have occurred among older persons, particularly men, Of the 81 deaths referred to only 5 were of those under 25, 14 aged 25-44, 38 aged 45/64, and 24 over 65: nearly all deaths over 45 were of men. Although the death rate has fallen strikingly in the country the notification rate has not fallen to keep pace with it This may be due to better diagnostic facilities which have led to the discovery of cases which previously might not have been recognized and also to the notification of such mild cases that previously would not have been dealt with in this way These factors have acted to an extent that little significance should be attached to the rate either in Finsbury or elsewhere. Many deaths continue, however, to be registered of cases who had not previously been notified. In Finsbury, however, thanks I believe to good co-operation with hospital and general practitioners, only 3 such cases occurred in 1955 In these cases the disease ran a very acute course and was not diagnosed until revealed by postmortem examination There was no evidence as to whether it could have been diagnosed earlier Altogether we cannot be too satisfied with the progress of tuberculosis in Finsbury and the position must be watched with vigilance The total number of new cases entered in the register during the year was 74. 86 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 Pulmonary M 1 1 1 - 1 1 3 6 8 8 7 37 F - 4 1 1 2 13 3 - 4 - 28 Non-Pulmonary M - - 1 _ - 1 2 _ - - - 4 F - - - - 1 - 2 2 - - - 5 Total 1 1 6 1 3 4 20 11 8 12 7 74 These figures do not necessarily correspond, due to technical reasons, with those shewn in the report of the Chest Physician. The non-pulmonary cases include:- 1 Spine; 1 Facial Lupus Vulgaris; 1 Right Knee; 1 Colon; 1 Hilar Gland; 1 Left Rib; 1 Meningitis; 1 Neck Gland; 1 Sacro-iliac Joint. The notification rate for all forms of tuberculosis was 21.08 per 10,000. There has been little change in this rate or the distribution of the cases as recorded above since 1946. The total number of cases remaining on the register after adjustments for deaths and transfers was on 31st December 1955, as follows:- Males Females Total Pulmonary 160 116 276 Non-Pulmonary 8 21 29 168 137 305 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 measure 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. 87 Disinfection was carried out whenever thought advisable and on request. There were fifteen deaths from pulmonary tuberculosis as follows: Males: 72, 71, 70(2), 69(2), 64, 62, 59, 58, 52 and 45. Females: 85, 62 and 28. There were no deaths from Non-Pulmonary tuberculosis. I should like to acknowledge the willing co-operation and facilities for the inter-change of information which have been provided by the Chest Physician, Dr. W. D. R. Thompson, and his staff. Finsbury Chest Clinic (Information kindly provided by Dr. W. D. R. Thompson, Chest Physician). At the end of the war when there had been some dislocation of the service due to persons being displaced after bombing, a revision of the register became necessary. This entailed much visiting and correspondence. Only active cases were retained on the register although healed patients were kept under observation. The treatment of tuberculosis was retarded at that time and up to 1952 by long waiting lists for in-patient treatment-nine months was the rule. Another aggravating factor was the prevalence of poor housing and overcrowding. Early in 1950 a miniature mass radiography unit came into operation, based at the Health Centre with the Chest Physician as Medical Director. This added considerably to the diagnostic facilities available. On the 5th July 1948 the chest clinic became part of the North East Metropolitan Regional Hospital Board under the administrative control of the Central Group (No.5) Hospital Management Committee, Changes have taken place in the treatment of Pulmonary Tuberculosis. After the war chest specialists recommended more frequently thoracoplasty operations and superseded artificial pneumothorax by pneumoperitoneum combined with phrenic crush. Later the introduction of antibiotics and chemotherapy became routine and section of the lung for tubercle and other pathological conditions followed, giving the chest clinic added interest and responsibility. 88 Further progress in prevention arose from the introduction of B.C.G. innoculation: Finsbury cases being dealt with at University College Hospital. From 1952 the waiting lists for hospitals and sanatoria became shorter and for some time now patients can be admitted without delay In February 1955, a complete new x-ray unit was installed, and the Finsbury Chest Clinic, equipped now as it is, must be considered one of the finest in the Health Service. The After-Care work has been undertaken by the Tuberculosis Health Visitor, and the Clerk to the Clinic became Secretary to the Finsbury Tuberculosis Care Committee- This scheme works very well, as the area is compact, and the cases and their problems are individually known to the staff. During the year 1955, a total number of 2,374 attendances were made to the Chest Clinic. Of this total, 80 attended-for the first time - as contacts of notified cases, and a further 290 were reexamined as routine contact checks. The number of new cases of tuberculosis taken on the clinic register amounted to 29, of which 28 were pulmonary, and 1 only nonrespiratory Of this total, 4 were contacts of previously notified cases In addition to these new cases, a further 11 cases of pulmonary tuberculosis - already notified - were transferred into the borough from other areas. The number of notified cases, therefore, shown on the register at the 31st December 1955, was as follows: Respiratory Non-respiratory Totals Grand Total M W. Ch. M. W. Ch. M W. Ch. 120 89 21 3 5 4 123 94 25 242 Of this total figure of 242 - ten less than in the previous year46 specimens of tubercle bacilli were found to be positive out of a total 310 specimens examined in the Laboratory. During the year, 15 cases were removed from the register as recovered; 14 were transferred out to other areas, 14 deaths were recorded; and 7 cases were further removed as being "diagnosis not confirmed' and 'lost sight of'. 89 The total number of cases x-rayed was 1,110. The Chest Physician made, during the course of the year, 125 routine domiciliary visits, 49 special visits at the request of private doctors, etc. and 21 visits to patients in hospitals and sanatoria. The London County Council Health Visitor - seconded to the Chest Clinic - made 997 visits to homes in the borough during the year Each case was visited with the view to tracing the source of infectioa and advising on the prevention of the disease spreading In a number of cases, disinfection was carried out by the Finsbury Borough Council. Mass Radiography Unit 60 (Information kindly provided by Dr W D. R. Thompson, Medical Director. The Mass Radiography Unit 6D commenced operations in May 1950 with the examination of the employees of Messrs. Blades, East & Blades - a Finsbury firm. Originally the zone of the Unit covered the City of London and the Metropolitan Boroughs of Bethnal Green, Finsbury, Hackney, Poplar, Shoreditch, Stepney and Stoke Newington, but it was found that owing to the intensive day population the area was too large to be covered adequately, so several of the Boroughs were transferred to other Units. The present zone of the Unit consists of the City of London and the Metropolitan Boroughs of Finsbury and Shoreditch. Up to the end of 1955 the Unit has examined 171,109 males and 124,358 females. During 1955 the Unit examined 37,776 males and 24,003 females, making atotal of 61,779, which shows a slight increase on the previous year's figures. All volunteers received the result of their x-ray within a week of their examination. Seventy-five cases of active tuberculosis were discovered and nine hundred and twenty-three cases with tuberculous lesions. The Unit operated at the Mass Radiography Centre, 20. Golden Lane, London, E.C.1. from the 1st January to the 31st August, and from the 21st November to the 31st December. During the intervening period of approximately two and a half months, the Unit visited several firms and organisations and carried out a special Survey at the Shoreditch Public Library, 236, Kingsland Road, London, E.2. by kind permission of the Public Libraries Committee of the Shoreditch Borough Council When the Unit visits a firm or organisation the x-ray apparatus has to be installed on the premises, so that endeavours are made to make any 90 'Survey' on any particular site a co-operative one. Thus, when the Unit operated at H.M. Customs & Excise, staffs from the Royal Mint, Trinity House and Inland Revenue Offices were included; also the General Post Office agreed to provide accommodation, so that their various branches in the St. Paul's area could be examined, and these totalled over 6,000. During 1955 over 1,700 firms (many new ones) were examined, and of these approximately 60% were small firms, viz., with less than 20 employees. Of the total number x-rayed, 14% of the men and 25% of the women had never had a Chest X-ray, while 18% of the men and 13% of the women had not been x-rayed for 3 years or more. Owing to the mobility of most Mass Radiography Units, it has been found extremely difficult to arrange for the Chest X-ray examination of London County Council teaching staffs in the North East Metropolitan Region. A scheme has been evolved by our Unit and approved by the London County Council whereby Teaching and Health staffs could utilise the services offered at the Mass Radiography Centre, 20 Golden Lane. The new scheme came into operation on the 1st January 1956. and we might here mention that so far it has worked satisfactorily. The object of a Mass Radiography Unit is to discover tuberculosis or other chest diseases in the early stages, when such ailments are more easily curable. By the adoption of the appointments system the Unit is able to examine large numbers of people in the minimum of time. The Service is free, reliable and confidential. The Organising Secretary, Mass Radiography Unit 6D, Finsbury Health Centre, Pine Street, London, E.C.1. (Telephone Nos. TERminus 0031, Ext. 9, or TERminus 6184) will be pleased to send full particulars of the Service to interested firms and individuals. 91 APPENDIX A' List of special reports submitted to the Health Committee by the Medical Officer of Health during 1955:- January 10 Aged Persons - Grants to Voluntary Associations for Meals and Recreation- February 7 A Charter for the Aged„ (Circulated to whole Council), June 13 Report of the Royal Sanitary Institute Congress July 11 Cynthia Street Properties. Report on the Fourth Commonwealth Health and Tuberculosis Conference, October 10 Finsbury Employment Scheme for the Elderly - Progress Report., The Markets. Review of Manual Staff., Mid-day Meal Services for the Aged- Report on the Annual Conference of the Sanitary Inspectors' Association, 1955. " Rodent Control - Victoria Dwellings. Rodent Control - Staff. November 7 Absences through Sickness - Manual Staff- Report on the Annual Conference of the National Smoke Abatement Society. Aged Persons - Holiday SchemeP 1955 December 5 Affleck Street Properties. Application for Grant - Family Welfare Association. Grants to Voluntary Societies: (Meals and Recreation for Aged Persons 1956/57),, 92 APPENDIX "B" List of special reports submitted to the Housing Committee by the Medical Officer of Health during 1955:- March Slum Clearance. Survey - Housing Repairs and Maintenance Act, 1954 July Cynthia Street Properties. October Representation as a Clearance Area of Ironmonger Passage Representation as a Clearance Area of Cynthia Street Properties. November Affleck Street Properties.