Ac4 341 1 5B 2 library FIN 37 The MetropoIitan Borough of Finsbury ANNUAL REPORT ON THE PUBLIC HEALTH OF FINSBURY for the Year 1956 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.I. 73026 The Metropolitan Borough of Finsbury ANNUAL REPORT ON THE PUBLIC HEALTH OF FINSBURY for the Year 1956 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.I. 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 on the state of the public health in Finsbury for the year 1956. In my last annual report I included a general survey of the health of the borough and the services operated by your Council in the ten years that had elapsed since the end of the Second World War. I also enlarged in more detail than usual on the details of the work of the Public Health Department. During the year 1956 there were no major developments and I have, therefore, confined my report to the more essential data. It is, however, one hundred years exactly since the first annual report that I have been able to discover was published. This was the report of the first Medical Officer of Health to the Vestry of St. James, Clerkenwell for 1856 and I believe it was his first annual report. My Deputy has kindly prepared for me a brief note on it and other material available in some of the older reports before the formation of the Metropolitan Borough. This I have included out of interest as an appendix to the main report. The general health of the borough has remained good and I believe has continued to improve. There were no outbreaks of any serious infectious disease. Food Hygiene and particularly the conditions in cafes and restaurants received the very close attention of the Health Committee and of the Department. The inadequacy of housing and the state of property generally are the most baneful influences in the sanitary environment. It is with pleasure that I once again am able to acknowledge your; generous support Mr. Mayor and that of the Chairman and Members of the Health and other Committees of the Council. I also wish to thank my staff most sincerely for their continued loyal help and co-operation. I have the honour to be Your obedient Servant, C. 0. S. BLYTH BROOKE Medical Officer of Health. 3 HEALTH COMMITTEE Chairman Councillor J. TROTTER Vice-Chairnan: Councillor J. CROSSLEY Councillor J. T. BELLAMY „ Mrs. S. CLIFFE „ W. J. DAVIES „ Mrs C. GRIFFITHS „ R. R. HULL „ C. SLATER „ C. R. TOZER „ Mrs. L. C. TROTTER 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. Public Health Inspectors: A. J. TRUSLOVE, M. A. P. H. I. (Deputy Chief Public Health Inspector) J. LEWIS, M. R. S. H. E. DITCHBURN, M.A.P.H.I. S. G. FISHER. F. A. P. H. I. A. TREVETHICK, M. A. P. H. I., M. R. S. H. S. J. CASSIDY, K. PALMER, M. A. P. H. I. (from 26.7.56) J. M. SOUTHWICK, M. A. P. H. I. (from 26.7.56) Student Public Health Inspector: B. G. F. PAYNE, D.F.C. Housing Inspector: H. J. NEWDICK, M. A. P. H. I. (Retired 4.11.56) 4 Senior Meat Inspector: R. S. BARBER, M. A. P. H.I. 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 F. W. HAYNES I. PATIENCE R. BLAKELEY (from 14.6.56) J. R. DALTON (National Service 4.7.55) D. NATTRESS Bathing 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 5 SECTION A PHYSICAL FEATURES AND SOCIAL CONDITIONS General Area of the Borough (acres) 587 Population, 1951 census 35,370 Population Density 60 Rateable Value (31.3.56) £1,053,941 Product of a penny rate (1955/1956) £4,143 General rate (1955/1956) 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 post-war development has been the erection of large blocks of modern flats. 6 PRINCIPAL VITAL STATISTICS Population (Mid year estimate) 34,870 Marriages registered 345 Live Births Legitimate Males 324 Females 323 Total 647 Illegitimate „ 25 „ 24 „ 49 Total „ 349 „ 347 „ 696 Birth Rate (standardized) 17.6 England & Wales 15.7 Stillbirths Legitimate Males 5 Females 3 Total 8 Illegitimate „ 1 „ 0 „ 1 Total „ 6 „ 3 „ 9 Stillbirth Rate Per 1,000 live & stillbirths 12.8 England & Wales (per 1,000 live & stillbirths) 23.0 Per 1,000 Population (standardized) 0.23 Deaths Males 179 Females 178 Total 357 Death Rate (standardized) 10.6 England & Wales 11.7 Infant deaths 21 Infant Mortality 30.1 England & Wales 23.8 Neonatal deaths 18 Neonatal Mortality 25.9 Illegitimate infant deaths 3 Illegitimate infant mortality 61.2 Maternal deaths 0 Maternal mortality 0 England & Wales 0.56 Tuberculosis (all forms) death rate 0.20 England & Wales 0.12 Area comparability factors - Births 0.88 Deaths 1.04 7 COMPARATIVE STATISTICS 1952-1956 1952 1953 1954 1955 1951-1955 1956 1. Population 35.740 35,640 35,490 35,100 35,500 34,870 2. Birth Rate Per 1,000 Population 19.1 18.9 19.7 19.7 18.9 p.a. 19.96 3. Sex Ratio Male/Female - - - - 1,084 - 4. Illegitimate Birth Rate Per 1,000 Population 1.1 1.3 1.3 1.4 1.2 p.a. 1.4 Per 1,000 Live Births 60 68 66 72 66 70 5. Stillbirth Rate Per 1,000 Population 0.39 0.42 0.20 0.46 0.36 p.a. 0.26 Per 1,000 Total Births 20 22 10 23 19 13 6. Death Rate Per 1,000 Population 13.4 9.9 8.6 10.2 11.3 p.a. 10.2 7. Infant Mortality Per 1,000 Live Births 16.2 22.2 30.0 30.3 24 30.1 8. Infant Mortality Illegitimate Per 1,000 Illegitimate Live Births - - - - 27 - 9. Neonatal Mortality Per 1,000 Live Births 9 12 27 19 17 26 10. Maternal Mortality Per 1,000 Total Births - - - - 0.6 - 11 Tuberculosis (all forms) Death Rate Per 1,000 Population 0.61 0.31 0.34 0.42 0.45 p.a. 0.20 Crude Population Rates have been given in every case. A dash indicates that numbers are too small for the calculation of a significant rate. 8 Population It is estimated that there has been little change in the population or in its age structure in recent years. Births The birth rate was very slightly higher than that for the previous year. The number of illegitimate births was almost exactly the same as in 1955. Stillbirths There was a very satisfactory fall in the number of stillbirths not only from the high figure recorded in 1955 but to the very low level of 1.3 per cent, of the total births. This more than counterbalances the increase in neonatal mortality referred to later. Deaths The standardized death rate for 1956 was 10 7 and remained therefore well below the prevailing rate of 11 7 for the country generally There was practically no change in the ages at which the deaths occurred or in the causes of death from 1955 Maternal Mortality There were no maternal deaths during the year Infant Mortality I am unhappy to report that for the third consecutive year the infant mortality has been about 30 as against the national figure of about 24. One half of the deaths were, however due to immaturity during the first week of life and it may be that a high standard of midwifery has resulted in more live births thus accounting for the low stillbirth rate only however for such births to end in early death. I must also report that there were 3 deaths among illegitimate infants which correspond to a mortality rate of 61 The average rate for the past five years was only 27 9 CAUSES OF DEATH -1956 0- 1- 5- 15- 25- 45- 65- 75- Total M F M F 1. Tuberculosis, respiratory 1 3 1 5 2. Tuberculosis, other 1 1 2 3. Syphilitic disease 3 1 1 5 4. Diphtheria - 5. Whooping Cough - 6. Meningococcal Infections - 7. Acute Poliomyelitis - 8. Measles - 9. Other infective and parasitic diseases 1 1 2 10. Malignant neoplasm - stomach 5 1 2 2 10 11.„ „ - lung bronchus 13 9 1 23 12. „ „ - breast 1 1 1 3 13. „ „ - uterus 1 1 2 14. Other malignant and lymphatic neoplasms 1 1 14 7 5 4 3 35 15. Leukaemia aleukaemia 1 1 16. Diabetes 1 1 2 17. Vascular lesions of nervous system 7 3 4 2 12 28 18 Coronary disease, angina 4 24 13 6 12 13 72 19. Hypertension with heart disease 2 3 1 6 20. Other heart disease 1 8 5 5 5 12 36 21. Other circulatory disease 1 2 2 2 3 10 22. Influenza 2 2 23. Pneumonia 2 3 5 2 3 6 21 24. Bronchitis 1 5 13 7 9 5 40 25. Other diseases of respiratory system 1 1 26. Ulcer of stomach and duodenum 2 2 1 2 7 27. Gastritis, enteritis and diarrhoea 1 1 28. Nephritis and nephrosis 1 1 1 3 29. Hyperplasia of prostate 1 1 30. Pregnancy, childbirth abortion - 31. Congenital malformations 3 1 1 5 32. Other defined and ill-defined diseases 15 3 3 2 2 25 33. Motor vehicle accidents 1 1 34. All other accidents 1 1 1 1 1 5 35. Suicide 1 2 3 36 Homicide and operations of war - Totals 21 1 2 1 14 101 63 45 44 65 357 10 Inquests Inquests were held on ten residents during the year. The causes of death found were Natural causes: (Female about 70) 1 Road Accidents: (Female 80) 1 Accidental Falls, excluding industrial: (Males 81, 51 and 38 Female 74) 4 Accidental: (Female 84 - inhalation of unburnt gas from partially unlit gas ring 1 Suicide: (Male 40, and Female 64 (Barbiturate poisoning) and Female 61 (Aspirin poisoning)) 3 Total 10 INFANT MORTALITY, 1956 - 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 Congenital malformation 1 1 - - 2 - 2 - - 4 Birth injury and other diseases of early infancy 4 - - - 4 - - - - 4 Immaturity 10 - - - 10 - - - - 10 Pneumonia - - 1 - 1 - - - - 1 Other defined causes 1 - • - 1 - - - - 1 TOTALS 16 1 1 - 18 - 3 - - 21 (In this table the international rules for classification have not been strictly followed). 11 SECTION B GENERAL PROVISION OF HEALTH SERVICES Health Centre The Council continued to maintain the Health Centre for the administration of the Public Health Services, and arrangements continued in force for the use by the Regional Hospital Board and by the London County Council of those portions of the building which were occupied by services transferred to those bodies under the National Health Service Act, 1946, The Council also continued to act as an agent for the Regional Hospital Board in respect of certain services controlled by them. There is no doubt 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. Numerous individual visitors and organised parties both from this country and overseas visited the Health Centre during 1956 All reasonable requests to visit the Health Centre were granted as the exchange of views and information thus afforded is of mutual benefit. 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. 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. 12 Work of the Public Health Department Number examined Throat & Nose Swabs 27 Sputums 261 Per-nasal Swabs (for Whooping Cough) 165 Faeces 1,380 Various Foods 38 Water 8 Milk (Methylene Blue & Phosphatase test): T. T. Pasteurised 54 Pasteurised 4 Sterilised 8 Ice Cream 30 Work of the Regional Hospital Board Blood counts and similar examinations 284 Blood sedimentation tests 188 Sera collected and prepared for Kahn and similar tests 8 Urines collected and prepared for pregnancy tests 17 Bacteriological examinations of Urine 57 Sundry bacteriological examinations 3 Antibiotic sensitivity tests 32 Biochemistry: Serum cholesterol 2 Serum uric acid 1 Domiciliary visits by technician 17 Blood Transfusion The Council continued to co-operate with the North London Blood Supply Centre of the National Blood Transfusion Service, by arranging Blood Donation Sessions at the Health Centre. Three sessions were held during the year at which 276 donors attended; 242 were bled and 34 rejected for various reasons. 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 Medical Officer of Health. The purpose of the authentication is to provide proof to health authorities abroad that the signature of the person 13 issuing the certificate is that of a registered medical practitioner. In 1956, 146 certificates were authenticated; no case of an improper signature was discovered, and no application in consequence refused. Burial or Cremation 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. During the year ten persons were buried or cremated under these provisions. Health Education Health Education was continued during the year by the exhibition of public posters and by the distribution of literature from suitable centres. The former Empire Marketing Boards were kept posted during the year with special poster sets. 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 and rodent control publicity issued by the Ministry of Agriculture, Fisheries & Pood. Book marks incorporating information on various health education subjects have also been distributed with the co-operation of the Libraries Department. 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. It may also be said that the character of the Health Centre building which houses the Public Health Department was designed to inspire the conception of health among the many members of the public who use it for one purpose or another. 14 Aged Persons The Council continued as in past years to take a very active interest in work on behalf of old people during 1956„ The services available to men over 65 years and women over 60 years included: (1) A Laundry Service for the Chronic Sick who were unable by reason of ill-health, senility, etc. to keep their personal and domestic laundry in a state of cleanliness required to ensure a healthy environment. 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. (ii) Holiday Scheme The Council continued this service designed to preserve the health of the elderly by allowing those sufficiently strong to benefit from a stay of two weeks in the country or at the seaside. Applications were invited by public announcement and through variously interested clubs and societies; such applications were made to the Health Department. Each applicant was required to contribute a small sum towards the cost,, normally ten shillings per week but varied slightly in some cases. Arrangements were then made for the holiday at one or other of the holiday homes run by voluntary organisations. A grant was made to each of the homes to cover the cost including the railway or coach fare and their necessary travelling expenses, less that amount which the individual was required to contribute. Arrangements were continued with the co-operation of the Red Cross Society and Women's Voluntary Service for those aged persons who so desired, to save, through the medium of Savings Stamps the amount or part of the amount they would be required to contribute towards the cost of the holiday„ Stamps were on sale at the Health Centre, Red Cross and Women's Voluntary Service Centres and in all a considerable sum was saved by aged persons,. In this way a holiday was provided during 1956 for 293 persons comprising 33 married couples, 54 men and 173 women, at a total cost to the Council of £2,058. Holidays were arranged at Ramsgate, Brighton, Bognor, Leigh-on Sea, Clacton, Herne Bay, Worthing and Walton-on-the-Naze. 15 The Scheme proved an unqualified success as was evidenced by the large number of appreciation letters received and in other ways. I am of the opinion that a holiday benefits considerably the permanent health of the individual, builds up the body for the winter months and is of considerable value socialogically. All this apart from the pleasure and enjoyment given to the aged persons at the time. (iii) Meal Services (a) Many of the aged, particularly those who live alone, are apt to take insufficient food, not only because of expense but also because of the difficulty and trouble involved in preparing a satisfactory meal for one. Dinner services, therefore, have been instituted through voluntary associations throughout the borough. A grant is given to the associations by the Council to cover their expenses and further grants are made by the London County Council and Finsbury Old People's Welfare Committee to enable the meals to be supplied at a cost of tenpence per head to the aged. During 1956 a total of 21,805 meals were served from such centres. 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. (b) Invalid Meals for London: Aged persons, who are unable by reason of sickness and infirmity to attend one of the Meal Centres run by the various voluntary organisations. were supplied with a meal delivered at their home. There is, however, a restricted service and there is often a waiting list of applicants. The Council makes a substantial grant to the Invalid Meals for London in respect of this service and 13, 746 meals were supplied during 1956 (iv) Finsbury Employment Scheme for the Elderly: This Scheme continued to develop and to expand during the year under review. 16 The Work Centre named Brooke House" situated at 39/41 Gloucester Way, E.C.1., made possible as a result of a number of generous benefactors, and opened by the late Lord Border in November 1954, has proved eminently satisfactory in every way. Some 110 elderly persons have undertaken work which 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 elderly employed have been paid a small wage amounting to 10/-d. a week which is slightly more than the actual value of the labour provided. 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. It has also attracted intense interest from many parts of the country and from overseas and many bodies are considering in augurating or have inaugurated similar schemes. (v) Nurse/Visitor: 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 - liaison with voluntary organisations - and ascertaining detailed information from applicants for one or more of the Council's services for the aged. (vi) Bathing and Cleansing Service: Baths are provided free of charge at the Health Centre to those aged persons who, on account of their condition, cannot use the existing Public Baths. A nurse is in attendance to render assistance, if this should be necessary Occasional cleansing services were provided 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. The Council continued to encourage all voluntary organisations in the borough to extend the services available to the aged for meals and recreation. Grants which were made on the basis of reports made to the Council on the work of each organisation amounted in all to £1. 660 in the financial year 1956/7. 17 There were no compulsory removals to suitable premises during 1956 of persons in need of care and attention under Section 47 of the National Assistance Act, 1948. Finsbury Old People's Welfare Committee: The work of the voluntary organisations is co-ordinated as far as possible by the Finsbury Old People's Welfare Committee which consists of representatives of most of the bodies who are concerned with the elderly and of which I am privileged to be Hon. 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: This service is provided free of charge for those aged persons who are unable by reason of senility, chronic sickness etc. to attend personally the Foot Clinic at the Health Centre and has proved of great benefit to the elderly. 245 visits were paid during 1956. The ages of the persons visited ranged from 63 to 96 years. 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. It is also of interest to record that, as in previous years, 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. 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. 18 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 House5*, 39/41 Gloucester Way E.C.1, at the Women's Voluntary Service Meal Centre in Exmouth Market E.C.1.U and at the St. Clement's Meal Centre, Lever Street, E.C.1. These have been much appreciated by the elderly persons using the 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 en suring 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 bed ridden were in the opinion of the officers deserving of the pro vision of wireless facilities and that in such cases the rental should be paid by the Committee At the end of the year thirteen 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 1956 The purpose of the Scheme is to enable old people living alone to contact someone outside their home in an emergency., The Scheme be sides 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 organisations represented on the Committee to visit Finsbury persons accommodated in hospital who are not receiving regular visits from friends and relations. 19 Nutritional Supplements The arrangements continued with Messrs. Wander0 Ltd., Messrs. Bovril, Ltd. and Messrs. Marmite Food Extract Co. Ltd., whereby "Ovaltine", Hospital Extract', 'Bovril' and 'Marmite' are supplied to the various organisations represented on the Committee for resale to the aged persons attending their clubs at a price considerably less than the normal retail price. 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. Thirty elderly persons received ophthalmic treatment in this way in the period under review. 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: The Committee were once again able to distribute an appreciable number of logs to aged persons, thanks to the gift of tree trunks and considerable voluntary effort in sawing them into logs of a suitable size. Barber Service: The Committee during the year inaugurated a Barber Service (Haircutting and Shaving) for elderly men who are housebound or bedridden and for whom it is not possible to make alternative arrangements. 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. 20 Further, a Physiotherapy Clinic provided by the Hospital Management Committee is available in the Health Centre. I should once again like to express my thanks and appreciation of the medical services rendered to the aged persons of Finsbury by the general practitioners in the district and their close co-operation with me and officers of my department and to Dr. Stern, the Medical Superintendent of St. Matthew's Hospital, and her staff. 21 SECTION C SANITARY CIRCUMSTANCES Water Apart from 3 business premises which obtain certain supplies from deep wells, the whole of the borough is supplied with water by the Metropolitan Water Board. Regular examinations of water are therefore considered to be unnecessary. In many houses and block dwellings supplies of drinking water are obtained from storage tanks and inspections of these are made often following complaint, to ascertain their condition and, if necessary enforce cleansing and adequate covering of the tanks in accordance with the Council's Bye Laws. If thought necessary, samples of water are taken. In 1956, 8 such samples were submitted for bacteriological examination and were found to be satisfactory. Action was required to be taken by the department in 113 instances following the withdrawal of the water supply by the Metropolitan Water Board or as the result of defects caused to the supply pipes by frost. In one case a block of 60 flats was without water following frost damage but as the result of serving notices under the Public Health (London) Act the supply was eventually restored. Swimming Baths Two establishments are maintained by the Council, one in Merlin Street and the other in Ironmonger Row. Both are of modern construction and in addition to an indoor swimming pool, slipper baths and facilities for washing clothes are provided. The Ironmonger Row establishment also possesses a Turkish Bath and a special Children's Pool. An indoor Swimming Pool is also open to the public at the Northampton Polytechnic during the summer months. The water at all these Swimming Baths is chlorinated and continues to be subject to chemical and bacteriological examination. Sanitary Conditions A large proportion of the time of the Public Health Inspectors is still spent in investigating environmental conditions in the homes of the inhabitants of the borough. 22 All complaints made by tenants and others were Investigated and the following table gives details of action taken by the Inspectors and nuisances abated under the Public Health (London) Act 1936:- Houses damp, dirty - remedied 423 Doors, windows, floors, walls, ceilings, sashcords repaired 775 Watercloset and urinal defects remedied 182 Soil and vent., pipe defects remedied 53 Rainwater pipes cleared repaired or renewed 94 Waste pipes cleared repaired or renewed 80 Drains cleared 113 Roofs and gutters repaired 407 Water storage tank defects remedied 3 Yard or area defects remedied 36 Washhouse defects remedied 12 Water supply to houses re-instated 113 Water supply laid on to upper storeys of house 3 Firegrates renewed or repaired 99 Animal nuisances abated 9 Miscellaneous nuisances abated 89 Dust receptacles renewed or repaired 76 Accumulations of refuse removed 65 Verminous or filthy articles destroyed 47 Overcrowding cases reported 35 No. of Basement Rooms inspected 224 No. of House Inspections 2,110 No. of House-to-House inspections 265 Total No. of First Visits for all purposes 7,486 Total No. of Re visits for all purposes 7,497 No. of Complaints received 1,681 No. of Intimation Notices served 920 No. of Nuisance Notices served 189 No. of Notices served re Food Premises 275 23 Legal proceedings were instituted under the Public Health (London) Act, 1936 for non-compliance with Nuisance Notices in the undermentioned cases:- Date Premises Offence Result 27. 2.56 7 Mora Street Defective roof, wallplaster and sashcord. Abatement Order (28 days) £2.2.0. Costs. 27. 2.56 8 Mora Street Defective roof and ceiling. Abatement Order (28 days) 27. 2.56 43 Macclesfield Road Leaking roof, dampness, defective flooring and sashcords. Abatement Order (28 days) 27. 2.56 45 Macclesfield Road Defective roof, defective ceiling plaster and hearth. Abatement Order (28 days) 19.10.56 69 White Lion Street Damp walls, broken plaster, sashcords and firegrate. Notice complied with. Summons withdrawn. 31.10.56 41 Wynyatt Street Damp wall and ceiling, broken plaster, choked gutter, defective window. Notice complied with. Summons withdrawn. 31.10.56 50 Wynyatt Street Damp walls. Notice complied with. Summons withdrawn Drainage Extensive rebuilding and alteration to existing industrial, commercial and residential properties has been going on since the war and continues to take place. This necessitates numerous visits to building sites and discussions relating to compliance by building contractors with the London County Council Drainage and W.C. Bye Laws. Eighty-one drainage plans were approved by the Council during 1956 and 2,391 visits were made by the Public Health Inspectors in connection with the supervision of work in progress. The following table is an indication of the extent of the work carried out during the year:- 24 Drains laid or amended 238 Soil and Vent. pipes erected 297 Drains or Soil pipes tested 329 Waste Pipes erected 338 Waterclosets erected 1,258 Urinals erected 192 Lavatory Basins fixed 1,358 Sinks fixed 914 Baths installed 492 During the year work was completed on the installation of the drainage and sanitary fittings in a 13 storey block of flats on the "Single Stack" system Until very recently, this method of drainage had not been used in buildings more than 6 or 8 storeys in height and it was agreed to allow this installation to be made on an experimental basis. Following completion tests were carried out in which considerable induced syphonage occurred particularly in the seals of the watercloset traps situated on the middle floors, As a result of consultations with the Building Research Department the traps of the W.Cs. on the third, sixth and ninth floors were ventilated and sub-sequent stringent tests proved to be satisfactory. It would therefore appear that whilst it is necessary to provide against syphonage of W.C. traps on the "single stack" method of drainage when used in multi-storeyed blocks of flats, complete venting of all traps is unnecessary and a modified system of ventilation can be adopted according to circumstances. Common Lodging Houses There is a Common Lodging House for men situated at 88 Old Street, E.C.1. which is owned and maintained by the Salvation Army. The premises are licensed for 313 inmates on the basis of the standards laid down by the London County Council prior to the transfer of functions in 1933. Separate quarters are provided for the Deputy Keeper and staff but generally, the common sleeping rooms are on the upper floors, the kitchen, dining room and office are on the ground floor and the washing facilities and lockers are in the basement. The main sanitary accommodation is situated in the ground floor yard but additional toilet facilities are also provided on each bedroom floor. Certain improvements and cleansing including modernisation of the kitchen, were carried out last year. Forty-three visits of inspection were made during the year. 25 Shops A duty is placed on the Council by the Shops Act, 1950 to carry out inspections of retail and wholesale shops and warehouses to ensure that adequate sanitary accommodation is provided and that sufficient means of ventilation and heating are provided and maintained. A register of shops is kept in the department and during the year 525 visits were paid by the Public Health Inspectors, In 12 instances notices were served on the occupiers requiring various matters to be dealt with. There are a number of exemption certificates in force which have been granted by the Council in the past allowing the use of sanitary accommodation elsewhere than on the premises owing to restricted space. No applications for exemption certificates were received in 1956 but one such certificate was revoked. The construction of many new shops and the modernisation of others has had the effect of raising the standards of shops generally. Rag and Bone Dealers There are 7 premises in the borough dealing in rags, waste paper, metal and similar articles but none is known to deal in bones. The operation of the London County Council Bye Laws in respect of Rag and Bone Dealers is therefore technically not possible. Nine visits were paid to such premises during the year however, and no nuisances were observed. Rag Flock Four premises in the borough are licensed for the manufacture or storage of rag flock and 8 premises registered to use filling materials under the Rag Flock & Other Filling Materials Act, 1951. Regular inspections of these premises were made during the year with a total of 14 visits. Eight samples of various types of filling materials were taken during the year and submitted to the approved analyst. All these passed the cleanliness standard. One sample alleged to be woollen felt failed to meet the standard of quality specified and should have been classified as rag flock layered. The matter was taken up with the suppliers. Offensive Trades One premises is at present licensed by the Council as an offensive trade for the processing of raw tripes. This is situated in Eagle Court in the area adjoining Smithfield Market and is regularly visited by the Senior Meat Inspector. 26 Factories During 1956 a survey of the Factories was completed with particular reference to non-power' factories. In the past the retention on the register maintained by the department of such factories technically not subject to the Factories Acts has led to a somewhat misleading figure. As a result of this survey, however, the numbers of factories on the Council's register now not only coincides with those recorded by H.M. Inspector of Factories but they represent a true pic ture of the factories now in the borough. The statistics for 1956 are as follows:- INSPECTIONS for purposes of provisions as to health (inspections made by Public Health Inspectors) Premises Number of 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 106 332 11 - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 1,375 693 47 - (iii) Other premises in which Section 7 is enforced by the Local Authority (excluding out workers premises) 10 8 - - TOTAL 1,491 1,033 58 - 27 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.1) 29 23 4 2 - Overcrowding (S.2) - - - - - Unreasonable temperature (S.3) 6 5 - 1 - Inadequate ventilation (S.4) 6 4 1 - - Ineffective drainage of floors (S.6) - - - - - Sanitary Conveniences (S. 7) (a) Insufficient 2 2 - - - (b) Unsuitable or defective 48 41 - 6 - (c) Not separate for sexes 1 1 - 2 - Other offences against the Act (not including offences relating to Outwork) 39 25 30 _ - TOTAL 131 101 35 11 - 28 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. 1,691 - - - - - Household linen 14 - - - - - Curtain and furniture hangings - - - - - - Furniture and upholstery - - - - - - Fur pulling - - - - - - Umbrellas, etc. 23 - - - _ _ Artificial flowers 36 - - - - - The making of boxes or other receptacles or parts thereof made wholly or partially of paper 101 - - - - - Brush making 23 - - - - - Feather sorting 24 _ - - - - Carding, etc. of buttons, etc. 42 - - - - - Cosaques Christmas crackers Christmas stockings, etc. 50 - - - - - Lampshades 30 - - - - - TOTAL 2,034 - - - - - 29 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 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 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 1956 was 184 The number of Finsbury outworkers employed by them was 430 The number of non Finsbury outworkers employed by them was 4,496 The number of Finsbury outworkers employed by firms outside the Borough was 151 The total number of Finsbury outworkers employed by firms in or outside the Borough was 581 Of these 137 were firms and 444 homeworkers. Number of visits paid to homes 421 The registers of outworkers which firms are required to maintain are inspected as part of the routine during the inspection of the factories concerned. 30 Atmospheric Pollution The number of complaints received by the department during 1956 in respect of smoke nuisances was 10. All these were investigated. The Public Health Inspectors made a total of 211 timed observations on industrial chimneys, in addition to keeping a general watch on smoke emission from boilers. On one day in October I arranged for continuous observations to be made from high buildings throughout the hours of daylight in order to obtain an overall picture of the size of the smoke problem in the borough, As a result of this survey it would appear that Finsbury is reasonably "clean". During the whole day no source within the borough produced smoke in such quantity or density as to create a serious nuisance, even the domestic sources were comparatively low. It was thought desirable, however to send a written intimation to 9 firms from whose chimneys smoke was particularly noticeable. Air pollution from industrial chimneys has certainly lessened during the year as a result of improvements to boiler plants carried out by firms and other institutions in the main because of pressure by officers of the department. The Council continues to co-operate with the Department of Scientific & Industrial Research in the daily measurement of the amount of smoke and free sulphur dioxide in the atmosphere and the monthly measurement of deposits and sulphur dioxide content by the lead peroxide method. Verminous Premises and Articles The Disinfestation Service provides for the eradication of insect pests, viz., ants, bugs, fleas (human and animal), cockroaches, beetles, moths, steam flies and other insects. During 1956, 382 premises were found or suspected to be verminous, and disinfection measures were carried out. Similar measures have been carried out on certain other occasions on request. In all, disinfestation measures were carried out in 454 premises. The usual 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. Whenever considered necessary bedding is also removed for steam disinfection. As a routine measure for the control of vermin, disinfestation is carried out in the case of tenants moving into the Council's Housing 31 Estates (other than Post-War Estates) or requisitioned property. The normal routine is for the old accommodation of the prospective tenant to be sprayed with a D.D.T. Solution some days before the removal and at the same time for the proposed new accommodation to be treated in the same way. On the day of removal bedding is collected from the old address, steam disinfected in the Council's ovens, and then removed to the new premises. In the case of Post War Estates the Council has entered into arrangements for the furniture and effects to be treated with hydrogen cyanide gas before removal to the Estate. Section 122 of the Public Health (London) Act, 1936 enables the Council, on a report from the Medical Officer of Health that any articles in a house in the borough are in such a filthy, dangerous or unwholesome condition that health is affected of endangered thereby to cause the articles to be cleansed, disinfected or destroyed 47 such representations were made in 1956. Cleansing of Verminous Persons The Borough Council continued the operation of the Cleansing Station in the Health Centre for the treatment of verminous conditions, including Scabies and the arrangements whereby school children were treated on behalf of the London County Council under the supervision of a nurse appointed by them. At other times the work was carried out under the supervision of the nurse appointed by the Council, who also undertook the Home Visiting when this was necessary. Arrangements were also continued during the year by which cases were treated on behalf of the Shoreditch Borough Council. 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 method 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. 32 Vermin Scabies Total Total number of treatments given to Finsbury cases (other than School Children) 64 55 119 Total number of treatments given to ditch cases (other than School children) 3 21 24 Total number of treatments given to School children (all the School children treated were not resident in Finsbury a proportion being from adjacent boroughs) 623 205 828 Total number of Home Visits paid Nil Prevention of Damage by Pests Act, 1949 Rodent Control The Council employs six rodent operatives, one foreman and one rodent officer. Treatment for the eradication of both rats and mice is provided free for all private dwellings, but otherwise a charge is made to cover the cost of the work. In conjunction with the Borough Engineer's Department the maintenance treatment of all sewers was carried out during January, June and October. It is on the recommendation of the Ministry of Agriculture, Fisheries & Food that such treatment is carried out every four months. Infestations at domestic premises are being slowly reduced, and during 1956 no serious infestation was discovered. A block inspection of all properties throughout the borough was commenced and a number of small infestations of Ship Rat (Rattus Rattus) and mice found. No. of complaints received Business premises 108 Domestic premises 316 Additional infestations found Business premises 532 Domestic premises 142 No. of private dwellings treated 458 No. of other premises treated 640 No. of visits to private dwellings for treatment purposes 8,625 No. of visits to other premises for treatment purposes 15,180 Additional premises Inspected Business premises 1,041 Domestic premises 1,129 33 Pet Animals The Pet Animals Act, 1951, requires that all premises including shops and stalls, where pets are sold shall be licensed annually by the local authority. Five licences were issued by the Council during 1956 viz, 2 in respect of shops, 2 in respect of stalls and 1 in respect of premises used for the breeding and sale of tropical fish„ Except for the latter, the amount of trade in pet animals and birds is comparatively small and no difficulties have arisen in connection with the implementation of the Act. All the premises were inspected during the year, a total of 9 formal visits being made. Heating Appliances The Heating Appliances (Fireguards) Act, 1952 and the Regulations made thereunder are enforced by the Health Department. Inspections were made of shops, warehouses and stalls known to be selling new or second-hand gas electric or oil fires to ensure that such appliances were adequately guarded in accordance with the standards laid down in the Regulations. Where necessary the prescribed probe, weight and burning tests were carried out by the Inspectors. Apart from many casual inspections, 9 official visits were made under the Act during 1956, as a result of which letters were sent to 4 retailers warning them of illegally offering for sale reconditioned heating appliances without a proper guard. In each case steps were taken to remove the offending heaters from sale. Reception House The portion of the Health Centre which had in the past been tained by the Council as a Reception House (for persons who could not remain in their own rooms whilst these were being cleansed after infectious disease or who had no alternative accommodation in which to reside during housing repairs) continued to be used, by agreement with the North East Metropolitan Regional Hospital Board for the purpose of accommodating the administrative side of the Mass Radiography Unit. The Islington Borough Council has kindly agreed to provide accommodation for Finsbury residents at their Reception House as and when the occasion should arise. 34 Disinfection Disinfection is carried out in all cases after infectious disease has occurred when it is considered necessary, and in other cases on request, generally after advice has been given that it would be advisable for it to be carried out. During the year it was carried out in the following instances for the reasons set out:- Suspected Scarlet Fever 24 ,, Poliomyelitis 7 ,, Dysentery and Gastro enteritis 79 ,, Measles 38 ,, Whooping Cough 46 Tuberculosis 12 Scabies 6 On behalf of St. Marks and other hospitals 8 Miscellaneous 34 254 Bedding and clothing were brought to the Disinfecting Station in the Health Centre in these cases, and disinfected with steam. In all, including the cases where this was carried out for the control of vermin, 9,177 articles were treated. Goods, mostly clothing, were also disinfected on behalf of certain export firms as follows:- Number of articles 167,282 Number of times disinfecting plant charged 325¾ 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. During 1956 two licences were in force. 35 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, At the end of the year the Council had under consideration the conversion of the portion of the Health Centre used as a mortuary into accommodation for rodent operatives. Alternative-mortuary accommodation being provided by an adjacent authority. Three bodies were accommodated in the mortuary during the year. Hairdressers Under the London County Council (General Powers) Act 1954 power was given to Borough Councils to require the registration of persons carrying on the business of a hairdresser or barber and the registration of the premises and the Council fixed the 1st February 1956 as the appointed day on which the provisions of the Act came into force in Finsbury. In accordance with the Act, the Council made byelaws for the purpose of securing the cleanliness of registered premises including the instruments, towels and equipment used therein and also the cleanliness of persons employed in such premises in regard both to themselves and their clothing.These were based on the model agreed by the metropolitan boroughs and were confirmed by the Ministry of Housing & Local Government. A total of 44 premises have been registered under the Act following a detailed inspection of each establishment by the Public Health Inspectors. In nearly every case the premises were found to be completely satisfactory but in one or two instances it was necessary to send a formal letter to the occupiers where certain matters required attention. In all, 98 visits were made to hairdressers and barbers during 1956. 36 SECTION D HOUSING General The estimated number of dwellings in the borough at the end of 1956 was 9,732 consisting of 3,559 houses, 6,125 flats and 48 huts. The houses are almost entirely privately owned. Ownership of the flats is as follows: Pinsbury Borough Council 1,580 London County Council 559 City Corporation 60 Metropolitan Police 126 Housing Associations 2,550 Private ownership 1,250 New Accommodation The housing construction programme of the Council and other housing authorities has continued to make progress during the year and I am pleased to report the erection and occupation of the following new flats during 1956: By the Pinsbury Borough Council - Priory Green Estate Extension: Calshot House 19 flats Wynford House 85 " By the City Corporation - Golden Lane Estate: Bowater House 30 flats Bayer House 30 " By Housing Associations - Peabody Estate Block D Roscoe Street 24 flats Fortune House 16 " 1-11(odd) Fortune Street 6 " Peabody Tower 52 " Block R Roscoe Street (conversion)10 " By Private Owners - 63-5 Myddelton Square (conversion) 8 flats Twelve certificates of habitation under Section 95 of the Public Health (London) Act, 1936 were issued during 1956 in connection with new or converted premises which included the above mentioned blocks of flats. 37 At the end of the year certain of the flats were still in course of construction on the Peabody Estate and City Corporation Estate In addition, work had begun on a scheme of 211 flats to be erected by the Council in Brunswick Close. Basement Rooms Steps are taken as and when necessary to prevent the re-occupation of unsatisfactory basement rooms by making Closing Orders. When information is received of the pending rehousing of families living in basements, inspection of the premises is carried out to ascertain whether the rooms could be made to comply substantially with the Council's Regulations at reasonable expense. If not an official Representation is made to the Council and in most cases a Closing Order results. Premises subject to a Closing Order are inspected annually for the purpose of ascertaining whether any infringement of the Order has occurred. One prosecution was successfully instituted in 1956 in respect of the use of basement rooms in contravention of a Closing Order. A total of 224 inspections of basement rooms were made for all purposes during the year and the following is a summary of action taken:- Premises Rooms No. of closing orders in force on 1st Jan. 1956 84 140 No. of Representations under consideration on 1st Jan. 1956 68 99 No. of Representations made during 1956 39 70 No. of Representations under consideration on 31st Dec. 1956 83 133 No. of undertakings accepted 4 7 No. of closing orders made 18 28 No. of closing orders determined during 1956 3 4 No. of closing orders in force on 31st Dec. 1956 99 164 Unfit Parts of Houses (other than Basement Rooms) Prom time to time it has become necessary to take action in respect 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. 38 Premises Rooms No. of closing orders in force on 1st Jan. 1956 (2 made in 1952, 1 in 1953, and 2 in 1954) 5 10 No. of representations under consideration on 1st Jan. 1956 3 7 No. of representations made during 1956 2 2 No. of representations under consideration on 31st Dec. 1956 5 9 No. of undertakings accepted during 1956 - - No. of closing orders made during 1956 - - No. of closing orders determined during 1956 - - 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. Repair of Houses under Sections 9 and 10 Housing Act, 1936 No action has been taken since the war under these Sections. Individual Unfit Houses Chiefly because of rehousing difficulties action to secure the demolition or closure of individual unfit houses has been restricted to a comparatively small number of very bad houses, including certain unoccupied premises. Since the war Demolition or Closing Orders have been made in respect of 101 premises. In 1956, 5 premises were represented and Demolition Orders made in respect of 2 of them, the other 3 were still under consideration at the end of the year. In addition, Closing Orders under the Local Government (Miscellaneous Provisions) Act 1953 were made in respect of 6 premises represented in 1955. During the year 2 premises were actually demolished involving the displacement of 5 persons. 39 Tabular Statement prepared in accordance with the Housing Consolidated Regulations, 1932 No. of houses considered on inspection to be unfit for human habitation 46 No. of houses wherein defects were remedied by informal action - No. of representations made with a view to: (a) serving notices requiring the execution of work - (b) making demolition or closing orders 46 No. of notices served requiring the execution of repairs - No. of houses rendered fit after service of notice - No. of demolition or closing orders made 24 No. of houses in respect of which undertakings were accepted 5 No. of houses demolished 2 Slum Clearance The position obtaining at the end of the year in respect of individual Clearance Areas is summarised below:- 1. Faulkner's Alley - 2 premises Rehousing was carried out and the premises demolished. 2. Macclesfield Place - 19 premises The tenants had not yet been rehoused. 3. Ironmonger Passage - Lizard Street - 3 premises The Clearance Order was confirmed by the Minister during the year but rehousing had not commenced. 4. James Gardens - Frye's Buildings - 25 premises Rehousing had substantially been completed, and Frye's Buildings and the east side of James' Gardens were demolished. 5. St. James, Row - 8 premises Rehousing of residential tenants was carried out but the area had not yet been cleared. 40 6. Cynthia Street - 8 premises A Clearance Order was made by the Council but had not been submitted to the Minister. 7. Galway Street - 158 premises Confirmation of the Clearance Order by the Minister was received during the year. Inspections During the year inspections were carried out by the Public Health (Housing) Inspectors of certain properties which it was felt might be added to the provisional list of premises scheduled for clearance under the Housing Acts. By far the greater number of these viz. 292 premises, were in an area in the central part of the borough and a further 10 houses were in Calshot Street. Discussions took place with the London County Council the outcome of which had not finally been determined by the close of the year. The total number of house to house inspections made in 1956 was 305. Overcrowding It is difficult to estimate the extent of overcrowding in the borough - either overcrowding based on the purely legal standard or what may well be considered to be overcrowding, of families living in cramped conditions necessitating the use of kitchens as bedrooms but not legally overcrowded. Generally speaking however serious overcrowding is much reduced and the majority of cases coming to the notice of the department are invariably overcrowded to the extent of ½ to 1 unit. Thirty-five such families were reported to the appropriate authority during 1956. Two cases of wilful overcrowding came to light during the year. In one of them, following strong pressure from this department, a tenant of a house, following Court action, succeeded in obtaining possession of a sub- tenant's grossly overcrowded room; in the other legal proceedings were pending at the end of the year. 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/ 41 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 Public Health Inspector. These reports are then correlated with the medical certificates, and a degree of medical priority is then allotted. During the year 461 applications were dealt with as follows: New cases 200 Cases reconsidered on new medical certificates 161 Cases reconsidered 17 Cases specially considered for Housing Committee 83 L.C. C. cases - 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 year was:- Rehoused in Finsbury Borough Council Plats 35 Rehoused from Clearance Areas 4 Rehoused by London County Council 38 Rehoused in new towns 17 In addition, 6 families on the Council's housing list were rehoused by the City Corporation and 3 by a private company. A considerable number of tenants allocated flats at the Peabody Estate were taken from the register of L.C.C. housing applicants. Certificates of Disrepair Since the Act came into force, the number of applications each year for certificates of disrepair under the Housing Repairs & Rents Act, 1954, has varied considerably. Whilst never being high, the number fell to 5 in 1956, and 3 certificates were in fact issued, of which one was subsequently revoked following the satisfactory completion of the necessary work. One application was received for a, certificate under the Increase of Rent & Mortgages Interest (Restrictions) Acts. This was granted and subsequently revoked upon completion of the schedule repairs. One additional certificate issued the previous year was also revoked. 42 Improvement Grants Property owners have taken little advantage of the financial assistance available under the Housing Acts whereby improvements can be effected to sub-standard houses at the discretion of the Council. One application outstanding at the beginning of the year was agreed to by the Council; this was in respect of the horizontal conversion of 2 houses in Pentonville Road to provide 5 three roomed flats. Two new formal applications were received during 1956 in respect of premises in Paget Street one to convert 2 houses into 3 threeroomed flats and the other to provide 3 single-room flats for elderly people. These applications were both approved and work was proceeding satisfactorily at the end of the year. Informal enquiries were received from two other owners but in each case it was considered the premises were unsuitable for conversion. 43 SECTION E FOOD Food Premises The number of known food premises in the borough at the end of the year was as follows: Restaurants, cafes & snack bars 161 Public houses 123 Off-licence premises 9 Factory canteens 73 Commercial canteens approx. 50 Dairies and milk distributors, etc. 134 Ice cream sellers 140 Confectioners (sweets) shops 74 Bakers shops 24 Bakehouses 15 Grocers and provision shops (retail) 37 Provision merchants (wholesale) 14 Cheese importers (wholesale) 3 Greengrocers and fruiterers 20 Fish shops 4 Fish curers 3 Fried fish shops 9 Eel & pie shops 4 Poultry dealers (wholesale) 4 Butchers shops (retail) 36 Wholesale butchers and offal dealers 21 Wholesale horseflesh dealer 1 Bacon factories 8 Sausage factories 3 Sausage casings merchants 5 Meat extract factory 1 Public cold stores 6 Chemists shops 19 Manufacturing and wholesale chemists 9 In addition, there are some 200 street market stalls dealing in various foodstuffs. The total number of visits paid to all food premises during 1956 was 2,135 and to food stalls 2,281. 44 Food Hygiene Regulations Following the coming into force of the Food Hygiene Regulations, a circular letter was addressed to the occupiers of all food premises in the borough during January 1956 informing them of the new legislation and requesting their co-operation in its implementation. Apart from visits to certain food premises for special purposes it was decided to survey in turn by type of business, all the premises in the borough subject to the Regulations commencing with restaurants, cafes and snack bars (excluding public houses). A detailed inspection was carried out by the Public Health (Food) Inspectors of all the 161 premises coming within this category. During the interview with the occupier the more obvious contraventions of the Regulations observed were outlined. At the same time a copy of a "Notice to those engaged in the handling of food" was given to the proprietor for display on the premises. Where contraventions were found an informal letter was forwarded to the occupier asking for his co-operation in the securing of a high standard of Food Hygiene in Finsbury and an observance of all statutory requirements. This letter also informed the occupier that any advice desired could be obtained from the Food Inspector responsible for the initial inspection. In view of the possible responsibility of an owner of premises under the Food and Drugs Act 1955 a further letter was sent in appropriate cases to the owner of the premises informing him of certain structural alterations required and asking for his co-operation. Although it is difficult to sub divide the above premises into categories of hygienic standards, a rough classification would be as under: 11% Good 46% Fair 43% Bad The survey disclosed the following interesting data: No. of restaurants and snack bars 161 Approximate no. of main meals served per day 9,770 No. of premises with one sink for all purposes 73 (45.6%) No, of kitchens with no washing facilities for personnel 103 (64%) No. of kitchens with wooden floors covered with linoleum 60 (37.5%) 45 No. of kitchens with matchboard lined walls 52 (32.3%) No. of kitchens with matchboard lined ceilings 43 (27%) No suitable storage facilities for refuse bins 41 (25.6%) No constant hot water 27 (17%) Absence of suitable clothing accommodation 63 (40%) No overalls worn 31 (20%) Absence of refrigeration 8 (5%) W.C. without ventilated lobby 10 (6.25%) No notice in W.C. re handwashing 113 (70.6%) Unsatisfactory drainage 14 (8.75%) No first aid equipment 66 (41%) Lack of maintenance of equipment 17 (10.6%) Evidence of infestation by vermin 2 (1.2%) Walls of bare brick 17 (10.6%) No security of tenure 24 (15%) It will be observed from the above figures that a considerable amount of work will have to be carried out in order to bring the premises up to a satisfactory state in accordance with the Food Hygiene Regulations. This work will of necessity in some cases have to be carried out over a fairly long period owing to various factors, e.g., (i) Where leases are nearing termination, negotiations have to be completed for a new lease before the occupier is willing to carry out extensive alterations. (ii) Owing to the confined space in some of the premises it is only possible to carry out works at weekends without interfering with the trade. (iii) Where extensive flooring work has to be carried out it is only possible to do this during holiday periods. Other difficulties revealed by the survey included the existence of unsatisfactory conditions of tenancy and premises included in possible slum clearance areas. Following the initial inspections many further visits were made to premises to meet builders and others to discuss proposals to effect compliance with the Regulations and to supervise work in progress. The total number of visits to restaurants, cafes and snack bars during the year was 677. 46 At the end of the year the position was as follows: NO. of premises now regarded as complying with the Regulations 32 No. of premises where work was in progress 40 No. of premises where no work had been commenced 78 No. of premises on Clearance Area 2 No. of premises closed 9 Total 161 Adulteration of Food In 1956 a total of 722 samples of food and drugs were submitted to the Public Analyst. Of these 12 were formal and the remainder were informal samples. Details are appended: No. of Samples Obtained Foods Milk 120 Cream and Condensed Milks 13 Ice Cream 14 Sausages 28 Meat and Fish Products 86 Butter 18 Cheese 9 Jams, etc. 14 Dried Fruits 28 Cake and Pudding Mixtures, etc. 23 Cereals, etc; 10 Flours, etc. 5 Tea, Coffee, Cocoa Extracts 11 Sauces, Vinegar, etc. 14 Soups, 21 Herbs Spices and Condiments and flavours 42 Canned Vegetables Fruits, Fish etc., 42 Non Alcoholic Drinks 22 Confectionery 48 Table jellies and gelatine 15 Cakes, Bread 24 Alcoholic Drinks 10 Fresh Fruit and Vegetables 12 47 No. of Samples Obtained Drugs Simple Medicines 26 Powders 19 Tablets 20 Ointments, lotions, etc. 17 Vitamin products 17 Total 722 One informal sample of vinegar was found to be adulterated. A formal sample was purchased and proceedings instituted against the vendor. An informal sample of Friar's Balsam was found to be deficient in total solids. A formal sample was purchased and the same deficiency was reported on this sample and the manufacturers were communicated with in the matter. A statement on the label of a sample of chlorophyll tablets made what was considered to be, excessive claims in respect of the product and the facts were reported to the British Pharmaceutical Society. Food Complaints Fifteen complaints in respect of alleged unsound or adulterated food purchased from shops in the borough were received from members of the public during the year. In every case an investigation was carried out and a report submitted to the Health Committee. Legal proceedings were recommended in 3 instances, all of which were successful. in the remaining twelve cases action appropriate to the circumstances was taken. 48 Legal Proceedings The Council instituted legal proceedings under the Food & Drugs Act, 1955 as under: Date Premises Offence Result 5. 3. 56 72 White Lion St. Bread contaminated by mice droppings sold in contravention of Section 2 Pood & Drugs Act, 1955. Fined £20 Costs £5.5.0. 22. 8. 56 34 Chapel Market Tapioca flakes containing extraneous matter (glass) sold in contravention of Section 2 Pood & Drugs Act, 1955. Fined £2. Costs £5.5.0. 6. 12. 56 365 St. John St. Bread roll containing "Blatta Orientaiis" sold in contravention of Section 2 Pood & Drugs Act, 1955. Pined £5. Costs £10.10.0. 6. 12. 56 Stall No. 43. Licence No. 97. Chapel Market "Vinegar" not of the nature and substance demanded, (formal sample) sold in contravention of Section 2 Food & Drugs Act, 1955. Fined £5, Costs £3.3.0. Bacteriological Examination of Food The pathological laboratory in the Health Centre was used whenever possible during the year for the routine examination of various types of food and whenever suspicion of contamination arose. Details of milk and ice cream examinations are given elsewhere, but the following additional foods were examined during 1956: Canned pork & veal products 7 Steak pies 5 Pork pie 1 Sausages 6 Canned Milk 6 Imitation cream filled cakes 8 Total 33 In general the bacterial quality of these foods was found to be satisfactory except in the case of the canned milk and certain of the veal and pork products. With regard to the former. 2 out of 6 tins of evaporated milk examined were found to contain staphylococci organisms and formed part of a consignment retailed at a reduced price originally released as old stock by the Ministry of Pood for manufacturing 49 purposes the remaining cans were surrendered by the retailer. In the latter case a total of 240 lbs, of imported pressed veal and pork was destroyed following the isolation of aerobic and anaerobic spore bearing organisms in each of 3 cans examined. Milk Regular sampling of milk for chemical analysis and bacteriological examination is carried out from shops, depots roundsmen, schools and day nurseries. In addition, routine inspections of dairies and milk shops are made, the number of visits during 1956 being 132. Summary No. of dairies on register at end of 1956 9 No. of distributors on register at end of 1956 125 No. of transfers approved during 1956 8 No. of new applications approved during 1956 3 No. of premises removed from register during 1956 2 Designated Milk Licences issued Dealers Supplementary Tuberculin 56 27 Pasteurised 73 27 Sterilised 77 30 Quality of Milk No. of samples submitted to Public Analyst 120 No. of samples reported as adulterated NIL Average fat content of milk samples 3.7% Average non fatty solids content 8.69% No. of samples submitted for bacteriological examination 83 No,, reported as fully satisfactory 80 (3 samples failed to pass the methylene blue test). Ice Cream Since the coming into force of the Ice Cream (Heat Treatment, etc.) Regulations, 1947-52, the number of premises where ice cream is manufactured has been considerably reduced. Although 22 premises are still registered for the purpose, the number where any manufacturing actually took place during the year was 3. At one of these the product is subjected only to the freezing process following delivery after 50 pasteurisation from a factory outside the district. One small manufacturer resumed operations for a trial period towards the end of the year. At the main plant in the borough, the ice cream is subjected to pasteurisation at a temperature of 150°P for 30 minutes. The standard of ice cream from a chemical and bacteriological standpoint, has generally been satisfactory. The number of visits to ice cream premises by the Public Health (Pood) Inspectors during 1956 was 121. Summary - Premises No. of premises registered for manufacture 22 No. of premises registered for storage and sale 116 No. of premises registered for storage only 2 No. of new registrations during 1956 9 - Sampling No. of samples submitted to Public Analyst 14 No. reported as adulterated NIL No. of bacteriological samples taken 30 No. reported as fully satisfactory 25 No. reported as unsatisfactory 3 No. reported as poor 2 Meat Inspection In the vicinity of the Smithfield Meat Market, London, E.C.l. there are a considerable number of wholesale butchers and offal shops. bacon and provision warehouses, bacon factories, wholesale game, poultry and rabbit shops, all of which were regularly inspected by the meat inspector. A systematic examination of imported frozen carcases of mutton and lamb for Caseous Lymphadenitis was carried out in the Public Cold Air Stores, often involving a 100% examination of the whole consignments. Consignments of Continental and Scandinavian offals and tinned hams continued to be imported into the borough and in many cases condemnations of these took place. An unusual carcase of cow beef was encountered and was found to be very badly affected with a disease known as Nodular Necrosis or RoeckF s Granuloma. The superficial muscular tissue contained hundreds of these nodules varying in size from a pea to a walnut. The granuloma are attributed to Blastomycomata, the Blastomyces being one of the pathogenic fungi. As the carcase was extensively affected and was poorly nourished, the whole carcase was condemned. 51 Approximately 2,000 cartons and 1,500 bags of New Zealand Beef Livers, each containing 6 or 7 livers were examined or will be examined for a parasitic hydatis cyst - the Echinococcus Granulosus. Each liver was slightly thawed out and 2 or 3 incisions were made into the liver substance to demonstrate the presence of these parasitic cysts. Between 10% and 12% of these livers were found to be affected many containing several cysts. Those livers affected were condemned. A tabular statement in regard to the examination is set out below: A total of 2,269 visits were made to the retail butchers shops and stalls in the borough. NEW ZEALAND BEEF LIVERS examined for Echinococcus cysts EXAMINED WEIGHT CONDEMNED PERCENTAGE NUMBER WEIGHT 1,581 Bags 136,699 lbs. 1,929 Livers 23,983 lbs. 16.72% 459 Cartons 28,178 lbs. 291 Livers 3,463 lbs. 12.3% 27 Cases 1,708 lbs. 3 Livers 35 lbs. 3.7% At the end of the year 1,541 cartons remained to be examined. The collection of unsound meat and other foodstuffs continues to be collected satisfactorily by the contractors, Messrs, Henson & Burbidge, Matusa Works, Beckton, who render down the foodstuffs for technical purposes only. During the year 162 certificates were issued for the export of meat, bacon sausage casings and meat essence. Several of these certificates were issued for the export of boneless quarters of cow beef to France. Bakehouses At the end of the year there were 11 underground bakehouses in the borough for which certificates under the Factories Acts are in force. in addition, there were 4 other bakehouses in use. A total of 63 visits were paid during 1956. 52 Registered Food Premises In addition to ice cream shops, the number of premises registered under Section 16 of the Food & Drugs Act 1955 for the manufacture of sausages or potted, pressed, pickled or preserved food is 72 The various types of business carried on at these premises are as follows:- Sausage manufacturing 32 Sausage smoking 1 Meat pickling 38 Offal cooking 5 Cooked meats and pie making 4 Ham boiling 10 Bacon curing and smoking 3 Fish curing 3 Shellfish cooking 2 Jellied eels 2 Meat extraction 1 A total of 216 visits were paid by the Inspectors during 1956. In some instances more than one type of business is carried on at the same premises. For example meat pickling is invariably done at retail and wholesale butchers shops, at most of which sausages are also manufactured. There are, however 3 wholesale sausage factories in the borough. The cooking of meat, offal and pies is done mostly at premises that specialise in that type of trade; this also applies to jellied eels. The number of premises at which the boiling of hams regularly takes place is not as high as pre war as several small provision merchants have ceased to cook their own, prefering to sell precooked or canned hams. Large quantities of bacon are smoked at the establishments in the borough registered for this purpose, The smoking of fish is also carried out locally, and in addition 2 retailers cook their own supplies of shellfish, One large firm has a factory in the borough for manufacturing and bottling meat extract. In general, the conditions under which this type of food preparation is carried on are reasonably satisfactory. Certain improve ments, however, have been effected at particular premises during the year. Street Markets The four Market Streets in the borough are Chapel Market. Exmouth Market, Whitecross Street and Farringdon Road. A total of 597 stalls were licensed by the Borough Council at the end of 1956 of which 197 were food stalls. The Food Inspectors visit the Market Streets daily and made 2,281 inspections during the year. 53 Pood stalls present many difficulties to be overcome in enforcing the Pood Hygiene Regulations which will have to be faced at some time in the not too distant future. A few individual stall holders have made an attempt to meet the requirements but all new street trading licences in respect of foodstuffs are only issued subject to the Public Health Department being satisfied that the stalls and storage places comply with the Regulations. In certain cases e.g. the confectionery trade, a licence is issued restricting sales to wrapped goods. Licensed Premises and Public Houses Pinsbury has 132 licensed premises all but 9 of which are public houses. The number of inspections carried out during the year was 160 of which 75 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 Act or Food Hygiene Regulations are dealt with accordingly. During 1956, 20 premises were improved in this way. Pharmacy & Poisons Act, 1933 The Council keeps a List of Sellers of Part II Poisons under the Act and in 1956 44 applications for names to be placed or retained on the List were approved. Each of the premises concerned was visited during the year to ensure that the provisions of the Act and Poisons Rules were complied with in regard to containers and labelling. Unsound Food No formal seizure and condemnation of food under Section 9 of the Pood & Drugs Act. 1955 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. The amount of food dealt with remained comparatively high because. in addition to the many retail food shops in Finsbury certain multiple stores have their warehouses in Finsbury to which doubtful food is returned from branches all over London. Similarly large quantities of foodstuffs are handled by the British Transport Commission which has depots in the borough and the Food Inspectors are frequently called in to adjudicate on food that has been damaged or contaminated in course of transit. 54 No occasion arose during the year for the special examination of any large quantity of a specific stock or consignment of food other than meat. A total of 134 visits were made by the Pood Inspectors during the year in connection with the examination of unsound food and 917 condemnation certificates were issued. These figures exclude any reference to meat inspection. Small quantities of food are subject to incineration where facilities exist, but generally, unsound food other than meat is removed as trade refuse by the Council's general contractor. Where necessary the cans containing food are pierced. Details of the unsound food surrendered during the year are as follows:- lbs. Meat (diseased 10,261 Meat (unsound) 49,991 Meat products 5,766 Bacon 9,742 Offals (diseases and unsound) 47,175 Poultry 11,206 Game 180 Rabbits 1,435 Canned foods 36,286 Bottled fruit, pickles, etc. 37 Dried fruit 928 Confectionery 2,000 Preserves 92 Cheese 2 222 Pats 334 Pish 426 Cereals 260 Eggs 382 Miscellaneous 3,664 Total 182,387 lbs. 81.42 tons 55 Education Owing to pressure of work, activities in the field of education in relation to food hygiene during 1956 were mainly confined to (i) the distribution of literature and the exhibition of posters (referred to in Section B) and (ii) the personal education of food handlers by the Public Health Inspectors in the course of routine visits to premises. Such influence has undoubtedly had an increased effect since personal persuasion has been backed by the Food Hygiene Regu1ations. Consideration has been given in the past to the formation of a clean food guild but for several reasons it was decided to abandon the idea. Pood Poisoning Thirty-three cases of Food Poisoning were notified during the year. There were no deaths. There were no outbreaks of Food Poisoning due to identified causes during the year. One outbreak due to an unidentified cause occurred as under:- Domestic(April). 4 cases notified. Suspected cause: Sausages., Apart from the outbreak detailed above the following individual cases were investigated Agent identified 1 in January Salmonella "Stanleyville" 1 in June Salmonella Typhi-murium 1 in June Salmonella "Thompson" 1 in June Cl. welchii 1 in July Salmonella Typhi-murium 1 in August Salmonella Typhi-murium 1 in August Cl. welchii 1 in October Salmonella "Derby" 1 in November Salmonella Typhi-murium 56 Agent not identified: 4 in January 1 in February 2 in March 1 in July 1 in September 1 in October 4 in November Agent not identified but possible cause: Mushroom Soup March Green Salad April Ice Lollies June(2) Sausage Roll October Cockles November. 57 SECTION F INFECTIOUS DISEASES General The incidence of infectious disease at no time during the year gave rise to any serious concern. The London County Council(General Powers) Act 1956 Section 61 deleted reference to "continued" fever in the Public Health(London) Act, 1936, both as a notifiable and dangerous infectious disease. All cases notified were visited by the Infectious Diseases Nurse/ Visitor and energetic measures taken wherever indicated to ensure adequate minimization of danger of infection to others. The number of visits made by the Infectious Diseases Nurs/Visitor in 1956 was 2,325. The following table shows the incidence of notifiable diseases in 1956:- All Ages Under 1 yr. 1-4 yrs. 5-14 yrs. 15-24 yrs. 25-44 yrs. 45-64 yrs. 65- Cases treated in Hosp. Acute Pneumonia 58 7 10 7 - 10 14 10 57 Dysentery 203 10 61 73 9 34 10 6 58 Erysipelas 6 - - - - 1 3 2 2 Pood Poisoning 33 3 4 5 4 11 4 2 10 Gastro enteritis(under 2 yrs) 29 21 8 - - - - - 26 Malaria 1 - - - 1 - - - 1 Measles 310 18 169 118 3 2 - - 42 Meningococcal Infection 2 1 - - - - 1 - 2 Ophthalmia Neonatorum 2 2 - - - - - - 2 Whooping Cough 145 30 65 49 1 - - - 55 Puerperal Pyrexia 1 - - - 1 - - - 1 Scabies 26 1 1 14 4 5 1 - - Scarlet Fever 28 - 11 16 - 1 - - 17 Typhoid 1 - - - - - 1 - 1 Tuberculosis(Pulmonary) 37 - 1 3 4 11 11 7 - Tuberculosis (Non-Pulmonary) 5 - 1 - 2 1 1 - - Poliomyelitis(Paralytic) 2 1 1 - - - - - 2 Total 889 94 332 285 29 76 46 27 276 58 DISEASES NOTIFIABLE IN FINSBURY Diphtheria There were no cases or contacts during the year. Smallpox There were no cases or contacts during the year. Enteric Fever(i) Typhoid One case of typhoid fever occurred in a man aged 48 years, who developed the disease after returning from a holiday in Spain. He was treated in hospital where all investigations were carried out and made satisfactory progress. All contacts were kept under supervision and remained well. There were no further contacts or cases during 1956. Enteric Fever(ii) Paratyphoid One case of paratyphoid 'A' was notified in 1956, but the final diagnosis was Salmonella Stanleyville. There were two contacts of a case of Paratyphoid 'B' which were kept under supervision and remained well. Ophthalmia Neonatorum Two cases were notified. Both responded well to treatment and no blindness developed. Puerperal Pyrexia Finsbury cases occurring in hospital are notified in the area in which the hospital is situated; one such case occurred in 1956. The patient responded to treatment and made satisfactory progress. Meningococcal Infections There were two notified cases of meningococcal infections during 1956. Both patients were severely ill, one was a contact of a case of meningococcal infection, in the other case the source of infection was unknown. The contacts in both instances remained well. One Finsbury resident developed a sudden onset of severe illness from an unknown source of infection whilst in hospital. The patient subsequently recovered and all known contacts remained well. 59 Malaria One case of malaria was notified during the year. The man in question had recently arrived from India; he was removed to hospital and progressed satisfactorily. Erysipelas Six cases were notified during the year. In no case was the infection severe. Two cases were removed to hospital. All made satisfactory progress. Poliomyelitis There were two notified cases of poliomyelitis(both paralytic) in 1956. One, a female child of 10 months, had paralysis of the left leg and at the end of the year was making slow but satisfactory progress. The other case was a remale child, aged 4 years who had paralysis of the back and leg muscles. This child is making only very slow progress. The contacts in both cases remained under supervision and were well throughout. There was also a case of a child of 5 years who was treated as an abortive case of poliomyelitis; this child was a contact of a paralytic case, was quite ill, but had no paralysis, and duly recovered. Pneumonia Acute Primary During 1956 there were 58 cases of pneumonia; three of which were influenzal pneumonia and were severely ill. Of the 55 cases of Acute Primary Pneumonia, 10 were severe, 33 moderately severe and the remainder were mild. Fifty-seven were removed to hospital and there were no deaths. Scarlet Fever There were 28 cases notified during the year, all of which were of a mild nature with one exception. Seventeen of the cases were removed to hospital. In one case a complication was reported - lymphadenitis. All cases subsequently recovered. Whooping Cough There was an increase in the number of cases of whooping cough during 1956 In all 146 cases came to the knowledge of the department, 145 of which were notified and one unnotified case. There were 93 cases in the previous year. Six were very severely affected, which were very young children, 84 moderately severe and in 3 cases the disease was only mild. One patient was an adult. Fifty-five cases were removed to hospital. 60 There were no deaths but the following complications were reported:- 1 Collapsed right lung. 2 Lt. Otitis Media. 8 Bronchitis. Measles There were 310 cases of measles during the year the largest number being in the second quarter. There was one severe case, 141 moderately severe, and the remainder were mild. All cases made a satisfactory recovery. Forty-two were removed to hospital. The following complications were reported:- 2 Pneumonia. 5 Bronchitis. Scabies Twenty-six cases were notified. Dysentery During the year 203 cases of Sonne dysentery were notified, of which 64 were from outbreaks in schools or nurseries, and 22 were parents of infected children. None were severely ill and most of the cases were in the first quarter. Gastro enteritis(under 2 years) There were 29 cases of gastro enteritis in babies during 1956; 13 were moderately severe, the remainder mild. Twenty six were removed to hospital. All cases made a satisfactory recovery. Gastro enteritis(over 2 years) There were 8 cases of gastro enteritis over 2 years all of which were mild. Rubella Although not a notifiable disease each case coming to the know ledge 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. Seventeen cases in all became known in 1956. All were mild and there was no known contact with an expectant mother in the first four months of her pregnancy. 61 DISEASES NOT NOTIFIABLE IN FINSBURY Chickenpox There were 69 cases of chickenpox which came to the knowledge of the department in 1956. None was severe and all made a satisfactory recovery. There were no known complications. Mumps Eighty-eight mild cases of mumps came to the knowledge of the department during 1956, All made a satisfactory recovery and there were no known complications. Infective Hepatitis There were no cases of this disease in 1956. Food Poisoning Please see Section 'E'-Food. Glandular Fever There were three cases of glandular fever known to the department during 1956 Two were adults and one a child. There was no contact between the cases and no further incidents arose from them. Tuberculosis The total number of new cases entered in the register during the year was 60. 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 2 6 5 3 6 7 30 F - 2 - 3 - 6 7 2 3 - 1 24 Non-Pulmonary M - 1 - - - - - - - - - 1 F - - - - - 2 2 - 1 - - 6 TOTAL - 3 - 3 1 10 15 7 7 6 8 60 62 These figures do not necessarily correspond, due to technical reasons, with those shown in the report of the Chest Physician. The non-pulmonary cases include: 2 Renal; 1 Meninges; 1 Adenitis; 1 Intestines; 1 Genital. The notification rate for all forms of tuberculosis was 17.26 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 1956, as follows: Males Females Total Pulmonary 153 116 269 Non-Pulmonary 8 21 29 161 137 298 The full details of each case obtained by the Tuberculosis Visitor were, by kind co-operation of the London County Council, made available to and any preventive measures possible co-ordinated with those of the Borough Council. There were five deaths from pulmonary tuberculosis as follows: Males: 77, 62, 57 & 31. Females: 56. There were two deaths from non-pulmonary tuberculosis-a male aged 84 and a female aged 26. There was one death where the case was not notified. The death rate for all forms of Tuberculosis showed the very welcome drop from 42 in 1955 to 20: it remains however above the national average which was 15 in 1955. I should like to acknowledge the willing co-operation and facilities for the interchange of information which have been provided by the Chest Physician, Dr. W. D. R. Thompson, and his staff. 63 Flnsbury Chest Clinic (Information kindly provided by Dr. W. D. R. Thompson Chest Physician). During the year 1956, a total of 2 027 patients were seen in the Chest Clinic. Of this total, 95 attended for the first time as contacts of notified cases, and a further 161 were re-examined as routine contact checks. The number of new cases of tuberculosis taken on the clinic register during the year amounted to 36 of which 30 were pulmonary and 6 non pulmonary. Of the pulmonary cases 12 proved to be infectious. In addition to these cases a further 21 notified cases(20 pulmonary, 1 non-pulmonary) were transferred into the borough from other clinics and hospitals. The number of notified cases shown on the clinic register at the 31st December 1956 was as follows: Respiratory Non respiratory Totals Grand Total M. W. Ch. M. W. Ch. M. W. Ch. 257 126 96 19 4 8 4 130 104 23 The previous year's total was 242. During 1956 there were 8 deaths(5 males and 3 females), 6 lower than 1955. Of the cases removed from the register during 1956 a total of 13 were recovered; 14 were transferred out to other areas, and the remaining 6 were removed as "lost sight-of" and "diagnosis-not-confirmed'". The total number of cases x-rayed during the year was 1,361 The London County Council Tuberculosis Health Visitor, seconded to the Chest Clinic, made 1,017 visits to homes in the borough during the year. Each case was visited with the view to tracing the source of infection, and advising on the prevention of the disease spreading, and on giving any other assistance where necessary. Disinfection was carried out by the Pinsbury Borough Council in a number of cases at the request of the Chest Physician. 64 Mass Radiography Unit 6D (Information kindly provided by Dr. W. D. R. Thompson Medical Director). Mass Radiography Unit 6D commenced operating in May 1950 and up to the end of 1956 it had examined 208,373 males and 152,274 females making a total of 360,647. The present zone of the Unit comprises the City of London and the Metropolitan Boroughs of Finsbury and Shoreditch all of which have intensive day populations. During 1956 the Unit examined 37.264 males and 27,916 females totalling 65,180, which shows an increase of about 3,400 on the previous year's figures. Sixty two active cases of tuberculosis were discovered and 883 cases with tuberculous lesions. The unit operated at the Mass Radiography Centre 20 Golden Lane E.C.1 from the 1st January to the 30th April and from the 8th August to the 31st December. During the intervening period the Unit visited several firms and organisations within its zone, including a special survey in Finsbury, when the Unit operated in the Finsbury Health Centre Pine Street, London, E.C.1. by kind permission of the Health Committee of the Borough of Finsbury. About 250 firms participated in this survey, which took place from the 14th June to the 6th July. Particular emphasis was laid on firms operating in the northern section of the Borough as those in the southern area are conveniently situated to the Mass Radiography Centre in Golden Lane. Also in this survey were included firms in the Ludgate Circus area as there is direct transport facilities to the Health Centre. During the Finsbury survey some Public Sessions were held at which no appointments were necessary, but the attendances at these sessions were disappointing. At the request of the Medical Officer of Health for Finsbury special periods were set aside for the examination of elderly folk. The attendances at the Public Sessions amounted to 542 people with over 4,299 at the Planned Sessions, Eight cases of active tuberculosis and 11 cases of inactive tuberculosis were discovered, as well as 2 cases of carcinoma of the lung, We would like to take this opportunity of recording our grateful appreciation to the Medical Officer of Health and his staff for their helpfulness during this survey. As this Unit does not have the usual X ray van and trailer, it is necessary for the apparatus to be installed within a firm's premises and so every endeavour is made during the mobile period to X-ray either firms in the vicinity of a particular site, or firms associated with the Company In which the apparatus has been installed. Thus 65 when carrying out an examination on the premises of Union International Company, the Unit X-rayed the staffs of twenty of their associated companies. The scheme for the examination of Teaching Staffs of the London County Council, commented upon in the previous Annual Report came into operation at the beginning of 1956, and has worked quite smoothly. Altogether the Unit X-rayed 535 teachers representing 93 schools in Divisions 3,4 and 5, Of the firms examined during 1956 a high proportion consisted of small and new firms,, Of the total number X-rayed about 42% had not been X-rayed before or been examined during the past three years. The object of a Mass Radiography Unit is to discover tuberculosis and other chest diseases in the early stages which will result in an earlier cure. By the adoption of an appointments system the Unit is able to examine large numbers of people in the minimum of time. Examinees, except when attending for a large film, are X-rayed over their clothes. All volunteers receive the result of their X-ray within a week of their examination. The Service is free, reliable and confidential, and the Organising Secretary Mass Radiography Unit 6D, Finsbury Health Centre Pine Street London E.C.1. (Telephone No. TERminus 0031 Ext. 9) will be pleased to send full particulars of the Service to firms and individuals who may be interested. 66 APPENDIX "A" List of special reports submitted to the Health Committee by the Medical Officer of Health during 1956:- January 9 Affleck Street Properties. February 6 Mid day Meal Services for the Aged. July 9 Report on the Health Congress of the Royal Society of Health. October 8 Finsbury Employment Scheme for the Elderly-Progress Report and Financial Statement, 1st April 1955-31st March 1956 8 Review of Manual Staff. 8 Rodent Control-Staff. 8 Absences through Sickness. November 12 Report on The Sanitary Inspectors' Association 63rd Annual Conference(Bournemouth 18th-21st September, 1956). 12 National Smoke Abatement Society Conference, Southport. 12 Report on Aged Persons Holiday Scheme 1956. 12 Air Pollution. December 3 Report on Restaurants and Cafes in the Borough of Finsbury. 3 Voluntary Organisations-Grants. 67 APPENDIX "B"r List of special reports submitted to the Housing Committees by the Medical Officer of Health during 1956:- February 27 Memorandum on Slum Clearance. March 12 List of properties considered unfit supplemental to those already agreed. November 5 Properties Nos. 10-32 Calshot Street, N.1. 68 APPENDIX "C" A HUNDRED YEARS AGO In 1855 the Metropolis Local Management Act and the Nuisances Removal Act for England made the Vestry the Local Authority and called for the appointment of a Medical Officer of Health. These two acts are probably the most important which have ever been framed for improving the sanitary and social conditions of the people. The Borough Council of Pinsbury, as we know it now consisted of the Vestries of the Parish of St. Luke and St. James and St. John, Clerkenwell. The early Medical Officers of Health were truly pioneers. With very little help from Parliament they were responsible for guiding their authorities towards realisation of the need for and carrying out of a comprehensive public health programme from which has been built the welfare services of today. The conditions in which people were living in London in 1855 were so bad that Medical Officers and Sanitary Inspectors were appointed in the Metropolis before the rest of the country. By modern standards the conditions were appalling. As Dr. Pavey said in his first report to the Vestry of St. Luke in 1856 "it is evident that those who are living under circumstances in which they are deprived of the ordinary elements of health and comfort, cannot be expected to be satisfied and happy, nor can they be expected to preserve those relations to their fellow creatures which are essential to their own welfare, and to that of all around them". Many of the houses were thoroughly unsatisfactory and had no back windows and yards and were walled in by higher houses and so had little or no ventilation. They were extremely dirty; the walls being covered with the stains of destroyed vermin and the drainage was either none or very imperfect. As Dr, Pavey said "frequently there are no privies and sometimes there is one privey for 50 100 persons. In some houses a donkey is kept in a lower room while a family occupies a room above", At least this animal must have had more room than some of the inhabitants, for overcrowding was rife, In a room of 709 cubic feet capacity in Macclesfield Street 5 adults and 5 children lived, each having an allowance of space equal to the capacity of a box a little over 4 feet square. There was no regard for decencya couple of sets of married people, with their children, and sometimes unmarried grown-ups of opposite sexes were found occupying one room. The water-supply was sadly deficient. The New River Company provided the general supply of the district from the reservoir, after 69 filtration through beds of sand and gravel but the supply was so little that hundreds of people were dependent on one tap in the yard with a supply lasting for less than an hour in the morning. The only other supply was from a few wells but the pump water was invariably contaminated with the contents of the sewers which had escaped into them. Dr. Pavey observed that "cholera has violently attacked those who have drunk pump water. Moreover the shallow well water receives the drainage water of Highgate cemetry, numerous burial grounds and innumerable cesspools in the district". In 1862 the population of the Vestry of St* Lukes was assessed as 57,073 and that of Clerkenwell as 69,960 and it was said that instead of a house to a family it is several families to a house they are so congested that it is a wonder that they can cling to life so long as they ever do". It is not surprising then to find that in 1863 there were 1765 deaths in the Parish and Workhouse of St. Lukes alone and of these 51.2 per cent were among infants and children under 5 years. In the Whitecross Street district which was particularly overcrowded there were 60.8 per cent deaths in children under five years. It was "lamentable how frequently deaths from suffocation under bedclothes in infants were recorded-also there was a painful significance in the words "illegitimate child" so often appended". The low proportion of 9.8 per cent of the mortality consisting of deaths over 60 years leads to the conclusion that a comparatively small population of aged people managed to exist. With the construction of warehouses and railways in the centre of London the evil of overcrowding increased as people driven out of a house that had to be pulled down added to the number of inhabitants a little further on. The substitution of warehouses and other business premises for dwelling houses gradually brought about a decrease and change of character of the population of Finsbury, During 1868 the Artizan's and Labourer's Dwellings Act came into force and made provision for taking down or improving dwellings occupied by working men and their families which were unfit for human habitation and "for the building and maintenance of better dwellings for such persons instead thereof". The Vestry then was empowered, after considering a report by the Medical Officer and Engineer to close the premises cause them to be pulled down and execute the works required in the event of non compliance with its order. This legislation was soon put to good use and several blocks of "miserable tenements" which had been condemned because "their condition is so deplorable that many of you would scarcely credit that human beings could exist in them" were pulled down and "model dwellings" for the working class were erected. Dr. Pavey, in a paper read to the Metropolitan Sanitary Association in 1865 about the current epidemic of typhoid fever said We must have better and healthier homes for the poorest classes not the 70 palaces designed by philanthropists, with appliances which do not often come within the means of the lower middle class, but cheap wholesome and suitable places-The authorities would display great economic wisdom in getting and using public money at per cent for this purpose". Smallpox was a relatively common disease; there were 32 deaths in St. Lukes from it in 1864 During a serious epidemic in 1871 a temporary hospital was opened and an ambulance provided-at a cost of £59-to remove the sick from home so as to avoid the employment of street cabs. Notices were also posted throughout the parish urging the importance of vaccination. There was also a serious outbreak of Fever in St. Mark's and the City of London Lying In Hospital which led to the use of disinfectants and isolation of patients as a method of checking the spread and then to a demand for information to be given to the health department as soon as an infectious disease was discovered. The Sanitary Act of 1866 provided for disinfection of houses and the construction of a place for the disinfection of materials instead of merely burning them and compensating the owners. Dr. Pavey held strong views about infectious diseases and said "there can scarcely be a greater crime than that of secretly infecting a fellow creature with a mortal disease, it differs only from that of secret poisoning in being done more frequently and without fear of punishment". In 1873 the Prevention of Adulteration of Food, Drink & Drugs Act came into force in St. Lukes and the first conviction in London was obtained here. The magistrate fined a man £10 and costs for selling adulterated tea. Two other cases fell through because of a loophole in the law which allowed a married woman to sell adulterated food with impunity unless legal proof of the marriage could be provided a matter of some difficulty and expense in those days. In the same year a man was summonsed at Clerkenwell Police Court for selling putrid rabbits in Levpr Street and fined £5 or 2 months imprisonment. In 1868 there had been inspections of 53 bakehouses 34 slaughterhouses and 15 cow sheds and 44 hampers of plaice, 4 trunks of soles. 2 bushels of periwinkles and 2 cwt. Ostend rabbits were among the articles which had been condemned as unfit for consumption by human beings. The improvement in housing and decrease in population, along with a better understanding of the infectivity of certain diseases helped to reduce the wastage of human life. As the years went by measures such as the Public Health (London) Act 1891, Notification of Births Act, 1907, appointment of Health Visitors and beginning of the Child Welfare Movement, Notification of Tuberculosis of the Lungs 1908. and Housing Act, 1935 helped to prepare the ground for the birth of the Welfare State.