ISL 79 LIBRARY METROPOLITAN BOROUGH OF ISLINGTON. ANNUAL (ABRIDGED) REPORT OF THE MEDICAL 0FFICER OF HEALTH G. CLARK TRORRER, M.D., D .P .H., P.R.S.E., F O R. THE YEA R 1940. To The Mayor, Aldemen and Councillors of the Metropolitan Borough of Islington. Mr. Mayor, Ladies and Gentlemen, I have the honour to present the Annual Report on the health of the Borough for the year 1940 on behalf of Dr. G. Clark Trotter under whose direction the work was carried out. Dr. Trotter retired in the early part of 194-1 after about 20 years service as Medical Officer of Health to the Metropolitan Borough of Islington. He therefore directed the work of the Public Health Department for almost the whole of the interregnum between the two world wars. Many important local developments in health activities took place during this period, in particular the development of the Child Welfare Services, and during more reccnt years, the very considerable increase in the Council's housing activities, which threw much additional work and responsibility upon the Medical Officer of Health and his Department. Dr. Trotter's courtesy and kindly personal consideration on all occasions were greatly appreciated by all who came into contact with him. During the year under review, the calls of Civil Defence made many heavy demands upon the staff of the Department here, as elsewhere. Both the Assistant Medical Officer of Health and Assistant Medical Officer, as well as many of the Sanitary Inspectors, Health Visitors and Clerical Staff spent much of their time wrestling with such problems as First Aid Posts, Stretcher Parties and their depots, Control-room duties and Shelters. It was therefore inovitable that some of the normal work should suffer by delay or temporary suspension of activities, but as will be observed in the Report, much was done in spite of those difficulties. It will be noted that the Registrar-General's estimate of population for mid-year 1940 was approximately 224,000 or 64,000 fewer than in 1939. The death-rate and total deaths for 1940 show an increase over the corresponding figures for 1939, mainly accounted for by increases in the deaths duo to 'Bronchitis' and 'other violent causes' which latter includes deaths due to enemy action. There was also some increase in the number of notifications and deaths due to cerebro-spinal fever. The Annual Report for 1940 has been drawn up in an abridged form in accordance with the Instructions of the Ministry of Health. Your obedient servant, V. FREEMAN. Medical Officer of Health. October 1941. METROPOLITAN BOROUGH OF ISLINGTON, SECTION A. GENERAL AND VITAL STATISTICS. Area of the Borough 3,092 acres. population. Registrar General's estimate of civilian population, Mid-year 1940 224,110 LIVE BIRTHS. Totals, M F. Birth rate per 1,000 estimated resident population 17.18 Legitimate 3,578 1,846 1,732 Illegitimate 272 142 130 3,850 1,938 1,862 STILL BIRTHS. Totals M F Rate per 1,000 total (live & still)births 32.17 Legitimate 119 66 53 Illegitimate 9 4 5 128 70 58 DEATHS Totals M F Death rate (unadjusted) per 1,000 population. 18.48 4,143 2,125 2,01.5 Death rate (adjusted) per 1,000 population (A.C.F. - 0.98) 18.11 DEATHS FROM PUERPERAL CAUSES Deaths Rate per 1,000 total births. Puerperal Sepsis 2 0.53 Other puerperal causes 4 l.06 6 1.59 DEATH RATE OF INFANTS UNDER ONE YEAR 0F AGE. All infants per 1,000 live births 47 Legitimate infants per 1,000 legitimate live births 46 Illegitimate infants per 1,000 illegitimate live births 59 NOTIFICATION OF BIRTHS The total number of notified births, including stillbirths from all sources, was 4,075; of this number 1,019 were not notified by Midwives. MARRIAGES. (Provisional figures) Marriages solemnised in the Borough during the year 3,689 Marriage rate 32.92 CLASSIFICATION OF DEATHS WITH AGE DISTRIBUTION. CAUSES OF DEATH. f AGES - BOTH SEXS. Under 1 year 1 and ; under 5 5 and under 15 15 and under 45 45 and under 65 65 and upwards TO T A L S. All ages M F. All causes 171 43 58 523 1,095 2,254 2,125 2,018 1.Typhoid & paratyphoid fevers – – 1 2 – – 3 3 – 2.Cerebrospinal fever 1 3 – 3 3 – 10 6 4 3.Scarlet fever 1 – – – – – 1 1 – A.Whooping Cough – – – – – – – – – 5.Diphtheria – 1 1 – – – 2 – 2 6. Tub. of the resp. system – 1 2 99 66 21 189 123 66 7.0ther forms of tuberculosis 1 3 5 9 2 1 21 14 7 8.Syphilitic diseases 1 – – 5 14 11 31 24 7 9. Influent 1 – – 4 5 17 27 12 15 10.Measles 2 2 1 – – – 5 3 2 ll.Ac. Polio-mel & polio-enceph – -– – – – – – – – 12.Ac.infectious enceph. – – – l 2 – 3 2 1 13.Cancer of buc.cav & oesoph(M) – – – 1 8 17 26 26 — uterus (F) – – – 4 16 15 35 – 35 l4.Canccr of stomach & duodenum – – – 8 38 49 95 59 36 15.Cancer of breast – – – 2 32 14 48 – 48 16.Cancer of all other sites •4 — – – – 22 109 144 275 154 121 17.Diabetes – – – 2 6 17 25 10 15 l8.Intra-cranial vascular lesion – – – 3 39 190 232 102 130 19.Heart diseases – – 1 43 180 700 924 432 492 20.Other diseases of circ. system – – – 1 20 85 106 47 59 21.Bronchitis 5 – – 9 147 325 486 264 222 22. Pneumonia 38 5 2 19 48 112 224 113 111 23.0thcr resp. diseases -– – – 6 41 29 76 42 34 24.Ulcer of stomach or duodenum – – – 6 29 26 61 45 16 25.Diarrhoea under 2 years 27 – – -– – – 27 16 11 26.Appendicitis -– – 3 1 5 2 11 7 4 27.Other digestive diseases 1 2 1 5 22 43 74 36 38 28.Nephritis – – 3 8 30 50 91 40 51 20.Puerperal & post-ebort: sepsis – – – 2 -– – 2 – 2 30.Other maternal causes – -– – 4 ' -– – 4 – 4 31.Premature birth 38 – – – – – 38 21 17 32.Con: mal: birth Inj: infant: dis: 37 1 1 2 – 1 42 22 20 33.Suicide – – -– 8 21 9 38 26 12 34.Road traffic accidents – – 1 10 7 14 32 20 12 35.Other violent causes 12 21 31 195 141 133 533 282 251 36.All other causes 6 4 5 38 64 229 346 173 173 3 SECTION B. GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. MATERNITY AND CHILD WELFARE SERVICES. WELFARE CENTRES. There are four Voluntary Welfare Centres as follows, each of which has received a grant from the Borough Council for the year ending March 31st.1940. Amount of grant. North Islington Maternity Centre & School for Mothers, 8 & 9 Honor Gardens, Holloway, N.7. North £5,755 plus redecoration grant of £60. South Islington Mothers'and Babies' Welfare Centre, 6 Clephane Road, N.l. South £2,776 East Islington Mothers' and Babies' Welfare Centre, 32 Erayton Park, N.5. East £2,137 West. Islington Infant Welfare Centre, 42 Richmond Avenue, N.l. We3t £1,923 SPECIAL FEATURES OF WORK ST 1940 • Until the commencement of mass air raids on London in August, 1940, the work of the Welfare Centres continued on approximately normal lines, making allowance for the fact that certain portions of the premises used by the North and South Centres were occupied for A.P.P. purposes. After air raids began, the services were reduced, but tended to increase again towards the end of the year. The Welfare Centres assisted by agreeing to the use of a proportion of their Health Visitor staff acting as Relief Nurses for First Aid Post3, and also assisted in the evacuation arrangements for mothers and children, the distribution of respirators and the operation of the National Milk Scheme. SUMMARY. 1. Ante-Natal Clinics:Number held weekly North 3 (3) South 1 (2) East 1(1) West 1(1) Total. 5 (*7) Number of expectant mothers who attended 452 (485) 153 (135) 193 (216) 122 (188) 920 (1,024) 2. Post-Natal Clinics:- North South East West Total Number held weekly 1 (1) 1 (2) 1 (*1) 1 (*1) 3 (*5) Number of mothers who attended 128 (131) 20 (119) jnr 87 (81) 43 (57) 278 (388) 3. Consultations for Children up to 5 years of ago. Total number of children who first attended at the centres during year, and who, on the date of their first attendance were:- North South East West Total. (i) Under 1 year 842 (980) 515 (571) 469 (501) 525 (615) 2,351 (2,667) (ii) 1-5 years 172 (176) 92 (50) 130 (111) 101 (108) 495 (445) (figures for 1939 in brackets.) 1939 *East Centre - 1 Clinic weekly and 2 others per month. *East & West Centres. Post-Natal Clinics are held with their ante-natal clinics. *To November only. 4 4. Home Visiting. North South East West Total. Number of visits made to:- (i) Expectant mothers (a) First visits 381 84 164 152 781 (b) Total visits 1,576 146 683 281 2,686 (ii)Children under 1 year Total visits 3,556 4,304 3,176 3,452 14,488 (iii)Children 1-5 years Total visits 5,543 7,022 4,069 6,674 23,308 5. Number of children who attended at the centres during the year, and who, at the end of the year were:- (i) Under 1 year 657 436 317 417 1,827 (ii) 1-5 years 1,461 1,302 636 973 4,572 MUNCIPAL HEALTH VISITORS. A good deal of time was voluntarily given by the Council's Health Visitors for duty at First Aid Posts and Mobile Units. Interruption of normal visiting was unavoidable for a period but was resumed as soon as conditions permitted. Summary of Visits. Totals. 1. Births, First Visits, Infants under 1 year 3,137 2. Births, Re-visits, Infants under 1 year 2,231 3. Visits to Children between 1st.& 2nd. years 2,372 4. Visits to Children between 2nd.& 5th years 5,974 5. Visits re Stillbirths 107 6. Deaths, Visits re Infants under 1 year 50 7. Deaths, Visits re Children 1-5 years. 3 8. Ante-natal Home visits 1,365 9. Puerperal (Fever, Home visits 5 (Pyrexia, Home visits 10. Attendances at Welfare Centre 100 11. Other work by direction 2,709 12. Visits declined 3 13. Visits House Shut 5,704 14. Visits Inopportune 33 Total visits 23,793 CHILD LIFE PROTECTION. Number of persons on register prepared to receive children at end of year 25 Number of children at end of year 24 home helps. 172 cases were attended by Home Helps, the not cost to the Council being:- £496. 13.9d. supply of milk to mothers and young children. The total quantity of milk supplied was as follows 260,296 pints at a cost to the Borough Council of £3,627. 1. 2d. The number of recipients was 11,393. 5 The National Milk Scheme for the provision of liquid milk for Expectant Mothers and Children under 5 years of age came into operation on the . 28th July, 1940, and "Full Cream" Dried Milk (known as "National Dried Milk") was included in the Scheme on 1st. September, 1940. 3 members of the staff dealing with milk enquiries under the Maternity and Child Welfare Scheme were seconded to the Milk Office of the Ministry of Pood under the National Milk Scheme. OBSTETRIC CONSULTANTS. A Specialist Consultant in connection with diagnosis of Puerperal Fever and maternity complications was provided in one instance. EMERGENCY UNIT. During the year this Unit was called out by Medical Practitioners on 2 occasions. DAY NURSERIES. The Miriam Price Coleman Day Nursery was closed as from August 30th, 1939. The under-mentioned Voluntary Day Nurseries evacuated from Islington took premises as follows Lower Holiday Day Nursery, from 547 Liverpool Road, N.7.to "Ashleigh" , Bakeham Lane, Virginia Water, Egham, Surrey. South Islington (Pro Patria) Day Nursery, from 8 & 9 Canonbury Place, to Church Farm, West Littleton, Chippenham, Wilts The Claremont Day Nursery, from white Lion Street, N.l.(Finsbury) to Ashford Residential Schools, Ashford, Middx. The Council's Grant to the above Islington Day Nurseries was continued, in accordance with the Ministry of Health's request, as indicated below:— Lower Holloway Day Nursery £260. South Islington (Pro Patria) Day Nursery £600. A grant was also continued to the Claremont Mission Day Nursery £50. ARTIFICIAL SUNLIGHT CLINIC. 38 sessions were held during the year at which 510 children and 31 adults were treated. MATERNITY HOSPITAL GRAINS. . Contributions for maternity cases admitted to beds at Maternity Hospitals at the rate of 10/- per case were:- City of London Maternity Hospital £22. 0. 0d. University College Hospital £24.10. 0d. £46.10. 0d. NURSING IN THE HOLE. The following payments were made to the North London Nursing Association:- Ophthalmia Neonatorum £ 4.16. 3d. Maternity & Child Welfare £ 7.0. 0d. Visits (Public Health) £ 5.7. 6d. 6 OTHER SERVICES. BACTERIOLOGICAL EXAMINATI0NS. TOTAL POSTIVE NEGATIVE. For Diphtheria Bacilli 560 31 529 Tubercle Bacilli 235 32 203 Typhosus Bacilli 3 1 2 PROVISION OF INSULIN. 19 patients received assistance during the year, the cost to the Borough Council was £31. 6. 5d. ISLINGTON CREMATORIUM. There were 69 cremations during the year at the Council's Crematorium at east finchley. SECTION C. sanitary circunstances of tie area. SUMMARY OF WORK DONE BY DISTRICT SANITARY INSPECTORS. During the year 24,940 inspections (including re-inspections) were carried out by the Sanitary Inspectors. 2,647 Intimation and 408 Statutory Notices were served. House to House inspections 803 Other premises inspected 3,815 Re-inspections, Calls made, etc. 19,939 Ice Cream Premises inspected 6 Dairies and Milk Purveyors premises inspected 36 Inspections - Council's property 21 Stables inspected 9 Yards inspected 20 Urinals attached to Public House inspected 1 Children & Young Persons Acts 15 Premises re Vermin 34 Premises re Rats and mice 168 Premises (re Water Certificates) inspected 4 Rag and Bone Dealers (2)Rag & Flock Act (l) 3 Smoke observations 2 Shops, Stalls and Markets (Saturday evening) 64 Notices served - Intimation (Public Health (London) Act,1936) 2,647 Notices served - Statutory (Public Health (London) Act,1936) 408 CLEANSING STATION. Number of children (L.C.C.Scheme)cleansed 2,956 Number of adults treated 198 plus 232 refugees. Number of children (under 5 years) 14 Number of baths 308 The following work was also carried, out for persons referred by the Borough Council of Stoke Newington. Number of adults treated 39 Number of Baths 54 DISINFECTION. During the year 759 disinfections were carried out after cases of infectious or other diseases. In addition 311 rooms and 258 bundles of bedding were disinfected for the presence of vermin. At the disinfecting station 69,282 articles of bedding etc., were disinfected. DISINFESTATION. The furniture and effects of 298 families were treated by Hydrogen Cyanide during the year. FACTORIES The number of insinuations was 4,942. in 713 instances. 726 defects were found, and remedied RATES AND MICE (DESTRUCTION) ACT, 1919. 141 complaints were received and 251 inspections carried out. 75 notices were served end 13 defective drains repaired. SUMMARY OF PROSECUTIONS DURING YEAR 1940. STATUTE. TOTAL Prosccutions Successful. Dis- missed. Withdrawn Amount of Penalties Costs received £. s. d. £. s. d. Public Health (London) Act, 1936. 64 62 – 2 58. 12. 0 102, .18. 0 Pood & Drugs Act, 1938 7 6 1 – 5. 0. 0 14. 14. 0 Housing Act, 1936 1 – 1 – – – – – – – 72 68 2 2 12. 12. 0 117 12. 0 SECTION D. housing. Work under the Housing Act has been at a standstill owing to the War, but 63 certificates of overcrowding have been submitted to the London County Council during the year. SECTION E. INSPECTION AND SUPERVISION OF POOD. MILK AND DAIRIES ORDER, 1926. Summary of Register. Number on Reg. 31.l2.39. Additions to Reg. Removals from Reg. No,on Reg. 31.12.40. Dairies 217 4 27 194 Purveyors of Milk in sealed containers only 470 14 26 458 Registered Purveyors of Milk dealing from registered premises outside the Borough. 92 2 1 93 Arising from routine inspections it was found that twenty seven premises had ceased to exist as dairies and were removed from the register. There was one prosecution taken under the Milk and Dairies Order, 1926, during the year. In this instance it was found that the Dairyman had, in contravention of article 28., failed to cleanse milk churns. The Defendant pleaded guilty, was fined £3., and ordered to pay £2. 2. 0d. costs. 8 ??? OF VISITS BY MILK & DAIRIES INSPECTOR. DAIRIES Routine inspections 444 Inspections for registration of 3 447 MILK-SHOPS (Milk sold in sealed containers only). Routine inspections 136 Inspections for registration of 8 DAIRIES AND MILKSHOPS INSPECTED UNDER THE MILK (Special Designation) ORDER, 1936 32 144 VHICLES INSPECTED 16 MISCELLAMEOUS VISITS 507 555 1,146 ICE CREAM PREMISES. Number of premises on the Register at the end of 1939 550 Number of promises added during the year 3 Number of promises removed during the year – Number of promises on the Register at end of 1940. 553 Routine inspections 112 Inspections for registration 6 118 ARTIFICIAL CREAM PREMISES. Number of premises on Register at end of 1940 4 During the year 46 notices intimating nuisances or defects were served, and 6 waring letters sent to Dairymen, Milk Purveyors, and Ice Cream Vendors drawing their attention to the contravention of the Acts and Regulations relating to their businesses. milk (Special Designations) order, 1936. During the year 1940 the following application were made for licences under the provisions of the above Order, to enable the persons to sell specially Designated Milk:- Licences granted under the Milk (Special Designations) Order, 1936 & 1938. Designation No.of applications made and granted. Tuberculin Tested (Dealer) 28 Tuberculin Tested (Supplementary) 5 Tuberculin Tested (Pasteurised) – Accredited (Dealer) 1 Accredited (Supplementary) – Pasteurised (Pasteuriser) 1 Pasteruised (Dealer) 75 Pasteurised (Supplementary) 9 119 9 MEAT AND OTHER FOODS. The Inspector of Meat and Other Foods (Mr. A.17. Haydock) reports that during the year 6 private slaughterhouses for local supplies and 1 slaughterhouse for the slaughter of horses, for export, held licences. The visits to these premises numbered 17. The following is a statement of oho number of animals slaughtered in them, carcases inspected, and parts of carcases condemned. Cattle excluding cows. COWS Calves. Sheep & Lambs. Pigs. Number killed 10 – – 61 – Number inspected 10 – – 6l – All-diseases except Tuberculosis Whole carcases con domed – – – – – Carcases of which a part or organ was condemned 1 – – – – Tuberculosis only Whole carcases condemned – – – – – Carcases of which a part or organ was condemned – – – –— — There were 262 horses slaughtered for export. The following table records the diseases found in slaughterhouses No of cases. Description of animals Nature of Disease Extent of Disease. How disposed of. 1 Oxen Distomatosis Liver Destructor. Food destroyed or otherwise disposed of so as to prevent its use for human consumption totalled - 67 tons, 15 cwts. 3 Qtrs. 8½ lbs. VISITS MADE TO SHOPS ETC., BY THE INSPECTOR OF MEAT AND OTHER FOODS WERE AS FOLLOWS: During the year 1,465 visits were paid to various food shops, markets, stalls etc. OFFENSIVE TRADES The offensive trades operating in the Borough are three tripe dressers, five gut scrapers and one knackers yard. Sixty three visits were made during the year and no breach of the Regulations was observed. Three skin dressers arc under the supervision of the Inspector of Workshops. BY-LAWS FOR THE PROTECTION OF FOOD. By-laws for this purpose were made under Public Health (London) Act, 1936, and came into force during 1937. No prosecution has been taken during the period under review. SLAUGHTERMAN'S LICENCE. 1 new application for a licence was received, and granted after investigation, making a total of 39 licenced slaughtermen on the register at the end of the year. FOOD & DRUGS ACT,1938. 818 samples (340 formal, 478 informal), were submitted to the Public Analyst for examination. Of these 6 were adulterated, (or 0.73 per cent), as shown in the following summary:- Formal Informal.  Milk 3 Cheese Slices 1 Cheese Slices 1 Double Cream Cheese 1 10 SHOPS ACT, 1934. There were 3,188 shops on the register at the end of the year, and 2,834 visits were made in the year. SECTION F. preVELANCE AND CONTROL OF INFECTIOUS and other diseases. TUBERCULOSIS: NEW CASES AND MORTALITY DURING 1940. NEW CASES. deaths. age periods respiratory. Non-Respiratory Respiratory non-Respiratory M. F. M. f. M. f. M. F. 0– 1 – – – – – – 1 1– 2 4 5 4 – 1 3 – 5– 2 9 7 5 1 1 3 2 15– 51 56 12 4 59 40 5 4 25– 71 44 6 8 35– 47 17 4 1 45– 26 16 – 1 52 14 2 – 55– 32 9 2 – 65–and upwards 3 15 8 1 2 11 10 1 – Total for all ages. 247 163 37 35 123 66 14 7 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS 1930. The total number of cases of tuberculosis on the Register as at 31st.December, 1940 va3 1,797 (Pulmonary - Males 774, Females 640. Non-pulmonary - Males l83, Females 200. DISPENSARY REGISTERS. Pulmonary. Non-pulmonary. Adults. Children. adults. Children Adults. Children. TOTAL. M. F. M. F. M. F. M. F. M. F. M. F. Number of definite cases of tuberculosis on Dispensary Registers at end of the year. 581 461 51 44 64 85 55 43 645 546 106 87 1,384 WORK OF THE TUBERCULOSIS DISPENSARIES. North South. Number of attendances 3,393 3,234 New cases and contacts examined 703 340 Number of visits by Tuberculosis Officers 237 175 Number of visits by Nurses 954 1,737 LIGHT TREATMENT. 2 patients received "Kromeyer Lamp" treatment and 1 "Ultra Violet Ray" treatment. The cost to the Council being - £7. 13. 6d. v TUBERCULOSIS CARE COMMITTEE. Miss K. Hadley, the Secretary, terminated her appointment on the 31st.December, 1940, after four years service. 316 new cases came to the notice of the Committee, 804 interviews were conducted, 1,827 letters sent, and 573 visits, made. 11 ARTIFICIAL PNEUMOTHORAX. 92 patients received treatment at a total cost of £3293. 16. 9d. EXTRA NOURISHMENT. 111 cases received extra nourishment at a total cost of £360. 6. 9d. BEDS AND BEDDING. 2 patients arc still provided with beds and bedding. DENTAL TREATMENT. 4 patients received treatment with assistance under the Council's scheme. NOTIFIABLE INGECTIOUS DISEASES AND DEATHS DURING THE YEAR 1940. DISEASES. No. of notifications. No. of Deaths. Cases Removed to Hospital. Scarlet Fever 140 1 133 Diphtheria 101 2 98 Enteric Fever(including Paratyphoid; 7 3 7 Puerperal Fever 9 1 6 Puerperal Pyrexia 43 — 32 Acute Primary & Influenzal Pheumonia 125 9 15 Ophthalmia Neonatorum 26 — 11 Encephalitis Lethargica 1 3 — Cerebro Spinal Fever 48 10 47 Anthrax 1 — 0 Dysentery 9 1 0 Malaria 1 1 — Erysipelas 78 3 40 Chicken Pox 73 — 15 Measles 372 5 83 Whooping Cough 43 — 13 small pox and vaccination. No case of smallpox was notified. Of the 3,440 births registered in Islington during 1939, 1,338 were successfully vaccinated. diphtheria immunisation. On the transfer of the First Aid Post from the Mirian Price Coleman Day Nursery, Scholefield Road, to the new premises at St. Mary, Islington, Hospital, the Diphtheria Immunisation Clinics were commenced at the Day Nursery in May. Only 13 sessions were held, as it was not possible, due to daylight earnings and night raiding, to maintain a satisfactory attendance, and the Clinic was temporarily suspended in September. Details of attendance are as under:— Total number of sessions at Miriam Price Coleman Day Nursery only 13 Total attendances at clinics 423 Average attendance per session 32.5 New cases commenced 108 Cases immunised and completed 90 OCTOBER, 1941.