library ISL-82. METROLITAN BOROUGH OF ISLINGTON ANNUAL (ABRIDGED) REPORT of the MEDICAL OFFICER OF HEALTH, V. FREEMAN, M.R.C.S., L.R.C.P., D.P.H. 1 9 4 3. public Health Department, Town Hall, Upper Street, N.l, To the Mayor, Aldermen and Councillors of the metropolitan Borough of Islington. I have the honour to submit herewith the Annual Report for 1945, which is again an interim report. The general health picture, in so far as it can at present be given, continues to remain satisfactory and even to present sons encouraging features. The infant mortality rate of 46 per 1,000 live births for 1943 is the lowest figure on record for this Borough, A reduction in infant mortality also means a general reduction in infant morbidity or sickness and it is to be hoped that those favourable factors (and the improvement in infant health cannot be ascribed to any one single factor) which have been oonducive to this improvement will continue to operate in future years. There is no reason to suppose that a further fall in infantile mortality cannot be effected, and to a degree which perhaps would have been far beyond our expectations a generation ego. The campaign gainst Diphtheria continued to go well during the past year and by the end of the. year it was estimated that 31% of children under the age of 5 and 70% of children over five had been protected against Diphtheria. Towards the end of 1943 the Borough she red in an Influsnza epidemic of a moderate severity and reference to which is made in the appropriate section of this report. Owing to the demands of women who desired, or were requested by the Ministry of Labour and National Service, to take up work, War-time Day Nurseries continued to be opened for the care of their children and by the end of the year 13 Day Nurseries were in operation. The War-time Nurseries have made a very considerable addition to the administrative and clerical work of the department with a staff which has not increased proportionately. Further developments also referred to in the report are in connection with the appointment of additional staff to combat Scabies and infestation with body vermin. The main feature of the year in connection with Tuberculosis was the commencement of the ,maintenance Allowances Scheme which is reported upon for the first time and which necessitated the appointment of a social officer by the Borough Council to deal with the enquiries and investigations arising out of the Council is responsibility for the administration of this section of the scheme. A number of staff changes occurred during the year and the shortage of clerical staff continued to be a source of chronic anxiety with sub-acute exacerbations from time to time. I desire to thank all those members of the staff who, in spite of these difficulties,have carried on and have made possible the carrying out of the work which is summarised in this report and which in certain directions has even increased in volume over previous years. I should again like to thank the Chairmen and Members of the Public Health and Maternity & Child welfare Committees for their courteous and helpful consideration of all the matters that were submitted and considered during the year 1943, V. FSSBMkN toiedical Officer of Health October, 1944 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 1943* LIVE BIRTHS: Totals M F. Legitimate 3,328 1,743 1,585 Illegitimate 264 137 127 Birth rata per 1,000 estimated residasnt 3,592 1,880 1,71.2 population. STILL BIRTHS: Totals M. F.. Legitimate 78 48 30 Illegitimate 14 6 6 92 J36_ Rate per 1,000 total (Live & Still) births 24.97 DEATHS; Totals M. F. 3,017 1 ,557 1,460 Death Rate (unad justed) per 1,000 population. DEATHS FROM PUERPERAL CAUSES: Deaths • Ratae be per 1,000 total births. Puerperal Sepsis 3 0.81 Other Puerperal causes 7 1.90 10 2,71 DEATH SATS OF INFANTS UNDER ONE YEAR OF AGES: All infants per l,000 live births 46 Legitimate infants per 1,000 legitimate live births 44 Illegitimate infants per 1,000 illegitimate live births 68 NOTIFICATION OF BIRTHS: The total number of notified births, including still births from all sources, was 4,063; of this number 470 were not notified by midwives. MARRIAGES (Provsional figures). Marriages solemnised in the Borough during the year 1,766 ¤Not available for publication 1 CLASSIFICATION OF DEATH AGE DISTRIBUTION. causes of death Under 1 year 1 year and under 5 5 end under 15 15 and under 45 1 45 and , under 65 65 and upwards ages - both sexes totals. All M. F. All causes 165 39 26 308 605 1,674 3,017 1,557 1,460 1. Typhoid & paratyphoid fevers - - - - - - - - 2. cerebrospenal fever 2 - - - - - 2 2 - 3. Scarlet Fever - - 1 - - - 1 1 - 4. whooping Cough 4 4 - - - - 8 5 3 5. Diphthsria 1 3 4 - 1 - 9 3 6 6. Tuberculosis of respiratory system 1 3 90 53 15 162 105 57 7. other ???? of tuberculosis 1 2 5 10 2 3 23 16 7 8. Syphilitic disease 1 - - 6 9 8 24 13 9 9.Influenzas 2 1 - 7 13 33 56 21 35 10. Mesales 2 1 - - - - 3 2 1 11. Acute poliomyelitis and polioencephalitis - - - - - - - - - 12. Acute infectious ??? - - - 2 - 1 3 2 1 13. Cencer of buccal cavity and cesophsgus (M) - - - 2 5 19 26 26 - Cancer of uterus (F) - - - 4 22 9 35 - 35 14. Cancer cf atoaach & duodenum - - - 3 31 42 76 42 34 15. Cancer of breast - - 5 30 17 62 - 52 1g. Cancer of all other sites - - 1 22 133 140 296 181 115 17. Deabstes -* - - 3 9 9 21 3 16 18. Intre-oranial Vascular - - - 1 54 160 215 96 119 19. Heart Disease - - - 26 145 569 740 362 378 20. Other diseases of the circulatory system - - - 4 26 63 93 41 52 21. Bronchitis 2 3 1 10 51 162 329 137 92 22. pneumohitis 32 10 1 19 64 139 265 144 121 23. Other respiratory diseases . - - - 2 18 11 31 17 14 24. Unceration of the stomach or duodsnum - - - 5 30 12 47 44 3 25. Diarrhoea under 2 years of age 26 2 - - - - 30 16 14 26. Appsndigestive discases - 1 - 1 2 4 8 5 3 27. Other digestive discases 5 - 1 10 20 45 81 30 51 28. Nephritis - - - 8 23 32 63 30 33 29. Puerperal and poat-abortive - - - 3 - - 3 - 3 30. Other maternal causes - - • 7 - - 7 - 7 31. premature birth 36 - - - - - 36 20 16 32. Congenital melformation, birth injury, infantile discases 39 - 1 2 3 1 49 27 22 33. Suicide - - - 4 8 3 ??? 9 6 34. Road traffic accidents - - 3 6 5 6 20 13 7 35. Other violent causes 2 1 2 14 10 43 72 28 44 36. All other causes 7 8 6 32 35 128 216 114 102 2 SECTION B. GENERAL PROVISION OF HEALTH SERVICES THE AREA MATERNITY AND CHILD WELFARE SERVICES. WELFARE CENTRE. 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, 1945. Amount of Grant: North Islinton Infant Welfare Centre & School for Mothers, £3,861. 0. 0. 6-9, Manor Gardens, Holloway, N.7. South Islington Mothers ' & Babies' welfare Centre, £1,050. 0. 0. 15, ??? Road , ??? East Islington Mothers' &St Babies' Welfare Centre, £1,194. 15. 2d, 32, Drayton Park, N.5. West Islington Infant welfare Centre, £1,572. 0. 0. 42, Richmo nd??? SUMMERY: 1. Ante-natal Clinics: A ??? increase in the number of expectant mothers who attended the Ante-natal Clinics in shown for 1943 over the previous year, particularly at the South Centre, where more than 100% increase is recorded and at the North Centre, with an increase of approximately 30%. A considerable number of expectant mothers also attended the Ante-natal departments of the various hospitals in and adjacent to the Borough, in particular, St. Mary, Islinston, Royal Northern, University College, and Royal Free Hospitals. Ante-natal Clinics: Norths South. East. Wests Totals: Number held weekly00 4 1½ 2 1 8½ No. of expectant mot hers. who attended:- 913 470 240 278 1,901 2. Post-natal Clinics: Number held weakly 1 l½ 2 1 5½ No. of mothers who attended 194 36 142 29 401 *Combined Ante-natal and Post-natal Clinics. 3. onsultations for children up to5 years of age: The number of children under one year who first attended the Centres, shows a satisfactory increase over the previous year, hut is still only about two-thirds of the live births occurring during the year. Total number of children who first attended at the Centres during the year, and who, on the date of their first attendance, were- North: South: East: West: Total: (i) Under 1 year 1,001 505 410 493 2,414 (ii) 1-5 years 121 91 66 66 344 3 4. Hone Visiting: North: South: East West: Total: Number of visits mads to:- (i) Expectant mothers- (a) First visits 626 334 387 171 ??? (b) Total visits 3,328 574 l,057 4713 5,431 (ii) Children under 1 year - Total visits 3,807 3,285. 2,378 3,024 12,994 (iii) Children 1-5 years- Total visits 5,001 4,234 2,617 6,351 18,253 5. Number of Children who attended at the Centres during the your, and who, at the and of the year, were:- North: South: East: West Total: (i) Under 1 year - 855 498 342 507 2,202 (ii) 1 - 5 years - 1,647 879 670 843 4,039 MUNICIPAL VISITORS: A temporary Health Visitor was appointed to take the place of the permanent Health Visiter seconded to the Ministry of Health. is reported in last year's Annual Report, the Health Visitors were from times to time taken from their normal Health Visiting work, as urged by the Ministry of Health, in order to take part in a special campaign in connection with Diphtheria Immunisation of children under 5, and to assist at the Diphtheria Immunisation Clinics, Visiting continued to remain difficult during the whole of the year owing to the increasing number of women taking up war work. SUMMERY OF VISITS TOTALS: 1. Births, First Visits, Infants under 1 year 3,128 2. Births, Re-visits, Infants under 1 year 3,011 3. Visits to Children between 1st and 2nd years 2,533 4. Visits to Children between 2nd and 5th years 5,922 5. Visits re Stillbirths 76 6. Deaths, Visits re Infants under 1 year 39 7. Deaths, Visits re Children 1-5 years 6 8. Ante-natal Rome Visits 1,403 9. Puerperal Fever, Home Visits 8 Puerperal Pyrexia Home Visits 6 10. Attendances at Walfare Centres 215 11. Other work by direction (which includes Clinics and visits re Diphtheria lmmunisation) 3,831 12. Visits declined 25 13. Visits house shut 4,739 14. Visits Inopportune 46 Total visiters: 25,738 CHILD LIFE PROTECTION: Number of persons on register prepared to receive children at end of year 38 Number of children at and of year 46 v 4 HOME HELPS: In June 1943, the Council in order to make the Home Help Service mora easily available to mothers, some of whom were unable to afford payments on the existing scale, adopted a revised scale or assessments which approximately halved the contributions to be paid by mothers over the scale as a whole. It became increasingly difficult to obtain women prepared to undertake intermittent employment, as Homs., Helps as was evident from the fact that before the War there were 39 names on the one Home Panel, whereas by the middle of 1943 there wore only 12 such names a on the Pencl. In addition, the Ministry of Labour & National Service was taking all possible ataps to diminish stand-by employment such as is necessitated in connection with a Home Help Panel with periods of unemployment in between cases. The Council therefore adopted a scheme for the employment of three whole-time Home Helps whose services in between Home Help cases would bo utilised in domestic work in the Borough Council's War-time Day Nursaries. Although every effort was made to obtain three such whole-time Home Helps, it was only possible to make effective one such appointment during 1943. Although many difficulties were encountered in working; the Horn Help Scheme, 175 cases were attended during the year, the cost to the Council being £742. 3s. 7d. SUPPLY OF SUPPLEMENTARY QUANTITY AND TO YOUNG CHILDREN: Under the national Milk Scheme certain quantities of liquid or Dried Milk are supplied to all expectant mothers and children under 5, either at 2d pint for wet milk, or ½d a packs for Dried Milk, or free, according to the Ministry of Food Assessment Scale. Children up to the age of 12 months are also eligible for a supplementary quantity of wet or Dried Milk, and in respect of those cases where the first pint or packet is. assessed as free the Council havea reed to pay the coat of the supplementary quantity. During 1943, the total quantity of milk supplied in this was and paid for by the Council was:- No. of Recipients - 352 Pints of Milk 7,019 £125. 7s. 3d. do. do. Lbs. of Dried Milk 5,181¾ £241. 7s. 4d. SUPPLY OF VITAMIN PREPARATION FOR CHILDREN UNDER FIVE: The Voluntary Welfare Centres continued to act as Distributing Centres on behalf of the Minitary of Food in connection with Vitamin products in the form of Cod Liver Oil Compound and Orange Juice for Expectant Mothers and Children under Five. SUPPLEMENTARY COUPONS FOR EXPECTANT MOTHERS: Arrangements were made by the Board of Trade for the issue of Supplementary Coupons to Expectant Mothers, which had hitherto been undertaken by the Maternity & Child welfare authority, to be undertaken by the Ministry of Food after the 24th of July 1943, in order to enable mothers to obtain their extras ration bocks for food and clothing from the same office and at the same time of application, on the presentation of a single Medical Certificate. During the period January to 24th July 1943, 2,220 Expectant Mothers resident in the Borough of Islington ware issued with these supplementary coupons at the Maternity & Child Welfare Office. A letter was received from the Board of Trade conveying their thanks for the help and co-operation afforded by local Health Authorities and Welfare Centres in the difficult early stages of clothes rationing. MATERNITY HOSPITAL GRANTS: Contributions for Maternity cases admitted to beds at Maternity Hospitals at the rate of 10/- per case for a percentage of notified births were made as follows:- University College Hospital 156 Cases Royal Free Hospital 119 " 3 NURSING IN THE HOME: The following payments were made to the North London District Nursing Association during the year:- Visits - Maternity & Child Welfare £42. 6s. 0d. Public Health £9. 2s.0d. DAY NURSERIES: A further five War-time Day Nurseries were opened in the Borough, with the approval of the Ministry of Health, during 1943, making 13 in all as listed under, providing accomodation for 755 children. plans for the, 10 th War-time Day Nursery Were also submitted and approved, and building commenced in 1943. Placed: Scholefield Road, N.19 55 265, Camden Road, N.7 66 160, Hornsey fane , n. 6, 64 34, Huntingdon Street N.1 33 6, ??? Road N.??? 35 21, Packingtoo street N.l. 33 2l , plimsoll Road N.4 47 Pembroke Street N.1. 50 547, Liverpool Road, N.l.50 8 & 9, Canonbury Place, N.l. 76 Legard Road, N.5. 70 Windsor street,N1 68 Mitford Road,N.19 68 Total of 735 All the work in connection with the planning, opening and administration of the above war-time Nurseries censtitute a very considerable load borne by the staff of the Public Health Dapartment, particularly in view of the impossibility of obtaining a sufficiency of clerical staff. The detailed administration of the Day Nurseries is parried out by Dr. K.M. Hirst. Deputy Medical Officer of Health and in place of the Superintendent Matron, the Maternity & Child Welfare Committee appointed Miss K,G. Header as Supervisor of War-time Day Nurseries and miss E. Danvers, as Superintendent Teacher of War-time Day Nurseries. Miss Reader was, with the approval of the Ministry of Health, seconded temporarily to this duty from her permanent position as a Sanitary Inspector. The authorised staff for the above Nurseries is:- 13 Matrons 13 Deputy Matrens 13 Wardens 26 Nursery Nurses 83 Nursery Assistants or Probationers 44 Domestic Workers (Equivalent whole-time). A considerable degree of sickness among the nursery staff and frequent staff changes have made the position difficult at times, There is also to be recorded the occurrence at one Nursery of an outbreak of Sonne Dysentery. About 40 children end four members of the staff were afrected, but fortunately most of the cases were light in character with no serious consequences in any. The risk of such an occurrence is necessarily inherent wherever a number of young children and infants arc congregated together and the risk can only be rendered minimal by the greatest precautions being observed at all times by an adequate and well trained staff. 6 The Council's Grants to the Islington Veluntary Day nurseries, evacuated to the country were continued, and were as under:- Lower Hollo way Day Nursery £260 South Islington (Pro patria) D/N £600 DAILY GUARDIAN SERVICE: As reported in last year's Annual Report, the Borough Council, in co-opperation with the Ministry of Labour & National Service, provided, in addition to the War-time Day Nurseries, a Registered Daily Guardian survice. By the end of 1943, 132 women were approved, and registered Daily Guardians providing for the care in their own homes of 186 young children under the of 5 years. The Voluntary Welfare Centres continued to co-operate with the Borough Council in the working of this scheme which was explained briefly in last year's Annul Report. TRAINING OF STUDENT HEALTH VISITORS: on request of Royal College of Nursing 4 Students attended during the year 1948. North Centre, south Centre, West Centre and Counci1 Health Visitors co-operated. EMERGENCY UNIT & OBSTETRIC CONSULTANT SERVICE: This Service was called out three tinea during 1943. INVALID CHILDREN'S AID ASSOCIATION: A grant of £100 was made to the Invalid Children's Aid Association for their work, for Islington children under 5 years of age during the year 1945. OTHER PUBLIC HEALTH SERVICES BACTERIOLOGICAL EXAMINATION Total Positive Negative For Diphtheria Bacilli 895 52 843 Tubercle Bacilli 164 15 149 Typhosus Bacilli 2 - 2 PROVISION OF INSULIN: 18 Patients received assistance during the- year, the Cost to the Borough Council was £89. 8s. 9d. ISLINGTON CREMATORIUM: There were 66 Cremations during the year at the Council's Crematorium at East ??? 7 SECTION C. SANITARY CIRCUMSTANCES OF THE AREA. SUMMERY OF WORK DONE BY DISTRICT SANITARY INSPECTORS. During the year 30,579 inspections (include re-inspect ions), were carried out by the Sanitary Inspectors, made up as follows:- House to House inspections 1,695 Other premises inspected 3,776 Re-inspections, Calls made, etc. 25,277 Ice Cream Premises inspected - Dairies and milk Purveyors' premises- inspected - Inspections - Council's property 199 Stables inspected 29 Yards inspected 159 Urinals - attached to Public Houses inspected 114 Children& 1 Young persons Acts 23 Premises re Vermin 908 Premises re Rata and Mice 2,081 Premises (re water Certificates) inspected Rag and Bone dealers. - Smoke Observations 1 Scabies 2,160 Shops 157 36,579 Notices served - Intimation (Public Health (London) Act, 1936) 3,472 Notices served - ??? (Public Health (London) Act, 1936) 603 CLEANSING STATION Scabies Vermin Children under 5 years- 361 102 " of baths 1,709 — " of treatment — 110 L.C.C. children- 1,276 3,163 " of baths given 6,214 — Adults - Number treated 1,893 178 x " of baths given 5,258 - " of treatment — 198 x 37 of this number were given baths for body ??? SCABIES: Arising out of the very large number of cases of scabies dealt with or referred to the Council's Cleansing Station and the desirability of treatment for Scabies being given as far as practicable on family basis, the Public Health Committee approved the appointment of two Assistant Nurses to Assist in the work under the Scabies Order, both at the Cleansing Station and in domiciliary visiting. These appointments have help-ad considerably in dealing with the problem. Arrangements were -.1 so made for a Medical Officer to attend weekly at the Cleansing Station to deal with special cases referred by the Nursing staff the Station or where medical supervision was required on account of secondary septicinfection in addition to Scabies or lice infestation. Scabies became notifiable on the 1st August 1945, under the County of London Scabies Regulations. 8 DISINFRCTIONS: During the year 1,193 disinfections were carried out after cases of infections or other diseases. In addition, 205 rooms were disinfected for the presence of vermin. at the disinfecting station 85,285 articles of bedding , ete., were disinfected. DISINFESTATION HYDROGEN-CYANIDE ??? No. of times Large Camber used Furniture and effected of families rehoused including- there of loveless Persons 34 Private reason furniture and effects 2 No. of times Sma11 Chamber used. Miscellansous (matresses, divans, etc.) 11 TOTAL 47 Thanks are due to the Cleansing Department for their assistant in working the boiler plant at ??? Grove Depot. FACTORIES: ' ' * The number of inspections, re-inspections and calls, etc., was 6,275. 535 selects were found, and remedied in 436 instances. Number of notices served was 388.. RATS AND MICE (DESTRUCTION) ACT,1919. 661 complaints were received and 1,018 inspection carried out. 129 notices were served and 53 defective drains repaired. INFESTATION ORDER, 1943. In accordance with the directions issue d to local authorities under the above order,??? systematic first baiting of the sewers was carried out in December. For this work seven men were specially engaged as Rodent Operators, workings with the Sewer Inspectors. The result of this treatment was the calculated destruction of over 4,000 rats. SUMMERY OF PROSECTIONS DURING YEAR 1943. Statute Total Prosecutions Successful Dismissed Withdrawn Adjourned 'Sine die' Amount of Penalties Costs Received Public Health) London) Act, 1936 ) 26 17 - 5 4 10/- £43. 1. 0d. Food & Drugs Act, 1938 8 - 2 6 - - £23. 2. 0d. Factories Act, 1937 ) - - - - - - - L.C.C, Drainage Byelaws, 1934 1 - - - 1 - - 35 17 2 11 5 10/- £66.3.0d. 9 SECTION D. HOUSING: Work under the Rousing Act has been at, a standstill owing to war conditions, the resultant lack of labour and material is prohibiting any extensive- repairs being carried out. PREPAIR AND MAINTENANCE OF BULDING (Circular 2871): The number of houses inspected in connection with the above circular was 32; the inspections -were carried out in ??? with the War Damage Surveyors. SECTION E. INSPECTION AND SUPERVISION OF FOOD. MILK AND DAIRIES ORDER, 1926. Summery Register. Number on Reg.31.12.42. Additions to Reg. Removals from Reg. No. on Reg. 31.12.43. Dairies. 157 2 - 159 purveyors of Milk in sealed containers only. 342 2 9 335 Registered Purveyors of Milk dealing from registered premises outside the Borough 93 1 - 94 SUMMERY OF VISITS BY MILK & DAURIES INSPECTIOR: DAIRIES. Routine inspection 540 Inspections for registration of 4 544 MILK-SHOPS (MILK sold in sealed containers- only). Routine inspections 277 inspections for registration of 4 281 DAIRIES AND MILKSHOPS INSPECTED UNDER THE MILK (Special Designations ) 48 VEHICLES. INSPECTED 53 MISCELLANEOUS VISITS 72 998 During the year 11 notices intimating nuisances or defects were served, and 17, warning letters sent to Dairymen and Milk Purveyors, drawing-their attention to the contrayention of the Acts and Regulations relating to their businesses. 10 MILK (Special Designations) REGULATIONS 1936-1945 During the year 1043 the following applications were made for licences under the provisions of the above Regulations, to enable the persons to sell specially Designated Milk- Designation No. of applications made and granted. Tuberculin Tested (Dealer) 25 Tuberculin Tested (Supplementary) 4 Accredited (Dealer) - Accredited (Supplementary) - Pasteurised (Pasteuriser) 1 Pasteurised (Dealer) 64 Pasteurised (Supplementary) 6 100 UNDER GROUND BANKEHOUSES: No. of Premises 69 " " Routine Inspections 132 " " Intimation Notices served 18 PHARMACY & POISONS ACTS. . No. of visits made 497 FOOD & DRUGS ACT, 1938 No. of visits made for inspection of food 721 Visits made to shops etc. - During the year 195 visits were paid to various shops, stalls, etc. (For other visits see item see Inspector of Meat and Other Foods.) Total weight of food condemned wa:s- 18 tons 4 cwts. 1 qr. 21.lbs. ???. (See also item under Meat and Other. Foods). RAG FLOCK ACT, 1911, etc. During the year 7 visits were made to premises to ascertain if rag flock was being sold. No sales were being made or rag flock being used. MEAT AND OTHER FOOD: The Inspector of Meat and Other Foods (Mr. A.W.Haydock) reports that during the year six private slaughter houses fox the preparation, of butchers' meat held licences but one was permanently closed in October. Owing to the control of meat supplies by the Ministry of Food no slaughtering of animals was carried on at these premises. One slaughter house for the slaughter of horses for human consumption was licensed. This was visited 42 times and 508 horses were slaughtered during the year. Food destroyed or otherwise disposed of so as to prevent its use for human consumption totalled 9 tons, 16 cwts., 1 qr. 4 lbs. (See also item under Food & Drugs Act, 1938). VISITS MADE TO SHOPS ETC., BY THE INSPECTOR OF MEAT AND OTHER FOODS WERE FOLLOWS: During the year 754 visits were paid to various food shops, markets, stalls, etc, (See also item under Food & Drugs Act, 1938). DISEASES OF ANIMALS ACT -ANTHRAX ORDER, 1928: On no occasion during the Year was the above order, relating to animals, applied in the Borough. 11 OFFENSIVE TRADES: The offensive trades operating in the Borough are three tripe dressers, five gut scrapers and one knackers' yard. Ten visits were made during the year and no breach of the Regulations was observed. Three skin dressers are under the supervision of the Inspector of Workshops. BYE-LAWS FOR THE PROTECTION OF FOOD: Bye-laws for this purpose were made under Public Health (London) Act, 1936, and came in to force during 1937. No prosecution had been taken during the period under review. ??? LICENCES: One application for the renewal of a licence was received, and granted after investigation, making a total of 26 licensed slaughtermen on the register at the end of the year. FOOD & DRUGS ACT, 1938 (Sampling): 302 samples (54 formal, 240 informal) were submitted to the public analyst for examination. of these 3 were adulterated (or 0.99 per cent), as shown in the following summery:- Formal Informal Milk 1 Gelatine 1 Gelatine 1 SHOPS ACT, 1934: The visits made were 4,970. In addition, the Inspector made 6 visits for other reasons, e.g. rats and insufficient or unsuitable sanitary accommodation. SECTION F. PREVALENCE AND CONTROL OF INFECTIOUS AND OTHER DISEASES. TUBERCULOSIS: NEW CASES AND MORTALITY DURING 1943. NEW CASES. DEATHS. Age Periods Respiratory Non-Respirator Respiratory Non-Respirator M. F. M. F. M. F. M. F. 0- — — 3 — 1 _ 1 1- 8 4 6 2 2 - 2 1 5- 12 13 18 11 3 - 3 2 15- 50 80 6 19 18 2 1 25- 65 51 3 10 7 13 *6 - 35- 53 20 6 3 24 9 1 - 45- 37 23 7 3 21 7 - - 55- 33 5 1 3 22 7 - 1 55- and upwards 20 8 3 2 13 3 1 2 Total for All a os 278 204 56 40 112 57 13 7 578 189 There has been a further rise in the rate of new cases of non-respiratory tuberculosis. 12 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS 1930: The total number of cases of tuberculosis on the Register as at 51st December, 1943 was:- 1716 -(Pulmonary - Males 833, Females 615: Non-Pulmonary - Males 145, Females 122.) DISPENSARY REGISTERS: Pulmonary Non-Pulmonary Total GRAND TOTAL Adults. Children Adult Children Adults. Children. Number of definite cases of tuberculosis on Dispensary Registers at and of the year M. F. M. F. M. F. M. F. M. F. M. F. 618 441 53 40 60 67 36 46 678 508 89 806 1,361 WORK OF THE TUBERCULOSIS DISPENSARIES: North South Number of attendances 6,143 4,548 New cases and contacts examined 1,830 735 Number of visits by Tuberculosis Officers 220 120 Number of visits Nurses 1,054 1,654 LIGHT TREATMENT 9 Patients received "Light" treatment, the cost to the Council being £18. 19. 0d. TUBERCULOSIS CARE COMMITTEE: 320 new case's came to the notice of the Committee; 1,123 interviews were conducted, 419 visits were made and 2,372 letters, sent. A very acceptable gift of clothing from Queen Mary's Needlework Guild was received and the receipts from the christmas "Seal sale amounted to £252. 14. 5d. MAINTENANCE ALLOWANCE SCHEME: A schema for the payment of Maintenance allowances to Tuberculous patients came into operation in London on the 30th June, 1943. Payments are made in conjunction with the London County Council on the basis set out in Ministry of Health Memorandum 266/T. The administrative work of the scheme in the first Place was done by the Secretary of the Tuberculosis Care Committee, in addition to her other work, but it quickly became evident that the enquiries to be dealt with end other work arising necessitated an additional appointment. Miss G. Black was accordingly appointed as Maintenance Allowances Officer for the Borough Council. The following table summarises the cases dealt with during the six months period to the end of 1943:- Number of patients receiving weekly allowances on last week of this period 152 Number of applications brought before the L.C.C.Assessment Officer 292 Number of orders made by the Assessment Officer 247 Number of applicants ineligible on medical grounds (not having worked for years) 6 Number of applicants financially ineligible 39 292 Number of patients formerly receiving allowances who have returned to full-time work 91 Amount paid in allowances during period £4,996 13 ARTIFICIAL PNEUMOTHORAX: 112 patients received treatment at a total cost of £463. 11. 6d. EXTRA NOURISHMENT: The Council agreed, on the recommendation of the Public Health Committee, to accept applications for "extra ??? on the recommendation of the Tuberculosis Officers up to an income limit of 15-per bead after deduction of rent, etc., in place of the previous maximum of 12. 6d. 112 cases received extra nourishment at a total coat of £449. 7s. 1d. BEDS AND BEDDING: 14 patients were provided with bed and bedding on loan. DENTAL TRETMENT: The Council -greed, upon the recommendation of the Public Health Committee,that tuberculous patients recommended for Dental treatment at the Royal Northern Hospital coming within the Council's scheme would not be asked to contribute towards the Most of dentures where the assessed income per head was less than 15/-, in place of the previous maximum of 12/6d. 3 patients received treatment with assistance under the Council's scheme. NOTIFIABLE INFECTION DISEASES AND DEATH DURING THE YEAR 1943: DISEASES. No. of Notification No. of Deaths. Cases removed to hospital. Scarlet Fever 778 1 658 Diphtheria 188 9 187 Enteric Fever (including Paratyphoid) 3 - 3 Puerperal Fever 15 1 12 Puerperal Pyrexia 50 - 38 Acute Primary & Influenzal pneumonis. 171 11 30 Ophthalmia Neonatorum 26 - 9 Encephalitis Latjargica 1 1 1 Corebro-Spinal Fever 23 2 19 Anthrax - - - Dysentery 120 3 109 Malaria 1 - 1 Erysipelas 90 - 49 Measles 1936 2 365 Whooping cough 645 3 156 Acute Poliomyelitis 7 - 6 Acute Polioencephalitis - - - Scabies 333 - - A considerable rise occurred during 1943 in the notifications of acute primary and influenzal pneumonia ever the previous year, and also in the deaths due to influenza and pneumonia. The letter part of 1943 was notable for an influenza. epidemic which, fortunately, was of comparatively short-lived duration, and whose severity was loss than might have been expected. Arrangements were made to transmit urgent enquiries for domestic assistance in the home on account of Influenza, and upon the recommendation of the Doctor or from the North London District Nursing Association to the women's Voluntary Services. Fortunately, the number of requests made for such Assistance was not large and they were all met by volunteers from the W.V.S. Scabies became notifiable on 1st August 1543 and the arrangemente made for dealing with Scabies are sot out in section 'C' under Cleansing Station. 14 SMALLPOX AND VACCINATION: No case of Smallpox was notified. of the 5,469 birth returned on. the "Birth List Sheets" during 1942, 1813 were successfully vaccinated. In addition, 993 children, whose births occurs elsewhere,.were ??? in. the borough. DIPHTHERIA IMMUNISATION Arising out of the increase in the number of request for immunisation and the number of sessions which it become necessary to arrange, the Public Health Committee approved the appointment of a whole time temporary Medical officer whose principal duties should be, in ??? with Diphtheria Immunisation. Dr. Sybil D. Goodwill, was appointed and took up her duties on 8th March, 1945, The nursing staff and auxiliary personnel at First Aid Posts also volunteered for Diphtheria, Immunisation clinic work when not otherwise required and rendered very useful assistance. The Borough Council's health visitors and some of the Health Visitors of the Voluntary Welfare Centres temporarily suspended some of their normal Maternity Child Welfare activities in order to take part in a special Immunisation campaign on the lines requested by the Ministry of Health. By December 1943, it was estimated that 51% of children under the age of five years and 70% of children between the ages of five and 15 years had been immunised. There were 9 deaths from diphtheria in 1943. None of these oases had been immunised. The total attendances at all clinics during the year of 55,618 is a record figure and nearly 50% ??? that the total attendences for 1942, Which itself was the hi ghost number to be recorded up to that year. In all, 499 clinic were held, at which attendance totalled 33,618, giving an everage attendance per session of 67.37, The sessions were held as under:- North Islington Branch Library, Manor Gardens, N.7. 107 First Aid Post, Mildmay- ??? Hall, Newington Green, N.l. 49 First Aid pest, London Fever Hospital, Liverpool, n.1. 52 Community Hall, Blythe Mansions, Hillrise Road. (New clinic apend) 28 At London County Council Schools in Borough. 189 War-time Day Nurseries. 74 499 Number of children who received full ocurse of immunisations Under 5 years 3,531 over 5 years 2,790 6,321 Of the above,5,606 were Post-Schick-Tested and in 865 cases further injections were -necessary. In addition to the above, 739 children were Primary schick-Tested, with a negative result and did not therefore require immunisation. The total number of children seen at the clinics during the ,year who were either protected or found to be immune was 8,564 (including 440 children re-tested with a negative result.) 15