ISL 84 METROPOLITAN 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. 1945. Public Health Department, Town Hall, Upper Street, N.1. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Islington: I have the honour to submit the Annual Report on the Public Health of the Metropolitan Borough of Islington for the year ended 31st December 1945. It is again an interim report as have been previous Annual Reports since 1939. During the greater part of this year from April 1945, Dr .Katherine M. Hirst, Deputy Medical Officer of Health, was responsible for the work of the Department as Acting Medical Officer of Health during my absence with H.M. Forces. Dr,Hirst was assisted by Dr .Mabol Brodio, who left at the end of 1945 to return to Malay. The year 1945 was in many respects a good one from the Public Health angle. The infant mortality rate at 46 per thousand live births equalled the lowest recorded in 1943, and the death rate at 14.59 per thousand population was the lowest since 1939. There was only one death ascribed to maternity causes during the year giving a rats of 0.26 per thousand births which is by far the lowest recorded rate, but it would be unwise to expect a similar rate in the immediate future. The number of notified diphtheria cases have continued to diminish gradually and during the year there were three deaths from this disease in young children not immunised. The only epidemic which might be said to have occurred during the year was Measles, with almost a threefold increase in notifications over 1944. Generally speaking the cases were not severe and only two deaths were ascribed to measles. A special feature of the campaign against Diphtheria in 1945 was the Mobile Clinic referred to in the Report, which brought the Immunisation Clinic to the homo during the summer months. This venture proved very successful, and also succeeded in drawing the attention of the public generally to the immunisation campaign. Attention is particularly drawn to that section of the report dealing with Maternity and Child Welfare services in which is mentioned a major change which occurred during the year in the administration of these services, the Borough Council becoming directly responsible for the employment of all health visitors and the assumption by the Borough Council of direct responsibility for the South Islington Welfare Centre, hitherto a Voluntary Centre since its inception. In view of the ending of hostilities in 1945, the opportunity is taken hero to make a few very bri6f and incomplete references to the part played by the Civil Defence Casualty Services during the whole period of the war. The Public Health Department, through its permanent medical, clerical, sanitary inspector and health visitor staff, and with enrolled Civil Defence personnel, whole-time and part-time numbering close on 1,000 in the early part of the war, was given the responsibility for casualty services and supervision of shelter health. First Aid Posts, Mobile First Aid Units, Light Rescue Party Depots, and Shelter Medical Aid Posts were established. Close liaison was maintained with hospitals receiving casualties in the area. A whole-time temporary medical officer was appointed for first aid training of Civil Defence personnel and a staff officer administered the Light Rescue Service. Medical officers to the First Aid Posts, fixed and mobile, and for shelter health supervision were appointed from among medical practitioners in the Borough who volunteered. One Medical Officer in charge of a mobile unit was awarded the H.B.E. Qualified nurses were appointed to each First Aid Post and Shelter Post in addition to Civil Defence personnel. Many lives were saved by the Light and Heavy Rescue Party personnel in their skilful and patient extrication of trapped casualties, often working under arduous or dangerous conditions. There were 958 fatal casualties in Islington as a result of enemy action, and 2,090 seriously injured were removed to hospital. Close on 3,000 were more slightly injured. The most serious incident was in December 1944, when there were 69 killed and 114 removed to hospital. In spite of much damage to water mains and sewers at times, there was no recorded case of infectious disease due to contaminated water supplies, thanks to the effectiveness of the measures, by chlorination and otherwise, taken by the Metropolitan Water Board, There were also no major epidemics, in spite of overcrowding in shelters and elsewhere, although there was a consistent increase in Scabies during the war years. The legacy of damaged and destroyed houses will remain a problem for sometime to come and has vastly intensified the housing needs of the Borough which were already acute before the war. With the close of hostilities during the year, the casualty sections of the Civil Defence Services were wound up, and the personnel of the First Aid Posts and Light Rescue Parties were demobilised. Two members of the staff were released from H.M. Forces in the latter part of the year and two retired on superannuation. A considerable number of changes took place among the temporary members of the staff, and generally speaking, the deficiencies of clerical staff mentioned in previous reports continued during this year. I have pleasure in expressing thanks to Dr.Hirst and to all members of the staff, both permanent and temporary, who assisted willingly and co-operated loyally in a difficult transition year. I desire also to express appreciation to the Chairmen and members of the Public Health and Maternity and Child Welfare Committees for their consideration and understanding of matters brought before them both by myself and the Acting Medical Officer of Health . V. FREEMAN MEDICAL OFFICER OF HEALTH December, 1946. 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 1945. - 195,770. LIVE BIRTHS: Totals. M. F. Legitimate 3270 1642 1628 Illegitimate 438 228 210 Birth rate per 1,000 estimated resident population 18.94 3708 1870 1838 STILL BIRTH: Totals. M. F. Legitimate 76 42 34 Illegitimate 9 3 6 Rate per 1,000 total 40 (Live & Still) births. -22.41 85 45 DEATHS: Totals. M. F. 2856 1521 1335 Death rate (unadjusted) per 1,000 population. -14.59 DEATHS FROM PUERPERAL CAUSES: Deaths Rate per 1,000 total births. Puerperal Sepsis - - Other Puerperal causes 1 0.26 1 0.26 DEATH RATE OF INFANTS UNDER ONE YEAR OF AGE: All infants per 1,000 live births 46 Legitimate infants per 1,000 legitimate live births 45 Illegitimate infants per 1,000 illegitimate live births 59 NOTIFICATION OF BIRTHS; The total number of notified births, including still births from all sources., was 4,281, of this number 419 were not notified by midwives. MARRIAGES (Provisional figures). Marriages solemnised in the Borough during the year 2447 - 1 - COMPARATIVE VITAL STATISTICS. - 1935 to 1945. (Compiled from Registrar General's Returns). 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 Population: 195,770 188,560 189,970 186,000 183,470 224,110 272,300 292,300 295,400 301,000 304,100 Live Births (total): 3,708 3,826 3,592 3,368 2,986 3,850 4,168 4,487 4,516 4,650 4,523 " " (Illegitimate): 438 335 264 251 214 272 245 278 218 222 173 Birth rate per 1000 pop: 18.94 20.29 18.91 18.10 16.27 17.18 14.47 15.35 15.32 15.45 14.87 Still Birth Rate per 1000 births: 22.41 25.72 24.97 33.29 26.72 32.17 30.24 27.52 29.86 29.02 21.21 Deaths: 2856 3057 3017 2852 3508 4143 3485 3492 3865 3785 3434 Death rate: 14.59 16.21 15.88 15.33 19.12 18.48 12.79 11.94 13.08 12.57 11.28 Maternal Death Rate per 1000 births: 0.26 2.03 2.71 2.29 3.02 1.59 1.47 2.17 2.79 2.09 2.38 Death rate of infants under 1: 46 43 46 54 59 47 50 65 67 62 53 Marriage Rate per 1000 pop: 25.00 18.36 18.59 25.30 28. 07 32.92 23.89 19.57 20.22 19.49 19.80 T.B. Notifications per 1000 pop:(all forms) 2.81 3.14 3.04 2.30 3.00 2.10 1.94 2.13 2.38 2.12 2.20 Death rates per 1000 pop: Pulmonary T.B. 0.80 0.86 0.85 0.93 1.20 0.84 0.82 0.73 0.70 0.69 0.66 Diphtheria: 0.01 0.01. 0.05 0.01 0.06 0.09 0.04 0.08 0.07 0.10 0.04 Suicides: 0.06 0.10 0.08 0.14 0.14 0.17 0.15 0.14 0.16 0.16 0.14 Road Traffic Accidents: 0.07 0.16 0.10 0.16 0.14 0.14 X X X X X Other violent causes: 1.05 1.84 0.38 1.45 1.74 2.38 0.56 0.37 0.34 0.45 0.42 x Not given separately by R.G. - 2 - CAUSES OF HEATH. AGES. BOTH SEXES TOTALS Under I year I year and under 5 5 and under 15 15 and under 45 45 and under 65 65 and upwards. All Ages M F All causes 172 27 36 268 748 1605 2856 1521 1335 1. Typhoid & paratyphoid fevers. - - - - - — — — - 2. Cerebrospinal fever - - - — — 2 2 1 1 3. Scarlet Fever - — - - — - - - - 4. Whooping Cough 5 — - - - - 5 5 - 5. Diphtheria - 1 2 - - - 3 1 2 6. Tuberculosis of respixatery system. 1 1 1 85 52 17 157 107 50 7. Other forms of tubercolosis 2 2 2 9 2 3 20 12 8 8. Syphilitic disease. 1 - - 2 6 6 15 10 5 9. Influenza 1 - - - 4 5 10 8 2 10. Measles 1 1 - - - - 2 1 1 11. Acute poliomyelitis and policencephalitis - - - - — _ - - - 12. Acute infectious encephalitis - - - 1 - - 1 1 13. Cancer of buco cav & cesop; (M) - - - 1 5 16 22 22 — Cancer: utocus (F) - - - - 16 8 24 . 2? 14. Cancer of stomach & duodenum. - - - 4 31 48 83 46 37 15. Cancer of breasts - - - 3 20 21 44 - 44 l6. Cancer of all other sites - — 1 21 122 141 285 172 113 17. Diabetes - - - - 3 11 14 3 11 l8. Intra-cranial Vascular lesions - - - 1 52 155 208 87 121 19. Heart, Disease - - 1 27 132 554 714 342 372 20. Other diseases of the circulatory system - - - 2 23 74 99 58 41 21. Bronchitis 3 2 1 6 76 154 242 157 85 22. Pneumonia 25 2 1 10 36 104 178 99 79 23. Other respiratory diseases 1 - - 1 13 8 23 17 6 24. Ulceration of the stomach or duodenum - - - 4 18 19 41 30 11 25. Diarrhoea ( under 2 years of age) 28 - - — - - 28 12 16 26. Appendicitis - 1 - 3 4 1 9 5 4 27. Other digestive diseases 1 3 3 3 17 37 64 32 32 28. Nephritis - — - 7 16 22 45 24 21 29. Puerperal and post-abortive sepsis - - - - - - — - — 30. Other maternal causes - - - 1 - - 1 - 1 31. Premature birth 32 - - - — - 32 20 12 32. Congenital malformations, birth injury, infantile disease 52 1 2 1 2 2 66 37 29 33. Suicide - — - 4 4 3 11 6 5 34. Road Traffic accidents - 1 1 2 4 6 14 13 1 35. Other violent causes 14 10 19 44 49 70 206 98 108 36. All other causes 5 2 2 20 41 118 188 101 87 3 SECTION B. General Provision of Health Services for the Area. METERNITY & CHILD WELFARE SERVICES. HEALTH VISITOR SERVICE: The year 1945 was notable for the formation of a single Health Visitor Service for the whole Borough. This may be regarded as the most important change in the organisation of the Health Visitors which has occurred since Maternity and Child Welfare Services were first set up in this Borough during the 1914-1918 War. Prior to 1945, each of the four Voluntary Welfare Centres had employed its own staff of qualified Health Visiters in addition to those employed directly by the Borough Council to visit those mothers and children not attending Welfare Centres. Although there was co-operation between these five separate groups of Health Visitors, there was, nevertheless much overlapping of work and a consequent wastage of trained personnel. For such reasons and also because the adoption of the Rushcliffe Scale of Salaries resulted for the first time in placing all Health Visitors in this Borough, both voluntary and municipal, on an equal basis in respect of salaries, the Council finally approved recommendations embodied in reports of the Medical Officer of Health, recommending a single body of Health Visitors for all Maternity and Child Welfare work in the Borough. The Committees of the four Voluntary Welfare Centres agreed to the proposed changes in the interests of the mothers and children, and at the beginning of May, all Health Visitors including the Superintendents of the Voluntary Centres became directly employed by the Borough Council. From this date all Visitors, including the Council's former Visitors, became attached to one or other of the Welfare Centres with the exception of a Special Health Visitor for illegitimate children and the Child Protection Visitor who had their central office at the Town Hall. This re-organisation with the consequent work necessary to bring records, etc,, into line one with another, meant a great deal of work both with the Welfare Centre staff and the central office, and for the first few weeks, the actual visiting work was in consequence unavoidably held up. WELFARE CENTRES: South Islington Welfare Centre-: Another major change from the original Maternity and Child Welfare Scheme set up during the first world War also took place during 1945. Mrs. Waley Joseph, Honorary Joint Secretary of the South Islington Welfare Centre for so many years, died at the beginning of the year. She had made the care of mothers and children in South Islington a very large part of her life and her loss was deeply felt by all. Following her death, the Voluntary Committee of the South Centre requested the Council to take on their work for mothers and children in this part of the Borough so that from April 1st 1945 the South Islington Welfare Centre, which had previously been grant-aided, became the sole responsibility of the Borough Council. During the latter part of the year it became necessary to vacate the Popham Road premises owing to war damage repairs being commenced. The Centre activities were, therefore, removed to Tibberton Square where the disused First Aid Post was converted into the main premises of the Centre. Miss Batty, who had been Superintendent of the South Centre working for the Voluntary Committee for many years, resigned from her appointment, and Miss Paley, a permanent Health Visitor of the Borough Council, was appointed to the post of Superintendent of the Centre in April 1945. 4 Ante-natal Clinics: The number of expectant mothers who attended the ante-natal clinics again shows a slight increase over the previous years:- North: South: East: West: Total: Number hold weekly: 5 2 2 2 11 Number of expectant mothers who attended 1141 499 457 421 2518 Post-natal Clinics: Number held weekly: 1 2 2 1 6 Number attending 196 33 73 24 326 These post-natal clinics are combined with the ante-natal clinics, and are also included in the weekly number of ante-natal clinics shown above. Centre Attendances: There has been a definite increase in the number of children attending; the Welfare Centres during the year. Since the average proportion of children under the age of 12 months attending the Welfare Centres during the past few years up to 1944 represents approximately 60% of the births in one year, it is satisfactory to note that for 1945 this proportion increased to 70%. It is not possible to say with certainty that this is the result of the change in the Health Visitors organisation, but since 70% represents the highest proportion of attendances ever attained for the under 1's, it seems reasonable to suppose that a large part, if not all, of this increase is due to the change over as was, to some extent, anticipated. 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 1073 630 475 626 2804 (ii) 1 - 5 years 135 90 55 82 362 Number of children who attended at the Centres; during the year, and who, at the end of the year, were:- North: South: East: West: Total: (i) Under 1 year 886 649 371 500 2406 (ii) 1 — 5 years 1687 888. 891 883 4349 Voluntary Welfare Centre Grants: The four Voluntary Welfare Centres in the Borough each received a grant from the Borough Council for the year ending March 31st 1945 as under:— Amount of grant: North Islington Infant Welfare Centre & School for Mothers, 6 -9, Manor Gardens, Holloway, N.7. £ 5, 942 South Islington Mothers' & Babies Welfare Centre, Tibberton Square, N.I. £ 3, 066 (Transferred to Islington Borough Council 1st April 1945) - 5 - Amount off grant: East Islington Mothers' & Babies' Welfare Centre, 32, Drayton Park, N.5, £ 2,345 West Islington Infant Welfare Centre 42, Richmond Avenue, N.I, £ 2,127 Home Visiting: It is not possible to give such a detailed analysis of Home Visiting during 1945 as in previous years, owing to the different methods of analyses of visists dona employed for the Council's Visitors and the Visitors of each of the four Voluntary Welfare Centres. Comparative figures will not, therefore, be available for 1945, but the following abbreviated statement is set out:- To expectant mothers - First visits 2,261 Total visits 4,838 To children under 1 year - First visits 3,488 Total visits l6,777 To children between 1 and 5 years - Total visits 28,809 Child Life Protection: Number of' persons on register prepared to receive children at end of 1945 27 Number of children being cared for at end of year 38 STUDENT HEALTH VISITORS: At the request, of the Royal College of Nursing two students attended during 1945 in this borough as part of their practical training in home visiting and in welfara centre clinic duties PREMATURE BABIES: In accordance with Ministry of Health Circular No. 20/44, special records were kept regarding premature births, from which the following figures are taken (i) Total number of prematura births notified during 1945 which occurred:- (a) at home 59 (plus 4 still - births); (b) in hospital 175 (plus 18 still-births): (ii) Number of babies born at home:— (a) who were nursed entirely at home 50 (b) who died during 1st 24 hours 6 (c) who survived at end of one month 51 (iii) Number of babies bom in hospital:- (a) who died during first 24 hours 28 (b) who survived at end of 1st month 125 (5 cases could not be traced at end of month.) 6 Special equipment was purchased by the Borough Council for loan to those homes where a premature infant was born and where inadequate facilities were available for nursing the infant at home, during the first few weeks and where removal to hospital was not recommended. This equipment was not used during 1945. ILLEGITIMATE CHILDREN: The Special Visitor allocated for this work in accordance with Ministry of Health Circular 2866(Revised) and referred to in last year's annual report, continued to do excellent work in assisting and advising unmarried mothers in difficulties in co-operation with Moral Welfare Works, Hospital Almoners, etc. Enquiries, visits, and follow-up work in respect of 232 children was carried out by the Special Health Visitor during the year. HOME HELPS: During 1945 175 cases were attended by Home Helps under the Borough Council's Scheme, at a total cost to the Borough of £1070. 19s.10d. At the end of 1945 there were 2 continuously employed whole-time Home Helps and 6 women on a panel for intermittent work. In March 1945, in accordance with Ministry of Health Circular 179/44, the Borough Council started a subsidiary scheme of Domestic Helps for assistance in households where there are aged and infirm people and where no other form of household help could be obtained. Under this scheme the borough employed 1 whole-time continuously engaged Domestic Help, and also tried to build up a panel of women. The two schemes, Home Help and Domestic Help, although kept separately so far as accounts are concerned, were run concurrently and in this way it was possible to assist 17 Domestic Help cases at a cost of £163.1s.3d, reclaimable from the Ministry of Health. EMERGENCY OBSTETRIC UNIT: This service was called out four times, during 1945. In each case the patient made a good recovery. PRIORITY DOCKETS FOR SHEETS FOR expectant MOTHERS: The Maternity & Child Welfare Office, at the request of the Ministry of Health on behalf of the Board of Trade, continued to issue dockets on a certificate from a certified Midwife to enable expectant mothers being confined at home to obtain priority in the purchase of utility sheets from retailers. During 1945 1 ,944 dockets were issued to 745 mothers. ADDITIONAL MATERNITY BED SCHEME: This scheme initiated in 1944 by the London County Council in co-operation with the Metropolitan Boroughs was continued during 1945. The Islington Borough Council under this Scheme, was allocated 4 beds per month ( total of 8 cases) at the Royal Northern Hospital and 6 beds per month(total of 12 cases) at the Mothers' Hospital, Clapton, the booking of these beds being arranged through the Medical Officer of Health. During 1945, 79 bookings had been arranged at the Royal Northern Hospital and 58 bookings at the Mothers' Hospital. - 7 - MATERNITY HOSPITAL GRANTS: Contributions for Maternity cases admitted to beds at Maternity Hospitals at the rate of 10/- per ease for a percentage of notified births were made as follows:- University College Hospital 176 cases. Royal Free Hospital 146 cases. SUPPLY OF SUPPLEMENTARY QUANTITIES OF MILK TO MOTHERS AND YOUNG CHILDREN: This scheme has already been described in previous Annual Reports and during 1945 the total quantity of milk supplied under the Scheme and paid for by the Council was:- No. of Recipients -124 Pints of Milk 3,318 Lbs. of Dried Milk 2,03¼ Total cost to Council- £151.17s.11d. SUPPLY OF VITAMIN PREPARATIONS FOR EXPECTANT MOTHERS AND CHILDREN UNDER 5: The Voluntary and the South Islington Welfare Centres continued to act as Distributing, Centres on behalf of the Ministry 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. PROVISION OF DENTURES FOR EXPECTANT AND NURSING MOTHERS: This Scheme initiated in 1944 provides for assisting expectant and nursing mothers to obtain dentures supplied through either the North or the South Islington Welfare Centre or Eastman's Dental Clinic. The number of mothers assisted under the Scheme during 1945 was 31 at a total cost to the Borough Council of £79.15s.4½d. INVALID CHILDREN'S AID ASSOCIATION: A grant of £150 was paid to the Invalid Children's Aid Association for their work for Islington children under five years of age during 1945. NURSING IN THE HOLE: A grant of £200 was paid during 1945 to the North London District Nursing Association in respect of the nursing of Islington children under five years of age in the home. The Borough Council also contributes at the rate of 2/- per visit to necessitous cases of maternity complications for which the services of a District Nurse are called in and in respect of the nursing in the home of Public Health cases. During 1945 £19.10s. was paid to the North London District Nursing Association in respect of these two types of cases. DAILY GUARDIAN SERVICE: The Daily Guardian Service continued to provide for the care of a number of children of mothers in work for whom accommodation could not be found in the Day Nurseries. At the end of the year 63 Daily Guardians were on the register of women approved for this Service and were caring for 72 children. VOLUNTARY DAY NURSERIES: The Council's grant to the Islington Voluntary Day Nursery evacuated to the country was as under:- Lower Holloway Day Nursery £260. 8 WAR-TIME DAY NURSERIES: The Borough Council's twelve War-time Day Nurseries continued to operate throughout 1945 providing accommodation for 711 children between the ages of a few months and 5 years, as set out hereunder:- Places: Scholefield Road, N.19 265, Camden Road, N.7 66 160, Hornsey Lane, N.6 48 34, Huntingdon St. N.1 33 6, Clephane Road, N.1 60 21, Plimsoll Road, N.4 47 Pembroke Street, N.I 50 8 & 9, Canonbury Place 76 Legard Road, N.5 70 Windsor Street, N.I 68 Mitford Road, N.19 68 Tufnell Park Road, N 70 Total: 711 Premises for a War-time Day Nursery were prepared at Highgate Hill, N.19. and during November 1945 it became necessary to transfer the Nursery at Tufnell Park Road to the premises at Highgate Hill, as the London County Council required the site to commence building thereon. The accommodation provided at Highgate Hill was for 50 children instead of 70 as at Tufnell Park. Also, during the early part of 1945 the accommodation at the Hornsey Lane Day Nursery was reduced from 64 to 48 places for children between the ages of 2 to 5 years. OTHER PUBLIC. HEALTH SERVICES. BACTERIOLOGICAL EXAMINATIONS: Total Positive Negative For Diphtheria Bacilli 627 23 604 Tubercle Bacilli 124 17 107 Typhosus Bacilli 3 - 3 PROVISION OF INSULIN: 21 Patients received assistance during the year, the cost to the Borough Council was £ 77. 1s. 1d. ISLINGTON CREMATORIUM: There were 68 Cremations during the year at the Council's Crematorium at East Finchley. 9 SECTION C. SANITARY CIRCUMSTANCES OF THE AREA. SUMMARY OF WORK DONE BY DISTRICT SANITARY INSPECTORS. During the year 32,352 inspections ( including re-inspections), were carried out by the District Sanitary Inspectors, made up as follows:- House to House inspections 1434 Other premises inspected 6192 re-inspections, Calls made etc. 24726 32352 Special matters dealt with when making the above visits:- Council's property 44 Stables 34 Yards 437 Urinals attached to public Houses 86 Premises for Poster children 23 Premises re vermin 891 Premises re Rats and Mice 1471 Premises re Water Certificates 71 Smoke Observations 7 Certificates of Essentiality 113 Shops 105 Non-effective visits 2789 Notices served - Intimation ( Public Health (London) Act, 1936) 4232 Notices served - Statutory ( public Health (London) Act, 1936) 550 SCABIES AND VERMIN: Treatment. Treatment for scabies and vermin was carried out at the Public Health Department, Seven Sisters Road ( Cleansing Station), as under:- øScabies Vermin Children under 5 years - Number treated 404 141 " of baths given 885 - " of treatments - 144 L.C.C. Children - Number treated 876 2127 " of baths given 4054 - Adults - Number treated 1702 424 " of baths given 3321 - " of treatments - 458 193 Contacts were given baths. Scabies Clinic. Dr. Marre is the Medical Officer in attendance. Number of clinics held 50 " of cases attended 667 Diagnosis of cases Scabies 201 Other conditions 466 667 10 Home visiting. Follow-up home visiting for cases of scabies and vermin was carried out by the Home Visitors of the Cleansing Station as under:- Families visited Re-visits Ineffective visits Treated at home Total Soabiea 2426 713 1377 - 4516 Vermin 1929 264 930 126 3249 LONDON (MEASLES & WHOOPING COUGH) REGULATIONS 1938: Home visiting of measles and whooping cough cases, of patients under 5 years, was carried out by the Home Visitors, as under (commencing 1st April 1945). No, of Investigations. Measles. Whooping Cough No. of Ineffective visits. 348 119 29 DISINFECTION AND DISINFESTATION: During the year 637 disinfections were carried out after cases of infectious, or other diseases. In addition 643 rooms and 2 shelters were disinfested for vermin. At the disinfecting station 104,204 articles of bedding, etc., were treated for infection or infestation (66,330 of these being for Clothing Contractors). HYDROGEN-CYANIDE FUMIGATION: No. of times Large Chamber used. Furniture and effects of families rehoused including those of Homeless Persons 89 Work for other Councils ( Shoreditch 1, Finsbury 1, St. Pancras 3.) 5 Private persons - furniture and effects 3 No. of times Small Chamber used. Miscellaneous (mattresses, divans, etc.) 11 TOTAL 108 Thanks are due to the Cleansing Department for their assistance in working the boiler plant at Ashburton Grove Depot. - 11 - FACTORIES ACT 1937: The number of inspections, re-inspections and calls, etc. was 4310. 693 defects were found, and remedied in 329 instances. Number of notices served was 256. Staff vacancies again hindered complete inspections being carried out during the year for the borough. Sanitary inspections arising out of applications for licences for opening of cafes increased considerably, and work under the Act which had previously been carried out by two women inspectors, had been done by one only since the retirement of Miss Daniell in duly 1944. Fortunately in November, 1945. it was found possible to return Miss Reader to her Sanitary Inspector's duties from her secondment as Day Nursery Superintendent. There was also a vacancy for a male Inspector under the Factories Act which it was not possible to fill till November 1945. rats and mice (destruction) act, 1919: 473 complaints were received and 735 inspections carried out. 22 notices were served and 29 defective drains repaired. INFESTATION ORDER. 1943: Sewer Treatment. In consequence of the difficulty of obtaining the necessary sewer men, it was not found possible to carry out systematic sewer treatment during the years In this connection, it may be mentioned that towards the end of the year, the Ministry of Food made available the services of 10 Italian Prisoners of War to act as sewer men and with the approval of the Committee, these men commenced work on sewer disinfestation. After a few days work, however, it was reported to the Ministry of Food that the attitude of the general public was hostile to the continued employment of those persons and they were, therefore, withdrawn. Surface Baiting: Three Rodent Operators were employed during the year and 1425 premises were baited, including 1045 houses, 229 shops, 62 shelters and 49 factories. The Ministry of Food agreed to the waiver of charges against small occupiers whose premises were contained under a block control scheme, but the Council were required to fix a scale of charges for business and industrial premises disinfested under the blook control scheme. The following scale was adopted:- (a) A service charge of 10/- in respect of each premises regardless of the amount of work done. (b) A charge of 2/- per baiting point for each of the first six baiting points (which will each be baited on five successive days). (c) A charge of a 1/- per baiting point; from 6 up to 24. (d) A charge of 6d. per baiting point subsequently. - 12 SUMMARY OF TOTAL PROSECUTIONS DURING YEAR, 1945. Statute: Total Prosecutions Success ful. Unable to be served Dismissed Withdrawn. Adjourned "Sinedie". Amt. of Penalties. Costs. Public Health (London) Act 1936. 6 5 - 1 - - - £7.7.0. Food & Drugs Act, 1938. 6 2 - 4 - — £18.0.0. £7.5.0. Factories Act 1937. 2 1 - 1 - - £ 3.0.0. - Milk & Dairies Order, 1926. 1 - - 1 - - - - Scabies Order 1941. 1 - 1 - - - - - Labelling of Food Order, 1944. 1 1 - - - - £ 1.0.0. £1.0.0. Food Standards Order 1944. 2 1 - 1 - - £ 2.0.0. £3.2.0. 19 10 1 8 - - £24.0.0. £18.14.0. WATER SUPPLIES: With the exception of a few wells in the Borough, the Metropolitan Water Board is responsible for all other supplies. 8 deep wells are in use for industrial purposes and 2 for one of the Council's swimming pools. Bacteriological and chemical sampling was carried out and in each case was satisfactory. SECTIOND. HOUSING: Work under Section 9 of the Housing Act has again been at a standstill, as a consequence of the lack of labour and materials prohibiting any extensive repairs being carried out. Repair and Maintenance of Buildings (Circular 2871) (Certificates of Essentiality). The number of houses inspected in connection with the above Circular was 293, the majority of visits being carried out in conjunction with the War Damage Surveyors. Requisitioned Properties. Supervision has been maintained of repairs or reconstruction of drainage and sanitary fitments in properties which have been requisitioned by the Council with a view to ensuring compliance with the Bye-Laws where practicable. 13 SECTION E. INSPECTION AND SUPERVISION OF FOOD. MILK AND DAIRIES ORDER, 1926: Summary of Register. Number on Reg. 31.12.44 Additions to Reg. Removals from Reg. No. om Reg. 31.12.45. Dairies 159 - - 159 Purveyors of Milk in sealed containers only. 337 6 343 Registered purveyors of Milk dealing from registered premises outside the Borough. 94 4 - 98 SUMMARY OF VISITS BY MILK AND DAIRIES INSPECTORS: DAIRIES. Routine inspections 823 Inspections for registration of 4 827 MILK-SHOPS (Milk sold in sealed containers only). Routine inspections 106 Inspections for registration of - 106 VEHICLES INSPECTED: 52 MISCELLANEOUS VISITS: 490 1475 During the year 6 notices intimating nuisances or defects were served, and 22 warning letters sent to Dairyman and Milk Purveyors, drawing their attention to the contravention of the Acts and Regulations relating to their businesses. ICE-CREAM: Visits to premises 234 REGISTERED ARTIFICIAL CREAM PREMISES: (at present, dealing in Synthetic Cream) Visits 5 MILK (Special Designations) REGULATIONS 1936 - 1946: (a) Number of Dairies and Milk-Shops inspected. 47 (b) The following Licences were granted:- Designation. Tuberculin Tested (Dealer) 28 Tuberculin Tested (Supplementary) 6 Accredited (Dealer) - Accredited (Supplementary) - Pasteurised (Pasteuriser) 1 Pasteurised (Dealer) 67 pasteurised (Supplementary) 8 110 14 HEAT TREATED MILK ORDER 1944: 39 samples of milk were taken under the Heat Treated Milk (Prescribed Tests) Order 1944 made under Defence Regulation 55 G, and were submitted to the appropriate tests. The results of the tests were forwarded to the Ministry of Food Milk Division each month. underground bakehouses: No. of Premises 44 " " Routine Inspections 28 " " Intimation Notices served 7 pharmacy & POISONS ACTS: No. of visits made 417 FOOD & DRUGS ACT. 1938. No, of visits made for inspection of food 933 Visits made to shops etc. - During the year 1561 visits were paid to various shops, stalls, etc. (For other visits see item re- Inspector of Meat and Other foods). Total weight of food condemned including meat was 70 tons 11 cwts 2 qrs. 15 lbs. MEAT AND OTHER FOODS: Five private slaughterhouses continued to be licensed, but owing to the control of meat supplies by the Ministry of Food no slaughtering of animals was carried out in these slaughterhouses. 730 inspections were carried out at the Caledonian Market (a Ministry of Food Depot), for the purpose of inspecting imported and other meat. One slaughterhouse for horses was licensed. The bulk of the meat. is exported. Slaughtermen's Licences:- 16 Licences are current. No further applications were made during: the year. Visits and Inspections:- During the year 869 visits were paid to various food shops, markets, stalls, etc. Bye-Laws for the Protection of Food:- Bye -Laws for this purpose were made under the Public Health ( London) Act, 1936, and came into force during 1937. No prosecution) has been taken during the period under review. DISEASES OF ANIMALS ACT.- During the year an outbreak of Foot and Mouth Disease in the proximity of London brought this borough within the infected area. - 15 - OFFENSIVE TRADES: The offensive trades operating in the Borough are three tripe dressers, five gut scrapers and one knackers' yard. Thirteen visits were made during the year and no breach of the Regulations was observed. Two skin dressers were under the supervision of the Sanitary Inspector carrying out duties under the Factories Act, 1937. FOOD & DRUGS ACT, 1938 (Sampling): 1072 samples (463 formal, 609 informal) were submitted to the Public Analyst for examination. Of these 22 were adulterated (or 2.05 per cent), as shown in the following summary:- Formal Milk 7 Baking Powder 1 Baking & Golden Raising Powders 1 Sausages 1 Vinegar2 Fruit squashes, cordials etc. (Lime juice) 1 Sultanas 1 14 Informal Milk 1 Baking Powder 1 Soft drinks & Squashes. (Orange Crush) 1 Mustard 1 Sausages 1 Sultanas 1 Dates 1 Infusion of tea with milk and sugar 1 8 Résumé of Food Decontamination Organisation:- This Organisation was disbanded with the Civil Defence Services in 1945, but it may be worth recording a note on the work done by the staff of the Department, although it was, of course, never called into act ion. The service was recruited pursuant to Ministry of Food Circular 4 in March 1941 and was designed to deal with gas contaminated food stocks salvaged from shops, etc., within the area of a poison gas attack. Mr. Bartlett, Senior Special Inspector and Mr. A.W. Haydock (Meat and Food Inspector) were made responsible. It was recruited largely from personnel engaged in food trades in the Borough and was officered by 8 male and 2 women Sanitary Inspectors. The total establishment for Islington was 188 part-time unpaid volunteers of both sexes. Two decontamination depots were established for men and women respectively and a food decontamination centre was set up in an L.C.C. School. Lectures were given by the Sanitary Inspectors as food decontamination officers, combined with practical exercises. The food decontamination organisation was linked with the general decontamination services. Thanks are due to all those who volunteered, although fortunately the measures taken proved to be only precautionary. SHOPS ACT, 1934: Inspections. 101 Re-vis its. 3023 A further 399 inspections were made of war damaged retail premises. 16 RAG FLOCK ACT, 1911, etc: During the year 6 visits were made to premises to ascertain if rag flock was being sold. No sales were being made or rag flock being used. SECTION F. PREVALENCE AND CONTROL OF INFECTIOUS AND OTHER DISEASES. TUBERCULOSIS: NEW CASES AND MORTALITY DURING 1945: Age Periods NEW CASES. D E A T H S. Respiratory Non-Respiratory Respiratory Non-Respiratory M. F. M. F. M. F. M. F. 0- 2 1 1 1 1 - 1 1 1- 11 6 6 3 — — 2 1 5- 5 10 6 7 1 — 1 1 15- 23 40 11 9 9 17 2 2 25- 90 101 9 4 16 10 - - 35- 43 31 1 2 25 11 1 2 45- 40 10 2 2 26 6 1 1 55- 31 13 - - 21 2 - - 65 and upwards 20 8 1 - 13 4 1 - Total for All ages. 265 220 37 28 112 50 9 8 550 179 There has been a further decrease in the rate of new cases of non-respiratory tuberculosis, but this is still substantially above the pre-war rates. Rate per 1,000 population: new cases - pulmonary 2.47, non-pulmonary 0.33: deaths - pulmonary £.83, non-pulmonary 0.09. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS 1930: The total number of cases of tuberculosis on the Register as at 31st December 1945 was:— 2.052 (Pulmonary - Males 981, Females 780: Non-Pulmonary - Males 155, Females 136). 17 DISPENSARY REGISTERS: Pulmonary Non-Pulmonary TOTAL GRAND TOTAL Adults. Children. Adults. Children. Adults.Children. Number of definite cases of tuberculosis on Dispensary Registers. at end of the year. M. F. M. F. M. F. M. F. M. F. M. F. 716 568 81 70 63 83 52 54 779 651 133 124 1,687 WORK OF THE TUBERCULOSIS DISPENSARIES: North South Number of attendances. 7357 4372 New cases and contacts examined 1443 505 Number of visits by Tuberculosis Officers 212 141 Number of visits by Nurses 980 1472 LIGHT TREATMENT: 15 Patients received" Light" treatment, the cost to the Council being - £36.4.0. MASS RADIOLOGY; As mentioned in last year's Annual Report, arrangements were continued into this year for the examination at a Mass Radiology Unit of persons residing or working in the Borough with a view to the early detection of pulmonary tuberculosis in its symptomless stages. The Unit was temporarily established by the London County Council in premises in an adjoining borough ( Hackney), and advantage was taken of the facilities afforded by ten firms who sent their workers to the Unit. The following analysis has been received from the London County Council regarding those visiting the unit which was only available during the first few months of the year:- Total examined. Referred for larger films. probably T. B. Men Women Total Men Women Total Men Women Total 280 194 412 6 18 1 2 3 TUBERCULOSIS CARE COMMITTEE: 74 patients have been helped with cash or in kind, and loans of bedding or medical appliances wore made to another 19 patients; others have been referred to organisations for assistance. Receipts from the Christmas "Seal Sale" amount to £276.0.6. maintenance allowances scheme: Number of patients receiving weekly allowance in last week of year 1945. 142 Number of applications brought before Assessment Officer 1804 Number of new cases 169 Number of renewals on existing orders 892 Number of orders adjusted, etc. 528 Number of patients returning to full time work 88 Number of deaths 30 Other "Cease payments 97 1804 Amount paid out in allowances during the year £11,368.0.10. - 18 - CMW/MAB. ??? Metropolitan Borough of Islington PUBLIC HEALTH DEPARTMENT Telephone : CANonbury 3388 all communications to be addressed to the MEDICAL OFFICER OF HEALTH V. Freeman. M. R. C.S. L.R.C.P.. D.P.H. Medical Officer of Health TOWN HALL, UPPER STREET, 5.2.47 N.I YOUR REF. OUR REF. ADM/8/A. Dear Sir, I enclose, herewith, a copy of my Annual (Abridged) Report on the Health and Sanitary Conditions of the Borough of Islington for the year 1945. Medical Officer of Health. The Chief Medical Officer, Ministry of Health, Whitehall, S.W.1. Enc/. Yours faithfully, ARTIFICIAL PNEUMOTHORAX: 131 patients received treatment at a total cost of £648.18.0. EXTRA NOURISHMENT: 82 cases received extra nourishment at a total cost of £433.1.5. BEDS AND BEDDING: 12 patients were provided with bed and bedding on loan. DENTAL TREATMENT: 9 patients received treatment with assistance under the Council's scheme. NOTIFIABLE INFECTIOUS DISEASES AND DEATHS DURING THE YEAR 1945: DISEASES No. of Notifications. No. of Deaths Cases removed to hospital Scarlet Fever 366 (314) - 209 Diphtheria 86 (94) 3 86 Enteric Fever (including Paratyphoid) - (3) - - Puerperal Fever 12 (19) - 11 Puerperal Pyrexia 41 (32) - 36 Acute Primary & Influenzal Pneumonia 65 (123) 4 4 Ophthalmia Neonatorum 24 (24) — 18 Encephalitis Lethargica - (-) 1 - Cerebro- Spinal Fever 11 (15) 2 10 Anthrax - (-) - - Dysentery 86 (172) - 71 Malaria 12 (7) - 7 Erysipelas 69 (81) - 23 Measles 1771 (627) 2 185 Whooping Cough 211 (806) 3 57 Acute Poliomyelitis 9 (-) - 9 Acute Polioencephalitis (-) - — Scabies 981 (1391) - - (Figures in brackets are notifications for 1944). SMALLPOX. AND VACCINATION: No case of smallpox was notified. Of the 4,155 births; returned on the "Birth List Sheets" during 1944, 1989 were successfully vaccinated. In addition, 1202 children, whose births occurred elsewhere, were vaccinated in the Borough. TYPHUS FEVER-IMMUNISATION: Owing to military operations during this year having increased the possible accidental introduction of the disease, immunisation against typhus was offered to and accepted by those members of the Public Health Staff who might have had to deal with the contacts of such cases if they had occurred. Immunisation was done at the London Hospital. MEASLES PREVENTION AND MODIFICATION: In the early part of 1945 & small supply of blood plasma concentrate containing Gamma Globulin antibodies became available through the courtesy of Dr. N. Bogg, Medical Superintendent of the Eastern Hospital. Supplies of this substance were limited and its use therefore had to be restricted to children: who had been, in intimate contact with a case of measles and for whom on account of age or dobility, it was especially desirable to prevent or modify an attack. 19 A letter was sent to all doctors in the borough informing them that Gamma Globulin solution would be supplied free of charge for suitable cases. and the Borough Council would pay a fee for each injection given. A suitable record card would be completed by the doctor and forwarded to the Medical Officer of Health. Applications from doctors were received in respect of 22 children who were measles contacts. Two of them subsequently developed a mild attack and one a moderate attack but with no complications. These numbers are too small for definite conclusions to be drawn, and further work is necessary to measure the value of measles preventive measures. DIPHTHERIA IMMUNISATION. A special feature of the Immunisation) Campaign for 1945 was the use of the Mobile Clinic during the summer months. This was originally planned for the summer of 1944 but had to be postponed owing to fly-bomb attacks. Much of the work planned for this Campaign depended upon the use of Civil Defence vehicles and the services of Civil Defence personnel and the withdrawal of these facilities, in 1945 necessitated considerable re-arrangements. A loud speaker car was obtained on loan from the Ministry of Information and the Civil Defence Controller made available for use as a travelling clinic the heavy mobile first-aid unit. The Campaign opened in April with the showing of a two minute trailer film, on Diphtheria Immunisation at all cinemas in Islington for three days. Wherever possible also a slide was shown giving particulars of the nearest Council's Clinic for Immunisation. Special advertisements and an article by the Acting Medical Officer of Health appeared in the local press and attention was drawn to the Mobile Clinic. Campaign. Specially designed new posters with a local interest were displayed throughout the borough and the Health Visitors took part in the intensive follow - up visiting. The Mobile Immunisation Clinic was in action from May 29th to July 31st. In each district this visit was preceded by a loud speaker car which toured the district the previous day broadcasting a message from the Medical Officer of Health and announcing the time that the Mobile Clinic would visit a particular street. The Mobile Clinic went out four times, weekly usually making five or six halts during each tour and accompanied by a loud speaker van. The team consisted of a Medical Officer, Health Visitor, two or three clerks, and the driver of the Mobile Clinic and the loud speaker car. The chief aim of the Mobile Clinic was to bring immunisation to those young children under school age whose mothers, because of the pressure of household cares or war work or possibly by reason of indifference or ignorance, had not previously taken their children to one of the existing clinics. The following figures show the work of the Mobile Clinic:- No. of Sessions held 36 Total attendances for first injections 1017 Total attendances for second injections. at Mobile Clinic 656 It is very probable that comparatively few of these children would have come forward for immunisation but for the use of the Mobile Clinic. It was noted that the summer campaign resulted in increased attendances at the fixed clinics. it is considered that the use of the Mobile Clinics and the loud speaker car has, undoubtedly, been a valuable advertising agent and has assisted in making the population of the borough "immunisation conscious". So for as is known, this was the first use of a Mobile Clinic for Diphtheria Immunisation in London, and the experiment attracted some attentions The work of the clinic was filmed by the Ministry of Information and photographs also appeared in the national daily press. - 20 - DIPHTHERIA IMMUNISATION (CONTD):- Under 5years. 5 to 15 years. Estimated number of children immunised at 31. 12.45. 48.7% 68.5% Total attendances ait all Clinics 16,947 Sessions hold 339 Average attendance 50 Sessions held as under:- North Islington Branch Library 49 First Aid Post, London Fever Hospital 25 " " " Tibberton Square 51 West Islington Welfare Centre 24 London County Council Schools in Borough 99 War - Time Day Nurseries 55 Mobile Clinics 36 339 Number of children who received full course immunising injections:- Under 5 5 to 15 Total 2,964 804 3,788 Number of children who were Primary Schick Tested with negative result and therefore did not require immunisation. 146 Number of children immunised whilst evacuated and tested with a negative result in Islington. 440 Number of L.C.C. Cases tested in Islington with negative result NIL. Number of children retested with negative result. 576 In addition to above 2,545 children were Post Schick Tested with a negative result. There have been only three deaths from diphtheria in the Borough during the year, one a child tinder five years, the other two over five: none had been immunised. - 21 -