1SL 85 19 4 6. ANNUAL REPORT on the HEALTH AND SANITARY CONDITIONS of the METROPOLITAN BOROUGH OF ISLINGTON. VICTOR FREEMAN, m.r.c.s., l.r.c.p., d.p.h., Medical Officer of Health. VAIL & Co., IyTD., Printers. 170 Farringdon Road, E.C.I 1 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 the Annual Report on the Public Health of the Metropolitan Borough of Islington for the year ended 31st December, 1946. Although this is an interim report, as in previous years, the opportunity has been taken, as desired by the Minister of Health, to deal in a little more detail with certain subjects of current interest. Among these may be mentioned Tuberculosis, including the Allowances Scheme; progress of diphtheria immunisation; the care of premature infants and of illegitimate children and the steps taken to combat infestation. The year has been a particularly difficult one for effecting necessary sanitary repairs, owing to deficiencies of essential materials and manpower; and there were also difficulties in maintaining adequate sanitary supervision, due to the great increase in the complaints to be dealt with and a temporary deficiency in the establishment of Sanitary Inspectors. The year 1946, in spite of the adverse conditions of extensive housing dilapidations and overcrowding was, in general, a good year in respect of the state of the public health in the Borough, and a number of favourable records were established upon which more detailed comment is made in the appropriate sections of the report. It should be noted, however, that the infant mortality rate is the lowest on record; the maternal mortality rate is also considerably lower than the average, and for the first time in Islington's public health history there have been no deaths due to diphtheria during the whole of the year. Tuberculosis figures are also now no less favourable than pre-war. A striking feature of 1946 was the great increase in the number of births and the birth rate, for which it is necessary to go back many years to find similar rates. 1946 was the first complete post-war year, and there are therefore no deaths included due to enemy action. With one exception, all members of the staff who had served in H.M. Forces returned during the year. Dr. Katherine M. Hirst was responsible for the work of the Public Health Department as Acting Medical Officer of Health for the first eight months of the year, and she was ably assisted by Dr. R. G. Samuel who was appointed Temporary Medical Officer from the early part of the year until November 1946. Following the return of members of the clerical staff of the Public Health Department, a re-organisation scheme was put into effect giving well deserved opportunities of promotion to members of the staff who were comparatively junior at the outbreak of the war, and also, it is hoped, increasing the working efficiency pf the department on the administrative side. 2 I again have pleasure in expressing thanks to Dr. Hirst for her work during my absence abroad and to all members of the staff, professional, clerical and manual, both temporary and permanent who assisted both her and then myself in the work of the department. I also have very much pleasure in expressing thanks once again to the Chairmen of the Public Health and Maternity & Child Welfare Committees and the members thereof for their courtesy, consideration and understanding of the many matters, majoR and minor, reported to them by the Acting Medical Officer of Health and myself, September, 1947 V. FREEMAN, Medical Officer of Health. 3 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 1946 227,160 LIVE BIRTHS Birth Rate per 1,000 Estimated Resident Population Totals. M. F. Islington London Admin. County. England and Wales. Legitimate 4,842 2,510 2,332 Illegitimate 442 226 216 5,284 2,736 2,548 23.26 21.5 19.1 STILL BIRTHS Legitimate 105 60 45 Rate per 1,000 Total (Live and Still) Births Illegitimate 15 12 3 120 72 48 22.20 DEATHS Death Rate (Unadjusted) per 1,000 Population Totals M. F. Islington London Admin. County England and Wales 2,947 1,551 1,396 12.97 12.7 11.5 DEATHS FROM PUERPERAL CAUSES. Deaths. Rate per 1,000 Total Births. Puerperal Sepsis 4 0.74 Other Puerperal Causes 4 0.74 8 1.48 DEATH RATE OF INFANTS UNDER ONE YEAR OF AGE. Islington London Admin. County. England and Wales. All infants per 1,000 live births 39 41 43 Legitimate infants per 1,000 legitimate live births 36 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 6,033, of this number 458 were not notified by midwives. MARRIAGES (Provisional figures). Marriages solemnised in the Borough during the year 2,296 4 COMPARATIVE VITAL STATISTICS—1935 TO 1946. (Compiled from Registrar General's Returns) 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 Population 227,160 195,770 188,560 189,970 186,000 183,470 224,110 272,300 292,300 295,400 301,000 304,100 Live Births—(total) 5,284 3,708 3,826 3,592 3,368 2,986 3,850 4,168 4,487 4,516 4,650 4,523 (illegitimate) 442 438 335 264 251 214 272 245 278 218 222 173 Birth Rate per 1,000 population 23.26 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 1,000 births 22.20 22.41 25.72 24.97 33.29 26.72 32.17 30.24 27.52 29.86 29.02 21.21 Deaths 2,947 2,856 3,057 3,017 2,852 3,508 4,143 3,485 3,492 3,865 3,785 3,434 Death rate 12.97 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 1,000 births 1.48 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 39 46 48 46 54 59 47 50 65 67 62 53 Marriage rate per 1,000 population 20.21 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 1,000 population (all forms) 2.18 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 1,000 population— Pulmonary T.B. 0.64 0.80 0.86 0.85 0.93 1.20 0.84 0.82 0.73 0.70 0.69 0.66 Diphtheria Nil 0.01 0.01 0.05 0.01 0.06 0.09 0.04 0.08 0.07 0.10 0.04 Suicides 0.11 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 0.10 0.07 0.16 0.10 0.16 0.14 0.14 * * * • * Other violent causes 0.45 1.05 1.84 0.38 1.45 1.74 2.38 0.56 0.37 0.34 0.45 0.42 * Not given separately by R.G. 5 CLASSIFICATION OF DEATHS WITH AGE DISTRIBUTION. Cause of Death Ages—Both Sexes Totals Under 1 year 1 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 207 25 22 246 638 1,809 2,947 1,551 1,396 1. Typhoid and paratyphoid fevers - - - - - - - - - 2. Cerebrospinal fever 1 1 - 2 1 - 5 2 3 3. Scarlet Fever - - - - - - - - - 4. Whooping Cough 6 3 - - - - 9 4 5 5. Diphtheria - - - - - - - - - 6. Tuberculosis of respiratory system - - 1 72 49 25 145 89 56 7. Other forms of tuberculosis 2 4 4 4 1 2 1 / 8 9 8. Syphilitic disease 2 - - 2 9 5 18 11 7 9. Influenza 2 - - 2 10 13 27 13 14 10. Measles 2 - - - - - 2 2 - 11. Acute poliomyelitis and polioencephalitis - - - - 1 - 1 l - 12. Acute infectious encephalitis - - 1 - 1 - 2 2 - 13. Cancer of buc. cav. and oesop (M) - - - - 8 10 18 18 - Cancer of uterus (F) - - - 4 16 13 33 - 33 14. Cancer of stomach and duodenum - - - 4 21 53 78 47 31 15. Cancer of breast - - - 7 13 15 35 1 34 16. Cancer of all other sites - - 1 22 116 184 323 185 138 17. Diabetes - - - - 6 6 12 5 7 18. Intra-cranial Vascular lesions - - - 1 52 163 216 85 131 19. Heart Disease - - 2 25 109 585 721 352 369 20. Other diseases of the circulatory system - - - 3 25 111 139 68 71 21. Bronchitis 3 - - 5 66 201 275 177 98 22. Pneumonia 32 - 3 4 28 101 168 91 77 23. Other respiratory diseases 1 - - 2 10 20 33 24 9 24. Ulceration of the stomach or duodenum - - - 6 15 23 44 34 10 25. Diarrhoea (under 2 years of age) 20 - - - - - 20 14 6 26. Appendicitis - 2 1 - 1 3 7 5 2 27. Other digestive diseases 4 2 1 7 12 47 73 40 33 28. Nephritis - - - 6 11 28 45 17 28 29. Puerperal and post-abortive sepsis - - - 4 - - 4 - 4 30. Other maternal causes - - - 4 - - 4 - 4 31. Premature birth 30 - - - - - 30 17 13 32. Congenital malformations, birth injury, infantile disease 86 2 1 5 3 1 98 57 41 33. Suicide - - - 12 8 5 25 13 12 34. Road Traffic accidents - 3 2 4 4 11 24 17 7 35. Other violent causes 12 5 2 6 10 67 102 42 60 36. All other causes 4 3 3 33 32 119 194 110 84 6 COMMENTS ON VITAL STATISTICS. No. of Births and Birth Rate. The number of births (5,284) for 1946 is the highest figure attained since 1931 when the number was almost the same (5,281) but, the population, in that year was much greater, namely, 324,600. The birth rate 23.26, which is the number of births per 1,000 resident population, is the highest since 1921. Illegitimate Births. 8.36 per cent. of the 1946 births were registered as illegitimate. This is lower than the previous year which was 11.81 per cent but is still considerably higher than the pre-war figures which averaged 5.08 per cent. It will be noted that children born illegitimately have a much poorer chance of survival during their first year than other children, and an increase in the number of illegitimate infants means an increase in the number of infants born into adverse physical circumstances. Deaths. The death rate has now returned to pre-war proportions and the figure of 12.97 per 1,000 population is the lowest since 1939. 1946 was the first year since 1939 in which there were no deaths due to enemy action and this fall was therefore to be expected. Deaths from Puerperal Causes. The rate of 1.48 (per 1,000 total births) of deaths associated with childbirth is somewhat higher than last year, which was exceptionally low, but still represents a very considerable improvement upon the pre-war situation. Death Rate of Infants under One Year of Age. The infant mortality rate of 39 per 1,000 live births for 1946 is the lowest in the history of the Borough. It is slightly lower than the average for the County of London and for the country as a whole. It speaks well for the care taken by Islington mothers of their young infants and also for the various hospital, ante-natal and child welfare services which serve them. It will be noted that if the legitimate infants only are taken, the rate is still lower, namely, 36 per 1,000 births, but for an infant born illegitimately the risk is almost twice as great, the rate for these children being 68. Special consideration has been given to this problem and the steps taken are described later in the report. Of the total number of 207 infant deaths under the age of one year in 1946, 121 occurred in infants under one month. The greater number of these deaths was associated with premature birth, congenital malformations, and birth injuries. A reduction of neo-natal deaths due to these causes is the most difficult problem of infant mortality, and prevention lies principally in concentrating on the care and health of the expectant mother. % Infectious Diseases. Sickness and fatality rates due to the principal infectious diseases are considered in more detail in Section F of this report. 7 SECTION B. General Provision of Health Services for the Area. MATERNITY AND CHILD WELFARE SERVICES. WELFARE CENTRES. In the last annual report reference was made to the taking over by the Borough Council of the work previously undertaken by the South Islington Voluntary Welfare Committee. During the year under review the Voluntary Committee of the East Islington Mothers' and Babies' Welfare Centre requested the Borough Council to take over their work in that part of the Borough. The work of the East Islington Welfare Centre therefore became the sole responsibility of the Borough Council from September 1st 1946. There are, therefore, now two Voluntary Welfare Centres and two Municipal Welfare Centres in the Borough. Both the Voluntary Welfare Centre Committees receive a grant from the Borough Council, and for the year ending March 31st, 1946 this was:— North Islington Infant Welfare Centre and School for Mothers 6-9, Manor Gardens, N.7. £4,000 West Islington Infant Welfare Centre, 42, Richmond Avenue, N.l. £1,000 Ante-Natal and Post-Natal Clinics. These are combined clinics, and the following figures show that the number of expectant mothers who attended the ante-natal clinics during the year was nearly twice as many as during the previous year. Attendances increased so much that it was necessary to hold five additional sessions each week. Attendances at the ante-natal and post-natal clinics at the four Welfare Centres are set out hereunder :— North South East West Total Number held weekly 7 (5) 3 (2) 3 (2) 3 (2) 16 (11) Number of expectant mothers who attended 1,661 (1,141) 1,081(499) 640(457) 643(421) 4,025(2,518) Number who attended post-natally 175 (196) 82 (33) 55 (73) 33 (24) 345 (326) (Figures in brackets are for 1945.) Child Welfare Clinics. As might be expected from the increase in the number of births the children's attendances at the Welfare Centres have also increased very considerabably over the previous year. There has, however, been some falling off as compared with the previous year in the number of toddlers who attended the Centres. This may be due to increasing domestic difficulties, e.g. shopping, etc., but efforts are being made which it is hoped will lead to an increase in the proportion of toddlers attending. The total number of children who first attended at the Centres during the year and who, on the date of their first attendances were:— s North South East West Total (i) Under 1 year 1,301 (1,073) 974 (630) 638 (475) 830 (626) 3,743 (2,804) (ii) 1-5 years 134 (135) 106 (90) 75 (55) 119 (82) 434 (362) The 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 1,133 (886) 973(649) 535(371) 756(500) 3,397 (2,406) (ii) 1-5 years 1,511 (1,687) 1,018(888) 722(891) 873(883) 4,124(4,349) (Figures in brackets are for 1945) Home Visiting Totals. 1. First Visits, infants under 1 year 4,904 2. Re-visits ditto. 11,335 3. Visits to children between 1st and 2nd years 7,369 4. Visits to children between 2nd and 5th years 13,840 5. Visits re stillbirths 104 6. Visits re deaths of infants under 1 year 39 7. Visits re deaths of children between 1st and 5th years 8 8. Ante-natal first visits 2 666 9. Ante-natal re-visits 1,419 10. Visits re Puerperal Fever cases 14 11. Visits re Puerperal Pyrexia cases 53 12. Visits re Home Help and Domestic Help cases 380 13. Visits re Approved Daily Guardian Scheme 46 14. Incomplete visits 3,480 15. Ineffective visits 13,901 16. Total number of mothers and children effectively visited 42,330 17. Clinic Sessions attended 5,678 Health Visitor Staff. In order to cope more effectively with the increase in Maternity and Child Welfare work both at the clinics and to enable visiting to be carried out at reasonable intervals, the Council approved an increase in the Health Visitor establishment from 28 to 32, both figures including the four Superintendents of the four Welfare Centres. It was not possible, however, to employ the full establishment at any time owing to general insufficiency of Health Visitors. Six Visitors resigned during the year and eight were appointed. Child Life Protection. The supervision of foster mothers is closely linked with the supervision of the problems of illegitimate children and unmarried mothers, and it has therefore been thought desirable that this work should be done by the same Health Visitor staff. To ensure more adequate attention being paid to the special problems concerned, two Visitors were allocated to this work in place of one previously. The table of foster mothers and foster children being cared for is as follows:— Number of persons on register prepared to receive children at end of 1946 31 Number of foster children being cared for at end of year 34 9 The number of foster mothers is very inadequate as compared with the demand and this leads often to children being placed with unsuitable or not entirely suitable women. The number of foster mothers showed an increase of four over the previous year, although four less children were being cared for at the end of 1946. Twenty-one new cases were approved during the year. In some instances in spite of the Public Health Act, a child may be found with a foster mother before application has been made for approval, and if this occurs in an unsuitable home there may be great difficulty in making alternative arrangements because of the scarcity of suitable foster mothers. The scheme inaugurated by the Council in 1945 for guaranteed payments to foster mothers in respect of illegitimate children placed in their care was continued. In 1946 weekly payments under the scheme were raised from 17s. 6d. for each child dealt with not exceeding 12 months, and 15s. for children from 1-5 years, to 21s. for each child. One child benefited under this scheme during the year. There were no deaths amongst foster children and no legal proceedings were instituted during the period under review. The Child Protection Visitors continued in close touch where necessary with Adoption Societies and various voluntary organisations who might be concerned. Illegitimate Children. The two Child Protection Visitors also act as Special Health Visitors supervising illegitimate children who present special problems owing to their home circumstancesThat this additional attention is required is shown by the fact that although the infant mortality rate for illegitimate infants under 12 months of age has fallen quite considerably over the past few years, it is still nearly twice the rate for children born in a normal home. There were 442 registered illegitimate births to Islington mothers during the year, which represents 8.36 per cent of the total births. As mentioned previously, this compares with 5.08 per cent. pre-war. Not all illegitimate children, of course, require special provision or supervision, but the need arises when the unmarried mother has to return to work soon after confinement; where problems of adoption may arise; and where there is no suitable alternative home for the child, such as with a relative. A "short-stay" hostel or residential nursery would greatly assist in tiding over temporary difficulties and might enable some mothers to retain the care of their children where the solution now sought is adoption or perhaps placing with an unsatisfactory foster mother. Married women with an illegitimate child are often in a very difficult situation with regard to the placing of their children; and with the scarcity of foster mothers and possibly the frequent change of home, the outlook for the illegitimate child is often much more unfavourable than it should be. 334 children in this group were dealt with by the Special Visitors during the year, 242 of these being new cases. Of the above total cases 18 children were adopted, 18 were admitted to institutions without mothers, e.g., Dr. Barnardo's Homes, and 16 were placed with foster mothers. With regard to the immediate arrangement made for mother and child the table on page 10 gives the detail of the care and disposal of each infant visited. The majority of mothers went with the baby to live with relatives; 55 were being cared for in hostels or institutions, and in 22 cases the parents were living together and therefore a special problem might not arise from the point of view of the infant. 293 interviews 10 were given by the Visitors to mothers of illegitimate children. The Special Visitors are available every Thursday evening at the Town Hall from 5.7 p.m. and this evening session has proved very helpful to mothers at work. Many personal problems are dealt with and advice is given. One particular difficulty which has been encountered too often is that of getting the father of an illegitimate child to take adequate financial or other responsibility. This work is carried on in co-operation with moral welfare workers, hospital almoners, welfare centres, and other social agencies. Supervision and following up of these children is often rendered difficult by the frequent changes made, sometimes without notice, in the arrangements for the care of an illegitimate child. In accordance with the recommendations of the Metropolitan Boroughs' Standing Joint Committee the Islington Borough Council contributed £212 for 1946 for moral welfare work in connection with illegitimate children. ANNUAL FIGURES OF WORK OF SPECIAL HEALTH VISITORS CONCERNING PROBLEM ILLEGITIMATE CHILDREN. Total Cases Dealt With During the Year 1946. Total Cases Dealt with Adopted Admitted to Institutions Died Fostered Number on Register at end of year 334 18 18 6 16 185 ANALYSIS OF NEW CASES FOR YEAR ENDING 31.12.46. Before Birth 0-2 mths. 2-6 mths. 6 mths to 1 year 1-2 years 2-3 years 3-4 years 4-5 years Total Infant with mother— (a) in grandmother's home 10 33 19 19 11 6 1 1 100 (b) in institution 1 43 1 2 5 1 2 — 55 (c) living alone 6 7 3 2 5 — 1 — 24 Infant with mother and father — 12 2 — 4 1 2 1 22 Infant with relatives (without mother) — — — — 2 3 1 1 7 Infant with foster-parents — 4 2 3 5 — — 14 Infant with adopting parents — 5 1 1 1 — — — 8 Infant temporarily in residential institution— (a) Social Welfare — — — — 1 — — — 1 (b) Other — 1 — — — — — — 1 Other arrangements — 7 1 2 — — — — 10 Total 17 112 29 26 32 16 7 3 242 Attending Day Nursery — — — 3 3 1 — 1 8 With Daily Guardian — — 1 2 1 — — — 4 11 Premature Infants. In accordance with Ministry of Health Circular 20/44 special records were kept recording premature births (i.e., birth weight 5 J lbs. or less) from which the following figures are taken— (i) Total number of premature births notified during 1946 which occurred— (a) at home 108 (plus 4 still-born) (b) in hospital 257 (plus 44 still-born) (ii) Number of babies born at home— (a) who were nursed entirely at home 95 (b) who died during first 24 hours 5 (c) who survived at end of first month 95 (iii) Number of babies born in hospital— (a) who died during first 24 hours 25 (b) who survived at end of first month 188 (5 cases could not be traced at end of month). Special equipment has been provided by the Borough Council on loan to those homes where a premature infant is born and where inadequate facilities are available for nursing the infant at home or for various reasons, transfer to hospital is not desired. The equipment includes a treasure cot, blankets, infant clothes, hot-water bottles, thermometers, feeding pipettes, etc. Three such outfits are available, and during 1946, these were used in respect of four premature births at home. In each case the midwife indicated that the outfit had been most useful in helping to nurse the infant satisfactorily at home. Home Helps and Domestic Helps. The number of applications and also the number of home helps available on an intermittent basis increased during the year. In order to cope with this and also to ensure reliability and a reasonable standard of service on the part of the Home Helps, the Council agreed, with the approval of the Ministry of Health, to the appointment of a temporary Home Help Organiser. The appointment, however, did not become effective until early 1947. During 1946 the work under these schemes increased considerably as is demonstrated by the following figures:— Home Help Cases (i.e. Confinements, incapacity during pregnancy and help in households where there are children under 5 years). No. of Cases—320. Cost to Borough Council—£2,306 6s. Od. Domestic Help Cases (i.e., mainly aged and infirm people). No. of Cases—23 for varying periods. Cost, which is reclaimable from Ministry of Health—£441 17s. Od. At the end of the year the following were on the Borough Council's Approved List of Home and Domestic Helps available for both schemes— 5 employed on regular basis. 18 on intermittent basis. 63 whole-time and 13 part-time had been employed temporarily during the year for individual cases. Student Health Visitors. At the request of the Royal College of Nursing three students attended in this Borough during 1946 as part of their practical training in home visiting and in welfare centre clinic duties. 12 Emergency Obstetric Unit. This service, which is provided by University College Hospital, and paid for by the Borough Council, was called out nine times during 1946. In each case the patient made a good recovery. Blood or other transfusions were given by the Unit in all of the cases for which the Unit was called out. Priority Dockets for Sheets for Expectant Mothers. Dockets continued to be issued through the Maternity and Child Welfare Office at the request of the Ministry of Health on behalf of the Board of Trade. During 1946 the following were dealt with:— Number of mothers to whom issued 1,426 Number of dockets issued 3,690 Additional Maternity Bed Scheme. This scheme was initiated in 1944 by the London County Council in co-operation with the Metropolitan Borough Councils. The Islington Borough Council under the scheme is allocated four beds per month (total of 8 cases) at the Royal Northern Hospital, and six beds per month (total of 12 cases) at the Mothers' Hospital, Clapton, the booking of the beds being arranged by the Medical Officer of Health through the Maternity & Child Welfare Office and the Welfare Centres. During 1946 the beds at both hospitals under this scheme were fully used. Maternity Hospital Grants. Contributions for maternity cases admitted to beds at Maternity Hospitals at the rate of 10s. per case for a percentage of notified births were made as follows:— University College Hospital 122 cases Royal Free Hospital . 170 cases Supply of Supplementary Quantities of Milk to Mothers and Young Children. Under this Scheme the Borough Council pays the cost of the additional pint or packet of milk allowed to the mother of a child under one year of age, if the mother has been assessed by the Ministry of Food to receive the basic pint or packet of milk free. During 1946 the total quantity of milk paid for by the Borough Council was as under:— Pints of Liquid Milk 802 Packets of Dried Milk (lbs.) 1,892 Total cost to Council £97 16s. 7d. Supply of Vitamin Preparations for Expectant Mothers and Children under 5. The four Welfare Centres in the Borough 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, Orange Juice, and Vitamin A & D Tablets. Provision of Dentures for Expectant and Nursing Mothers. As described in previous annual reports, this scheme, which was initiated in 1944, provides for assisting expectant and nursing mothers to obtain dentures supplied through either the North or South Islington Welfare Centres, or the Eastman Dental Clinic. Number of Mothers assisted under the scheme 49 Cost to Council £138 15s. 8d. 13 Invalid Children's Aid Association. A grant of £200 was paid to the Invalid Children's Aid Association for their work for Islington children under 5 years of age during 1946. Nursing in the Home. A grant of £200 was paid during 1946 to the North London District Nursing Association in respect of the nursing of Islington children under 5 years of age in the home. Daily Guardian Service. This service became the direct responsibility financially as well as administratively of the Borough Council from the 1st April 1946. Prior to then, although the Borough Council administered the scheme, the cost of it was reimbursed by the Ministry of Labour who paid a subsidy of 4s. per child per week to approved Daily Guardians. Since the Borough Council took over the financial side of the scheme this subsidy has been raised to 6s. per week per child. At the end of 1946 there were 44 approved guardians on the register undertaking daytime care for 75 children. Day Nurseries. From 1st April 1946 the Wartime Day Nurseries ceased to function as such, and became Borough Council Day Nurseries for which a 46 per cent grant is received from the Ministry of Health. The Highgate Hill Nursery, accommodating 50 children, was handed over to the London County Council on 1st April for use as a Nursery School. At the end of June the Legard Road Nursery was closed, as the premises were required by the owners for their former use. At the end of September the Hornsey Lane premises were likewise required by their former owners, the Kingsdown Orphanage for Girls, and the Day Nursery therefore had to be closed. Miss Harris, permanent Health Visitor, seconded to the position of Superintendent Matron of the Day Nurseries, resigned from her service with the Islington Borough Council on being appointed to the staff of the Ministry of Health. Miss Kelly was appointed to succeed Miss Harris and carried this responsibility for the second half of the year. At the end of the year there were 9 Day Nurseries open providing accommodation for children as under:— Scholefield Road, N.19 60 places 265, Camden Road 66 „ 34, Huntingdon Street, N.1. 33 „ 6, Clephane Road, N.l. 60 ,, 21, Plimsoll Road, N.4 47 „ Pembroke Street, N.l 50 ,, 8 and 9, Canonbury Place, N.l. 70 ,, Windsor Street, N.l. 68 „ Mitford Road, N.l. 68 „ OTHER PUBLIC HEALTH SERVICES. Bacteriological Examinations. Total Positive Negative For Diphtheria bacilli 892 36 856 Tubercle bacilli 176 18 158 Typhosus bacilli 1 1 14 Provision of Insulin. 22 patients received assistance during the year, the cost to the Borough Council was £83 10s. Od. Islington Crematorium. There were 93 cremations during the year at the Council's Crematorium at East Finchley. This represents the highest number of cremations in any one year since the Crematorium was opened in 1937. Public Mortuary. During the year 1946 thirteen bodies were received pending burial. The Coroner's Court was not used, neither were inquests nor autopsies carried out in the Court. The major proportion of Islington housing accommodation was constructed during the nineteenth century and a good deal of it has now attained a "century" or more. In consequence of this age and because during the war normal repair work was, to all intents and purposes, in suspense, there is a vast amount of dilapidation work to be done. In addition, much property was also damaged as a result of enemy action, which still further increased the repair work due on those damaged premises which were left standing. With the post-war demobilisation and the return of many evacuees to Islington the population has increased considerably since the end of the war. Problems of housing, sanitary repair and overcrowding are therefore acute, and are made still more so by shortages of labour and materials to enable work to be done. The volume of sanitary complaints arriving in the Public Health Department is approximately treble the pre-war figure. All these complaints must be dealt with, and with a depleted Sanitary Inspector staff (varying from four to six below establishment) it has only been possible to deal with the more urgent cases with a minimum of follow-up after the initial complaint has been made. On account of the suspension of the qualifying examinations for Sanitary Inspectors during the war period, it will probably be some time before Sanitary Inspectors are available to all local authorities in sufficient numbers. The Public Health Department is therefore working under a severe handicap in its efforts to ameliorate some of the bad housing conditions under which many residents are living. Summary of Work done by District Sanitary Inspectors. During the year 34,044 inspections (including re-inspections) were carried out by the District Sanitary Inspectors, made up as follows:— House to house inspections 1,268 Other premises inspected 7,362 Re-inspections, calls made, etc. 25,414 34,044 SECTION C. SANITARY CIRCUMSTANCES OF THE AREA. 15 Special Matters dealt with when making the above visits— Council's property 10 Stables — Yards 7 Urinals attached to Public Houses 34 Premises for Foster children 33 Premises re vermin 287 Premises re Rats and Mice 1,005 Premises re Water Certificates 64 Certificates of Essentiality 110 Non-effective visits 2,859 Notices served — Intimation (Public Health (London) Act, 1936) 6,047 Notices served — Statutory (Public Health (London) Act, 1936) 893 Rent and Mortgage Restrictions Acts, 1920, etc. Certificates applied for 67 Certificates issued 55 Certificates refused 7 Balance to 1947 5 Clearance Certificates applied for 19 Clearance Certificates granted 11 Clearance Certificates refused 8 Scabies and Vermin. The treatment of choice for Scabies is still benzyl benzoate which is applied as a 25 per cent. emulsion. The treatment of verminous heads has been simplified and made more effective by the use of proprietory preparations in which the active principal is a 2 per cent. D.D.T. emulsion. This preparation will kill lice effectively within a very short time, but the nits or eggs are more resistant. However, this does not make for any practical difficulty since sufficient D.D.T. remains in the hair for about fourteen days to deal with the nits when they hatch out. Treatment for scabies and vermin was carried out at the Public Health Department, Seven Sisters Road (Cleansing Station), as under— * Scabies Vermin Children under 5 years — Number treated 580 149 Number of baths given 1,340 — Number of treatments — 159 L.C.C. Children — Number treated 821 2,560 Number of baths given 3,952 — Number of treatments — 2,580 Adults — Number treated 2,184 418 Number of baths given 4,782 — Number of treatments — 476 *281 Contacts were given baths. Scabies Clinic.—A consultant dermatologist is in attendance. Number of Clinics held 51 Number of cases attended- 490 16 Adults 289 Children under 5 years 102 School children 99 Diagnosis of cases— 490 Scabies 258 Other conditions 232 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 Total. Scabies 2,191 349 1,419 3,959 Vermin 2,247* 223 1,451 3,921 * 5 cases were treated at home. London (Measles and Whooping Cough) Regulations, 1938. Home visiting of measles and whooping cough cases, under 5 years of age, was carried out by the Home Visitors as under— No. of Investieations. Measles Whooping Cough No. of Ineffective Visits. 1,488 547 367 Disinfection and Disinfestation. During the year D.D.T. (dichlor-diphenyl-trichlorethane) either in the form of a spray or powder became the method of choice for the disinfestation of premises from bugs and other insect vermin. The standard solution used is 3 per cent. D.D.T. in White Kerosene. Floors, walls, ceilings and woodwork, etc. are sprayed with this solution. Furniture and bedding may also be sprayed or alternatively D.D.T. dusting powder may be used, consisting of 10 per cent. D.D.T. and Kaolin. When the solution is used the Kerosene evaporates and leaves behind on the surfaces of walls, etc. a fine deposit of D.D.T. powder which remains effective against any further infestation for at least a month. Remarkable success has attended the use of this preparation which has now superseded other methods of disinfestation in this Borough. No recurrances of the original infestation have so far been reported out of many hundreds of treatments carried out. During the year 760 disinfections were carried out after cases of infectious or other diseases. In addition 386 rooms were disinfested for vermin. At the disinfecting station 264,226 articles of bedding, etc., were treated for infection or infestation (225,557 of these being for Clothing Contractors). In the case of families removing to new Council properties, furniture and premises are sprayed with D.D.T. solution before removal as a routine. The new premises are also sprayed soon after occupation in order to ensure that both furniture and premises remain free from infestation for at least a month. Hydrogen Cyanide Chamber. The Hydrogen Cyanide Chamber was infrequently used during the last few months of the year owing to the changeover to disinfestation by D.D.T. in the homes, mentioned above. The Chamber, however, is being reserved for the time 17 being for special cases, although it may in course of time become redundant. Owing to the deadly nature of hydrogen cyanide gas it would be a great advantage if thorough disinfestation could be carried out with materials which are without danger to human life. No. of times Large Chamber used— Furniture and effects of families rehoused, including those of Homeless Persons 97 Work for other Councils (Finsbury 5, St. Pancras 1) 6 Islington and Finsbury Housing Association 1 No. of times Small Chamber used— Miscellaneous (mattresses, divans, etc.) 4 Thanks are due to the Cleansing Department for their assistance in working the boiler plant at Ashburton Grove Depot. WORK OF SANITARY INSPECTORS ADMINISTERING FACTORIES ACT, 1937 AND OTHER RELEVANT ACTS. A.—Male Sanitary Inspectors. 3,381 inspections and re-inspections were made by these Inspectors during the year. These are summarised as follows:— Factories (mechanical power) 2,219 Factories (non-mechanical power) 374 Fried Fish Shops 180 Fish Curers 12 Rag and Bone Dealers — Noise Nuisances 66 Smoke Nuisances 178 Rats and Mice (Destruction) Act, 1919, Factories 123 Miscellaneous 229 3,381 (See separate sections on Underground Bakehouses and Offensive Trades). 1,039 defects or contraventions were found. A summary, under statutory enactments, is as follows Factories Act, 1937 613 Food and Drugs Act, 1938 225 Public Health (London) Act, 1936 201 1,039 378 Notices were served. These are summarised below:— Factories Act, 1937 191 Food & Drugs Act, 1938 70 Public Health (London) Act, 1936 117 378 In addition, the following notices were served:— Rats and Mice (Destruction) Act, 1919 8 Other notices served 8 16 18 551 defects or contraventions were remedied, as follows :— Factories Act, 1937 338 Food and Drugs Act, 1938 107 Public Health (London) Act, 1936 106 551 The following Notices were also complied with:— Rats and Mice (Destruction) Act, 1919 6 Other Notices complied with 3 9 125 complaints were received, as follows:— General 101 Home Office 24 125 B. Female Sanitary Inspectors. 4,660 inspections and re-inspections were made by these Inspectors during the year 1946. These are summarised in the following manner:— Factories (mechanical power) 1,325 Factories (non-mechanical power) 574 Other premises under the Factories Act, 1937 — Outworkers 1,142 Hotel and Restaurant Kitchens 199 Coffee and Dining Rooms 567 Refreshment Rooms 482 Provisions 52 Common Lodging Houses 4 Special Inspections (Food Licences) 242 Other visits 73 4,660 519 contraventions or nuisances were found, as follows:— Factories Act, 1937 301 Food and Drugs Act, 1938 137 Public Health (London) Act, 1936 81 519 216 Notices were served, as follows:— Factories Act, 1937 76 Food & Drugs Act, 1938 80 Public Health (London) Act, 1936 60 216 311 contraventions or nuisances were remedied, as follows:— Factories Act, 1937 164 Food & Drugs Act, 1938 92 Public Health (London) Act, 1936 55 311 19 5 complaints were received, as follows:— General 4 Home Office 1 5 Rats and Mice (Destruction) Act, 1919. 517 complaints were received and 696 inspections carried out. 27 notices were served and 29 defective drains repaired. These figures do not include work done by the Inspectors engaged under the Factories Act, 1937. Infestation Order. 1943. Work under the Infestation Order is carried out under the authority of Infestation Control, Ministry of Food. In accordance with the directive received from the Ministry of Food a comprehensive rat disinfestation scheme for the Borough as a whole was prepared. The scheme provided for sewer maintenance treatment and the treatment of premises by the Block control method. The following staff were recommended by the Public Health Committee and approved by the Minister of Food, but the establishment was not implemented until the following year. 1 Rodent Officer—to supervise the work under the direction of the Senior Sanitary Inspector. 4 Rodent Investigators—to be engaged in visiting premises for the ascertainment of any infestation and in the case of factories or premises other than private dwellings, to arrange for the signing of agreements, payment for baiting, arrangement of baiting points, etc. 10 Rodent Operators—to be increased from 6 previously employed. Disinfestation of Sewers. In conjunction with the Borough Engineer's Department four parties carried out the baiting and poisoning of sewers during the year 1946. The results were as follows:— Party No. of Manholes baited Complete Take Partial Take No Take Bodies Seen 1 170 130 31 9 20 2 149 95 47 7 25 3 170 98 60 12 34 4 178 112 59 7 13 667 435 197 35 92 The minimum number of rats destroyed, on a calculation based on the amount of poison taken, is 11,265. The sewers were found to have a very high percentage of infestation. In 65 per cent. of the manholes the posion was taken completely, in 30 per cent. of the manholes the poison was partially taken and in only 5 per cent, was there "no take" recorded. Surface baiting.—Three Rodent Operators were employed during the year, and in October three additional Operators were taken on the temporary staff, 20 The work carried out during the year was as follows:— Dwellings Business Premises Shelters Bombed Shelters Total 963 260 83 7 1.313 Summary of Total Prosecutions during the Year 1946. Statute Total Prosecutions Successful Unable to be served Dismissed Withdrawn Adjourned "Sine die" Amount of Penalties Costs Public Health (London) Act, 1936 11 4 1 3 3 - - £5 5s. and £3 3s. against Council. Food & Drugs Act, 1938 12 6 - 4 2 - £22 £14 14s. Milk & Dairies Regs. 1926/43 & Food & Drugs Act, 1938 5 3 - 2 - - £15 £17 12s. Milk & Dairies Order 1926 & Food & Drugs Act, 1938 2 - - 2 - - - £3 3s. Food Standards (Bakery & Golden Raising Powder) Order, 1944 1 1 - - - - £3 £2 2s. L.C.C. Byelaws for the Protection of Food, 1937 1 - - - 1 - - – Meat Products, etc., (Control & Maximum Prices) Order 1944 4 - - 1 3 - - £3 3s. against Council. Labelling of Food (No. 2) Order, 1944 2 - - 1 - 1 - £5. 38 14 1 13 9 1 £40 £47 16s. (£6 6s. against Council). Water Supplies. With the exception of a few wells in the Borough, the Metropolitan Water Board is responsible for all other supplies. Eight 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. SECTION D. Housing. Work under Section 9 of the Housing Act 1936 has again been at a standstill, as a consequence of the lack of labour and material, prohibiting any extensive repairs being carried out. Requisitioned Property.—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 Byelaws where practicable. Housing Exhibition. The Council decided to hold a housing exhibition for one week which was extended to a fortnight in October, 1946. Each Department was invited to make 21 a contribution to the exhibition, and the main demonstration by the Public Health Department consisted of— (a) Atmospheric Pollution.—Photographs, posters and material demonstrated the extent to which atmosphere is polluted by smoke, with particular reference to smoke from domestic chimneys. Alongside this exhibit there were two bays, one demonstrating an old fashioned coal fireplace with its concommitant smoke and dirt, and in the other bay a modern fireplace suitable for burning smokeless fuel such as will be installed in the new Borough Council flats. This section demonstrated the means by which the Borough Council encouraged, and contributed to, the prevention of atmospheric pollution. (b) Destruction of Household Pests.—This section included a demonstration of the fly nuisance and its dangers and the action of the new insecticide, D.D.T. in the prevention of household pests, particularly bugs, flies, head vermin, etc. A number of films of public health interest were also loaned and shown, together with other films bearing on the work of other departments. Models, charts and exhibits were kindly loaned by many persons and public bodies, whose co-operation and services were much appreciated. SECTION E. INSPECTION AND SUPERVISION OF FOOD Milk and Dairies Order, 1926. Summary of Register. No. on Reg. 31.12.45 Additions to Reg. Removals from Reg. No. on Reg. 31.12.46 Dairies 159 - - 159 Purveyors of Milk in sealed containers only 343 2 - 345 Registered Purveyors of Milk dealing from registered premises outside the Borough 98 — — 98 Summary of Visits by Milk and Dairies Inspectors. Dairies—Routine Inspections 719 Milkshops—(Milk sold in sealed containers only) Routine Inspections 116 Vehicles inspected 65 Miscellaneous Visits 609 1,509 During the year 10 Notices intimating nuisances or defects were served. The following is an analysis of Milk samples taken during the year— Number of Samples taken 549. 22 For Chemical Analysis 507 For Bacteriological Examination 42 Formal 482 Passed Failed Genuine 482 Adulterated Nil Methylene Blue 36 5 Informal 25 Phosphatase 38 3 Genuine 19 Adulerated 6 B. Coli 29 10 Milk (Special Designations) Regulations, 1936-1946. (a) Number of Dairies and Milk Shops inspected 41 (b) The following Licences were granted:— Designation Tuberculin Tested (Dealer) 30 Tuberculin Tested (Supplementary) 6 Accredited (Dealer) — Accredited (Supplementary) — Pasteurised (Pasteuriser) 1 Pasteurised (Dealer) 65 Pasteurised (Supplementary) 9 111 The Milk (Special Designations) Regulations, 1946, came into operation 1st March 1946, superseding the Heat-Treated Milk (Prescribed Tests) Order of 1944 and amending the Milk (Special Designations) Order 1936. The principle of the amendment is that both Tuberculin Tested (Pasteurised) Milk and Pasteurised Milk shall comply with prescribed bio-chemical tests known as the phosphatase and methylene blue tests. The technique of the tests is defined for each of the graded milks and is carried out by the Royal Institute of Public Health on behalf of the Council. Ice Cream. Visits to premises—276. Registered Artificial Cream Premises. (At present dealing in Synthetic Cream) Visits—4. Underground Bakehouses. Number of premises 42 Number of routine Inspections 158 Number of Intimation Notices served 30 Pharmacy & Poisons Acts. Number of visits made 485 Number of sellers of Part II poisons other than registered pharmacists 191 Number of initial registrations during the year 36 During the year applications were received, more or less simultaneously from 48 shopkeepers in the Borough to have their names entered in the list of persons 23 entitled to sell Part II Poisons. It would appear that these applications were principally in respect of the proprietory preparations of one firm. Whilst no objection could be raised in some cases, the majority of the shops were food premises, including registered dairies or milk shops and also general food shops. 18 of the applicants subsequently withdrew their applications, and in a number of other cases the premises were deemed," not fit " under the Act. Food & Drugs Act, 1938. Number of visits made for inspection of food 379 Visits made to shops, etc.—During the year 1,270 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— 60 tons 8 cwts. 1 qr. Action was taken in two cases under the Food & Drugs Act in connection with substances found in bread. In one case the foreign substance was the remains of a mouse, and in the other, a nail was found. The defendants pleaded and were found guilty in both cases. 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. 388 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—19 licences are current. Three licences were authorised during the year. Visits and Inspections—During the year 826 visits were paid to various food shops, markets, stalls, etc. Byelaws for the Protection of Food—Byelaws for this purpose were made under the Public Health (London) Act, 1936, and came into force during 1937. No prosecutions have taken place 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. Offensive Trades. The offensive trades operating in the Borough are three tripe dressers, five gut scrapers and one knackers' yard. 38 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). 1,106 samples (511 formal, 595 informal) were submitted to the Public Analyst 24 for examination. Of these 27 were adulterated (or 2.44 per cent) as shown in the following summary— Formal Rum Essence 1 Cake Flour 1 Pork Sausages 6 Beef Sausages 1 Pork Sausage Meat 7 Golden Raising Powder 1 17 Informal Yorkshire Relish 1 Cake Flour 1 Golden Raising Powder 1 Granulated Sugar 1 Bread 2 Milk Bottles (improperly cleansed) 4 10 Shops Act, 1934. Inspections 179 Re-visits 2,337 Rag Flock Act, 1911, etc. During the year 2 visits were made to premises to ascertain if rag flock was being sold. One sample was taken and reported against, which resulted in legal action being taken. SECTION F. PREVALENCE AND CONTROL OF INFECTIOUS AND OTHER DISEASES. Notifiable Infectious Diseases and Deaths during the year 1946. Diseases No. of Notifications No. of Deaths Cases removed to hospital Scarlet Fever 394 (366) — 164 Diphtheria 137 (86) — 136 Enteric Fever (including Paratyphoid) 5 (-) 5 Puerperal Fever 13 (12) 3 13 Puerperal Pyrexia 66 (41) — 57 Acute Primary and Influenzal Pneumonia 112 (65) 13 32 Ophthalmia Neonatorum 25 (24) — 21 Encephalitis Lethargica — ( -) 1 — Cerebro-spinal Fever 10 (11) 3 9 Anthrax — (-) — — Dysentery 68 (86) 1 47 Malaria 11 (12) — 4 Erysipelas 86 (69) 1 32 Measles 1,877 (1,771) 1 174 Whooping Cough 567 (211) 8 135 Acute Poliomyelitis – ( 9) — — Acute Polioencephalitis – (-) — — Scabies 809 (981) — — (Figures in brackets are notifications for 1945) Smallpox and Vaccination. No case of smallpox was notified. Of the 4,233 births returned on the "Birth 25 List Sheets" during 1945, 2,329 were successfully vaccinated. In addition, 1,495 children, whose births occurred elsewhere, were vaccinated in the Borough. Measles and Whooping Cough. Measles and Whooping Cough became generally notifiable in London at the end of 1939. Prior to this there was only a limited notification. The following chart shows the measles and whooping cough notifications since 1941, and the table shows fatality rates per 1,000 notifications for each of the groups 0-1; 1-5; and 5 and upwards and the proportion of notifications in each of the age groups. INCIDENCE OF MEASLES & WHOOPING COUGH, 1941—1946. 26 Fatality Rates per 1,000 notifications each age group (1940-1946) Percentage of notifications (1940-1946) 0—1 1—5 5 & upwards 0—1 1—5 5 & upwards Measles 19.10 1.86 0.27 6.3 53.2 40.5 Whooping Cough 90.17 8.36 – 13.8 62.0 24.2 It will be noted that the highest fatality rate in both measles and whooping cough occurs in children under the age of one. In children with whooping cough under one, very nearly one case in ten proves fatal and this rate is approximately 4½ times the corresponding rate for measles. Both whooping cough and measles become much less dangerous after the age of one although the largest percentage of cases (62 per cent. in case of whooping cough and 53.2 per cent. in case of measles) occurs in children between 1-5 years. Whilst, therefore, it is very important that children of all ages should avoid all possible contact with other children who may be suffering from either of these diseases as far as is practicable, it is most important to avoid whooping cough for infants under 12 months. Where there are older children in the family, and particularly under circumstances where there is overcrowding, it is difficult to avoid contact if there is also an infant brother or sister. The longer it is possible to delay exposure to whooping cough the less is the risk entailed. Unfortunately, immunisation against whooping cough does not yet afford the same degree of certainty against attack as is the case with diphtheria, but a vaccine may give limited protection. 27 Diphtheria. A chart of the number of diphtheria cases and deaths over a period of twelve years, together with the number of children immunised, is shown as follows:— 28 No. OF ISLINGTON CHILDREN IMMUNISED AGAINST DIPHTHERIA, 1937-1946. 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 281 1078 525 89 3261 5734 6321 3165 3688 3425 TOTAL—27,667 No. OF CHILDREN WHO DIED FROM DIPHTHERIA OUT OF 27,667 IMMUNISED IN ISLINGTON—NIL. It will be Noted that there were no Deaths from Diphtheria in the Borough during the Year. This is the First Year since Records were kept in 1859 that the Borough of Islington has been Free of any Deaths from Diphtheria. Diphtheria Immunisation. Under 5 years per cent. 48 5-15 years per cent. 67 Estimated proportions of children immunised at 31.12.46 Total attendance at all Clinics 16,296 Sessions held 242 Average attendance 67.3 Sessions held as under:— North Islington Branch Library 51 South Islington Welfare Centre 53 West Islington Welfare Centre 51 London County Council Schools in Borough 34 Day Nurseries 23 Mobile Clinic 30 242 Number of children who received full course of immunising injections:— Under 5 years 2,876 5-15 years 546 3,422 Number of children who were Primary Schick Tested with negative result and therefore did not require immunisation 61 Number of children immunised whilst evacuated and tested with a negative result in Islington 403 Number of L.C.C. cases tested in Islington with a negative result 7 Number of children re-tested with a negative result 806 In additon to the above, 2,743 children were Post Schick Tested with a negative result. 29 Mobile Diphtheria Immunisation Clinic.—The Mobile Clinic, which was reported upon in detail in the Annual Report for 1945, was again in action during 1946. Various districts of the Borough were visited on two afternoons in the week. Owing to the weather attendances were not as favourable as in the previous year. Considerable publicity was given to diphtheria immunisation with the issue of 2,000 double crown posters, local press publicity, occasional film trailers on diphtheria immunisation in the local cinemas, with the co-operation of the Managers, and continual propaganda throughout the year by the Health Visitors, Medical Officers and Welfare Centres. In circulars Nos. 193/45 and 194/45 the Minister of Health asked for special efforts to secure the immunisation of children under school age and placed sibility for securing immunisation upon Welfare Authorities as from January 1st 1946. The suggestion in the circulars that each Health Visitor should be made responsible for securing immunisation of children under school age in her district has already been part of the Islington scheme for some years. In view of the fact that the work for children under 5 and over 5 in Islington is already very closely integrated, the Maternity & Child Welfare Committee agreed that its powers in this respect as a Welfare Authority should be exercised by the Public Health Committee. Tuberculosis. It will be noted from the table "Comparative Vital Statistics" on page 2 that the Tuberculosis notification rate per 1,000 population for 1946 was 2.18, which is now back to the pre-war rates. The death rate per 1,000 notifications for pulmonary tuberculosis is also lower than in any year since 1939, and it would therefore appear reasonable to assume that the upward trend which took place during the war has now been checked and that the return to the pre-war position has almost been achieved and should therefore form a basis for further improvement. It may be noted that these improvements in the tuberculosis figures have taken place in spite of the very considerable degree of overcrowding which exists in housing throughout the Borough, and which is worse than the pre-war situation. New Cases and Mortality during 1946. Ages New Cases Deaths Respiratory Non-Respiratory Respiratory Non- Respiratory M. F. M. F. M. F. M. F. 0— 1 — — 3 — — — 2 1— 9 9 3 5 — — 2 2 5— 15 21 14 11 — 1 3 1 15— 53 66 7 2 7 15 2 25— 40 43 9 6 7 18 — 35— 28 34 3 1 18 8 — 1 45— 29 14 — — 17 5 — 55— 30 7 1 1 21 4 — 1 65 and upwards 20 9 1 1 17 7 1 — Total for all ages 225 203 38 30 87 58 8 7 496 160 30 Rate per 1,000 population— New cases—pulmonary 1.88 non-pulmonary 0.30 Deaths — pulmonary 0.63 non-pulmonary 0.06 Public Health (Tuberculosis) Regulations 1930. The total number of cases of tuberculosis on the Register as at 31st December, 1946, was— Pulmonary—Males 1,041 Females 866 Non-Pulmonary—Males 172 Females 150 2,229 Work of the Tuberculosis Dispensaries. By arrangement with the Royal Northern Hospital Corporation, the dispensary sessions continued throughout the year at the Royal Northern Hospital (North) under Dr. W. S. Craig, and at the Royal Chest Hospital, City Road (South) under Dr. Leitch. North South Number of attendances 8,631 4,587 New cases and contacts examined 1,727 709 Number of visits by Tuberculosis Officers 225 115 Number of visits by Nurses 768 1,470 Dispensary Registers. Pulmonary Non-Pulmonary Total Grand Total Adults Children Adults Children Adults Children 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 731 634 83 74 71 89 51 54 802 723 134 128 1,787 Light Treatment. Sixteen patients received "Light" treatment, the cost to the Council being £22 11s. 0d. Mass Radiology. Arrangements were continued 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 (St. Pancras) and 16 firms took advantage of the facilities afforded by sending their workers to the Unit, 31 The following analysis has been received from the London County Council regarding those visiting the Unit, which was only available during the last few months of the year.— Persons examined Referred for larger films Probably T.B. Men 276 Women 292 Total 568 Men 3 Women 10 Total 13 Men 2 Women 5 Total 7 Extra Nourishment. During the year the Public Health Committee considered the position in respect of the Council's scheme for providing extra nourishment for tubercular patients. This scheme has been in existence since 1937. Both the food provided and the income limit under which it is provided have been varied from time to time. Although eggs, butter and cream were available under the original scheme, they are not obtainable under present conditions and for practical purposes assistance is normally confined to additional milk and payment for the purchase of fish. The basis of assessment is that income per head after deduction of rent does not exceed 15s. and in such case the cost of extra nourishment is borne by the Council. Exceptional circumstances are considered by the Committee on their individual merits. The Committee approved the increase in the income limit for free supply of extra nourishment on the following basis:— 15/- per head per week if there are 6 or more in the family. 16/- do. do. 5 in family 17/6 do. do. 4 do. 20/- do. do. 3 do. 22/6 do. do. 2 do. Members of the family living at home but earning would not be included, except that the patient for whom application is made would always be included as a member of the family. Tuberculosis Care Committee and Maintenance Allowances Scheme. It was agreed that the Tuberculosis Care Committee Secretary and the Maintenance Allowances Officer should divide the work on the social side of tuberculosis for the Borough between them so that each, in their respective areas, would carry out both Tuberculosis Care Committee and Maintenance Allowances enquiries. One Officer was attached to the Northern and one to the Southern Dispensaries. Tuberculosis Care Committee—During the year the Care Committee dealt with 339 applications for assistance relating to 82 patients who were helped, some on several occasions, with cash or kind. Loans of bedding or medical appliances were made to another 25 patients. Other cases were referred to organisations for assistance, 32 Receipts from the Christmas "Seal Sale" amounted to £281 15s. 11d. Maintenance Allowances Scheme Number of patients receiving weekly allowance in last week of year 1946 143 Number of applications brought before Assessment Officer 1,781 Number of new cases 159 Number of renewals on existing orders 1,047 Number of orders adjusted, etc. 362 Number of patients returning to full time work 67 Number of deaths 43 Other"Cease payments" 103 Amount paid out in allowances during the year—£12,395 5s. 2d. Artificial Pneumothorax. 175 patients received treatment at a total cost of £788 16s. 3d. Beds and Bedding. 14 patients were provided with beds and bedding on loan. Dental Treatment. 5 patients received treatment with assistance under the Council's scheme.