ISL 86 1947. 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. VAIIy & Co., X,td., Printers. 170 Farriugdon 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 (abridged) on the public health of the Metropolitan Borough of Islington for the year ended 31st December, 1947. This report marks the end of an epoch since it will be the last full year for which the Borough Council have responsibility for all services, as set out in this Report, prior to the coming into force of the National Health Service Act in July, 1948. The epoch covers a period of thirty years, i.e., from the passing of the Maternity & Child Welfare Act in 1918. Great strides in public health have been made since then and some indications of the progress made can be seen from the tables, charts, and contents of this Report. Each year, for many years past, new low records have been established in infant mortality, and in 1947 there was the exceptionally low rate of 32 per 1,000 live births. Even this rate can be reduced still further, but only with increasing difficulty as the "hard core" of infant deaths is approached. Diphtheria is not far from being eliminated, whilst tuberculosis, although not as dramatically reduced, is much less widespread and the outlook for the tuberculous patient is much more hopeful. The general standard of health, especially for children, has risen immensely and in this progress Local Authorities, including Maternity & Child Welfare Authorities and their staffs, have displayed initiative and played a worthy part which has materially assisted in bringing about the present favourable situation which, for Local Health Authorities, now constitutes the basis of their further endeavours. The birth rate and the total number of births in 1947 have exceeded even the recent record figures of the previous year and are the highest in the Borough since the early 1920s. It is also satisfactory to record that the death rate was slightly lower than in 1946. Infectious diseases generally were less prevalent than in 1946, although there was some increase in the cases of whooping cough, but the one exceptional feature of 1947 was the occurrence of the highest recorded number in any one ypar of cases of Poliomyelitis and Polioencephalitis (commonly known as Infantile Paralysis). This is dealt with in some detail in the appropriate section of this report, in which it is also noted that Islington, fortunately, was less badly hit by this disease than some other areas. The main problem in environmental hygiene continues to be proper housing and the remedying of vast numbers of sanitary defects in a Borough where three quarters of the housing may be considered out of date by modern standards. With much of this type of property the remedying of nuisances is very frequently followed within a short space of time by the occurrence of other nuisances which necessitate repeated and almost continual work for the remedying of defects. For the next 10, 15 or 20 years much labour and material must perforce go into old premises to render them wind and weatherproof, since the rate of new housing does not permit of any other measures. It may become an increasingly important question as to the extent to which owners can economically retain old properties in a habitable condition, 2 The increase in the number of restaurants and other catering establishments and the greater attention which is being paid to restaurant hygiene generally, has necessitated a re-organisation of Special Inspectors' duties to cover more comprehensively the inspection of restaurants. Proper kitchen equipment for restaurants is not easy to obtain, but even more important is the education of restaurant and kitchen staff to a higher standard of personal care and personal hygiene. The introduction of new methods of laboratory examination have enabled a better check to be kept upon the purity and safety of ice cream. A considerable amount of work has also been done during the past year in connection with the destruction of rats and mice, and the systematic application of the newer insecticides, such as compounds containing D.D.T., now gives some hope of the eventual eradication of the bug nuisance. I again have pleasure in expressing my appreciation of the work of the staff of the Department, and although Dr. Katherine Hirst's loss bv appointment to the Ministry of Health, was a serious one to the maternity & child welfare services of the Borough, her place was well filled by the appointment of Dr. Elsie Madeley, formerly Deputy Medical Officer "of Health, Acton. Important new appointments during the year also included Mr. Bartlett, Senior Sanitary Inspector, Mr. Ashcroft, Deputy Senior Sanitary Inspector and Mr. Bargh, Chief Clerk. My appreciation and thanks are also due once more to the Chairmen and members of the Public Health and Maternity & Child Welfare Committees for their understanding reception and helpful guidance in the matters reported to them. V. FREEMAN, Medical Officer of Health. 3 MEMBERS OF THE PUBLIC HEALTH COMMITTEE (As at December 1947) Mayor : Alderman Gwyn David Jones, J.P., M.R.S.T. Alderman : Herbert James Lowton Lygoe. J.P., M.S.M. Councillors : George Bennett, J.P. Miss Mary Eva Gertrude Bull Robert Henry Gordon Bushnell Mrs. Florence Hilda Cantwell, J. P. Mrs. Gladys Dorothy Cantwell Mrs. Phyllis Mabel Edwards Henry Alfred Gregory Alfred Ernest Kirby Harry Maurice Mann George William Riley, J.P. Albert John Rogers Mrs. Doris Kathleen Annette Rogers Francis Sedgley Mrs. Emily Mary Simms Mrs. Edith Agnes Spriggs Edward Albert Willis Chairman—Alderman Herbert James Lowton Lygoe, J.P., M.S.M. Vice-Chairman—Councillor Mrs. Edith Agnes Spriggs. MATERNITY & CHILD WELFARE COMMITTEE (As at December 1947) Mayor : Alderman Gwyn David Jones, J.P., M.R.S.T. Aldermen : Mrs. J. L. Blythe, J.P. Mrs. J. J. Jones H. J. L. Lygoe, J.P., M.S.M. Councillors : B. A. Bagnari Mrs. E. E. Baker Mrs. J. M. Barnes Mrs. F. H. Cantwell, J.P. L. W. Childs C. A. Goatcher Mrs. A. E. Hardy H. W. Herrington W. G. Keer A. E. Kirby Mrs. A. McKay J. H. Manley H. M. Mann Mrs. E. A. Spriggs E. A. Willis Members appointed by the Council from outside their own body. Mrs. S. Bagnari Mrs. V. G. Lygoe Mrs. Kingley Curtis Mrs. R. Simmons Mrs. C. A. Dewhurst Mrs. B. M. Vorley Mrs. K. Dowse Miss W. Wilson 4 Staff of the Public Health Department, Town Hall, Islington, N.l. (T = Staff on Temporary Establishment) Medical Officer of Health and Administrative Tuberculosis Officer. V. Freeman, M.R.C.S., L.R.C.P., D.P.H. Deputy Medical Officer of Health. Katherine M. Hirst, M.B., B.S., D.P.H. (resigned March 1947) Senior Maternity <k Child Welfare Officer. Elsie J. Madeley, M.B., Ch.B., D.M.R.&S., D.P.H. (appointed May 1947) Public Analyst. Alan W. Stewart, D.Sc., F.R.I.C. Senior Sanitary Inspector. W. C. Bartlett. Deputy Senior Sanitary Inspector. B. J. Ashcroft. Sanitary Inspectors. J. W. Aiken J. S. Ashworth A. A. Aslamidis G. W. C. Cassidy P. L. S. Clark K. L. Garner Miss V. M. Goddard G. S. Green A. W. Haydock H. R. Homewood N. Lightowlers S. A. C. Lord G. W. Maidlow S. P. Marks A. Moxon F. H. W. Pedrick Miss S. H. Prentice Miss K. G. Reader J. H. Riley H. H. Uren H. F. Williams Miss B. Wilson Joint Secretaries and Maintenance Allowances Officers, Tuberculosis Care Committee. Miss E. Cumming (T) B. Wallace (T) Tuberculosis Visiting Nurse. Miss B. E. McGoldrick. Public Vaccinators. Dr. M. J. Healy Dr. P. Inwald Dr. M. Templeton Dr. W. E. Swanston Dr. S. N. Forbes Dr. J. C. McGregor Dr. J. E. Ambrose Dr. H. D. Christie Dr. D. F. O'Donoghue Dr. G. Madden Vaccination Officers. J. Jennings L. T. K. Stevens 5 Clerical Staff: J. H. Bargh (Chief Clerk) Public Health : E. A. Bardin (T) Mrs. A. E. Ford (T) Mrs. M. L. Murden (T) Miss M. A. Blennerhassett (T) Miss D. Francis D. A. Owen Mrs. Q. V. Brown (T) E. W. George L. P. J. Regan S. A. Brown W. H. Goody (T) J. Riddlesdale (T) W. R. Causton* Mrs. E. Grattan (T) Miss W. E. Stittle Miss T. Coyle (T) P. Hardwick (T) J. Thompson (T) C. J. Cridland W. A. Mac Adam* C. M. Wheble* A. Crow (T) C. J. Moore Mrs. A. V. Williams Miss J. Dudley Maternity d- Child Welfare. Mrs. M. L. Bardin (T) Miss A. L. Gates (T) Miss C. A. Smith (T) Miss E. G. Chartres (T) Mrs. D. Gardiner (T) A. E. Vanstone Miss P. Dawson (T) Miss M. M. Haseldine (T) Miss S. J. Verney (T) L. W. Edis Miss E. C. R. Saunders (T) Miss P. I. Webb (T) Miss D. Egginton* * = Senior Sectional Clerk. Staff at Public Health Department, Seven Sisters Road, N.7. Disinfecting and Bathing Stations. W. Hampshire (Engineer-in-charge) Mrs. H. W. M. Godkin (Nurse-in-charge) 4 Home Visitors and Visitors under Scabies Order 5 Bathing Attendants 1 Stoker Handyman 1 Mortuary Keeper 1 Driver 1 Assistant Driver 3 Disinfectors. 1 Van Driver 6 SECTION A. GENERAL AND VITAL STATISTICS. Area of the Borough 3,092 acres. Population. Registrar General's estimate of civilian population, Mid-year 1947 236,840 Live Births Birth Rate per 1,000 Estimated Resident Population Totals. M. F. Islington London Admin. County. England and Wales. Legitimate 5,146 2,641 2,505 Illegitimate 431 220 211 5,577 2,861 2,716 23.55 22.7 20.5 Still Births. Legitimate 98 59 39 Rate per 1,000 Total (Live and Still) Births Illegitimate 10 4 6 108 63 45 18.99 Deaths. Death Rate (Unadjusted) per 1,000 Population Totals M. F. Islington London Admin. County England and Wales 3,053 1,552 1,501 12.89 12.8 12.0 Death from Puerperal Causes. Deaths. Rate per 1,000 Total Births. Puerperal Sepsis 2 0.35 Other Puerperal Causes 2 0.35 4 0.70 Death Rate of Infants Under One Year of Age. Islington London Admin. County. England and Wales. All infants per 1,000 live births 32 37 41 Legitimate infants per 1,000 legitimate live births 31 Illegitimate infants per 1,000 illegitimate live births 39 Notification of Births The total number of notified births, including still births from all sources, was 6,674, of this number 801 were not notified by midwives. Marriages (Provisional figures). Marriages solemnised in the Borough during the year 2,314 7 COMPARATIVE VITAL STATISTICS—1936 TO 1947. (Compiled from Registrar General's Returns) 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 Population 236,840 227,160 195,770 188,560 189,970 186,000 183,470 224,110 272,300 292,300 295,400 301,000 Live Births—(totcl) 5,577 5,284 3,708 3,826 3,592 3,368 2,986 3,850 4,168 4,487 4,516 4,650 (illegitimate) 431 442 438 335 264 251 214 272 245 278 218 222 Birth Rate per 1,000 population 23.55 23.26 18.94 20.29 18.91 18.10 16.27 17.18 14.47 15.35 15.32 15.45 Still Birth Rate per 1,000 births 18.99 22.20 22.41 25.72 24.97 33.29 26.72 32.17 30.24 27.52 29.86 29.02 Deaths 3,053 2,947 2,856 3,057 3,017 2,852 3,508 4,143 3,485 3,492 3,865 3,785 Death rate 12.89 12.97 14.59 16.21 15.88 15.33 19.12 18.48 12.79 11.94 13.08 12.57 Maternal Death rate per 1,000 births 0.70 1.48 0.26 2.03 2.71 2.29 3.02 1.59 1.47 2.17 2.79 2.09 Death-rate of infants under 1 32 39 46 48 46 54 59 47 50 65 67 62 Marriage rate per 1,000 population 19.54 20.21 25.00 18.36 18.59 25.30 28.07 32.92 23.89 19.57 20.22 19.49 T.B. Notifications per 1,000 population (all forms) 2.43 2.18 2.81 3.14 3.04 2.30 3.00 2.10 1.94 2.13 2.38 2.12 Death-rates per 1,000 population— Pulmonary T.B. 0.70 0.64 0.80 0.86 0.85 0.93 1.20 0.84 0.82 0.73 0.70 0.69 Diphtheria 0.004 Nil 0.01 0.01 0.05 0.01 0.06 0.09 0.04 0.08 0.07 0.10 Suicides 0.07 0.11 0.06 0.10 0.08 0.14 0.14 0.17 0.15 0.14 0.16 0.16 Road Traffic Accidents 0.11 0.10 0.07 0.16 0.10 0.16 0.14 0.14 * * * * Other violent causes 0.37 0.45 1.05 1.84 0.38 1.45 1.74 2.38 0.56 0.37 0.34 0.45 * Not given separately by R.G. 8 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 179 19 18 258 674 1,905 3,053 1,552 1,501 Percentages 5.86 0.62 0.59 8.45 22.08 62.40 - - - 1. Typhoid and paratyphoid fevers - - - — 1 - 1 l - 2. Cerebrospinal fever - - - - 1 - 1 i - 3. Scarlet Fever - - - - - - - - - 4. Whooping Cough 4 1 - - - - 5 2 3 5. Diphtheria - - - 1 - - 1 - 1 6. Tuberculosis of respiratory system 1 1 1 82 65 l6 166 92 74 7. Other forms of tuberculosis - 1 _ 4 5 1 11 3 8 8. Syphilitic disease - - - 3 11 12 26 1 7 5 9. Influenza - - 1 - 6 7 14 9 1 10. Measles 1 1 - - - - 2 1 1 11. Acute poliomyelitis and polioencephalitis 1 _ 1 1 - - 3 i 1 2 12. Acute infectious encephalitis - - - 1 - - i 1 - 13. Cancer of buc. cav. and oesop (M) - — - — 9 12 21 21 - Cancer of uterus (F) - - - 3 14 17 34 - 34 14. Cancer of stomach and duodenum - - - 5 28 53 86 43 43 15. Cancer of breast - - - 3 15 17 35 - 35 16. Cancer of all other sites - 1 - 18 99 184 302 174 128 17. Diabetes - - - 4 2 15 21 11 10 18. Intra-cranial Vascular lesions - — - 2 44 189 235 87\ 148 19. Heart Disease 1 - 1 23 131 616 772 3964 408 20. Other diseases of the circulatory system _ 1 - 5 18 117 141 72 69 21. Bronchitis 5 - - 4 82 229 320 204 116 22. Pneumonia 27 5 - 7 30 128 197 100 97 23. Other respiratory diseases - 2 - 1 10 17 30 l9 11 24. Ulceration of the stomach or duodenum - _ - 5 13 23 41 30 7 25. Diarrhoea (under 2 years of age) 18 1 - - — - 19 12 4 26. Appendicitis - - 2 3 2 1 8 4 41 27. Other digestive diseases 7 1 - 11 19 38 76 28 26 28. Nephritis — - - 9 20 25 54 - 2 29. Puerperal and post-abortive sepsis.. - - - 2 _ - 2 - 2 30. Other maternal causes - - — 2 - - z 20 15 31. Premature birth 35 - — - - - 35 20 - 32. Congenital malformations, birth injury, infantile disease 63 1 - 1 1 - 67 38 29 33. Suicide - — — 6 5 7 18 15 3 34. Road Traffic accidents - - 5 5 5 11 26 17 9 35. Other violent causes 8 2 4 14 7 53 88 41 47 36. All other causes 8 1 3 33 31 116 192 89 103 9 COMMENTS ON VITAL STATISTICS. Number of Births and Birth Rate. The Annual Report for 194(5 stated that the number of births for that year was the highest attained since 1931, and the birth rate the highest since 1921. In 1947 both the number of births (live) 5,577 and the birth rate, 23.55, have exceeded even those of the previous year. It is satisfactory to record, however, that the still birth rate, i.e., number of still births per 1,000 total births, was at 18.99 substantially lower than the corresponding figure of 22.20 for the previous year. Illegitimate Births. 7.76 per cent, of the 1947 births were registered as illegitimate. This continues the post-war downward trend. Deaths and the Principal Causes at each Age. The 1947 death rate was fractionally lower—12.89—as compared with the previous year of 12.97. This is not unsatisfactory in view of the very slightly higher figure for the County of London and England and Wales. It will be noted that in the classification of deaths Table the percentages of deaths in the different age groups have been given. Infants under 1 year.—The dramatic decrease in the infant deaths during the past few years has continued unabated. 1947 has produced yet another low record with an infant mortality rate of only 32 per 1,000 live births. This is substantially lower than the figure for the County of London and considerably lower than the figure for England and Wales. In view of the housing situation in Islington with considerable overcrowding and much disrepair, it is a remarkable tribute to the individual care and the better knowledge and management which has enabled so many more mothers to rear healthy infants, even as compared with the immediate pre-war years. An extremely satisfactory and startling reduction is in the infant mortality rate for illegitimate infants, which was only 39 as against last year's figure of 68. This is, of course, by far the lowest infant mortality rate for illegitimate infants ever recorded in the Borough, and where it has been necessary to emphasise in the past the adverse circumstances in which an illegitimate child may be born and brought up, it would appear that greater attention to this problem in its various aspects, including the care of the mother in pregnancy, has greatly improved the chances of child survival. Of 179 infant deaths under one year, 103, or 57.5 per cent, took place before the age of one month. Over three quarters of these neo-natal deaths were associated with premature birth, congenital malformations and birth injury, and improvement must lie principally in better ante-natal care and supervision together with medical enquiry into causes which may arise during pregnancy. From 1 to 12 months, the greatest group of deaths are now due to bronchitis and pneumonia, and not to enteritis or diarrhoea as formerly. A reduction must therefore be looked for in the avoidance of colds, respiratory catarrh generally, and whooping cough and measles in the young infant . Deaths from Puerperal Causes.—There were only 4 deaths in 1947, giving a rate of 0.70 per 1,000 births. With the exception of 1945 this is the lowest rate on record in Islington, but as every maternal death must be regarded as potentially avoidable, there is till a lower target to be achieved. 10 Other Causes.—In the age group 15-45 no less than 82 of the 258 deaths in this group were ascribed to pulmonary tuberculosis. It is to be regretted that the death rate for pulmonary tuberculosis, although no higher than in the immediate pre-war years and lower than the peak war years, is not showing the tendency with most other infectious diseases, to a further decline. In the age groups, 45 and upwards, the principal causes of death are diseases of the heart and circulation (34.2 per cent.), various forms of cancer (17.4 per cent.) and bronchitis and pneumonia (17.4 per cent). Infectious Diseases. Sickness and fatality rates due to the principal infectious diseases are considered in more detail in Section F of this report. 11 SECTION B. GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. Maternity & Child Welfare. Welfare Centres. WELFARE CENTRE Chil iren's Ante-Natal and Post-Natal Immunisation De ntal Medical Officers Health Visitors North Islington Voluntary Welfare Centre, Mon. to Tues. to Mon. 1.30 p.m. Mrs. Mavis Stratford. M.R.C.S., L.R.C.P. Miss A. Davies (Supt.) fi-9, Manor Gardens, N.7. Fri. 1.45 p.m. Fri. 9 a.m. Tues. 9 a.m. & Mrs. Eve Attkins, M B., B.S.(I«dn.), D.A., Miss Callaghan 2.45 p.m. (R.C.P. & S.Eng.). Miss Cassell Mrs. Amelie Boyd, M.B., Ch.B., B.A.O., D.P.H. Miss Flower Miss Anne Campbell, M.B., Ch.B. Miss Jones Mrs. Louise Hewlett, M.D., B.S., M.R.C.P. Miss Kitchener Mrs. Joan Warwick, M.R.C.S., L,.R.C.P. Mrs. Lynch Mrs. Aileen Cobbe, M.B., D.R.C.O.G. Miss McNamara Miss Marv Adams, M.R.C.S., L.R.C.P., M.B., Mrs. Main B.S.(Ldn.). Miss Rose Mrs. Dorothy Gibson. L.R.C.P. & S.(Edin.) North Branch Clinic, Fri. 1.45 p.m. Blythe Mansions, Hornsev Rise, N.19. North Branch Clinic, Wed. 1.45 p.m. 112, Fonthill Road, N.4. Miss Rochelle Churin, M.R.C.S., L-R.C.P. Miss Pyle (Supt.) West Islington Voluntary Welfare Centre, Mon., Tues. 9.45 a.m. Wed. 10.30 a.m. Mrs. Cecilia Galton, M.R.C.S., I,.R.C.P. Miss Hepburn 42 & 44, Richmond Avenue, N.l. Wed. & Tues. 1.30 p.m. Miss Evelyn Maclagen, M.B., B.S., B.Ch., Miss Trueman Fri. 1.30 p.m. Thurs. 9.45 a.m. D.P.H. Mrs. Leopold Miss Hilda Page, M.R.C.S., Iy.R.C.P. Miss Evelvn Pakeman, M.R.C.S., I*.R.C.P., M.B., B.S. Mrs. Joyce Simpson, M.B., B.S., B.Ch., D.P.H. West Branch Clinic, Thurs. 11 a.m. & St. Luke's Mission Hall, Goodinge Road, N.7. 1.30 p.m. South Islington Welfare Centre, Wed. 1.30 p.m. Mon. 9.30 a.m. Tues. 2 p.m. Wed. 9.30 a.m. E. Harford Rees, M.R.C.S., L.R.C.P., M.B., Miss Paley (Supt.) Tibberton Square, Essex Road, N.l. Thurs. 9.30 a.m. Fri. 9.30 a.m. B.S. Miss Devine & 1.30 p.m. & 1.30 p.m. Mrs. Charlotte Himsworth, M.R.C.S., Iy.R.C.P., Miss Garabedian M B., B.S. Miss Hitchings Miss Margaret McLaughlin, M.R.C.S., I,.R.C.P., Miss Langridge M B., B.S. Miss Moffatt Mrs. Joan Warwick, M.R.C.S., L.R.C.P. Mrs. Wilkinson (Dental Surgeon) South Branch Clinic, Mon. 1.30 p.m. Miss Cicely Peake, M.B., B.S. Union Chapel, Canonbury Avenue, N.l. Tues. 9.30 a.m. South Branch Clinic, Tues. 9.30 a.m. Mildmay Sunray Clinic, Mildmay Memorial & 1.30 p.m. Hospital, Newington Green, N.l. Thurs. 1.30 p.m. East Islington Welfare Centre, ... Tues. 9.30 a.m. Mon. 9 a.m. Fri. 10 a.m. Mrs. Rosalie Burke, M.R.C.S., L.R.C.P. Miss Anderson (Supt.) 32, Drayton Park, N.5. & Fri. 1.30 p.m. Wed. 9.30 a.m. Mrs. Elma Chitty, M.B., Ch.B. Miss Oliver 1.30 p.m. & 1.30 p.m. E. Harford Rees, M.R.C.S., L.R.C.P., M.B., Miss Schlund B.S. Miss Thomas Miss Soothill East Branch Clinic, Thurs. 9.30 a.m. Highbury Vale Mission Hall, Hurlock Street, & 1.30 p.m. N.5. 12 The two Voluntary Welfare Centre Committees receive a grant from the Borough Council, and for the year ending 31st March, 1947 this was :— £ North Islington Infant Welfare Centre 4,825 West Islington Welfare Centre 1,150 Ante-natal and Post-natal Clinics. These are combined clinics, and attendances, which had been doubled during the previous year, were well maintained. The number of clinics held weekly, and the attendances at each of the four Welfare Centres are set out hereunder :— North South East West Total Number held weekly 7 3 3 3 16 Number of expectant mothers whoattended 1,507 (1,661) 746(1,081) 593(640) 734(643) 3,580(4,025) Number who attended post- natally 234 (175) 96 (82) 75 (55) 67 (33) 472 (345) I Figures in brackets are for 1946) Child Welfare Clinics. The total number of children who first attended at the Centres during the year and who, on the date of their first attendances were :— North South East West Total (i) Under 1 year 1,405 (1,301) 1,125 (974) 746 (638) 878 (830) 1,154 (3,743) (ii) 1-5 years 123 (134) 45 (106) 62 (75) 105 (119) 335 (434) The number of children who attended at the Centres duriug the year and who at the end of the year, were :— (i) Under 1 year 1,229 (1,133) 971 (973) 633 (535) 804 (756) 3,637 (3,397) (ii) 1-5 years 1,907 (1,511) 1,184 (1,018) 896 (722) 1,062 (873) 5,049 (4,124) (Figures in brackets are for 1946) Home Visiting. Totals l. First Visits, infants under 1 year 5,595 (4,904) 2. Revisits ditto 15,874 (11,335) 3. Visits to children between 1st and 2nd years 10,116 (7,369) 4. Visits to children between 2nd and 5th years 16,586 (13,840) 5. Visits re stillbirths 88 (104) 6. Visits re deaths of infants under 1 year 46 (39) 7. Visits re deaths of children between 1st and 5th years — (8) 8. Visits re Ophthalmia Neonatorum 37 (-) 9. Visits re other Infectious Diseases 40 (—) 10. Ante-natal first visits 2,783 (2,666) 11. Ante-natal re-visits 1,641 (1,419) 12. Post-natal visits 152 (-) 13. Visits re Puerperal Fever cases 4 (14) 14. Visits re Puerperal Pyrexia casees 38 (53) 15. Visits re Home Help and Domestic Help cases 419 (380) 16. Visits re Registration of Daily Guardians 84 (46) 17. Incomplete visits 5,738 (3,480) 18. Ineffective visits 13,926 (13,901) 19. Total number of effective visits 53,503 (42,330) 20. Clinic Sessions attended 5,493 (5,678) (Figures shown in brackets are for 1946) Those with no figures in brackets for 1946 were not reported last year. Health Visitor Staff. As mentioned in last year's Annual Report, the Health Visitor establishment was increased to 32, including the four Superintendents of Welfare Centres. At no time during the year under review was this figure reached at any one time, although 7 new health visitors were appointed during the year. During the same period, however, 1 Health Visitor died, 1 retired, and 5 resigned. 13 Olio part-time Clinic Nurse was engaged on a sessional basis to assist the health visitors in clinic duties. Child Life Protection. As stated in the report for 1946, Child Protection work was undertaken by the two Special Health Visitors and Child Protection Visitors, who undertake the work connected with problem illegitimate children and unmarried mothers. connected with problem illegitimate children and unmarried mothers. 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 1947 24 Number of foster children being cared for at end of year 30 These figures show a decrease of 7 foster-mothers and 4 foster-children as compared with the figures given at the end of 1946. The number of foster-mothers is still inadequate causing hardship in emergencies, especially in the case of an unmarried mother urgently needing to work and with no one available to take on the care of her child. Fifty-four w invn acted as foster-mothers during the year, some taking a child for a short period only, and not wishing to be approved to continue as foster-mothers. In these short term cases arrangements were generally made between a mother and friend, and there appears still to be a widespread lack of knowledge of the need to notify the Local Authority when a foster-child is about to be received, or is already being cared for. During the period under review 4 foster-mothers were removed from the Register, and 12 new ones were approved. The special scheme for assisting with the payment of fees to foster mothers in respect of illegitimate children, was used in respect of two children during the year. There were no deaths amongst foster children and no legal proceedings were instituted. The Child Protection Visitors continued to co-operate with various voluntary organisations. Mrs. V. M. Rennie and Miss R. Harding carried out the duties of Child Life Protection Visitors, the latter replacing Miss M. Robinson, who was granted a year's leave of absence to undertake additional training. Illegitimate Children. During 1947 there were 431 registered illegitimate births for this area. The Special Health Visitors dealt with 474 cases, 323 of which were new during the year. These mothers were helped in making arrangements for the confinement, and other personal problems were dealt with. In many cases the mother and child returned to relatives, and in a large number the mother and father co-habited. In a few other cases the putative father contributed towards the maintenance of the child. Arrangements were made for the adoption of 22 children, 18 were admitted to residential nurseries (Institutions), and 25 were placed with foster-parents. 14 327 interviews were given to mothers at the Town Hall during the year, and the two Special Health Visitors were available at the Town Hall every Thursday evening from 5-7 o'clock. This evening session proves of great help to mothers at work. This work is carried on in co-operation with moral welfare workers, hospital almoners, welfare centres, and other social agencies. In accordance with the Metropolitan Boroughs' Standing Joint Committee, the Islington Borough Council contributed £212 for 1947 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 Year 1947. Total Cases Dealt with Adopted Admitted to Institutions Died Fostered Number on Register at end of year 474 22 18 5 (plus 1 still-birth) 25 273 ANALYSIS OF NEW CASES FOR YEAR ENDING 31.12.47 Before Birth 0-2 mths. 2-6 mths. 6-12 mths. 1-2 yrs. 2-3 yrs. 3-4 yrs. 4-5 yrs. Total Infant with Mothers :— (a) at home (Grandmother's) 9 15 7 19 9 4 4 3 70 (b) in institution. — 28 18 3 1 — — — 50 (c) living alone 12 2 3 11 5 4 1 1 39 Infant with mother and father co-habiting — 16 14 23 9 5 5 3 75 Infant with relatives without mother — — — 2 — 2 2 — 6 Infant with foster-parents ... — 2 7 2 6 5 3 25 Infant with adopting parents — 7 9 3 1 1 1 — 22 Infant temporarily in residential nursery— (a) Social Welfare — — 2 2 — 1 — 1 6 (b) Other — — 2 1 — — 1 1 5 Other arrangements — 4 5 11 1 2 2 — 25 Total 21 74 67 77 32 24 19 9 323 Attending Day Nursery - - - 10 4 4 6 2 26 With Daily Guardian — — — 4 1 2 — — 7 Premature Infants. The following figures are taken from records kept for the year 1947 in accordance with Ministry of Health Circular 20/44 with regard to premature births (i.e. birth weight 5£ lbs. or less):— 15 (i) Total number of premature births notified during 1947 which occurred:— (a) at home 106 (6) in hospital 181 (ii) Number of babies born at home:— (a) who were nursed entirely at home 97 (6) who died during first 24 hours 2 (c) who survived at end of 1st month 97 (iii) Number of babies born in hospital:— (a) who died during first 24 hours 14 (b) who survived at end of 1 st month 149 Three premature baby outfits have been provided by the Borough Council oi loan free of charge to those homes where a premature infant is born and wher inadequate facilities are available for nursing the infant at home or for variou reasons transfer to hospital is not desired. Each outfit includes a treasure cot blankets, infant clothes, hot-water bottles, thermometers, feeding pipettes, etc Two of these outfits were loaned for several weeks during 1947 to a home in whicl twin premature infants were born. They were greatly appreciated both by th parents and the midwife in charge of the case. Home Helps and Domestic Helps. These services have continued to expand, and in the case of Domestic Hel] the service has grown rapidly and considerably during the period under review. Ii order to build up a more efficient and more easily controlled band of workers, th establishment of regularly employed Council Helps was increased from 6 to 2C towards the end of the year, in addition to the continued building up of the panel o approved Helps available on an intermittent basis. As will be seen from the following figures both applications for the service, am women available to do the work, increased considerably. Even so, the demand especially in the case of aged and infirm people, is always greater than the supply. As will be realised the average length of stay of a Help in confinement cases i usually 2 weeks, though there have been an increasing number of Home Help case where extension of the service has been granted for varying periods. In Domesti Help cases, however, the help extends over varying periods, many of them indefinitely The majority of them are part-time cases, where the number of hours help requirei may vary considerably from only 3 hours to 20 or 30 a week, and this part of th service calls for a great deal of organisation satisfactorily to fit in as many a possible of those so urgently in need of help. The figures for 1947 are as under :— Home Helps cases (i.e., confinements, incapacity during pregnancy and help in households where there are children under 5 years): £ s. d. No. of cases 353 Cost to Borough Council 2,770 15 1 Domestic Help cases (i.e., mainly aged and infirm people) : • No. of cases 101 Cost, which is reclaimable from Ministry of Health 1,209 10 4* At the end of the year the following were on the Borough Council's Approved List of Home Helps available for both services :— 13 employed on regular basis. 36 on intermittent basis (15 whole-time and 21 part-time). 16 Student Health Visitors. At the request of the Royal College of Nursing, the Battersea Polytechnic and the London County Council, a total of eight Health Visitor Students attended in this Borough during 1947 as part of their practical training in home visiting, and in welfare centre clinic duties. Emergency Obstetric Unit. One of the most valuable contributions towards saving the lives of mothers in confinements was the establishment of the Emergency Obstetric Unit, popularly known as the "Flying Squad." This service was first provided for the Borough on behalf of the Council by University College Obstetric Hospital in 1938, and is believed to be the first of such Units formed in the Metropolis. It was provided to cope with emergencies arising in home confinements, in particular to give treatment in the home in cases where there would be an undesirable risk in removing the mother to hospital immediately. The Hospital undertook to make the Unit available any time day or night when called by doctor or midwife for any home confinement in the Borough. The Unit consists of a staff of three, one senior obstetric specialist, an assistant medical officer, and an experienced nurse, and the equipment also includes everthing necessary for blood or similar transfusions. By the nature of the Unit it was intended that every call for its assistance should be of a life and death character. Naturally, therefore, it was not expected or hoped that calls would be frequent, although every call would be of the utmost importance. Since the Unit was first established, doctors and midwives in the Borough have made increasing use of it as shown by the following figures. Year No of cases 1938 - 1939 2 1940 2 1941 - 1942 2 1943 3 1944 2 1945 4 1946 9 1947 10 The following cases are typical of those for which the Unit is being called out. Case 1.—The obstetric Flying Squad was called at 11.20 p.m. the call being received from Dr.—. Patient who is 22 had been delivered of her first baby and immediately after delivery of the placenta there had been a very severe post-partum haemorrhage with the loss of 80 ounces of blood. On arrival of the Flying Squad at the house the patient was found to be in a state of collapse with a pulse rate of 140 and blood pressure of 80/50. Patient was given plasma and blood transfusion, one pint of each, and morphia, and with this treatment she made a very satisfactory improvement and the Flying Squad left the house at 1 a.m. Case 2.—The Obstetric Flying Squad was called by Dr. —, at 10 a.m. and the Unit arrived at the house at 10.20 a.m. The patient was found to be in a state of obstetric shock suffering from post-partum haemorrhage. Her blood pressure was 80/50 and her pulse rate about 100. An immediate transfusion of Group O Rh— 17 was put up, and manual removal of the placenta was carried out under chloroform anaesthesia. The transfusion was completed and the patient received a total of 420 c.c. of blood and 500 c.c. human serum. A course of penicillin and sulphathiazole is ordered. At 11.30 a.m. the patient's condition showed a great improvement, there being no further bleeding ; the blood pressure rate was 130/70 and the pulse rate 110. The patient's general condition was satisfactory when the Unit left the house at 11.40. Case 3.—A call was received at 8.10 p.m. from Dr.—, and the Unit arrived at 8.30. The patient was suffering from acute blood loss. At 6 o'clock the patient had been delivered of an 8 lb. baby and within half an hour haemorrhage started. By the time the Unit arrived it was estimated she had lost two pints of blood. On examination of the patient the pulse rate was found to be 130 and blood pressure 00/60. Resuscitation commenced immediately and this necessitated a transfusion of blood and plasma ; in all two pints of plasma and one pint of blood were given. The team left at 10.10 p.m. with the patient much better. Case 4.—The Obstetric Flying Squad was called at 12.01 a.m. by Dr. —, patient having been delivered of twins earlier in the evening. There was very severe postpartum haemorrhage associated with the retention of the second placenta. The Unit reached the patient's house at 12.30 a.m. Treatment consisted of plasma and blood transfusion and a manual removal of the placenta under anaesthetic. The patient's condition was very satisfactory when the Unit left the house at 2 a.m. Coupon-Equivalent Dockets tor Sheets for Expectant Mothers. Dockets continued to be issued through the Maternity & Child Welfare Office at the request of the Ministry of Health on behalf of the Board of Trade. During 1947 the following were dealt with :— Number of mothers to whom issued 961 Number of dockets issued 2,454 Additional Maternity Bed Scheme. Under this scheme, initiated by the London County Council in 1944 with the co-operation of the Metropolitan Borough Councils, the Islington Borough Council 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 these beds is arranged by the Medical Officer of Health through the Maternity & Child Welfare Office and the Welfare Centres. In 1947 the beds at both hospitals under this scheme were fully used, witli the exception of two or three months in the late summer. 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 Hospital50 cases Royal Free Hospital 188 cases 18 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 1947 the total quantity of milk paid for by the Borough Council was as under :— Pints of Liquid Milk 703 Packets of Dried Milk (lbs.) 1.717½ Total cost to Council £73 6s.0 1d. 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 and D Tablets. Vitamins. From information kindly supplied by the Islington Food Office, the take-up of cod liver oil, etc., in the Borough was as follows :— Cod Liver Oil 39.73 per cent. Orange Juice 41.98 per cent. Vitamins A and D 32.67 per cent. It is agreed with the Food Office that the take-up is not as satisfactory as it might be, and medical officers at Welfare Centres and health visitors have been asked to pay special attention as to whether mothers attending or visited are taking full advantage of the supplies made available through the Ministry of Food. It is thought that the availability of these special foods is a potential factor in the health of mothers and children. Provision of Dentures for Expectant and Nursing Mothers. As described in previous annual reports, this scheme 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 40 Cost to Council £121 4s. 9d. Invalid Children's Aid Association. A grant of £250 was paid to the Invalid Children's Aid Association for their work for Islington children under 5 years of age during 1947, an increase of £50 over the previous year. Nursing in the Home. A grant of £200 was paid during 1947 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. Under this scheme the Borough Council pay a subsidy of 6s. per week per child to Approved Daily Guardians caring for Islington children under 5 years during the day-time whilst their mothers are at work. The subsidy is paid through the four Welfare Centres at which the Daily Guardian attends with the child, and her care of the child is supervised by the Health Visitor. At the end of 1947 there were 59 19 approved daily guardians on the Register with accommodation for a total of 105 children. 51 of these were employed as such at the end of the year and were caring 'or 88 children. The amount paid out in subsidies by the Borough Council for 1047 totalled £816 3s. Od. Day Nurseries. At the beginning of 1947 there were 9 Day Nurseries in operation. The number of child places was 483. Three circulars were received from the Ministry of Health and the Ministry of Education during the year. The first, in March (Circular 30/47 (Ministry of Health) and 135/47 (Ministry of Education))—dealt with recruitment of Wardens. The second, in August, (Circular 119/47 Ministry of Health) dealt with the free supply to each Day Nursery child attending during the morning and afternoon of 2/3rds. pint of liquid milk per day and 6 ozs. of cod liver oil per 12 weeks. All Day Nurseries had to register in order to benefit and Day Nurseries not belonging to Local Authorities had to be certified by the Medical Officer of Health to be genuine non-residential Day Nurseries suitable to receive benefit. The source and quality of the milk supplied had also to be certified as suitable by the Medical Officer of Health. The third circular, in December (Circular 168/47 (Ministry of Health) and 157/47 (Ministry of Education) ) dealt with a complete revision of all salaries of non-domestic workers in Day Nurseries. This joint circular was adopted as from 1st October, 1947. In October the Day Nursery in Huntingdon Street had to be closed as the building was found to be a dangerous structure. All the children in attendance at the Nursery were found places at other Day Nurseries. During the year there was a total of 190 cases of infectious disease at the Day Nurseries. The greatest number of cases was due to measles and whooping cough which accounted for 61.6 per cent, of all cases. There was only one case of diphtheria (nasal) during the year. 1947 will be remembered as the year when there was an alarming outbreak of Poliomyelitis all over the country. Special precautions were taken at all Day Nurseries in the Borough because of the vulnerability of the child population. The Ministry of Health had advised that if a case occurred at a Day Nursery it should be closed and that a contact should be excluded for three weeks. One child was excluded from Camden Road Day Nursery as a contact, but the case was not confirmed and the child was re-admitted. There were no cases of Poliomyelitis among Day Nursery children during the year. At the end of the year there were 8 Day Nurseries open :— Scholefield Road 60 places Camden Road 66 „ Clephane Road 60 „ Plimsoll Road 33 „ Pembroke Street 50 „ Canonbury Place 70 „ Windsor Street 68 ,, Mitford Road 68 „ 475 20 Miss Kelly, S.R.N., Superintendent Matron of Day Nurseries, resigned at the end of the year, and her place was not tilled until 21st January 1948 by Miss Powell, S.R.N. The following are the matrons of the Day Nurseries:— Miss Sampson, Mrs. Parker, Mrs. Tew, Miss Selby, Mrs. Drake, Mrs. Watson, Miss Wellacott, Mrs. Hicks. There are also 8 Deputy Matrons, 8 Wardens, 21 Nursery Nurses and 47 Nursery Assistants. The two medical officers who visit the Day Nurseries are— Miss Mary Adams, M.R.C.S., L.R.C.P., M.B., B.S. (Ldn). Mrs. Phyllis Dobbs, M.R.C.S., L.R.C.P., B.,Chir. There is one private nursery in the Borough sited in the premises of a laundry, and established so that mothers working in the laundry could leave their children during the day. There are approximately 35 children in this laundry. The nursery is not under the control of the Council, but the premises have been well adapted to their purpose. The Matron is a State Registered Nurse and a Medical Officer, privately appointed, is on call and inspects the children periodically. Other Public Health Services. Bacteriological Examinations. Total Swabs (Diphtheria) 679 Sputum (Tuberculosis) 126 Faeces (Typhoid) 1 Faeces (Paratyphoid) 2 Faeces (Dysentery) 3 Faeces (Food poisoning) 23 Swab (Streptococci) 1 Blood (Syphilis) 1 Vomits (Food poisoning) 10 Total 846 Provision of Insulin. Under Section 227 of the Public Health (London) Act, 1936 34 patients received assistance during the year. The cost to the Borough Council was £185 13s. 5d. 24 Home Visits of enquiry were paid by the Council's Home Visitors. Islington Crematorium. There were 137 cremations daring the year at the Council's Crematorium, East Finchley, all of which were certified by the Medical Referee or Deputy Medical Referee. Public Mortuary. During the year 1947 ten bodies were received pending burial. The Coroner's Court was not used, neither were inquests nor autopsies carried out in the Court, 21 SECTION C. SANITARY CIRCUMSTANCES OF THE AREA. There is little that can be added to the information recorded in last year s Annual Report. Consequent upon the number of Sanitary Inspectors continuing to be below establishment and the volume of complaints which must be dealt with, considerable difficulty has been experienced during the year, and only the more urgent cases have received attention. It is hoped that with the completion of flats which are under construction, the position with regard to overcrowding will be somewhat eased, but it will be some considerable time before any appreciable improvement will be felt. Whilst there is a shortage of Sanitary Inspectors at present, it is anticipated that with training facilities for Inspectors being resumed, the position will improve in the course of the next few years. With a view to ensuring that complaints received were attended to as expeditiously as possible, a priority scheme was introduced. By this method the complaints were divided into three categories, viz.: A. B. and C., and the Inspectors instructed to arrange inspections according to the category of the complaint and thus ensure that the most serious ones received earliest attention. In spite of this arrangement, all complaints did not receive initial attention owing to the depleted number of Inspectors and the volume of complaints requiring attention. The re-visiting of premises in order to follow up Notices which were served by the Inspectors was also required to be carried out in the order of priority. During the year the question of the clearance of bombed sites was one which received considerable attention, particularly in view of many complaints which were being received by this Department. Difficulty was caused by fly-tippers and much of the deposits and accumulations could not be considered as falling within the definition for Statutory Nuisance, and therefore no action could be taken by this Department. Where any accumulation was alleged to exist on such sites, arrangements were made for the Sanitary Inspector to visit and confirm the existence of a nuisance. Upon receipt of such a report details were passed to the Cleansing Superintendent who arranged for the accumulation to be removed. This arrangement has worked satisfactorily, the cost has not been excessive and has prevented accumulation of putrescible material further decomposing and being a breeding ground for flies, rats, etc. As a result of the abnormal spell of hot weather experienced during the summer months the problem? relative to fly nuisance were very pronounced. A particularly heavy infestation occurred at one of the railway sidings in the Borough but with the co-operation of the Railway officials and others concerned the nuisance was soon overcome. The problem of vermin infested houses also became more acute, but with the application of D.D.T., premises were efficiently dealt with. Due to the deterioration in the condition of property generally and certain publicity which was given in the Borough, there was a considerable increase in the number of Certificates issued under the Rent & Mortgage Restrictions Act. 22 Public Health (London) Act, 1936. Emission of Smoke. Considerable difficulty has been experienced in enforcing the appropriate provisions of this Act relevant to smoke nuisances during the year. The London County Council has forwarded information conce-ning a number of observations carried out by their Inspector in respect of certain Factories within the Borough, and the firms concerned have been given details of these observations. In addition, two Inspectors of this Department engaged on work in connection with Factories, etc., have also made a number of observations and where necessary, Notices have been served. The various Factory owners have, almost without exception, replied to the effect that they are unable to ensure that no nuisance occurs owing to the very poor quality of the fuel supplied to them. In addition, difficulty has been experienced in regard to the stoking of the furnaces> partly because many of the stokers have had limited experience in this work. While appreciating these difficulties, the Department, has, through its Inspectors, endeavoured to assist wherever possible either by giving personal advice to the engineers or stokers or by communicating with the Ministry of Fuel and Power supporting the application of the various firms for a supply of a higher grade coal. In some cases the furnaces have been converted in order to burn oil fuel and this has so far proved to be a satisfactory method of abating the nuisance. Summary of Work done by District Sanitary Inspectors. During the year 31,542 inspections (including re-inspections) were carried out by the District Sanitary Inspectors, made up as follows :— House to house inspections 1,413 Other premises inspected 8,602 Re-inspections, calls made, etc. 21,527 31,542 Special Matters dealt with when making the above visits— Urinals attached to Public Houses 29 Premises for Foster children 12 Premises re vermin 463 Premises re Rats and Mice 207 Premises re Water Certificates 247 Non-effective visits 3,590 Notices served—Intimation (Public Health (London) Act, 1936) 7,134 Notices served—Statutory (Public Health (London) Act, 1936) 1,107 Rent and Mortgage Restrictions Acts. 1920, etc. Certificates applied for 251 Certificates issued 230 Certificates refused 20 Balance to 1948 1 Clearance Certificates applied for 53 Clearance Certificates granted 34 Clearance Certificates refused 19 23 Prosecutions (North London Police Court). Public Health (London) Act, 1936. Date of Hearing Address Offence Result of Proceedings 18.2.47 6, Medina Road, N.7 Roof and wall defective. Obstructed W.C. drain. Fined £5. Costs £1 Is. 14.7.47 28, Highbury Grove, N.5 Defective soil and rainwater pipes, ceilings, W.Cs., and floor. 14 days' Order. Costs £3 3s. 30.6.47 28, Highbury Grove, N.5 Defective roofs, soil pipe ; bath and wash-hand bowl wastes broken and leaking. Adjourned sine die. 30.6.47 18, Sheriugham Road, N .7 Defective floorboards, sashcords and main roof. Insecure fixing of sink. 14 days' Order. Costs £2 2s. 23.7.47 36, Davenant Road, N.19 Defective main and back addition roofs. 21 days' Order. Costs £3 3s. 23.7.47 8 & 9. King Edward Buildings, N.7. W.Cs. stopped. Landing ceiling fallen and roofs leaking. 14 days' Order. Costs 10s. 6d. 23.7.47 50, King Edward Buildings, N.7 W.C. pan, trap and floor broken. Soil pipe obstructed. 14 days' Order. Costs 10s. 6d. 23.7.47 51, King Edward Buildings, N.7 (1) W.C. pan and trap broken. Landing floor broken. 14 days' Order. Costs 10s. 6d. (2) Window sills, frame and sash defective. Walls dirty and dilapidated. 21 days' Order. Costs 10s. 6d. 23.7.47 52, King Iidward Buildings, N.7 W.C. and kitchen floors broken. Flushing cistern defective. 14 days' Order. Costs 10s. 6d. 23.7.47 53, King Edward Buildings, N.7 Sink waste pipe trap and pipe on external wall leaking. Flushing cistern defective. 14 days' Order. Costs 10s. 6d. 23.7.47 71, King Edward Buildings, N.7 Roof leaking and causing dampness and damage. 42 days' Order. Costs 10s. 6d. 16.10.47 11, Rhodes Street, N.7 Roof, gutters, down pipes, brickwork, pointing, floors, sink, W.C. floor and cistern defective. Unfinished condition of top floor rooms and landing—uninhabitable. 28 days' Order. Costs £2 2s. 1.10.47 23, BurderRoad, N.l Defective firebacks and grate ; roof, front box gutter, floor joists and boards. Walls and ceiling damp. 28 days' Order. Costs £1 Is. 27.10.47 3, Lesly Street, N.7 Defective main roof and ceilings ... 60 days' Order. Costs £1 1s. 27.10.47 25, Lesly Street, N.7 Roofs ; front steps and stop valve to water main leaking. Wall damp. 60 days' Order. Costs £1 1s. 27.10.47 31, Lesly Street, N.7 Defective gutter, wall and ceiling plaster. Damp and dirty walls— stove broken. 60 days' Order. Costs £1 1s. 27.10.47 39, Lesly Street, N.7 Roof defective 60 days' Order. Costs £1 1s. 14 J 1.47 107, Mildmay Grove, N.l (1) No cooking facilities top floor flat. Defective roof, ceiling and W.C. door. 21 days' Order. Costs £1 1s. (2) Insufficient domestic water supply. 21 days' Order. Costs £1 1s. 14.11.47 42. Tilloch Street, N.l (1) Roof and ceiling defective. Dampness. 28 days' Order. Costs £1 1s. (2) Failure to provide water supply Adjourned sine die. (3) Failure to cleanse rooms 28 days' Order. Costs £1 1s. 14.11.47 101, Eiversdale Road, N.5 (1) Defective roofs, rainwater downpipe and pointing. 28 days' Order. Costs £1 1s. (2) Defective roofs, ceiling, wall plaster and window. 28 days' Order. Costs £1 1s. 14.11.47 1, Corinth Road, N.7 Defective roof; gutter; sink waste; water service pipe; wall plaster; ceilings and sashcords. Stove broken and walls wet. 28 days' Order. Costs £1 1s. 24 Date of Hearing Address Offence Result of Proceedings 4.12.47 1, Lesly Street, N.7 • (1) Defective soil and rainwater pipes ; roofs ; wall and ceiling plaster ; fireranges and stove ; window woodwork, etc., and W.C. flushing cistern. Floor broken and damp walls. Rubbish accumulation. 84 days' Order. (2) Verminous room Adjourned 4.12.47 3, Lesly Street, N.7 Rear roof, walls and ceilings defective. Section rainwater pipe missing. Dangerous main rear wall. 84 days' Order. 4.12.47 5, Lesly Street, N.7 Defective wall ; firerange and grates ; ceilings ; copper flue ; window woodwork, etc., and guttering. Accumulation of rubbish. 84 days' Order. 4.12.47 7, Lesly Street, N.7 Defective roof ; gutters ; walls and ceiling plaster ; window frames, etc., and flushing cistern. W.C. seat broken. Washing copper unusable. Rainwater pipe missing. 84 days' Order. 4.12.47 9, Lesly Street, N.7 Defective wall and ceiling plaster ; roof : gutters ; windows ; firebacks and range and wall boarding. Accumulation of rubbish. 84 days' Order. 4.12.47 11, Lesly Street, N.7 (1) Defective roof ; gutters; walls and ceiling plaster ; firegrates and ranges ; window woodwork, etc. ; and sink. Air inlet grate missing. External wall damp. 84 days' Order. (2) Verminous rooms Adjourned. 4.12.47 13, Lesly Street, N.7 Rainwater downpipe broken, part missing. Defective gutters ; firegrate ; flue to copper ; window woodwork, etc. ; ceiling plaster and flushing cistern. Burst water pipe ; external wall damp. Accumulation of rubbish. 84 days' Order. 4.12.47 15, Lesly Street, N.7 (1) Defective windows ; roofs ; walls and ceiling ; fireplace ; brickwork and j pointing ; rainwater pipe and flushing cistern. Damp walls. Burst water pipe. Accumulation of rubbish. 84 days' Order. (2) Verminous rooms Adjourned. 4.12.47 17, Lesly Street, N.7 Defective main roof ; rainwater pipes; wall plaster and firebacks. Accumulation of rubbish. 84 days' Order. 4.12.47 19, Lesly Street, N.7 Defective roofs; walls and ceiling plaster; fire-ranges and grates; window woodwork, etc.; and floor. Walls damp and dirty. 84 days' Order. 4.12.47 21, Lesly Street, N.7 Defective stove; fireplaces; wall plaster; window; W.C. cistern; roof; gutter; and sink. Burst water service pipe. Main roof top light missing. Accumulation of rubbish. 84 days' Order. 4.12.47 23, Lesly Street, N.7 Defective rainwater pipes; W.C. roof; wall and ceiling plaster; and window woodwork. 84 days' Order. 4.12.47 25, Lesly Street, N.7 (1) Defective ceiling and wall plaster; window woodwork, etc. Door off hinges. Accumulation of rubbish. 84 days' Order. (2) Verminous rooms Adjourned. 4.12.47 27, Lesly Street, N.7 Rainwater pipe defective 84 days' Order. 4.12.47 29, Lesly Street, N.7 Defective gutters; rainwater pipe; roofs; ceilings; wall plaster; fireranges; match boarding. Damp walls. Tap defective. 84 days' Order. 25 Date of Hearing Address Offence Result of Proceedings 4.12.47 31, Lesly Street, N.7 Defective rainwater gutters and wall plaster. Wall damp. 84 days' Order. 4.12.47 35, Lesly Street, N.7 (1) Defective walls, ceilings; chimney breast; windows; balusters; W.C.; flushing cistern; rainwater pipe; firerange and grates. Accumulation of rubbish. 84 days' Order. (2) Verminous rooms. Adjourned. 4.12.47 37, Lesly Street, N.7 (1) Defective roofs; gutters; rainwater pipes; sink waste pipe; walls and ceiling plaster; window and handrail. Firegrate dangerous. Dampness. 84 days' Order. (2) Verminous rooms Adjourned. 4.12.47 41, Lesly Street, N.7 W.C. floor dangerous. Defective fireplace. 84 days' Order. Scabies and Vermin. The Scabies Order 1941 and Defence Regulation 33a, which were introduced as an emergency wartime mea.sure to combat an exceptional increase of Scabies, was rescinded by the Ministry of Health on the 31st December, 1947. It was not considered warrantable to keep in force the powers of entry into residential premises and compulsory examination and treatment which were authorised under the Order. Following the rescindment of the Order powers for dealing with persons affected with Scabies and vermin would be those given in the Public Health Acts. Since the inception of the Scabies Order in 1941 it was not found necessary, fortunately, to use the Order on many occasions although it proved useful with a few exceptionally difficult families. Though the Order has been rescinded, Scabies continues to be notifiable under the County of London (Scabies) Regulations, 1943. Scabies Order, 1941. During 1947 the following Notices were served :— Notice A (inspection of premises) 6 Notice B (medical examination) 16 Notice C (cleansing) 2 Legal proceedings were instituted in three cases during the year. Each case was adjourned for a week to enable the defendants to comply with the requirements of the Order, which they did. At the resumed hearings each case was dismissed and each defendant was ordered to pay one guinea costs. Benzyl benzoate continues to be the treatment of choice for Scabies and proprietory 2 per cent. D.D.T. emulsion for the treatment of verminous heads. Both of these preparations have given extremely satisfactory results for their respective purposes. Complicated cases of Scabies and special cases referred by the general practitioners continue to be seen by the Council's consulting dermatologist, Dr. Marre, at the Scabies Clinic, which is held weekly. 26 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 247 135 Number of baths given 654 — Number of treatments — 167 L.C.C. Children Number treated *304 2,363 Number of baths given 1,336 — Number of treatments — 2,388 Adults... Number treated 985 297 Number of baths given 2,558 — Number of treatments — 368 * 89 Contacts were given baths. Scabies Clinic.—A consultant dermatologist is in attendance. Number of Clinics held 53 Number of cases attended 501 Adults 294 Children under 5 years 129 School children 78 Diagnosis of cases— 501 Scabies 271 Other conditions 230 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 Revisits Ineffective Visits Total Scabies 1,231 60 921 2,212 Vermin 2,397 186 1,892 4,475 Disinfection and Disinfestation. During the year, D.D.T. (dichlor-diphenyl-trichlorethane) continued to be the method of choice for the disinfestation of premises from bugs or other insect vermin. The standard solution used is 3 per cent. D.D.T. in white kerosene, or alternatively a dusting powder, consisting of 10 per cent. D.D.T. in Kaolin. This insecticide has superseded all other methods of disinfestation in the Borough, and there was a considerable increase in the number of rooms treated. Free treatment of rooms and furniture in recommended cases was continued and in this connection no charge was made in 117 cases. A total of 911 rooms were disinfested for vermin. During the year 1,049 disinfections were carried out after cases of infectious or other diseases. At the Disinfecting Station 309,532 articles of bedding etc., were treated for infection or infestation (287,285 of these being for clothing contractors). In addition 58 tons 9 cwts. of material were disinfected on behalf of clothing contractors. In the case of families removing to new Council properties, the 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. During the year the effects of 127 families were so treated. 27 Hydrogen Cyanide Chamber. No cyanide fumigations were carried out during the year, and negotiations have been initiated for the large cyanide chamber to be transferred to another Department of the Council. WORK OF SANITARY INSPECTORS ADMINISTERING FACTORIES ACT, 1937, AND OTHER RELEVANT ACTS. Inspections and Re-Inspections. 7,430 inspections and re-inspections were made by these Inspectors during the year. These are summarised as follows:— Coffee and Dining Rooms 505 Factories (Mechanical) 2,723 Factories (Non-mechanical) 780 Other premises under Factories Act, 1937 1 Fish Curers 9 Fried Fish Shops 158 Half-Way Houses 7 Hotel & Restaurant Kitchens 172 Noise Nuisances 45 Outworkers 974 Provisions 34 Rats and Mice (Destruction) Act, 1919—Factories 86 Refreshment Rooms 514 Smoke Nuisances 167 Special Inspections (Food Licences) 407 Miscellaneous 848 Total 7,430 (See separate sections On Underground Bakehouses and Offensive Trades). Defects or Contraventions found. 2,515 defects or contraventions were found. A summary, under statutory enactments, is as follows:— Factories Act, 1937 Food and Drugs Act, 1938 1,123 865 Public Health (London) Act, 1936 527 Total 2,515 Notices served. 832 Notices were served. These are summarised below:— Factories Act, 1937 271 Food and Drugs Act, 1938 289 Public Health (London) Act, 1936 Total 272 832 Defects or Contraventions Remedied. 1,840 defects or contraventions were remedied, as follows:— Factories Act, 1937 984 Food and Drugs Act, 1938 505 Public Health (London) Act, 1936 351 Total 1,840 The following Notices were also served and complied with:— Rats and Mice (Destruction) Act, 1919 5 28 Complaints received. 203 complaints were received, as follows:— Genera 175 Home Office 28 Total 203 Infestation Order, 1943. During the year, measures for the destruction of rats and mice were carried out by the Rodent Control staff, the establishment of which was made up as follows: One Temporary Rodent Officer—to supervise the work under the direction of the Senior Sanitary Inspector. Four Temporary 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 treatment, assessing the number of baiting points required and to supervise the work of the Rodent Operators. Ten Temporary Rodent Operators—for the laying of baits and recording of "takes." During the year:— 1,388 complaints were received. 12,677 investigations were carried out. 2,290 infestations were found comprising: 464 business premises and 1,826 dwellings. The treatments carried out were:— Dwellings Business Premises Shelters Bombed Unclassified Total Sites 1,504 46 up to 31.3.47 12 30 238 2,024 194 from 1.4.47 to 31.12.47 240 Number of Agreements sent out between the 1.4.47 and the 31.12.47 208 Number of Agreements returned between the 1.4.47 and the 31.12.47 194 Number of premises post-baited 141 Disinfestation of Sewers. In conjunction with the Borough Engineer's Department, four parties carried out the baiting and poisoning of sewers on two occasions and six parties on a third occasion during the year. The results were as follows:— PERIOD, JANUARY TO DECEMBER, 1947. 17th March to 19th April. Party Manholes Baited Complete Takes Partial Takes No Takes Bodies Seen 1 183 83 56 52 20 2 183 87 55 55 20 3 184 63 53 55 21 4 184 63 52 60 24 734 296 216 222 85 29 The minimum number of Rats destroyed, on a Calculation based on the amount of poison taken, is 7,960. In 45 per cent. of the manholes the poison was taken completely, in 35 per cent. of the manholes the poison was partially taken, and in only 20 per cent. was there "no take" recorded. 6th October to 6th November. Party Manholes Baited Complete T akes Partial Takes No Takes Bodies Seen 1 196 50 64 82 — 2 217 26 48 143 — 3 198 18 73 107 1 4 175 26 42 107 7 786 120 227 439 8 The minimum number of Rats destroyed, on a Calculation based on the amount of poison taken, is 3,113. In 15 per cent. of the manholes the poison was completely taken, in 30 per cent. of the manholes the poison was partially taken, and in 55 per cent. of the manholes was there " no take " recorded. 8th December to 30th December. Party Manholes Baited Complete Takes Partial Takes No Takes Bodies Seen 1 149 9 46 74 — 2 139 21 35 18 — 3 168 13 80 57 — 4 151 27 83 41 — 5 47 — 29 18 — 6 48 5 23 20 — 702 75 296 228 — The minimum number of Rats destroyed, on a calculation based on the amount of poison taken, is 4,64. In 11 per cent. of the manholes the poison was completely aken, in 55 2/3 per cent. of the manholes the poison was partially taken, and in 33 1/3 per cent. of the manholes was there " no take " recorded. During the early part of the year the Ministry of Food, in co-operation with this Department, investigated certain premises in the Borough, including a Factory, for the purpose of making a film. Considerable time was spent in the preparation of this work and the results proved very satisfactory. Water Supplies. With the exception of a few wells in the Borough, the Metropolitan Water Board is responsible for all supplies. Eight bore holes exist in the Borough for industrial purposes, two of which are out of commission due to shortage of fuel or mechanical defects. In addition, two boreholes are normally used in connection with one of the Council's public baths, but one of these is out or order. During the erection of prefabricated dwellings a large brick constructed well was discovered on one of the housing sites. It was deemed advisable not to fill in this well, and it was therefore securely covered, 30 In accordance with the requirements of the Public Health (London) Act 1936, 129 applications for Water Certificates were received and 129 Certificates were issued in respect of 298 premises. The following samples of water were taken Chemical Bacteriological Satisfactory Unsatisfactory Chemical Bacteriological Chemical Bacteriological 7 8 7 6 — 2 The bacteriologically unsatisfactory samples were:— (a) Prom a house tap drawing water from a storage cistern. In this case the cistern was cleansed and further samples proved satisfactory. (b) From a deep well, the water being used for boiler and washing purposes only. Swimming Bath Water.—During the year the following samples were taken from the Council's swimming pools. Chemical Bacteriological Satisfactory Unsatisfactory Chemical Bacteriological Chemical Bacteriological 10 10 8 10 2 — After each of the chemically unsatisfactory samples the Swimming Bath water was changed. SECTION D. HOUSING. During the year 1947, 1638 new applications for accommodation on London County Council Estates were received by this Department. Of this number, 802 were found to be living under overcrowded conditions and Overcrowding Reports were submitted to the London County Council. In 133 instances recommendations were submitted to that Authority on grounds of serious ill-health, such as Tuberculosis, Rheumatism, Valvular Disease of the Heart. No official representation was submitted under Section 12 of the Housing Act, 1936, to close basement rooms as being unfit for human habitation (excluding 43, Pemberton Gardens). In December, 1947, 16 Flats at King Edward Buildings were represented under this Section with a view to closure owing to their extremely dilapidated condition These flats had been the subject of Reports to the Public Health and Housing Committees of the Council. It is not possible to assess the degree of overcrowding existing in the Borough at the present time owing to the considerable changes of the population since the Housing Survey of 1936. Before this may be ascertained, with any degree of accuracy, it will be necessary for another full and systematic survey of the Borough to be carried out. No Section 9 Notices were served during the year. 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. 31 SECTION E. INSPECTION AND SUPERVISION OF FOOD Food and Drugs Act, 1938. Action was taken in 6 cases under the Food & Drugs Act, 1938 in connection with foreign substances found in bread. In one case the substance was a piece of brick, and in others, a portion of cigarette ; a roll of tobacco ; a quantity of dirt; and a piece of rope. Action was also taken in respect of a glass of pickles which contained a quantity of wire. Prosecutions. Date of Hearing Offence Result of Proceedings Court 14.3.47 Selling bread unfit for human consumption. Summons dismissed North London Police Court 14.3.47 Selling bread not of nature, substance and quality demanded. Fined £2. Costs £2 2s. do. 14.3.47 Selling bread unfit for human consumption. Fined £2. Costs £2 2s. do. 14.3.47 Selling iodine deficient in iodine by 30.4 per cent. Fined £2. Costs £2 2s. do. 23.4.47 16.5.47 Selling pickles unfit for human consumption. Fined £5. Costs £5 5s. do. 6.6.47 Selling bread not of nature, substance and quality demanded. Dismissed under P. of O. Act. Costs £2 2s. Old Street, Police Court 30.7.47 Selling bread unfit for human consumption. Fined £3. Costs £2 2s. North London Police Court 17.11.47 Selling bread not of the nature, substance and quality demanded. Fined £2. Costs £2 2s. Old Street, Police Court. 4.12.47 Selling biscuits not of the nature, substance and quality demanded. Fined £2. Costs £1 Is. North London Police Court 4.12.47 Selling milk not of the nature, substance and quality demanded. Dismissed under P. of O. Act. Costs £3. 3s. do. Food and Drugs Act, 1938. Milk and Dairies Order, 19 26. 30.6.47 Filling bottle with milk at place other than registered premises. Fined £4. Costs £1 1s. North London Police Court 32 Sampling. 818 samples (294 formal, 524 informal) were submitted to the Public Analyst for examination. Of these 18 were adulterated (or 2.25 per cent) as shown in the following summary— Formal Informal Milk 2 Milk 4 Tincture of Iodine 1 Tincture of Iodine 1 Malt Vinegar 1 Peanut Toffee 1 Bread 3 Bread Roll 1 Fish Paste 1 Cake Sponge and Pudding Powder 1 Milk Bottles 2 4 14 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. 175 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 licenced. Slaughtermen's Licences—23 licences are current, including 4 new licences which were authorised during the year. Visits and Inspections—During the year 910 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. Registered Artificial Cream Premises. (At present dealing in Synthetic Cream) Visits—1. Ice Cream. The Administration of the Ice Cream (Heat Treatment, etc.) Regulations, 1947 increased the work of the Department considerably, particularly in view of the large increase in the number of persons dealing in this commodity. Visits to Ice Cream premises—327. Ice Cream (Heat Treatment) Regulations, 1947. The Ice Cream (Heat Treatment, etc.) Regulations, 1947 came into force on the 1st May 1947, although the enforcement of certain requirements relating to recording thermometers will come into force on a date to be appointed by the Minister of Health. The Ministry of Health recommended the testing of ice cream by the methylene blue test and arrangements were made to carry out these tests by the Royal Institute of Public Health on behalf of the Department. 33 The time taken to decolourise methylene blue dye will depend upon the amount of bacterial contamination present. Ice cream samples may be divided into four grades; grade 1 showing, according to the test, the least contamination and grade IV the maximum. Results of Methylene Blue Tests:— Grade I Grade II Grade III Grade IV Total 7 15 16 33 71 It will be noted that nearly 50 per cent. of the samples examined were placed by the bacteriologist in Grade IV. Where ice cream manufacturing firms regularly produced ice cream in Grade IV detailed attention was given by the staff to the methods of production, with a view to producing ice cream which was hygienically safer. It did not always prove an easy matter to track down the particular mode by which bacterial contamination was introduced. But, generally speaking, it was found possible, sometimes only after considerable enquiry and by paying special attention to detail, for a higher grade of ice cream to be manufactured. Samples taken prior to the introduction of these Regulations (1/5/47) numbered 5:—Very Good 2. Good 2 and Fair 1. Milk Samples. The total number of samples taken during 1947 was 429. Samples submitted to chemical analysis:— Genuine Adulterated Total Formal 183 2 185 Informal 95 5 100 285 Samples submitted to bacteriological examination:— Class of Milk Results Test Total Number of Samples Plate Count B. Coli Phosphatase Methylene Blue Pasteurised Satisfactory 3 71 102 90 102 Unsatisfactory — 1 — 12 Heat Treated Satisfactory 1 12 25 16 27 Unsatisfactory — — 2 11 Sterilised ... Satisfactory 2 2 8 6 8 Unsatisfactory — — — — Tuberculin Tested (Pastuerised) Satisfactory 1 1 2 2 2 Unsatisfactory — 1 — — Raw Satisfactory 3 4 — — 5 Unsatisfactory 2 1 — 5 34 Milk and Dairies Order, 1926. Summary of Register. No. on Reg. 31.12.46 Additions to Reg. Removals from Reg. No. on Reg. 31.12.47 Dairies 159 — 5 154 Purveyors of Milk in sealed containers only 345 — 6 339 Registered Purveyors of Milk dealing from registered premises outside the Borough 98 — — 98 Summary of VisitS by Milk and Dairies Inspectors. Dairies—Routine Inspections 251 Milkshops—(Milk sold in sealed containers only) Routine Inspections 59 Vehicles inspected 45 Miscellaneous Visits 97 452 During the year 23 Notices intimating nuisances or defects were served. Underground Bakehouses. Factories Act Food & Drugs Act Total No. of Premises 40 — 40 No. of routine inspections 2 238 240 No. of Notices served 2 29 31 No. of Notices complied with 2 25 27 Public Health Act, 1936—Offensive Trades. The offensive trades operating in the Borough are as follows:— (a) Three Tripe Dressers. (b) One Knacker. (c) Two Fur Skin Dressers. (d) Six Gut Scrapers (One of these was established anew, with the consent of the Council, during the year). 80 visits were made and appropriate action taken where necessary. Diseases of Animals Act. During the year no outbreak of Foot and Mouth Disease occurred in the proximity of London which brought this Borough within an infected area. Pharmacy & Poisons Acts, 1933-1941. Number of visits made 363 Number of sellers of Part II poisons other than registered pharmacists 35 1/1/47—30/4/47 189 1/5/47—31/12/47 192 Number of initial registrations during the year 18 Applications continued to be received from shopkeepers in the Borough to have their names and addresses entered in the List of Persons entitled to sell Part II Poisons. In one case where the premises in question were used for the sale of provisions, including unwrapped food, the applicant was interviewed by the Public Health Committee, and upon an assurance being given to the Committee that the poison would be kept entirely separate from the foodstuffs and served from a separate counter and only by an assistant allocated to the sale of poisons, a licence was granted. Factories Act, 1937. Prescribed particulars on the administration of the Factories Act, 1937. 1.—Inspections for purposes of provisions as to health (including inspections made by Sanitary Inspectors). Premises Number on Register Number of Inspections Written notices Occupiers prosecuted (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities ... 308 519 39 — (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 1,474 1,733 229 — (iii) Other Premises in which Section 7 is enforced by the Local Authority* (excluding out-workers' premises) — — — — Total 1,782 2,252 268 — 2.—Cases in which Defects were Found. Particulars Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied Referred To H.M. Inspector By H.M. Inspector Want of cleanliness (S.l) 304 269 — — — Unreasonable temperature (S.3) 41 35 — — — Inadequate ventilation (S.4) 91 78 — — — Ineffective drainage of floors (S.6) 2 1 — — — Sanitary Conveniences (S.7)— (a) insufficient 27 19 — 2 — (b) Unsuitable or defective 601 592 — 10 — (c) Not separate for sexes 31 29 — 4 — Other offences against the Act (not including offences relating to Outwork) 54 19 33 5 — Total 1,151 1,042 33 21 — * i.e. Electrical Stations (Section 103(1)), Institutions. (Section 104) and sites of Building Operations and Works of Engineering Construction (Sections 107 and 108). 36 Outwork. (Sections 110 and 111) Nature of Work Section 110 Section 111 No. of outworkers in August list required by Sec. 110 (1) (c) No. of cases of default in sending lists to the Council No. of prosecutions for failure to supply lists No. of instances of work in unwholesome premises Notices served Prosecutions (1) (3) (4) (5) (6) (7) (8) Wearing v apparel 'Making, etc. 586 — — 7 7 — Cleaning and washing — — — — — — Umbrellas, etc 6 — — — — — Artificial flowers 248 — — 1 1 — The making of boxes or other receptacles or parts thereof made wholly or partially of paper 401 — — 1 1 — Brush making 18 — — — — — Carding etc. of buttons, etc. 20 — — — — — Stuffed toys 39 — — — — — Basket making 14 — — — — — Cosaques, Christmas crackers, Christmas stockings, etc. 21 — — 1 — — Lampshades 29 — — — — — Total 1,382 — _ 10 9 — Shops Act, 1934. Inspections 328 Re-visits 1,302 37 SECTION F. PREVALENCE AND CONTROL OF INFECTIOUS AND OTHER DISEASES. Notifiable Infectious Diseases and Deaths during the year 1947. Diseases No. of Notifications No. of Deaths Cases removed to hospital Scarlet Fever 350 (394) — 124 Diphtheria 72 (137) 1 72 Enteric Fever (including Paratyphoid) 7 (5) 1 6 Puerperal Fever 6 (13) 1 5 Puerperal Pyrexia *42 (66) — 41 Acute Primary and Influenzal Pneumonia 70 (112) 3 1 Ophthalmia Neonatorum 18 (25) — 16 Encephalitis Lethargica - (-) 1 — Cerebro-spinal Fever 21 (10) 1 20 Anthrax - (-) — — Dysentery 11 (68) — 8 Malaria 1 (11) — — Erysipelas 54 (86) 1 19 Measles ... ... ' ... 1,708 (1,877) 2 111 Whooping Cough 734 (567) 6 96 Acute Poliomyelitis ... 29 (-) 4 29 Acute Polioencephalitis † 6 (-) — 6 Scabies 279 (809) — — (Figures in brackets are notifications for 1046) † Including 1 Military Case. * Including 2 Cases occurring in City of London Maternity Hospital, Liverpool Road. Home addresses outside London Area. Smallpox and Vaccination. No case of smallpox was notified. Of the 5,943 births returned on the "Birth List Sheets" during 1946, 3,079 were successfully vaccinated. In addition, 1,858 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, 38 Fatality Rates per 1,000 notifications each age group (1940-1947) Percentage of notifications (1940-1947) 0-1 1-5 5 &upwrds 0-1 1-5 5 & upwards Measles 17.70 1.71 0.23 6.3 54.1 39.6 Whooping Cough 81.91 7.26 - 13.9 62.2 23.9 The highest fatality rates in both measles and whooping cough are in children under the age of one year. In children under one with whooping cough, approximately one case in 14 is fatal, which is over four times the corresponding rate for measles. 39 62.2 per cent. of all cases of whooping cough and 54.1 per cent. of all cases of measles occur in children 1-5 years. Although it is still the subject of medical enquiry, whooping cough vaccination is being increasingly requested by parents. London (Measles and Whooping Cough) Regulations, 1938. Home visiting of measles and whooping cough cases was carried out by the Home Visitors as under— No. of Investigations. Measles Whooping Cough No. of Ineffective Visits. 1,347 695 606 Plus 8 Re-visited Acute Poliomyelitis and Polioencephalitis. In common with the country as a whole the number of cases of Poliomyelitis and Polioencephalitis (" Infantile Paralysis ") was the largest number recorded in the history of the Borough. Although 35 cases were notified, the number of confirmed cases (including two transferred notifications who probably contracted the disease during their residence in Islington) was 24. The maximum incidence occurred during the late summer and early autumn, and the number of confirmed cases which occurred month by month according to date of onset, is as follows:— Jan. Feb. Mar. Apl. May June July August Sept. Oct. Nov. Dec. ——11—2354431 Of these 24 cases the incidence and deaths were as under, in each of the age groups given:— Under 1 year 1-5 years 5-15 years 15-25 years 25 ds over. Cases 1 7 6 7 3 Deaths 1 — 1 2 — Although the number of cases was the highest recorded in Islington, Islington was fortunate in that, according to estimated population, the " attack " rate was proportionately the lowest of any London Borough. It is not possible, however, to ascribe this relatively fortunate outcome to any special precautions which were taken in the Borough, although all possible steps within our present knowledge were adopted. The attention of all general practitioners in the Borough was drawn to the possibility of Poliomyelitis cases arising, but it was not felt necessary in this Borough to close swimming pools or special cinema shows for children. Swimming galas, however, were discouraged. Local publicity was given by the Medical Officer of Health to the advisability of general hygienic precautions, and it was pointed out that prevention by inoculation was not possible in the present stage of medical control of this disease. There is evidence that when there is an increase in the number of cases of Poliomyelitis there is a very great increase at the same time in the number of healthy carriers. Control is therefore an extremely difficult matter. It is fortunate that there were not a greater number of cases locally and it is not possible to say that similar outbreaks, perhaps of an even more severe character, may not occur in the future. The distribution of cases is shown on the accompanying " spot-map." 40 41 The number of cases of diphtheria notified (72) in 1947 was the lowest on record. It will be seen from the chart that this is almost a tenth of the pre-war annual notifications. Of these notifications 23 were confirmed. The children under 5 completely immunised (3,862) represents 69.23 per cent. of the births in 1946. It is regretted that last year's record of no deaths due to diphtheria could not be repeated in 1947. One child died from this disease. She was not immunised, and aged 16 years. Against this it must be emphasised that by the end of the year over 32,000 children had been immunised in Islington, with not a single recorded death among them. The total attendances (17,659) at all clinics represents a very considerable volume of work and organising, and the high average attendance of 70 per session indicates the large clinics which frequently have to be dealt with by Dr. Fenton and Dr. Clyne, the medical officers to the immunisation clinics. The Diphtheria Immunisation Mobile Clinic was again in action during the ummer of 1947 and successfully attracted considerable attention. General diphtheria immunisation publicity with posters, special handbills, local press information, cinema trailers, as well as the customary advice by medical officers and health visitors, continued throughout the year. No. OF ISLINGTON CHILDREN IMMUNISED AGAINST DIPHTHERIA, 1937-1947 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 281 1,078 525 89 3,261 5,734 6,321 3,165 3,688 3,425 4,563 TOTAL—32,130. No. OF CHILDREN WHO DIED FROM DIPHTHERIA OUT OF 32,130 IMMUNISED IN ISLINGTON—NIL. Diphtheria Immunisation. Under 5 years per cent. 5-15 years per cent. Estimated proportion of children immunised at 31.12.47 50.9 72.9 Total attendance at all Clinics 17,659 Sessions held Average attendance 252 70.06 Sessions held as under:— North Islington Branch Library 53 South Islington Welfare Centre 52 West Islington Welfare Centre 53 East Islington Welfare Centre 26 London County Council Schools in Borough 20 Day Nurseries 23 Mobile Clinics 25 252 42 Number of children who received full course of immunising injections Under 5 years 3,862 5-15 years 360 4,222 Number of children who were Primary Schick Tested with negative result and therefore did not require immunisation 18 Number of Children Immunised outside the Borough and Tested in Islington with a Negative Result 322 Number of L.C.C. cases tested in Islington with a negative result 19 Number of children re-tested with a negative result 598 In addition to the above 2,945 children were Post Schick Tested with a negative result. Food Poisoning. A limited number of outbreaks of food poisoning occurred during 1947. In three cases the premises affected were those of School Meals Centres, 300-400 meals being served daily at each Centre. Those affected were a relatively small proportion of all those taking the meals, the numbers in each Centre being respectively 18, 16 and 51, and consisting of kitchen staff, teachers and children. All attacks were of a mild character occasioning either no absenteeism at all or for no longer than twentyfour hours. Enquiries were made by the staff of the Department in all cases in conjunction with the appropriate Department of the London County Council. In no instance could the causative organism be declared with exactitude, but precautionary measures in respect of premises and personnel were discussed with those concerned. Two other cases of food poisoning were reported by a hospital in respect of Islington residents. The food suspected was meat, and staphylococcus pyogenes aureus was isolated from the cultures from the vomit of one patient, and also from the meat. It was thought probable that this was the incriminating organism. Tuberculosis. The reductions in Tuberculosis notification rates and death rates for pulmonary tuberculosis which were noted in 1946 as compared with the wartime increase, have not been maintained during 1947. There was an increase to 2.18 per 1,000 population for new cases of pulmonary tuberculosis, as against 1.88 for 1946, representing an increase of 16.5 per cent. The increase was greater in males than in females. There was also an increase in the deaths due to pulmonary tuberculosis— 0.70 per 1,000 population, the 1946 rate being 0.64. There was, however, a decrease in notifications and deaths due to tuberculosis other than lung forms. 43 New Cases and Mortality during 1947. Ages New Cases Deaths Respiratory Non-Respiratory Respiratory Non-Respiratory M. F. M. F. M. F. M. F. 0- 2 — — 1 — — 1- 6 8 8 5 1 — — 1 5- 27 20 7 7 — 1 — — 15- 63 86 2 12 6 20 — 1 25- 60 55 5 6 13 13 — — 35- 45 21 2 1 17 17 — 2 45- 38 19 1 1 30 10 — 1 55- 36 12 — 1 23 10 1 1 65 and upwards 23 6 1 14 3 1 — Total for all ages 298 229 26 33 104 75 2 6 586 187 Rate per 1,000 population— New cases—pulmonary 2.18 non-pulmonary 0.24 Deaths— pulmonary 0.74 non-pulmonary 0.03 Public Health (Tuberculosis) Regulations 1930. The total number of cases of tuberculosis on the Register as at 31st December, 1947, was— Pulmonary— Males 1,099 Females 907 Non-Pulmonary— Males Females 163 151 2,320 Work of Tuberculosis Dispensaries. The work of the Tuberculosis Dispensaries at the Royal Northern and Royal Chest Hospitals was re-organised during 1947. Following the retirement of Dr. A Leitch, Tuberculosis Officer at the South Dispensary since 1920, Dr. J. Wallace Craig, of the Northern Dispensary was promoted to take charge of the clinical work at both Dispensaries. Dr. B. Simonds was appointed as a whole-time assistant tc Dr. Craig and Dr. R. Nicholson as part-time Assistant Tuberculosis Officer. It will be noted that there was an increase of work at both Dispensaries. North South Number of Attendances 9,472 4,578 New cases and contacts examined 2,239 1,114 Number of visits by Tuberculosis Officers 221 168 Number of visits by Nurses 736 946 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. N umber of definite cases of tuberculosis on Dis pensary Registers at end of the year ... 815 698 94 72 75 75 36 47 890 773 130 119 1,912 44 Light Treatment. Ten patients received " Light " treatment, the cost to the Council being £8 l18. Od. Mass Radiography. Arrangements were continued for the examination at a Mass Radiography Unit of persons residing or working in the Borough with a view to the early detection of pulmonary tuberculosis in its symptomless stages. Three Islington firms availed themselves of the services of the Unit when it was operating in adjacent Boroughs, viz., 1 firm when the Unit was at Bethnal Green Hospital and 2 firms when it was at St. Bartholomew's Hospital. The following analysis has been received from the London County Council •egarding those from Islington visiting the Unit.— Persons examined Referred for larger films Probably T.B. Men Women Total Men Women Total Men Women Total 117 21 138 10 — 10 1 — 1 Extra Nourishment. The Council's scheme for financial assistance to tuberculous patients in need of extra nourishment, as recommended by the Tuberculosis Officers, was continued luring the year on the same scale as reported in the 1946 Annual Report. 196 cases received extra nourishment at a total cost of £959 18s. 11d. ruberculosis Care Committee and Maintenance Allowances Scheme. The Care Committee Secretaries jointly shared the Care Committee work and maintenance allowances, enquiries and payments, for the respective parts of the Borough attached to the North and South Islington Tuberculosis Dispensaries. During the year the Care Committee dealt with 401 cases. 93 patients have been helped, some on several occasions with cash or in kind, and loans of bedding or medical appliances were made to another 37 patients ; others have been referred to organisations for assistance. Receipts from the Christmas '' Seal Sale " amounted to £266 15s. 5d. Maintenance Allowances Scheme. Number of patients receiving weekly allowance in last week of year 1947 166 Number of applications brought before Assessment Officer ... 1,625 Number of new cases ... 185 Number of renewals on existing orders ... 688 Number of orders adjusted, etc. ... 529 Number of patients returning to full-time work ... 81 Number of deaths ... 33 Other " Cease payments " ... 109 Amount paid out in allowances during the year £14,121 17s. 5d. 45 Artificial Pneumothorax. 195 patients received treatment at a total cost of £1,080 17s. 3d. Beds and Bedding. 10 patients were provided with beds and bedding on loan. Dental Treatment. 8 patients received treatment with assistance under the Council's scheme. Home Nursing of Notifiable Pneumonias (All Ages). During the year 106 visits were paid to these cases by the North London District Nurses, the total cost of which, at 2s. per visit, was £10 12s. Od. 46 INDEX. page Acute Poliomyelitis 39 Acute Polioencephalitis 39 Additional Emergency Beds Scheme 17 Ante-Natal Clinics 12 Artificial Cream 32 Artificial Pneumothorax 45 Bacteriological Examinations 20, 30 Births 6, 9 Cerebro-Spinal Fever 37 Child Life Protection 13 Child Welfare Centres 12 Crematorium 20 Daily Guardian Service 18 Day Nurseries 19 Deaths 6, 8, 9 Dental Treatment—T.B. Cases 45 Dentures—Expectant Mothers 18 Diphtheria 40 Diphtheria Immunisation 41 Diseases of Animals Act 34 Disinfection 26 Disinfestation 26 Disinfestation of Sewers 28 Domestic Helps 15 Dysentery 37 Emergency Obstetric Unit 16 Encephalitis Lethargica 37 Enteric Fever 37 Erysipelas 37 Factories Act—Complaints 28 Factories Act—Contraventions 27, 35 Factories Act—Inspections 27, 35 Factories Act—Notices served 27 Food and Drugs Act 31 Food—Inspection & Supervision 31 Food Poisoning 42 Food Sampling 32 Health Visitors 12 Home Helps 15 Home Nursing 45 Home Visiting—M. & C. W. 12 Home Visiting—Scabies 26 Housing 30 Hydrogen Cyanide Chamber 27 Ice Cream 32 Ice Cream (Heat Treatment, etc.) Regulations 32 Illegitimate Births 9 Illegitimate Children 13 Infant Mortality 6, 8 Infectious Diseases 37 Infestation Order, 1943 28 Insulin 20 Invalid Children's Aid Association 18 Light Treatment 44 Live Births 6 M. & C. W. Committee 3 M. & C. W. Section 11 Maintenance Allowances—T.B. Cases 44 Malaria 37 Marriages 6 page Mass Radiography 44 Maternal Mortality 6 Maternity Hospital Grants 17 Measles 37 Meat 32 Milk & Dairies Order, 1926 34 Milk Samples 32, 33 Milk Supply for Expectant Mothers 18 Mortuary. 20 Nurseries—Day 19 Nurseries—Private 20 Nursing in the Home 18 Obstetric Unit—Emergency 16 Offensive Trades 34 Ophthalmia Neonatorum 37 Outwork 36 Pharmacy & Poisons Acts 34 Pneumonia 37 Pneumonia—Home Nursing 45 Polioencephalitis 39 Population 6 Post-Natal Clinics 12 Premature Infants 14 Prosecutions 23, 31 Public Health Committee 3 Public Health Officers 4 Puerperal Fever 37 Puerperal Pyrexia 37 Sampling 32 Sanitary Circumstances 21 Sanitary Inspection—District Work 22 Sanitary Inspection—Special Work 27 Scabies 25 Scarlet Feve 37 Sheets for Expectant Mothers 17 Shops Acts 36 Smallpox 37 Smoke 22 Staff 4 Statistics—General 6 Statistics—Vital 6,7,9 Still-Births 6 Swimming Baths 30 Tuberculosis 42, 43 Tuberculosis—Artificial Pneumothorax 45 Tuberculosis—Beds and Bedding 45 Tuberculosis—Care Committee 44 Tuberculosis—Dental Treatment 45 Tuberculosis—Dispensaries 43 Tuberculosis—Extra Nourishment 44 Tuberculosis—Light Treatment 44 Tuberculosis—Maintenance Allowances 44 Tuberculosis—Mass Radiography 44 Underground Bakehouses 34 Vaccination 37 Vermin 25 Vitamin Preparations 18 Water Supplies 29 Welfare Centres 11 Whooping Cough 37