LIBRARY 1948. ♦ ANNUAL REPORT on the HEALTH AND SANITARY CONDITIONS of the METROPOLITAN BOROUGH OF ISLINGTON. ♦ VICTOR FREEMAN, m.r.c.s., l.r.c.p., d.p.h., Medical Officer of Health. VAIL & Co., Ltd., Printers. 170 Farringdon Road, E.C.I 1 Public Health Department, Town Hall, Upper Street, N.l. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Islington. In presenting the Annual Report (Abridged) on the public health of the Metropolitan Borough of Islington for the year ended 31st December, 1948, the opportunity has been taken of amplifying a little certain aspects of the work of the Department. The year 1948 marks a major transition in the health services administered by the Borough since the responsibility for the personal health services, including maternity and child welfare, vaccination and diphtheria immunisation, passed from the Borough to the London County Council as the Local Health Authority, and the Tuberculosis Dispensary Service to the Regional Hospital Board, on 5th July, 1948, under the National Health Service Act, 1946. Much important health work, however, still remains to the Borough as, for example, the notification, control and prevention of infectious disease, the recording and application of vital statistics, and the supervision of the environmental health services concerned with food hygiene and purity, housing and sanitary work under the Public Health, Housing, and Factories Acts, and the education of the public in health matters generally. The progress which has been made in the health of the people and the reduction of infectious disease during the last thirty years or so, is remarkable, and there can be no doubt that the services which have been administered by the Borough have contributed considerably to this happy position. In order that there might be some record in convenient form of work done by the Borough Council on services transferred under the National Health Service Act, reports were presented to the Public Health and Maternity & Child Welfare Committees of this Council, and the more important sections of these reports have been set out in the form of appendices to this Annual Report. The general health of the Borough, insofar as it is possible to measure this by the various statistics which are kept, continues to be satisfactory and, with one or two exceptions, to improve still further. The birth rate, although still above the pre-war level, is falling slowly from its post-war maximum, and the infant mortality rate continues at a low level. At 35 deaths per 1,000 births, however, it is slightly higher than the figure for 1947, which was 32, but with the continued vigilance by doctors, health visitors, and the rising standard of personal care taken by the mothers themselves, it is anticipated that the downward trend in the rate of infant deaths will continue in the future. Infectious diseases generally were at a low level with measles and whooping cough providing the majority of the notifications, as usual, but, fortunately, with no undue proportion of severe cases. Poliomyelitis, or infantile paralysis, was substantially lower than in 1947. Diphtheria is fast becoming a rare disease, and, again in 1948, not a single death was ascribed to this infection. Tuberculosis is the principal infection which gives rise to serious concern, in particular, because of its social importance. It is the principal cause of death in the adolescent and adult under the age of 45, and since the rate of tuberculosis appears to be, at least partly, linked with adverse housing conditions—in particular, overcrowding—the prevalence of tuberculosis presents a serious problem to be dealt with from many aspects. Not the least of these is a reduction in the waiting time of admission to hospital or sanatorium after the case has been diagnosed, with the consequent removal of a source of infection to other members of the family, 2 and the priority offer by housing authorities of housing accommodation to enable the tuberculous patient to have a bedroom of his own and to give more space to other members of the family. Increasing attention is being given to the supervision of restaurant and eating establishments, and to the hygiene of food preparation. Food poisoning outbreaks continue to occur although, fortunately, food infections have so far been of a relatively mild nature. Here there is much which the public themselves can do by insisting upon obvious cleanliness, whether of food service or of premises, in restaurants and canteens, and where the staffs themselves, by giving greater consideration to their personal cleanliness, may materially assist in reducing the risks inherent in large scale catering when so much more of the public is taking meals out than before the War. The provision of new housing and the reasonable maintenance of existing housing continues to present problems of great difficulty. The greater part of Islington housing was constructed 75 years or more ago, and, apart from obviously being out-of-date in many respects by modern standards, requires an increasing amount of maintenance with ever increasing expenditure. The extent of the supervision necessary has thrown a heavy burden upon the Public Health Department, and from the section of the report dealing with this, it will be noted that there was a very substantial increase over the previous year in the number of inspections made by the District Sanitary Inspectors under the Public Health (London) Act, 1936. The difficulties in securing the abatement of nuisances were also considerable as evidenced by the long list of prosecutions under this Act. The population of Islington is only some 50,000 less than pre-war, and, with the smaller number of premises available (owing to war damage) in spite of increases in new housing, it is obvious that not only must there be more overcrowding, but there is also greater wear and tear upon property which is ageing all the time. It may well be, therefore, that in a Borough such as Islington the continued maintenance of old houses in a proper sanitary condition will become an increasingly intolerable financial burden, particularly upon small owners, and will create serious problems which will have to be faced. The year 1948 was a particularly difficult one for the staff of the Department, on the one hand owing to the great increase of work arising from sanitary complaints, and, on the other, arising out of the transfer of some of the Council's services to the Local Health Authority. The Council naturally regret losing officers who have given many years' faithful service to work which has now become the responsibility of the Local Health Authority, but it is satisfactory to know that their experience will be of value and that they will continue their work for the service of the public under the new Authority. I am therefore particularly appreciative of the successful efforts made by all members of the staff under these circumstances, especially Dr. Elsie J. Madeley, Senior Maternity & Child Welfare Officer, and Mr. W. C. Bartlett and Mr. B. J. Ashcroft, Senior and Deputy Senior Sanitary Inspector respectively. I also desire to express my appreciation of the consideration given to the Department and the staff by the Public Health and Maternity & Child Welfare Committees and their respective Chairmen, namely, Alderman H. J. L. Lygoe, J.P., M.S.S., and Councillor Mrs. F. H. Cantwell, J.P. V. FREEMAN, Medical Officer of Health. MEMBERS OF THE PUBLIC HEALTH COMMITTEE (As at December 1948) Mayor : Alderman A. E. Smith, J.P. Alderman : Herbert James Lowton Lygoe. J.P., M.S.M. Councillors: Matthew Thomas Sidney Abbott Mrs. Emma Elizabeth Baker George Bennett, J.P. Miss Mary Eva Gertrude Bull Robert Henry Gordon Bushnell Mrs. Florence Hilda Cantwell, J.P. Mrs. Gladys Dorothy Cantwell Henry Alfred Gregory Mrs. Ada Edith Hardy Alfred Ernest Kirby Harry Maurice Mann 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 (To 4th July, 1948) Mayor : Alderman A. E. Smith, J.P. 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 Miss M. E. G. Bull Mrs. F. H. Cantwell, J.P. C. A. Goatcher Mrs. A. E. Hardy T. W. Isaacs A. E. Kirby Mrs. A. McKay H. M. Mann W. J. H. B. Rodwell Mrs. E. A. Spriggs J. Walsh E. A. Willis Members appointed by the Council from outside their own body. Mrs. S. Bagnaki Mrs. Kingley Curtis Mrs. C. A. Dewhurst Mrs. K. Dowse Mrs. V. G. Lygoe Mrs. R. Simmons Mrs. B. M. Vorley 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. Senior Maternity & Child Welfare Officer. Elsie J. Madeley, M.B., Ch.B., D.M.R.&S., D.P.H. † Public Analyst. Alan W. Stewart, D.Sc., F.R.I.C. Senior Sanitary Inspector. (b), (c), (d) W. C. Bartlett. Deputy Senior Sanitary Inspector. (b), (c), (e) B. J. Ashcroft. Sanitary Inspectors. (b) J. W. Aiken (b) J. S. Ash worth (b), (c) A. A. Aslamidis (b), (c) K. L. Garner (b), (c) Miss V. M. Goddard (b) W. B. Goddard (f) J. N. Hamilton (b), (c) A. W. Haydock (b), (c) H. R. Homewood (b) C. G. Howell (b), (c), (d) N. Lightowlers (b), (c) G. W. Maidlow (a), (c) S. P. Marks (b) A. Moxon (b), (e) F. H. W. Pedrick (b) D. H. Poole (b), (c) Miss S. H. Prentice (b), (c), (d), (e) J. H. Riley (b) H. H. Uren (b) A. Watson (b) W. A. Watts (b) L. Weeks (b) Miss B. Wilson Joint Secretaries and Maintenance Allowances Officers, Tuberculosis Care Committe. Miss E. Cumming (T)† B. Wallace (T)† Tuberculosis Visiting Nurse. Miss B. E. McGoldrickt. Public Vaccinators (to 4th July. 1948) 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 Officer. L. T. K. Stevens† Clerical Sta ff: F. E. Young (Chief Clerk) Miss M. A. Blennerhassett (T) Mrs. Q. V. Brown (T) S. A. Brown† Mrs. M. O. Browning (T) W. R. Causton* C. J. Cridland Public Health: Mrs. A. E. Ford (T) Miss D. Francis E. W. George W. H. Goody (T) P. Hardwick (T) L. F. Hummerstone (T) W. A. McAdam* Mrs. R. Mitchell (T) C. J. Moore Mrs. M. L. Murden (T)† D. A. Owen Miss G. Parkes (T) P. L. J. Regan J. Riddlesdale (T)† Miss C. A. Smith (T) Miss W. E. Stittle J. Thompson (T) A. E. Vanstone C. M. Wheble* Mrs. A. V. Williamst Mrs. M. L. Bardin (T)† Miss E. G. Chartres (T)† L. W. Edis† Miss D. Egginton*† Maternity & Child Welfare. Miss A. L. Gates (T)† Mrs. D. Gardiner (T)† Miss M. M. Haseldine (T)† Miss E. C. R. Saunders (T)† * = Senior Sectional Clerk. Miss C. A. Smith (T)† Miss S. J. Verney (T)† Miss P. I. Webb (T)† 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 5 Bathing Attendants 1 Stoker Handyman 1 Mortuary Keeper 1 Driver 1 Assistant Driver 3 Disinfectors 1 Van Driver † Transferred to London County Council 5.7.48. (a) = Certificate Sanitary Inspectors' Examination Board. (b) = Certificate of the Royal Sanitary Institute and the Sanitary Inspectors' Examination Joint Board. (c) = Royal Sanitary Institute Meat Inspectors' Certificate. (d) = Royal Sanitary Institute Certificate in Sanitary Science. (e) = Royal Sanitary Institute Smoke Inspectors' Certificate. (f) = Sanitary Inspectors' Certificate, Royal Association of Scotland. 5 SECTION A. GENERAL AND VITAL STATISTICS. Area of the Borough 3,092 acres. Population. Registrar General's estimate of civilian population, Mid-year 1948 : 238,200 Live Births M. F. Birth Rate Per 1,000 Estimated Resident Population Totals. Islington London Admin. County. England and Wales. Legitimate 4,277 2,239 2,038 Illegitimate 331 180 151 4,608 2,419 2,189 19.34 20.1 17.9 Still Births. Legitimate 82 36 46 Rate per 1,000 Total (Live and Still) Births Illegitimate 7 4 3 89 40 49 18.94 Deaths. Death Rate (Unadjusted) per 1,000 Population Totals M. F. Islington London Admin. County England and Wales 2,682 1,417 1,265 11.26 10.8 11.6 Death from Puerperal Causes. Deaths. Rate per 1,000 Total Births. Puerperal Sepsis 3 0.64 Other Puerperal Causes 1 0.21 • 4 0.85 Death Rate of Infants Under One Year of Age. Islington London Admin. County. England and Wales. All infants per 1,000 live births 35 31 34 Legitimate infants per 1,000 legitimate live births 35 Illegitimate infants per 1,000 illegitimate live births 39 Notification of Births. For ½ year ending 3rd July, 1948 2,942 (423 not notified by midwives) For ½ year ending 31st December, 1948 2,125 (corrected figure from L.C.C.) Total 5,067 Marriages (Provisional figures). Marriages solemnised in the Borough during the year 2,343 COMPARATIVE VITAL STATISTICS—1937 TO 1948. (Compiled from Registrar General's Returns) 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 Population 238,200 236,840 227,160 195,770 188,560 189,970 186,000 183,470 224,110 272,300 292,300 295,400 Live Births—(total) 4,608 5,577 5,284 3,708 3,826 3,592 3,368 2,986 3,850 4,168 4,487 4,516 (illegitimate) 331 431 442 438 335 264 251 214 272 245 278 218 Birth Rate per 1,000 population 19.34 23.55 23.26 18.94 20.29 18.91 18.10 16.27 17.18 14.47 15.35 15.32 Still Birth Rate per 1,000 births 18.94 18.99 22.20 22.41 25.72 24.97 33.29 26.72 32.17 30.24 27.52 29.86 Deaths 2,682 3,053 2,947 2,856 3,057 3,017 2,852 3,508 4,143 3,485 3,492 3,865 Death rate 11.26 12.89 12.97 14.59 16.21 15.88 15.33 19.12 18.48 12.79 11.94 13.08 Maternal Death rate per 1,000 births 0.85 0.70 1.48 0.26 2.03 2.71 2.29 3.02 1.59 1.47 2.17 2.79 Death-rate of infants under 1 year 35 32 39 46 48 46 54 59 47 50 65 67 Marriage rate per 1,000 population 19.67 19.54 20.21 25.00 18.36 18.59 25.30 28.07 32.92 23.89 19.57 20.22 T.B. Notifications per 1,000 population (all forms) 2.25 2.43 2.18 2.81 3.14 3.04 2.30 3.00 2.10 1.94 2.13 2.38 Death-rates per 1,000 population— Pulmonary T.B. 0.66 0.70 0.64 0.80 0.86 0.85 0.93 1.20 0.84 0.82 0.73 0.70 Diphtheria Nil 0.004 Nil 0.01 0.01 0.05 0.01 0.06 0.09 0.04 0.08 0.07 Suicides 0.15 0.07 0.11 0.06 0.10 0.08 0.14 0.14 0.17 0.15 0.14 0.16 Road Traffic Accident 0.08 0.11 0.10 0.07 0.16 0.10 0.16 0.14 0.14 * * * Other violent causes 0.43 0 37 0.45 1.05 1.84 0.38 1.45 1.74 2.38 0.56 0.37 0.34 6 * Not given separately by Registrar General. 7 CLASSIFICATION OF DEATHS WITH AGE DISTRIBUTION. Cause of Death Ages—Both Sexes Totals Under 1 year 1 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 162 29 15 210 647 1,619 2,682 1,417 1,265 Percentages 6.04 1.08 0.55 7.84 24.12 60.37 1. Typhoid and paratyphoid fevers — — — — — — — — — 2. Cerebrospinal fever 2 1 — — — — 3 l 2 3. Scarlet Fever — — — 1 — — 1 1 — 4. Whooping Cough 4 2 — — — — 6 3 3 5. Diphtheria — — — — — — — — — 6. Tuberculosis of respiratory system 1 1 1 79 49 26 157 105 52 7. Other forms of tuberculosis 2 5 2 8 6 2 25 13 12 8. Syphilitic disease — — — 1 6 9 16 10 6 9. Influenza — — — 1 — 5 6 3 3 10. Measles 1 — — — — — 1 — 1 11. Acute poliomyelitis and polioencephalitis — — — — — — — — — 12.. Acute infectious encephalitis — — — 1 — — 1 — 1 13. Cancer of buc. cav. and oesop (M) — — — — 6 10 16 16 — Cancer of uterus (F) — — — 1 18 10 29 — 29 14. Cancer of stomach and duodenum — — — 8 33 48 89 48 41 15. Cancer of breast — — — 2 25 27 54 — 54 16. Cancer of all other sites — 1 1 19 116 198 335 204 131 17. Diabetes — — — 1 7 4 12 3 9 18. Intra cranial Vascular lesions — — — 6 52 158 216 94 122 19. Heart Disease _ — 2 19 114 463 598 279 318 20. Other diseases of the circulatory system — — — 5 24 135 164 81 83 21. Bronchitis 7 — — 2 49 139 197 136 61 22. Pneumonia 29 4 — 4 24 107 168 95 73 23. Other respiratory diseases 1 — — 5 7 12 25 13 12 24. Ulceration of the stomach or denum — — — 2 15 24 41 31 10 25. Diarrhoea (under 2 years of age) 11 2 — — — — 13 7 6 26. Appendicitis — — — 3 1 4 8 6 2 27. Other digestive diseases — 2 — 2 19 48 71 29 42 28. Nephritis — — 1 4 12 27 44 24 20 29. Puerperal and post-abortive sepsis — — — 3 — — 3 _— 3 30. Other maternal causes — —_ — 1 — — 1 — 1 31. Premature birth 23 — — — — 23 16 7 Congenital malformations, birth injury, infantile disease 58 3 — 2 3 1 67 42 25 33. Suicide _ — — 5 19 11 35 22 13 34. Road Traffic accidents 1 1 3 2 1 11 19 10 9 35. Other violent causes 19 4 4 9 8 59 103 46 57 36. All other causes 3 3 1 14 33 81 135 79 56 8 SUMMARY OF INFANT MORTALITY 1948. (Based on Registrar General's Returns) Primary Cause of Death Under 1 day Days Weeks Months 1-2 2-3 3-4 4—5 5—6 6-7 1-2 2-3 3-4 1-2 2-3 3—4 4-5 5—6 6—7 7-8 8— 9 9-10 10-11 11-12 Totals Measles 1 1 Whooping Cough 1 1 1 1 4 Cerebro Spinal Fever 1 1 2 Tuberculosis Lungs 1 1 Tuberculosis—Other forms 1 1 2 Bronchitis 1 1 1 2 1 1 7 Pneumonia 1 2 1 1 2 3 8 6 2 2 1 1 1 31 Enteritis 1 1 2 2 2 1 1 1 11 Premature Birth 10 8 1 2 1 1 23 Congenital Malformation, Birth Injury, Atelectasis Atrophy and Marasmus 19 7 3 4 3 6 1 1 3 2 3 1 1 1 55 Suffocation Overlying 1 1 1 3 Violent Causes 4 1 2 3 2 2 1 1 16 Road Traffic Accidents 1 1 All other causes 1 1 1 1 4 Totals 34 16 5 6 5 1 1 10 4 4 13 15 9 9 8 7 3 8 8 2 — 1 161 COMMENTS ON VITAL STATISTICS. Births and Birth Rate. The peak of the post-war rise in the birth rate was in 1047 when there were 5,577 live births with a rate of 23.55 per 1,000 population. In 1948, the birth rate fell in common with the country as a whole, there being 4,608 live births with a rate of 19.34 per 1,000 population. This rate is the lowest since 1945, but is still higher than the corresponding pre-war rate. The still-birth rate at 18.94 per 1,000 births is still continuing its downward trend (the corresponding figure was 30.24 in 1939) and this is satisfactory since it may to some extent be taken as evidence of the maternal care taken and attention given to any abnormalities which may arise during pregnancy. Illegitimate Births. 7.18 per cent, of the 1948 births were registered as illegitimate. This continues the post-war downward trend. Principal Causes of Death. The death rate for 1948 at 11.26 per 1,000 population continues its post-war fall and is a little under the death rate for England and Wales. The percentage of deaths in each age group is given in the table "Classification of Deaths" on page 7. Infants under one year. The infant death rate at 35 per 1,000 live births was a little higher than the corresponding figure of 32 for 1947, and compares with, say, 67 in 1937. 1948 is the first year for several years in which a new low record has not continued to be produced. This need not give rise to anxiety since it is probable that it is only a temporary phase. Nevertheless, it does show that our efforts to improve the chances of survival of the infant may not be relaxed. I commented in the 1947 report on the very great reduction in the infant mortality figure of illegitimate 9 infants which was at the rate of 39 per 1,000. That this improvement in the care given to the illegitimate child has come to stay is a probability which is borne out by the fact that the rate was the same in 1948. I have also thought that a further table giving the summary of infant mortality in 1948 by age-groupings would be informative, and have therefore included this additional table. It will be seen that out of 161 infant deaths 34, or 21.12, per cent., took place in the first day; 68, or 42.23 per cent., in the first week; 86, or 53.41 per cent., in the first month; and 140, or 86.96 per cent., in the first six months. Deaths due to congenital malformations etc. constitute 34.16 per cent, of all infant deaths, and to this cause is overwhelmingly due the highest proportion of deaths in the early days and weeks of life. Prematurity was associated as a principal cause in 14.3 per cent, of all infant deaths, and again most of these occurred during the first week of life. The child having survived possible accidents of development and injury at birth, the greatest single risks in later infancy are due to the respiratory infections, bronchitis and pneumonia accounting for 23.6 per cent, of infant deaths, mostly in the one to six months age group. These should be regarded as very largely preventable deaths to be avoided by better mothercraft, including the proper feeding of the infant; its reasonable protection from infection by such measures as the provision of a separate cot; protection from indiscriminate and over-frequent handling by other members of the family, whether adults or children; and avoidance of unnecessary exposure to adverse weather particularly during the winter months. It surely cannot bo helpful for small infants to be taken out in cold and wet weather in the late evening. As might be expected, respiratory infections and the deaths which may result from them are seasonal in incidence. Thus, of the 31 deaths due to pneumonia 16 occurred in the two months January and December, and 23 out of 31 in the four months, January, February, November and December. 6 out of 7 bronchitis deaths took place in February and March. The general reduction in infant mortality also brings to light what is now becoming one of the major causes of infant deaths, i.e. due to violent causes of one form or another. 3 deaths were ascribed to overlying, which should be entirely preventable. Of the 16 deaths due to other violent causes, 11 were connected with asphyxia due to regurgitated stomach contents. It cannot be doubted that better mothercraft would also assist in reducing the risks from such causes. Deaths due to infectious diseases in infancy such as measles, whooping cough, tuberculosis, meningitis, and even enteritis, now form quite a small proportion of all infant deaths. Deaths from Puerperal Causes.—The maternal death rate is again less than one per 1,000 births, there being only 4 deaths in all. Other Causes.—In the age group 15.45 by far the greatest single cause of death is that due to pulmonary tuberculosis. This was the cause of death in 79 out of 210 persons, giving a rate of 37.62 per cent, for this age group. The social significance of this high proportion is important since in each case there has probably been also a considerable period of invalidism, perhaps extending over some years at a time when the patient should be most active and in the prime of life as a breadwinner and useful member of the community. Consequently, not only is the patient's means affected but also those of his family. The 79 deaths from pulmonary tuberculosis 10 in this age group also represents 50.32 per cent, of the deaths from this cause at all ages. Of the total of pulmonary tuberculosis deaths, 66.88 per cent, were males and 33.12 per cent, were females. In the age group 45.65, 17.62 per cent, of all deaths were ascribed to heart diseases; 30.60 per cent, to cancer of all types; 11.28 per cent, to bronchitis and pneumonia. 60.37 per cent, of all deaths occurred in the age group 65 and upwards. The principal causes were heart disease 28.60 per cent.; cancer of all types 18.09 per cent.; and bronchitis and pneumonia 15.19 per cent. Infectious Diseases. Sickness and fatality rates due to the principal infectious diseases are considered in more detail in Section B of this report. SECTION B. PREVALENCE AND CONTROL OF INFECTIOUS AND OTHER DISEASES. Notifiable Infectious Diseases and Deaths during the year 1948. Disease Number of Notifications Number of Deaths Removed to Hospital Number of Cases returned to Registrar General after correction of Diagnosis Cases "coming to knowledge" but not Notified Smallpox — — — — — — Scarlet Fever 328 (350) 1 109 326 26 Diphtheria 44 (72) — 44 7 1 Enteric Fever (including Paratyphoid) 3 (7) — 3 1 — T=1,PT = 2 Typhus Fever — — — — — — Puerperal Fever †7 (6) 3 7 8 6 Puerperal Pyrexia *59 *(42) 1 54 61 8 Ac. Primary & Influenzal Pneumonia 68 (70) 6 3 72 1 Ophthalmia Neonatorum 25 (18) — 19 25 4 Encephalitis Lethargica — (—) — — — — Cerebro-spinal Fever 14 (21) 2 14 7 2 Anthrax — (—) — — — — Dysentery 34 (11) — 26 27 1 Malaria 2 (1) — 1 1 — Erysipelas 49 (54) — 17 47 7 Measles 1,993 (1,708) 1 117 2,010 57 Whooping Cough 944 (734) 5 122 953 62 Ac. Poliomyelitis 11 (29) — 11 9 1 Ac. Polioencephalitis - (6) — — — — Food Poisoning 10 (7) — 4 Not returnable during 1948 1 Tuberculosis—Lungs 485 (454) 157 — Not returned 74 Tuberculosis—Other Forms 52 (46) 25 — do. 13 Scabies 88 (279) — — 90 426 (Figures in brackets are notifications for 1947) * Including 2 Cases occurring in City of London Maternity Hospital, Liverpool Road. Home addresses outside London Area, † Puerperal Fever : L.C.C. (General Powers) Act, 1948, repealed Section 304 Public Health (London) Act, 1936, requiring Puerperal Fever as distinct from Puerperal Pyrexia to be notified (August, 1948). 11 Smallpox and Vaccination. No. of births returned on "Birth List Sheets" No. successfully vaccinated Children successfully vaccinated in Borough whose births occurred outside Borough Year 1947 6,573 3,345 1,777 Period 1.1.48—3.7.48 2,929 1,124 479 During the period 5th July, 1948 to the end of the year 702 were successfully vaccinated in Islington. No case of smallpox occurred during the year. 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. 12 INCIDENCE OF MEASLES & WHOOPING COUGH, 1941—1948. Fatality Rates per 1,000 notifications each age group (1940-1948) Percentage of notifications (1940-1948) 0—1 1—5 5 & upwards 0—1 1—5 5 & upwards Measles 16.47 1.41 0.20 6.2 55.4 38.4 Whooping Cough 71.23 6.55 — 14.1 62.2 23.6 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. 13 62.2 per cent, of all cases of whooping cough and 55.4 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. Re-visits 2,100 1,023 20 20 Acute Poliomyelitis and Polioencephalitis. The great increase in the number of cases of Poliomyelitis and Polioencephalitis which was reported for 1947 did not recur, fortunately, in 1948. Although 11 cases were notified the number of confirmed cases was only 9. The occurrence of the cases during the year and their incidence in age groups, is set out as under:— Jan. Feb. Mar. Apl. May June July August Sept. Oct. Nov. Dec. — 1—2—1—2— 1 1 1 Of these 9 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 & over. Cases — 2 5 1 1 Deaths — — — — — 14 Diphtheria. A chart of the number of diphtheria cases and deaths over a period of fourteen years, together with the number of children immunised, is shown as follows:— 15 Once again I have to report that the number of cases of diphtheria notified (44) during the year 1948 was the lowest on record. Of these notifications only 7 were confirmed. The notifications represent no more than about 6 per cent, of the annual average notification prior to 1938. It is satisfactory, again, also to record that as in 1946 diphtheria did not cause a single death in any resident in Islington. Although it is not safe to make any firm prophecy in the case of an infectious disease, it would, at any rate, seem highly probably that diphtheria is well on the way to becoming a rare infection, even if it cannot be completely eliminated. There can be little doubt but that this entirely satisfactory situation has been brought about by the willing acceptance of the great majority of parents of the opportunities given, whether at the clinics or through their own private practitioners, to have their children immunised against this once much feared disease. It will also be noted from the details of the immunisation report below that the arrangements for the transfer of the diphtheria immunisation service from the Borough Council to the London County Council on 5th July did not detrimentally affect the number of children who were immunised during the year; in fact, the number treated in any one year was the highest except for 1942 and 1943, during which years, of course, there was a greater leeway to make up in dealing with the reservoir of children not immunised. It is also pleasing to record that the diphtheria immunisation Mobile Clinic, which commenced its activities during the summer of 1945 and which is believed to be the only such Clinic in London successfully operated again in 1948. It was transferred in July to the L.C.C., who expressed every intention of continuing its activities. The services of Dr. Fenton and Dr. Cline, the medical officers to the immunisation clinics, were accepted by the London County Council for their work to be continued after the transfer date. The Borough Council were responsible for diphtheria immunisation up to 5th July, 1948, and therefore, where the figures are given for the whole year, I am indebted to the Divisional staff of the London County Council for providing these annual totals. No. OF ISLINGTON CHILDREN IMMUNISED AGAINST DIPHTHERIA, 1937-1948 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 281 1,078 525 89 3,261 5,734 6,321 3,165 3,688 3,425 4,563 5,387 TOTAL—37,517. No. OF CHILDREN WHO DIED FROM DIPHTHERIA OUT OF 37,517 IMMUNISED IN ISLINGTON—NIL. Diphtheria Immunisation. Under 5 yrs. 5—15 vrs. Estimated proportion of Children Immunised at 31.12.48 50.2% 75.5% 1.1.48—4.7.48 5.7.48—31.12.48 Total Attendance at all Clinics 11,674 9,463 Sessions held 149 131 Average Attendance 78.3 72.2 16 Number of Children who received Full Course of Immunising— Injections:— 1.1.48—4.7.48 5.7.48—31.12.48 Under 5 years 2,616 2,048 5-15 years 156 68 2,772 2,116 Number of children who were Primary Schick Tested with negative result and therefore did not require immunisation 15 3 Number of Children Immunised outside the Borough and Tested in Islington with a Negative Result 277 104 Number of children re-tested with a negative result 618 297 Number of children Post Schick Tested with a negative result 1,947 2,212 Food Poisoning. During the year 10 cases of food poisoning were notified. There was one death but the diagnosis of food poisoning was not confirmed in this case, the death being due to heart disease. The causative organisms were not ascertainable either in the foods consumed or in specimens taken from the patients, with the exception of one patient who was found to be suffering from a Salmonella Typhi-murium infection and which was probably derived from duck egg. This patient continued to be a carrier of this organism for a considerable time and was kept under observation. The sum total of illness due to the consumption of contaminated food is considerably greater than would appear from the notified cases alone. The majority of food poisoning cases are generally of such short duration and lacking in severity that it is only a minority of patients that seek medical attention. It may, therefore, be assumed that most cases are not notified. The inference of food poisoning must frequently be drawn from the fact that the persons affected have consumed food from the same source about the same time, although in each case the illness may be of a relatively trivial nature. This, however, does not give ground for complacency since the same mode of spread may occur with an infection of a much more severe character. All reports of food poisoning outbreaks therefore serve as warnings to take precautions if there is to be no repetition with more unfortunate results than hitherto. The number of persons affected in any outbreak is usually very much less than the number who have partaken of the questionable meal. This is illustrated in the following table of outbreaks during the year, of which the first occurred in a staff canteen and the others in restaurants attached to the London County Council School Meals service. Date No. of Notifications No. of persons served No. of cases reported No. of deaths Foods involved and Organisms responsible 21.1.48 Nil 222 30 — Predominant growth of coliform bacilli found on meat, custard powder and dried eggs. 11.3.48 Nil 458 25 — Food and organisms not determined. 29.6.48 Nil 360 42 — Hot pot with fresh meat and corned beef. Presumed staphylococcal entero-toxin. 29.9.48 Nil 423 26 — Probably meat and dried egg used in custard powder. Organisms, B. Proteus, and coliform bacilli. 9.11.48 Nil 358 79 — Food and organisms not determined. 14.12.48 Nil 868 37 — Food and organisms not determined. 17 In all the above outbreaks investigations were carried out by the officers of the Department. Food samples were taken for analysis where possible, and pathological specimens were sent for examination ; enquiries were made in conjunction with the London County Council staff in respect of the school meals service outbreaks. Food infection of another type also occurred in connection with meat prepared by an Islington firm. Information was received of cases of food poisoning from the City of London, Finsbury and Bournemouth, and the reports indicated that the food responsible was the meat processed by this firm. Extensive enquiries were made in conjunction with the staff of the Central Public Health Laboratory, Colindale, and every assistance was given by the firm concerned, which is of good standing with up-to-date equipment and where all reasonable precautions are taken. It was eventually ascertained that the chef and his assistant, responsible for the preparation of the meat, were both carriers of the same type of germ (coagulase positive staphyloccocci), as that reported to have caused the outbreaks, and also as found on meat samples taken at the factory. The employees concerned were taken off food processing until found free of the causative organisms, but it is obvious that even where conditions of food preparation are good there still remains a small risk of contamination whenever there is large scale food processing, and that there can never be any laxity in the hygienic precautions which have to be taken if dangerous outbreaks of food poisoning are to be minimised. It is not always realised that foods, such as meat or meat dishes which have become slightly infected by the usual handling for example, if left overnight at room temperature to be consumed the following day, may give rise to symptoms of food poisoning owing to rapid multiplication of germs within 24 hours. It is therefore essential, so far as restaurants and canteens are concerned, that foods which are not immediately consumed should be put back without delay in refrigerator storage until they arc next served. Scabies and Vermin. Benzyl benzoate continues to be the treatment of choice for Scabie3 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. 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 93 84 Number of baths given 229 — Number of treatments — 112 L.C.C. Children Number treated *112 1,608 Number of baths given 435 — Number of treatments — 1,612 Adults Number treated 337 180 Number of baths given 819 — Number of treatments — 233 * 63 Contacts were given baths. 18 Scabies Clinic.—A consultant dermatologist is in attendance. Number of Clinics held 52 Number of cases attended 475 Adults 240 Children under 5 years 115 School children 120 Diagnosis of cases— 475 Scabies 350 Other conditions 125 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 Revisits Ineffective Visited Visits Total Scabies 457 15 320 792 Vermin 1,441* 102 1,056 2,599 (*5 cases were treated at home) Bacteriological Examinations. Total Swabs (Diphtheria) 646 Sputum (Tuberculosis) 59 Faeces (Typhoid) 2 Blood (Typhoid) 1 Faeces (Dysentery) 6 Faeces (Food poisoning) 10 Swabs (Streptococci) 38 Total 762 Tuberculosis. The notification rate for new cases of pulmonary tuberculosis was 2.34 per 1,000 population as against 2.18 for 1947, representing an increase of 6.8 per cent. The increase was greater in males than in females. There was also a decrease in the deaths due to Pulmonary Tuberculosis—0.65 per 1,000 population against 0.70 in 1947. There was an increase in notifications and in deaths due to tuberculosis other than lung forms. New Cases and Mortality during 1948. Ages New Cases Deaths Respiratory Non-Respiratory Respiratory Non-Respiratory M. F. M. F. M. F. M. F. 0— 2 2 2 — — 1 2 — 1— 4 11 6 5 1 — 2 2 5— 16 14 11 5 — — 1 2 15— 67 82 7 11 10 15 1 — 25— 86 71 2 3 14 13 — 1 35— 49 27 1 4 19 10 2 — 45— 34 11 — — 21 4 — 1 55— 37 10 2 4 20 4 2 1 65 and upwards 23 13 1 1 19 5 — 1 Total for all ages 318 241 32 33 104 52 10 8 624 174 Rate per 1,000 population— New cases—pulmonary 2.34 non-pulmonary 0.27 Deaths— pulmonary 0.65 non-pulmonar 07 19 Public Health (Tuberculosis) Regulations 1930. The total number of cases of tuberculosis on the Register as at 31st December, 1948, was— Pulmonary— Males 1,154 Females 938 Non-Pulmonary—Males 158 Females 151 2,401 Work of Tuberculosis Dispensaries. In consequence of the National Health Service Act, the Tuberculosis Dispensaries and staff at the Royal Northern and Royal Chest Hospitals were transferred to the Regional Hospital Board as from 5th July, 1948. It is satisfactory to note, however, that Dr. J. Wallace Craig, Senior Tuberculosis Physician, continues to be responsible for the two Dispensaries which still serve the population of Islington. I am indebted to the Divisional Health Office, London County Council for the following figures to 31st December, 1948. To 5th July To 31st Dec. North South North South Number of Attendances 4,678 2,956 9,449 6,003 New cases and contacts examined 1,337 920 2,708 1,740 Number of visits by Tuberculosis Officers 116 91 236 210 Number of visits by Nurses 421 312 827 598 Dispensary Registers. Pulmonary Non-Pulmonary Total Grand Total Adults Children Adults Children Adults Children M. F. M. F. M. F. M. F. M. F. M. F. Number of definite cases of tuberculosis on Dispensary Registers at 5th July 844 735 95 69 71 74 34 47 915 809 129 116 1,969 At 31st December 967 752 88 70 64 78 33 41 931 830 121 111 1,993 Mass X-Ray Campaign. During the latter part of 1948 information was received from the Mass X-Ray Unit of the North West Metropolitan Regional Hospital Board regarding examinations carried out by them at St. Mary, Islington, Hospital from 15th November to the end of December. The Public Health Department were requested to co-operate by giving local publicity and arranging with firms and bodies employing staffs for the attendance of those who desired to be examined. Three open sessions for the public were also arranged by the Unit in December, and the Department assisted in giving publicity to this new venture, so far as Islington is concerned. From the figures given by the Unit, it is clear that this was the most successful Mass X-ray campaign so far held in the Borough. This was also the first occasion upon which the X-ray Unit has been set up in the Borough, since on previous occasions it was stationed in neighbouring Boroughs to which Islington residents or employees were invited. It was therefore obvious that local contact has been very effoctive. 20 Invitations to co-operate were accepted by the staffs of 61 firms, and employees who were X-rayed were as follows:— St. Mary, Islington Hospital 1,365 males 987 females — 2,352 Royal Free Hospital 697 3,049 Those attending at the Royal Free Hospital were X-rayed after the 31st December, and there was a balance of 406 for whom the Unit were unable to make any arrangements. The names of these applicants were put on the Unit's waiting list and included, as far as possible, at another Centre. At the public sessions 510 males and 513 females were X-rayed, although these were not divided separately into Islington and St. Pancras residents. In addition, a very considerable number of school leavers were X-rayed by direct arrangements between the schools and the Unit. The Unit state it would have been very desirable for them to have stayed longer in Islington, but the Secretary of the Hospital wished to take the ward back into use at the beginning of the new year. Of the total number of those X-rayed, 212 or 3.06 per cent, were recalled for full sized films. 52 of these cases were recommended for further medical advice and 53 cases were requested to return to the Unit for further X-ray at a later date. Extra Nourishment. The responsibility for extra nourishment and additional allowances was transferred to the London County Council as the Local Health Authority and Welfare Authority and also to the National Assistance Board, as from 5th July. The undermentioned information relates to the position up to this period during which the Borough Council was responsible. 177 cases received extra nourishment at a total cost of £369 18s. 5d. Tuberculosis Care Committee. Care work, including tuberculosis care work, became the responsibility of the London County Council as the Local Health Authority, and the Tuberculosis Care Committee staff, including the two Secretaries and a Clerk, were transferred to the service of that Authority. From the information supplied by the Divisional Health Office, the Care Committee, during the year, dealt with 342 cases. 113 patients have been helped, some on several occasions with cash or in kind, and loans of bedding or medical appliances were made to another 20 patients; others have been referred to various organisations for assistance. Maintenance Allowances Scheme. Number of patients receiving weekly allowance at July 5th, 1948 167 Number of cases brought before Assessment Officer 849 Number of new cases (i.e., applications) 103 21 Number of renewals 011 existing orders 313 Number of orders adjusted, etc. 2.97 Number of patients returning to full-time work 40 Number of deaths 14 Other "Cease payments" 82 Number of cases transferred to National Assistance Board on 5.7.48 160 Amount paid out in allowances 1.1.49-4.7.49 £3,828 1s. 8d. Beds and Bedding. 7 Patients were provided with beds and bedding on loan. SECTION C. SANITARY CIRCUMSTANCES OF THE AREA. The number of Sanitary Inspectors throughout the year continued to be below establishment, but it was found that more students were qualifying and were available for engagement as Inspectors. During the year a revision in the procedure in respect of the receipt and follow-up of complaints was adopted, which has been of considerable benefit to the Department and resulted in the District Sanitary Inspectors' work being performed and recorded in a more expeditious and satisfactory manner. As a result of the implementation of this scheme, Statutory Notices were served shortly after the Intimation Notices and this procedure accounts for the large increase in the number of Statutory Notices served as compared with last year, the figures for which are given in the table on page 22. The existence of bombed sites, static water tanks and air-raid shelters still caused nuisances to arise from misuse, and numerous complaints were received by the Department in respect of them. The presence of water in static water tanks provided ideal breeding grounds for mosquitoes, and in this connection the services of the London Fire Service were appreciated. By arrangement with this Service the tanks were cleared of water and bleach placed on any remaining debris inside the tank. Difficulty was experienced owing to the unauthorised tipping of refuse in areas or yards belonging to derelict or unoccupied properties, thus causing a Public Health nuisance in many cases, and in others the existence of unsightly accumulations of papers and other non-putrescible matter. In conjunction with the Ministry of Labour and National Service a scheme was adopted whereby young ex-servicemen received training in the duties of a Sanitary Inspector. During the year four students were so engaged. These Students agreed to stay with the Council for a period of two years, during the first year of which they received a grant from the Ministry and after that period they became temporary officers of the Council. This scheme proved highly beneficial both to the students and also to the Department. It resulted in the Inspectors making 1,000 more inspections and 7,000 more re-inspections than in 1947. Consequent upon the Council adopting the scheme set out in Circular N.S. 19 of the Ministry of Agriculture and Fisheries, relative to Rodent Control, the Rodent Control Section of the Department has been placed on a permanent basis. 22 This has rendered possible the systematic inspection of the Borough, and the carrying out of treatment where necessary. Private dwellings continue to be treated free of charge, but the Council has fixed a scale of charges in respect of the treatment of business premises, half of which sum is re-imbursed by the Ministry of Agriculture and Fisheries. Public Health (London) Act, 1936. Emission of Smoke. Difficulty continued to be experienced in the enforcement of part 5 of the Public Health (London) Act, 1936, due, mainly, to the inferior quality of the fuel available and to the limited experience of some of the stokers engaged by the firms in the Borough. Any improvement made, in the abatement of nuisances caused by the emission of smoke, resulted from the close supervision by the Inspectors and the co-operation of the Ministry of Fuel and Power and the firms concerned. In one instance a serious nuisance was caused to neighbouring factory premises by the emission of grit from the chimney of an industrial boiler which was being fired with coke. Following the adoption of suggestions made by the Sanitary Inspector the nuisance was abated. Frequent and serious nuisances were caused by the emission of black smoke from the chimney of a Government Department due, it was stated, to the use of unsuitable fuel. The matter was still the subject of correspondence between this Department and the appropriate Government Department at the end of the year. Following a meeting on the premises, between the Sanitary Inspector and a representative of the Ministry of Fuel and Power, one factory, which was causing a nuisance to adjoining flats by the emission of black smoke, installed an oil-fired furnace. The number of complaints received during the year 46 The number of observations made 75 The number of Notices served 5 The number of Notices complied with 5 Summary of Work done by District Sanitary Inspectors. During the year 40,372 inspections (including re-inspections) were carried out by the District Sanitary Inspectors, made up as follows:— 1948 1947 House to house inspections 1,314 1,413 Other premises inspected 9,824 8,602 Re-inspections, calls made, etc. 29,234 21,527 40,372 31,542 Special Matters dealt with when making the above visits— Urinals attached to Public Houses 76 29 Premises for Foster children 14 12 Premises re vermin 414 463 Premises re Rats and Mice 226 207 Premises re Water Certificates 935 247 Non-effective visits 5,810 3,590 Notices served—Intimation (Public Health (London) Act, 1936) 7,083 7,134 Notices served—Statutory (Public Health (London) Act, 1936) 5,564 1,107 23 Rent and Mortgage Restrictions Acts, 1920, etc, Certificates applied for 194 251 Certificates issued 181 230 Certificates refused 6 20 Balance to 1949 7 1 Clearance Certificates applied for 132 53 Clearance Certificates granted 52 34 Clearance Certificates refused 65 19 Balance to 1949 15 Prosecutions. Public Health (London) Act, 1936. Date of Hearing and Court Address Offence Result of Proceedings 20.1.48 North London 83, Richmond Avenue Leaky roof, dampness, etc. ... Order to abate nuisance within 21 days. 26.1.48 North London 91, Queensland Road Main and back addition roofs leaking, dampness, etc. Summons withdrawn— work done. 6.2.48 North London 33a, Highbury New Park. Defective and leaky main roof Abatement Order within 28 days. Work done. 13.2.48 North London 101, Riverdale Road (1) Failure to comply with an Abatement Order dated 14th November, 1947. (2) Failure to comply with an Abatement Order dated 14th November, 1947. Fined 20s. on each summons. 25.2.48 Tower Bridge Police Court 107, Mildmay Grove Failure to comply with an Abatement Order dated 14th November, 1947. Fined £35. Costs 3s. (Three months to pay) 25.2.48 North London 66, Offord Road Defective floorboards, dampness, etc. (basement). Abatement Order within 28 days. Costs £2 2s. 17.3.48 North London 2, Petherton Road (1) General dilapidations (2) Defective roofs, gutters, etc. Abatement Order within 5 weeks. Costs £2 2s. 17.3.48 North London 1, Lesly Street Verminous Rooms Fined £5. 17.3.48 North London 11, Lesly Street Verminous Rooms Fined £5. 17.3.48 North London 15, Lesly Street Verminous Rooms Fined £5. 17.3.48 North London 25, Lesly Street Verminous Rooms Fined £5. 17.3.48 North London 35, Lesly Street Verminous Rooms Fined £5. 17.3.48 North London 37, Lesly Street Verminous Rooms Fined £5. 8.4.48 North London 32, St. John's Grove Defective main roof Costs £2 2s. Summons withdrawn — work done. 23.4.48 North London 3, Lesly Street Main roof defective, etc. Fined £10.Costs £1 Is. 23.4.48 North London 25, Lesly Street Main and back addition roofs leaking, dampness, etc. Fined £10. Costs £1 1s. 23.4.48 North London 31, Lesly Street Dampness and general defects Fined £10. Costs £1 1s. 23.4.48 North London 39, Lesly Street Back addition roof defective Fined £1, Costs £3 3s. 28.4.48 North London 57, Hilldrop Crescent Roof leaking, gutter and ceiling defective, etc. Abatement Order within 48 days. Costs £2 2s. 14.5.48 North London 1, Lesly Street Back addition roof defective, dampness, etc. No penalty as some of work done. 14.5.48 North London 3, Lesly Street Rear roof defective ; dilapidated condition of walls, ceilings, etc. Fined £12. 14.5.48 North London 5, Lesly Street Dampness and general dilapidations. Fined £12 14.5.48 North London 7, Lesly Street Roof, gutters, rainwater pipes, etc., defective. Fined £12. 24 Date of Hearing and Court Address Offence Result of Proceedings 14.5.48 North London 9, Lesly Street Roof and gutters leaking: general defects. Fined £59 14.5.48 North London 11, Lesly Street Roof and gutters defective ; general defects. Fined £59 14.5.48 North London 13 Lesly Street General dilapidations Fined £12 14.5.48 North London 15, Lesly Street General dilapidations Fined £12 14.5.48 North London 17, Lesly Street Main roof leaking, and general dilapidations. No penalty 14.5.48 North London 19, Lesly Street Roof leaking, dampness, etc. Fined £12 14.5.48 North London 21, Lesly Street General dilapidations Fined £12 14.5.48 North London 23, Lesly Street General defects Fined £12 14.5.48 North London 25, Lesly Street General defects Fined £12 14.5.48 North London 27, Lesly Street Rainwater pipe defective Fined £59 14.5.48 North London 29, Lesly Street Main and addition roofs leaking; general dilapidations. Fined £12 14.5.48 North London 31, Lesly Street Rainwater gutters defective, dampness, etc. No penalty 14.5.48 North London 35, Lesly Street General dilapidations Fined £12 14.fi.48 North London 37, Lesly Street Main roof, gutters, rainwater pipes defective, dampness. Fined £12 14.5.48 North London 41 Lesly Street Ground floor water closet— defects extending to scullery below. Fined £17 19.5.48 North London 12, Thornhill Square Leaky roof and dampness Work done—summons withdrawn. 25.5.48 North London 28, Warrender Road Defective roofs, gutters, ceiling plaster, etc. Abatement Order within 21 days. Costs £1 Is. 25.5.48 North London 41, Frederica Street Defective roofs, dampness, etc. Abatement Order within 21 days. Costs £1 Is. 25.5.48 North London 101, Riversdale Road Defective roof, defective ceiling. Abatement Order within 21 days. Costs £1 Is- 25.5.48 North London 27, Warrender Road Floorboards broken, sashcords broken, etc. Abatement Order within 7 days. 25.5.48 North London 30b, Hartham Road Roof leaking, dampness Work done. Costs £2 2s. 16.6.48 North I.on don 135. Bemerton Street Dampness, defective ceilings, etc. Abatement Order within 5 days. Costs £2 2s. 25.6.48 North London 23, Dorinda Street General dilapidations Closing Order made. 28.6.48 North London 37, Kinlock Street Roofs leaking, ceiling defective. Work done. Summons withdrawn. Defendants to pay £1 Is. Costs. 28.6.48 North London 17, Kinlock Street Roof and gutters defective and leaking, etc. Abatement Order within 14 days. 28.6.48 North London 65, Roden Street (1) Defective soil vent pipe (Sec. 109). (2) Roofs defective, etc. (i) Fined £5. Abatement Order within 21 days. Costs £2 2s. 28.6.48 North London 36, Davehant Road Defective main and back addition roofs. Abatement Order within 21 days. Costs' £2 2s. 13.7.48 North London 25, Arthur Road Roofs defective, wall plaster broken, etc. Work done. Costs £2 2s. 13.7.48 North London 18, Pemberton Terrace. General dilapidations Magistrate made a Closing Order. Costs £2 2s. 14.7.48 North London 17, Albany Place Defective main and backaddition roofs, etc. Abatement Order within 28 days. Costs£2 2s. 14.7.48 North London 2, Freegrove Road Main roof leaking Abatement Order within 28 days. Costs £2 2s. 14.7.48 North London 48, Hornsey Road Roof defective and leaking New summons issued 25 Date of Hearing and Court Address Offence Result of Proceedings 14.7.48 North London 27, Warrender Road Main and back addition roofs leaking. Summons withdrawn— work done. Costs £2 2s. 14.7.48 North London 23, Witherington Road. Hall floor front and back room —dampness of walls. Summons withdrawn— work done. Costs £2 2s. 14.7.48 North London 35, Yonge Park Roof leaking; dampness Work completed. Costs £2 2s. 14.7.48 North London 26, Petlierton Road General defects Summons withdrawn— work done. 15.7.48 Old Street 26, Cleveland Road Rain water pipes and gutters defective—basement. Summons withdrawn— work done. 21.7.48 North London 250, Brecknock Road Main, addition and scullery roofs leaking, etc. Abatement Order within 28 days. Costs £2 2s. 29.7.48 Old Street 29, Cloudesley Road Roofs and celings defective; dampness. Abatement Order within 28 days. Costs £2 2s. 10.8.48 North London 2, Petlierton Road,.. Failure to comply with Abatement Order dated 17th March, 1948. Adjourned sine die 10.8.48 North London 22, Salisbury Road Basement wall plaster in damp and crumbling condition. Summons withdrawn— work done. Costs £3 3s. 10.8.48 North London 124, Mercers Road Roof leaking, ceiling plaster broken. Work done. Costs £2 2s. 10.8.48 North London 28, Gifford Street Summons not served— defendant in U.S.A. 10.8.48 N orth London 83, Richmond Avenue Failure to comply with an Abatement Order dated 20th January, 1948. Adjourned sine die 12.8.48 Old Street 2, Crowland Terrace Leaking main roof, dampness, broken sashcords, etc. Abatement Order in 28 days. Costs £2 2s. 18,8.48 North London 45, Pemberton Gar Main and back addition roofs, sashcords broken, etc. Work done. Costs £'3 3s 18.8.48 North London 28, Warrender Road Failure to comply with an Abatement Order dated 25th May, 1948. Fined £5. Costs £5 5s. 18.8.48 North London 29, King Henry's Walk Leaking main roof, defective sashcords, etc. Abatement Order within 28 days. Costs £2 2s. 25.8.48 North London 58, Whitehall Park Defective main and back addition roofs, etc. Abatement Order within 14 days. Costs £1 Is. 25.8.48 North London 18, Mildmay Park Back addition roof leaking Summons withdrawn— work done. 25.8.48 North London 36, Davenant Road Failure to comply with an Abatement Order dated 28th June, 1948. Fined £5. Costs £1 1s. 25.8.48 North London 23, Pemberton Gardens. Main roof leaking; staircase ceiling plaster cracked and broken. Work in progress. Adjourned sine die. 14.9.48 North London 48, Hornsey Road Roof defective and leaking Abatement Order within 21 days. Costs £1 1s. 14.9.48 North London 14, Delhi Street General dilapidations; drains choked. Abatement Order within 28 days. Costs £1 1s. 14.9.48 North London 119, Southgate Road Leaking roof, perished wall plaster, etc. Summons withdrawn— new owners. 14.9.48 North London 40, Stock Orchard Crescent. Main roof leaking, ceiling broken, etc. Abatement Order within 14 days. Costs £1 1s. 14.9.48 North London 71, Theberton Street Main roof defective, windows defective, etc. Abatement Order within 21 days. Costs £1 1s. 14.9.48 North London 21, Anatola Road Main roof leaking; back addition roof defective, plaster defective, etc. Work done. Costs £11s. 14.9.48 North London 31, Anatola Road ... Main roof leaking ; dampness, etc. Abatement Order within 28 days. 14.9.48 North London 26, Hilldrop Crescent General defects Abatement Order within 21 days. Costs £1 1s. 26 Date of Hearing and Court Address Offence Result of Proceedings 17.9.48 Old Street 154, Barnsbury Road General defects Abatement Order within 21 days. Costs £1 1s. 17.9.48 Old Street 11, Cleveland Road General defects Case withdrawn — work completed. 8.10.48 Old Street 50, Elizabeth Avenue Leaking roofs, broken wall plaster. Adjourned sine die 3.10.48 Old Street 41, Oakley Road Main roof leaking; defective firegrate. Summons withdrawn— work done. 12.10.48 North London 43, Mildmay Park (1) Leaking roof, dampness, etc. (2) Basement—defective flooring, dry rot, etc. Costs £5 5s. Costs £5 5s. (To pay within 14 days). 12.10.48 North London 32, Mildmay Grove Main and back addition roofs leaking, etc. Work done. Costs £2 2s. 12.10.48 North London 3, Northampton Grove Dampness in first floor rooms due to defective roof. Work done. Costs £2 2s. 27.10.48 North London 70, Brecknock Road Main and hall roofs leaking; general defects. Work completed. Costs £2 2s. 27.10.48 North London 41, Frederica Street Failure to comply with an Abatement Order dated 25th May, 1948. Case withdrawn 4.11.48 North London 57, Hilldrop Crescent Failure to comply with an Abatement Order dated 28th April, 1948. Fined £5. Costs £2 2s. 4.11.48 North London 13, Clifton Terrace... Main roof defective ; general defects. Abatement Order within 21 days. Costs £1 1s. 4.11.48 North London 107, Tollington Way Main roof leaking, etc. Summons withdrawn— work done. 10.11.48 North London 23, Havelock Street General dilapidations Abatement Order within 14 days. 18.11.48 North London 36, Davenant Road Failure to comply with an Abatement Order dated 28th June, 1948. Fined 10s. Costs £1 1s. 6.12.48 North London 91, Mitchison Road Main roof leaking, etc. Abatement Order within 28 days. Costs £2 2s. 6.12.48 North London 250, Brecknock Road Failure to comply with an Abatement Order dated 21st July, 1948. Owners present address unknown. (Public Health Committee 29th December, '48, adopted a resolution to employ an Enquiry Agent). 6.12.48 North London 15, Luard Street First floor front room and kitchen—general defects. Reported work done. Costs £1 1s. 6.12.48 North London 52, Bingfield Street Dampness and general dilapidations. Abatement Order within 28 days. Costs £1 1s. 6.12.48 North London 14, Delhi Street Failure to comply with an Abatement Order dated 14th September, 1948. Adjourned sine die 29.12.48 North London 11, Fulbrook Road Roof leaking, dampness, and dilapidations. Work done. Council awarded £2 2s. Costs. Public Health (London) Act, 1936. Sections 40 & 109. During the year, as the result of notices served by the Sanitary Inspectors under Sections 40 & 109 respectively of the Public Health (London) Act, 1936, the Council, in pursuance of their powers under the Act, carried out work in default at a total cost of approximately £1,600. Disinfection and Disinfestation. The employment of D.D.T. (dichlor-diphenyl-trichlorethane) was continued as the method of choice for the Disinfestation of premises from bugs and other insect 27 vermin, and, in consequence of the success of this method, the large cyanide chamber was transferred to the Cleansing Department. No cyanide fumigations were carried out during the year either by the Council or privately. The free treatment of rooms and furniture in recommended cases was continued; the number of cases so treated was 158. A total of 1,153 rooms were disinfested for vermin. During the year 846 rooms were disinfected after cases of infectious or other diseases. At the Disinfecting Station 237,341 articles of clothing or bedding, etc. (227,079 for Clothing Contractors) were treated for infection or infestation. In addition 28 tons 1 cwt. of material was disinfested on behalf of Clothing Contractors. As a routine item, the practice of spraying with D.D.T. solution, before removal, the furniture and premises of families removing to new Council properties, was continued. The new premises were also sprayed soon after occupation in order to ensure that both furniture and rooms were free from infestation for at least a month. During the year the effects of 408 families were so treated, as follows:— 399 in respect of tenants moving into Council property; 9 in respect of tenants moving into flats owned by a private housing trust. WORK OP SANITARY INSPECTORS ADMINISTERING FACTORIES ACT, 1937, AND OTHER RELEVANT ACTS. Inspections and Re-Inspections. 5,984 inspections and re-inspections were made by these Inspectors during the year. These are summarised as follows :— Coffee and Dining Rooms 707 Factories (Mechanical) 1,830 Factories (Non-mechanical) 645 Fish Curers 33 Fried Fish Shops 168 Half-Way Houses 11 Hotel & Restaurant Kitchens 296 Noise Nuisances 69 Outworkers 476 Provisions 4 Rats and Mice (Destruction) Act, 1919—Factories 38 Refreshment Rooms 544 Smoke Nuisances 69 Special Inspections (Food Licences) 240 Miscellaneous 854 Total 5,984 (See separate sections on Underground Bakehouses and Offensive Trades). •28 Defects or Contraventions found. 1,561 defects or contraventions were found. A summary, under statutory enactments, is as follows:— Factories Act, 1937 603 Food and Drugs Act, 1938 503 Public Health (London) Act, 1936 455 Total 1,561 Notices served. 537 Notices were served. These are summarised below:— Factories Act, 1937 123 Food and Drugs Act, 1938 193 Public Health (London) Act, 1936 221 Total 537 Defects or Conlraventions Remedied. 1,610 defects or contraventions were remedied, as follows:— Factories Act, 1937 661 Food and Drugs Act, 1938 503 Public Health (London) Act, 1936 446 Total 1,610 The following Notices were also served:— Rats and Mice (Destruction) Act, 1919 2 Number complied with 1 Complaints received. 164 complaints were received, as follows:— General 131 Home Office 33 Total 164 Underground Bakehouses. Pursuant to Section 54 of the Factories Act, 1937, it became nccessary for all basement bakehouses, in respect of which a certificate of suitability had been issued, to be examined. Number of Premises on Register 40 Number of Routine Inspections 55 Number of Notices served 4 Number of Notices complied with 21 29 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 375 632 32 — (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 1,653 1,666 91 . — (iii) Other Premises in which Section 7 is enforced by the Local Authority* (excluding out-workers' premises) — — Total 1,928 2,293 123 — 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) 99 136 11 Overcrowding (S.2) — 5 — — — Unreasonable temperature (S.3) — 27 — — — Inadequate ventilation (S.4) 10 32 — 1 — Ineffective drainage of floors (S.6) 3 5 — — — Sanitary Conveniences (S.7)— (a) insufficient 11 14 — — — (6) Unsuitable or defective 429 416 — 9 — (c) Not separate for sexes 6 15 — 1 — Other offences against the Act (not including offences relating to Outwork) 55 22 14 2 Total 613 672 14 24 — *i.e. Electrical Stations (Section 103(1)), Institutions. (Section 104) and sites of Building Operations and Works of Engrineering Construction (Sections 107 and 108). 30 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 apparel Making, etc. 646 — — — — — Cleaning and washing — — — — — — Household linen 2 — — — — — Curtains and Furniture hangings 4 — — — — — Furniture and Upholstery 1 — — — — — Electro-plate 1 — — — — — Umbrellas, etc 8 — — — — — Artificial flowers 131 — — — — — Paper bags 4 — — — — — The making of boxes or other receptacles or parts thereof made wholly or partially of paper 245 — — — — — Brush making 17 — — — — — Feather sorting 2 — — — — — Carding etc. of buttons, etc 8 — — — — — Stuffed toys 40 — — — — — Basket making 1 — — — — — Cosaques, Christmas crackers, Christmas stockings, etc. 20 — — — — — Lampshades 11 — — — — — Total 1,141 — — — — — Shops Act, 1934. Inspections 904 Re-visits 376 Infestation Order, 1943. Consequent upon the Council's adoption of the scheme laid down by the Ministry of Agriculture and Fisheries in their Circular, N.S.19, the rodent control staff of this Department was placed on a permanent basis and the establishment of this section was made up as follows:— 1 Rodent Officer— To supervise the work under the direction of the Senior Sanitary Inspector. 3 Rodent Investi- To be engaged on inspecting premises for the ascertainment of any gators— infestation and, in the'case of factories or premises other than private dwellings, to arrange for the signing of agreements and payment for treatment, to assess the number of baiting points required and to supervise the work of the Rodent Operators. 6 Rodent Operators— To lay baits and record "takes." 1 Clerk. No charge was made for the treatment of domestic premises but it was considered that, as the new consolidated grant did not apply in respect of expenditure incurred in the treatment of business, factory or similar premises, it would be advisable to revise the scale of charges. 31 During the year:— 1,397 complaints were received 12,930 investigations were carried out 2,095 infestations were found comprising 392 Business premises and 1,703 dwellings. Treatments carried out were:— Dwellings 1,703 with 12,005 baits being laid Business Premises 151 with 1,359 baits being laid Post bait treatments in respect of dwellings and Business premises 476 with 4,000 baits being laid 2,330 17,364 Bombed Sites—Test baited only. The number of agreements sent out—196 The number of agreements returned—151. A number of business premises were dealt with by the occupiers' staff or private servicing firms. Where this procedure was adopted the premises were kept under supervision to ensure that the treatment was satisfactory. It was also necessary in the case of several premises to have post-bait treatment carried out. During the year defective drains were found to be a source of access by rats to premises in the Borough and in this connection thirty smoke tests were carried out from July to December with the result that seventeen defective drains were found. Although treatment at dwelling houses is carried out free of charge, tenants are not always appreciative of the efforts of the Council to rid their premises of rats. In one case it was necessary for the Sanitary Inspector to take an action for assault and the tenant was bound over for the sum of 40s. to keep the peace for one year. The treatment at this house proved very difficult to carry out and a considerable amount of time and labour was expended in relation thereto. Two premises were dealt with by the Ministry of Agriculture and Fisheries with a view to the Ministry testing the effectiveness of new poisons. The co-operation of the staff of the Ministry of Agriculture and Fisheries and of the Council's Borough Engineer's Department has been appreciated by this Department. An analysis of infestation in the Borough has shown that the proportion of black rat infestation was approximately 2 per cent., and the number of premises found to be infested with black rats was twenty-eight. Disinfestation of Sewers. In conjunction with the Borough Engineer's Department, sewer treatment was carried out on two occasions during the year. Details were as follow :— 31st May to 24th June, 1948. Manholes Baited Pre-Bait takes Complete takes No takes Bodies seen Percentage of poison takes Estimated kill 681 458 338 223 12 CT PT NT 4,783 19% 73% 8% 32 6th to 16th December, 1948. Manholes baited Pre-Bait takes Complete takes No takes Bodies seen Percentage of poison takes Estimated kill 728 530 350 108 16 CT PT NT 4,035 10% 71% 19% Water Supplies. With the exception of a few wells in the Borough, the Metropolitan Water Board is responsible for all supplies. The number of bore holes, for industrial purposes, in the Borough remained at eight. Two additional bore holes are normally used in connection with the supply of water to one of the Council's Public Baths, but one of these was out of order during the whole of the year. Upon a report being received from one of the householders in the Borough it was found, upon inspection, that a disused well had been discovered in the garden at the rear of his house. The facts in this case were as follow:— The householder had previously arranged for an Anderson Air-Raid Shelter to be removed and had cultivated that portion of the garden and laid a path. One evening whilst he was showing a friend round the garden he saw what appeared to be a movement of earth and shouted to his friend to keep clear. Within a few minutes a large portion of the garden had caved in, exposing a disused well which had a brick lining and a cover put over on two occasions at different levels. The well was approximately 4 ft. 6 ins. wide by 30 ft. deep. After negotiations with the proper authorities the well, which had been directly beneath the air raid shelter, was filled in. In accordance with the requirements of the Public Health (London) Act 1936, 42 applications for Water Certificates were received and 42 Certificates were issued in respect of 935 premises. The following samples of water were taken:— Satisfactory Unsatisfactory Chemical Bacteriological Chemical Bacteriological Chemical Bacteriological 10 10 10 10 — — Swimming Bath Water.—During the year the following samples were taken from the Council's swimming pools. Satisfactory Unsatisfactory Chemical Bacteriological Chemical Bacteriological Chemical Bacteriological 18 18 16 18 2 — After each of the chemically unsatisfactory samples the Swimming Bath water was changed. SECTION D. HOUSING. During the year 1948, 1,684 new applications for accommodation on London County Council Estates were referred to this Department for investigation. Of this number, 924 were found to be living in overcrowded conditions and overcrowding reports were submitted to the London County Council. In 141 instances, 33 recommendations were submitted to that authority on the grounds of serious illhealth, such as tuberculosis, rheumatism, valvular heart disease, etc. It is not possible to assess the degree of overcrowding existing in the Borough at the present time owing to considerable changes in population since the housing survey of 1936. During the year the following action was taken under the Housing Act, 1936. Section 9 One Notice served. Section 11 Four premises were represented. Section 12 Thirty-nine flats in King Edward Buildings, as well as the basement rooms in respect of four premises, were represented. Closing Orders Twenty-one flats in King Edward Buildings were closed under Section 12 as unfit for human habitation. Prosecutions., Date Hearing and Court Address Offence Result of Proceedings 16.6.48 North London 72, King Edward Buildings, Block 4. Failure to comply with a Closing Order contrary to Section 14 of the Housing Act, 1936. Adjourned Generally 16.6.48 North London 75, King Edward Buildings, Block 4. Failure to comply with a Closing Order contrary to Section 14 of the Housing Act, 1936. Adjourned Generally Public Health (London) Act, 1936. Two premises were subjected to closing orders in accordance with the provisions of paragraph 8 of the 5th schedule, until the premises are made fit for habitation. Particular attention was paid to a certain area in the Borough comprising 139 properties which were the subject of numerous complaints and petitions. A considerable amount of money was expended on this property by the various owners, but the whole of the area is typical of most of the property in the Borough which is old, worn out and, owing to lack of repairs during the war, as well as war damage, in urgent need of repair in order to keep it in a reasonably fit condition. Attention was also directed to a block of terraced houses in the Borough where difficulty was experienced in serving the Notices upon the owner. Summonses were taken out, but in turn, difficulty was experienced in serving these. The Magistrate agreed to the issue of a warrant for the owner's arrest and eventually he was brought to the court, the cases proved, and fines imposed totalling £399, and £6 6s. C03ts. Abatement Orders were obtained in respect of the property involved and, at the end of the year, the work necessary to comply with the requirements of the Notices was well in hand on behalf of a Building Society which became responsible for this property in default of the owner. Requisitioned Property. The supervision of repairs, reconstruction or replacement of drainage and sanitary fitments has been maintained in properties which have been requisitioned by the Council, with a view to ensuring where practicable, compliance with the Bye-laws, SECTION E. INSPECTION AND SUPERVISION OF FOOD. Clean Food Campaigns. During the year a single lecture and demonstration course, to meet the educational requirements of kitchen workers, was arranged in conjunction with the Central Council for Health Education and all individual restaurant and cafe proprietors, as well as firms with canteens, etc., were invited to send members of their staff. A number of large firms with restaurants in the Borough wrote to the effect that they had their own arrangements for the education of their staff in food hygiene. t ' Following this, a three lecture course was arranged specifically for those in charge of restaurants, canteens, etc., and senior staff. Invitations were forwarded to firms with restaurants, and cafe proprietors, these invitations being followed up by personal visits by the Sanitary Inspector concerned. Taking part in this course were the Medical Officer of Health, the Pathologist of the Archway Group Laboratory, a member of the staff of the Westminster Technical College and also two Sanitary Inspectors. Talks and practical demonstrations were given, and the attendance varied between 30 and 40. The lectures were advertised in the local press and circulars were forwarded to interested persons in the Borough inviting the staffs engaged in restaurants, canteens, etc., to attend. Food hygiene posters and handbills were widely distributed and also prominent notices regarding washing of hands, etc., were displayed in appropriate positions in restaurant premises. Local publicity was also given by reports of lectures in the local press and in a monthly information booklet circudated by the Council's Libraries Department. The Council engage three women Sanitary Inspectors who were very largely concerned, in the parts of the Borough which were allocated to them, for the inspection of restaurants and cafes. Much of their time was spent in individual discussion and giving individual advice in the course of their inspections of food establishments and they made a particular point of discussing food hygiene with kitchen employees on all possible occasions. Inspection of Refreshment and Coffee Stalls. It was considered advisable, consequent upon the complaints which had been received regarding unclean crockery at refreshment and coffee stalls, for the Sanitary Inspectors to pay evening visits, having regard to the fact that, in the majority of cases, refreshment stalls do not set up until late in the evening when inspections were not normally carried out. Accordingly arrangements were made for evening routine inspections of food stalls to be carried out and, in this connection, it was reported by the Inspectors that most of the stalls were found to be in a satisfactory condition. Out-Door Food Handlers. The provisions of the Food and Drugs Act, 1938, require certain precautions to be taken in relation to the protection and hygienic preparation of food, the keeping of premises in a clean condition, and the taking of such steps as may be reasonably necessary, by the persons exposing food for sale, to prevent risk of contamination. It was appreciated by the Council that difficulty arose relative to the personal hygiene of out-door food handlers, such as vendors handling unwrapped food, milk roundsmen etc. The out-door food handler was at a big disadvantage in view of 35 the fact that the law does not require him to have a sufficient and suitable supply of hot and cold water for personal cleanliness; he may have a clean stall and utensils but his hands, during the course of the day, become contaminated by the handling of money and by normal street dust and sometimes also in the handling of his goods. He was also placed under an additional disadvantage having regard to the fact that, although premises must have a sanitary convenience, stall-holders and other street traders must rely in practically all cases upon public conveniences. Public Health Authorities advocate the washing of hands after using the toilet, but in the case of out-door food handlers there were no facilities readily available to them for this purpose. It was doubtful whether, after using the toilet in a public convenience, a food handler would spend a further fee in order to wash his hands. In order to encourage greater cleanliness among such food handlers, and as a means of giving publicity to the need for greater personal hygiene, a scheme was adopted in principle, whereby outside food handlers could be enabled to use, free of charge, the washing facilities available in public conveniences. By the adoption of this scheme it was considered that a most favourable impression upon food handlers and upon the public would result, and the Sanitary Inspectors would be in a better position to enforce personal cleanliness when making an inspection of stalls, barrows, ice-cream tricycles, etc. The use of public conveniences by food handlers would also form part of the education in personal hygiene and the hygienic handling of food. Food and Drugs Act, 1938—Milk and Dairies Regulations, 1926/1943. Sampling of Food, including Milk. Prosecutions. The following table gives details of the actions taken by the Council under the Food and Drugs Act, 1938, and the Milk and Dairies Regulations, 1926/1943 :— Food and Drugs Act, 1938. Date of Hearing Offence Result of Proceedings Court 5.1.48 Selling fish not of the nature substance and quality demanded. Fined £10 and ordered to pay £4 10s. Costs. Old Street Police Court. 5.1.48 Selling a sweet which was not of the nature, substance and quality demanded (nail in sweet). Fined£5 and Costs£3 3s. Old Street Police Court. 13.1.48 Selling bread not of the nature, substance and quality demanded. Found guilty. Case dismissed under P. of O. Act. Costs £1 1s. North London Police Court. 25.5.48 Permitting an unsound barrel of cooking fat to remain in yard. Dismissed—defendant found not guilty. North London Police Court. 25.5.48 Failure to keep clean walls of flour store. Fined £7 North London Police Court. 25.5.48 Failure to keep clean floors Fined £7 North London Police Court. 25.5.48 Permitting dust to accumulate on shelves. Fined £7 North London Police Court. 1.6.48 Selling bread unfit for human consumption. Fined £15 North London Police Court. 1.6.48 Failure to observe cleanliness in rooms in which food is prepared for sale. Fined £10 North London Police Court. 6.10.48 Selling sausages not of the nature, substance and quality demanded. Defendant found guilty. Case dismissed under P. of O. Act. Costs £5 5s. Clerkenwell Police Court. 36 Food and Drugs Act, 1938. Milk and Dairies Regulations, 1926/1943. Date of Hearing Offence Result of Proceedings Court 20.1.48 Failure to cause a vessel containing milk to be kept in a state of proper cleanliness (M. & D. Regs. 1926 & 1943. and Food and Drugs Act, 1938). Dismissed under P. of O. Act. Costs £1. • North London Police Court. 20.1.48 Failure to cause a vessel containing milk to be kept in a state of proper cleanliness (M. & D. Regs. 1926 & 1943, and Food and Drugs Act, 1938). Defendant acquitted. Wholesalers cited under warranty (s. 83, F. & D. Act, 1938). Dismissed under P. of O. Act. Costs £1. North London Police Court. 12.3.48 Selling milk not of the nature, substance and quality demanded (Sec. 3 Food and Drugs Act, 1938, and The Sale of Milk Regs., 1939). 1st sample Fined £10. Costs £2 2s. 2nd sample Summons withdrawn. Old Street Police Court. 4.11.48 Failure to cause a vessel containing milk to be kept in a proper state of cleanliness (M. & D. Regs., 1926/1943, and Food and Drugs Act, 1938). Dismissed under P. of O. Act. Costs £5 5s. North London Police Court. • It will be seen that 16 cases were taken under the Food and Drugs Act, 1938, 3 cases under the Milk and Dairies Regulations, 1926/1943 and Food and Drugs Act, 1938, and 1 case under the Food & Drugs Act, 1935-, and The Sale of Milk Regulations, 1939. Inspectors Visits. Number of visits made for inspection of food 186 Visits made to shops, etc.—During the year 963 visits were paid to various shops, stalls, etc. (For other visits see item re Meat and Other Foods). Total weight of food condemned, including meat— 43 tons 14 cwts. lqr. 9 lbs. 6 ozs. Sampling. 1,309 samples (521 formal, 788 informal) were submitted to the Public Analyst for examination. Of these 19 (or 1.45 per cent.) were adulterated as shown in the following summary— Formal Informal Milk 3 Milk 2 Sausages & Sausage Bread 3 Meat) 2 Sausages (Beef, Liver, Tomato Sauce 1 etc.) 1 Sausages (Beef) 1 Sausage Roll 1 Salt 1 Tinned Cheese 1 Mineral Oil 1 Milk Bottle 1 Tomato Sauce 1 Total 6 Total 13 37 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. 146 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—20 licences are current, 13 renewals and 7 new licences which were authorised during the year. Visits and Inspections—During the year 1,002 visits were paid to various food shops, markets, stalls, etc. Bye-laws for the Protection of Food—No prosecutions have taken place during the period under review. Registered Artificial Cream Premises. (At present dealing in Synthetic Cream) Visits—3. Ice Cream. The administration of the Ice-Cream (Heat Treatment, etc.) Regulations, 1947/ 1948, caused a considerable increase in the work of the Department, particularly having regard to the increased number of persons dealing in this commodity. Difficulty being experienced in obtaining a grade one quality by some of the manufacturers, the Sanitary Inspectors engaged in the administration of these regulations paid particular attention to premises where unsatisfactory ice-cream was being produced. Samples were taken, at the different stages of manufacture, for bacteriological examination in order to find out the source of contamination. In the majority of cases the unsatisfactory product resulted from the lack of complete sterilisation of the plant prior to manufacture and, following advice from Sanitary Inspectors, improvements were experienced. It was found that a poor grade ice-cream was often produced from premises having the most modern equipment, while a grade one product was continuously produced on premises where, although the equipment was far from up-to-date, particular attention was paid to sterilisation. In the case of the former it appeared that difficulty was experienced in obtaining complete sterilisation of the whole of the equipment, the cooler requiring particular attention. Visits to Ice Cream Premises. 607. During the year 172 samples of ice-cream were sent for bacteriological examination. The gradings of those submitted to the Methylene Blue Test were:— Grade I Grade II Grade III Grade IV Total 54 41 27 38 160 Of the remaining 12 samples, 3 were found to be unsatisfactory. Milk Samples. The total number of samples taken during 1948 was 882. 38 Samples submitted to chemical analysis:— Genuine Adulterated  Formal 499 3 502 Informal 136 2 138 640 Samples submitted to bacteriological examination:— Class of Milk Results Test Total Number of Samples Plate Count B.Coli Phosphatase Methylene Blue Pasteurised Satisfactory - 138 180 172 181 Unsatisfactory - 1 1 9 Heat Treated Satisfactory 1 14 21 18 22 Unsatisfactory — - l 4 Sterilised Satisfactory - 5 17 17 17 Unsatisfactory - - - - Tuberculin Tested (Pasteurised) Satisfactory - 3 6 5 6 Unsatisfactory - 1 - 1 Tuberculin Tested (Raw) Satisfactory 13 11 - 13 16 Unsatisfactory 3 5 - 13 Milk (Special Designations) Regulations, 1936—1946 Number of Dairies and Milk Shops inspected 91 The following licences were granted:— Tuberculin Tested (Dealer) 41 Tuberculin Tested (Supplementary) 7 Pasteurised (Pasteuriser) 1 Pasteurised (Dealer) 67 Pasteurised (Supplementary) 9 Total 125 Milk and Dairies Order, 1926. Summary of Register. No. on Reg. 31.12.47 Additions to Reg. Removals from Reg. No. on Reg. 31.12.48 Dairies 154 1 - 155 Purveyors of Milk in sealed containers only 339 1 - 340 Registered Purveyors of Milk dealing from registered premises outside the Borough 98 - - a 98 39 Summary of Visit by Milk and Dairies Inspectors. Dairies—Routine Inspections 400 Miscellaneous visits 21 Milkshops—(Milk sold in sealed containers only) Routine Inspections 164 Miscellaneous Visits 22 Vehicles inspected 78 Dairies and Milkshops—Inspections under Milk (Special Designations) Regulations, 1936/1946 91 776 During the year 38 Notices intimating nuisances or defects were served. Public Health (London) Act, 1936—Offensive Trades. The offensive trades operating in the Borough are as follows:— (a) Three Tripe Boilers. (b) One Knacker. (c) Two Fur Skin Dressers. (d) Six Gut Scrapers. 52 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 554 Number of sellers of Part II poisons othe than registered pharmacists:— 1/1/48—30/4/48 195 1/5/48—31/12/48 198 Number of initial registration during the year 29 Number of samples taken 39 . Islington Crematorium. There were 151 cremations during 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 1948 four bodies were received pending burial. The Coroner's Court was not used, neither were inquests nor autopsies carried out in the Court. 40 SECTION F. Maternity & Child Welfare. (5th July 1948). Welfare Centres. WELFARE CENTRE Children's Ante-Natal and Post-Natal Immunisation Dental Medical Officers Health Visitors North Islington Voluntary Welfare Centre, 6-9, Manor Gardens, N.7. Mon. to Fri. 1.45 p.m. Tues. to Fri. 9 a.m. Mon. Tues. 1.30 p.m. 9 a.m. & 2.45 p.m. Mrs. Mavis Stratford, M.R.C.S., LRC.P. Mrs. Eve Attkins, M.B., B.S.(Ldn.), D.A., (R.C.P. & S.Eng.). Mrs. Amelie Boyd, M.B., Ch.B., B.A.O., D.P.H. Miss Anne Campbell, M.B., Ch.B. Mrs. Louise Hewlett, M.D., B.S., M.R.C.P. Mrs. Joan Warwick, M.R.C.S., L,.R.C.P. Mrs. Aileen Cobbe, M.B., D.R.C.O.G. Miss Marv Adams, M.R.C.S., L.R.C.P., M.B., B.S.(Ldn.). Mrs. Dorothy Gibson, L.R.C.P. & S.(Edin.) Miss A. Davies (Supt.) Miss Callaghan Miss Cassell Miss Flower Miss Jones Miss Kitchener Mrs. Lynch Miss McNamara Mrs. Main Miss Ross North Branch Clinic, Blythe Mansions, Hornsey Rise, N.19. Fri. 1.45 p.m. North Branch Clinic, 112, Fonthill Road,N.4. Wed. 1.45 p.m. Miss Rochelle Churin, M.R.C.S., L.R.C.P. Mrs. Cecilia Galton, M.R.C.S., L.R.C.P. Miss Evelyn Maclagen, M.B., B.S., B.Ch., D.P.H. Miss Hilda Page, M.R.C.S., L.R.C.P. Miss Evelyn Pakeman, M.R.C.S., L.R.C.P., Mrs. Joyce Simpson, M.B., B.S., B.Ch., D.P.H. Miss Pyle (Supt.) Miss Hepburn Miss Trueman Mrs. Leopold West Islington Voluntary Welfare Centre, 42 & 44, Richmond Avenue, N.l. Mon., Wed. & Fri. 1.30 p.m. Tues. Tues. Thurs. 9.45 a.m. 1.30 p.m. 9.45 a.m. Wed. 10.30 a.m. Mrs. Baker Miss Hall App'ta May1948 West Branch Clinic, St. Luke's Mission Hall, Goodinge Road, N.7. Thurs. 11 a.m. & 1.30 p.m. South Islington Welfare Centre, Tibberton Square, Essex Road, N.I. Mon. Wed. Thurs. & 1.30 p.m. 1.30 p.m. 9.30 a.m. 1.30 p.m. Mon. Fri. & 9.30 a.m. 9.30 a.m. 1.30 p.m. Tues. 2 p.m. Wed. 9.30 a.m. E. Harford Recs, M.R.C.S., L.R.C.P., M.B., Mrs. Charlotte Himsworth, M.R.C.S., L.R.C.P., M.B.. B.S. Miss Margaret McLaughlin, M.R.C.S., L.R.C.P., M.B., B.S. Mrs. Joan Warwick, M.R.C.S., L.R.C.P. Mrs. Wilkinson (Dental Surgeon) Miss Cicely Peake, M.B., B.S. Miss Paley (Supt.) Miss Devine Miss Garabedian Miss Hitchings Miss Langridge Miss Moffatt South Branch Clinic, Union Chapel, Canonbury Avenue, N.l. Mon. Tues. 1.30 p.m. 9.30 a.m. South Branch Clinic, Mildmay Sunray Clinic, Mildmay Memorial Hospital, Newington Green, N.l. Tues. & Thurs. 9.30 a.m. 1.30 p.m. 1.30 p.m. East Islington Welfare Centre, 32, Drayton Park, N.5. Tues. & Fri. 9.30 a.m. 1.30 p.m. 1.30 p.m. Mon. Wed. & 9 a.m. 9.30 a.m. 1.30 p.m. Fri. 10 a.m. Mrs. Rosalie Burke, M.R.C.S., L.R.C.P. Mrs. Elma Chitty, M B., Ch.B. E. Harford Rees, M.R.C.S., L.R.C.P., M.B., B.S. Miss Anderson (Supt.) Miss Oliver Miss Schlund Miss Thomas Mrs. Owen East Branch Clinic, Highbury Vale Mission Hall, Hurlock Street, N.5. Thurs. & 9.30 a.m. 1.30 p.m. 41 The two Voluntary Welfare Centre Committees receive a grant from the Borough Council, and for the period 1.4.47 to 5.7.48 this was:— £ North Islington Infant Welfare Centre 1,600 West Islington Welfare Centre 105 Ante Natal and Post Natal Clinics. These are combined clinics, and details for the four Welfare Centres are set out hereunder:— North South East West Number of sessions 185 74 76 78 Total attendances 2,999 1,618 1,497 1,342 Number of new cases 469 336 246 694 Child Welfare Clinics. North South East West Number of sessions 256 220 129 156 Total attendances 11,153 10,346 6,304 6,994 Number of new cases 740 457 374 444 Home Visiting. Totals l. First Visits, infants under 1 year 2,344 (5,595) 2. Revisits ditto 7,515 (15,874) 3. Visits to children between 1st and 2nd years 5,912 (10,116) 4. Visits to children between 2nd and 5th years 7,922 (16,586) 5. Visits re stillbirths 45 (88) 6. Visits re deaths of infants under 1 year 22 (46) 7. Visits re deaths of children between 1st and 5th years 3 (-) 8. Visits re Ophthalmia Neonatorum 7 (37) 9. Visits re other Infectious Diseases 34 (40) 10. Ante-natal first visits 1,343 (2,783) 11. Ante-natal re-visits 752 (1,641) 12. Post-natal visits 145 (152) 13. Visits re Puerperal Fever cases 7 (4) 14. Visits re Puerperal Pyrexia cases 19 (38) 15. Visits re Home Help and Domestic Help cases 180 (419) 16. Visits re Registration of Daily Guardians 113 (84) 17. Incomplete visits 3,304 (5,738) 18. Ineffective visits 6,352 (13,926) 19. Total number of effective visits 26,363 (53,503) 20. Clinic Sessions attended 2,641 (5,493) (Figures shown in brackets are for 1947) Health Visitor Staff. The Health Visitor establishment was 32, including the four Superintendents of Welfare Centres. 4 new health visitors were appointed during the year and 2 health visitors resigned. 1 Superintendent and 1 Health Visitor were due to retire in June and April respectively, but owing to shortage of Health Visitors they agreed to continue their services, and were transferred to the London County Council on the appointed day. There were 2 whole-time and 1 part-time Health Visitor vacancies which were partly filled by 3 part-time Clinic Nurses engaged on a sessional basis. Child Life Protection. The supervision of foster mothers is closely linked with the problem of illegitimate children and unmarried mothers. The same two Health Visitors (Mrs. Rennie and Miss Harding) carried out these duties. 42 In connection with the special requirement of illegitimate children, the Special Visitors had an open session at the Town Hall on one evening each week so that mothers at work could attend by appointment, or otherwise. This was found to be a most useful arrangement. 164 interviews were given. Illegitimate children who present special problems are carefully followed up so long as they are in need of particular attention. The table of foster-mothers and foster-children being cared for is as follows:— at 5.7.48 at 31.12.48 Number of persons on register prepared to. receive children 28 29 Number of foster-children being cared for 36 43 Fifty-one women 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, no foster-mother was removed from the Register, but 2 moved from the district. 20 new ones were approved, although some were only for short periods. The special scheme for assisting with the payment of fees to foster mothers in respect of illegitimate children was used in respect of one child for approximately six months. 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. Illegitimate Children. During 1948 there were 331 registered illegitimate births for this area. The Special Health Visitors dealt with 455 cases, 163 of which were new during the period. The 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 10 children, 49 were admitted to residential nurseries (Institutions), and 9 were placed with foster-parents. This work is carried on in co-operation with moral welfare workers, hospital almoners, welfare centres, and other social agencies. 43 ANNUAL FIGURES OF WORK OF SPECIAL HEALTH VISITORS CONCERNING PROBLEM ILLEGITIMATE CHILDREN. Total Cases Dealt With During Year 1948. Total Cases Dealt with Adopted Admitted to Institutions Died Fostered Number on Register at end of year 455 10 49 13 9 449 Premature Infants. Three premature baby outfits have been provided by the Borough Council on loan free of charge to those homes where a premature infant is born and where . inadequate facilities are available for nursing the infant at home or for various reasons transfer to hospital is not desired. Each outfit includes a treasure cot, blankets, infant clothes, hot-water bottles, thermometers, feeding pipettes, etc. At the 5th July these outfits were transferred to the London County Council. Arrangements were made in April for Health Visitors to attend St. Mary, Islington Hospital for 1 hour, three mornings a week, to refresh their knowledge on the care of premature infants. Home Helps and Domestic Helps. During the year there was an increased demand for Home Help assistance for the elderly chronic sick. This is to be understood since, owing to the restriction on hospital admissions, there were many who could not be admitted to hospital or only admitted after a greater delay than in the past. Such persons, therefore, needed a greater degree of attention in their own homes and this added to the requests made for home help assistance. As will be realised the average length of stay of a Help in confinement cases is usually 2 weeks, though there have been an increasing number of Home Help cases where extension of the service has been granted for varying periods. In Domestic 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 required may vary considerably from only 3 hours to 20 or 30 a week, and this part of the service calls for a great deal of organisation satisfactorily to fit in as many as possible of those so urgently in need of help. Cases dealt with for the first six months of 1948:— Home Helps 152 Domestic Helps 146 The following were on the Approved List of Home Helps available for both services:— at 5.7.48 at 31.12.48 Employed on regular basis 17 17 On intermittent basis—whole-time 19 17 part-time 23 76 Emergency Obstetric Unit. A discussion of the Unit and a brief account of its history and work was given in the Annual Report for 1947. In the period to 5th July, 1948, the Unit was called out for 8 cases. In every one of these cases it was found necessary to give a blood 44 transfusion and patients recovered in all cases except one. In this instance the Unit was called by her own doctor to a patient who had been delivered in a private nursing home. She had been given transfusions in the nursing home, but it was considered advisable to remove her to hospital where she had further repeated transfusions, but unfortunately died the following day. It is satisfactory to record that this most valuable life-saving service, approved by the Borough Council early in 1938 and which has now been transferred to the Regional Hospital Board, constitutes an essential part of the existing maternity services. 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 35.18 per cent. Orange Juice 1.28 per cent. Vitamins A and D 30.09 per cent. It was agreed with the Food Office that the take-up was not as satisfactory as it might be, and medical officers at Welfare Centres and health visitors were asked to pay special attention as to whether mothers attending or visited were 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. Invalid Children's Aid Association. A grant of £65 was paid to the Invalid Children's Aid Association for their work for Islington children under 5 years of age, for the period to 5th July, 1948. Nursing in the Home. A grant of £50 was paid 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 Scheme. Islington has the most extensive assisted Daily Guardian service of any Borough in London. At the date of transfer there were 92 approved Daily Guardians on the Register with accommodation for a total of 149 children. 84 of these were employed as such at the 5th July and were caring for 132 children. The amount paid out in subsidies by the Borough Council totalled £469 14s. Od. The Guardians receive payment at the rate of 6s. a week at the Welfare Centre only, in order to ensure that the child is seen by a doctor or Health Visitor. From the number of children it will be seen that those cared for form the equivalent of two larger size Day Nurseries. Day Nurseries. At the beginning of 1948 there were 8 Day Nurseries in operation. The number of child places was 480. 45 At the date of transfer there were 8 Day Nurseries open : Scholefield Road 65 places Camden Road 66 ,, Clephane Road 60 ,, Plimsoll Road 33 „ Pembroke Street 50 „ Canonbury Place 70 „ Windsor Street 68 „ Mitford Road 68 „ 480 „ Miss Powell, S.R.N., Superintendent Matron of Day Nurseries, commenced duties on 21st January, 1948. 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 nursery. 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 examines the children periodically. Where figures in this Section have been given for the whole year, I am indebted to the staff of the Divisional Health Office, London County Council. 46 APPENDIX I. EXTRACTED FROM REPORT TO THE MATERNITY & CHILD WELFARE COMMITTEE—22nd JUNE, 1948. The Metropolitan Borough of Islington has been a welfare authority since the passing of the Maternity & Child Welfare Act, 1918. During this period there has been a vast change in the maternity and child welfare services and in the health of mothers and small children. Objectives which seemed impossible of attainment or fantastic to hope for in 1918 have been surpassed by actual fact in 1948. With the transfer of welfare powers from the Borough Council to the County Council under the National Health Service Act, 1946, it is thought appropriate to mark the passing of the Council's Maternity & Child Welfare Committee by a brief survey of Islington's maternity and child welfare developments to date. I think it will be seen from the survey that if progress in the past has at times been less rapid than might have been hoped for, a condition of the services has now been arrived at which is comprehensive and of which advantage can be taken by every mother and child, and which has contributed very materially to the present satisfactory aspect from the health angle. It should be appreciated that prior to the passing of the Maternity & Child Welfare Act, 1918, the risks to mother and child, although taken for granted at the time, would by present day standards be considered incredibly high. Knowledge of child care and upbringing were at a very low level and many infants were fed on the most undesirable forms of infant food. Cleanliness in the home, particularly the protection of food and milk, was of a much lower standard and the quality of the milk, as then supplied, made it a dangerous food in many instances because of the degree of bacterial contamination. With regard to the expectant mother, a very high proportion received no antenatal care whatever and called in the midwife or presented themselves at hospital only when the confinement became due. The Medical Officer of Health received inadequate information since notification of births was not made compulsory until 1915, although the adoptive Act was passed in 1907, and in any case, he had no health visitors at this time to visit in the homes and advise, even if he had received information of the births. Some measure of the risks to which both mother and child were exposed in the early days can be deduced from the proportion of deaths which have taken place in the various years in children under the age of one, and in mothers due to causes associated with childbirth. I have therefore incorporated tables of infant mortality and puerperal mortality for the last forty years. Infant Puerperal Mortality Mortality 1908 103 1.8 1909 102 3.3 1910 95 3.0 1911 129 2.3 1912 86 1.6 1913 107 3.5 1914 104 2.7 1915 107 2.2 1916 87 2.9 1917 97 2.0 1918 110 1.3 1919 83 3.8 1920 72 2.3 1921 81 2.1 1922 77 2.6 1923 66 2.4 1924 66 2.9 1925 63 2.6 1926 66 4.4 1927 53 3.9 Infant Puerperal Mortality Mortality 1928 64 4.3 1929 73 3.4 1930 70 3.3 1931 64 4.2 1932 68 2.8 1933 63 3.6 1934 62 2.3 1935 52 2.4 1936 61 2.1 1937 66 2.8 1938 65 2.2 1939 50 1.5 1940 47 1.6 1941 59 3.0 1942 54 2.3 1943 46 2.7 1944 48 2.0 1945 46 0.3 1946 39 1.5 1947 32 0.7 47 That the position of maternity and child welfare was unsatisfactory in the early 1900's was a fact of which the Medical Officer of Health at the time (Dr. A. E. Harris) was well aware. In his annual report for the year 1905, he stated:— "There is no problem which at the present time is engaging the attention of Sanitary Authorities so much as the prevention of deaths among children, especially among infants in their very earliest days of life. Hitherto, no special effort has been made in this direction in Islington and, indeed, it was not required here so much as in the large towns and in some other of the London districts; nevertheless, it is quite possible by educating parents and especially young mothers, to reduce even the low mortality experienced in Islington." (In 1905 this was 123 deaths per 1,000 births !) "The methods usually adopted are to place in the hands of mothers short directions as to the feeding, care and rearing of their infants and to supplement these directions by visits of Health Visitors who are women thoroughly conversant with these matters." In 1907 the Medical Officer of Health presented to the Public Health Committee a very complete and well documented report on "The Prevention of Infant Mortality." He recommended the adoption of the Notification of Births Act, 1907; the appointment of three Health Visitors and a clerk (i.e. for maternity and child welfare work), and the encouragement of voluntary associations to assist the health visitors. A number of local authorities and. voluntary bodies, both in London and in the provinces, had already, by this time, appointed health visitors and formed or started milk kitchens for infants and schools for mothers. The Public Health Committee of the day, however, were unfortunately not persuaded by Dr. Harris and he regretfully had to record the following stricture:— "There can be no doubt that these rates (i.e. Infant Mortality rates) are excessive and that something should be done, some endeavour made, by instructions to mothers, to reduce them. The Borough Council, in their wisdom, have, however, declined to adopt the Medical Officer of Health's recommendation with respect to the prevention of the excessive infantile mortality in the Borough so far as the appointment of trained, qualified, and paid lady Health Visitors is concerned and therefore the undue mortality among infants must continue unchecked. It is a sad thought and one to cause serious reflection that a body of business men could arrive at the conclusion, with the report of the Medical Officer of Health on the prevention of infantile mortality before them, that there was no need for paid Health Visitors." Eventually in November 1913 a Maternity Centre and School for Mothers was opened in mission rooms loaned for the purpose, with one voluntary doctor and one paid superintendent. There was one consultation day a week. The pioneer of this Centre was Mrs. W. B. Keen who opened the North Islington School for Mothers in Elthorne Road without any financial assistance from the Borough Council. November, 1915.—South Islington School for Mothers and Babies Welfare Centre opened at 9, Tyndale Place with two doctors and two consultations a week. By this time the North Islington School for Mothers had three paid doctors and three nurses, and held seven consultations a week at 9, Manor Gardens. There were 820 children's names on the register with an average weekly attendance of 140. 163 names of expectant mothers were also on the register. The Centre also had four trained women to go out as home helps and their work was supervised by the superintendent to the Centre. This is the first mention of homo helps in the Borough of Islington. December, 1915.—On the recommendation of the Medical Officer of Health a resolution put that five Health Visitors be appointed at a salary of £100 per annum was lost by 7 votes to 3. The Committee considered that the matter was one which could best be dealt with by philanthropic effort rather than administrative action. There was also a further motion that the Council be recommended to make grants of £100 a year to the North Islington School for Mothers and South Islington Mothers and Babies Welfare Centres. This was also lost. January, 1916.—Having regard to the legal liabilities imposed upon the Council by the General Order of the Local Government Act relating to the notification of 48 measles and german measles, the Council agreed to appoint two Health Visitors (3 recommended by the Medical Officer of Health) to assist the Medical Officer of Health in enforcing and executing the Public Health (Measles and German Measles) Regulations, 1915, at a commencing salary of £100 rising by annual increments of £5 to a maximum of £125 per annum. In July, 1916 these two Health Visitors were appointed. July, 1916.—Richmond Road Centre for West Islington opened. Also in 1916 the Council approved a grant of £200 per annum to each of the three Voluntary Centres of which £100 was reimbursed to the Council by the Local Government Board. April, 1918.—The East Islington Welfare Centre, Drayton Park was set up and was given a grant at the rate of £200 per annum. By April 1918 also the Council were subsidising milk grants for mothers and babies at the rate of £600 per annum. April, 1919.—The Council approved the formation of the Maternity & Child Welfare Committee in accordance with the requirements of the Maternity & Child Welfare Act, 1918. May, 1919.—Representatives (one each) of the North, South, East and West Centres and also Islington Women's Guild and Islington Labour Party Women's Section were nominated for appointment on the Maternity & Child Welfare Committee, and in June the Committee made its first report to the Council under the Chairmanship of Councillor Mrs. Southgate. The Council adopted a recommendation to pay 10s. per Islington case for confinements taking place in the City of London Maternity Hospital, subject to the Local Government Board contributing half the amount, and also adopting a recommendation that £30 be paid by the Council towards the expenses of the conjoint Committee of the four Islington Maternity & Child Welfare Centres in connection with the Child Welfare and Health Exhibition held in Islington in July 1919 (subject to Local Government Board paying half). January, 1920.—Report to Council of preparation of scheme for efficient administration of the Maternity & Child Welfare Act, 1918. This included payment of fees to lying-in hospitals; provision of food and milks to nursing and expectant mothers; grants to creche and day nursery (at a rate of £2 per annum for each child accommodated daily at Lower Holloway, South Islington, Elizabeth Codnor Creche and St. Luke's Day Nurseries). The work of the Maternity & Child Welfare Centres was also reviewed and it was thought that home helps should be provided through the Voluntary Centres. It was recommended that a fee of 1s. per visit should be paid in respect of attendance of district nurses on cases of measles, whooping cough and ophthalmia neonatorum. Appointment of five health visitors was recommended additional to the appointments of the original two in 1916. April, 1920.—Council contributed £25 per annum, for the first time, to the Invalid Children's Aid Association. June, 1920.—The Council appointed five Health Visitors at salaries of £200 per annum rising by annual increments of £10 to a maximum of £280 per annum. December, 1920.—On the representation of the Conjoint Committee of Welfare Centres work in connection with the Milk Order was transferred from the Centres to the Maternity & Child Welfare Office. January, 1921.—Grants to the Voluntary Welfare Centres were increased to £600, £400, £550 and £450 respectively to the North, South, East and West Islington Welfare Centres. June, 1921.—Maternity & Child Welfare Committee adopted milk scheme. The Council's expenditure on milk was £6,500. October, 1921.—Dr. Clark Trotter appointed Medical Officer of Health to the Borough. January, 1922.—Grants to the Welfare Centres again increased, 49 February, 1926.—Council's Health Visitor establishment was increased to 8. April, 1930.—At the time of the passing of the Local Government Act, 1929 the following grants were being paid by the Borough Council in respect of various maternity and child welfare activities being carried out in the Borough. £ North Islington Welfare Centre 3,706 North Islington Wards 1,322 South Islington Welfare Centre 2,033 South Centre Convalescent Cottage, Flamstead 297 East Islington Welfare Centre 1,712 West Islington Welfare Centre 1,426 West Islington Wards 442 Lower Holloway Day Nursery 244 St. Luke's Day Nursery 299 South Islington Day Nursery, Pro Patria 712 The Council first appointed Dr. A. J. Wrigley as consultant for cases of puerperal fever and puerperal pyrexia. I am glad to say that Dr. Wrigley is still on the Council's list of consultants. July, 1932.—The Minister of Health approved revised grants as follows:— £ North Islington Welfare Centre 5,182 South Islington Welfare Centre 2,386 East Islington Welfare Centre 1,782 West Islington Welfare Centre 1,882 Lower Holloway Day Nursery 244 St. Luke's Day Nursery 229 South Islington Day Nursery, Pro Patria 600 December, 1932.—The Council considered the transfer to its Authority of functions relating to infant life protection from the County Council under Part I of the Children Act, 1908. This was a transfer from the London County Council. April, 1933.—Miss Lewis, Health Visitor, was authorised to exercise the powers of infant life protection and to supervise foster mothers in connection therewith. July, 1935.—The Maternity & Child Welfare Committee agreed to estimate of £1,350 for the acquisition of premises for use as a Day Nursery. October, 1935.—Council approved a scheme for the provision of home helps in maternity cases. They also acquired a redundant Police Station (Scholefield Road) at a freehold interest of £1,850. January, 1936.—Proposed Day Nursery and Sun Clinic scheme approved at Scholefield Road. June, 1937.—Council revised milk scheme consequent upon Ministry of Health Circular, 1915. The existing milk scheme was extended to cover nursing mothers and children up to 5 years of age (previously limited to 3 years) not attending school1 pint per day. Expectant mothers eligible for up to one pint per day on presentation of medical or midwife's certificate. Children from 3-18 months were also made eligible for extra milk. September, 1937.—Additional nursing staff approved for North Islington Welfare Centre, and approved recommendation for appointment of an additional medical officer on the staff of the Public Health Department, particularly in connection with the Wards of the North and West Centres and for other maternity and child welfare duties. October, 1937.—Designation of Scholefield Road Day Nursery approved as Miriam Price Coleman Day Nursery and Sunlight Clinic. December, 1937.—Council agreed to establish a consultative ante-natal and postnatal gynaecological clinic at Scholefield Road and appointed Mr. Christie Brown as consultant. 50 February, 1938.—Emergency Obstetric Unit ("Flying Squad") approved on recommendation by Dr. Freeman. "Flying Squad" based at University College Hospital and available to medical practitioners and midwives in cases of urgent necessity. It is believed that this is the first Obstetric "Flying Squad" to be established in London and one of the first in the country. July, 1938.—Reported to Council that 1,144 sunlight treatments had been given at Scholefield Road during the spring quarter. November, 1938.—Experimental ante-natal and post-natal evening clinic established for provisional period of six months. Dr. Hirst in charge of the clinic. January, 1939.—Estimate of £7,750 approved for acquisition of site 17-29, Canonbury Road and 21, 21a and 22-25, Asteys Row by Maternity & Child Welfare Committee for maternity and child welfare scheme to include day nursery, dental clinic, sunlight clinic and T.B. dispensary. May, 1939.—Council considered report from Maternity & Child Welfare Committee regarding supervision of women undertaking the custody of children by day for reward. Council agreed that a communication should be addressed to M.P.'s for Islington urging legislation to bring these children under the supervision of the child protection visitors the same way as foster children. (This is now being incorporated in legislation under the Children's Bill, 1948.) February, 1940.—Canonbury Housing scheme, including Health Centre for maternity and child welfare activities, postponed indefinitely. July, 1940.—National scheme for supply of milk free or at reduced cost to expectant and nursing mothers and children under 5 introduced under control of Ministry of Food. December, 1941.—Scheme considered for provision of war-time Day Nurseries on behalf of Minister of Health. February, 1942.—Schemes for further Day Nurseries approved, including wartime Day Nurseries at Hornsey Lane, Camden Road, Huntingdon Street, Clephane Road, Plimsoll Road and Packington Street. June, 1942.—Five Day Nurseries opened; two more due to be opened. Daily Guardian Scheme authorised. Reported to Council that Islington is first Borough in London to apply to the Ministry of Labour and National Service for local operation of the scheme and the only Borough, apart from the City of Birmingham, in which the Ministry have agreed that the whole administration subject to Ministry reimbursement, shall be through the Maternity & Child Welfare Department and Welfare Centres. September, 1942.—Daily Guardian scheme—51 children being cared for under this scheme. October, 1942.—Seven war-time Day Nurseries opened and two others under consideration. June, 1943.—Canonbury Road and Legard Road opened as Day Nurseries. Approval given for hutted Nursery at Mitford Road. November, 1943.—12 Day Nurseries opened or about to be opened and scheme extended to provide for 15 Nurseries. December, 1944.—Maternity & Child Welfare Committee approved report from Medical Officer of Health recommending that all Health Visitors hitherto employed by Welfare Centres become members of the Borough Council's staff in order to end division of Health Visitors into those employed by each Welfare Centre and those employed by Borough Council. All Health Visitors in the Borough would thereby have equal opportunity of carrying out all health visitor work. This was the most important change in the organisation of the Health Visitor service since the beginning of any maternity and child welfare scheme, voluntary or municipal, in the Borough. February, 1945.—Care of illegitimate children:—Health Visitor seconded as Special Health Visitor for problems arising out of illegitimacy. 51 March, 1945.—Council approved the transfer of the South Islington Welfare Centre to the Council consequent upon the death of Honorary Secretary, Mrs. Waley Joseph. Premature Infant Care. (a) Care of premature infants. Recording of weight, and therefore indication of prematurity, on the Notification of Birth cards approved. (b) Purchase of special equipment approved for nursing of premature infants at home. (c) Consulting paediatrician appointed and special arrangements for admission of selected cases to Mothercraft Training Society Institution, Highgate Hill. March, 1946.—Health Visitor establishment increased from 28 to 32. April, 1946.—Report considered from East Islington Welfare Centre desiring to relinquish their work and asking for Centre activities to be taken over by Borough Council. (This was done from September, 1946.) Ministry of Health war-time Day Nursery scheme and Daily Guardian scheme terminated and responsibility in respect of former returned to Borough Council. Daily Guardian Scheme. Payment to guardians increased by Council from 4s. to 6s. per week. May, 1946.—First-aid Post, Tibberton Square opened as temporary Welfare Centre. January, 1947.—Union Chapel, Compton Terrace opened as Branch Clinic for South Centre. Child Mortality and Sickness. Summer diarrhoea, which was formerly the greatest single danger to infants under 12 months, is now practically unknown in the form in which it occurred, although enteritis is still a dangerous disease to the newly born in particular. The widespread epidemics of summer diarrhoea, however, are fortunately no longer with us. Measles, whooping cough, bronchitis and pneumonia are the most dangerous illnesses to young children, the two former in particular, because they are apt to give rise to the complications of bronchitis and pneumonia from which a child may die. Even without special immunisation for these diseases, the standard of infant care and the condition of the infants has much improved, so that those falling victims to these two infectious diseases have a very much better chance of recovery. However, both are distressing diseases still—whooping cough in particular. Fair progress, however, is being made with whooping cough inoculation and within the next few years should do much to diminish the risk. A certain amount of temporary protection can be given against measles, lasting for a matter of 2-3 weeks only and sometimes not protecting altogether, but allowing the child to have the disease in a very much milder form. This is sometimes done in the case of young children in whom it is particularly desirable to prevent or modify an attack. Diphtheria is almost entirely preventable now and the public response over the last few years to diphtheria immunisation has been so remarkable that at least 50 per cent. of the children under 5 years are now protected. All this has been done voluntarily by the parents and is testimony to the reasonable attitude that parents now take on health matters. Diphtheria in Islington is now almost a rare disease. There were only 20 cases in 1947, of whom only three were under 5, and there has been only one death in the last two years which was in an unimmunised child of 16 years of age. Infant Mortality. During the last few years, each year has given a new record low figure and this improvement, dramatic within the last ten years, is still going on. The rate of 32 for 1947 has again created a new record in infant survival which is better than the average rate for London as a whole. 52 Observations on the Past and Future. There are many matters in the history of maternity and child welfare in Islington which I have had neither the time nor space to mention. I have, for example, paid insufficient tribute to the original founders of the Welfare Centres and the doctors and nurses who had faith and laid the foundation stones in the face of official indifference and sometimes public indifference which, however, lasted only for a short time. I should have liked to have mentioned them all by name. I should also have liked to mention all the voluntary workers at the various Centres who have assisted for so many years and made the Centre sessions run so very much more smoothly. I have mentioned in the chronological summary only the main points, but I think it will be sufficient to indicate that although maternity and child welfare had a slow and somewhat delayed start, during the past few years the Council have encouraged and stimulated the growth of the services to an extent which has contributed to obtaining such a healthy condition of the mothers and children as is indicated by the records given, and which has taken place in spite of the war, overcrowding and bad housing conditions. The improvement in health which has taken place over the years mentioned does not seem to indicate that there is much that could be fundamentally unsound in the present services. There is, of course, even now, room for further advances, as there always must be with a growth in our knowledge of the control of social and human factors. The Council, however, have no reason to be ashamed of, and much to be proud of, in the services which, under the National Health Service Act, will now pass to the London County Council as the Local Health Authority. It now rests with that Authority to improve still further the health and welfare of the mother and child and it is obvious from the records that the Borough Council has set a standard which it will not be easy to maintain and may be difficult to surpass. All members of the staff, as well as myself insofar as I may be permitted to do so, will do our best to assist in the smooth transfer of administration, and our utmost to help the Local Health Authority in the great responsibility which has been placed upon them, recognising that the administration may have changed but the objective, namely, the health of mother and child, is still the same. Finally, I would desire to express my very great thanks to all members of the staff, both past and present, of the Maternity & Child Welfare Department who have assisted and enabled me to carry those responsibilities which were given to me by the Council in 1940. In particular, I would like again to place on record my appreciation of the great services given both to myself and to the Council by my former Deputy, Dr. Katherine M. Hirst, and for her enthusiasm in maternity and child welfare and administrative ability. She has a worthy successor in Dr. Elsie J. Madeley who will, no doubt, have further opportunities as the service again begins to expand as it must do one day. I should also like to place on record the service of Miss D. Egginton, Senior Maternity & Child Welfare Clerk, who was recommended by me originally to the Committee as temporary Maternity & Child Welfare Clerk in 1937 and who, by her rapid rise to the senior administrative position, so far as this Committee is concerned, has fully justified her original appointment. I should also like to thank all Centre Superintendents, Health Visitors, the Day Nursery Superintendent and members of the Day Nursery staffs; all other members of the clerical staff, and finally, but by no means least, the home and domestic helps and the Organiser in particular. I have also had the privilege of being responsible to two Chairmen of the Maternity & Child Welfare Committee. In the first place to Councillor Mrs. Miriam Price Coleman and secondly, Councillor Mrs. F. H. Cantwell. I greatly appreciate that I have been so much more fortunate than my predecessor first mentioned in this report, in that I have at all times on all major matters, had the full support of the Chairman and Members of the Committee and have been happy in that major suggestions and recommendations for improvements in the service have been adopted by the Committee and the Council to the benefit of the mothers and children of Islington. 53 APPENDIX II. EXTRACTED FROM REPORT TO PUBLIC HEALTH COMMITTEE 28th JUNE, 1948. IMMUNISATION AGAINST DIPHTHERIA. Prevalence of Diphtheria Prior to 1938. In the decade before the Second World War there were an average of 700 notifications of diphtheria every year, and between 20 and 30 deaths due to the same cause. In 1933, for example, there were 33 deaths; 1934—31 deaths; 1936—31 deaths, and even as late as 1938 there were 23 deaths. Prior to 1935 I can trace no record of any immunisation being done or offered through the Council's services, although no doubt a few children were being dealt with by private doctors, but this cannot have amounted to very much. In 1935 Mrs. Mortimer Wolf, at the East Islington Welfare Centre, offered immunisation to children under 5 attending the Centre and there is a record of over 50 children who were so immunised during the year. In 1936 I commenced the Council's first municipal immunisation clinic at the Town Hall, shortly after my appointment. The first clinic was held in November of that year and I conducted one session per week. From November to the end of the year there were 266 attendances and over 200 children were immunised. The public response was so rapid that in the following year—the first complete year of municipal immunisation—there were over 2,000 attendances and it was found necessary to have an additional clinic which was held at the Miriam Price Coleman Day Nursery. The attendances continued to increase rapidly and in 1938 they had again doubled with over 4,000 attendances and over 1,000 children immunised in the Borough. As mentioned previously, there were 23 deaths in this year from diphtheria but not one of these was in an immunised child. During the early part of the war the dislocation of services and the movement of population was so great that clinics were unfortunately suspended. A few were held in the early part of 1940, but the clinics were not resumed until January, 1941. The Local Health Authorities, in their campaign against diphtheria, were now fully supported by the publicity of the Ministry of Health, broadcasts, national press propaganda, etc. This stimulated the local results very considerably and the attendances of children and cases of diphtheria are shown in the following table:— Attendances No. of Cases No. of Cases of children Notified Confirmed No. of Deaths 1941 15,860 174 - 11 1942 23,520 201 - 2 1943 33,618 188 - 9 1944 19,494 94 38 2 1945 16,947 86 45 3 1946 16,296 137 50 Nil. 1947 17,659 72 19 1 Plans were arranged to commence in 1944 the first diphtheria immunisation mobile clinic in London, and one of the first in the country. The object of the mobile clinic was to offer clinic facilities to those mothers who had difficulty in bringing their children to the Council's permanent clinics, but unfortunately the German aerial bombardment of London interfered with the plan for the mobile clinic, which had to be postponed. It began successfully, however, immediately at the close of the European war and has played a successful part in the immunisation campaign every summer since then. It is estimated that 75 per cent. of the school children and 50 per cent. of children under 5 are now immunised against diphtheria, so that the child who is not protected against diphtheria is in the minority rather than the reverse. Diphtheria immunisation in Islington is now something which is taken for granted by the great majority of parents in the same way as are other services for the benefit of their children. 54 It will be seen from the table above that the results of the immunisation campaign have been dramatic. Instead of 700 notifications per year there are now less than 100, and instead of 20-30 deaths per year there has only been one death in the last two years. Since immunisation began in Islington not a single child in the thousands who have been immunised, has died of diphtheria. A very small number have contracted diphtheria, but usually this has occurred some considerable time after immunisation and the disease has been in a mild form and has never taken a fatal form. Over 1,000 children have attended the mobile clinic each year. It can be said that taking the type of population and the size of the Borough into account, Islington's immunisation campaign has been one of the most successful in London. Islington is still the only Borough which is conducting a mobile clinic campaign during the summer, and it is a matter of some sentimental regret that the mobile clinic trailer is being transferred to the London County Council although, of course, there is every hope that the London County Council will continue to hold this clinic. The London County Council have, for some years now, agreed to all immunisation work, both in school and for the under 5's, being co-ordinated under the Medical Officer of Health, which is not the case in every London Borough. It is felt that this unified campaign for children of all ages in this Borough has contributed materially to the success of the Islington campaign. During the last few years Dr. M. J. Fenton and Dr. H. Clyne have conducted the greater part of the clinics under the direction of the Medical Officer of Health. It is understood that their services are being retained by the London County Council. I would desire to thank not only the medical staff who have taken the clinics, but also those health visitors who have attended, and the immunisation clerks who have been most enthusiastic about the campaign, and apart from the clerical work have made the detailed arrangements for the many thousands of clinic sessions which have been held over the last few years and which have been arranged not only under the direct auspices of the Borough Council, but also by the Borough Council in London County Council school premises. I should also like to thank the London County Council, and in particular, the Divisional Education Officer, and the head teachers of the schools in Islington who have co-operated in the most willing and enthusiastic manner to achieve the very successful results given above. 55 INDEX. PAGE Acute Poliomyelitis 7, 10, 13 Acute Polioencephalitis 7, 10, 13 Ante-Natal Clinics 40, 41 Artificial Cream 37 Bacteriological Examinations 18 Births 5, 6, 8 Cerebro-Spinal Fever 7, 8, 10 Child Life Protection 41, 42 Child Welfare Centres 40,41 Child Mortality and Sickness 51 Crematorium 39 Daily Guardian Service 41,44 Day Nurseries 44, 45 Deaths 5-15 Dental Clinics 40 Diphtheria 6, 7, 10, 14, 18 Diphtheria Immunisation 15, 16, 40 Diphtheria Immunisation (Appendix II) 53-54 Diseases of Animals Act 39 Disinfection 26, 27 Disinfestation 26, 27 Disinfestation of Sewers 31, 32 Domestic Helps 41, 43 Dysentery 10, 18 Emergency Obstetric Unit 43,45 Encephalitis Lethargica 10 Enteric Fever 7, 10, 18 Erysipelas 10 Factories Act—Complaints 28 Factories Act—Contraventions 28 Factories Act—Inspections 27-29 Factories Act—Notices served 28, 29 Food and Drugs Act 28, 34-36 Food (Clean Food Campaign) 34 Food—Inspection & Supervision 34, 36-39 Food Poisoning 10, 16, 17, 18 Food Sampling 36 Foster Mothers 42 Health Visitors 40, 41 Home Helps 41, 43 Home Nursing 44 Home Visiting—M. & C. W. 41 Home Visiting—Scabies 18 Housing 32, 33 Hydrogen Chamber 27 Ice Cream 37 Ice Cream (Heat Treatment, etc.) Regulations 37 Illegitimate Births 5, 6, 8, 42 Illegitimate Children 8, 9, 42, 43 Infant Mortality 6, 6, 8, 9, 41, 53 Infectious Diseases 10, 41 Infestation Order, 1943, etc. 21, 22, 30, 31 Invalid Children's Aid Association 44 Live Births 5 M. & C. W. Committee 3 M. & C. W. Section 40 M. & C. W. Services (Appendix I) 46-52 Maintenance Allowances—T.B. Cases 20 Malaria 10 Marriages 5, 6 PAGE Mass Radiography 19, 20 Maternal Mortality 5, 6, 9 Measles 7, 8, 10, 13 Meat 37 Milk & Dairies Order, 1926 38 Milk and Dairies Regulations, 1926/1943 35, 36 Milk (Special Designations) Regulations 38, 39 Mortuary 39 Nurseries—Day 44, 45 Nurseries—Private 45 Nursing in the Home 44 Obstetric Unit—Emergency 43, 44 Offensive Trades 39 Ophthalmia Neonatorum 10, 41 Outworkers 27, 30 Pharmacy & Poisons Acts 39 Pneumonia 10 Polioencephalitis 7, 10, 13 Poliomyelitis 7, 10, 13 Population 5, 6 Post-Natal Clinics 40, 41 Premature Infants 7, 8, 43 Prosecutions 23, 33, 35, 36 Public Health Committee 3 Public Health Officers 4 Puerperal Fever 5, 7, 9, 10, 41 Puerperal Pyrexia 5, 7, 9, 10, 41 Rats & Mice Destruction Acts 27, 28 Rent Restriction Acts (Certificates) 23 Sampling 32, 36, 37 Sanitary Circumstances 21 Sanitary Inspection—District Work 22-26 Sanitary Inspection—Special Work 27-29 Scabies 10, 17, 18 Scarlet Fever 7, 10 Shops Acts 30 Smallpox 10, 11 Smoke 22, 27 Staff 4 Statistics—General 5 Statistics—Vital 5, 6, 8 Still-Births 5, 6, 41 Swimming Baths 32 Tuberculosis—Beds and Bedding 21 Tuberculosis—Care Committee 20 Tuberculosis—Deaths 6-10 Tuberculosis—Dispensaries 19 Tuberculosis—Extra Nourishment 20 Tuberculosis—Maintenance Allowances 20, 21 Tuberculosis—Mass Radiography 19, 20 Tuberculosis—Notifications 6, 10, 18, 19 Tuberculosis—Transfer of Services 19 Underground Bakehouses 28 Vaccination 11 Vermin 17, 18, 22, 26, 27 Vitamin Preparations 44 Water Supplies 22, 32 Welfare Centres 40 Whooping Cough 7, 8, 10, 11, 12, 13